Lplpo 2018

LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT
( L P L P O )
KODE PUSKESMAS : 2 6 0 3
PUSKESMAS : SANGGENG
DISTRIK : MANOKWARI BARAT ,
KAB / KOTA : MANOKWARI
PROVINSI : PAPUA BARAT
STOCK PENERI PERSE PEMAKA STOCK STOCK PERMIN

NO NAMA OBAT SATUAN
AWAL MAAN DIAAN IAN AKHIR OPTIMUM TAAN
1 Abbocath no 18 Pcs 1 85 85 7 78
2 Abbocath no 20 Pcs 1 109 109 - 109
3 Abbocath no 22 Pcs 1 77 - 77 1 77
4 Abbocath no 24 Pcs 1 41 41 41
5 Acyclovir Cream Tube 25 30 - 30 30 - 100
6 Acyclovir Tabl 200mg Box 100 700 700 150 550
7 Acyclovir Tabl 400mg Box 100 150 150 100 50 300
8 Air raksa dental use 100 Gram Set 1 -
9 Alat suntik sekali pakai 1 ml Pcs 100 800 - 800 300 500 1,000
10 Alat suntik sekali pakai 3 ml Pcs 100 500 500 400 100 1,500
12 Alat suntik sekali pakai 10 ml Pcs 100 300 - 300 - 300
13 Alkohol 70 % 100 ml botol 7 - 7 - 7 10
14 Alkohol 70 % 1000 ml botol 3 - 3 2 1 10
15 Alkohol swab ### Box 100 - 10 10 5 5
16 Allupurinol tab 100mg box 100 800 - 800 400 400 5,000
17 Alprazolam tab 0,5 mg box 100 175 0 175 40 135
18 Ambroxol Syr btl 60ml - - - - - 500
19 Ambroxol tab Tablet 100 - 1,000 1,000 1,000 - 10,000
20 Aminofilin inj. 24 mg / ml -10 ml Ampul 30 30 30 - 30
NO NAMA OBAT SATUAN
21 Aminofilin tablet 200 mg Tablet 100 800 - 800 100 700

22 Amitriptilin HCl tabl. 25 mg Tablet 100 - - - - -
23 Amlodipine tab 5 mg Tablet 30 1,770 - 1,770 1,320 450 3,000
24 Amlodipine tab10 mg Tablet 30 960 - 960 900 60 - 3,000
25 Amoksisilin kaps. 250 mg Kaplet 100 - - - - -
26 Amoksisilin kaps. 500 mg Tablet 100 18,000 - 18,000 7,300 10,700 10,000
27 Amoksisilin sir.kering 125 mg / 5 ml botol - 150 150 150 - 1,000
28 Ampicillin Inj 1 g Vial 4 - 4 - 4
29 Ampisilin kaplet 500 mg Tablet 100 9,600 - 9,600 - 9,600 -
30 Ampisilin sir.kering 125 mg / 5 ml botol 300 - 300 - 300
31 Anoskopi paket 1 2 - 2 - 2
32 Antalgin Inj. 250 mg / 2 ml Ampul 30 100 - 100 - 100
33 Antalgin tabl. 500 mg Tablet 100 - 0 - - -
34 Antasida DOEN tabl. Tablet 100 14,600 0 14,600 800 13,800
35 Antasida syr box 1 50 0 50 50 - 250
36 Anti Hemmoroid suppositoria Tube 10 12 12 - 12
37 Anti Malaria paket 9 133 0 133 130 3 254
38 Antibakteri doen salep kulit/BACYTRACYN Tube 25 75 0 75 - 75
39 Aqua pro inj.steril bebas pirogen 20 ml Vial 10 41 0 41 31 10
40 As.Sali 2% + Belerang 4% ( 2-4) Salap Tube 24 - 0 - - -
41 Asam Askorbat (Vit.C) tabl. 250 mg Tablet 1,000 - 0 - - -
42 Asam Askorbat (Vit.C) tabl. 50 mg Tablet 1,000 2,000 0 2,000 2,000 - 10,000
43 ASAM FOLAT Tablet 50 2,000 2,000 800 1,200
44 Asam Klorida 0.1 N 100 ml botol 1 - - - - -
45 Asam Mefenamic Cap 500 mg tablet 100 18,800 18,800 3,500 15,300
46 Asam Sulfosalisilat 20% 100 ml Botol 1 - - - -
47 Asetosal tabl. 100 mg Tablet 100 200 - 200 - 200
48 Atropin sulfat tetes mata 0.5% botol 1 - - - - -
49 Bayclean 1 lt botol 1 1 - 1 - 1 5
NO NAMA OBAT SATUAN
50 Bedah Set Sederhana / Sirkum set Set 1 - - - - -

51 Benzatin benzil penisilin inj. 1.2 juta IU Pcs 1 - - - - -
52 Benzatin benzil penisilin inj. 2.4 juta IU Tablet 100 24 - 24 2 22
53 Besi II Sulfat (Sulfas Ferrosus) Tablet 100 - - - -
54 Betametason cream Tube 25 25 0 25 25 - 200
55 Bioplacenton gel Tube 1 20 - 20 20
56 Blood Lanset box 100 - 10 10 8 2 50
57 Carbol fuchsin botol 1 - - - -
58 Chloramfecort cream Tube 24 24 - 24 - 24
59 Cimetidin tabl Tablet 100 700 700 - 700
60 Ciprofloxacin cap. 500 mg Tablet 100 500 600 1,100 - 1,100 1,000
61 CLINDAMYCIN 150 MG Kapsul 100 200 200 200
62 CLINDAMYCIN 300 MG Kapsul 100 - 1,000 1,000 - 1,000
63 Dexametason inj. 5 mg / ml - 1 ml Ampul 100 215 - 215 15 200
64 Dexametason tabl. 0.5 mg Tablet 100 12,200 12,200 3,800 8,400 5,000
65 Diazepam inj. 5 mg / ml - 2 ml Ampul - - - - -
66 Diazepam tablet 2 mg Tablet 100 - - - - -
67 Dietilkarbamazin sitrat tablet 100 mg Tablet 100 - - - -
68 Difenhidramin HCl inj. 10 mg / ml Ampul 30 75 - 75 - 75
69 Digoksin tablet 0.25 mg Tablet 100 - - - - -
70 Domperidon syr Botol 1 50 - 50 50 - 200
71 Domperidon tablet Tablet 100 200 200 - 200 1,000
72 Doxycyclin 100 mg Kapsul 100 900 - 900 - 900
73 Dulcolax BOX 80 - - - - -
74 Efedrin HCl tablet 25 mg Tablet 100 - - - - - -
75 Eosin 2% Botol 1 - - - - -
76 Epinefrin HCl (Adrenalin) 0.1 % - 1 ml Botol 1 - - -
77 Eppendrorl 1000UI Botol 1 - - - - -
78 Eppendrorl 200 UI botol 1 - - - - -
NO NAMA OBAT SATUAN
79 Ergota tartr 1 mg + Kafein 50 mg tab Botol 100 - - - - - 1,000

80 Eritromicyn capsul 500 mg BOX 100 300 - 300 200 100 1,000
81 Eritromicyn syr 125 mg botol 1 - - - - 100
82 Etakridin (Rivanol) 0.1 % 300 ml botol 1 5 5 5 -
83 Etambutol tablet 250 mg Tablet 100 - - - - - -
84 Etambutol tablet 500 mg Tablet 100 600 600 - 600 -
85 Etil klorid semprot 100 ml botol 1 - - - - - -
86 Fenil butason botol 1,000 - - - - -
87 Fenobarbital 100 mg Tablet 100 - - - - -
88 Fenobarbital inj. 50 mg / ml - 2 ml Vial 30 - - - -
89 Fenobarbital tabl. 30 mg Tablet 100 646 646 - 646 -
90 Fenoksimetil penisilin tabl. 500 mg Tablet 100 500 - 500 500 - -
91 Fenol gliserol tetes telinga 5 ml Pot 1 - - - -
92 Fetal Dopler Pcs 1 1 - 1 - 1
93 Fitomenadion (Vit.K1) inj. 10 mg Ampul 30 30 30 30
94 Fitomenadion (Vit.K1) tabl. 10 mg tablet 100 400 - 400 100 300 1,000
95 Furosemid tabl. 40 mg Tablet 100 300 300 - 300
96 Garam oralit untuk 200 ml SATUAN 1,000 800 - 800 400 400
97 Garam oralit untuk 1000 ml 1 - - -
98 Gentamicin cream Tube 1 10 10 10 - 200
99 Gentian violet larutan 1% 10 ml Botol 1 72 72 - 72 -
100 Glibenklamid tabl. Tablet 100 200 - 200 200 - 1,000
101 Gliseril guayakolat tabl. 100 mg botol 1,000 5,000 5,000 3,000 2,000 10,000
102 Gliserol 100 ml botol 1 - -
103 Glukosa larutan infus 5% steril Pcs 1 57 - 57 2 55 -
104 Glukosa larutan infus 10% steril Pcs 1 56 - 56 - 56 -
105 Glukosa larutan infus 40% steril Set 1 - - -
106 Griseofulvin 125 mg tablet Tablet 100 1,900 - 1,900 - 1,900
107 Gunting Bengkok Pcs 1 - - - - -
NO NAMA OBAT SATUAN
108 Gunting Operasi no.14 pcs 1 - - - - -

109 Gunting Operasi no.18 Pcs 1 - - - -
110 Gunting verban Pcs 1 - - - - -
111 Haloperidol 0,5 mg Tablet 100 200 - 200 - 200
112 Harmoni inj 1 bln Box 12 - - - - -
113 Hidroklortiazid (HCT) tabl. 25 mg Tablet 100 - - - - -
114 Hidrokortison krim 2.5% 5 g Tube 1 48 48 24 24 200
115 holder/prunto Botol 1 - -
116 Hyscopan Tablet 100 300 - 300 - 300
117 Ibuprofen tabl. 200 mg Tablet 100 500 500 400 100 2,000
118 Ibuprofen tabl. 400 mg tablet 100 1,600 - 1,600 600 1,000 1,000
119 Ichtiol salap 30 g Pot 1 - - - 100
120 Imersi Oil Botol 1 - - -
121 Infus set anak Pcs 1 76 - 76 2 74
122 Infus set dewasa Pcs 1 48 - 48 2 46
123 Intec test kit Set 1 - 1 1 1 - 2
124 Interhistin syrup botol 60ml - - - -
125 Interhistin tab Tablet 100 - -
126 Iodiol kapsul lunak Botol 20 - - - - -
127 Iodium povidon 10% 30 ml botol 1 - -
128 Iodium povidon 10% 60 ml botol 1 8 - 8 3 5 10
129 Iodium povidon 10% 300 ml botol 1 - - - -
130 Iodium povidon 10% 1000 ml botol 1 -
131 Isoniazid (INH) tabl. 100 mg Tablet 100 400 - 400 100 300 500
132 Isoniazid (INH) tabl. 300 mg Tablet 100 - - - - - 500
133 Isosorbit dinitrat tabl Tablet 100 400 500 900 - 900
134 Jarum jahit 1/2 sircle Pcs 1 4 - 4 - 4
135 Kalium permanganat serbuk 5 g Pot 1 27 - 27 6 21
136 Kalsium laktat tabl. 500 mg tablet 100 800 800 100 700
NO NAMA OBAT SATUAN
137 Kanamisin sulfat inj. 100 mg / vial Vial 1 - - - -

138 Kapas berlemak 500 g Pcs 1 - - - - -
139 Kapas pembalut 100 g Pcs 1 - - - - -
140 Kapas pembalut 250 g Pcs 1 10 10 8 2
141 Kaptopril 12,5 mg Tablet 100 400 - 400 100 300
142 Kaptopril 25 mg Tablet 100 2,000 - 2,000 100 1,900
143 Kasa hidrofils Roll 1 - - - - -
144 Kasa kompres 40 / 40 Pcs 1 30 100 130 50 80
145 Kasa pembalut 4 x 15 cm Roll 1 80 - 80 20 60
146 Kasa pembalut 4 x 3 cm Tablet 1,000 100 - 100 30 70
147 Kasa Steril dos Tablet 1,000 14 - 14 14 - - 120
148 Kertas puyer Roll 1 - -
149 Ketoconazole Cream Tube 25 25 25 25 - 250
150 Ketoconazole tablet 200mg Tablet 50 100 50 150 100 50 500
151 Khinin antipyrin inj. 25% / 2 ml - 2 ml Ampul 100 - - - - -
152 Kinina dihidro (Kina) inj. 25% - 2 ml Tablet 100 - - - - -
153 Kinina sulfat tabl. 222 mg Tablet 100 8,000 - 8,000 - 8,000
154 Kloramfenikol kaps. 250 mg Kapsul 100 - - -
155 Kloramfenikol salap mata 1% Tube 1 - - - - - 200
156 Kloramfenikol tetes mata 3% Botol 1 - - - - -
157 Kloramfenikol tetes telinga 3% Botol 1 - - - - - -
158 Klorfeniramin maleat (CTM) 4 mg tablet 100 200 200 - 200 10,000
159 Klorokina fosfat (Klorokin) 250 mg box 100 - - - -
160 Klorpromazin HCl inj. 5 mg / ml Ampul 1 - - - - -
162 Klorpromazin HCl tabl. 100 mg tablet 100 - - - - -
163 Klorpromazin HCl tabl. 25 mg Tablet 100 1,985 - 1,985 10 1,975
164 Kodein HCl (Kodeina) tabl. 10 mg Tablet 100 - 200 200 87 113 -
165 Komb. Sulfadoksin Pyrime 525 mg Botol 1 300 - 300 - 300
NO NAMA OBAT SATUAN
166 Korentang Box 1 - - - -

167 Kotrimoksazol suspensi Botol 1 100 100 50 50 150
168 Kotrimoksazol tabl. Komb. Tablet 100 8,300 - 8,300 1,700 6,600 5,000
169 Kotrimoksazol Pediatrik, Komb. tablet 100 - - - - -
170 Lampu duduk kecil operasi Set 1 - - - - -
171 Larutan Gabbet Vial 10 - - -
172 Larutan Giemsa Botol 500cc - - - - - 1,000
173 Larutan Natrium Klorida 0.8% Botol 1 34 34 28 6 40
174 Larutan Turk Botol 1 - - - - - 2
175 Larutan Ziehl Nellseen box 1 - - - 2
176 Lidokain comp. Inj. Kombinasi. Botol 1 120 - 120 - 120
177 Lisol, kreosol tersabun 50% Botol 1 3 3 3
178 Loratadin box 50 - - - - - 10
179 Lumpang + stamfer Pcs 1 1 1 1
180 Magnesiun sulfat serbuk 30 mg Pot 100 - - - - -
181 Masker Pcs 100 300 - 300 300 - 1,000
182 MDT Adult botol 100ml - - -
183 Mebendazol tabl. 100 mg tabl tablet 30 - - - -
184 Meloxicam 7,5 mg Tablet 50 2,100 0 2,100 300 1,800 2,000
185 Metakresol sulfonat ( Albothyl ) 10 ML Botol 1 - - - -
186 Metanol Botol 1 - - -
187 Metformin 500 Tablet 100 - - - 1,000
188 Metformin 850mg Tablet 100 - - - - -
189 Metil ergometrin tabl. Salut 0,125 mg Tablet 100 - - - - - 500
190 Metilen biru Btl 100ml - - - - - 2
191 Metronidazol tabl. 250 mg tablet 100 1,200 1,200 - 1,200
192 Metronidazol tabl. 500 mg tablet 100 2,000 2,000 500 1,500 -
193 Miconazole Cream Pcs 1 13 13 13 - 240
194 Monoklorkamf ment cairan(clorfenol) set 1 1 1 - 1
NO NAMA OBAT SATUAN
195 Na. Diklofenat 25 mg tablet Tablet 50 200 1,000 1,200 1,100 100 5,000
196 Na. Diklofenat 50 mg Tablet Tablet 50 - - - - - 5,000
197 Nasogastrik tube Tube 1 - - - - -
198 Natr fenitoina (Fenitoina) 30 mg tablet 250 160 - 160 - 160
200 Natrium bikarbonat tabl. 500 mg tablet 1,000 - - -
201 Natrium Citrat 3.8 % Botol 1 - - -
202 Natrium tiosulfat inj. 25% - 10 ml Ampul 1 - - - - -
203 Nelaton cateter Pcs 10 - - - - -
204 Nifedipin Tablet box 100 13 13 - 13
205 Nistatin 100.000 IU / g tabl. Vaginal tablet 100 100 100 100
206 Nistatin Oral tablet tablet 100 200 - 200 200 - 500
207 Obat Batuk Hitam (OBH) Botol 1 73 - 73 41 32 - 248
208 Obat TB Paru FDC paket 1 16 16 8 8
209 Obat TB Paru Katagori Anak paket 1 - - - -
210 Obat TB Paru Katagori I paket 1 - - - - -
211 Obat TB Paru Katagori II paket 1 - 4 4 2 2
212 Obat TB Paru Katagori III paket 1 - - - - -
213 Objec glass 72"s box 72 15 10 25 4 21 50
214 Oksigen gas dalam tabung 1 - - - - -
215 Oksitetrasiklin HCl salap kulit 3% Tube 1 - - 240
216 Oksitetrasiklin HCl salap mata 1% Tube 24 - - - - - 120
217 Oksitetrasiklin HCl inj. 50 mg/ml Vial 10 12 12 - 12
218 Oksitoksin inj. 10 im / ml - 1 ml Ampul 30 30 - 30 - 30
219 Omeprazole Kapsul 30 6,480 6,480 600 5,880 -
220 Papaverin HCl inj. 40 mg / ml Ampul 100 - - - - -
221 Papaverin HCl tabl. 40 mg Tablet 100 800 - 800 - 800
222 Paraformaldehid tablet 1 g tablet 100 - - - - -
223 Parasetamol 100 mg tablet tablet 100 - - - -
NO NAMA OBAT SATUAN
224 Parasetamol sirup 120 mg / 5 ml Botol 1 - - - - - 500

225 Parasetamol tabl. 500 mg tablet 100 16,100 - 16,100 5,500 10,600 10,000
226 Perhidrol 3% Botol 1 1 - 1 - 1
227 Phytomenadione inj Ampul 1 - - - - -
228 Pingset tidak bergigi Pcs 1 - 0 - - -
229 Pirantel pamoat (Pirantel)125 mg Tablet 100 - - - - 1,000
230 Piridoksin HCl (Vit.B6) 10 mg Tablet 1,000 11,000 11,000 11,000
231 Piroxicam tab. 20 mg tablet 100 1,100 - 1,100 600 500 2,000
232 Pisau Bisturi box 1 100 - 100 20 80
233 Plester 5 yards x 2 inch Roll 1 13 - 13 6 7
234 Pot Sputum Pot 1 - 200 200 160 40
235 Prednison tabl. 5 mg tablet 100 2,600 - 2,600 2,500 100 10,000
236 Primaquin tabl 15 mg tablet 100 1,000 - 1,000 200 800
237 Prokain pen G inj. 3 juta IU / vial Vial 1 10 - 10 3 7
238 Propanolo HCl (Propanolo) 40 mg Caplet 100 100 - 100 - 100
239 Propiltiourasil 100 mg (PTU) Tablet 1,000 200 - 200 - 200
240 Propiretic Suppo 160mg Tube 1 12 12 - 12
241 Propiretic Suppo 80mg Tube 1 12 - 12 - 12
242 Ranitidin injeksi 25mg/ml Ampul 100 200 200 - 200
243 Ranitidin tab tablet 100 1,400 - 1,400 100 1,300
244 RDT paket 1 22 120 142 20 122
245 Retinol (Vit. A) kapsul 100.000 IU Kapsul 50 50 - 50 - 50
246 Retinol (Vit. A) tablet 200.000 IU Kapsul 50 400 - 400 - 400 -
247 Rifampisin kaplet 600 mg Kapsul 100 300 - 300 - 300 -
248 Rifampisin kapsul 300 mg Kapsul 100 300 - 300 - 300 -
249 Rifampisin kapsul 450 mg Kapsul 100 300 - 300 - 300
250 Ringer laktat larutan infus steril Botol 1 40 40 5 35 -
251 RPR 100 Antigen box 1 - - - - - - -
252 Sabun cair Botol 1 1 1 1 -
NO NAMA OBAT SATUAN
253 Safety box box 1 - - - - -

254 Salbutamol tabl. 2mg tablet 100 - - - - 5,000
255 Salbutamol tabl. 4mg tablet 100 300 300 200 100 1,000
256 Salisil spiritus 10% 25 ml Botol 1 - - - - -
257 Salisil talk 25% Pcs 1 120 - 120 30 90
258 Sarung tangan M Pcs 100 2,500 2,500 200 2,300
259 Sarung tangan Obgyn Pcs 1 70 - 70 - 70
260 Sarung tangan S Pcs 100 1,300 1,300 500 800 2,000
261 Sarung tangan L Pcs 100 500 - 500 500 - 2,000
262 SD HIV dos 1 5 - 5 2 3
263 SD sifilis dos 1 26 - 26 4 22 -
264 Serum abu pol inj. 50 mg (ABU II) Ampul 1 - - - - -
265 Serum anti tetanus inj. 20.000 IU (ATS) Ampul 1 - - - -
266 Serumen Hag Pcs 1 - - -
267 Sianokobalamin inj. 500 mcg/ml-1ml Ampul 1 78 - 78 - 78
268 Silk bedah sutera no. 3/0 75 cm Set 1 24 24 2 22 -
269 Silver amalgam serbuk 65 - 75% Set 1 - - - - -
270 Simvastatin 10 mg tablet 30 - - - 3,000
271 Simvastatin 20 mg tablet 50 300 300 240 60 - 5,000
272 Sohobion tablet Caplet 100 - - -
273 Spons gelatin cubicles 1 x 1 x 1 cm Botol 1 - - - -
274 Stesolid rectal 5mg Tube 1 - - - - - -
275 Streptomisin sulfat serbuk inj. 1000 mg Vial 1 - - - - - -
276 Sulfadimidin tabl. 500 mg Tablet 1 - - - - -
277 Tabung HB Pcs 1 - - - - -
278 Tabung Sahli haemometer kit 1 2 - 2 - 2 -
279 Tabung tutup kuning pcs 1 - - - - -
280 Tabung tutup ungu EDTA box 1 100 100 100 -
281 Tensimeter Air Raksa Pcs 1 - - - - -
NO NAMA OBAT SATUAN
282 Tensimeter lapangan Pcs 1 - - - 0 -

283 Termometer Pcs 1 - - - - -
284 Test kehamilan Pcs 1 - - - - -
285 Tetrakain HCl tetes mata 0,5% Botol 1 - - - - -
286 Tetrasiklin HCl kapsul 250 mg Kapsul 100 900 - 900 900 - 200
287 Tetrasiklin HCl kapsul 500 mg Kapsul 100 5,000 5,000 5,000 - 200
288 Thiamin HCl (Vit. B1) tabl. 50 mg tablet 1,000 5,000 5,000 - 5,000
289 Thiamin inj. 100 mg / 1 ml Ampul 30 120 - 120 - 120
290 THT kit Set 1 1 - 1 - 1
291 Urin Kateter no 16 Pcs 1 3 - 3 - 3
292 Urin Kateter no 18 Pcs 1 4 - 4 4
293 Vaksin carier box 1 - - - - -
294 VIKIA test HIV box 5 - 5 2 3
295 Vitamin B Komplek tabl. 50 mg Tab 100 0 2000 2,000 2000 - 10,000
296 Zink Dispersibel tablet 100 200 200 200 - 1,000
GIGI -
1 Devitalisasi pasta Tube 1 - - - -
2 Fluor Tablet Botol 1 - 1 1 - 1
3 Fuji IX dos 1 - 1 1 - 1
4 Glass Ionomer Cement Set Botol 1 1 1 1 -
5 Gutta percha points pcs 1 - - - - -
6 Iodoform paste Tube 1 -
7 Kaca mulut Set 1 - - - - -
8 Kalsium hidroksida pasta Pot 1 - - - - -
9 Mata boor Set 1 1 1 1
10 Tang rahang atas Pcs 1 - - - - -
11 Tang rahang bawah Pcs 1 - - - - - -
12 Hemospan dos 1 1 1 1
13 Double Check dos 1 1 1 1
NO NAMA OBAT SATUAN
14 Eugenol Botol 1 1 1 1
15 Topical Anastesi Botol 1 2 2 2
16 Pulp X Pcs 1 1 1 1
17 Disposable Dental Needle dos 1 1 1 1
18 Elite Cement Pcs 1 1 1 1
19 Fuji 7 1 1 1
Laboratorium
U M U M
BPJS JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
-
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN KEPALA PUSKESMAS YANG MELAPORKAN

KEPALA DINAS KESEHATAN PENANGGUNG JAWAB GUDANG FARMASI PENANGGUNG JAWAB APO
GUDANG FARMASI
Drg. HENRI SEMBIRING ZUL AZMI dr. IVONNE F. KALELE, M.Kes GINANJAR EKO, S.Farm.A
NIP . 19641025 199103 1 012 NIP . 19640202 198603 1 032 NIP. 19780212 201004 2 001 NIP. 19870718 201004 3 00
BULAN M
: ARET
TAHUN 2018
:
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
Feb-20
Feb-19
Jun-20
Oct-19
1100 1,105 Jan-20

150 550 Dec-19
0 135 Nov-21
-
1200 1,200
30
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
700
- Aug-19
480 930
180 240
- Nov-18
10,700 May-18
- Jun-19
4 ED
9,600 Aug-18
300 Apr-19
2
100
-
13,800
100 100
12
3
75 Sep-18
10
-
-
- Jun-18
1,200
- Apr-20
15,300
-
200
-
1
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
100 100 Feb-20
2100 2,100
22
- May-19
1100 1,100 Oct-20
20
2
- Apr-18
0 24 May-18
700
1,100
200
1,000
200
8,400
500 500 Jan-20
- Apr-20
2 2 Sep-19
0 75
100 100
50 50
200
900 Apr-19
- Oct-20
-
reagen - Oct-18
-
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
100
-
5
- Oct-18
1 601
-
-
-
-
646
-
-
1 Jul-18
30
30 330 Sep-20
300
400 Nov-20
-
- Jul-20
72 Oct-20
- Apr-20
2,000
-
55
56
-
48 48 Nov-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
- Feb-20
500 500 Oct-20
200
-
-
24
-
300
100 Jun-18
1,000
-
lab -
74
46
hiv - Apr-19
-
-
-
-
5 Oct-21
-
300
700 700 Jul-20
4400 5,300 Jul-21
4
21
700
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
2
300 Apr-19
1,900
7 7 Jan-19
80 Mar-18
60
1700 1,770 Apr-20
-
-
-
50
-
- Nov-18
8,000 Jun-18
-
- May-19
- May-19
-
200
-
- Aug-20
- Oct-18
-
500 2,475
113
300
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
30 30 Oct-18
6,600 Nov-19
-
-
lab -
lab -
lab -
lab -
120
3
- Sep-19
1
- Nov-20
- Feb-19
-
300 300 Aug-19
1,800
-
-
-
- Oct-18
- Oct-19
-
1,200
1,500
- Apr-19
1 Nov-18
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
100 Apr-18
-
-
160
100
-
-
-
17 17
13
100
-
32
-
- Jun-19
2
- May-18
21
360 360 Oct-18
-
-
12 Jul-19
30 Sep-18
5,880
1000 1,800 Sep-19

- Aug-20
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
10,600
1 Dec-18
3600 3,600
-
-
11,000
500
80
7 Jul-18
40
100
2200 3,000
7
100
200
12
12 Oct-18
1000 1,200
1,300
122
50
400
300
300
300
35
lab -
1
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
100
-
90
2,300
70
800
-
3
22
-
-
-
78
22
-
60
-
-
-
-
-
lab -
lab 2
lab
lab -
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
- Jul-18
2200 2,200 May-20
3300 3,300 Jul-20
-
-
-
5,000
120
2000 2,001 Apr-19
3
4
100 100 Mar-19
3 Jul-18
0 Oct-19
-
1 Sep-20
1
1
- Jun-19
-
-
-
1
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
YANG MELAPORKAN
ENANGGUNG JAWAB APOTIK
GINANJAR EKO, S.Farm.Apt

NIP. 19870718 201004 3 001
( L P L P O )
KODE PUSKESMAS :
PUSKESMAS :
DISTRIK : ,
KAB / KOTA : PEGAF

NO NAMA OBAT SATUAN
1 Abbocath no 18 Pcs 1
5 Acyclovir Cream Tube 25
6 Acyclovir Tabl 200mg Box 100
7 Acyclovir Tabl 400mg Box 100
8 Air raksa dental use 100 Gram Set 1
9 Alat suntik sekali pakai 1 ml Pcs 100
13 Alkohol 70 % 100 ml botol
14 Alkohol 70 % 1000 ml botol
15 Alkohol swab ### Box 100
16 Allupurinol tab 100mg box 100
17 Alprazolam tab 0,5 mg box 100
18 Ambroxol Syr btl 60ml
19 Ambroxol tab Tablet 100
20 Aminofilin inj. 24 mg / ml -10 ml Ampul 30
NO NAMA OBAT SATUAN
21 Aminofilin tablet 200 mg Tablet 100

22 Amitriptilin HCl tabl. 25 mg Tablet 100
23 Amlodipine tab 5 mg Tablet 30
24 Amlodipine tab10 mg Tablet 30 -
25 Amoksisilin kaps. 250 mg Kaplet 100
26 Amoksisilin kaps. 500 mg Tablet 100
27 Amoksisilin sir.kering 125 mg / 5 ml botol
28 Ampicillin Inj 1 g Vial
29 Ampisilin kaplet 500 mg Tablet 100 -
30 Ampisilin sir.kering 125 mg / 5 ml botol
31 Anoskopi paket 1
32 Antalgin Inj. 250 mg / 2 ml Ampul 30
33 Antalgin tabl. 500 mg Tablet 100
34 Antasida DOEN tabl. Tablet 100
35 Antasida syr box 1
36 Anti Hemmoroid suppositoria Tube 10
37 Anti Malaria paket 9
38 Antibakteri doen salep kulit/BACYTRACYN Tube 25
39 Aqua pro inj.steril bebas pirogen 20 ml Vial 10
40 As.Sali 2% + Belerang 4% ( 2-4) Salap Tube 24
41 Asam Askorbat (Vit.C) tabl. 250 mg Tablet 1,000
42 Asam Askorbat (Vit.C) tabl. 50 mg Tablet 1,000
43 ASAM FOLAT Tablet 50
44 Asam Klorida 0.1 N 100 ml botol 1
45 Asam Mefenamic Cap 500 mg tablet 100
46 Asam Sulfosalisilat 20% 100 ml Botol 1
47 Asetosal tabl. 100 mg Tablet 100
48 Atropin sulfat tetes mata 0.5% botol 1
49 Bayclean 1 lt botol 1
NO NAMA OBAT SATUAN
50 Bedah Set Sederhana / Sirkum set Set 1

51 Benzatin benzil penisilin inj. 1.2 juta IU Pcs 1
52 Benzatin benzil penisilin inj. 2.4 juta IU Tablet 100
53 Besi II Sulfat (Sulfas Ferrosus) Tablet 100
54 Betametason cream Tube 25
55 Bioplacenton gel Tube 1
56 Blood Lanset box 100
57 Carbol fuchsin botol 1
58 Chloramfecort cream Tube 24
59 Cimetidin tabl Tablet 100
60 Ciprofloxacin cap. 500 mg Tablet 100
61 CLINDAMYCIN 150 MG Kapsul 100
62 CLINDAMYCIN 300 MG Kapsul 100
63 Devitalisasi pasta Tube 1
64 Dexametason inj. 5 mg / ml - 1 ml Ampul 100
65 Dexametason tabl. 0.5 mg Tablet 100
67 Diazepam inj. 5 mg / ml - 2 ml Ampul
68 Diazepam tablet 2 mg Tablet 100
69 Dietilkarbamazin sitrat tablet 100 mg Tablet 100
70 Difenhidramin HCl inj. 10 mg / ml Ampul 30
71 Digoksin tablet 0.25 mg Tablet 100
72 Domperidon syr Botol 1
73 Domperidon tablet Tablet 100
74 Doxycyclin 100 mg Kapsul 100
75 Dulcolax BOX 80
76 Efedrin HCl tablet 25 mg Tablet 100 -
77 Eosin 2% Botol 1
78 Epinefrin HCl (Adrenalin) 0.1 % - 1 ml Botol 1
79 Eppendrorl 1000UI Botol 1
NO NAMA OBAT SATUAN
80 Eppendrorl 200 UI botol 1

81 Ergota tartr 1 mg + Kafein 50 mg tab Botol 100
82 Eritromicyn capsul 500 mg BOX 100
83 Eritromicyn syr 125 mg botol 1
84 Etakridin (Rivanol) 0.1 % 300 ml botol 1
85 Etambutol tablet 250 mg Tablet 100
86 Etambutol tablet 500 mg Tablet 100
87 Etil klorid semprot 100 ml botol 1 -
88 Fenil butason botol 1,000
89 Fenobarbital 100 mg Tablet 100
90 Fenobarbital inj. 50 mg / ml - 2 ml Vial 30
91 Fenobarbital tabl. 30 mg Tablet 100
92 Fenoksimetil penisilin tabl. 500 mg Tablet 100
93 Fenol gliserol tetes telinga 5 ml Pot 1
94 Fetal Dopler Pcs 1
95 Fitomenadion (Vit.K1) inj. 10 mg Ampul 30
96 Fitomenadion (Vit.K1) tabl. 10 mg tablet 100
97 Fluor Tablet Tablet 100
98 Fuji IX Pot 1
99 Furosemid tabl. 40 mg Tablet 100
100 Garam oralit untuk 200 ml SATUAN 1,000
101 Garam oralit untuk 1000 ml 1
102 Gentamicin cream Tube 1
103 Gentian violet larutan 1% 10 ml Botol 1
104 Glass Ionomer Cement Set Botol 1
105 Glibenklamid tabl. Tablet 100
106 Gliseril guayakolat tabl. 100 mg botol 1,000
107 Gliserol 100 ml botol 1
108 Glukosa larutan infus 5% steril Pcs 1
NO NAMA OBAT SATUAN
109 Glukosa larutan infus 10% steril Pcs 1

110 Glukosa larutan infus 40% steril Set 1
111 Griseofulvin tabl. 125 mg, micro Tablet 100
112 Gunting Bengkok Pcs 1
113 Gunting Operasi no.14 pcs 1
114 Gunting Operasi no.18 Pcs 1
115 Gunting verban Pcs 1
116 Gutta percha points pcs 1
117 Haloperidol 0,5 mg Tablet 100
118 Harmoni inj 1 bln Box 12
119 Hidroklortiazid (HCT) tabl. 25 mg Tablet 100
120 Hidrokortison krim 2.5% 5 g Tube 1
121 holder/prunto Botol 1
122 Hyscopan Tablet 100
123 Ibuprofen tabl. 200 mg Tablet 100
124 Ibuprofen tabl. 400 mg tablet 100
125 Ichtiol salap 30 g Pot 1
126 Imersi Oil Botol 1
127 Infus set anak Pcs 1
128 Infus set dewasa Pcs 1
129 Intec test kit Set 1
130 Interhistin syrup botol 60ml
131 Interhistin tab Tablet 100
132 Iodiol kapsul lunak Botol 20
133 Iodium povidon 10% 30 ml botol 1
137 Iodoform paste Roll 1
NO NAMA OBAT SATUAN
138 Isoniazid (INH) tabl. 100 mg Tablet 100

139 Isoniazid (INH) tabl. 300 mg Tablet 100
140 Isosorbit dinitrat tabl Tablet 100
141 Jarum jahit 1/2 sircle Pcs 1
142 Kaca mulut Set 1
143 Kalium permanganat serbuk 5 g Pot 1
144 Kalsium hidroksida pasta Pot 1
145 Kalsium laktat tabl. 500 mg tablet 100
146 Kanamisin sulfat inj. 100 mg / vial Vial 1
147 Kapas berlemak 500 g Pcs 1
148 Kapas pembalut 100 g Pcs 1
149 Kapas pembalut 250 g Pcs 1
150 Kaptopril 12,5 mg Tablet 100
151 Kaptopril 25 mg Tablet 100
152 Kasa hidrofils Roll 1
153 Kasa kompres 40 / 40 Pcs 1
154 Kasa pembalut 4 x 15 cm Roll 1
155 Kasa pembalut 4 x 3 cm Tablet 1,000
156 Kasa Steril dos Tablet 1,000 -
157 Kertas puyer Roll 1
158 Ketoconazole Cream Tube 25
159 Ketoconazole tablet 200mg Tablet 50
160 Khinin antipyrin inj. 25% / 2 ml - 2 ml Ampul 100
161 Kinina dihidro (Kina) inj. 25% - 2 ml Tablet 100
162 Kinina sulfat tabl. 222 mg Tablet 100
163 Kloramfenikol kaps. 250 mg Kapsul 100
164 Kloramfenikol salap mata 1% Tube 1
165 Kloramfenikol tetes mata Botol 1
166 Kloramfenikol tetes telinga 3% Botol 1 -
NO NAMA OBAT SATUAN
167 Klorfeniramin maleat (CTM) 4 mg tablet 100

168 Klorokina fosfat (Klorokin) 250 mg box 100
169 Klorpromazin HCl inj. 5 mg / ml Ampul 1
170 Klorpromazin HCl inj. 25 mg / ml Ampul 1
171 Klorpromazin HCl tabl. 100 mg tablet 100
172 Klorpromazin HCl tabl. 25 mg Tablet 100
173 Kodein HCl (Kodeina) tabl. 10 mg Tablet 100 -
174 Komb. Sulfadoksin Pyrime 525 mg Botol 1
175 Korentang Box 1
176 Kotrimoksazol suspensi Botol 1
177 Kotrimoksazol tabl. Komb. Tablet 100
178 Kotrimoksazol Pediatrik, Komb. tablet 100
179 Lampu duduk kecil operasi Set 1
180 Larutan Gabbet Vial 10
181 Larutan Giemsa Botol 500cc
182 Larutan Natrium Klorida 0.8% Botol 1
183 Larutan Turk Botol 1
184 Larutan Ziehl Nellseen box 1
185 Lidokain comp. Inj. Kombinasi. Botol 1
186 Lisol, kreosol tersabun 50% Botol 1
187 Loratadin box 50
188 Lumpang + stamfer Pcs 1
189 Magnesiun sulfat serbuk 30 mg Pot 100
190 Masker Pcs 100
191 Mata boor Set 1
192 MDT Adult botol 100ml
193 Mebendazol tabl. 100 mg tabl tablet 30
194 Meloxicam 7,5 mg Tablet 50
195 Metakresol sulfonat ( Albothyl ) 10 ML Botol 1
NO NAMA OBAT SATUAN
196 Metanol Botol 1

197 Metformin 500 Tablet 100
198 Metformin 850mg Tablet 100
199 Metil ergometrin tabl. Salut 0,125 mg Tablet 100
200 Metilen biru Btl 100ml
201 Metronidazol tabl. 250 mg tablet 100
202 Metronidazol tabl. 500 mg tablet 100
203 Miconazole Cream Pcs 1
204 Monoklorkamf ment cairan(clorfenol) set 1
205 Na. Diklofenat 25 mg tablet Tablet 50
206 Na. Diklofenat 50 mg Tablet Tablet 50
207 Nasogastrik tub Tube 1
208 Natr fenitoina (Fenitoina) 30 mg tablet 250
209 Natr fenitoina (Fenitoina) 100 mg tablet 250
210 Natrium bikarbonat tabl. 500 mg tablet 1,000
211 Natrium Citrat 3.8 % Botol 1
212 Natrium tiosulfat inj. 25% - 10 ml Ampul 1
213 Nelaton cateter Pcs 10
214 Nifedipin Tablet box 100
215 Nistatin 100.000 IU / g tabl. Vaginal tablet 100
216 Nistatin Oral tablet tablet 100
217 Obat Batuk Hitam (OBH) Botol 1 -
218 Obat TB Paru FDC paket 1
219 Obat TB Paru Katagori Anak paket 1
220 Obat TB Paru Katagori I paket 1
221 Obat TB Paru Katagori II paket 1
222 Obat TB Paru Katagori III paket 1
223 Objec glass 72"s box 72
224 Oil Emmersion Botol 1
NO NAMA OBAT SATUAN
225 Oksigen gas dalam tabung 1

226 Oksitetrasiklin HCl salap kulit 3% Tube 1
227 Oksitetrasiklin HCl salap mata 1% Tube 24
228 Oksitetrasiklin HCl inj. 50 mg/ml Vial 10
229 Oksitoksin inj. 10 im / ml - 1 ml Ampul 30
230 Omeprazole Kapsul 30
231 Papaverin HCl inj. 40 mg / ml Ampul 100
232 Papaverin HCl tabl. 40 mg Tablet 100
233 Paraformaldehid tablet 1 g tablet 100
234 Parasetamol 100 mg tablet tablet 100
235 Parasetamol sirup 120 mg / 5 ml Botol 1
236 Parasetamol tabl. 500 mg tablet 100
237 Perhidrol 3% Botol 1
238 Phytomenadione inj Ampul 1
239 Pingset tidak bergigi Pcs 1
240 Pirantel pamoat (Pirantel)125 mg Tablet 100
241 Piridoksin HCl (Vit.B6) 10 mg Tablet 1,000
242 Piroxicam tab. 20 mg tablet 100
243 Pisau Bisturi box 1
244 Plester 5 yards x 2 inch Roll 1
245 Pot Sputum Pot 1
246 Prednison tabl. 5 mg tablet 100
247 Primaquin tabl 15 mg tablet 100
248 Prokain pen G inj. 3 juta IU / vial Vial 1
249 Propanolo HCl (Propanolo) 40 mg Caplet 100
250 Propiltiourasil 100 mg (PTU) Tablet 1,000
251 Propiretic Suppo 160mg Tube 1
252 Propiretic Suppo 80mg Tube 1
253 Ranitidin injeksi 25mg/ml Ampul 100
NO NAMA OBAT SATUAN
254 Ranitidin tab tablet 100

255 RDT paket 1
256 Retinol (Vit. A) kapsul 100.000 IU Kapsul 50
257 Retinol (Vit. A) tablet 200.000 IU Kapsul 50
258 Rifampisin kaplet 600 mg Kapsul 100
259 Rifampisin kapsul 300 mg Kapsul 100
260 Rifampisin kapsul 450 mg Kapsul 100
261 Ringer laktat larutan infus steril Botol 1
262 RPR 100 Antigen box 1 -
263 Sabun cair Botol 1
264 Safety box box 1
265 Salbutamol tabl. 2mg tablet 100
266 Salbutamol tabl. 4mg tablet 100
267 Salisil spiritus 10% 25 ml Botol 1
268 Salisil talk 25% Pcs 1
269 Sarung tangan M Pcs 100
270 Sarung tangan Obgyn Pcs 1
271 Sarung tangan S Pcs 100
272 Sarung tangan L Pcs 100
273 SD HIV dos 1
274 SD sifilis dos 1
275 Serum abu pol inj. 50 mg (ABU II) Ampul 1
276 Serum anti tetanus inj. 20.000 IU (ATS) Ampul 1
277 Serumen Hag Pcs 1
278 Sianokobalamin inj. 500 mcg/ml-1ml Ampul 1
279 Silk bedah sutera no. 3/0 75 cm Set 1
280 Silver amalgam serbuk 65 - 75% Set 1
281 Simvastatin 10 mg tablet 30
282 Simvastatin 20 mg tablet 50 -
NO NAMA OBAT SATUAN
283 Sohobion tablet Caplet 100

284 Spons gelatin cubicles 1 x 1 x 1 cm Botol 1
285 Stesolid rectal 5mg Tube 1
286 Streptomisin sulfat serbuk inj. 1000 mg Vial 1
287 Sulfadimidin tabl. 500 mg Tablet 1
288 Tabung HB Pcs 1
289 Tabung Sahli haemometer kit 1
290 Tabung tutup kuning pcs 1
291 Tabung tutup ungu EDTA box 1
292 Tang rahang atas Pcs 1 -
293 Tang rahang bawah Pcs 1 -
294 Tensimeter Air Raksa Pcs 1
295 Tensimeter lapangan Pcs 1
296 Termometer Pcs 1
297 Test kehamilan Pcs 1
298 Tetrakain HCl tetes mata 0,5% Botol 1
299 Tetrasiklin HCl kapsul 250 mg Kapsul 100
300 Tetrasiklin HCl kapsul 500 mg Kapsul 100
301 Thiamin HCl (Vit. B1) tabl. 50 mg tablet 1,000
302 Thiamin inj. 100 mg / 1 ml Ampul 30
303 THT kit Set 1
304 Urin Kateter no 16 Pcs 1
305 Urin Kateter no 18 Pcs 1
306 Vaksin carier box 1
307 VIKIA test HIV box
308 Vitamin B Komplek tabl. 50 mg Tab 100
309 Zink Dispersibel tablet 100
310
311
NO NAMA OBAT SATUAN
U M U M
BPJS JUMLAH
-

GUDANG FARMASI
NIP . NIP . NIP. NIP.

BULAN :
TAHUN 2018
:
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
YANG MELAPORKAN
NIP.
( L P L P O )

NO NAMA OBAT SATUAN
1 Abbocath no 18 Pcs 1 85 85 7 78
2 Abbocath no 20 Pcs 1 109 109 - 109
3 Abbocath no 22 Pcs 1 77 - 77 1 77
5 Acyclovir Cream Tube 25 30 - 30 30 - 100
7 Acyclovir Tabl 400mg Box 100 150 150 100 50 300
9 Alat suntik sekali pakai 1 ml Pcs 100 800 - 800 300 500 1,000
12 Alat suntik sekali pakai 10 ml Pcs 100 300 - 300 - 300
13 Alkohol 70 % 100 ml botol 7 - 7 - 7 10
14 Alkohol 70 % 1000 ml botol 3 - 3 2 1 10
15 Alkohol swab ### Box 100 - 10 10 5 5
16 Allupurinol tab 100mg box 100 800 - 800 400 400 5,000
17 Alprazolam tab 0,5 mg box 100 175 0 175 40 135
18 Ambroxol Syr btl 60ml - - - - - 500
19 Ambroxol tab Tablet 100 - 1,000 1,000 1,000 - 10,000
20 Aminofilin inj. 24 mg / ml -10 ml Ampul 30 30 30 - 30
NO NAMA OBAT SATUAN
21 Aminofilin tablet 200 mg Tablet 100 800 - 800 100 700

22 Amitriptilin HCl tabl. 25 mg Tablet 100 - - - - -
23 Amlodipine tab 5 mg Tablet 30 1,770 - 1,770 1,320 450 3,000
24 Amlodipine tab10 mg Tablet 30 960 - 960 900 60 - 3,000
25 Amoksisilin kaps. 250 mg Kaplet 100 - - - - -
26 Amoksisilin kaps. 500 mg Tablet 100 18,000 - 18,000 7,300 10,700 10,000
27 Amoksisilin sir.kering 125 mg / 5 ml botol - 150 150 150 - 1,000
28 Ampicillin Inj 1 g Vial 4 - 4 - 4
29 Ampisilin kaplet 500 mg Tablet 100 9,600 - 9,600 - 9,600 -
30 Ampisilin sir.kering 125 mg / 5 ml botol 300 - 300 - 300
31 Anoskopi paket 1 2 - 2 - 2
32 Antalgin Inj. 250 mg / 2 ml Ampul 30 100 - 100 - 100
33 Antalgin tabl. 500 mg Tablet 100 - 0 - - -
34 Antasida DOEN tabl. Tablet 100 14,600 0 14,600 800 13,800
35 Antasida syr box 1 50 0 50 50 - 250
36 Anti Hemmoroid suppositoria Tube 10 12 12 - 12
37 Anti Malaria paket 9 133 0 133 130 3 254
38 Antibakteri doen salep kulit/BACYTRACYN Tube 25 75 0 75 - 75
39 Aqua pro inj.steril bebas pirogen 20 ml Vial 10 41 0 41 31 10
40 As.Sali 2% + Belerang 4% ( 2-4) Salap Tube 24 - 0 - - -
41 Asam Askorbat (Vit.C) tabl. 250 mg Tablet 1,000 - 0 - - -
42 Asam Askorbat (Vit.C) tabl. 50 mg Tablet 1,000 2,000 0 2,000 2,000 - 10,000
43 ASAM FOLAT Tablet 50 2,000 2,000 800 1,200
44 Asam Klorida 0.1 N 100 ml botol 1 - - - - -
45 Asam Mefenamic Cap 500 mg tablet 100 18,800 18,800 3,500 15,300
46 Asam Sulfosalisilat 20% 100 ml Botol 1 - - - -
47 Asetosal tabl. 100 mg Tablet 100 200 - 200 - 200
48 Atropin sulfat tetes mata 0.5% botol 1 - - - - -
49 Bayclean 1 lt botol 1 1 - 1 - 1 5
NO NAMA OBAT SATUAN
50 Bedah Set Sederhana / Sirkum set Set 1 - - - - -

51 Benzatin benzil penisilin inj. 1.2 juta IU Pcs 1 - - - - -
52 Benzatin benzil penisilin inj. 2.4 juta IU Tablet 100 24 - 24 2 22
53 Besi II Sulfat (Sulfas Ferrosus) Tablet 100 - - - -
54 Betametason cream Tube 25 25 0 25 25 - 200
55 Bioplacenton gel Tube 1 20 - 20 20
56 Blood Lanset box 100 - 10 10 8 2 50
57 Carbol fuchsin botol 1 - - - -
58 Chloramfecort cream Tube 24 24 - 24 - 24
59 Cimetidin tabl Tablet 100 700 700 - 700
60 Ciprofloxacin cap. 500 mg Tablet 100 500 600 1,100 - 1,100 1,000
61 CLINDAMYCIN 150 MG Kapsul 100 200 200 200
62 CLINDAMYCIN 300 MG Kapsul 100 - 1,000 1,000 - 1,000
63 Devitalisasi pasta Tube 1 - - - -
64 Dexametason inj. 5 mg / ml - 1 ml Ampul 100 215 - 215 15 200
65 Dexametason tabl. 0.5 mg Tablet 100 12,200 12,200 3,800 8,400 5,000
67 Diazepam inj. 5 mg / ml - 2 ml Ampul - - - - -
68 Diazepam tablet 2 mg Tablet 100 - - - - -
69 Dietilkarbamazin sitrat tablet 100 mg Tablet 100 - - - -
70 Difenhidramin HCl inj. 10 mg / ml Ampul 30 75 - 75 - 75
71 Digoksin tablet 0.25 mg Tablet 100 - - - - -
72 Domperidon syr Botol 1 50 - 50 50 - 200
73 Domperidon tablet Tablet 100 200 200 - 200 1,000
74 Doxycyclin 100 mg Kapsul 100 900 - 900 - 900
75 Dulcolax BOX 80 - - - - -
76 Efedrin HCl tablet 25 mg Tablet 100 - - - - - -
77 Eosin 2% Botol 1 - - - - -
78 Epinefrin HCl (Adrenalin) 0.1 % - 1 ml Botol 1 - - -
79 Eppendrorl 1000UI Botol 1 - - - - -
NO NAMA OBAT SATUAN

81 Ergota tartr 1 mg + Kafein 50 mg tab Botol 100 - - - - - 1,000
82 Eritromicyn capsul 500 mg BOX 100 300 - 300 200 100 1,000
83 Eritromicyn syr 125 mg botol 1 - - - - 100
84 Etakridin (Rivanol) 0.1 % 300 ml botol 1 5 5 5 -
86 Etambutol tablet 500 mg Tablet 100 600 600 - 600 -
87 Etil klorid semprot 100 ml botol 1 - - - - - -
88 Fenil butason botol 1,000 - - - - -
89 Fenobarbital 100 mg Tablet 100 - - - - -
91 Fenobarbital tabl. 30 mg Tablet 100 646 646 - 646 -
92 Fenoksimetil penisilin tabl. 500 mg Tablet 100 500 - 500 500 - -
93 Fenol gliserol tetes telinga 5 ml Pot 1 - - - -
94 Fetal Dopler Pcs 1 1 - 1 - 1
95 Fitomenadion (Vit.K1) inj. 10 mg Ampul 30 30 30 30
96 Fitomenadion (Vit.K1) tabl. 10 mg tablet 100 400 - 400 100 300 1,000
97 Fluor Tablet Tablet 100 - - - - -
98 Fuji IX Pot 1 - - - -
100 Garam oralit untuk 200 ml SATUAN 1,000 800 - 800 400 400
101 Garam oralit untuk 1000 ml 1 - - -
102 Gentamicin cream Tube 1 10 10 10 - 200
103 Gentian violet larutan 1% 10 ml Botol 1 72 72 - 72 -
104 Glass Ionomer Cement Set Botol 1 1 1 1 -
105 Glibenklamid tabl. Tablet 100 200 - 200 200 - 1,000
106 Gliseril guayakolat tabl. 100 mg botol 1,000 5,000 5,000 3,000 2,000 10,000
107 Gliserol 100 ml botol 1 - -
108 Glukosa larutan infus 5% steril Pcs 1 57 - 57 2 55 -
NO NAMA OBAT SATUAN
109 Glukosa larutan infus 10% steril Pcs 1 56 - 56 - 56 -

110 Glukosa larutan infus 40% steril Set 1 - - -
111 Griseofulvin tabl. 125 mg, micro Tablet 100 1,900 - 1,900 - 1,900
112 Gunting Bengkok Pcs 1 - - - - -
113 Gunting Operasi no.14 pcs 1 - - - - -
114 Gunting Operasi no.18 Pcs 1 - - - -
115 Gunting verban Pcs 1 - - - - -
116 Gutta percha points pcs 1 - - - - -
117 Haloperidol 0,5 mg Tablet 100 200 - 200 - 200
118 Harmoni inj 1 bln Box 12 - - - - -
119 Hidroklortiazid (HCT) tabl. 25 mg Tablet 100 - - - - -
120 Hidrokortison krim 2.5% 5 g Tube 1 48 48 24 24 200
121 holder/prunto Botol 1 - -
122 Hyscopan Tablet 100 300 - 300 - 300
123 Ibuprofen tabl. 200 mg Tablet 100 500 500 400 100 2,000
124 Ibuprofen tabl. 400 mg tablet 100 1,600 - 1,600 600 1,000 1,000
125 Ichtiol salap 30 g Pot 1 - - - 100
126 Imersi Oil Botol 1 - - -
127 Infus set anak Pcs 1 76 - 76 2 74
128 Infus set dewasa Pcs 1 48 - 48 2 46
129 Intec test kit Set 1 - 1 1 1 - 2
130 Interhistin syrup botol 60ml - - - -
131 Interhistin tab Tablet 100 - -
132 Iodiol kapsul lunak Botol 20 - - - - -
133 Iodium povidon 10% 30 ml botol 1 - -
134 Iodium povidon 10% 60 ml botol 1 8 - 8 3 5 10
135 Iodium povidon 10% 300 ml botol 1 - - - -
137 Iodoform paste Roll 1
NO NAMA OBAT SATUAN
138 Isoniazid (INH) tabl. 100 mg Tablet 100 400 - 400 100 300 500
139 Isoniazid (INH) tabl. 300 mg Tablet 100 - - - - - 500
140 Isosorbit dinitrat tabl Tablet 100 400 500 900 - 900
141 Jarum jahit 1/2 sircle Pcs 1 4 - 4 - 4
142 Kaca mulut Set 1 - - - - -
143 Kalium permanganat serbuk 5 g Pot 1 27 - 27 6 21
144 Kalsium hidroksida pasta Pot 1 - - - - -
145 Kalsium laktat tabl. 500 mg tablet 100 800 800 100 700
146 Kanamisin sulfat inj. 100 mg / vial Vial 1 - - -
147 Kapas berlemak 500 g Pcs 1 - - - - -
148 Kapas pembalut 100 g Pcs 1 - - - - -
149 Kapas pembalut 250 g Pcs 1 10 10 8 2
150 Kaptopril 12,5 mg Tablet 100 400 - 400 100 300
151 Kaptopril 25 mg Tablet 100 2,000 - 2,000 100 1,900
152 Kasa hidrofils Roll 1 - - - - -
153 Kasa kompres 40 / 40 Pcs 1 30 100 130 50 80
155 Kasa pembalut 4 x 3 cm Tablet 1,000 100 - 100 30 70
156 Kasa Steril dos Tablet 1,000 14 - 14 14 - - 120
157 Kertas puyer Roll 1 - -
158 Ketoconazole Cream Tube 25 25 25 25 - 250
159 Ketoconazole tablet 200mg Tablet 50 100 50 150 100 50 500
161 Kinina dihidro (Kina) inj. 25% - 2 ml Tablet 100 - - - - -
162 Kinina sulfat tabl. 222 mg Tablet 100 8,000 - 8,000 - 8,000
163 Kloramfenikol kaps. 250 mg Kapsul 100 - - -
164 Kloramfenikol salap mata 1% Tube 1 - - - - - 200
165 Kloramfenikol tetes mata Botol 1 - - - - -
166 Kloramfenikol tetes telinga 3% Botol 1 - - - - - -
NO NAMA OBAT SATUAN
167 Klorfeniramin maleat (CTM) 4 mg tablet 100 200 200 - 200 10,000
168 Klorokina fosfat (Klorokin) 250 mg box 100 - - - -
171 Klorpromazin HCl tabl. 100 mg tablet 100 - - - - -
172 Klorpromazin HCl tabl. 25 mg Tablet 100 1,985 - 1,985 10 1,975
173 Kodein HCl (Kodeina) tabl. 10 mg Tablet 100 - 200 200 87 113 -
174 Komb. Sulfadoksin Pyrime 525 mg Botol 1 300 - 300 - 300
175 Korentang Box 1 - - - -
176 Kotrimoksazol suspensi Botol 1 100 100 50 50 150
177 Kotrimoksazol tabl. Komb. Tablet 100 8,300 - 8,300 1,700 6,600 5,000
178 Kotrimoksazol Pediatrik, Komb. tablet 100 - - - - -
179 Lampu duduk kecil operasi Set 1 - - - - -
180 Larutan Gabbet Vial 10 - - -
181 Larutan Giemsa Botol 500cc - - - - - 1,000
182 Larutan Natrium Klorida 0.8% Botol 1 34 34 28 6 40
183 Larutan Turk Botol 1 - - - - - 2
184 Larutan Ziehl Nellseen box 1 - - 2
185 Lidokain comp. Inj. Kombinasi. Botol 1 120 - 120 - 120
186 Lisol, kreosol tersabun 50% Botol 1 3 3 3
187 Loratadin box 50 - - - - - 10
188 Lumpang + stamfer Pcs 1 1 1 1
189 Magnesiun sulfat serbuk 30 mg Pot 100 - - - - -
190 Masker Pcs 100 300 - 300 300 - 1,000
191 Mata boor Set 1 1 1 1
192 MDT Adult botol 100ml - - -
193 Mebendazol tabl. 100 mg tabl tablet 30 - - - -
194 Meloxicam 7,5 mg Tablet 50 2,100 0 2,100 300 1,800 2,000
195 Metakresol sulfonat ( Albothyl ) 10 ML Botol 1 - - - -
NO NAMA OBAT SATUAN
196 Metanol Botol 1 - - -

197 Metformin 500 Tablet 100 - - - 1,000
198 Metformin 850mg Tablet 100 - - - - -
199 Metil ergometrin tabl. Salut 0,125 mg Tablet 100 - - - - - 500
200 Metilen biru Btl 100ml - - - - - 2
201 Metronidazol tabl. 250 mg tablet 100 1,200 1,200 - 1,200
202 Metronidazol tabl. 500 mg tablet 100 2,000 2,000 500 1,500 -
203 Miconazole Cream Pcs 1 13 13 13 - 240
204 Monoklorkamf ment cairan(clorfenol) set 1 1 1 - 1
205 Na. Diklofenat 25 mg tablet Tablet 50 200 1,000 1,200 1,100 100 5,000
206 Na. Diklofenat 50 mg Tablet Tablet 50 - - - - - 5,000
207 Nasogastrik tub Tube 1 - - - - -
210 Natrium bikarbonat tabl. 500 mg tablet 1,000 - - -
211 Natrium Citrat 3.8 % Botol 1 - - -
212 Natrium tiosulfat inj. 25% - 10 ml Ampul 1 - - - - -
213 Nelaton cateter Pcs 10 - - - - -
214 Nifedipin Tablet box 100 13 13 - 13
215 Nistatin 100.000 IU / g tabl. Vaginal tablet 100 100 100 100
216 Nistatin Oral tablet tablet 100 200 - 200 200 - 500
217 Obat Batuk Hitam (OBH) Botol 1 73 - 73 41 32 - 248
218 Obat TB Paru FDC paket 1 16 16 8 8
219 Obat TB Paru Katagori Anak paket 1 - - - -
220 Obat TB Paru Katagori I paket 1 - - - - -
221 Obat TB Paru Katagori II paket 1 - 4 4 2 2
222 Obat TB Paru Katagori III paket 1 - - - - -
223 Objec glass 72"s box 72 15 10 25 4 21 50
224 Oil Emmersion Botol 1 - - - - -
NO NAMA OBAT SATUAN
225 Oksigen gas dalam tabung 1 - - - - -

226 Oksitetrasiklin HCl salap kulit 3% Tube 1 - - 240
227 Oksitetrasiklin HCl salap mata 1% Tube 24 - - - - - 120
228 Oksitetrasiklin HCl inj. 50 mg/ml Vial 10 12 12 - 12
229 Oksitoksin inj. 10 im / ml - 1 ml Ampul 30 30 - 30 - 30
230 Omeprazole Kapsul 30 6,480 6,480 600 5,880 -
231 Papaverin HCl inj. 40 mg / ml Ampul 100 - - - - -
233 Paraformaldehid tablet 1 g tablet 100 - - - - -
234 Parasetamol 100 mg tablet tablet 100 - - - -
235 Parasetamol sirup 120 mg / 5 ml Botol 1 - - - - - 500
236 Parasetamol tabl. 500 mg tablet 100 16,100 - 16,100 5,500 10,600 10,000
237 Perhidrol 3% Botol 1 1 - 1 - 1
238 Phytomenadione inj Ampul 1 - - - - -
239 Pingset tidak bergigi Pcs 1 - 0 - - -
240 Pirantel pamoat (Pirantel)125 mg Tablet 100 - - - - 1,000
241 Piridoksin HCl (Vit.B6) 10 mg Tablet 1,000 11,000 11,000 11,000
242 Piroxicam tab. 20 mg tablet 100 1,100 - 1,100 600 500 2,000
243 Pisau Bisturi box 1 100 - 100 20 80
245 Pot Sputum Pot 1 - 200 200 160 40
246 Prednison tabl. 5 mg tablet 100 2,600 - 2,600 2,500 100 10,000
247 Primaquin tabl 15 mg tablet 100 1,000 - 1,000 200 800
248 Prokain pen G inj. 3 juta IU / vial Vial 1 10 - 10 3 7
249 Propanolo HCl (Propanolo) 40 mg Caplet 100 100 - 100 - 100
250 Propiltiourasil 100 mg (PTU) Tablet 1,000 200 - 200 - 200
251 Propiretic Suppo 160mg Tube 1 12 12 - 12
252 Propiretic Suppo 80mg Tube 1 12 - 12 - 12
253 Ranitidin injeksi 25mg/ml Ampul 100 200 200 - 200
NO NAMA OBAT SATUAN
254 Ranitidin tab tablet 100 1,400 - 1,400 100 1,300

255 RDT paket 1 22 120 142 20 122
257 Retinol (Vit. A) tablet 200.000 IU Kapsul 50 400 - 400 - 400 -
258 Rifampisin kaplet 600 mg Kapsul 100 300 - 300 - 300 -
259 Rifampisin kapsul 300 mg Kapsul 100 300 - 300 - 300 -
260 Rifampisin kapsul 450 mg Kapsul 100 300 - 300 - 300
261 Ringer laktat larutan infus steril Botol 1 40 40 5 35 -
262 RPR 100 Antigen box 1 - - - - - - -
263 Sabun cair Botol 1 1 1 1 -
265 Salbutamol tabl. 2mg tablet 100 - - - - 5,000
266 Salbutamol tabl. 4mg tablet 100 300 300 200 100 1,000
267 Salisil spiritus 10% 25 ml Botol 1 - - - - -
268 Salisil talk 25% Pcs 1 120 - 120 30 90
269 Sarung tangan M Pcs 100 2,500 2,500 200 2,300
270 Sarung tangan Obgyn Pcs 1 70 - 70 - 70
271 Sarung tangan S Pcs 100 1,300 1,300 500 800 2,000
272 Sarung tangan L Pcs 100 500 - 500 500 - 2,000
273 SD HIV dos 1 5 - 5 2 3
274 SD sifilis dos 1 26 - 26 4 22 -
275 Serum abu pol inj. 50 mg (ABU II) Ampul 1 - - - - -
276 Serum anti tetanus inj. 20.000 IU (ATS) Ampul 1 - - - -
277 Serumen Hag Pcs 1 - - -
279 Silk bedah sutera no. 3/0 75 cm Set 1 24 24 2 22 -
280 Silver amalgam serbuk 65 - 75% Set 1 - - - - -
281 Simvastatin 10 mg tablet 30 - - - 3,000
282 Simvastatin 20 mg tablet 50 300 300 240 60 - 5,000
NO NAMA OBAT SATUAN
283 Sohobion tablet Caplet 100 - - -

284 Spons gelatin cubicles 1 x 1 x 1 cm Botol 1 - - - -
285 Stesolid rectal 5mg Tube 1 - - - - - -
286 Streptomisin sulfat serbuk inj. 1000 mg Vial 1 - - - - - -
287 Sulfadimidin tabl. 500 mg Tablet 1 - - - - -
288 Tabung HB Pcs 1 - - - - -
289 Tabung Sahli haemometer kit 1 2 - 2 - 2 -
290 Tabung tutup kuning pcs 1 - - - - -
291 Tabung tutup ungu EDTA box 1 100 100 100 -
292 Tang rahang atas Pcs 1 - - - - - -
293 Tang rahang bawah Pcs 1 - - - - - -
294 Tensimeter Air Raksa Pcs 1 - - - - -
295 Tensimeter lapangan Pcs 1 - - - 0 -
296 Termometer Pcs 1 - - - - -
297 Test kehamilan Pcs 1 - - - - -
298 Tetrakain HCl tetes mata 0,5% Botol 1 - - - - -
299 Tetrasiklin HCl kapsul 250 mg Kapsul 100 900 - 900 900 - 200
300 Tetrasiklin HCl kapsul 500 mg Kapsul 100 5,000 5,000 5,000 - 200
301 Thiamin HCl (Vit. B1) tabl. 50 mg tablet 1,000 5,000 5,000 - 5,000
302 Thiamin inj. 100 mg / 1 ml Ampul 30 120 - 120 - 120
303 THT kit Set 1 1 - 1 - 1
304 Urin Kateter no 16 Pcs 1 3 - 3 - 3
305 Urin Kateter no 18 Pcs 1 4 - 4 4
306 Vaksin carier box 1 - - - - -
307 VIKIA test HIV box 5 - 5 2 3
308 Vitamin B Komplek tabl. 50 mg Tab 100 0 2000 2,000 2000 - 10,000
309 Zink Dispersibel tablet 100 200 200 200 - 1,000
310
311
NO NAMA OBAT SATUAN
U M U M
BPJS JUMLAH
-

GUDANG FARMASI
NIP . 19641025 199103 1 012 NIP . 19640202 198603 1 032 NIP. 19780212 201004 2 001 NIP. 19870718 201004 3 00
BULAN M
: ARET
TAHUN 2018
:
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
Feb-20
Feb-19
Jun-20
Oct-19
1100 1,105 Jan-20

150 550 Dec-19
0 135 Nov-21
-
1200 1,200
30
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
700
- Aug-19
480 930
180 240
- Nov-18
10,700 May-18
- Jun-19
4 ED
9,600 Aug-18
300 Apr-19
2
100
-
13,800
100 100
12
3
75 Sep-18
10
-
-
- Jun-18
1,200
- Apr-20
15,300
-
200
-
1
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
100 100 Feb-20
2100 2,100
22
- May-19
1100 1,100 Oct-20
20
2
- Apr-18
0 24 May-18
700
1,100
200
1,000
-
200
8,400
500 500 Jan-20
- Apr-20
2 2 Sep-19
0 75
100 100
50 50
200
900 Apr-19
- Oct-20
-
- Oct-18
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
100
-
5
- Oct-18
1 601
-
-
-
-
646
-
-
1 Jul-18
30
30 330 Sep-20
- Sep-20
-
300
400 Nov-20
-
- Jul-20
72 Oct-20
1
- Apr-20
2,000
-
55
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
56
-
48 48 Nov-19
-
- Feb-20
500 500 Oct-20
- Jun-19
200
-
-
24
-
300
100 Jun-18
1,000
-
-
74
46
- Apr-19
-
-
-
-
5 Oct-21
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
300
700 700 Jul-20
4400 5,300 Jul-21
4
-
21
-
700
-
-
-
2
300 Apr-19
1,900
7 7 Jan-19
80 Mar-18
60
1700 1,770 Apr-20
-
-
-
50
-
- Nov-18
8,000 Jun-18
-
- May-19
- May-19
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
200
-
- Aug-20
- Oct-18
-
500 2,475
113
300
30 30 Oct-18
6,600 Nov-19
-
-
-
-
-
-
120
3
- Sep-19
1
- Nov-20
- Feb-19
1
-
300 300 Aug-19
1,800
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
- Oct-18
- Oct-19
-
1,200
1,500
- Apr-19
1 Nov-18
100 Apr-18
-
-
160
100
-
-
-
17 17
13
100
-
32
-
- Jun-19
2
- May-18
21
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
360 360 Oct-18
-
-
12 Jul-19
30 Sep-18
5,880
1000 1,800 Sep-19

- Aug-20
-
-
10,600
1 Dec-18
3600 3,600
-
-
11,000
500
80
7 Jul-18
40
100
2200 3,000
7
100
200
12
12 Oct-18
1000 1,200
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
1,300
122
50
400
300
300
300
35
-
1
-
-
100
-
90
2,300
70
800
-
3
22
-
-
-
78
22
-
60
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
-
-
-
2
-
-
-
-
- Jul-18
2200 2,200 May-20
3300 3,300 Jul-20
-
-
-
5,000
120
2000 2,001 Apr-19
3
4
100 100 Mar-19
3 Jul-18
0 Oct-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
YANG MELAPORKAN

NIP. 19870718 201004 3 001
( L P L P O )

NO NAMA OBAT SATUAN
1 Abbocath no 18 Pcs 1 85 85 - 85
2 Abbocath no 20 Pcs 1 109 109 - 109
3 Abbocath no 22 Pcs 1 77 - 77 - 77
5 Acyclovir Tabl 200mg Box 100 700 - 700 100 600
6 Acyclovir Cream Tube 25 30 30 - 30
9 Alat suntik sekali pakai 1 ml Pcs 100 900 - 900 100 800
10 Alat suntik sekali pakai 10 ml Pcs 100 300 300 - 300
11 Alat suntik sekali pakai 3 ml Pcs 100 900 900 400 500
12 Alat suntik sekali pakai 5 ml Pcs 100 1,000 - 1,000 400 600
13 Alkohol 70 % 100 ml 10 - 10 3 7
14 Alkohol 70 % 1000 ml botol 6 - 6 3 3
15 Allupurinol tab 100mg### Box 100 2,000 - 2,000 1,200 800
16 Ambroxol Syr btl 60ml 50 - 50 50 -
17 Ambroxol tab 2,000 0 2,000 2,000 -
18 Aminofilin inj. 24 mg / ml -10 ml Ampul 30 30 - 30 30
19 Aminofilin tablet 200 mg Tablet 100 800 800 800
20 Amitriptilin HCl tabl. 25 mg Tablet 100 - - -
NO NAMA OBAT SATUAN
21 Amoksisilin kaps. 250 mg Kapsul 120 - - - - -

22 Amoksisilin kaps. 500 mg Kaplet 100 23,400 - 23,400 5,400 18,000
23 Amoksisilin sir.kering 125 mg / 5 ml Botol 1 150 - 150 150 -
24 Ampicillin Inj 1 g Vial 10 4 - 4 - 4 -
25 Ampisilin kaplet 500 mg Kaplet 100 10,100 - 10,100 500 9,600
26 Ampisilin sir.kering 125 mg / 5 ml Botol 1 300 - 300 300
27 Antalgin Inj. 250 mg / 2 ml Ampul 30 - 100 100 - 100
28 Antalgin tabl. 500 mg Tablet 100 - - - - -
29 Antasida DOEN tabl. Tablet 100 16,400 - 16,400 1,800 14,600 -
30 Anti Hemmoroid suppositoria Suppo 10 15 - 15 3 12
31 Antibakteri doen salep kulit/BACYTRACYN Tube 25 75 - 75 - 75
32 Aqua pro inj.steril bebas pirogen 20 ml Vial 10 58 58 17 41
33 Anti Malaria paket 9 244 0 244 131 113
34 Anoskopi paket 1 2 0 2 - 2
35 Alkohol swab box 1 500 0 500 500 -
36 As.Sali 2% + Belerang 4% ( 2-4) Salap Tube 24 - - - -
37 Asam Askorbat (Vit.C) tabl. 250 mg Tablet 1,000 - 0 -
38 Asam Askorbat (Vit.C) tabl. 50 mg Tablet 1,000 7,000 0 7,000 5,000 2,000
39 Asam Klorida 0.1 N 100 ml Botol 1 - - - -
40 Asam Mefinamic Cap.500 mg Kaplet 100 21,900 0 21,900 3,100 18,800
41 Asam Sulfosalisilat 20% 100 ml Botol 1 - -
42 Asetosal tabl. 500 mg Tablet 100 200 0 200 - 200
43 Atropin sulfat tetes mata 0.5% Tablet 1 - -
44 Chloramfecort cream 24 - 24 - 24
45 Bedah Set Sederhana / Sirkum set Set 1 - -
46 Bayclean 1 lt Botol 1 1 - 1 1
47 Benzatin benzil penisilin inj. 1.2 juta IU Vial 10 - - - - -
48 Benzatin benzil penisilin inj. 2.4 juta IU Vial 10 24 24 - 24
49 Besi II Sulfat (Sulfas Ferrosus) Tablet 3,000 - - - - -
NO NAMA OBAT SATUAN
50 Betametason cream Tube 25 25 - 25 25 -

51 Blood Lanset Pcs 1 500 - 500 500 -
52 Cimetidin tabl Tablet 100 900 - 900 200 700
53 CLINDAMYCIN 150 MG Tablet 100 200 200 - 200
54 Ciprofloxacin cap. 500 mg Tablet 100 500 0 500 400 100
55 Carbol fuchsin botol 1 - - -
56 Devitalisasi pasta Tube 1 - -
57 Dexametason inj. 5 mg / ml - 1 ml Vial 100 225 225 10 215
58 Dexametason tabl. 0.5 mg Tablet 100 15,500 - 15,500 3,300 12,200
59 CLINDAMYCIN 300 MG Tablet 50 - - - -
60 Dextrose 5 % 50 50 - 50
61 Diazepam inj. 5 mg / ml - 2 ml Vial 30
62 Diazepam tablet 2 mg Tablet 1,000 - - - - -
63 Dietilkarbamazin sitrat tablet 100 mg Tablet 100 -
64 Difenhidramin HCl inj. 10 mg / ml Vial 30 75 - 75 - 75
65 Digoksin tablet 0.25 mg Tablet 100 - - - -
66 Domperidon SYR Botol 100 50 - 50 50 -
67 Domperidon tablet 500 - 500 300 200
68 Doxycyclin 100 mg Caplet 100 600 300 900 - 900
69 Dulcolax Kotak 80 - - - -
70 Efedrin HCl tablet 25 mg Tablet 250 - - - - -
71 Epinefrin HCl (Adrenalin) 0.1 % - 1 ml Ampul 30 - - - - -
72 Ergota tartr 1 mg + Kafein 50 mg tab Tablet 100 100 - 100 100 -
73 Eritromicyn syr 125 mg Botol - - - -
74 Eritromicyn capsul 500 mg Caplet 100 400 - 400 100 300
75 Etakridin (Rivanol) 0.1 % 300 ml Botol 1 5 - 5 - 5
77 Etambutol tablet 500 mg Botol 1 600 - 600 - 600
78 Eosin 2% Botol 1 - - -
NO NAMA OBAT SATUAN
79 Etil klorid semprot 100 ml Botol 1 - - - - -

81 Eppendrorl 1000UI Botol 1 - - - - - -
82 Fenil butason - - - - - -
83 Fenobarbital 100 mg Tablet 1,000 - - - - -
85 Fenobarbital tabl. 30 mg Tablet 1,000 670 - 670 24 646 -
86 Fetal Dopler Set 1 - - - - -
87 Fenoksimetil penisilin tabl. 500 mg Tablet - 500 500 500 - - -
88 Fenol gliserol tetes telinga 5 ml Botol 24 - - - - -
89 Fitomenadion (Vit.K1) inj. 10 mg Vial 30 - - - - -
90 Fitomenadion (Vit.K1) tabl. 10 mg Tablet 100 400 400 - 400
91 Fluor Tablet Tablet 100 - - -
92 Fuji IX Pot - - - - - -
94 Garam oralit untuk 200 ml Sachet 100 1,100 - 1,100 300 800
95 Garam oralit untuk 1000 ml Sachet 1 - -
96 Gentamicin cream Tube 50 - 50 40 10
97 Gentian violet larutan 1% 10 ml Botol 1 72 - 72 - 72
98 Glass Ionomer Cement Set Set 1 1 1 1
99 Glibenklamid tabl. Tablet 100 200 200 - 200
100 Gliseril guayakolat tabl. 100 mg Tablet 1,000 7,000 - 7,000 2,000 5,000
101 Gliserol 100 ml 1 - -
102 Glukosa larutan infus 5% steril Botol 1 57 57 - 57 -
104 Glukosa larutan infus 40% steril Botol 10 - - -
105 Griseofulvin tabl. 125 mg, micro Tablet 100 2,000 - 2,000 100 1,900
106 Gunting Bengkok Pcs 1 - - -
107 Gunting Operasi no.14 Pcs 1 - -
NO NAMA OBAT SATUAN
108 Gunting Operasi no.18 Pcs 1 - - -

109 Gunting verban Pcs 1 - - -
110 Gutta percha points Set 1 - - -
111 Hidroklortiazid (HCT) tabl. 25 mg Tablet 1,000 - - - - -
112 Hidrokortison krim 2.5% 5 g Tube 24 24 - 24 24 -
113 holder/prunto pcs 1 - - - - -
114 Hyscopan Tablet 100 300 300 - 300
115 Ibuprofen tabl. 200 mg Tablet 100 1,000 - 1,000 500 500
116 Ibuprofen tabl. 400 mg Tablet 100 1,800 - 1,800 200 1,600
117 Ichtiol salap 30 g Pot 1 - - - - - 100
118 Imersi Oil Btl - - - - -
119 Infus set anak Set 1 81 - 81 5 76
120 Infus set dewasa Set 1 53 53 5 48
121 Iodiol kapsul lunak Kapsul 100 - -
122 Iodium povidon 10% 30 ml Botol 1 - - - - -
123 Iodium povidon 10% 60 ml Botol 1 11 11 3 8
125 Iodium povidon 10% 1000 ml Botol 1 - - -
126 Iodoform paste Set 1 - - -
127 Isoniazid (INH) tabl. 100 mg Tablet 1,000 - 400 400 - 400
128 Isoniazid (INH) tabl. 300 mg Tablet 1,000 - - - - -
129 Isosorbit dinitrat tabl Tablet 100 400 - 400 - 400
130 Jarum jahit 1/2 sircle Set 1 4 4 - 4
131 Kaca mulut Set 1 - -
132 Kalium permanganat serbuk 5 g Botol 20 32 - 32 5 27
133 Kalsium hidroksida pasta Tube 1 - -
134 Kalsium laktat tabl. 500 mg Tablet 100 1,500 - 1,500 700 800
135 Kanamisin sulfat inj. 100 mg / vial Vial 10 - - - -
136 Kapas berlemak 500 g Roll 1
NO NAMA OBAT SATUAN
137 Kapas pembalut 100 g Roll 1

138 Kapas pembalut 250 g Roll 1 10 - 10 3 7
139 Kaptopril 12,5 mg Tablet 500 - 500 100 400
140 Kaptopril 25 mg Tablet 100 500 - 500 300 200
141 Kasa kompres 40 / 40 Lbr 1 40 - 40 10 30
142 Kasa Steril dos dos 1 87 - 87 73 14
145 Kasa hidrofils Roll - - - -
146 Kertas puyer Lbr 500 - - -
147 Ketoconazole tablet 200mg 100 - 100 100 -
149 Kinina dihidro (Kina) inj. 25% - 2 ml Ampul 30 - - - -
150 Kinina sulfat tabl. 222 mg Tablet 1,000 8,000 - 8,000 - 8,000
151 Kloramfenikol kaps. 250 mg Kapsul 250 - - - -
152 Kloramfenikol tetes telinga 3% TUBE 1 - - -
153 Kloramfenikol salap mata 1% Tube 1 48 - 48 48 -
154 Kloramfenikol tetes mata 3% Tube 24 - - - - -
155 Klorfeniramin maleat (CTM) 4 mg Tablet 1,000 3,000 - 3,000 2,800 200
156 Klorokina fosfat (Klorokin) 250 mg Tablet 1,000 - - - - - -
157 Klorpromazin HCl inj. 5 mg / ml Ampul 30 - -
158 Klorpromazin HCl inj. 25 mg / ml Tablet 30 - -
159 Klorpromazin HCl tabl. 100 mg Tablet 1,000 - - -
160 Klorpromazin HCl tabl. 25 mg Tablet 1,000 1,985 - 1,985 500 1,485
161 Kodein HCl (Kodeina) tabl. 10 mg Tablet 100 85 - 85 85 -
162 Komb. Sulfadoksin Pyrime 525 mg Tablet 100 300 - 300 - 300
163 Korentang Set 1 - -
164 Kotrimoksazol suspensi Botol 1 100 - 100 - 100
165 Kotrimoksazol tabl. Komb. Tablet 100 11,300 - 11,300 3,000 8,300
NO NAMA OBAT SATUAN
166 Kotrimoksazol Pediatrik, Komb. Tablet 300 - - - - - -

167 Lampu duduk kecil operasi Set 1 - -
168 Larutan Ziehl Nellseen box 1 - - - -
169 Bioplacenton gel Botol 1 - 20 20 - 20
170 RDT BOX 1 89 - 89 67 22
171 Larutan Gabbet Botol 1 - - - - -
172 Larutan Giemsa Botol 1 - - - - -
173 Tabung tutup kuning Botol 1 - - - - - -
174 Tabung tutup ungu EDTA Botol 1 - - - - -
175 Loratadin Box 1 - - - -
176 Larutan Turk Botol 1 - - - -
177 Lidokain comp. Inj. Kombinasi. Ampul 30 160 - 160 40 120
178 Lisol, kreosol tersabun 50% Botol 1 3 - 3 - 3
179 Lumpang + stamfer Set 1 4 - 4 - 4
180 Magnesiun sulfat serbuk 30 mg Vial 10 - -
181 Masker pcs 1 300 - 300 300 -
182 Mata boor Set 1 2 - 2 - 2
183 Mebendazol tabl. 100 mg tabl Tablet 30 - -
184 Metakresol sulfonat ( Albothyl ) 10 ML Botol 1 10 - 10 10 -
185 Metanol Botol 1 - -
186 Meloxicam 7,5 mg box 50 2,600 - 2,600 500 2,100
187 Metil ergometrin tabl. Salut 0,125 mg Tablet 100 100 100 100
188 Metronidazol tabl. 250 mg Tube 100 1,300 - 1,300 100 1,200
189 Metronidazol tabl. 500 mg Tablet 100 2,000 - 2,000 200 1,800
190 Monoklorkamf ment cairan(clorfenol) Set 1 1 1 1
191 Metilen biru botol 100ml - - -
192 Metformin 500 TAblet 100 - - -
193 Na. Diklofenat 25 mg tablet Tablet 50 - 500 500 500 -
194 Na. Diklofenat 50 mg Table Tablet 50 - - - -
NO NAMA OBAT SATUAN
195 Nasogastrik tub Tube 1 -

196 Natrium bikarbonat tabl. 500 mg Tablet 1,000 -
197 Natr fenitoina (Fenitoina) 30 mg Tablet 250 160 - 160 - 160
198 Natr fenitoina (Fenitoina) 100 mg Tablet 250 100 - 100 - 100
199 Natrium Citrat 3.8 % Btl - - - - -
200 Natrium tiosulfat inj. 25% - 10 ml Ampul 1 - -
201 Nelaton cateter Pcs 10 - - -
202 Nifedipin Tablet Pcs 100 13 13 - 13
203 Nistatin 100.000 IU / g tabl. Vaginal Tablet 100 200 200 100 100
204 Nistatin Oral tablet Tablet 100 300 - 300 100 200
205 Norit tabl. Tablet 750 - - - - -
206 Obat Batuk Hitam (OBH) Botol 1 144 72 216 143 73
207 Obat TB Paru Katagori Anak Paket 1 - - - - -
208 Obat TB Paru Katagori I Paket 1 - - - - -
209 Obat TB Paru Katagori II Paket 1 - -
210 Obat TB Paru Katagori III Paket 1 - -
211 MDT Adult Paket 1 - - - - -
212 Objec glass 72"s box 72 40 - 40 25 15
213 Oil Emmersion Botol 1 - - - -
214 Oksigen gas dalam tabung 1 - - -
215 Oksitetrasiklin HCl salap kulit 3% Tube 1 25 - 25 25 -
216 Oksitetrasiklin HCl salap mata 1% Tube 24 - - - -
217 Oksitetrasiklin HCl inj. 50 mg/ml Vial 10 - - - - -
218 Oksitoksin inj. 10 im / ml - 1 ml Ampul 30 30 30 30
219 Omeprazole cap 1 6,600 - 6,600 120 6,480
220 Papaverin HCl inj. 40 mg / ml Ampul 100 - - - -
222 Paraformaldehid tabl. 1 g Tablet 100 - -
223 Parasetamol 100 mg tablet Tablet 100 - - - - -
NO NAMA OBAT SATUAN
224 Parasetamol sirup 120 mg / 5 ml Botol 1 200 - 200 200 -

225 Pingset tidak bergigi Pcs 1 - -
226 Parasetamol tabl. 500 mg Tablet 100 17,100 - 17,100 1,000 16,100
227 Propiretic Suppo 80mg Set 1 12 12 - 12
228 Propiretic Suppo 160mg Set 1 12 - 12 - 12
229 Perhidrol 3% botol 1 1 1 1 -
230 Pirantel pamoat (Pirantel)125 mg Tablet 100 300 - 300 300 -
231 Piridoksin HCl (Vit.B6) 10 mg Tablet 1,000 14,000 - 14,000 3,000 11,000
232 Piroxicam tab. 20 mg Kapsul 100 1,300 - 1,300 200 1,100
233 Pisau Bisturi Pcs 1 210 - 210 210
235 Pot Sputum Pot 1 - - - - -
236 Prednison tabl. 5 mg Tablet 100 2,600 - 2,600 - 2,600
237 Primaquin tabl 15 mg Tablet 100 2,600 - 2,600 1,600 1,000
238 Prokain pen G inj. 3 juta IU / vial Vial 30 - 10 10 - 10
239 Propanolo HCl (Propanolo) 40 mg Tablet 100 - -
240 Propiltiourasil 100 mg PTU Tablet 1,000 200 200 200
241 SD HIV box 1 - - - - -
242 RPR 100 Antigen box 1 - - - - -
243 SD sifilis Box 1 27 - 27 1 26
244 Intec test kit box 100 - - - - -
246 Retinol (Vit. A) tablet 200.000 IU Kapsul 50 450 - 450 50 400
247 Rifampisin kaplet 600 mg Caplet 100 - - - - -
248 Rifampisin kapsul 300 mg Caplet 100 - - - - -
250 Ringer laktat larutan infus steril Botol 1 43 43 3 40
251 Salbutamol tabl. 4mg 700 - 700 400 300
252 Salbutamol tabl. 2mg Tablet 100 - - - -
NO NAMA OBAT SATUAN
253 Salisil spiritus 10% 25 ml Botol 12 -

254 Salisil talk 25% Pot 1 170 - 170 50 120
255 Sarung tangan S Set 1 1,400 - 1,400 100 1,300
256 Sarung tangan M Set 1 2,800 - 2,800 300 2,500 -
257 Sarung tangan L Set 1 800 - 800 300 500 -
258 Sarung tangan Obgyn 70 - 70 - 70 -
259 Ranitidin injeksi 25mg/ml Ampul 1 97 - 97 - 97
260 Serum abu pol inj. 50 mg (ABU II) Ampul 10 - - -
261 Serum anti tetanus inj. 20.000 IU (ATS) Ampul 10 - - - - - - -
262 Serumen Hag Set 1 - - -
264 Silk bedah sutera no. 3/0 75 cm Kotak 36 24 24 - 24
265 Silver amalgam serbuk 65 - 75% Set 1 - - -
266 Spons gelatin cubicles 1 x 1 x 1 cm Set 1 1 - 1 1 -
267 Stesolid rectal 5mg Tube 1 - - - - -
268 Streptomisin sulfat serbuk inj. 1000 mg Vial 1 - - - -
269 Sohobion tablet Pcs 100 - - - - -
270 Sulfadimidin tabl. 500 mg Tablet 1 - - -
272 Sabun cair 1 1 - 1 1
273 Tabung HB Pcs 1 - - - -
274 Tabung Sahli haemometer kit 1 2 2 - 2 -
275 Tang rahang atas Pcs 1 - - -
276 Tang rahang bawah Pcs 1 - - -
277 VIKIA test HIV box 1 - - - -
278 THT kit Set 1 1 1 1 -
279 Tensimeter Air Raksa Set 1 - - - - -
280 Tensimeter lapangan Set 1 - - - -
281 Termometer Pcs 1 - - -
NO NAMA OBAT SATUAN
282 Tetrakain HCl tetes mata 0,5% Botol 1 - - -

283 Tetrasiklin HCl kapsul 250 mg Kapsul 1,000 900 - 900 - 900 -
284 Tetrasiklin HCl kapsul 500 mg Kapsul 100 400 - 400 - 400 -
285 Thiamin HCl (Vit. B1) tabl. 50 mg Tablet 1,000 5,000 - 5,000 - 5,000
286 Thiamin inj. 100 mg / 1 ml Ampul 30 - 120 120 - 120
287 Urin Kateter no 16 pcs 1 3 - 3 - 3 -
288 Urin Kateter no 18 pcs 1 4 - 4 - 4
290 Vaksin carier box 1 - -
292 Harmoni inj 1 bln Vial 1 - - - - - -
294 Metformin 850mg Tablet 100 - - - - - -
296 Vitamin B Komplek tabl. 50 mg Tablet 1,000 2,000 - 2,000 1,800 200
298 ASAM FOLAT tab 3,300 - 3,300 1300 2,000
300 ZinC Dispersibel 500 - 500 300 200
302 Simvastatin 20 mg 700 - 700 400 300
304 Amlodipin 10 mg - 1,050 1,050 90 960
306 Ketoconazole Cream 25 - 25 25 -
308 Interhistin syrup - -
310 Miconazole Cream - - - -
312 Test kehamilan dos - - - - -
314 Ranitidin tab box 1,800 - 1,800 400 1,400
316 Interhistin tab box - - - -
318 phytomenadione inj - -
320 Antasida syr botol 1 50 - 50 50 -
322 Amlodipine tab 5 mg box 3,450 - 3,450 1,680 1,770
323 Alprazolam tab 0,5 mg Tab 200 0 200 25 175
324 Haloperidol 0,5 mg tab - 200 200 - 200
NO NAMA OBAT SATUAN
U M U M
BPJS JUMLAH
-

GUDANG FARMASI
NIP . 19641025 199103 1 012 NIP . 19640202 198603 1 032 NIP. 19780212 201004 2 001 NIP. 19870718 201004 3 00
BULAN F
: EBRUARI
TAHUN 2018
:
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
Feb-20
Feb-19
Jun-20
Oct-19
1100 1,900 Jan-20

150 150 Dec-19
0 - Nov-21
30
800
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
18,000 Aug-19
0 -
4
9,600 Nov-18
300 May-18
100 Jun-19
- ED
14,600 Aug-18
12 Apr-19
75
41
113
2
100 100
-
-
2,000 Sep-18
-
18,800
-
200 Jun-18
-
24 Apr-20
-
1
-
24
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
100 100 Feb-20
2100 2,100
700
200 May-19
1100 1,200 Oct-20
-
-
215 Apr-18
0 12,200 May-18
-
50
-
-
-
75
-
50 50 Jul-19
500 700 Jan-20
900 Apr-20
2 2 Sep-19
0 -
-
-
-
300 Apr-19
5 Oct-20
-
600 Oct-18
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
-
-
-
646 Oct-18
1 1
-
-
-
400
-
-
300
800 Jul-18
-
30 40 Sep-20
72 Sep-20
1
200
5,000 Nov-20
-
57 Jul-20
56 Oct-20
-
1,900 Apr-20
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
48 48 Nov-19
-
300 Feb-20
500 1,000 Oct-20
1,600 Jun-19
-
-
76
48
-
-
8 Jun-18
-
-
-
400
-
400 Apr-19
4
-
27
-
800 Oct-21
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
7
700 1,100 Jul-20
4400 4,600 Jul-21
30
14
80
100
-
-
-
-
-
8,000 Apr-19
-
7 7 Jan-19
- Mar-18
-
1700 1,900 Apr-20
-
-
-
-
1,485
- Nov-18
300 Jun-18
-
100 May-19
8,300 May-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
20 Aug-20
22 Oct-18
-
500 500
-
-
30 30 Oct-18
120 Nov-19
3
4
-
-
2
-
-
-
2,100 Sep-19
100
1,200 Nov-20
1,800 Feb-19
1
-
300 300 Aug-19
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
160 Oct-18
100 Oct-19
-
-
-
13 Apr-19
100 Nov-18
200 Apr-18
-
73
-
-
-
-
-
17 32
-
-
-
-
-
30
6,480 Jun-19
-
800 May-18
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
360 360 Oct-18
-
16,100
12 Jul-19
12 Sep-18
1
1000 12,000 Sep-19

1,100 Aug-20
210
13
-
2,600 Dec-18
3600 4,600
10
-
200
-
-
26 Jul-18
-
50
400
-
-
-
40
300 Oct-18
1000 1,000
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
120
1,300
2,500
500
70
97
-
-
-
78
24
-
1
-
-
-
-
-
1
-
2
-
-
-
1
-
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
900
400
5,000
120
3
-
-
-
200
2,000 Jul-18
2200 2,400 May-20
3300 3,600 Jul-20
960
-
-
-
-
2000 3,400 Apr-19
-
-
100 100 Mar-19
1,770 Jul-18
175 Oct-19
200
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
YANG MELAPORKAN

NIP. 19870718 201004 3 001
( L P L P O )

NO NAMA OBAT SATUAN
1 Abbocath no 18 Pcs 1 85 85 - 85
2 Abbocath no 20 Pcs 1 109 109 - 109
3 Abbocath no 22 Pcs 1 77 - 77 - 77
5 Acyclovir Tabl 200mg Box 100 1,000 - 1,000 200 800
6 Acyclovir Cream Tube 25 40 40 10 30
11 Alat suntik sekali pakai 3 ml Pcs 100 1,300 1,300 400 900
13 Alkohol 70 % 100 ml 3 10 13 3 10
14 Alkohol 70 % 1000 ml botol 4 6 10 4 6
15 Allupurinol tab 100mg### Box 100 - 2,000 2,000 - 2,000
16 Ambroxol Syr btl 60ml - 100 100 50 50
17 Ambroxol tab - 2,000 2,000 - 2,000
NO NAMA OBAT SATUAN

22 Amoksisilin kaps. 500 mg Kaplet 100 19,600 10,000 29,600 6,200 23,400
23 Amoksisilin sir.kering 125 mg / 5 ml Botol 1 - 150 150 150
25 Ampisilin kaplet 500 mg Kaplet 100 10,100 - 10,100 - 10,100
29 Antasida DOEN tabl. Tablet 100 10,200 7,200 17,400 1,000 16,400 -
33 Anti Malaria paket 9 - 254 254 10 244
35 Alkohol swab box 1 - 500 500 - 500
36 As.Sali 2% + Belerang 4% ( 2-4) Salap Tube 24 24 24 24 -
38 Asam Askorbat (Vit.C) tabl. 50 mg Tablet 1,000 - 7,000 7,000 7,000
40 Asam Mefinamic Cap.500 mg Kaplet 100 9,400 16,000 25,400 3,500 21,900
44 Chloramfecort cream - 24 24 - 24
NO NAMA OBAT SATUAN
50 Betametason cream Tube 25 - 25 25 25

51 Blood Lanset Pcs 1 - 500 500 500
52 Cimetidin tabl Tablet 100 900 - 900 - 900
54 Ciprofloxacin cap. 500 mg Tablet 100 - 500 500 - 500
57 Dexametason inj. 5 mg / ml - 1 ml Vial 100 225 225 - 225
58 Dexametason tabl. 0.5 mg Tablet 100 - 16,500 16,500 1,000 15,500
59 CLINDAMYCIN 300 MG Tablet 50 150 150 150 - ED
60 Dextrose 5 % 50 50 - 50
65 Digoksin tablet 0.25 mg Tablet 100 100 100 100 -
66 Domperidon SYR Botol 100 - 50 50 - 50
67 Domperidon tablet - 500 500 - 500
68 Doxycyclin 100 mg Caplet 100 - 700 700 100 600
72 Ergota tartr 1 mg + Kafein 50 mg tab Tablet 100 100 - 100 - 100
74 Eritromicyn capsul 500 mg Caplet 100 1,500 - 1,500 1,100 400
75 Etakridin (Rivanol) 0.1 % 300 ml Botol 1 9 - 9 4 5
NO NAMA OBAT SATUAN
79 Etil klorid semprot 100 ml Botol 1 1 - 1 1 -

85 Fenobarbital tabl. 30 mg Tablet 1,000 670 - 670 - 670 -
87 Fenoksimetil penisilin tabl. 500 mg Tablet - 500 500 - 500 - -
92 Fuji IX Pot - - - - - -
94 Garam oralit untuk 200 ml Sachet 100 800 1,000 1,800 700 1,100
96 Gentamicin cream Tube - 50 50 - 50
97 Gentian violet larutan 1% 10 ml Botol 1 24 48 72 - 72
100 Gliseril guayakolat tabl. 100 mg Tablet 1,000 9,000 2,000 11,000 4,000 7,000
105 Griseofulvin tabl. 125 mg, micro Tablet 100 1,000 1,000 2,000 - 2,000
NO NAMA OBAT SATUAN

112 Hidrokortison krim 2.5% 5 g Tube 24 - 48 48 24 24
114 Hyscopan Tablet 100 300 300 - 300
115 Ibuprofen tabl. 200 mg Tablet 100 - 1,000 1,000 - 1,000
116 Ibuprofen tabl. 400 mg Tablet 100 1,400 1,000 2,400 600 1,800
119 Infus set anak Set 1 81 - 81 - 81
120 Infus set dewasa Set 1 53 53 - 53
127 Isoniazid (INH) tabl. 100 mg Tablet 1,000 - - - -
129 Isosorbit dinitrat tabll Tablet 100 - 500 500 100 400
134 Kalsium laktat tabl. 500 mg Tablet 100 1,000 1,000 2,000 500 1,500
135 Kanamisin sulfat inj. 100 mg / vial Vial 10 28 28 28 -
NO NAMA OBAT SATUAN

138 Kapas pembalut 250 g Roll 1 5 10 15 5 10
139 Kaptopril 12,5 mg Tablet - 500 500 - 500
140 Kaptopril 25 mg Tablet 100 - 500 500 - 500
141 Kasa kompres 40 / 40 Lbr 1 40 - 40 - 40
142 Kasa Steril dos dos 1 1 100 101 14 87
144 Kasa pembalut 4 x 3 cm Roll 1 265 - 265 - 265
147 Ketoconazole tablet 200mg 150 - 150 50 100
150 Kinina sulfat tabl. 222 mg Tablet 1,000 2,000 6,000 8,000 - 8,000
153 Kloramfenikol salap mata 1% Tube 1 72 - 72 24 48
155 Klorfeniramin maleat (CTM) 4 mg Tablet 1,000 - 3,000 3,000 - 3,000
160 Klorpromazin HCl tabl. 25 mg Tablet 1,000 1,985 - 1,985 - 1,985
161 Kodein HCl (Kodeina) tabl. 10 mg Tablet 100 125 - 125 40 85
164 Kotrimoksazol suspensi Botol 1 - 100 100 - 100
165 Kotrimoksazol tabl. Komb. Tablet 100 2,000 10,000 12,000 700 11,300
NO NAMA OBAT SATUAN

170 RDT BOX 1 89 - 89 - 89
173 Tabung tutup kuning Botol 1 - 100 100 100 - -
174 Tabung tutup ungu EDTA Botol 1 - 100 100 100 -
177 Lidokain comp. Inj. Kombinasi. Ampul 30 20 180 200 40 160
181 Masker pcs 1 50 300 350 50 300
182 Mata boor Set 1 2 - 2 - 2
184 Metakresol sulfonat ( Albothyl ) 10 ML Botol 1 - 10 10 - 10
186 Meloxicam 15 mg box 50 2,750 1,000 3,750 1,150 2,600
188 Metronidazol tabl. 250 mg Tube 100 800 500 1,300 - 1,300
193 Na. Diklofenat 25 mg tablet Tablet 50 - 0 - - -
194 Na. Diklofenat 50 mg Table Tablet 50 8 8 8 -
NO NAMA OBAT SATUAN

197 Natr fenitoina (Fenitoina) 30 mg Tablet 250 250 - 250 90 160
198 Natr fenitoina (Fenitoina) 100 mg Tablet 250 100 100 - 100
203 Nistatin 100.000 IU / g tabl. Vaginal Tablet 100 200 200 - 200
204 Nistatin Oral tablet Tablet 100 300 - 300 - 300
206 Obat Batuk Hitam (OBH) Botol 1 - 216 216 72 144
212 Objec glass 72"s box 72 - 50 50 10 40
215 Oksitetrasiklin HCl salap kulit 3% Tube 1 - 25 25 - 25
216 Oksitetrasiklin HCl salap mata 1% Tube 24 25 25 25 -
218 Oksitoksin inj. 10 im / ml - 1 ml Ampul 30 - -
219 Omeprazole cap 1 300 7,620 7,920 1,320 6,600
221 Papaverin HCl tabl. 40 mg Tablet 100 1,000 - 1,000 200 800
NO NAMA OBAT SATUAN
224 Parasetamol sirup 120 mg / 5 ml Botol 1 - 200 200 200

226 Parasetamol tabl. 500 mg Tablet 100 12,500 20,000 32,500 7,700 24,800
227 Propiretic Suppo 80mg Set 1 12 12 - 12 12
228 Propiretic Suppo 160mg Set 1 12 - 12 - 12 12
230 Pirantel pamoat (Pirantel)125 mg Tablet 100 300 - 300 - 300
231 Piridoksin HCl (Vit.B6) 10 mg Tablet 1,000 - 15,000 15,000 1,000 14,000
234 Plester 5 yards x 2 inch Roll 1 20 - 20 - 20
236 Prednison tabl. 5 mg Tablet 100 - 2,900 2,900 300 2,600
237 Primaquin tabl 15 mg Tablet 100 - 4,100 4,100 1,500 2,600
241 SD HIV box 1 - - - - -
242 RPR 100 Antigen box 1 - - - - -
243 SD sifilis Box 1 30 - 30 3 27
244 Intec test kit box 100 2 - 2 2 -
246 Retinol (Vit. A) tablet 200.000 IU Kapsul 50 450 - 450 - 450
250 Ringer laktat larutan infus steril Botol 1 43 43 - 43
251 Salbutamol tabl. 4mg 500 300 800 100 700
NO NAMA OBAT SATUAN

254 Salisil talk 25% Pot 1 170 - 170 - 170
257 Sarung tangan L Set 1 1,000 - 1,000 200 800 -
258 Sarung tangan Obgyn 20 50 70 - 70 -
267 Stesolid rectal 5mg Pcs 1 - - - - -
272 Sabun cair 1 1 - 1 1
278 THT kit Set 1 1 1 1 -
NO NAMA OBAT SATUAN

296 Vitamin B Komplek tabl. 50 mg Tablet 1,000 - 2,000 2,000 - 2,000
298 ASAM FOLAT tab 500 3,000 3,500 200 3,300
300 ZinC Dispersibel - 500 500 - 500
302 Simvastatin 20 mg 1,000 1,000 300 700
304 Amlodipin 10 mg - - - - -
306 Ketoconazole Cream - 25 25 25
314 Ranitidin tab box - 2,000 2,000 200 1,800
320 Antasida syr botol 1 - 50 50 50
322 Amlodipine tab 5 mg box - 3,660 3,660 210 3,450
U M U M
BPJS JUMLAH
-
NO NAMA OBAT SATUAN
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN PJS. KEPALA PUSKESMAS YANG MELAPORKAN

GUDANG FARMASI
Drg. HENRI SEMBIRING ZUL AZMI LUMIANNA HUTAPEA, S.Sos GINANJAR EKO, S.Farm.A
NIP . 19641025 199103 1 012 NIP . 19640202 198603 1 032 NIP. 19651230 199303 2 008 NIP. 19870718 201004 3 00
BULAN F
: EBRUARI
TAHUN 2018
:
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
Feb-20
Feb-19
Jun-20
Oct-19
1100 3,100 Jan-20

50 100 Dec-19
1700 3,700 Nov-21
30
800
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
23,400 Aug-19
100 250 Aug-19
4
10,100 Nov-18
300 May-18
100 Jun-19
- ED
16,400 Aug-18
15 Apr-19
75
58
244
2
500 1,000
-
-
7,000 Mar-18
-
21,900
-
200
-
24 Apr-20
-
1
-
24
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
25 50 Feb-20
3000 3,500
900
200 May-19
1300 1,800 Oct-20
-
-
225 Apr-18
2500 18,000 May-18
-
50
-
-
-
75
-
120 170 Jul-19
700 1,200 Jan-20
600 Apr-20
2 2 Sep-19
0 -
-
100
-
400 Apr-19
5 Oct-20
-
600 Oct-18
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
-
-
-
670 Oct-18
1 1
500
-
-
400
-
-
300
1,100 Jul-18
-
100 150 Sep-20
72 Sep-20
1
200
7,000 Nov-20
-
57 Jul-20
56 Oct-20
-
2,000 Apr-20
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
72 96 Nov-19
-
300 Feb-20
700 1,700 Oct-20
1,800 Jun-19
-
-
81
53
-
-
11 Jun-18
-
-
-
-
-
400 Apr-19
4
-
32
-
1,500 Oct-21
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
10
700 1,200 Jul-20
4400 4,900 Jul-21
40
87
100
265
-
-
100
-
-
8,000 Apr-19
-
17 17 Jan-19
48 Mar-18
-
1700 4,700 Apr-20
-
-
-
-
1,985
85 Nov-18
175
-
100 May-19
11,300 May-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
20 Aug-20
89 Oct-18
-
500 500
-
-
38 38 Oct-18
160 Nov-19
3
4
-
300
2
-
10
-
2,600 Sep-19
100
1,300 Nov-20
2,000 Feb-19
1
-
300 300 Aug-19
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
160 Oct-18
100 Oct-19
-
-
-
13 Apr-19
200 Nov-18
300 Apr-18
-
144
-
-
-
-
-
17 57
-
-
25
-
-
-
6,600 Jun-19
-
800 May-18
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
216 416 Oct-18
-
24,800
12 Jul-19
12 Sep-18
1
1000 15,000 Sep-19

1,300 Aug-20
210
20
-
2,600 Dec-18
3600 6,200
10
-
200
-
-
27 Jul-18
-
50
450
-
-
-
43
700 Oct-18
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
170
1,400
2,800
800
70
97
-
-
-
78
24
-
1
-
-
-
-
-
1
-
2
-
-
-
1
-
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
900
400
5,000
120
3
-
-
-
2,000
3,300 Jul-18
2600 3,100 May-20
3600 4,300 Jul-20
-
25
-
-
-
3500 5,300 Apr-19
-
-
100 150 Mar-19
3,450 Jul-18
200 Oct-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
YANG MELAPORKAN

NIP. 19870718 201004 3 001
( L P L P O )

NO NAMA OBAT SATUAN
1 Abbocath no 18 Pcs 1 85 85 - 85
2 Abbocath no 20 Pcs 1 109 109 - 109
3 Abbocath no 22 Pcs 1 77 - 77 - 77
5 Acyclovir Tabl 200mg Box 100 1,000 - 1,000 200 800
6 Acyclovir Cream Tube 25 40 40 10 30
11 Alat suntik sekali pakai 3 ml Pcs 100 1,300 1,300 400 900
13 Alkohol 70 % 100 ml 3 10 13 3 10
14 Alkohol 70 % 1000 ml botol 4 6 10 4 6
15 Allupurinol tab 100mg### Box 100 - 2,000 2,000 - 2,000
16 Ambroxol Syr btl 60ml - 100 100 50 50
17 Ambroxol tab - 2,000 2,000 - 2,000
NO NAMA OBAT SATUAN

22 Amoksisilin kaps. 500 mg Kaplet 100 19,600 10,000 29,600 6,200 23,400
23 Amoksisilin sir.kering 125 mg / 5 ml Botol 1 - 150 150 150
25 Ampisilin kaplet 500 mg Kaplet 100 10,100 - 10,100 - 10,100
29 Antasida DOEN tabl. Tablet 100 10,200 7,200 17,400 1,000 16,400 -
33 Anti Malaria paket 9 - 254 254 10 244
35 Alkohol swab box 1 - 500 500 - 500
36 As.Sali 2% + Belerang 4% ( 2-4) Salap Tube 24 24 24 24 -
38 Asam Askorbat (Vit.C) tabl. 50 mg Tablet 1,000 - 7,000 7,000 7,000
40 Asam Mefinamic Cap.500 mg Kaplet 100 9,400 16,000 25,400 3,500 21,900
44 Chloramfecort cream - 24 24 - 24
NO NAMA OBAT SATUAN
50 Betametason cream Tube 25 - 25 25 25

51 Blood Lanset Pcs 1 - 500 500 500
52 Cimetidin tabl Tablet 100 900 - 900 - 900
54 Ciprofloxacin cap. 500 mg Tablet 100 - 500 500 - 500
57 Dexametason inj. 5 mg / ml - 1 ml Vial 100 225 225 - 225
58 Dexametason tabl. 0.5 mg Tablet 100 - 16,500 16,500 1,000 15,500
59 CLINDAMYCIN 300 MG Tablet 50 150 150 150 - ED
60 Dextrose 5 % 50 50 - 50
65 Digoksin tablet 0.25 mg Tablet 100 100 100 100 -
66 Domperidon SYR Botol 100 - 50 50 - 50
67 Domperidon tablet - 500 500 - 500
68 Doxycyclin 100 mg Caplet 100 - 700 700 100 600
72 Ergota tartr 1 mg + Kafein 50 mg tab Tablet 100 100 - 100 - 100
74 Eritromicyn capsul 500 mg Caplet 100 1,500 - 1,500 1,100 400
75 Etakridin (Rivanol) 0.1 % 300 ml Botol 1 9 - 9 4 5
NO NAMA OBAT SATUAN
79 Etil klorid semprot 100 ml Botol 1 1 - 1 1 -

85 Fenobarbital tabl. 30 mg Tablet 1,000 670 - 670 - 670 -
87 Fenoksimetil penisilin tabl. 500 mg Tablet - 500 500 - 500 - -
92 Fuji IX Pot - - - - - -
94 Garam oralit untuk 200 ml Sachet 100 800 1,000 1,800 700 1,100
96 Gentamicin cream Tube - 50 50 - 50
97 Gentian violet larutan 1% 10 ml Botol 1 24 48 72 - 72
100 Gliseril guayakolat tabl. 100 mg Tablet 1,000 9,000 2,000 11,000 4,000 7,000
105 Griseofulvin tabl. 125 mg, micro Tablet 100 1,000 1,000 2,000 - 2,000
NO NAMA OBAT SATUAN

112 Hidrokortison krim 2.5% 5 g Tube 24 - 48 48 24 24
114 Hyscopan Tablet 100 300 300 - 300
115 Ibuprofen tabl. 200 mg Tablet 100 - 1,000 1,000 - 1,000
116 Ibuprofen tabl. 400 mg Tablet 100 1,400 1,000 2,400 600 1,800
119 Infus set anak Set 1 81 - 81 - 81
120 Infus set dewasa Set 1 53 53 - 53
127 Isoniazid (INH) tabl. 100 mg Tablet 1,000 - - - -
129 Isosorbit dinitrat tabll Tablet 100 - 500 500 100 400
134 Kalsium laktat tabl. 500 mg Tablet 100 1,000 1,000 2,000 500 1,500
135 Kanamisin sulfat inj. 100 mg / vial Vial 10 28 28 28 -
NO NAMA OBAT SATUAN

138 Kapas pembalut 250 g Roll 1 5 10 15 5 10
139 Kaptopril 12,5 mg Tablet - 500 500 - 500
140 Kaptopril 25 mg Tablet 100 - 500 500 - 500
141 Kasa kompres 40 / 40 Lbr 1 40 - 40 - 40
142 Kasa Steril dos dos 1 1 100 101 14 87
144 Kasa pembalut 4 x 3 cm Roll 1 265 - 265 - 265
147 Ketoconazole tablet 200mg 150 - 150 50 100
150 Kinina sulfat tabl. 222 mg Tablet 1,000 2,000 6,000 8,000 - 8,000
153 Kloramfenikol salap mata 1% Tube 1 72 - 72 24 48
155 Klorfeniramin maleat (CTM) 4 mg Tablet 1,000 - 3,000 3,000 - 3,000
160 Klorpromazin HCl tabl. 25 mg Tablet 1,000 1,985 - 1,985 - 1,985
161 Kodein HCl (Kodeina) tabl. 10 mg Tablet 100 125 - 125 40 85
164 Kotrimoksazol suspensi Botol 1 - 100 100 - 100
165 Kotrimoksazol tabl. Komb. Tablet 100 2,000 10,000 12,000 700 11,300
NO NAMA OBAT SATUAN

170 RDT BOX 1 89 - 89 - 89
173 Tabung tutup kuning Botol 1 - 100 100 100 - -
174 Tabung tutup ungu EDTA Botol 1 - 100 100 100 -
177 Lidokain comp. Inj. Kombinasi. Ampul 30 20 180 200 40 160
181 Masker pcs 1 50 300 350 50 300
182 Mata boor Set 1 2 - 2 - 2
184 Metakresol sulfonat ( Albothyl ) 10 ML Botol 1 - 10 10 - 10
186 Meloxicam 15 mg box 50 2,750 1,000 3,750 1,150 2,600
188 Metronidazol tabl. 250 mg Tube 100 800 500 1,300 - 1,300
193 Na. Diklofenat 25 mg tablet Tablet 50 - 0 - - -
194 Na. Diklofenat 50 mg Table Tablet 50 8 8 8 -
NO NAMA OBAT SATUAN

197 Natr fenitoina (Fenitoina) 30 mg Tablet 250 250 - 250 90 160
198 Natr fenitoina (Fenitoina) 100 mg Tablet 250 100 100 - 100
203 Nistatin 100.000 IU / g tabl. Vaginal Tablet 100 200 200 - 200
204 Nistatin Oral tablet Tablet 100 300 - 300 - 300
206 Obat Batuk Hitam (OBH) Botol 1 - 216 216 72 144
212 Objec glass 72"s box 72 - 50 50 10 40
215 Oksitetrasiklin HCl salap kulit 3% Tube 1 - 25 25 - 25
216 Oksitetrasiklin HCl salap mata 1% Tube 24 25 25 25 -
218 Oksitoksin inj. 10 im / ml - 1 ml Ampul 30 - -
219 Omeprazole cap 1 300 7,620 7,920 1,320 6,600
221 Papaverin HCl tabl. 40 mg Tablet 100 1,000 - 1,000 200 800
NO NAMA OBAT SATUAN
224 Parasetamol sirup 120 mg / 5 ml Botol 1 - 200 200 200

226 Parasetamol tabl. 500 mg Tablet 100 12,500 20,000 32,500 7,700 24,800
227 Propiretic Suppo 80mg Set 1 12 12 - 12 12
228 Propiretic Suppo 160mg Set 1 12 - 12 - 12 12
230 Pirantel pamoat (Pirantel)125 mg Tablet 100 300 - 300 - 300
231 Piridoksin HCl (Vit.B6) 10 mg Tablet 1,000 - 15,000 15,000 1,000 14,000
234 Plester 5 yards x 2 inch Roll 1 20 - 20 - 20
236 Prednison tabl. 5 mg Tablet 100 - 2,900 2,900 300 2,600
237 Primaquin tabl 15 mg Tablet 100 - 4,100 4,100 1,500 2,600
241 SD HIV box 1 - - - - -
242 RPR 100 Antigen box 1 - - - - -
243 SD sifilis Box 1 30 - 30 3 27
244 Intec test kit box 100 2 - 2 2 -
246 Retinol (Vit. A) tablet 200.000 IU Kapsul 50 450 - 450 - 450
250 Ringer laktat larutan infus steril Botol 1 43 43 - 43
251 Salbutamol tabl. 4mg 500 300 800 100 700
NO NAMA OBAT SATUAN

254 Salisil talk 25% Pot 1 170 - 170 - 170
257 Sarung tangan L Set 1 1,000 - 1,000 200 800 -
258 Sarung tangan Obgyn 20 50 70 - 70 -
267 Stesolid rectal 5mg Pcs 1 - - - - -
272 Sabun cair 1 1 - 1 1
278 THT kit Set 1 1 1 1 -
NO NAMA OBAT SATUAN

296 Vitamin B Komplek tabl. 50 mg Tablet 1,000 - 2,000 2,000 - 2,000
298 ASAM FOLAT tab 500 3,000 3,500 200 3,300
300 ZinC Dispersibel - 500 500 - 500
302 Simvastatin 20 mg 1,000 1,000 300 700
304 Amlodipin 10 mg - - - - -
306 Ketoconazole Cream - 25 25 25
314 Ranitidin tab box - 2,000 2,000 200 1,800
320 Antasida syr botol 1 - 50 50 50
322 Amlodipine tab 5 mg box - 3,660 3,660 210 3,450
U M U M
BPJS JUMLAH
-
NO NAMA OBAT SATUAN
MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN PJS. KEPALA PUSKESMAS YANG MELAPORKAN

GUDANG FARMASI
Drg. HENRI SEMBIRING ZUL AZMI LUMIANNA HUTAPEA, S.Sos GINANJAR EKO, S.Farm.A
NIP . 19641025 199103 1 012 NIP . 19640202 198603 1 032 NIP. 19651230 199303 2 008 NIP. 19870718 201004 3 00
BULAN J: ANUARI
TAHUN 2018
:
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
Feb-20
Feb-19
Jun-20
Oct-19
1100 3,100 Jan-20

50 100 Dec-19
1700 3,700 Nov-21
30
800
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
23,400 Aug-19
100 250 Aug-19
4
10,100 Nov-18
300 May-18
100 Jun-19
- ED
16,400 Aug-18
15 Apr-19
75
58
244
2
500 1,000
-
-
7,000 Mar-18
-
21,900
-
200
-
24 Apr-20
-
1
-
24
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
25 50 Feb-20
3000 3,500
900
200 May-19
1300 1,800 Oct-20
-
-
225 Apr-18
2500 18,000 May-18
-
50
-
-
-
75
-
120 170 Jul-19
700 1,200 Jan-20
600 Apr-20
2 2 Sep-19
0 -
-
100
-
400 Apr-19
5 Oct-20
-
600 Oct-18
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
-
-
-
670 Oct-18
1 1
500
-
-
400
-
-
300
1,100 Jul-18
-
100 150 Sep-20
72 Sep-20
1
200
7,000 Nov-20
-
57 Jul-20
56 Oct-20
-
2,000 Apr-20
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
72 96 Nov-19
-
300 Feb-20
700 1,700 Oct-20
1,800 Jun-19
-
-
81
53
-
-
11 Jun-18
-
-
-
-
-
400 Apr-19
4
-
32
-
1,500 Oct-21
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
10
700 1,200 Jul-20
4400 4,900 Jul-21
40
87
100
265
-
-
100
-
-
8,000 Apr-19
-
17 17 Jan-19
48 Mar-18
-
1700 4,700 Apr-20
-
-
-
-
1,985
85 Nov-18
175
-
100 May-19
11,300 May-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
-
20 Aug-20
89 Oct-18
-
500 500
-
-
38 38 Oct-18
160 Nov-19
3
4
-
300
2
-
10
-
2,600 Sep-19
100
1,300 Nov-20
2,000 Feb-19
1
-
300 300 Aug-19
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
-
160 Oct-18
100 Oct-19
-
-
-
13 Apr-19
200 Nov-18
300 Apr-18
-
144
-
-
-
-
-
17 57
-
-
25
-
-
-
6,600 Jun-19
-
800 May-18
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
216 416 Oct-18
-
24,800
12 Jul-19
12 Sep-18
1
1000 15,000 Sep-19

1,300 Aug-20
210
20
-
2,600 Dec-18
3600 6,200
10
-
200
-
-
27 Jul-18
-
50
450
-
-
-
43
700 Oct-18
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
170
1,400
2,800
800
70
97
-
-
-
78
24
-
1
-
-
-
-
-
1
-
2
-
-
-
1
-
-
-
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
-
900
400
5,000
120
3
-
-
-
2,000
3,300 Jul-18
2600 3,100 May-20
3600 4,300 Jul-20
1230 1,230
25
-
-
-
3500 5,300 Apr-19
-
-
100 150 Mar-19
3,450 Jul-18
200 Oct-19
PEMBERIAN
P2M STOK
KAB. PEMPROV
KAB JKN AKHIR ED
YANG MELAPORKAN

NIP. 19870718 201004 3 001
PEMAKAIAN DAN PENGAMBILAN VAKSIN PUSKESMAS SANGGENG JANUARI
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
1 FDC 0 16 16 8 8
2 Kategori II 0 4 4 2 2
3 pot spuctum 0 200 200 160 40
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
PEMAKAIAN DAN PENGAMBILAN VAKSIN PUSKESMAS SANGGENG JANUARI
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR
1 HB 0 3 20 23 23 0
2 DPS/ HB- HIB 54 54 68 -14
3 BCG 10 10 8 2
4 POLIO 40 40 39 1
5 CAMPAK 48 48 12 36
6 IPV 18 18 18 0
NO NAMA BARANG SATUAN STOK AWAL PENERIMAAN PERSEDIAAN
1 HEMOSPON DUS 1
2 GC FUJI 9 DUS 1
3 DOUBLE CHECK DUS 1
4 EUGENOL BOTOL 1
5 TOPICAL ANASTESI BOTOL 2
6 PILP X PCS 1
7 DISPOSIBLE DENTAL NEEDLE DUS 1
8 ELITE CEMENT PCS 1
9 FLOUR BOTOL 1
10 FUJI 7 DUS 1
PEMAKAIAN STOK AKHIR

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LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT

STOCK PENERI PERSE PEMAKA STOCK STOCK PERMIN

21 Aminofilin tablet 200 mg Tablet 100 800 - 800 100 700

50 Bedah Set Sederhana / Sirkum set Set 1 - - - - -

79 Ergota tartr 1 mg + Kafein 50 mg tab Botol 100 - - - - - 1,000

108 Gunting Operasi no.14 pcs 1 - - - - -

137 Kanamisin sulfat inj. 100 mg / vial Vial 1 - - - -

166 Korentang Box 1 - - - -

224 Parasetamol sirup 120 mg / 5 ml Botol 1 - - - - - 500

253 Safety box box 1 - - - - -

282 Tensimeter lapangan Pcs 1 - - - 0 -

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN KEPALA PUSKESMAS YANG MELAPORKAN

1100 1,105 Jan-20

1000 1,800 Sep-19

GINANJAR EKO, S.Farm.Apt

STOCK PENERI PERSE PEMAKA STOCK STOCK PERMIN

21 Aminofilin tablet 200 mg Tablet 100

50 Bedah Set Sederhana / Sirkum set Set 1

80 Eppendrorl 200 UI botol 1

109 Glukosa larutan infus 10% steril Pcs 1

138 Isoniazid (INH) tabl. 100 mg Tablet 100

167 Klorfeniramin maleat (CTM) 4 mg tablet 100

196 Metanol Botol 1

225 Oksigen gas dalam tabung 1

254 Ranitidin tab tablet 100

283 Sohobion tablet Caplet 100

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN KEPALA PUSKESMAS YANG MELAPORKAN

NIP . NIP . NIP. NIP.

STOCK PENERI PERSE PEMAKA STOCK STOCK PERMIN

21 Aminofilin tablet 200 mg Tablet 100 800 - 800 100 700

50 Bedah Set Sederhana / Sirkum set Set 1 - - - - -

80 Eppendrorl 200 UI botol 1 - - - - -

109 Glukosa larutan infus 10% steril Pcs 1 56 - 56 - 56 -

196 Metanol Botol 1 - - -

225 Oksigen gas dalam tabung 1 - - - - -

254 Ranitidin tab tablet 100 1,400 - 1,400 100 1,300

283 Sohobion tablet Caplet 100 - - -

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN KEPALA PUSKESMAS YANG MELAPORKAN

1100 1,105 Jan-20

1000 1,800 Sep-19

GINANJAR EKO, S.Farm.Apt

STOCK PENERI PERSE PEMAKA STOCK STOCK PERMIN

21 Amoksisilin kaps. 250 mg Kapsul 120 - - - - -

50 Betametason cream Tube 25 25 - 25 25 -

79 Etil klorid semprot 100 ml Botol 1 - - - - -

108 Gunting Operasi no.18 Pcs 1 - - -

137 Kapas pembalut 100 g Roll 1

166 Kotrimoksazol Pediatrik, Komb. Tablet 300 - - - - - -

195 Nasogastrik tub Tube 1 -

224 Parasetamol sirup 120 mg / 5 ml Botol 1 200 - 200 200 -

253 Salisil spiritus 10% 25 ml Botol 12 -

282 Tetrakain HCl tetes mata 0,5% Botol 1 - - -

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN KEPALA PUSKESMAS YANG MELAPORKAN

1100 1,900 Jan-20

1000 12,000 Sep-19

GINANJAR EKO, S.Farm.Apt

STOCK PENERI PERSE PEMAKA STOCK STOCK PERMIN

21 Amoksisilin kaps. 250 mg Kapsul 120 - - - - -

50 Betametason cream Tube 25 - 25 25 25

79 Etil klorid semprot 100 ml Botol 1 1 - 1 1 -

108 Gunting Operasi no.18 Pcs 1 - - -

137 Kapas pembalut 100 g Roll 1

166 Kotrimoksazol Pediatrik, Komb. Tablet 300 - - - - - -