PERENCANAAN KEBUTUHAN 1 TAHUN KEDEPAN
TOTAL RATA2 PEMAKAIAN USULAN KEBUTUHAN
NO NAMA OBAT SATUAN
PEMAKAIAN 2022 PERBULAN 1 TAHUN KEDEPAN
1 Allupurinol tab. 100mg Tablet 4,000 333 4,800
2 Allupurinol tab. 300mg Tablet -
3 Alprazolam 0,5 mg Tablet -
4 Amaril M 2 mg/500 mg (Sanofi Aventis) box -
5 Ambroxol Syrup Botol 79 7 96
6 Ambroxol tablet Tablet 9,000 750 12,000
7 Aminofilin inj. 24 mg / ml -10 ml Ampul -
8 Aminofilin tablet 200 mg Tablet -
9 Amitriptilin HCl tabl. 25 mg Tablet -
10 Amlodipine 10 mg Tablet 3,300 275 4,800
11 Amlodipine 5 mg Tablet 1,950 163 2,400
12 Amoksisilin kaps. 500 mg kaplet 15,200 1,267 16,000
13 Amoksisilin sir.kering 125 mg / 5 ml Botol 34 3 240
14 Ampicillin Inj 1 g(PHAPROS) Vial -
15 Ampisilin kaplet 500 mg kaplet 1,600 133 2,400
16 Ampisilin sir.kering 125 mg / 5 ml Botol 35 3 Rp 50
17 Antalgin Inj. 250 mg / 2 ml Ampul 63 5 84
18 Antalgin tabl. 500 mg Tablet - Rp 1,200
19 Antasida DOEN syrup. Botol 112 9 144
20 Antasida DOEN tabl. Tablet 6,600 550 7,200
21 Anti Hemmoroid suppositoria suppos 28 2 36
22 Aquadest steril 500 ml Botol 4 0 6
23 As.Benz 3% + As.Salisil 6% Salap Pot -
24 As.Sali 2% + Belerang 4% ( 2-4) Salap Pot 96 8 120
25 Asam Folat 1mg Tablet - 1,000
26 Asam Mefinamic Cap.500 mg kaplet 9,300 775 10,800
27 Asam Trancksamat.500 mg Tablet 35 3 60
28 Asam traneksamat inj Ampul - 20
29 Aspilet 80 mg tabler 40 3 120
30 Atropin sulfat inj. 0.25 mg / ml - 1 ml Ampul - Rp 5
31 Bacitracin Salep Tube -
32 Betahistine tablet Tablet 140 12 360
33 Betametason cream Tube 64 5 120
34 Bioplcenton Salap Tube 23 2 60
35 calsium guconas inj Ampul -
36 Candesartan 16 mg tablet - 200
37 Cimetidin tabl Pcs 200 17 600
38 Ciprofloxacin cap. 500 mg Tablet 560 47 Rp 1,200
39 CPG 75 mg Tablet -
40 Curliv Pluss Tablet - 200
41 Dexametason inj. 5 mg / ml - 1 ml Ampul 35 3 60
42 Dexametason tabl. 0.5 mg Tablet 10,600 883 13,200
43 Diazepam tablet 2 mg Tablet -
44 Dietilkarbamazin sitrat 100 mg Tablet -
45 Difenhidramin HCl inj. 10 mg / ml Ampul 42 4 120
46 Digoksin tablet 0.25 mg Tablet -
47 Diltiazem 30 mg Tablet -
48 Domperidon 10 mg Tablet 1,000 83 1,800
49 Domperidon Syrup Botol 110 9 180
50 Doxycyclin 100 mg Kapsul 60 5 240
51 Epinefrin HCl (Adrenalin) 0.1 % - 1 ml Ampul - 5
52 Eritromicyn capsul 500 mg Tablet 400 33 1,200
53 erlamicetin tetes telinga Botol 40 3 Rp 120
54 Fenobarbital tabl. 30 mg (KF) Tablet - 100
55 Ferrous Iron Tablet -
56 Fitomenadion (Vit.K1) inj. 10 mg Ampul 53 4 72
57 Fitomenadion (Vit.K1) tabl. 10 mg Tablet -
58 Furosemid tabl. 40 mg Tablet 50 4 200
59 Garam oralit untuk 200 ml sach 942 79 1,200
60 Gemfibrozil 300mg Tablet -
61 Gentamicyn inj Ampul -
62 Gentamicyn Zalf Kulit Tube 93 8 240
63 Gentian violet larutan 1% 10 ml Botol 2 0 12
64 Glibenklamid tabl. Tablet 1,100 92 2,400
65 Glimeperide 1mg Tablet -
66 Glimepirid 2 mg tablet 100 8 120
67 Gliseril guayakolat tabl. 100 mg Tablet 3,500 292 12,000
68 Glukosa larutan infus 5% steril Kolf 40 3 60
69 Glukosa larutan infus 10% steril Kolf - 20
70 Griseofulvin tabl. 125 mg Tablet 200 17 600
71 Haloperidol 5 mg tablet 234 20 1,200
72 Hidroklortiazid (HCT) 25 mg Tablet - Rp 100
73 Hidrokortison krim 2.5% 5 g Tube 86 7 120
74 Hyscopan Tablet -
75 Ibuprofen Susp Botol - 50
76 Ibuprofen tabl. 200 mg Tablet 2,100 175 Rp 3,600
77 Ibuprofen tabl. 400 mg Tablet 1,400 117 3,600
78 Ichtiol salap 30 g Pot 30 3 Rp 60
79 Isosorbit dinitrat 10 tablet Tablet -
80 Kalium permanganat serbuk 5 g Pot 22 2 60
81 Kalsium laktat tabl. 500 mg Tablet 6,700 558 12,000
82 Kanamisin sulfat inj. 100 mg / vial Vial 5 0 Rp 10
83 Ketokonazole 2 % cream Tube 163 14 Rp 240
84 Ketokonazole 200 mg Tablet 950 79 1,800
85 Ketorolac inj Ampul - Rp 10
86 Ketorolac tab Tablet - 100
87 Klindamisin Kaps 150 mg Tablet - 500
88 Kloramfecort - H Cream Tube - Rp 36
89 Kloramfenikol kaps. 250 mg Kapsul -
90 Kloramfenikol salap mata 1% Tube 60 5 96
91 Klorpromazin HCl inj. 5 mg / ml Ampul -
92 Kodein tabl. 10 mg (KF) Tablet -
93 Kotrimoksazol tabl. Komb. Tablet 1,000 83 Rp 3,600
94 Lethira 500mg (Pharos) Keppra box -
95 Levetran Salep Tube - Rp 24
96 Lidokain comp. Inj. Kombinasi. Ampul 80 7 240
97 Loperamid Tab 2 mg Tablet 80 7 300
98 Loratadine 10 mg Tablet 400 33 Rp 1,200
99 Meloxicam 15 mg Tablet 100 8 Rp 200
100 Meloxicam 7.5 mg Tablet 300 25 Rp 600
101 Metakresol sulfonat ( Albothyl ) 10 ML Botol - Rp 12
102 Metformin 500 mg Tablet 1,660 138 3,600
103 Methyl Prednisolon 4 mg Tablet 5,500 458 9,600
104 Metilergometrin tabl. Salut 0,125 mg Tablet - 100
105 Metilergometrin tabl. Salut 0,125 mg Tablet -
106 Metoclopramide 10 mg Tablet -
107 Metoclopramide 5 mg Tablet -
108 Metronidazol tabl. 500 mg Tablet 1,600 133 6,000
109 MgSO4 20% Botol - 3
110 Miconazole 2 % cream Tube 24 2 96
111 Na. Diklofenat tablet 25 mg Tablet 2,550 213 4,800
112 Na. Diklofenat tablet 50 mg Tablet 2,300 192 Rp 4,800
113 Natr fenitoina (Fenitoina) 100 mg Tablet -
114 Natr klorida infus 0,9% steril Kolf 78 7 120
115 Nifedipin Tablet Tablet 50 4 300
116 Norit tabl. Tablet 480 40 960
117 Obat Batuk Hitam (OBH) Botol - Rp 50
118 Oksitetrasiklin HCl salap kulit 3% Tube 138 12 240
119 Oksitetrasiklin HCl salap mata 1% Tube 29 2 Rp 120
120 Oksitetrasiklin HCl inj. 50 mg/ml Vial -
121 Oksitoksin inj. 10 im / ml - 1 ml Ampul 11 1 Rp 200
122 Omeprazole 20 mg Tablet 1,760 147 2,400
123 Ondancentron inj Ampul 20 2 Rp 60
124 Ondansentron 4 mg tab Tablet 100 8 600
125 Papaverin HCl tabl. 40 mg Tablet - 200
126 Paracetamol infus Vial -
127 Parasetamol Drop Botol 45 4 Rp 120
128 Parasetamol sirup 120 mg / 5 ml Botol 379 32 480
129 Parasetamol tabl. 500 mg Tablet 13,400 1,117 Rp 18,000
130 Pehacain inj Ampul -
131 phenobarbital 30 mg Tablet -
132 Pirantel pamoat 125 mg Tablet 22 2 Rp 200
133 Pirantel Suspensi Botol - 50
134 Piroxicam tab. 20 mg Tablet 1,800 150 Rp 2,400
135 Prednison tabl. 5 mg Tablet 2,300 192 3,600
136 Propanolo HCl (Propanolo) 40 mg Tablet -
137 Propiltiourasil 100 mg PTU Tablet -
138 Propiretic Supp 160 mg suppos -
139 Propiretic Supp 240 mg suppos -
140 Propiretic Supp 80 mg suppos 7 1 Rp 24
141 Retinol (Vit. A) kapsul 100.000 IU Kapsul 100 8 400
142 Retinol (Vit. A) tablet 200.000 IU Kapsul 100 8 400
143 Ringer Asetat larutan infus steril Kolf
144 Ringer laktat larutan infus steril Kolf 92 8 120
145 Salbutamol tabl. 2 mg Tablet 900 75 1,200
146 Salbutamol tabl. 4 mg Tablet 500 42 600
147 Salisil talk 25% Pot 11 1 Rp 60
148 Sefadroksil 500 mg Kapsul 1,630 136 3,600
149 Serum abu pol inj. 50 mg (ABU II) Vial - 1
150 Serum anti tetanus inj. 1.500 IU (ATS) Ampul - 10
151 Simvastatin 20 mg Tablet 1,300 108 2,400
152 Stesolid Suppo 5 mg suppos - Rp 5
153 Suvesco 10 mg (Dipa Pharmalab Intersais) box -
154 Tetrasiklin HCl kapsul 500 mg Pcs -
155 Trihexyphenidyl HCl 2 mg Pcs 230 19 600
156 Univit Pcs - 180
157 Vitamin B6 tab 10 mg Pcs 1,200 100 Rp 2,400
158 Vitamin B 12 Tablet Tablet 100 8 600
159 Vitamin B Komplek 50 mg Tablet 11,300 942 14,400
160 Vitamin Vit C. 50 mg Tablet 13,000 1,083 15,600
161 Zink Dispersible 20 mg Tablet 2,400 200 4,800
BMHP -
1 Abbocath 18 Pcs 12 1 60
2 Abbocath 20 Pcs 41 3 60
3 Abbocath 22 Pcs 28 2 60
4 Abbocath 24 Pcs 28 2 60
5 ABO test Set -
6 Alat suntik sekali pakai 1 ml Pcs 99 8 300
7 Alat suntik sekali pakai 10 ml Pcs 57 5 200
8 Alat suntik sekali pakai 2,5 ml Pcs 679 57 1,000
9 Alat suntik sekali pakai 5 ml Pcs 320 27 600
10 Alat suntik sekali pakai 20 ml Pcs - 100
11 Alkohol Swab box 8 1 12
12 Benang Chromic Catgut 2/0 Pcs 36 3 60
13 Benang Chromic Catgut 3/0 Pcs -
14 Benang Silk Braided 2/0 Pcs -
15 Benang Silk Braided 3/0 Pcs 86 7 180
16 Benang Silk Suture 3/0 Pcs -
17 Blood transfusi set pcs -
18 Carpule citoject orabloc pcs -
19 Catgut / benang bedah No 2/0-3/0 12'S Pcs 36 3 60
20 Cotton roll pack -
21 Dentin conditioner Pcs -
22 Etakridin (Rivanol) 0.1 % 300 ml Botol 5 0 24
23 Eugenol 100 ml Botol -
24 feeding tube/ NGT Fr 5 pcs -
25 feeding tube/ NGT Fr 8 pcs -
26 Folley cateter no 16 Pcs 3 0 5
27 Folley cateter no 18 Pcs 3 0 5
28 Folley Catheter 12 Pcs -
29 Folley catheter 14 Pcs -
30 Folley catheter 20 Pcs -
31 Folley Catheter 22 Pcs -
32 Formalin 1 liter btl - 2
33 Hypafix 5cm x 5 m plester Roll 3 0 12
34 Infus set anak box 31 3 60
35 Infus set dewasa box 44 4 60
36 Iodium povidon 10% 300 ml Botol 13 1 24
37 Jarum jahit (bedah) no. 09 Pcs - 24
38 Jarum jahit (bedah) no. 10 Pcs - 24
39 Jarum jahit (bedah) no. 11 Pcs - 24
40 Jarum jahit (bedah) no. 12 Pcs - 24
41 Jarum jahit (bedah) no. 13 Pcs - 24
42 Jarum jahit (bedah) no. 14 Pcs - 24
43 Kaca Mulut Pcs -
44 Kapas pembalut 250 g Roll 5 0 8
45 Kasa pembalut 2 x 80 cm Pcs - 12
46 Kasa pembalut 4 x 15 cm Roll 169 14 300
47 Kasa pembalut 4 x 3 cm Roll 282 24 400
48 Kasa Pembalut 40x80cm Pcs 8 1 16
49 Kasa Steril 16 x 16 kotak 165 14 240
50 Lab As Klorida 0.1 N 100 ml Botol 3 0 6
51 Lab Benedict Botol -
52 Lab Eosin 2% Botol -
53 Lab Etanol asam Botol -
54 Lab Giemsa Botol - 4
55 Lab H2O2 3% 100ml Botol - 6
56 Lab Hayem 100 ml Botol -
57 Lab KOH 10 % Botol -
58 Lab KY Jelly Botol 4 0 12
59 Lab Metanol Botol - 4
60 Lab Natrium Citrat Botol -
61 Lab Oil Emmersion Botol -
62 Lab Rees ecker Botol -
63 Lab Turk Botol -
64 Lab Ziehl Nelseen Botol - 4
65 Lisol, kreosol tersabun 50% Botol 6 1 24
66 Maxyflow anak Pcs -
67 Maxyflow bayi Pcs -
68 Maxyflow dewasa Pcs -
69 Nasal oksigen anak Pcs -
70 Nasal oksigen dewasa Pcs -
71 NGT 18 Pcs -
72 Objec glass 72"s Pcs 16 1 36
73 OG Alvogyl Botol -
74 OG Bonding 3 M botol -
75 OG CaOH cairan Irigasi botol -
76 OG Cotten roll pcs -
77 OG Dentroit / Kaviton Pot -
78 OG Devitalisasi Pasta Pot -
79 OG Etil klorid semprot 100 ml Botol 2 0 4
80 OG Etza botol -
81 OG Eugenol cairan 10 ml Botol -
82 OG Fuji IX kotak -
83 OG Fuji X kotak -
84 OG Glass Ionomer Cement Set Set -
85 OG Gutta percha points Pot -
86 OG H2O2 Cairan Irigasi botol - 4
87 OG Kalsium hidroksida pasta Pot -
88 OG Komposit solere warana A1 tube -
89 OG Komposit solere warana A2 tube -
90 OG Komposit solere warana A3 tube -
91 OG Mummying pasta Pot -
92 OG Spons gelatin cubicles 1 x 1 x 1 cm pcs -
93 OG Topicaina (Topical Gel) Botol -
94 OG Trikresol formalin (TKF) cairan Botol -
95 Oxyflow anak Pcs -
96 Oxyflow bayi Pcs -
97 Oxyflow dewasa Pcs -
98 Pengikat tali pusat Pcs 100 8 100
99 Pisau Bisturi No.11 Pcs 420 35 600
100 Plester 5 yards x 2 inch (Leucoplast) Roll 36 3 60
101 Sarung tangan non Steril (Sensi Glove L) Pcs 15 1
102 Sarung tangan non Steril (Sensi Glove M) Pcs 15 1 60
103 Sarung tangan non Steril (Sensi Glove S) Pcs 11 1 60
104 Silk (b bedah sutera) no. 3/0 75 cm Pcs -
105 Spiritus 1 ltr Botol - 3
106 Stik test Asam urat (Serenity) 25x2 tube box - 60
107 Stik test Glukosa (autocek) '50 box - 60
108 Stik test Kolesterol (auto cek) box - 60
109 Tabung EdTA 5 M1 Pcs -
110 Tabung K3 EDTA Pcs -
111 Tabung Vacutainer/ Merah Pcs -
112 Aseptic gel 500 ml btl 37 3 72
113 Nystatin drops btl - 48
114 Becom C tab - 2,400
115 Spoit 0,5 cc pcs 200 17 600
116 Masker Box 106 9 120
117 Vitamin K neo inj Amp - - 50
118 -
Manokwari 27 Februari 2023
Kepala Puskesmas Maripi
AYUB MANSIM, Amd.Kep
NIP. 19810802 200312 1004
Catatan :
a. Rencanakan sesuia kebutuhan sebebenarnya
b. Format jangan dirubah bila ada item yang ingin ditambahan tulis dibagian bawah
