LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

DINAS KESEHATAN KABUPATEN BINTAN

PUSKESMAS : TANJUNG UBAN BULAN : KIA APRIL

KECAMATAN : BINTAN UTARA TAHUN : 2024
HARGA PENERIM PERSEDIA PEMAKA STOK STOK PERMINT PEMBERI
NO NAMA OBAT SATUAN STOK AWAL TOTAL HARGA KET
SATUAN AAN AN IAN AKHIR OPTIMUM AAN AN
1 2 3 4 5 6 7=5+6 8 9=7-8 10 11 12 13=4*9 14
1 A C T ( Artesunat 50 mg + Amodiaquin 200 mg ) tablet tablet Rp 1,409 -
2 Artemeter Injeksi @ 1ml ampul ampul Rp 12,500 -
3 Artesunat Injeksi vial Rp 19,000 -
4 Albendazol tablet 400 mg tablet Rp 451 -
5 Alopurinol tablet 100 mg tablet Rp 180 -
6 Alprazolam tab 0,5 mg tablet Rp 88 -
7 Alprazolam tab 1 mg tablet Rp 120 -
8 Ambroksol sirup 15 mg/5 ml. @ 60 ml. botol Rp 4,887 -
9 Ambroksol tablet 30 mg tablet Rp 211 -
10 Amitriptilin HCl tablet salut 25 mg tablet Rp 202 -
11 Amlodipin 10 mg tablet tablet Rp 650 -
12 Amlodipin tablet 5 mg tablet Rp 355 -
13 Amoksisilin capsul 250 mg kapsul Rp 456 -
14 Amoksisilin kaplet 500 mg kaplet Rp 550 -
15 Amoksisilin sirup kering 125 mg / 5 ml botol Rp 2,600 -
16 Antasida DOEN I tablet komb : Al(OH) 200 mg + Mg (OH) 200 mg tablet Rp 110 -
Antasida DOEN II susp. 60 [Link].:Al(OH) 200 mg/5 ml.+Mg(OH) 200
17 botol Rp 1,756 -
mg/5 ml
Anti Bakteri DOEN salap komb : Basitrasin 500 IU/g + Polimiksin 1000
18 tube Rp 3,477 -
IU/g
19 Anti Fungi DOEN komb : As. Benzoat 6 % + As. Salisilat 3 % pot Rp 3,637 -
20 Anti Hemoroid DOEN kombinasi supp Rp 3,738 -
21 Anti Migren DOEN kombinasi : Ergotamin Tartrat 1 mg + Koffein 50 mg tablet Rp 255 -
22 Anti Skabies (Permetrin) 5% krim 10 gr tube Rp 46,454 -
23 Aqua Dest Steril 500 ml botol Rp 12,100 - 1
24 Aqua Pro Injeksi steril 25 ml botol Rp 2,900 - 2 2 - 2 -
25 Air Untuk Irigasi 1000 ml botol Rp 16,500 -
26 Asam Asetil Salisilat ( Asetosal ) tablet 80 mg tablet Rp 89 -
27 Asam Askorbat tablet 50 mg tablet Rp 82 -
28 Asam Askorbat tablet 250 mg tablet Rp 232 -
29 Asam Folat tablet 0.4 mg tablet Rp 58 -
30 Asam Mefenamat kaplet 500 mg kaplet Rp 150 -
31 Asam Traneksamat injeksi 100 mg @ 5 ml ampul Rp 2,725 -
32 Asam Traneksamat tablet 500 mg tablet Rp 1,700 -
33 Asetil sisteina 200 mg kapsul kapsul Rp 1,020 -
34 Asiatikosida krim 1 % @ 10 g tube Rp 56,100 -
35 Asiklovir krim 5 % @ 5 gram tube Rp 5,840 -
36 Asiklovir tablet 200 mg tablet Rp 376 -
37 Asiklovir tablet 400 mg tablet Rp 908 -
38 Atropin Sulfat Injeksi 0,25mg/ml-1 ml. ampul Rp 3,770 -
39 Atropin Sulfat Tetes Mata 0,5 % @ 5 ml. tablet Rp 13,500 -
40 Attapulgite tablet 600 mg tablet Rp 580 -
41 Benzatin Benzil Penisillin injeksi 2,4 Juta IU vial Rp 16,675 -
42 Besi (Fe) 15 mg per 15 ml suspensi 120 ml botol Rp 44,000 -
43 Betahistin Mesilat tablet 6 mg tablet Rp 200 -
44 Betametason Krem 0,1 % @ 5 g tube Rp 2,100 -
45 Betamethasone valerat 0.1 %, Gentamycin sulfat 0.1% krim (Benoson G) tube Rp 76,590 -

46 Betamethasone valerat 0.1 %, Miconazole nitrate 2% krim (Benoson M) tube Rp 70,152 -

47 Betametason 0,1%, Neomisin 0,5% krim (Nisagon) tube Rp 9,546 -
48 Bisakodil suppositoria 10 mg dewasa supp Rp 4,325 -
49 Bisakodil suppositoria 5 mg anak-anak supp Rp 5,085 -
50 Bisakodil tablet 10 mg tablet Rp 337 -
51 Bisakodil tablet 5 mg tablet Rp 168 -
52 Bisoprolol tablet 5 mg tablet Rp 316 -
53 Borax Gliserin solutio 15 ml. botol Rp 3,850 -
54 Bromheksin sirup 100 ml botol Rp 13,320 -
55 Bromheksin tablet 8 mg tablet Rp 210 -
56 Calcium Alginate/Bioplacenton Tulle lembar Rp 11,500 -
57 Cefadroksil 125 mg / 5 ml sirup kering @ 60ml botol Rp 4,086 -
58 Cefadroksil kapsul 500 mg capsul Rp 994 -
59 Cefixime 100 mg capsul Rp 625 -
60 Cefixime 100 mg/5 ml sirup kering @ 30ml botol Rp 5,195 -
61 Cefotaksim injeksi 1 g vial Rp 3,050 -
62 Ceftriakson injeksi 1 g vial Rp 16,600 -
63 Carboxymetyhlcelulose (Cendo Cenfresh) eye drop Mini Dose Botol Rp 25,000 -
64 Cendo Lyters eye drop 15 ml Botol Rp 24,500 -
65 Cendo Xitrol eye drop 5 ml Botol Rp 29,600 -
 Tiap ml mengandung, Dexamethasone sodium phosphate setara dengan
66 Dexamethasone 1 mg Neomycin sulfate setara dengan Neomycin 3,5 botol Rp 20,091 -
mg Polymyxin B sulfate 6000 IU (Alletrol)
67 Cetirizina Hcl 10 mg/ml tetes botol Rp 82,973 -
68 Cetirizina kapsul 10 mg kapsul Rp 77 -
69 Cetirizina sirup 5 mg / 5 ml @ 60 ml botol Rp 3,861 -
70 Cimetidin tablet 200 mg tablet Rp 348 -
71 Ciprofloksasin kaplet 500 mg kaplet Rp 396 -
72 Ciprofloksasin tetes mata 3 mg/ml minidose 0.6 ml strip Rp 6,383 -
73 Clindamisin Capsul 150 mg capsul Rp 743 -
74 Clobazam 10 mg tablet Rp 384 -
75 Deksametason injeksi 5 mg / ml - 1 ml ampul Rp 2,344 20 - 20 - 20
76 Deksametason tablet 0,5 mg tablet Rp 62 -
77 Diazepam injeksi 5 mg / ml - 2 ml ampul Rp 1,777 -
78 Diazepam larutan Rectal 5 mg/2.5 ml tube Rp 14,459 -
79 Diazepam Enema 5 mg/2,5 ml tube Rp 13,665 -
80 Diazepam tablet 2 mg tablet Rp 242 -
81 Diazepam tablet 5 mg tablet Rp 108 -
82 Difenhidramin HCl injeksi 10 mg / ml - 1 ml ampul Rp 825 -
83 Digoksin tablet 0,25 mg tablet Rp 124 -
84 Dimenhidrinat tablet 50 mg tablet Rp 150 -
85 Doksisiklin capsul 100 mg/Interdoxin 100 mg capsul Rp 8,890 -
86 Domperidon Suspensi 5mg/5ml @ 60 ml botol Rp 2,401 -
87 Domperidon tablet 10 mg tablet Rp 147 -
88 Efedrin HCl tablet 25 mg tablet Rp 182 -
89 Ekstrak Plasenta Gel @ 15 g tube Rp 36,200 4 - 4 3 1 2
90 Ekstrak Centella Asiatica 1% salep (Tekasol) tube Rp 51,171 -
91 Epinefrin HCl (Adrenalin) inj 0,1 % - 1 ml ampul Rp 3,885 -
92 Eritromisin kaplet 500 mg kaplet Rp 900 -
93 Etakridin ( Rivanol ) larutan 0,1 % @ 300 ml. botol Rp 8,030 -
94 Etanol larutan 70 % @ 100 ml. botol Rp 5,335 -
95 Etanol larutan 70 % @ 300 ml. botol Rp 10,213 -
96 Etanol larutan 70 % @ 1000 ml. botol Rp 113,609 -
97 Etanol larutan 96% @ 1000 ml botol Rp 46,369 -
98 Etil Klorida semprot @100 ml botol Rp 160,000 -
99 Eugenol cairan 10 ml. botol Rp 23,173 -
100 Fenobarbital injeksi 50 mg / ml - 2 ml ampul Rp 1,700 -
101 Fenobarbital tablet 100 mg tablet Rp 276 -
102 Fenobarbital tablet 30 mg tablet Rp 209 -
103 Fenol Gliserol Tetes Telinga 10% botol Rp 3,300 -
104 Fero Sulfat tablet 300 mg (tablet tambah darah) tablet Rp 43 -
105 Fitomenadion (Vitamin K1) injeksi 10 mg/ml - 1 ml ampul Rp 6,900 15 - 15 3 12 5
106 Fitomenadion (Vitamin K1) tablet salut gula 10 mg tablet Rp 810 -
107 Fitomenadion (Vitamin K1) 2 mg/ml injeksi ampul Rp 3,818 -
108 Flavoksat HCl tab. 200 mg tablet Rp 6,233 -
109 Flukonazol 150 mg kapsul kapsul Rp 20,700 -
110 Flouksetin kaps 10 mg kapsul Rp 547 -
111 Framisetin sulfat gauze dressing 10 cm x 10 cm lembar Rp 10,455 -
112 Furosemid injeksi 10 mg/ml @ 2 ml. ampul Rp 2,400 -
113 Furosemid tablet 40 mg tablet Rp 514 -
114 Gameksan Emulsi 1 % botol Rp 4,400 -
115 Garam Oralit untuk 200 ml air sachet Rp 263 -
116 Gemfibrozil capsul 300 mg capsul Rp 436 -
117 Gemfibrozil capsul 600 mg capsul Rp 853 -
118 Gentamisin injeksi 40 mg/ml @ 2ml ampul Rp 3,545 -
119 Gentamisin injeksi 80 mg vial Rp 3,355 -
120 Gentamisin salep kulit 5 g tube Rp 3,117 -
121 Gentamisin Sulfat tetes mata 0.3% botol Rp 4,885 -
122 Gentian Violet larutan 1 % 10 ml botol Rp 3,850 -
123 Glibenklamid tablet 5 mg tablet Rp 179 -
124 Glimepiride tablet 1 mg tablet Rp 200 -
125 Glimepiride tablet 2 mg tablet Rp 500 -
126 Gliseril Guayakolat tablet 100 mg tablet Rp 105 -
127 Gliserin larutan 50% @ 100 ml botol Rp 6,600 -
128 Griseofulvin tablet 125 mg, micronized tablet Rp 223 -
129 Griseofulvin 500 mg tab tablet Rp 1,040 -
130 Haloperidol 5 mg tablet tablet Rp 81 -
131 Haloperidol tablet 1,5 mg tablet Rp 74 -
132 Haloperidol tablet 2 mg tablet Rp 54 -
133 Haloperidol decanoat inj 50 mg/ml ampul Rp 101,300 -
134 Hidroklortiazida tablet 25 mg tablet Rp 170 -
135 Hidrokortison krim 2,5 % @ 5g. tube Rp 2,940 -
136 Hiosin-N-Butilbromide injeksi ampul Rp 3,205 -
137 Hiosine-N-Butilbromide tablet 10 mg tablet Rp 743 -
138 Ibuprofen tablet 200 mg tablet Rp 160 -
139 Ibuprofen tablet 400 mg tablet Rp 199 -
140 Ichtyol ( Salap Hitam ) pot Rp 9,935 -
141 Ipratrium Br 21 mcg, Salbutamol Sulfat 120 mcg perhirup (Combivent) botol Rp 4,550 -
142 Isoniazid tablet 100 mg tablet Rp 79 -
143 Isoniazid tablet 300 mg tablet Rp 170 -
144 Isosorbid Dinitrat tablet sublingual 5 mg tablet Rp 300 -
145 Jelly (Ecolab aquagel sterile) 82 g tube Rp 32,505 -
146 Jelly USG @ 250 g botol Rp 14,472 - - - - 2
147 Kalium diklofenak 25 mg tablet tablet Rp 410 -
148 Kalium diklofenak 50 mg tablet tablet Rp 440 -
149 Kalium Permanganat serbuk 5 g. pot Rp 5,500 -
150 Kalsium Glukonat injeksi 10% (100 mg/ml) @ 10 ml ampul Rp 6,199 -
151 Kalsium Laktat tablet 500 mg tablet Rp 162 -
152 Kanamycin injeksi 1 gram vial Rp 7,959 -
153 Kaptopril tablet 12,5 mg tablet Rp 89 -
154 Kaptopril tablet 25 mg tablet Rp 200 -
155 Kaptopril tablet 50 mg tablet Rp 134 -
156 Karbamazepin tablet 200 mg tablet Rp 706 -
157 Karbol (Fenol) Gliserol tetes telinga 10% @ 5 ml botol Rp 6,000 -
158 Ketokonazol krim 2 % @ 10 g. tube Rp 4,100 -
159 Ketokonazol tablet 200 mg tablet Rp 440 -
160 Ketoprofen injeksi 100 mg @ 1 ml ampul Rp 5,933 -
161 Ketoprofen tablet 100 mg tablet Rp 1,417 -
162 Ketoprofen Supp 100 mg supp Rp 2,380 -
163 Ketorolac 30 mg/ml injeksi @ 1ml/Trometamol injeksi ampul Rp 1,464 -
164 Kloramfenikol capsul 250 mg capsul Rp 255 -
165 Kloramfenikol salap mata 1 % @ 3,5 g. tube Rp 7,848 -
166 Klobazam tab 10 mg tablet Rp 739 -
167 Klozapin tab 25 mg tablet Rp 496 -
168 Kloramfenikol tetes mata 0,5 % botol Rp 9,000 -
169 Kloramfenikol tetes mata 0,5 % + Deksametason botol Rp 14,541 -
170 Kloramfenikol tetes telinga 3 % @ 5 ml botol Rp 16,206 -
171 Klorfeniramin Maleat ( CTM ) tablet 4 mg/Dehista tablet Rp 105 -
172 Klorheksidin lar 0.2% (larutan kumur antiseptik gigi) @ 60 ml botol Rp 35,742 -
173 Klorokuin tablet 150 mg tablet Rp 58 -
174 Klorpromazin HCl injeksi 25 mg / ml - 1 ml ampul Rp 3,203 -
175 Klorpromazin HCl tablet salut 25 mg tablet Rp 24 -
176 Klorpromazin HCl tablet salut 100 mg tablet Rp 603 -
177 Kodein Fosfat tablet 10 mg tablet Rp 690 -
Kombinasi anti alergi lotion 100 ml (Kalamin 8%, Difenhidramin HCl 1%,
178 botol Rp 13,662 -
Kamfer 0.1%, Gliserol alkohol 2%)
Kombinasi krim mengandung Metilsalisilat 102 mg, Menthol 54,4 mg,
179 tube Rp 22,200 -
Eugenol 13,6 mg, kapsaicin/Nostren
Kotrimoksazol susp. komb. : Sulfametoksazol 200 mg. + Trimetoprim 40
180 botol Rp 2,100 -
mg/5ml
Kotrimoksazol tab dewasa komb : Sulfametoksazol 400
181 tablet Rp 126 -
mg+Trimetoprim 80 mg
 Kotrimoksazol tab dewasa komb : Sulfametoksazol 800
182 kaplet Rp 512 -
mg+Trimetoprim 160 mg
183 Krim untuk nyeri @30 gr tube Rp 14,850 -
184 Kuinin Injeksi IV 25 % sebagai 2HCl - 2 ml ampul Rp 6,510 -
185 Lactobacillus sachet Rp 15,625 -
186 Lansoprazol Kapsul 30 mg kaplet Rp 650 -
187 Larutan infus Glukosa 10% steril @ 500 ml. botol Rp 7,500 -
188 Larutan infus Glukosa 40% steril botol Rp 1,525 -
189 Larutan infus Glukosa 5% steril @ 500 ml botol Rp 6,900 - - 20
190 Larutan Infus Ringer Laktat steril @ 500 ml botol Rp 8,825 20 - 20 2 18
191 Larutan NaCl 0,225 %+ Dextrose 5 % ( cairan 1 : 4 ) infus @ 500 ml. botol Rp 9,840 -
Larutan NaCl 1,75 g, KCl 1,5 g, Na Laktat 2,24 g, Dextrose 27 g @ 500 ml
192 botol Rp 12,700 -
(KaEN 3B)
193 Larutan Natrium Klorida Infus 0,9 % steril @ 500 ml. botol Rp 6,900 40 - 40 - 40
194 Lidocain HCL 2% + Epinefrin 1:80.000 inj @ 2 ml ampul Rp 847 2 - 2 - 2 5
195 Lidocain injeksi 2 % @ 2 ml ampul Rp 1,330 -
196 Lidocain jelly 2% 10 gr syringe Rp 40,000 -
197 Lidocain semprot 10 % botol Rp 149,100 -
198 Linkomisin capsul 500 mg capsul Rp 197 -
199 Lisol solutio 1000 ml. botol Rp 57,800 1 1 2 2 - 1
200 Loperamid tablet 2 mg tablet Rp 83 -
201 Loratadin tablet 10 mg tablet Rp 115 -
202 Lorazepam tablet 2 mg tablet Rp 932 -
203 Magnesium Sulfat injeksi (IV) 20 % - 25 ml vial Rp 3,200 - - - - -
204 Magnesium Sulfat injeksi (IV) 40 % - 25 ml vial Rp 5,600 2 - 2 - 2
205 Mantoux test (PPD 2 UT 1,5) vial Rp 777,000 -
206 Mebendazol tablet 100 mg tablet Rp 141 -
207 Meloksikam capsul 15 mg capsul Rp 400 -
208 Metampiron ( Antalgin ) injeksi 500 mg /1 ml ampul Rp 3,050 -
209 Metampiron ( Antalgin ) tablet 500 mg tablet Rp 453 -
210 Metformin tablet 500 mg tablet Rp 180 -
211 Metilergometrin Maleat injeksi 0,200 mg - 1 ml ampul Rp 2,150 -
212 Metilergometrin Maleat tablet salut 0,125 mg tablet Rp 118 -
213 Metilprednisolon tablet 4 mg tablet Rp 230 -
214 Metoklopramid injeksi 5 mg/ml @ 2 ml ampul Rp 3,904 -
215 Metoklorpramid tablet 10 mg tablet Rp 118 -
216 Metronidazol infus botol Rp 10,250 -
217 Metronidazol tablet 500 mg tablet Rp 221 -
218 Mikonazol krim 2 % @ 10 g tube Rp 4,113 -
219 Multivitamin anak sirup dengan kalsium pidolat 300 mg, botol Rp 46,620 -
fruktooligosakarida 300 mg dan kurkuminoid 2 mg per 5 ml
220 Multivitamin mineral dengan zat besi tablet dewasa tablet Rp 1,023 -
 Multivitamin As folat 1 mg, B-caroten 10.000 IU, Vit B1 10 mg, Vit B2 2,5
mg, nikotinamid 20mg, Vit B6 12 mg, Ca Pantothenate 7,5 mg, Vit B12 4
221 Kapsul Rp 1,915 -
mcg, Vit C 100 mg, Vit D 400 IU, p-Iodida 100 mcg, Fe 90 mg, Cu 0.1 mg,
Ca Laktat 250 mg, NaF 1 mg (Folamil )
Multivitamin Fe 30 mg, Asam Folat 200 mcg, Vitamin B12 2 mcg per 5
222 botol Rp 22,339 -
ml (Ferri Kid Sirup)

Vitamin A 4,000 IU, vitamin C 50 mg, vitamin D 400 IU, vitamin E 10 mg,
vitamin B1 3 mg, vitamin B2 3 mg, vitamin B6 2 mg, vitamin B12 2 mcg,
223 nicotinamide 20 mg, Ca pantothenate 5 mg, folic acid 1 mg, biotin 0.1 tablet Rp 994 -
mg, Fe fumarate 20 mg, Ca 100 mg, copper 0.5 mg, mangan 0.5 mg, Mg
1 mg, Zn 0.25 mg (Pehavral)

224 Amilase 100 mg, Protease 100 mg, Lipase 180 100 mg/ Vitazym ) tablet Rp 2,550 -

Curcuma xanthorrhiza Extract 20 mg (mengandung Curcuminoid 15%)

225 tablet Rp 800 -
(Cavicur)
Curcuminoid 2mg, beta-carotene 10% 4mg, Vit B1 3mg, Vit B2 2mg, Vit
226 B6 5mg, Vit B12 5mcg, Vit D 100 IU, Dexpanthenol 3mg, Ca pidolate botol Rp 37,740 -
300mg Fructooligosaccharides 300 mg/Apecur Syrup
Calcium carbonate 766 mg, Magnesium Hydroxide 372,5 mg, zinc 5 mg,
227 tablet Rp 5,106 -
Vitamin D3 2,5 mcg, Boron 1 mg (Formical B)
228 Natrium Bikarbonat tablet 500 mg tablet Rp 10 -
229 Natrium Diklofenak emulgel/Galtren gel tube Rp 24,975 -
230 Natrium Diklofenak tab. 25 mg tablet Rp 142 -
231 Natrium Diklofenak tab. 50 mg tablet Rp 200 -
232 Natrium Heparina gel @ 20 g/Thrombo Gel tube Rp 39,000 -
233 Natrium Tiosulfat injeksi 25 % - 10 ml ampul Rp 14,768 -
Natrium laurilsulfoasetat, Natrium sulfat, Sorbitol, PEG 400 enema @ 5
234 tube Rp 29,360 -
ml (Mikrolax)
235 Neurotropik (Vit B1 100 mg, Vit B6 200 mg, Vit B12) injeksi ampul Rp 6,160 -
236 (Neurotropik (Vit B1 100 mg, Vit B6 200 mg, Vit B12) (Vastral) tablet Rp 770 -
237 Nifedipin tablet 10 mg tablet Rp 157 -
238 Nistatin oral drop botol Rp 38,500 -
239 Nistatin tablet salut 500.000 IU tablet Rp 881 -
240 Nistatin tablet vaginal 100.000 IU / g tablet Rp 645 -
241 Norepinefrin inj 1 mg/ml ampul Rp 55,248 -
242 Norit (Carbo adsorben) tablet tube Rp 11,000 -
243 Noskapin 25 mg kapsul Rp 5,585 -
244 Obat Anti Malaria/OAM (DHP) tablet Rp 2,000 -
245 Obat Anti Tuberkulosis Kategori Anak ( FDC ) paket Rp 267,400 -
246 Obat Anti Tuberkulosis Kategori I ( FDC ) paket Rp 430,539 -
247 Obat Anti Tuberkulosis Kategori II ( FDC ) paket Rp 1,492,574 -
248 Obat Anti Tuberkulosis Kategori III paket Rp 154,000 -
249 Obat Anti Tuberkulosis Sisipan paket Rp 66,000 -
250 Obat Batuk Hitam ( O B H ) sirup 100 ml. botol Rp 7,493 -
251 Octenic Spray Advance Wound Protection 50 ml botol Rp 42,150 -
252 Oksimetazolin tts hidung 0.025% @10 ml botol Rp 40,326 -
253 Oksimetazolin tts hidung 0.05% @10 ml botol Rp 36,000 -
254 Oksitetrasiklin HCl injeksi i.m 50 mg/ ml - 10 ml vial Rp 3,255 -
255 Oksitetrasiklin HCl salap 3 % 5 g tube Rp 2,398 -
256 Oksitetrasiklin HCl salap mata 1 % @ 3,5 g. tube Rp 2,600 - - - - - 2
257 Oksitoksin inj 10 IU / ml-1 ml ampul Rp 3,132 24 - 24 3 21 5
258 Omeprazol capsul 20 mg capsul Rp 240 - -
259 Omeprazol injeksi 40 mg ampul Rp 6,000 - 10
260 Ondansetron injeksi 4mg/2ml @ 2ml ampul Rp 1,415 - 10
261 Ondansetron tablet 8mg tablet Rp 384 -
262 Pancreatin komb. tablet tablet Rp 3,080 -
263 Papaverin inj 40 mg / ml ampul Rp 716 -
264 Papaverin tablet 40 mg tablet Rp 766 -
265 Parasetamol 125 mg rektal Suppos Rp 15,235 -
266 Parasetamol 250 mg rektal Suppos Rp 22,478 -
267 Parasetamol syr 120mg / 5 ml @ 60 ml botol Rp 1,160 -
268 Parasetamol tablet 500 mg tablet Rp 195 -
269 Perak sulfadiazin krim 1% tube Rp 21,500 -
270 Permetrin krim 5 % 10 gram tube Rp 46,454 -
271 Pirantel tablet 125 mg tablet Rp 331 -
272 Pirasetam inj ampul Rp 2,021 -
273 Pirasetam tablet 400 mg tablet Rp 360 -
274 Piratiazin teoklat 40 mg, Piridoksin HCl 30 mg tablet tablet Rp 3,108 -
275 Pirazinamid tablet 500 mg tablet Rp 248 -
276 Piridoksin tablet 10 mg tablet Rp 70 -
277 Piridoksin injeksi 1 ml. ampul Rp 1,050 -
278 Piroksikam capsul 10 mg capsul Rp 103 -
279 Piroksikam tablet 20 mg tablet Rp 128 -
280 Povidon Iodida 10 % 30 ml botol Rp 3,110 -
281 Povidon Iodida 10 % 300 ml botol Rp 37,044 3 - 3 1 2
282 Prednison tablet 5 mg tablet Rp 107 -
283 Primakuin tablet 15 mg tablet Rp 258 -
284 Prokain Benzil Penisillin injeksi 3 Juta IU vial Rp 375 -
285 Propanolol HCl tablet 40 mg tablet Rp 129 -
286 Propanolol tablet 10 mg tablet Rp 69 -
287 Propiltiourasil tablet 100 mg tablet Rp 472 -
288 Ranitidine Inj 25 mg/ml @ 2 ml ampul Rp 1,460 - - 10
289 Ranitidine tablet 150 mg tablet Rp 180 -
290 Reserpin tablet 0,10 mg tablet Rp 26 -
291 Reserpin tablet 0,25 mg tablet Rp 45 -
292 Retinol (Vitamin A) Dosis Tinggi 100.000 IU capsul Rp 327 -
293 Retinol (Vitamin A) Dosis Tinggi 200.000 IU capsul Rp 582 -
294 Rifampisin capsul 300 mg capsul Rp 785 -
295 Rifampisin kaplet 450 mg kaplet Rp 1,031 -
296 Rifampisin kaplet 600 mg kaplet Rp 1,420 -
297 Risperidon tab sal 2 mg tablet Rp 130 -
298 Salap 2 - 4 Kombinasi : [Link] 2 % + Belerang Endap 4 % @ 30 g pot Rp 1,475 -
299 Salbutamol inhalasi 100 mcg/dosis @ 200 dosis/Ventolin inhaler botol Rp 89,500 -
300 Salbutamol Nebules cairan ih 0.1% @ 2.5ml ampul Rp 4,400 -
301 Salbutamol tablet 2 mg tablet Rp 78 -
302 Salbutamol tablet 4 mg tablet Rp 89 -
303 Salisil Bedak 2 % @ 50 g dus Rp 1,765 -
304 Serum Anti Bisa Ular I injeksi (ABU I) (im/iv) @ 5ml vial Rp 517,132 -
305 Serum Anti Difteri injeksi 20.000 IU / vial (ADS) vial Rp 732,848 -
306 Serum Anti Tetanus injeksi 1.500 IU/ml (ATS) @1 ml ampul Rp 140,188 -
307 Serum Anti Tetanus injeksi 20.000 IU / Vial (ATS) vial Rp 130,999 -
308 Sianokobalamin injeksi 500 mcg/ml - 1 ml ampul Rp 1,066 -
309 Sianokobalamin tablet 50 mcg tablet Rp 49 -
310 Simvastatin tablet 10 mg tablet Rp 73 -
311 Simvastatin 20 mg tablet tablet Rp 182 -
312 Streptomisin injeksi 1500 mg / ml @ 15 ml. vial Rp 54,840 -
313 Tetrasiklin HCl kapsul 500 mg capsul Rp 777 -
314 Tiamfenikol capsul 500 mg capsul Rp 1,205 -
315 Tiamin HCl injeksi 100 mg / ml - 1 ml ampul Rp 1,035 -
316 Tiamin HCl tablet 50 mg tablet Rp 82 -
317 Timolol 0.5% tetes mata 5 ml botol Rp 12,100 -
318 Tramadol capsul 50 mg capsul Rp 361 -
319 Tramadol Injeksi 50 mg/ml @ 2ml ampul Rp 6,383 -
320 Triheksifenidil Hidroklorida tab 2 mg tablet Rp 63 -
321 Tripolidin Hcl 1.25mg, Pseudoefedrin Hcl 30mg/5ml @60 ml botol Rp 11,267 -
322 Tripolidin HCl 2.5 mg, Pseudoefedrin 60 mg tablet/Eflin tablet tablet Rp 1,388 -
323 Vitamin B-Kompleks tablet tablet Rp 70 -
324 Vitamin D3 1000 IU tablet tablet Rp 2,872 -
Vitamin B1 100 mg, B6 200 mg, B12 200 mcg, vit E 30 mg per tablet
325 tablet Rp 1,787 -
(Lapibion)
326 Zinc sirup 20mg/5ml @60 ml botol Rp 2,489 -
327 Zinc tablet dispersible 20 mg tablet Rp 182 -
BAHAN HABIS PAKAI
328 Alat Suntik Sekali Pakai 1 ml pcs Rp 1,700 70 - 70 10 60 20
329 Alat Suntik Sekali Pakai 3 ml pcs Rp 923 130 100 230 70 160 100
330 Alat Suntik Sekali Pakai 5 ml pcs Rp 1,271 57 - 57 5 52 20
331 Alat Suntik Sekali Pakai 10 ml pcs Rp 2,700 58 - 58 - 58 -
332 Auto Disposibel syringe 0,05 ml pcs Rp 1,940 - -
333 Auoto Disposibel syringe 0,5 ml pcs Rp 1,350 - -
334 Alcohol swab pcs Rp 138 220 200 420 100 320 100
335 Antiseptik tangan dengan dibilas 500 ml botol Rp 79,000 -
336 Antiseptik tangan tanpa dibilas 500 ml botol Rp 72,500 2 - 2 2 - 2
337 Arm sling ukuran S pcs Rp 17,424 -
338 Arm sling ukuran M pcs Rp 17,424 -
339 Arm sling ukuran L pcs Rp 17,424 -
340 Autoclick lancing device pcs Rp 23,870 -
341 Baygel Ultrasound Transmission Gel 250 ml botol Rp 17,653 -
342 Bracket hand wash plastik pcs Rp 19,360 -
343 Bistury / mata pisau bedah pcs Rp 575 - -
344 Blood lancet pcs Rp 228 15 - 15 15 - 15
345 Box Slide (kotak slides) isi untuk 50 slides kotak Rp 58,000 -
346 Cat Gut Chromic No. 2/0 DS 19 mm pcs Rp 29,806 - 10
347 Cat Gut Chromic No. 3/0 DS 19 mm pcs Rp 29,806 - 10
348 Cat Gut Chromic 2-0 90 cm Round Bodied 1/2 circle 35 mm pcs Rp 63,603 -
349 Cat Gut Chromic 3-0 76 cm Reverse Cutting 3/8 circle 24 mm Rp 64,602 -
350 Cat Gut Plain No. 2/0 DS 19 mm pcs Rp 29,806 1 1 1 - 10
351 Cat Gut Plain No. 3/0 DS 19 mm pcs Rp 29,806 4 4 2 2 10
352 Cat Gut Plain 2-0 90 cm Tuper cut 1/2 circle 35 mm pcs Rp 62,604 -
353 Cat Gut Plain 3-0 76 cm reverse cutting 3/8 circle 16 mm pcs Rp 62,604 -
354 Carbon Steel Surgical Blade Size No.11 kotak Rp 90,000 -
355 Carbon Steel Surgical Blade Size No.10 kotak Rp 90,000 -
356 Cervical collar universal (neck collar) pcs Rp 127,776 -
357 Chlorine Desinfectan 1% 1L botol Rp 21,875 -
358 Disposible Blood Transfution set Rp 12,143 -
359 Dermafik T 10 x 25 cm lembar Rp 25,000 -
360 Feeding tube 3,5 fr (3,5cm) set Rp 8,841 -
361 Folley Catheter 2. W 30 cc No.14 pcs Rp 13,320 -
362 Folley Catheter 2. W 30 cc No.16 pcs Rp 10,925 - - - 4
363 Folley Catheter 2. W 30 cc No.18 pcs Rp 10,925 -
364 Handscoon No.6 non steril pasang Rp 3,000 -
365 Handscoon No.6.5 non steril pasang Rp 3,000 -
366 Handscoon No.7.5 non steril pasang Rp 3,000 -
367 Handscoon No.6.5 steril pasang Rp 10,350 -
368 Handscoon No.7 steril pasang Rp 10,350 -
369 Handscoon No.7.5 steril pasang Rp 10,350 -
370 Handscoon (gloves) ukuran L pcs Rp 392 -
371 Handscoon (gloves) ukuran M pcs Rp 670 210 200 410 210 200 200
372 Handscoon (gloves) ukuran S pcs Rp 564 -
373 Handschoon obgyn steril pasang Rp 30,819 6 - 6 - 6
374 I.V. Canula Venocath No. 20 pcs Rp 16,088 -
375 I.V. Canula Venocath No. 22 pcs Rp 16,088 -
376 I.V. Canula Venocath No. 26 pcs Rp 14,824 -
377 I.V. Catheter Nomor 18 pcs Rp 8,250 19 - 19 1 18 5
378 I.V. Catheter Nomor 20 pcs Rp 8,250 45 - 45 3 42 5
379 I.V. Catheter Nomor 22 pcs Rp 8,250 7 - 7 1 6 5
380 I.V. Catheter Nomor 24 pcs Rp 8,250 -
381 Infus Set Anak set Rp 7,567 -
382 Infus Set Dewasa set Rp 7,567 8 - 8 2 5 5
383 Kapas Berlemak 500 gram roll Rp 31,300 -
384 Kapas Pembalut / Absorben 250 gram roll Rp 22,333 -
385 Kasa Hidrofil 40 x 80 cm roll Rp 149,000 -
386 Kasa hidrofil 36 x 80 cm roll Rp 147,327 -
387 Kasa Hidrofil Steril 18 x 22 cm (isi 12 lbr) bungkus Rp 8,167 -
388 Kasa Kompres 40 cm x 40 cm bungkus Rp 1,600 -
389 Kasa Pembalut 16 x 16 steril kotak Rp 7,100 12 - 12 10 2 10
390 Kasa Pembalut 2 m x 80 cm bungkus Rp 1,550 5 - 5 - 5
391 Kasa Pembalut Hidrofil 4 m x 10 cm roll Rp 2,035 -
392 Kasa Pembalut Hidrofil 4 m x 15 cm roll Rp 2,140 23 - 23 3 20
393 Kasa Pembalut Hidrofil 4 m x 3 cm roll Rp 891 -
394 Kasa Pembalut Hidrofil 4 m x 5 cm roll Rp 775 -
395 Kaca Mata Pelindung (Google) pcs Rp 195,000 -
396 Kartu Golongan Darah kotak Rp 49,300 -
397 Kertas Perkamen pack Rp 25,000 -
398 Kateter Nelaton No.10 Rp 52,500 -
399 Kateter Nelaton No.12 Rp 52,500 -
400 Kateter Nelaton No.14 Rp 52,500 -
401 Lubricant Gel tube Rp 76,000 -
402 Mitela Kain pcs Rp 13,987 -
Medical Recording Chart Paper, Kertas ECG/EKG Paper Ukuran 110mm
403 roll Rp 195,940 -
x30mm
Medical Recording Chart Paper, Kertas ECG/EKG Paper Ukuran 215mm
404 roll Rp 458,000 -
x280mm
 Medical Recording Chart Paper, Kertas ECG/EKG Paper Ukuran 88mm
405 roll Rp 128,000 -
x25mm
406 Mask (sungkup) oksigen anak pcs Rp 19,500 - 5
407 Mask (sungkup) oksigen dewasa pcs Rp 19,500 - - 5
408 Masker hi oxygen dewasa (non rebreathing mask) pcs Rp 14,137 -
409 Masker Disposible 3 ply pcs Rp 990 -
410 Masker 4 ply earloop kotak Rp 72,655 - 400 400 400 - 400
411 Masker N95 pcs Rp 19,500 -
412 Micropore Dispenser 3 M pcs Rp 28,500 -
413 Micropipette Tips Blue Tip pack Rp 46,845 -
414 Nasal canula anak pcs Rp 9,300 - 5
415 Nasal canula bayi pcs Rp 9,300 - 5
416 Nasal canula dewasa pcs Rp 4,200 - 5
417 Nasal Oxygen Canula Dewasa pcs Rp 11,150 -
418 Needle 23 G pcs Rp 311 - 100
419 Needle 24 G pcs Rp 311 - 200
420 Needle 25 G pcs Rp 311 - 100
421 NGT (Naso Gastric Tube/stomach tube) no.14 pcs Rp 12,870 -
422 NGT (Naso Gastric Tube/stomach tube) no.16 pcs Rp 12,870 -
423 NGT (Naso Gastric Tube/stomach tube) no.18 pcs Rp 12,870 -
424 Pembalut elastis ukuran 4 inci (10 cm x 4.55 m) roll Rp 64,500 -
425 Pembalut elastis ukuran 3 inci (7,5 cm x 4.55 m) roll Rp 54,500 -
426 Pembalut Gips roll Rp 5,600 -
427 Plester 5 cm x 5 m roll Rp 16,500 4 - 4 3 1 3
428 Plester kertas 9.2 m X 2,5 cm dengan pemotong roll Rp 8,575 3 - 3 3 - 3
429 Plester Tahan Air ( 25 cm x 10 cm ) pcs Rp 20,000 -
430 Plester transparan 5 m X 1,25 cm roll Rp 16,500 -
431 Penjepit Tali Pusat pcs Rp 2,430 23 - 23 3 20 5
432 Polifix 5 cm x 5 M pcs Rp 47,758 -
433 S i l k ( Benang Bedah Sutera ) No. 1 DS 24 mm sachet Rp 31,040 -
434 S i l k ( Benang Bedah Sutera ) No. 2/0 DS 19 mm sachet Rp 31,765 -
435 S i l k ( Benang Bedah Sutera ) No. 3/0 DS 19 mm sachet Rp 31,125 -
436 S i l k ( Benang Bedah Sutera ) No. 4/0 DS 19 mm sachet Rp 21,267 -
437 Silk Non Absopabel Suture 75 Black 3-0 26mm 38 sircle reversecutting kotak Rp 234,103 -
438 Silk Braided black 4-0 DS 19mm 75cm pcs Rp 21,267 -
439 Safety Box kotak Rp 20,182 - 10
440 Speculum vaginal disposible pcs Rp 11,220 - 20
441 Suction Catheter FR 6 pcs Rp 5,580 -
442 Suction Catheter FR 8 pcs Rp 5,678 -
443 Suction Catheter FR 10 pcs Rp 5,595 - 3
444 Three (3) way pcs Rp 12,631 -
445 Underpad ukuran 60x90 cm steril pcs Rp 6,885 8 5 13 3 10
446 Underpad (120X100) pcs Rp 66,600 -
447 Urine Bag set Rp 10,600 2 - 2 1 1 2
448 Tes Kehamilan pcs Rp 2,276 30 - 30 30 - 100
449 tes lakmus pcs Rp 19,435 - 50

JUMLAH TOTAL PERSEDIAAN

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Menyetujui Yang Menyerahkan Yang Melapor Petugas Pengelola Obat

Kepala Dinas Kesehatan Kepala Balai Pengelola Farmasi dan Alkes Kepala Puskesmas Puskesmas
Kabupaten Bintan Kabupaten Bintan ..................................... ………………………..

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