LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

KODE PUSKESMAS : 7313120101

PUSKESMAS : PITUMPANUA Pelaporan Bulan : JULI 2021 Dokumen Nomor Tanggal
KECAMATAN : PITUMPANUA Permintaan Bulan : AGUSTUS 2021 Dinkes Kab. Wajo
KAB / KOTA : WAJO IF Kab. Wajo
PROVINSI : SULAWESI SELATAN Puskesmas 094/ /PKM PIT 03 AGUSTUS 2021

PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 ACT Tab tablet - 0
2 ACT inj vial - 0
3 Obat Suntik KB I : inj depo 150 mg - 0
Medroxyprogesteron Acetat 150 mg - 0
4 Air untuk irigasi 1000 ml botol 1000ml - 0
5 Albendazol tablet 400 mg tablet 3500 3,500.00 0 600.00 3,500.00
6 Albendazol suspensi 200 mg/ 5 ml botol 10 ml 832 832.00 0 230.00 830.00
7 Alopurinol Tablet 100 mg tablet 710 1000 1,710.00 446 1,264.00
8 Alopurinol Tablet 300 mg tablet 0 - 0 -
9 Ambroxol tablet 30mg tablet 0 - - 2,000.00
10 Ambroxol sirup 15 mg/ 5 ml btl 60 ml 72 72.00 0 72.00
11 Aminofilin injeksi 24 mg/ml ampul 0 - 0 -
12 Aminofilin tablet 200 mg tablet 0 - 0 -
13 Amitriptilin tablet salut 25 mg (HCl) tablet 1291 1,291.00 124 1,167.00
14 Amlodipin tablet 5 mg tablet 410 1500 1,910.00 770 1,140.00 1,500.00
15 Amlodipin tablet 10 mg tablet 1885 1500 3,385.00 807 2,578.00 1,500.00
16 Amoksisilin kapsul 250 mg kapsul 0 - 0 - 3,000.00
17 Amoksisilin kaplet 500 mg kaplet 2220 2000 4,220.00 2790 1,430.00 5,000.00
18 Amoksisilin sirup kering 125 mg/5 ml btl 60 ml 97 50 147.00 22 125.00 50.00
Amoksisilin sirup kering forte 250 mg/5
19 btl 60 ml 0 - 0 -
ml
20 Ampisillin serbuk inj. i.v. 1000 mg/vial ktk 10 vial 41 41.00 0 41.00
21 Ampisilin sirup kering 125 mg/ 5 ml btl 60 ml 0 - 0 -
22 Antasida DOEN Tab tablet 0 5000 5,000.00 832 4,168.00
23 Antasida DOEN II suspensi btl 60 ml 0 - - 300.00
24 Anti Bakteri DOEN salep tube @ 5 g 0 - 0 - 50.00
25 Antifungi DOEN pot @ 30 g 0 - 0 -
26 Antihemoroid DOEN supp @ 2 g 0 - 0 - 50.00
27 Antimigren tablet 300 300.00 37 263.00
28 Antiparkinson DOEN tablet tablet 0 - 0 -
29 Aqua pro injeksi steril, bebas pirogen vial @ 20 ml 5 5.00 0 5.00
30 Artemether injeksi 1 ml : 80 ml ampul 0 -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Articain hidrokloride 4 mg : efinefrin
31 ampul 118
118.00
0
118.00 -
bitartrat 0,01 mg (ORABLOC)
32 Asam asetilsalisilat tablet 80 mg tablet 0 - 0 -
33 Asam asetilsalisilat tablet 100 mg tablet 0 - 0 -
34 Asam asetilsalisilat tablet 500 mg tablet 0 - 0 -
35 Asam askorbat (Vit.C) tablet 50 mg tablet 0 5000 5,000.00 1279 3,721.00 10,000.00
36 Asam askorbat (Vit.C) tablet 100 mg tablet 0 - 0 -
37 Asam askorbat (Vit.C) tablet 250 mg tablet 0 - 0 -
38 Asam Mefenamat kaplet 500 mg tablet 7638 10000 17,638.00 2680 14,958.00
39 Asam valproat sirup botol 0 - 0 -
40 Asetil sistein kapsul 200 mg tablet 1600 1,600.00 695 905.00 2,000.00
41 Asiklovir krim 5 % tube 5 g 0 - 0 -
42 Asiklovir tablet 200 mg tablet 500 500.00 0 500.00
43 Asiklovir tablet 400 mg tablet 690 690.00 60 630.00
44 Attapulgite tablet 600 mg tablet 1105 1,105.00 371 734.00
45 Atropin injeksi 0,25 mg/ml ampul 0 - 0 -
46 Benzatin benzil penisilin inj. 2,4 juta IU vial 0 - 0 20.00 -
47 Betametason krim 0,1 % tube @ 5 g 0 - - 150.00
48 Betametason tetes mata 1 mg/ml botol @ 5 ml 0 0 -
49 Bisakodil tab 5 mg tablet 0 - 0 - 1,000.00
50 Bisakodil suppositoria 5 mg Suppositoria 0 - 0 - 20.00
51 Bisakodil suppositoria 10 mg Suppositoria 0 - 0 - 30.00
52 Bromheksin HCl 8 mg tablet 0 - 0 -
53 Bromheksin HCl sirup botol 0 - 0 -
54 Dehidro Atemisin + Piperakuin (DHP) tablet 22 36 58.00 0 - 58.00
55 Deksametason injeksi i.v 0,5 mg/ml ampul 0 - 0 - -
56 Deksametason tablet 0,5 mg tablet 0 - - 5,000.00
57 Dekstrometorfan sirup 10 mg/5 ml btl 60 ml 0 - 0 -
Dekstrometorfan sirup 10 mg/5 ml
58 btl 60 ml 100 254.00 183.00 100.00
kombinasi 154 71
59 Dekstrometorfan tablet 15 mg (HBr) tablet 0 - 0 -
60 Diazepam injeksi 5 mg/ml ampul 29 29.00 29 -
61 Diazepam larutan rektal 5 mg/2,5 ml tube @ 2,5 ml 6 6.00 6 -

62 Diazepam rectal 10 mg/2,5 ml tube 0

-
0
-

63 Diazepam tablet 2 mg tablet 0 - 0 -

64 Diazepam tablet 5 mg tablet 410 500 910.00 142 768.00
Difenhidramin injeksi i.m 10 mg/ml
65 ampul 0 - 0 -
(HCl)
66 Digoksin tablet 0,25 mg tablet 160 160.00 0 160.00
67 Diltiazem HCl tablet 30 mg tablet 0 - 0 -
68 Dimenhidrinat tablet 50 mg tablet 490 490.00 20 470.00
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
69 Doksisiklin 100 mg kapsul 0 - 0 -
70 Domperidon tablet 10 mg tablet 0 - - 3,000.00
71 Efedrin tablet 25 mg (HCl) tablet 0 - 0 -
72 Ekstraks Belladona tablet 10 mg tablet 0 - 0 -
Epinefrin (Adrenalin) injeksi 0,1 %
73 ampul 10 10.00 10 10.00 - 10.00
(sebagai HCl)
74 Eritromisin kapsul 250 mg kapsul 0 - 0 -
75 Eritromisin kapsul 500 mg tablet 150 150.00 20 130.00
76 Eritromisin sirup kering 200 mg/ 5 ml btl 60 ml 0 - 0 -
77 Etanol 70 % btl 100 ml 0 - 0 -
78 Fenilbutason tablet 200 mg tablet 0 - 0 -
79 Fenobarbital injeksi i.m/i.v 50 mg/ml ampul 0 - 0 -
80 Fenobarbital tablet 30 mg tablet 1291 1,291.00 84 1,207.00
81 Fenol Gliserol tetes telinga 10% botol 5 ml 0 24 24.00 8 16.00 50.00
Fitomenadion (Vit K) tablet salut gula 10
82 tablet 1945 1,945.00 53 1,892.00
mg
83 Fitomenadion (Vit K) injeksi 10 mg/ml ampul 0 - 0 -
84 Fitomenadion (Vit K) injeksi i.m.2 mg/ml ampul 64 64.00 50 14.00
85 Furosemid tab 40 mg tablet 0 - 0 -
86 Garam Oralit serbuk 200 ml sachet 1345 1,345.00 138 1,207.00
87 Gentamisin inj.40 mg/ml ampul 0 - 0 -
88 Gentian violet larutan 1 % btl 10 ml 0 - 0 - 50.00
89 Glibenklamida tablet 5 mg tablet 1560 1,560.00 65 1,495.00
90 Glimepiride tablet 1 mg tablet 596 596.00 310 286.00
91 Glimepiride tablet 2 mg tablet 0 - 0 -
92 Gliseril Guaiakolat tablet 100 mg tablet 533 533.00 533 - 5,000.00
93 Glukosa larutan infus 10% steril btl 500 ml 0 - -
94 Glukosa larutan infus 5% btl 500 ml 41 50 91.00 33 58.00 40.00
95 Griseofulvin tablet 125mg Micorinized tablet 0 - 0 -
96 Griseofulvin tablet 500 mg tablet 0 - 0 -
97 Haloperidol tablet 1,5 mg tablet 0 - 0 -
98 Haloperidol tablet 5 mg tablet 1555 1,555.00 304 1,251.00 1,000.00
99 Haloperidol inj 5 mg/ml ampul 10 10.00 0 10.00
100 Haloperidol inj 50 mg/ml ampul @ 1 ml 6 6.00 0 6.00
101 Hidroklortiazid tablet 25 mg tablet 1000 1,000.00 0 1,000.00
102 Hidrokortison krim 2,5% tube @ 5 g 0 48 48.00 27 21.00 50.00
103 Hyosicine-N-Butilbromide tablet 10mg tablet 0 - 0 - 1,000.00
104 Ibuprofen sirup 100 mg/ 5 ml btl 60 ml 42 42.00 22 20.00
105 Ibuprofen tablet 200 mg tablet 0 - -
106 Ibuprofen tablet 400 mg tablet 0 - - 10,000.00
107 Iodiol kapsul lunak kapsul 0 - -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
108 Isoniazid tablet 100 mg tablet 354 354.00 122 - 232.00
109 Isoniazid tablet 300 mg tablet 177 177.00 0 177.00
110 Isosorbid Dinitrat tablet sublingual 5mg tablet 0 - 0 -
111 Kalsium Laktat (Kalk) tablet 500 mg tablet 0 - 0 -
Kalsium Glukonat injeksi i.v. 10%
112 ampul 0 - 0 -
(100mg/ml)
113 Kaptopril 25 mg tablet 358 358.00 0 358.00
114 Karbamazepin tablet 200 mg tablet 0 - 0 -
115 Ketokonazol tablet 200mg tablet 0 - 0 -
116 Klobazam 10 mg tablet 0 - 0 -
117 Kloramfenikol kapsul 250 mg kapsul 0 - 0 -
118 Kloramfenikol salep kulit 2 % tube @ 15 g 72 48 120.00 41 79.00 50.00
119 Kloramfenikol salep mata 1 % tube @ 5 g 51 51.00 1 50.00 48.00
120 Kloramfenikol suspensi 125 mg/5 ml btl 60 ml 0 - 0 -
121 Kloramfenikol tetes telinga 3% btl @ 10 ml 0 - 0 -
122 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 0 - - 5,000.00
123 Klorpromazin injeksi i.m 5 mg/ml - 2 ml ampul 0 - 0 -
124 Klorpromazin tablet salut 25 mg (HCl) tablet 0 - 0 - 1,000.00

125 Klorpromazin tablet salut 100 mg (HCl) tablet - - 1,000.00

0 0
126 Klozapin 25 mg tablet 0 - 0 -
127 Kodein tablet 10 mg tablet 0 - 0 - 2,000.00
128 Kodein tablet 20 mg tablet 0 - 0 -
129 Kotrimoksazol DOEN (dewasa) tablet 5000 5,000.00 162 4,838.00
130 Kotrimoksazol DOEN (Pediatrik) tablet 0 - 0 -
131 Kotrimoksazol suspensi btl 60 ml 14 50 64.00 10 54.00 50.00
Kombipak PMS (Azithomycin 500
132 paket 0 - 0 -
mg+Cefixime 200 mg)
133 Kuinin dihidroklorida injeksi 25% - 2ml ampul 0 - 0 -
134 Kuinin (kina) tablet 222 mg tablet 0 - 0 -
135 Lidokain injeksi 2% ampul @ 2 ml 0 180 180.00 26 154.00
Lidokain injeksi 2% (HCl) + Epinefrin 1 :
136 ampul 0 - - 200.00
80.000 - 2 ml
137 Loratadin tablet 10 mg tablet 0 - 0 - 100.00
138 Magnesium sulfat inj 20% vial 25 ml 0 - 0 -
139 Magnesium sulfat inj 40% vial 25 ml 25 25.00 5 9.00 11.00
140 Mebendazol sirup 100 mg/ 5ml btl 30 ml 0 - 0 -
141 Mebendazol tablet 500 mg tablet 0 - 0 -
142 Metampiron injeksi 250 mg/ml ampul 0 - 0 -
143 Metampiron tablet 500 mg tablet 0 - 0 -
144 Metformin HCl tablet 500 mg tablet 0 - 0 -
145 Metformin HCl tablet 850 mg tablet 0 - 0 -
Metil Ergometrin Maleat
146 tablet 0 - -
(Metilergometrin) tablet salut 0,125 mg
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Metilergometrin Maleat injeksi 0.200
147 ampul 10 10.00 0 10.00
mg/ml
148 Metilprednisolon 4 mg tablet 0 - 0 - 1,000.00
149 Metoklopramide tablet 5 mg tablet 0 - 0 -
150 Metoklopramide tablet 10 mg tablet 0 - 0 -
151 Metronidazol tablet 500 mg tablet 0 - 0 - 2,000.00
152 Metronidazol infus 500 mg/100 ml botol @ 100 ml 0 - 0 -
153 Metronidazol sirup 125 mg/5 ml botol @ 60 ml 0 - 0 -
154 Mikonazol krim/salep 2 % (Nitrat) tube @ 10 g 0 48 48.00 31 17.00 50.00
155 Mineral Mix sachet 0 - 0 -
156 Natrium Bikarbonat tablet 500 mg tablet 0 - 0 -
157 Natrium Bikarbonat injeksi i.v. 8,4% ampul 25 ml 0 - 0 -
158 Natrium Diklofenak tablet 50 mg tablet 419 419.00 419 - 5,000.00
159 Natrium Diklofenak tablet 25 mg tablet 0 - 0 -
Natrium Diklofenak Gel emulsi (hotin
160 Tube 0 - 0 -
DCL)
161 Natrium Klorida larutan infus 0,9% btl 500 ml 227 227.00 50 177.00
162 Natrium Tiroksin 100 mcg tablet 0 - 0 -
163 N.B Topical Oint tube 5 g 0 - 0 -
164 Nifedipin tablet 10 mg tablet 0 - 0 - 500.00
165 Nifedipin tablet 20 mg (adalat oros) tablet 0 - 0 -
166 Nistatin drops botol 0 - 0 -
167 Nistatin tablet salut 100.000 IU/g tablet 0 - 0 -
168 Nistatin tablet 500.000 IU/g tablet 0 - 0 -
169 Obat antituberkulosis kategori 1 dewasa paket 8 11 19.00 11 8.00 10.00
170 Obat antituberkulosis kategori 2 dewasa paket 0 - 0 -
171 Kombipak Kategori 1 paket 0 - 0 -
172 Obat antituberkulosis kategori anak paket 0 - 0 -
173 Obat antituberkulosis sisipan dewasa paket 0 - 0 -
174 Obat Batuk Hitam ( O.B.H ) cairan btl 100 ml 0 - 0 -
175 Obat Batuk Hitam ( OBH Itra) btl 120 ml 0 - 0 -
Obat gigi : 0 - 0 -
Bahan Tumpatan sementara
176 pot @ 30 g 0 - 0 -
(Ceivitron)
177 Etil Klorida Spray btl 100 ml 8 8.00 0 8.00
178 Eugenol cairan Botol @ 10 ml 0 - 0 -
179 Glass Ionomer Cement ART set 0 - 0 -
180 Hemospon set 0 - 0 -
181 Kalsium Hidroksida Pasta set 0 - 0 -
182 Klorfenol kamfer Menthol (CHKM) set 0 - 0 -
183 Mummiffying pasta set 0 - 0 -
184 Semen seng Fosfat serbuk dan cairan set 0 - 0 -
185 Silver Amalgam set 0 - 0 -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Temporary Stopping Fletcher serbuk
186 set 0 - 0 -
dan cairan
187 Oksimetazolin tetes hidung 0,025% Botol @ 10 ml 0 - 0 -
188 Oksitetrasiklin salep mata 1% (HCl) tube @ 3,5 g 198 198.00 7 191.00
189 Oksitetrasiklin salep kulit 3% tube @ 5 g 0 - 0 -
190 Oksitosin injeksi 10 IU/ml - ml ampul @ 1 ml 52 52.00 52 - 100.00
191 Omeprazol kapsul 20 mg kapsul 0 - 0 - 6,000.00
192 Omeprazol injeksi 40 mg/10 ml vial 0 - 0 -
193 Papaverin tab 40 mg tablet 414 414.00 87 327.00
194 Paracetamol drops 100 mg/ml btl 15 ml 2 60 62.00 1 61.00
195 Parasetamol sirup 120 mg/ 5 ml btl 60 ml 0 - 28 (28.00) -
196 Parasetamol tablet 100 mg tablet 0 - 0 -
197 Parasetamol tablet 500 mg tablet 9632 5000 14,632.00 5273 9,359.00 5,000.00
198 Perak sulfadiazin krim 1% tube @ 35 g 0 - 0 -
199 Permetrin krim 5% tube @ 10 g 0 - 0 -
200 Pirantel suspensi 125 mg/ 5 ml btl 60 ml 0 - 0 -
201 Pirantel tab.Score (base) 125 mg tablet 0 - 0 -
202 Piridoksin (Vit. B6) tablet 10 mg (HCl) tablet 0 - - 3,000.00
203 Piridoksin tab 25 mg tablet 0 - 0 -
204 Piroksikam tablet 10 mg tablet 0 - 0 -
205 Piroksikam tablet 20 mg tablet 0 - 0 -
206 Polikresulen cairan btl 10 ml 0 - 0 -
207 Povidon Iodida larutan 10% btl @ 300 ml 0 - 0 -
208 Prednison tablet 5 mg tablet 0 2000 2,000.00 240 - 2,000.00
209 Primakuin tablet 15 mg tablet 86 86.00 0 86.00
210 Probenesid tab 500 mg tablet 0 - 0 -
211 Prokain Benzil Penisilin injeksi 3 jt IU vial 0 - 0 -
212 Propanolol tablet 10 mg (HCl) tablet 0 - 0 -
213 Propranolol 40 mg tablet 406 550.00 0 550.00
214 Propiltiourasil tablet 100 mg tablet 180 180.00 180 - 2,000.00
215 Ranitidin tablet 150 mg tablet 0 5000 5,000.00 670 4,330.00
216 Ranitidin injeksi ampul 0 - 0 - 100.00
217 Reserpin tablet 0,25 mg tablet 0 - 0 -
218 Retinol (Vit.A) 100.000 IU kapsul lunak kapsul 0 - 0 - 200.00
219 Retinol (Vit.A) 200.000 IU kapsul lunak kapsul 0 - 0 - 2,000.00
220 Ringer Laktat larutan infus btl 500 ml 370 370.00 127 243.00
221 Risperidon 2 mg tablet 0 - 0 -
222 Salbutamol tablet 2 mg (sebagai sulfat) tablet 0 - 0 -

223 Salbutamol tablet 4 mg (sebagai sulfat) tablet 5000 5,485.00 4,951.00

485 534
224 Salbutamol cairan ih 0,1% botol @ 2,5 ml 0 - 0 -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Salep 2-4,kombinasi : Asam sulfat 2 %
225 pot @ 30 g 85 85.00 12 73.00 50.00
+ Belerang endap 4 %
226 Salisil bedak serbuk 2 % ktk 50 gram 55 50 105.00 24 81.00 50.00
227 Sefadroxil sirup 250 mg/5 ml botol 0 - 0 -
228 Sefadroxil 500 mg kaplet 0 - 0 - 2,000.00
229 Setrizin drops botol 0 - 0 -
230 Setirizin sirup 5 mg/5 ml Botol @ 60 ml 0 - 0 -
231 Setrizin tab 10 mg tablet 0 - 0 - 2,000.00
Sianokobalamin (Vit.B 12) tablet 50
232 tablet 0 - - 3,000.00
mcg
Sianokobalamin (Vit.B 12) tablet 10
233 tablet 0 - 0 -
mcg
Sianokobalamin (Vit.B 12) injeksi 500
234 ampul 0 - 0 -
mcg
235 Simetidine tablet 200 mg tablet 0 - 0 -
236 Simvastatin tablet 10 mg tablet 2545 2,545.00 800 1,745.00
237 Simvastatin tablet 20 mg tablet 0 500 500.00 130 370.00 500.00
238 Siprofloksasin tablet 500 mg (HCl) tablet 0 500 500.00 150 350.00 3,000.00
239 Spironolakton tablet 25 mg tablet 0 - 0 -
Tablet tambah darah : tablet 0 - 0 -
_ Besi (II) sulfat 200 mg, asam folat
tablet 0 - 0 -
240 0,25 mcg
_ Ferrous Fumarate 180 mg, Folic Acid
tablet 30,110.00 25,290.00
400 mcg 30110 4820
241 Taburia sachet 0 - 0 -
242 Tetrakain HCl tetes mata 0,5% botol 5 ml 0 - 0 -
243 Tetrasiklin kapsul 250 mg kapsul 0 - 0 -
244 Tiamin (Vit.B1) tablet 50 mg tablet 0 - - 3,000.00
245 Tiamin (Vit.B1) injeksi 100 mg/ml ampul 0 - 0 -
246 Triheksifenidil tablet 2 mg tablet 1260 1000 2,260.00 656 1,604.00 5,000.00
247 Triheksifenidil tablet 2 mg (Arkine) tablet 0 - 0 -
Vaksin BCG serb inj. 0,75 mg/ml +
248 vial 22 22.00 0 22.00
pelarut
249 Vaksin campak serb inj. + pelarut vial 0 - 0 -
250 Vaksin kombinasi DPT-HB-Hib inj vial 74 74.00 0 74.00
Vaksin jerap difteri tetanus (DT) inj.
251 vial 0 - 0 -
40/15 If per ml
Vaksin jerap difteri tetanus pertusis
252 vial 0
-
0
-
(DPT) inj.
253 Vaksin HB-PID vial 0 - 0 -
254 Vaksin polio b-OPV drops 10 dosis vial 169 169.00 0 169.00
255 Vaksin polio IPV inj. 0,5 ml vial 31 31.00 0 31.00
256 Vaksin Td vial 11 11.00 0 11.00
257 Vaksin rabies serb inj +booster vial 7 10 17.00 9 8.00
258 Vaksin HBIG vial 2 2.00 2.00
259 Vaksin MR vial 46 46.00 0 46.00
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
260 Vaksin Hepatitus B syringe 47 47.00 0 47.00
261 Vitamin B Kompleks tablet tablet 0 - 0 - - 10,000.00
262 Zinc Tab 20 mg tablet 2560 2,560.00 364 1,880.00
263 Zinc drop 10 mg/ml botol @ 15 ml 0 - 0 -
264 Zinc sirup 10 mg/ml botol 100 ml 0 - -
265 Zinc sirup 20 mg/5 ml botol 60 ml 15 50 65.00 41 24.00 50.00
266 Efavirens (EFV) 600 mg botol @ 30 tab 0 - 0 -
267 Nevirapine (NVP) 200 mg botol @ 60 tab 0 - 0 -
268 Lamivudin (3TC) 150 mg botol @ 60 tab 0 - 0 -
269 Tenofovir (TDF) 300 mg botol @ 30 tab 0 - 0 -
270 Zidovudin (ZDV) 100 mg botol @ 60 tab 40 40.00 40 -
ZDV+3TC+NVP Ped Triple FDC
271 botol @ 30 tab 0 - 0 -
(60/30/50)
TDF+3TC+EFV (300/300/600) Triple
272 botol @ 30 tab 0
-
0
-
FDC
Zidovudin (300 mg) + Lamivudin (150
273 botol @ 60 tab 0
-
0
-
mg)
Multivitamin : 0 - 0 -
- Anagens sirup botol @ 60 ml 0 - 0 -
- Becefort sirup botol @ 60 ml 0 50 50.00 32 18.00 50.00
- Biovitan syr botol 0 - 0 -
- Bioron tablet tablet 0 - 0 -
274
- Bioron injeksi amp 78 78.00 0 78.00
- Corobion tab tablet 0 - 0 -
- Corovit sirup botol @ 60 ml 0 - 0 -
- Corovit tablet tablet 0 - 0 -
- Takana sirup botol 0 - 0 -
275 Helmezin sirup botol 0 - 0 -
276 Hemafort tab tablet 0 - 0 -
277 Hustab tab tablet 0 - 0 -
278 Hustab P sirup botol 60 ml 0 - 0 -
279 Lactulose sirup botol 0 - 0 -
280 L-Bio sachet 0 - - 100.00
281 Livron B plex tablet 0 - 0 -
282 Pehacain inj. ampul 0 - 0 -
283 Potensik (diaz, metampiron) tablet 0 - 0 -
284 Flufenazine decanoat 25 mg/ml ampul 0 0 -
285 Trifluoperazine HCl 5 mg tablet 0 - 0 -
286 Betahistin mesilate 6 mg tablet 0 - 0 -
287 Oseltamivir 75 mg tablet 0 - 0 -
288 Azithromycin 500 mg tablet 0 - 0 -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
289 Chloroquine phosphate 150 mg tablet 0 - 0 -
290 Pehavral tab tablet 0 - 0 -
291 Becefort tab tablet 0 - 0 -
292 Klorpromazin injeksi i.m 25 mg/ml - 2 ml ampul 0 - 0 -

0
0
0
0
0
0

1 Alat suntik 0,05 ml set 200 340.00 40.00 500.00

140 300
2 Alat suntik 0,5 ml set 200 100 300.00 87 213.00 100.00
3 Alat suntik 1 ml set 0 - -
4 Alat suntik 2,5 ml set 0 - 0 - 300.00
5 Alat suntik 3 ml set 0 - - 500.00
6 Alat suntik 5 ml set 130 100 230.00 34 196.00 500.00
7 Alat suntik 10 ml Set 20 20.00 15 5.00 100.00
8 Alat suntik 20 ml Set 0 - 0 -
9 Alat suntik 50 ml Set 0 - 0 -
10 Alkohol swab ktk 100 lbr 1 5 6.00 5 1.00 10.00
11 Aquades steril btl 1000 ml 0 - 0 -
12 Aquades 20 liter gallon 20 L 2 2.00 0 2.00
13 Aquagel Steril Jelly 82 gram Tube - 0 - 5.00
14 Asam Klorida (HCl) 0,1 N btl 1000 ml 0 - 0 -
15 Asam sulfosalisilat 20 % btl 100 ml 0 - 0 -
16 Aseptic Gel btl 500 ml - 0 -
17 Blood Lancet ktk 100 pcs 5 5.00 4 1.00
Blood Lancet (BD Microtainer Contact
18 Pcs 0 - 0 -
Actived Lancet 21 G x 1.8 m)
19 Blood Collection Tube (BD Vacutainer) Tube 0 - 0 -
20 Blood Collection Tube (EDTA) tube 201 201.00 0 201.00
21 Boule cleaning kit set (3x450 ml) 0 - 0 -
22 Bracket Handwash plastik Pcs 0 - 0 -
23 Brugia Rapid (filariasis test) Test 0 - 0 -
24 Control Hematologi Normal vial 0 - 0 -
25 Cover glass 22x22 ktk 10 pak @ 10 pcs 0 - 0 -
26 CutGut No. 3-0 100 m set 0 - 0 - -
CutGut Cromic SMI 3/0 HR 26 MM set 0 - 0 -
27
CutGut Cromic SMI 3/0 HR 30 MM set 0 - 0 - 240.00
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
28 Cutgut Cromic SMI 4/0 HR 30 MM set 0 - 0 -
29 Dengue Test/RDT Ns1 test 0 - 0 -
30 Etakridin larutan 0,1 % btl 300 ml 0 - 0 -
31 Etanol 70 % 1 Liter btl 1000 ml 0 - 0 -
32 Folley Catheher 12 Set 0 - 0 -
33 Folley Catheher 14 Set 0 - 0 -
34 Folley Catheher 16 Set 0 - 0 -
35 Folley Catheher 18 Set 0 - -
36 Folley Catheher 20 Set 0 - -
37 Folley Catheher 22 Set 0 - 0 -
38 HbsAg Fast Test test 30 30.00 15 15.00
39 HIV Test 1/2 3.0 test 577 100 677.00 25 652.00
40 HIV Test (Fokus) test 0 - 0 -
41 HIV Test (Vikia 1/2) test 0 - 0 -
42 HIV Test (Fokus HIV 1+2 (KHB)) test 0 - 0 -
43 ID Band Baby Pink ktk 100 pcs 6 6.00 0 6.00
44 ID Band Baby Blue ktk 100 pcs 20 20.00 0 20.00
45 ID Band Dws Pink ktk 100 pcs 8 8.00 0 8.00
46 ID Band Dws Blue ktk 100 pcs 0 - 0 -
47 Infuset Anak set 20 20.00 0 20.00 -
48 Infuset Dewasa set 276 100 376.00 36 340.00
49 IV Catheter No. 16 G set 0 - -
50 IV Catheter No. 18 G set 26 100 126.00 59 67.00 100.00
51 IV Catheter No. 20 G set 0 - - 100.00
52 IV Catheter No. 22 G set 0 - - 100.00
53 IV Catheter No. 24 G set 13 50 63.00 15 48.00 100.00
IV Cannula with inj.port, snap fit cap,
54 set - -
and suture wings (22) 0 0
55 Immersion oil btl 100 ml 0 - 0 -
56 Iodium Test btl 10 ml 0 - 0 -
57 Kapas pembalut 250 g roll 22 50 72.00 2 70.00
58 Kapas Pembalut 500 g roll 0 - 0 -
59 Kartu golongan darah pak 100 lbr 1 1.00 1 -
60 Kasa kompres 40/40 steril roll 0 - 0 -
61 Kasa 2 x 80 cm roll 27 27.00 3 24.00
62 Kasa 4 x 15 cm roll 137 137.00 0 137.00
63 Kasa 4 x 10 cm roll 0 - 0 -
64 Kasa 4 x 5 cm roll 0 - 0 -
65 Kasa 4 x 3 cm roll 0 - 0 -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
66 Kasa hidrofil uk. 36 m x 80 cm roll 0 - - 10.00
67 Kasa Hydrophil 40 x 80 cm roll 8 1 9.00 3 6.00 5.00
68 Kapas pembalut 1000 gram Roll 0 - 0 -
69 Kasa steril 16x16 Lbr 0 - 0 -
70 Kasa steril 18x22 Lbr 0 - 0 -
71 Kertas Perkamen bks 200 lbr 0 - -
72 Kantong urine steril 2L Pcs 3 10 13.00 5 8.00 30.00
73 Labstrip U11 Plus Urine Test Tube 150 strip 0 - 0 - 10.00
btl 1000 ml 0 - 0 -
74 Larutan Turk
btl 100 ml 0 - 0 -
btl 100 ml 0 - 0 -
75 Larutan Giemsa Stain
btl 500 ml 0 - 0 -
76 Larutan Karbol Fucsin btl 100 ml 0 - 0 -
77 Larutan HCl- Alkohol btl 100 ml 0 - 0 -
78 Larutan Metilen Blue btl 100 ml 0 - 0 -
79 Larutan Benedict btl 1000 ml 0 - 0 -
80 Larutan EDTA btl 100 ml 0 - 0 -
81 Larutan Eosin btl 100 ml 0 - 0 -
82 Larutan Hayem btl 1000 ml 0 - 0 -
83 Larutan Natrium Sitrat 3,8 % btl 500 ml 0 - 0 -
84 Larutan Rees Ekker btl 100 ml 0 - 0 -
85 Larutan Spiritus btl 1000 ml 1 1.00 0 1.00
86 Lisol btl 1000 ml 7 7.00 0 7.00
87 Malaria Test test 11 11.00 0 11.00
88 Masker 3 ply E/L Lbr 0 - 0 - 1,000.00
89 Masker 3 ply plus E/L Lbr 0 - 0 - 1,000.00
90 Masker 3 ply T/O Lbr 0 - 0 - 1,000.00
91 My Jelly 82 g btl 0 - 0 -
92 Nasal Oxygen canula child pcs 0 - 0 -
93 Nasal Oxygen canula adult pcs 0 5 5.00 0 5.00 10.00
94 Object glass pcs 9 9.00 0 9.00
95 One Clean (Chlorine) botol 1 L 7 7.00 0 7.00
96 Oxygen mask pediatric pcs 5 5.00 3 2.00
97 Oxygen mask adult pcs 29 29.00 0 29.00
98 Paraformaldehid tab tablet 0 - 0 -
99 Penjepit tali pusat Buah 197 197.00 20 177.00
100 Plester 2" x 5 yard roll 0 - 0 -
101 Plester hospital 2,5 cm x 4,5 m roll 0 - 0 - 10.00
102 Plester hospital 7,5 cm x 4,5 m roll 0 - 0 -
103 Pot sputum buah 3439 3,439.00 30 3,409.00 PROGRAM
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
104 Povidon iodida larutan 10 % (betadine) btl 60 ml 9 9.00 7 2.00 10.00
105 Povidon iodida larutan 10 % btl 300 ml 0 - 0 -
106 Reagensia Ziehl Neelsen 100 ml/btl paket 0 - 0 -
107 Refil strip asam urat strip 0 - 0 - 200.00
108 Refil strip glukosa strip 113 113.00 113 -
109 Refil strip Hb strip 0 - 0 - 200.00
110 Refil strip kolesterol strip 95 100 195.00 195 - 200.00
111 RDT Anti HCV (Hepatitis C) Test 300 300.00 0 300.00
112 Reagen Dual Pack Hematologi set 0 - 0 -
113 Reagen kimia cholesterol set (6 x 100 ml) 0 - 0 -
114 Reagen kimia creatinine set (2 x 125 ml) 0 - 0 -
115 Reagen kimia glukosa set (2 x 100 ml) 0 - 0 -
116 Reagen kimia SGOT (AST) set (2 x 62,5 ml) 0 - 0 -
117 Reagen kimia SGPT (ALT) set (2 x 62,5 ml) 0 - 0 -
118 Reagen kimia triglyserides set (4 x 50 ml) 0 - 0 -
119 Reagen kimia urea set (2 x 62,5 ml) 0 - 0 -
120 Reagen kimia uric acid set (4 x 50 ml) 0 - 0 -
121 Safety Box 2,5 Lt ktk 10 10.00 0 10.00
122 Safety Box 5 Lt kuning ktk 42 42.00 0 42.00
123 Salmonella Test/Widal Test test 75 75.00 0 75.00 PROGRAM
124 Sarung tangan uk. 6 Psg 0 - 0 -
125 Sarung tangan uk. 6,5 Psg 0 - - 1000
126 Sarung tangan uk. 7 Psg 0 - - 1000
127 Sarung tangan uk. 7,5 Psg 0 - 0 -
128 Sarung tangan uk. 8 Psg 0 - 0 -
129 Sarung tangan S pcs 0 - 0 - 1,000.00
130 Sarung tangan M pcs 0 - 0 - 1,000.00
131 Sarung tangan L pcs 0 1000 1,000.00 500 500.00
132 Sarung tangan XL pcs 0 - 0 -
133 Shypilis 3,0 test test 1247 1,247.00 0 1,247.00
134 Shypilis Test (RPR Fokus) test 0 0 -
Silk (benang bedah sutera) no.3/0 HR
135 set 11.00 11.00
30 MM 11 0
136 Silk Black 3/0 HR 26 MM set 0 - 0 -
137 Silk 4-0 100M roll 0 - 0 -
138 Silk braided black 6/0 DS 12 mm roll 0 - 0 -
139 Soft cloth tape on liner roll 0 - 0 - 10.00
140 Stomach tube FR 18 Set 0 - 0 -
141 Suction Catheter No. 6 Set 0 - 0 -
142 Suction Catheter No. 8 Set 0 - 0 -
143 Suction Catheter No. 10 Set 0 - 0 -
144 Suction Catheter No. 12 Set 0 - 0 -
145 Suction Catheter No. 14 Set 0 - 0 -
146 Surgical Blade No. 10 ktk 100 pcs 0 2 2.00 1 1.00
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
147 Surgical Blade No. 11 ktk 100 pcs 0 2 2.00 2.00
148 Surgical Blade No. 18 ktk 100 pcs 0 2 2.00 2.00
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
149 Surgical Scrub (hydrex) btl 500ml 0 - 0 -
Surgical glove sterile gynecolog No. 6,5
150 pasang - - 200.00
(Remedi) 0 0
Surgical glove sterile gynecolog No. 7
151 pasang - - 200.00
(Remedi) 0 0
Surgical glove sterile gynecolog No. 7,5
152 pasang - -
(Remedi) 0 0
153 Suture needle (jarum hecting) BT bks 12 pcs 1 1.00 0 1.00
154 Suture needle (jarum hecting) BR bks 12 pcs 2 2.00 0 2.00
155 Suture needle (jarum hecting) GT bks 12 pcs 2 2.00 0 2.00
156 Suture needle (jarum hecting) GR bks 12 pcs 1 1.00 0 1.00
157 Tes golongan darah A, B, AB set 0 - 0 -
158 Tes kehamilan (Ultraone) Strip 275 275.00 275 - 500.00
159 Tip warna putih Pcs 539 539.00 0 539.00
160 Tip warna putih (kecil) (10 ul) Pcs 0 - 0 -
161 Tip warna biru (1 ml) Pcs 220 220.00 0 220.00
162 Tip warna kuning (200 ul) Pcs 0 - 0 -
163 Transfusi set Set 0 - 0 -
164 Three way stopcock Pcs 40 40.00 0 40.00
165 Underpad 60 x 90 cm pads 35 200 235.00 30 205.00 200.00
166 Plastik klip 4 x 6 cm bks 100 lbr 0 - 0 -
167 Plastik klip 5x8 cm bks 100 lbr 27 27.00 0 27.00
168 Plastik klip beretiket 5 x 8 cm bks 100 lbr 0 - 0 -
169 Plastik klip 10 x 7 cm bks 100 lbr 49 49.00 0 49.00
170 Plastik klip beretiket 10 x 7 cm bks 100 lbr 0 - 0 -
171 Plastik 14 x 25 cm pak 25 25.00 0 25.00
172 Cavidagel tube 10 10.00 0 10.00
173 MILDEX 30 (glutaraldehyde 2,5 %) galon 0 - 0 -
174 MILZYME TRIPLE ENZYME botol 1 L 0 - 0 -
175 Pharmafix 10 cm x 500 cm roll 1 1.00 0 1.00 20.00
176 Softanol (etanol, propanol) botol 1 L 0 - 0 -
177 RDT SARS-CoV-2 Antibody Test 205 205.00 0 205.00
178 Septalkan 1 1.00 0 1.00 -
179 Plesterin bulat non woven 0 - 0 -
180 TABUNG VACUTAINER BTL 1000 1,000.00 0 1,000.00 PROGRAM
181 FLASHBACK NEEDLE PCS 1500 1,500.00 0 1,500.00 PROGRAM
182 PLESTER WP PCS 3 3.00 2 1.00 PROGRAM
183 ALCOHOL SWAB PCS 1 1.00 1 - PROGRAM
0 - 0 -
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
0
BANTUAN COVID 0 - 0 -
1 PENUTUP KEPALA REMEDI BOX ISI 50 PCS 610 610.00 0 610.00 ASET
2 MASKER HIJAB/KERUDUNG BOX ISI 50 PCS 2965 2,965.00 1106 1,859.00 ASET
3 MASKER TELINGA/BEDAH BOX ISI 50 PCS - 0 - ASET
4 MASKER N-95 BOX ISI 20 PCS 0 - 0 - ASET
5 APPRON 10 10.00 0 10.00 ASET
6 HAZMAT 0 50 50.00 10 40.00 ASET
7 KACAMATA PELINDUNG 4 4.00 0 4.00 ASET
8 SARUNG TANGAN STERIL NO 6,5 BOX ISI 50 PCS 93 93.00 93 - ASET
9 SARUNG TANGAN S BOX ISI 100 PCS 0 - 0 - ASET
10 SARUNG TANGAN M BOX ISI 100 PCS 61 61.00 61 - ASET
11 SARUNG TANGAN L BOX ISI 100 PCS 0 - 0 - ASET
12 FACE SHIELD 51 52 103.00 0 103.00 ASET
13 RAPID TEST COVID 19 BOX ISI 25 TEST 167 100 267.00 267 - ASET
14 ASTAR C BOX ISI 30 2960 2,960.00 740 2,220.00 ASET
16 VIT.C 500 MG 535 535.00 197 338.00 ASET
17 HANDSANITIZER BOTOL 500 ML 10 10.00 0 10.00

PENGADAAN OBAT BHP JKN TH 2020 - 0

1 ALLOPURINOL 100 MG 546 546.00 0 546.00
2 BECEFORT TABLET 0 - 0 -
3 BECEFORT SYRUP 0 - -
4 COROVIT TABLET 0 - -
5 COROVIT SYRUP 179 179.00 50 129.00
6 COROBION TABLET 0 - 0 -
7 DEXAMETASONE TABLET 0 - 0 -
8 ETHYL CHLORIDE SPRAY 12 12.00 0 12.00
9 GLYCERIL GUAIACOLATE TAB 100 MG 8854 8,854.00 921 7,933.00
10 GLIMEPIRIDE 1 MG 500 500.00 0 500.00
11 HUSTAB TABLET 14212 14,212.00 540 13,672.00
12 IM BOOST FORCE TAB 0 - 0 -
13 IMUNOS TABLET 2925 2,925.00 126 2,799.00
14 IMUNOS SYRUP 81 81.00 0 81.00
15 LIDOCAIN AMPUL 2 % 0 - 0 -
17 METFORMIN TAB 500 MG 7753 7,753.00 1160 6,593.00
18 OMEPRAZOLE CAP 30MG 0 - 0 -
19 PARASETAMOL SYRUP 125 MG 304 304.00 60 244.00
20 PEHACAIN INJEKSI 215 215.00 0 215.00
21 RANITIDINE AMPUL 0 - 0 -
22 ALKOHOL 70% KEMASAN 1 LITER 8 8.00 2 6.00
23 ASEPTIC GEL 1 LITER 6 6.00 1 5.00
24 ASEPTIC GEL JERGEN 12 12.00 0 12.00
25 LARUTAN H2O2 18 18.00 0 18.00
26 LARUTAN HCL 20 20.00 0 20.00
 PENGELUARAN
PENERIMA STOK PEMBERIAN
NO NAMA OBAT / BMHP SATUAN STOK AWAL PERSEDIAAN PEMA- RUSAK/ DLL SISA STOK PERMINTAAN KET.
AN OPT
KAIAN ED PROG APBD BUFFER LAIN JML
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
27 MASKER HIJAB 0 - 0 -
28 PAMPERS UKURAN M 323 323.00 20 303.00
29 STRIP HB EASY TOUCH KOTAK ISI 25 STRIP 454 454.00 0 454.00
30 NASAL CANULA DEWASA 1 1.00 0 1.00
31 DENTAL NEEDLE 30 G NO.16 300 300.00 72 228.00
32 DENTAL NEEDLE 30 G NO.21 300 300.00 0 300.00
33 BAYCLYN 5 LITER 5 5.00 2 3.00
34 PAMPERS UKURAN L 67 67.00 0 67.00
35 KANTONG SAMPAH 20 20.00 8 12.00
36 FOLLEY KATETER 18 179 179.00 2 177.00
0 - -
PENGADAAN OBAT BHP JKN TH 2021 0 - -
1 ABBOCATH 20 SET 100 100 200.00 200.00
2 ABBOCATH 22 SET 76 76.00 0 76.00
3 Alat suntik 1 ml SET 56 56.00 56 -
4 Alat suntik 3 ml SET 266 300 566.00 174 392.00
5 Alat suntik 5 ml SET 300 300.00 0 300.00
6 Alat suntik 10 ml SET 200 200 400.00 0 400.00
7 Leukoplast 5 x 4,5 ROL 1 20 21.00 1 20.00
8 cutgut 3/10 SET 24 120 144.00 47 97.00
9 Refill Strip asam urat nesco STRIP 25 25.00 0 25.00
10 Refill Strip kolesterol nesco STRIP 10 10.00 0 10.00
11 SARUNG TANGAN M BOX ISI 100 0 2000 2,000.00 1256 744.00
12 NASSAL CANULA DEWASA PCS 40 40.00 0 40.00
13 AMLODIPIN 10 BOX @50 1500 1,500.00 0 1,500.00
14 MASKER E/L BOX @50 600 600.00 0 600.00
15 COROBION TABLET BOX @100 5000 5,000.00 1829 3,171.00
16 URINE BAG PCS 50 50.00 0 50.00
17 SARUNG TANGAN S

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP
290 1,439 1,729
Siwa, 03 AGUSTUS 2021

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

Kepala Dinas Kesehatan Kab. Wajo Pengelola IFK Kepala Puskesmas Pitumpanua Petugas Puskesmas Pitumpanua

Dr.drg.HJ.ARMIN,M.Kes., Hj. ANDI ASMANIAR, S.Si., Apt. dr. SUSANNI SAID,S.Ked., PRATIWI RAHIM, S.Farm., Apt
NIP : 19700916 200012 2 002 NIP : 19790523 201406 2 002 NIP.19850427 201503 2 003 NIP.19860430 202012 2 002
 5430
1218
0
0
0
94
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1788
1453
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118
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 58
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