Lplpo 2018

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
Lembar Putih : Gudang Farmasi

( LPLPO ) Lembar Merah : Dinkes Kab.
Lembar Kuning: Puskesmas
Kode Puskesmas : 720401201 Pelaporan Bulan : Desemberr 2013

Puskesmas : Lawanga Permintaan Bulan : Januari 2014
Kecamatan : Poso Kota Utara No. LPLPO :
Kabupaten : Poso Hari/Tanggal :
Propinsi : Sulawesi Tengah
KEMASAN PEMBERIAN
HARGA
NO NAMA OBAT STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN TOTAL HARGA KET
SATUAN KEMASAN KEMASAN DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 Abbocath N0. 18 1 buah 19,500 3 0 3 3 0 0 0 DAK 2012 0
2 Abbocath N0. 18 1 buah 21,800 0 0 0 0 0 0 DAU 2012 0
3 Abbocath N0. 18 1 buah 0 0 0 0 0 0 0
4 Abbocath No. 20 ` 1 buah 19,500 0 0 0 0 0 0 DAK 2012 0
5 Abbocath No. 20 1 buah 0 0 0 0 0 0 0
6 Abbocath N0. 22 1 buah 19,500 0 0 0 0 0 DAK 2012 0
7 Abbocath N0. 22 1 buah 21,800 8 0 8 8 0 0 0 DAU 2012 0
8 Abbocath N0. 22 1 buah 0 0 0 0 0 0 0
9 Abbocath N0. 24 1 buah 19,500 16 0 16 16 0 312,000 DAK 2012 0
10 Abbocath N0. 24 1 buah 0 0 0 0 0 0 0
11 Aethylis Carbonas Chinie (Eukinin tab ) 1,000 btl 1000 137,500 0 0 0 0 0 0 0
12 Air Raksa Dental Use 1 btl 100 g 0 0 0 0 0 0 0
13 Alat suntik sekali pakai 1 ml 100 ktk 100 pcs 136,500 0 0 0 0 200 0 0 DAU 2012 0
14 Alat suntik sekali pakai 1 ml 100 ktk 100 pcs 0 0 0 0 0 0 0
15 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 118,200 0 0 0 0 300 0 0 DAU 2012 0
16 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 103,800 100 0 100 100 0 103,800 DAK 201`3 0
17 Alat suntik sekali pakai 5 ml 1 Pcs 1,042 100 0 100 100 0 100 0 0 BUFFER 0
18 Alat suntik sekali pakai 5 ml 100 ktk 100 pcs 145,455 0 0 0 0 0 0 DAU 2012 0
19 Alat suntik sekali pakai 5 ml 100 ktk 100 pcs 145,459 0 0 0 0 0 0 0
22 Albendazole Tab. 400 mg 100 ktk 30 12,200 2,300 0 2,300 2,300 0 280,600 BUFFER 0
23 Albendazole Tab. 400 mg 100 ktk 30 0 0 0 0 0 0 0
24 Allopurinol Tab. 100 mg 100 ktk 100 14,518 0 300 300 300 0 0 0 BUFFER 0
25 Allopurinol Tab. 100 mg 100 ktk 100 14,518 200 0 200 200 300 0 29,036 DAK 2013 0
26 Alprazolam 0,5 mg 100 ktk 100 0 0 0 0 200 0 0 0
27 Albotil 1 Btl 10 ml 40,909 0 0 0 0 10 0 0 DAK 2012 0
28 Albotil 1 Btl 10 ml 0 0 0 0 0 0 0
29 Aminofilin Inj. 10 ktk 10 amp 35,744 10 0 10 10 0 35,744 0
30 Aminofilin Inj. 30 ktk 30 amp 90,000 0 0 0 0 0 0 DAK 2012 0
31 Aminofilin Inj. 30 Ktk 30 Amp 0 0 0 0 0 0 0
32 Phaminov inj 10 ktk 10 amp 42,500 0 0 0 0 0 0 DAK 2011 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
33 Ambroksol 30 mg 100 ktk 100 0 0 0 0 300 0 0 0
34 Aminofilin tab. 200 mg 100 Btl 100 11,330 0 0 0 0 0 0 DAK 2012 Exp Sep'13
35 Aminofilin tab. 200 mg 100 Btl 100 0 0 0 0 0 0 0
36 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 0 0 0 0 0 0 0
37 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 200 0 200 200 0 26,402 DAK 2013 0
38 Amlodipin Tab 50 Ktk 50 52,800 0 0 0 0 300 0 0 0
39 Amlodipin Tab 50 Ktk 50 0 0 0 0 0 0 0
40 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 3,700 0 0 0 0 0 DAK 2012 0
41 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 4,070 32 20 52 29 23 60 0 93,610 DAK 2013 0
42 Amoksisilin Kapsul 250 mg 100 ktk 100 28,740 800 0 800 800 0 1,500 0 0 DAK 2102 0
43 Amoksisilin Kapsul 250 mg 100 Ktk 100 0 0 0 0 0 0 0
44 Amoksisilin Kaplet 500 mg 100 ktk 100 37,000 0 3,000 3,000 2,500 500 3,000 0 DAK 2012 0
45 Amoksisilin Kaplet 500 mg 100 Ktk 100 0 0 0 0 0 0 0
46 Ampisilin Sirup Kering 125 mg/5 ml 1 Btl 100 0 0 0 0 0 0 0
47 Ampisilin Serbuk Inj. 1000 mg/ml 10 ktk 10 vial 52,250 10 0 10 10 0 52,250 DAK 2011 0
48 Ampisilin Serbuk Inj. 1000 mg/ml 10 ktk 10 vial 53,680 0 0 0 0 0 0 DAK 2012 0
49 Ampisilin Serbuk Inj. 1000 mg/ml 10 ktk 10 vial 0 0 0 0 0 0 0
50 Anemolat Tab 1 mg 100 Ktk 100 15,000 0 0 0 0 0 0 DAK 2011 0
51 Antalgin (metampiron) tab. 500 mg 100 btl 1000 191,279 0 0 0 0 0 0 DAK 2012 0
52 Antalgin (metampiron) tab. 500 mg 100 ktk 100 0 0 0 0 0 0 0
53 Antalgin Inj. 250 mg/ml-2 ml 30 ktk 30 amp 0 0 0 0 0 0 0
54 Antasida DOEN, Tab. kombinasi 100 ktk 100 16,200 1,600 0 1,600 1,100 500 1,000 0 0 DAK 2012 0
55 Antasida DOEN, Tab. kombinasi 100 ktk 100 14,850 0 0 0 0 0 0 DAK 2011 0
56 Antasida DOEN, Tab. kombinasi 100 ktk 100 0 0 0 0 0 0 0
57 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 3,850 17 0 17 5 12 10 0 46,200 DAK 2012 0
58 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 0 0 0 0 0 0 0
59 Antihaemorodial folium 30 ktk/30 0 0 0 0 0 0 0
60 Anti Parkinson DOEN Tab. Komb 100 ktk/100 0 0 0 0 0 0 0
61 Asiklovir 400 mg 30 ktk /30 57,133 0 0 0 0 0 0 DAK 2012 0
62 Asiklovir 400 mg 100 Ktk 100 0 0 0 0 0 0 0
63 Asiklovir 200 mg 100 ktk 100 42,700 0 0 0 0 0 0 DAK 2011 Exp Sep'13
64 Asiklovir 200 mg 30 Ktk 30 0 0 0 0 0 0 0
65 Asiklovir salep 25 ktk 25 75,000 0 0 0 0 0 0 DAK 2012 0
66 Asiklovir salep 1 tube 3,463 25 0 25 25 0 86,575 DAK 2013 0
67 Anti Bakteri Doen Slp Kombinasi 25 Ktk/25 tube 69,212 0 0 0 0 25 0 DAK 2013 0
68 Anti fungi Doen 24 Ktk/24 45,372 0 0 0 0 24 0 0 0
69 Anti fungi Doen 24 Ktk/24 0 0 0 0 0 0 0
70 AntiHemoroid DOEN komb. 10 ktk 10 supp 22,000 20 0 20 10 10 30 0 22,000 DAK 2011 0
71 AntiHemoroid DOEN komb. 10 ktk 10 supp 0 0 0 0 0 0 0
72 Asam Folat tab 1 mg 100 btl 100 0 0 0 0 0 0 0
73 Aquadest steril 25 ml 1 Vial 0 0 0 0 0 0 0
74 Aquadest steril 25 ml 10 ktk 10 btl 15,000 70 0 70 70 0 105,000 BUFFER 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
75 Aquadest steril 25 ml 10 ktk 10 btl 60,500 0 0 0 0 0 0 0
76 Asam askorbat (Vit. C) tab. 250 mg 250 btl 250 0 0 0 0 1,000 0 0 0
77 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 30,250 0 0 0 0 0 0 BUFFER 0
78 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 35,200 1,000 1,000 2,000 2,000 0 2,000 0 0 DAK 2013 0
79 Asam Klorida 0,1 N 1 btl 60 ml 0 0 0 0 0 0 0
80 Asam Mefenamat Tab. 500 mg 100 ktk 100 17,050 0 0 0 0 0 0 BUFFER 0
81 Asam Mefenamat Tab. 500 mg 100 ktk 100 17,600 0 0 0 0 0 0 DAK 2012 0
82 Asam Mefenamat Tab. 500 mg 100 ktk 100 19,350 100 500 600 500 100 500 0 19,350 DAK 2013 0
83 Atropin Sulfat Tetes Mata 24 Ktk/24 0 0 0 0 0 0 0
84 Atropin Sulfat Inj 0,25 mg/ml 30 ktk 30 amp 36,300 90 0 90 90 0 108,900 DAK 2011 0
85 Atropin Sulfat Inj 0,25 mg/ml 30 ktk 30 amp 0 0 0 0 0 0 0
86 Atropin Sulfat Tab. 0,5 mg 500 btl 500 14,410 0 0 0 0 0 0 DAK 2010 0
87 Atropin Sulfat Tab. 0,5 mg 500 btl 500 0 0 0 0 0 0 0
88 Acetosal 100 mg 100 ktk/100 0 0 0 0 0 0 0
89 Baloon cateter no. 18 1 set 0 0 0 0 0 0 0
90 Baloon cateter no. 22 1 Set 0 0 0 0 0 0 0
93 Benzatin benzil penisilin inj. 1,2 juta IU/vial 10 ktk 10 vial 79,200 0 0 0 0 0 0 DAK 2011 0
94 Besi II sulfat 200 mg + asam folat 100 ktk/100 0 0 0 0 0 0 0
95 Betamidon 1 Vial 11,500 0 0 0 0 10 0 0 DAU 2012 0
96 Betamidon 1 Vial 0 0 0 0 0 0 0
97 Betadryl Injeksi 1 Vial 9,500 0 0 0 0 10 0 DAU 2012 0
98 Betadryl Injeksi 1 Vial 0 0 0 0 0 0 0
99 Betametason krim 0,1% 25 Ktk 25 tube 51,310 0 0 0 0 0 0 DAK 2011 0
100 Betametason krim 0,1% 1 Tube 2,053 0 0 0 0 50 0 0 BUFFER 0
101 Betametason krim 0,1% 1 Tube 0 0 0 0 0 0 0
102 Bioplasenton 1 Tube 27,045 0 0 0 0 20 0 0 DAU 2012 0
103 Bioplasenton 1 Tube 0 0 0 0 0 0 0
104 Calcii Glukonas Inj. 24 ktk 24 amp 0 0 0 0 0 0 0
105 Captopril Tab. 12,5 mg 100 ktk 100 0 0 0 0 300 0 0 0
106 Captopril Tab. 25 mg 100 ktk 100 13,775 0 0 0 0 0 0 DAK 2012 0
107 Captopril Tab. 25 mg 100 ktk 100 15,153 0 0 0 0 0 0 BUFFER 0
108 Captopril Tab. 25 mg 100 ktk 100 15,133 0 500 500 300 200 500 0 30,266 DAK 2013 0
109 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 320,000 0 0 0 0 0 0 BUFFER 0
110 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,909 24 0 24 24 0 24 0 0 DAK 2012 0
111 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,000 0 0 0 0 0 0 DAK 2011 0
112 Catgut/benang bedah no. 2/0-3/1 24 ktk 24 0 0 0 0 0 0 0
113 Cetoconazole tab 50 ktk/50 22,550 250 0 250 250 0 112,750 DAK 2013 0
114 Cholesterol 4 x 100 ml 1 kit 0 0 0 0 0 0 0
115 Cetirizine 10 mg 30 ktk/30 0 150 150 150 0 300 0 0 0
116 Cetirizine 10 mg 50 ktk 50 15,675 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
117 Cetirizine 10 mg 50 ktk 50 0 0 0 0 0 0 0
118 Cimetidin Tab. 100 ktk 100 11,490 0 0 0 0 500 0 0 DAK 2012 0
119 Cimetidin Tab. 100 ktk 100 0 0 0 0 0 0 0
120 Ciprofloxacin 500mg 100 ktk 100 31,240 300 200 500 500 0 500 0 0 DAK 2013 0
121 Cendo Fluorecin 24 Ktk/24 0 0 0 0 0 0 0
122 Clonidine 0.15 mg 100 Ktk/100 0 0 0 0 500 0 0 0
123 Calcidol B12+DHA Sirup 1 Btl/60 ml 0 0 0 0 30 0 0 0
124 Dasabion 100 Ktk/100 0 0 0 0 500 0 0 0
125 Deksametason Inj. 5 mg/ml-1 ml 100 ktk 100 amp 200,200 0 0 0 0 0 0 DAK 2012 0
126 Deksametason Inj. 5 mg/ml-1 ml 100 ktk 100 amp 220,220 100 0 100 100 0 0 0 DAK 2013 0
127 Deksametason Tab. 0,5 mg 1,000 btl 1000 0 0 0 0 0 0 0
128 Deksametason Tab. 0,5 mg 100 Ktk 100 9,349 0 0 0 0 3,000 0 0 BUFFER 0
129 Deksametason Tab. 0,5 mg 100 Ktk 100 17,400 0 0 0 0 0 0 DAK 2012 0
130 Deksametason Tab. 0,5 mg 100 Ktk 100 9,560 500 1,000 1,500 1,500 0 1,000 0 0 DAK 2013 0
131 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 2,970 0 0 0 0 0 0 DAK 2011 0
132 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 3,152 11 0 11 11 0 20 0 0 DAK 2013 0
133 Dekstrometorfan HBr tab. 15 mg 1,000 btl 1000 0 0 0 0 0 0 0
134 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 11,000 0 0 0 0 1,000 0 0 DAK 2012 0
135 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 10,890 600 0 600 200 400 0 43,560 BUFFER 0
136 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 0 0 0 0 0 0 0
137 Devitalisasi Pasta Non Arsen (Devitasol) 1 ktk/btl 0 0 0 0 2 0 0 0
138 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 78,147 0 0 0 0 0 0 BUFFER 0
139 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 26,049 0 0 0 0 0 0 0
140 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 0 0 0 0 0 0 0
141 Diazepam tab. 2 mg 100 btl 1000 27,000 0 0 0 0 0 0 DAK 2011 0
142 Diazepam tab. 2 mg 100 btl 1000 35,090 0 0 0 0 0 0 BUFFER 0
143 Diazepam tab. 2 mg 1,000 btl 1000 35,090 1,000 0 1,000 1,000 0 35,090 DAK 2013 0
144 Diazepam tab. 2 mg 100 Btl 100 0 0 0 0 0 0 0
145 Diazepam tab. 5 mg 250 btl 250 0 0 0 0 0 0 0
146 Dietilkarbamazin Sitrat tab. 100 mg/5 ml 100 ktk 100 10,725 14,300 0 14,300 14,300 0 1,533,675 0
147 Dietilkarbamazin Sitrat tab. 100 mg/5 ml 100 ktk 100 0 0 0 0 0 0 0
148 Difenhidramin HCl inj. 10 mg/ml-1 ml 30 ktk 30 amp 13,787 0 0 0 0 200 0 0 BUFFER 0
149 Difenhidramin HCl inj. 10 mg/ml-1 ml 30 ktk 30 amp 0 0 0 0 0 0 0
150 Dextran 70 lar. Infus 1 Btl 500 ml 0 0 0 0 0 0 0
151 Digoxin Tab.0,25 mg 100 ktk 100 14,300 0 0 0 0 0 0 DAK 2012 0
152 Digoxin Tab.0,25 mg 100 ktk 101 0 0 0 0 0 0 0
153 Diltiazem 30 mg 100 Ktk 100 15,163 200 0 200 200 0 30,326 DAK 2012 0
154 Diltiazem 30 mg 100 Ktk 101 0 0 0 0 0 0 0
155 Doxyciclin 100 ktk 100 55,660 0 0 0 0 0 0 0
156 Doxyciclin 100 ktk 100 0 0 0 0 0 0 0
157 Domperidon Tab 10 mg 100 Ktk 100 44,031 0 0 0 0 300 0 0 DAK 2012 0
158 Domperidon Tab 10 mg 100 Ktk 100 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
159 Domperidon syr 1 Btl 60 ml 12,650 10 0 10 10 0 126,500 DAU 2012 0
160 Domperidon syr 1 Btl 60 ml 0 0 0 0 0 0 0
161 Ergotamin tartrat + kofein 100 Btl/100 10,367 100 0 100 100 0 10,367 DAK 2011 0
162 Ergotamin tartrat + kofein 100 Btl/100 0 0 0 0 0 0 0
163 Efedrin HCl tab. 25 mg 250 btl 250 28,500 0 0 0 0 1,000 0 0 DAK 2011 0
164 Efedrin HCl tab. 25 mg 250 btl 250 0 0 0 0 0 0 0
165 Ekstrak Belladon Tab. 100 btl 1000 17,892 0 0 0 0 1,000 0 0 BUFFER 0
166 Epinefrin HCl Inj. 0,1% 30 ktk 30 amp 0 0 0 0 0 0 0
167 Erithromisin Kapsul 250mg 120 ktk 120 60,000 600 0 600 240 360 0 180,000 DAK 2012 0
168 Erithromisin Kapsul 250mg 120 ktk 120 0 0 0 0 0 0 0
169 Erithromisin Kapsul 500mg 100 ktk 100, strip 78,100 0 0 0 0 0 0 DAK 2011 0
170 Erithromisin Kapsul 500mg 100 ktk 100, strip 0 0 0 0 0 0 0
171 Eritromisin Syr. 200 mg/ 5 ml 1 btl 60 ml 7,732 0 0 0 0 30 0 0 DAK 2012 0
172 Eritromisin Syr. 200 mg/ 5 ml 1 btl 60 ml 0 0 0 0 0 0 0
173 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 1,981 0 0 0 0 10 0 0 DAK 2011 0
174 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 1,800 0 0 0 0 0 0 DAK 2012 0
175 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 9 0 9 5 4 0 0 DAK 2013 0
176 Etambutol Tab. 100 ktk 100 52,580 100 0 100 100 0 52,580 DAK 2011 0
177 Etanol 70% 1 Btl 300 ml 6,820 0 0 0 0 10 0 0 BUFFER 0
178 Etanol 70% 1 Btl 300 ml 11,990 0 5 5 3 2 0 23,980 DAU 2013 0
179 Etanol 70% 1 btl 1000 ml 45,000 0 0 0 0 5 0 DAK 2011 0
180 Etanol 70% 1 btl 1000 ml 0 0 0 0 0 0 0
181 Etanol 70% 1 btl 100 ml 0 0 0 0 0 0 0
182 Etil klorida semprot 1 btl 100 ml 181,000 0 0 0 0 0 0 DAU 2012 0
183 Etil klorida semprot 1 btl 100 ml 115,490 0 1 1 1 0 115,490 DAU 2013 0
184 Entrasol susu 1 ktk 185 gr 0 0 0 0 0 0 0
185 Ethigent injeksi 80 mg/ml 1 ktk 1 vial 2 ml 0 0 0 0 0 0 0
186 Eugenol Cairan 12 bks 12 btl 0 0 0 0 12 0 0 0
187 Fenilbutason Tab 1,000 Btl 1000 89,100 0 0 0 0 1,000 0 0 BUFFER 0
188 Fenitoin Natrium Inj.g/ml 1 btl 1000 0 0 0 0 0 0 0
189 Fenitoin Natrium kap 100mg 100 btl 100 0 0 0 0 0 0 0
190 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 0 0 0 0 0 0 0
191 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 20,100 0 0 0 0 0 0 BUFFER 0
192 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 42,899 0 0 0 0 0 0 0
193 Fenobarbital tab. 30 mg 100 btl 100 5,115 0 0 0 0 0 0 BUFFER 0
194 Fenobarbital tab. 30 mg 100 btl 1000 60,355 1,000 0 1,000 1,000 0 603,550 DAK 2013 0
195 Fenobarbital tab. 30 mg 1,000 btl 1000 34,100 0 0 0 0 0 0 DAK 2010 0
196 Fenobarbital tab. 100 mg 250 btl 250 0 0 0 0 0 0 0
197 Fenoksimetil Penisilina Tab. 500 mg 100 btl 100 tab. 45,650 0 0 0 0 0 0 DAK 2011 0
198 Fenol gliserol tetes telinga 10% 24 ktk 24 btl 0 0 0 0 24 0 0 0
199 Ferrolat Tab. 30 ktk 30 tab 0 0 0 0 0 0 0
200 Ferrous Sulfat Tab. 1,000 btl 1000 0 0 0 0 1,000 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
201 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 47,250 0 0 0 0 120 0 0 0
202 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 47,850 0 0 0 0 0 0 DAK 2011 0
203 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 0 0 0 0 0 0 0
204 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 68,062 100 0 100 100 0 200 0 0 DAK 2012 0
205 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 74,868 0 100 100 100 0 74,868 DAK 2013 0
206 Fluor Tab. 0,5 mg 100 btl 100 tab. 0 0 0 0 100 0 0 0
207 Forinokresol (Pengganti TKF) 1 btl 10 ml 0 0 0 0 2 0 0 0
208 Furosemid tab. 40 mg 200 ktk 200 19,800 200 0 200 200 0 19,800 DAK 2011 0
209 Furosemid tab. 40 mg 200 ktk 200 15,844 0 0 0 0 0 0 DAK 2010 0
210 Furosemid tab. 40 mg 200 ktk 200 0 0 0 0 0 0 0
211 Gameksan Emulsi 1% 1 btl 30 ml 0 0 0 0 0 0 0
212 Gentamisin Sulfat tetes mata 1 Botol 5 ml 3,630 0 0 0 0 0 0 DAK 2013 0
213 Garam Oralit untuk 200 ml air 100 ktk 100 sach 41,800 200 0 200 200 200 0 83,600 DAK 2013 0
214 Garam Oralit untuk 200 ml air 25 ktk 25 sach 10,026 0 0 0 0 0 0 DAK 2011 0
215 Garam Oralit untuk 200 ml air 25 ktk 25 sach 0 0 0 0 0 0 0
216 Gentamisin Inj. 1 ampul 18,480 0 0 0 0 0 0 DAK 2011 0
217 Gentamisin Inj. 5 ampul 20,328 5 0 5 5 0 10 0 0 DAK 2013 0
218 Gentamisin Salep 1 ktk 25 50 0 50 50 0 50 0 0 DAK 2013 0
219 Gentian violet larutan 1% 1 btl 10 ml 1,930 0 0 0 0 0 0 DAK 2012 0
220 Gentian violet larutan 1% 1 btl 10 ml 0 0 0 0 0 0 0
221 Glass Ionomer Cement (gc ix) 1 set 0 0 0 0 1 0 0 0
222 Glibenklamid Tab. 2 mg 100 ktk 100 7,200 400 0 400 400 0 28,800 DAK 2012 0
223 Glibenklamid Tab. 2 mg 100 ktk 100 0 0 0 0 0 0 0
224 Gliserin 1 Btl 100 ml 0 0 0 0 1 0 0 0
225 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 25,563 0 0 0 0 0 0 BUFFER 0
226 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 27,900 0 0 0 0 0 0 DAK 2012 0
227 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 30,690 1,000 1,000 2,000 2,000 0 3,000 0 0 DAK 2013 0
228 Glukosa 4 x 100 ml 1 kit 0 0 0 0 0 0 0
229 Glukosa lar. infus 5% steril 1 500 ml 8,272 15 0 15 15 0 124,080 DAK 2012 0
230 Glukosa lar. infus 5% steril 1 500 ml 0 0 0 0 0 0 0
231 Glukosa lar. infus 10% steril 1 btl 500 ml 0 0 0 0 0 0 0
232 Glukosa lar. infus 40% steril 10 Ktk 10 0 0 0 0 0 0 0
233 Griseofulvin tab. 125 mg, micronized 100 btl 100 24,000 100 0 100 100 0 500 0 0 DAK 2012 0
234 Griseofulvin tab. 125 mg, micronized 100 btl 100 24,600 0 500 500 500 0 0 0 0
235 Hanschoend steril No. 6,5 1 Pcs 0 0 0 0 10 0 0 0
236 Hanschoend steril No. 7 1 Pcs 8,200 0 0 0 0 0 0 DAU 2012 0
237 Hanschoend steril No. 7 1 Pcs 0 0 0 0 0 0 0
238 Hanschoend steril No. 7,5 1 Pcs 8,200 0 0 0 0 10 0 0 DAU 2012 0
241 Hanschoend steril No. 8 1 Pcs 4,675 0 10 10 10 0 0 0 DAU 2013 0
242 Hustab P Syrup 1 btl 60 ml 10,000 0 0 0 0 20 0 0 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
243 Hustab P Syrup 1 btl 60 ml 11,500 0 0 0 0 0 0 DAU 2011 0
244 Hustab P Syrup 1 btl 60 ml 0 0 0 0 0 0 0
245 Hub Cutter 1 buah 0 0 0 0 0 0 0
246 Haloperidol Tab. 0,5 mg 100 ktk 100 0 0 0 0 0 0 0
248 Haloperidol Tab.5 mg 100 ktk 100 12,229 100 0 100 100 0 12,229 DAK 2012 0
249 Haloperidol Tab.5 mg 100 ktk 100 0 0 0 0 0 0 0
250 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 39,930 1,000 0 1,000 1,000 0 0 0 DAK 2011 0
251 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 0 0 0 0 0 0 0
252 Hidrokortison krim 2,5% 24 ktk 24 tube 71,500 0 0 0 0 0 0 DAK 2012 0
253 Hidrokortison krim 2,5% 24 ktk 24 tube 78,650 0 24 24 24 0 24 0 0 DAK 2013 0
254 Hemaglobin 500 ml 1 btl 0 0 0 0 0 0 0
255 Hemafort 100 ktk 100 0 0 0 0 500 0 0 0
256 Ibuprofen suspensi 1 Btl 60 ml 4,500 0 0 0 0 30 0 0 DAK 2012 0
257 Ibuprofen suspensi 1 Btl 60 ml 0 0 0 0 0 0 0
258 Ibuprofen tab. 200 mg 100 btl 100 0 0 0 0 0 0 0
259 Ibuprofen tab. 400 mg 100 btl 100 19,799 200 0 200 200 0 1,000 0 0 BUFFER 0
260 Ibuprofen tab. 400 mg 100 btl 100 20,476 0 0 0 0 0 0 DAK 2012 0
262 Infus Set Anak 1 set 7,000 6 0 6 6 0 42,000 DAK 2012 0
263 Infus Set Anak 1 set 14,500 0 0 0 0 0 0 DAU 2012 0
264 Infus Set Anak 1 set 0 0 0 0 0 0 0
265 Infus Set Dewasa 1 set 12,500 4 0 4 4 0 50,000 DAU 2012 0
266 Infus Set Dewasa 1 set 7,000 0 0 0 0 0 0 DAK 2012 0
267 Infus Set Dewasa 1 set 0 0 0 0 0 0 0
268 Insulin Inj. 10 ml 1 Vial 0 0 0 0 0 0 0
269 Iodium Tes 1 btl 10 ml 0 0 0 0 0 0 0
270 Iodiol Kapsul lunak 100 btl 100 102,300 0 0 0 0 0 0 DAK 2011 0
271 Iodiol Kapsul lunak 100 btl 100 0 0 0 0 0 0 0
272 Isoniasid (INH) Tab. 100 mg 100 ktk 100 40,700 0 0 0 0 0 0 DAK 2011 0
273 Isoniasid (INH) Tab. 100 mg 100 ktk 100 0 0 0 0 0 0 0
275 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 41,000 0 0 0 0 0 0 DAK 2012 0
276 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 8,910 0 0 0 0 0 0 BUFFER 0
277 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 0 0 0 0 0 0 0
278 Isi ulang oksigen tabung besar 1 tabung 0 0 0 0 0 0 0
279 Isi ulang oksigen tabung kecil 1 tabung 0 0 0 0 0 0 0
280 Isi ulang oksigen tabung sedang 1 tabung 0 0 0 0 0 0 0
281 Jarum Hecting Jar. Otot no 7 12 lusin 113,500 0 0 0 0 0 0 DAU 2012 0
282 Jarum Hecting kulit no 5 12 lusin 113,500 0 0 0 0 0 0 DAU 2012 0
283 Jarum hecting kulit no 7 12 lusin 113,500 0 0 0 0 0 0 DAU 2012 0
284 Jarum otot no 5 12 lusin 113,500 12 0 12 12 0 113,500 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
285 Kalium Permanganat Serbuk 1 ktk 20 btl 0 0 0 0 0 0 0
286 Kalsium Hidroksida Pasta 2 Ktk 2 tube 0 0 0 0 4 0 0 0
287 Kalium Diklopenac 25 mg 50 ktk /50 0 0 0 0 50 0 0 0
288 Kalsium laktat 1,000 btl 1000 57,200 0 0 0 0 0 0 DAK 2011 0
289 Kalsium laktat 1,000 btl 1000 57,200 1,000 1,000 2,000 2,000 0 3,000 0 0 DAK 2013 0
290 Kanamycin Base 1g Inj. 1 Vial 4,650 0 0 0 0 20 0 0 BUFFER 0
291 Kanamycin Base 1g Inj. 1 Vial 0 0 0 0 0 0 0
292 Kapas 250 g 1 bungkus 27,500 0 0 0 0 0 0 DAU 2012 0
293 Kapas 250 g 1 bungkus 13,670 5 0 5 5 0 0 136,700 DAK 2011 0
294 Kapas 250 g 1 bungkus 0 0 0 0 0 0 0
295 Karbamazepin Tab. 200 mg 100 ktk 100, strip 24,645 0 0 0 0 0 0 DAK 2012 0
296 Karbamazepin Tab. 200 mg 100 ktk 100, strip 300 0 300 100 200 0 0 DAK 2013 0
297 Kasa kompres 40/40 steril 1 bks 0 0 0 0 0 0 0
298 Kasa pembalut hdrofil 4 m x 10 cm 1 rol/50 0 0 0 0 0 0 0
299 Kasa Pembalut Hidrofil 4 x 3 cm 1 rol 0 0 0 0 0 0 0
300 Kasa Pembalut Hidrofil 16 x 16 cm 1 ktk 0 0 0 0 0 0 0
301 Kasa Pembalut 2 x 80cm 1 Rol 16,500 0 0 0 0 0 0 DAU 2012 0
302 Kasa Pembalut 2 x 80cm 1 Rol 0 0 0 0 0 0 0
303 Kasa Steril 18 x 22 cm 16 ktk 16 lbr 0 0 0 0 0 0 0
304 Kasa Hidrofil 40 x 80 cm 1 rol 172,500 0 0 0 0 1 0 0 DAU 2012 0
305 Kasa Hidrofil 40 x 80 cm 1 rol 172,850 0 0 0 0 1 0 0 DAK 2012 0
306 Kasa Hidrofil 36 x 80 cm 1 rol 1 0 1 1 0 0 DAK 2013 0
307 Kasa pembalut hdrofil 3,6 m x 5 cm 1 rol 2,500 0 0 0 0 0 0 DAU 2012 0
308 Kasa pembalut hdrofil 3,6 m x 5 cm 1 rol 0 0 0 0 0 0 0
311 Ketokonazol krim 2% 1 tube 15 gr 7,000 0 0 0 0 25 0 0 DAK 2012 0
312 Ketokonazol krim 2% 1 tube 15 gr 0 0 0 0 0 0 0
313 Ketokonazol Tablet 200 mg 50 Ktk 50 20,473 0 0 0 0 0 0 DAK 2012 0
315 Ketoprofen Tablet 100 Ktk 100 68,826 0 0 0 0 0 0 DAU 2012 0
316 Kloramfenikol Kaps. 250 mg 250 Btl/250 57,750 1,250 0 1,250 250 1,000 0 231,000 DAK 2011 0
317 Kloramfenikol Kaps. 250 mg 250 Btl/250 0 0 0 0 0 0 0
318 Kloramfenikol Kaps. 250 mg 1,000 Btl 1000 57,750 0 0 0 0 0 0 DAK 2011 0
320 Kloramfenikol Kaps. 250 mg 1,000 Btl 1000 0 0 0 0 0 0 0
321 Kloramfenikol Salep Mata 1% 25 ktk 25 tube 0 0 0 0 25 0 0 0
322 Kloramfenikol Sirup 1 btl 60 ml 4,400 0 0 0 0 0 0 DAK 2011 0
323 Kloramfenikol Sirup 1 btl 60 ml 4,950 27 50 77 29 48 0 237,600 DAK 2013 0
324 Kloramfenikol Tetes Telinga 24 ktk 24 btl 0 0 0 0 24 0 0 0
325 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 0 0 0 0 0 79,200 DAK 2011 0
326 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 24,000 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
327 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 1,000 1,000 2,000 2,000 0 3,000 0 0 DAK 2013 0
328 Klorokuin fosfat tab. 150 mg 1,000 btl 1000 85,000 0 0 0 0 0 0 DAK 2012 0
330 Klorokuin fosfat tab. 150 mg 1,000 btl 1000 0 0 0 0 0 0 0
331 Klorpromazin HCl Inj. 5mg/ml - 2ml 30 ktk 30 amp 0 0 0 0 0 0 0
332 Klorpromazin HCl Inj. 25ml/ml-2ml 30 ktk 30 amp 0 0 0 0 0 0 0
333 Klorpromazin HCl Tab. 25 mg 1,000 btl 1000 26,895 0 0 0 0 0 0 DAK 2010 0
334 Klorpromazin HCl Tab. 25 mg 1,000 btl 1000 0 0 0 0 0 0 0
335 Klorpromazin HCl Tab. 100 mg 1,000 btl 1000 91,509 1,000 0 1,000 1,000 0 91,509 BUFFER 0
336 Klorpromazin HCl Tab. 100 mg 250 btl 250 153,000 0 0 0 0 0 0 0
337 Klorpropamid Tab. 100 mg 250 btl 500 0 0 0 0 0 0 0
338 Kodein Fosfat Tab. 10 mg 250 btl 250 106,820 0 0 0 0 250 0 0 DAK 2011 0
339 Kodein Fosfat Tab. 10 mg 250 btl 250 0 0 0 0 0 0 0
340 Komb. pirimetamin 25mg + sulfadoksin500mg 100 ktk 100 52,030 0 0 0 0 0 0 DAK 2011 0
341 Kotrimoksazol pediatrik tab. 120 mg 100 btl 100 7,590 0 0 0 0 500 0 0 DAK 2012 0
342 Kotrimoksazol pediatrik tab. 120 mg 100 btl 100 0 0 0 0 0 0 0
343 Kotrimoksazol suspensi 1 btl 60 ml 3,958 0 0 0 0 0 0 DAK 2012 0
344 Kotrimoksazol suspensi 1 btl 60 ml 3,850 0 0 0 0 0 0 BUFFER 0
345 Kotrimoksazol suspensi 1 btl 60 ml 4,356 20 0 20 20 0 60 0 0 DAK 2013 0
346 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 16,500 0 0 0 0 0 0 DAK 2012 0
347 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 18,149 200 200 400 200 200 300 0 36,298 DAK 2013 0
348 Kuinin dihidroklorida inj. - 2 ml 30 ktk 30 amp 126,800 0 0 0 0 0 0 DAK 2012 0
349 Kuinin dihidroklorida inj. - 2 ml 30 ktk 30 amp 0 0 0 0 0 0 0
350 Kuinin Sulfat Tab. 222 mg 60 ktk 60 49,700 0 0 0 0 0 0 DAK 2012 0
351 Kuinin Sulfat Tab. 222 mg 60 ktk 60 0 0 0 0 0 0 0
352 Lar. benedict 1 btl 100 ml 28,324 0 0 0 0 0 0 DAU 2010 0
353 Lar. benedict 1 btl 100 ml 0 0 0 0 0 0 0
354 Lar. Eosin 2% 1 btl 100 ml 66,000 0 0 0 0 0 0 DAU 2010 0
355 Lar. Eosin 2% 1 btl 100 ml 0 0 0 0 0 0 0
356 Lar. Etanol Asam 1 btl 100 ml 0 0 0 0 0 0 0
357 Lar. Giemsa Stain 1 btl 100 ml 0 0 0 0 0 0 0
358 Lar. Karbol Fuchsin 1 btl 100 ml 0 0 0 0 0 0 0
359 Lar. Metanol 1 btl 100 ml 0 0 0 0 0 0 0
360 Lar. Turk 1 btl 100 ml 16,254 0 0 0 0 0 0 BUFFER 0
361 Lar. Turk 1 btl 100 ml 32,500 0 0 0 0 0 0 DAK 2010 0
362 Lar. Turk 1 btl 100 ml 0 0 0 0 0 0 0
363 Lidokain Komp. Inj. 30 ktk 30 amp 101,000 0 0 0 0 0 0 DAK 2012 0
364 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 0 0 0 0 0 0 BUFFER 0
365 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 60 0 60 60 0 68,198 DAK 2013 0
366 Lidokain Inj. 100 ktk 100 amp 101,000 0 0 0 0 0 0 DAK 2012 0
367 Lidokain Inj. 100 ktk 100 amp 101,750 0 0 0 0 0 0 BUFFER 0
368 Lidokain Inj. 100 ktk 100 amp 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
369 Lisol 1 btl 1000 ml 45,000 0 0 0 0 10 0 0 DAU 2012 0
370 Lisol 1 btl 1000 ml 0 0 0 0 0 0 0
371 levofloksasin 30 Ktk 30 33,200 0 0 0 0 300 0 0 DAK 2012 0
372 levofloksasin 50 Ktk 50 0 0 0 0 0 0 0
373 Magnesium Sulfat Inj. (IV) 20%-25ml 10 ktk 10 16,931 4 0 4 4 0 0 0 DAK 2011 0
374 Magnesium Sulfat Inj. (IV) 20%-25ml 10 ktk 10 0 0 0 0 0 0 0
375 Magnesium Sulfat Inj. (IV) 40%-25ml 1 btl 25 ml 19,479 0 0 0 0 0 0 DAK 2012 0
376 Magnesium Sulfat Inj. (IV) 40%-25ml 1 btl 25 ml 0 0 0 0 0 0 0
377 Magnesium Sulfat serbuk 30 g 10 Ktk 10 Bks 0 0 0 0 0 0 0
378 Masker 50 ktk 50 68,500 50 0 50 50 0 68,500 DAU 2012 0
379 Masker 50 ktk 50 0 0 0 0 0 0 0
380 Metanol 1 Btl 100 ml 0 0 0 0 0 0 0
381 Malasiqrin 10 ktk 10 sase 0 0 0 0 0 0 0
382 Mata Pisau Carbon No.10 1 pcs 6,750 0 0 0 0 10 0 0 DAU 2012 0
383 Mata Pisau Carbon No.10 1 pcs 0 0 0 0 0 0 0
388 Mata Pisau Carbon No. 20 1 pcs 6,750 0 0 0 0 10 0 0 0
389 Mata Pisau Carbon No. 20 1 pcs 0 0 0 0 0 0 0
392 Mata Pisau Carbon No.22 1 pcs 6,750 0 0 0 0 0 0 0
394 Mebendazol Sirup 100 mg/5 ml 1 btl 30 ml 0 0 0 0 20 0 0 0
395 Mebendazol Tab. 100 mg 30 ktk 30, strip 0 0 0 0 0 0 0
396 Metampiron Tab 500 mg 100 Ktk 100 14,900 0 0 0 0 0 0 0
397 Metampiron Tab 500 mg 100 Ktk 100 0 0 0 0 0 0 0
398 Metilergometrin maleat inj. 0,200 mg - 1 ml 30 ktk 30 amp 45,100 0 0 0 0 0 0 0
399 Metilergometrin maleat inj. 0,200 mg - 1 ml 10 ktk 10 amp 16,390 20 30 50 30 20 0 32,780 DAK 2013 0
400 Metilergometrin maleat tab. salut 0,125 mg 100 ktk 100 0 0 0 0 0 0 0
401 Metilergometrin maleat tab. salut 0,125 mg 100 ktk 100 12,096 0 0 0 0 500 0 0 BUFFER 0
402 Metoklorpropamid Tab. 10 mg 100 ktk 100 11,000 0 0 0 0 500 0 0 DAK 2012 0
403 Metoklorpropamid Tab. 10 mg 100 ktk 100 0 0 0 0 0 0 0
404 Metformin tab 100 ktk 100 18,150 0 0 0 0 0 DAK
0 2012/BUFFER 0
405 Metformin tab 100 ktk 100 100 0 100 100 0 0 0
406 Metronidazol tab. 250 mg 100 ktk 100, strip 0 0 0 0 0 0 0
407 Metronidazol tab. 500 mg 100 ktk 100, strip 24,200 100 500 600 500 100 500 0 24,200 DAK 2013 0
408 Metronidazol tab. 500 mg 100 ktk 100, strip 0 0 0 0 0 0
409 Metil prednisolon tab 100 ktk 100 44,055 0 0 0 0 500 0 0 DAU 2012 0
410 Metil prednisolon tab 100 ktk 100 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
411 Mikonazole Krim 1 tube 3,000 0 0 0 0 24 0 0 DAK 2013 0
412 Mikonazole Krim 1 tube 0 0 0 0 0 0 0
413 Monoklor Kamfer Mentol (CHKM) 1 btl 10 ml 0 0 0 0 0 0 0
414 Mummifying Pasta 1 btl 0 0 0 0 1 0 0 0
415 Natrium bikarbonat tab. 1,000 btl 1000 15,730 0 0 0 0 0 0 DAK 2011 0
416 Natrium bikarbonat tab. 1,000 btl 1000 0 0 0 0 0 0 0
417 Natrium Diklofenak Tab. 50 mg 50 ktk 50 8,384 0 0 0 0 500 0 0 DAK 2012 0
418 Natrium Diklofenak Tab. 50 mg 50 ktk 50 0 0 0 0 0 0 0
419 Natrium klorida lar. infus steril 0,9% 1 500 ml 5,390 4 0 4 4 0 20 0 0 DAK 2011 0
420 Natrium klorida lar. infus steril 0,9% 1 500 ml 0 0 0 0 0 0 0
421 Natrium Tiosulfat Inj.25%-10 ml 10 ktk 10 amp 16,359 0 0 0 0 0 0 BUFFER 0
422 Nifedipin Tab. 10 mg 100 ktk 100 37,000 0 0 0 0 0 0 0
423 Nifedipin Tab. 10 mg 100 ktk 100 12,900 100 0 100 100 300 0 12,900 DAK 2013 0
424 Nifedipin Tab. 10 mg 100 ktk 100 0 0 0 0 0 0 0
425 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 37,000 0 0 0 0 0 0 DAK 2012 0
426 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 47,200 0 300 300 300 0 300 0 0 DAK 2013 0
427 Nistatin tab. 500.000 iu/g 100 ktk 100 60,074 0 0 0 0 100 0 0 DAK 2012 0
429 Novadryl Inj. 1 Vial 0 0 0 0 0 0 0
430 Novamydon Inj. 1 Vial 0 0 0 0 0 0 0
431 Obat antituberkulosis kategori I 1 Paket 0 0 0 0 0 0 0
432 Obat antituberkulosis kategori II 1 Paket 0 0 0 0 0 0 0
433 Obat antituberkulosis kategori III 1 Paket 0 0 0 0 0 0 0
434 Obat antituberkulosis kategori anak 1 Paket 0 0 0 0 0 0 0
435 Obat Batuk Hitam (OBH) 1 Btl 0 0 0 0 30 0 0 0
436 OBH Plus 1 btl 100 ml 9,750 0 0 0 0 30 0 0 DAU 2012 0
437 OBH Plus 1 btl 100 ml 0 0 0 0 0 0 0
438 Oksitetrasiklin HCl Inj. 50 mg/ml - 10 ml 10 ktk 10 vial 34,100 0 0 0 0 0 0 DAK 2013 0
439 Oksitetrasiklin HCl Salep Kulit 3% 1 tube 1,843 0 0 0 0 25 0 0 0
440 Oksitetrasiklin salep mata 25 ktk 25 tube 48,000 0 0 0 0 0 0 DAK 2012 0
441 Oksitetrasiklin salep mata 25 ktk 25 tube 52,800 25 0 25 25 0 52,800 DAK 2011 0
442 Oksitetrasiklin salep mata 25 ktk 25 tube 0 0 0 0 0 0 0
443 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 53,550 15 0 15 5 10 0 53,550 DAK 2012 0
444 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 0 0 0 0 0 0 0
445 Oksitosin inj. 10 iu/ml - 1 ml 30 Ktk 30 amp 0 0 0 0 0 0 0
446 Omeprazol kapsul 20 mg 30 Ktk 30 12,250 0 0 0 0 150 0 0 DAK 2012 0
447 Omeprazol kapsul 20 mg 30 Ktk 30 13,475 0 0 0 0 0 0 BUFFER 0
448 Omeprazol kapsul 20 mg 30 Ktk 30 0 0 0 0 0 0 0
449 Papaverin tab 1,000 btl 1000 99,500 1,000 0 1,000 1,000 0 99,500 DAK 2012 0
450 Papaverin tab 1,000 btl 1000 0 0 0 0 0 0 0
451 Papaverin injeksi 100 ktk 100 0 0 0 0 0 0 0
452 Paramidon Inj. 1 Vial 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
453 Parasetamol sirup 120 mg/5 ml 1 btl 60 ml 2,300 0 0 0 0 0 0 DAK 2012 0
454 Parasetamol sirup 120 mg/5 ml 1 btl 60 ml 2,529 0 0 0 0 0 0 BUFFER 0
455 Parasetamol sirup 120 mg/5 ml 1 btl 60 ml 2,529 25 30 55 55 0 30 0 0 DAK 2013 0
456 Parasetamol Tab. 100 mg 100 btl 100 0 0 0 0 2,000 0 0 0
457 Parasetamol tab. 500 mg 100 Ktk 100 11,550 0 900 900 900 0 0 0 BUFFER 0
458 Parasetamol tab. 500 mg 100 ktk 100 11,544 500 600 1,100 600 500 2,000 0 57,720 DAK 2013 0
459 Parasetamol tab. 500 mg 120 Ktk 120 12,600 0 0 0 0 0 0 DAK 2012 0
460 Parasetamol tab. 500 mg 120 Ktk 120 0 0 0 0 0 0 0
461 Parasetamol drop 1 Btl 15 ml 5,280 0 0 0 0 30 0 0 DAK 2012 0
462 Parasetamol drop 1 Btl 15 ml 0 0 0 0 0 0 0
463 Pehavral 100 ktk 100 96,500 0 0 0 0 500 0 0 DAU 2012 0
464 Pehavral 100 ktk 100 0 0 0 0 0 0 0
465 Petidin inj 10 ktk/10 131,904 0 0 0 0 0 0 DAK 2011 0
466 Petidin inj 5 ktk/5 64,250 0 0 0 0 0 0 0
467 Petidin inj 10 ktk/10 0 0 0 0 0 0 0
468 Pembalut Gips 1 rol 42,500 0 0 0 0 0 0 BUFFER 0
469 Pirantel pamoat tab. 365 mg 60 ktk 100 20,450 200 0 200 100 100 0 34,083 DAK 2013 0
470 Pirantel pamoat tab. 365 mg 60 ktk 60 0 0 0 0 0 0 0
471 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 15,725 4,000 0 4,000 4,000 0 15,725 DAK 2011 0
472 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 0 0 0 0 0 0 0
473 Pilokarpin tetes mata (HCL/nitrat) 1 btl 5 ml 0 0 0 0 0 0 0
474 Piroxicam Tab. 100 Ktk 100 8,400 0 0 0 0 0 0 DAK 2012 0
475 Piroxicam Tab. 100 Ktk 100 11,552 500 0 500 400 100 0 11,552 DAK 2013 0
476 Piroxicam Tab. 100 Ktk 120 0 0 0 0 0 0 0
477 Pirasetam Kaplet 1200 mg 100 KTK 100 129,360 0 0 0 0 0 0 DAK 2012 0
478 Plastik Obat 1 bks 100Sach 5,455 80 0 80 10 70 0 381,850 DAK 2012 0
479 Plester 1 rol 50,200 0 0 0 0 6 0 DAU 2012 0
480 Plester 1 rol 3,964 0 0 0 0 0 0 BUFFER 0
481 Plester 1 rol 25,980 0 5 5 4 1 0 25,980 DAU 2013 0
482 Pot sputum 1 pot 0 0 0 0 0 0 0
483 Prednison tab. 5 mg 1,000 btl 1000 68,750 3,000 0 3,000 3,000 0 3,000 0 275,000 DAK 2013 0
484 Prednison tab. 5 mg 1,000 btl 1000 62,500 0 0 0 0 0 0 DAK 2012 0
485 Prednison tab. 5 mg 1,000 btl 1000 63,250 0 0 0 0 0 0 BUFFER 0
486 Primakina tab. 15 mg 1,000 btl 1000 0 0 0 0 0 0 0
487 Prokain Benzil Penisilin Inj. 3 juta 1 Vial 198,550 0 0 0 0 0 0 0
488 Propil Tiourasil Tab. 100 mg 100 btl 100 29,957 100 0 100 100 0 29,957 DAK 2012 0
489 Propil Tiourasil Tab. 100 mg 100 btl 100 0 0 0 0 0 0 0
490 Pytogin injk 10 IUml/ml-2 10 ktk 10 0 0 0 0 0 0 0
491 Propranolol HCl Tab. 40 mg 100 btl 100 13,310 0 0 0 0 0 0 BUFFER 0
493 Propranolol HCl Tab. 40 mg 100 btl 100 0 0 0 0 0 0 0
494 Rapit test kit 1 Ktk 25 strip 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
495 Ranitidin Tab. 150 mg 100 ktk 100 22,000 0 0 0 0 500 0 0 DAK 2012 0
496 Ranitidin Tab. 150 mg 100 ktk 100 24,200 200 300 500 500 0 300 0 0 DAK 2013 0
497 Ranitidin inj 25 ktk 25 ampul 64,250 0 0 0 0 25 0 0 DAK 2012 0
498 Ranitidin inj 25 ktk 25 ampul 0 0 0 0 0 0 0
499 Reserpin Tab. 0,10 mg 250 btl/250 11,500 0 0 0 0 500 0 0 BUFFER 0
500 Reserpin Tab. 0,10 mg 250 btl/250 0 0 0 0 0 0 0
501 Reserpin Tab. 0,25 mg 1,000 btl 1000 0 0 0 0 0 0 0
502 Retinol (Vit. A) kaps. 100.000 IU 50 btl 50 0 0 0 0 0 0 0
504 Rifampisin Kaps. 450 mg 100 ktk 100 49,500 0 0 0 0 0 0 DAK 2010 0
505 Rifampisin Kaps. 450 mg 100 ktk 100 60,500 200 0 200 200 0 121,000 DAK 2011 0
506 Reagen TB 2 N 1 Kit 0 0 0 0 0 0 0
507 Ringer laktat (RL) lar. Steril 1 500 ml 9,000 0 0 0 0 0 0 DAK 2012 0
509 Ringer laktat (RL) lar. Steril 1 500 ml 5,717 10 10 20 12 8 10 0 45,736 DAK 2013 0
510 Salbutamol Tab. 4 mg 100 ktk 100 9,000 0 0 0 0 0 0 0
511 Salbutamol Tab. 2 mg 100 ktk 100 0 0 0 0 0 0 0
512 Salbutamol Tab. 4 mg 100 ktk 100 9,749 200 0 200 200 0 19,498 DAK 2012 0
514 Salep 2-4 Komb 24 Ktk/24 Pot 32,450 0 24 24 24 0 24 0 0 DAK 2013 0
515 Salisil bedak 2% 1 50 g 1,430 0 0 0 0 0 0 DAK 2012 0
516 Salisil bedak 2% 1 50 g 1,210 0 0 0 0 20 0 0 DAK 2011 0
517 Salisil bedak 2% 1 50 g 0 0 0 0 0 0 0
518 Salisil spritus 10 % 1 ktk 10 btl 0 0 0 0 0 0 0
519 Sefadroksil 250 mg 100 Ktk 100 0 0 0 0 0 0 0
520 Sefadroksil 500 mg 100 Ktk 100 84,000 0 0 0 0 500 0 0 DAK 2012 0
522 Sefadroksil syr 1 Btl 60 ml 0 0 0 0 60 0 0 0
523 Serum ATS Inj. 10 ktk 10 vial 0 0 0 0 0 0 0
524 Sefotaksim Inj 1 gram 2 Ktk 2 Vial 69,300 0 0 0 0 0 0 DAK 2012 0
525 Sefotaksim Inj 1 gram 2 Ktk 2 Vial 0 0 0 0 0 0 0
526 Sianokobalamin (Vit. B12) inj. 500 mcg/ml 100 ktk100amp 103,700 0 0 0 0 0 0 DAK 2012 0
527 Sianokobalamin (Vit. B12) inj. 500 mcg/ml 100 ktk100amp 114,070 100 0 100 100 0 0 0 DAK 2013 0
528 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 13,102 0 0 0 0 0 0 DAK 2012 0
529 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 14,412 2,000 0 2,000 2,000 0 28,824 0
530 Silk (benang bedah sutera) no. 3/0 36 ktk 36 pcs 818,182 36 0 36 36 0 818,182 DAK 2012 0
531 Silk (benang bedah sutera) no. 3/0 100m 36 ktk 36 pcs 0 0 0 0 0 0 0
532 Simvastatin 10 mg 30 Ktk 30 15,390 120 0 120 120 0 150 0 0 DAK 2012 0
533 Simvastatin 10 mg 30 Ktk 30 15,250 0 0 0 0 0 0 DAU 2012 0
534 Simvastatin 10 mg 30 Ktk 30 0 0 0 0 0 0 0
535 Semen Seng Fosfat (Doriden) 1 Set 30gram 0 0 0 0 1 0 0 0
536 Spons Gelatin Cubicles (Spongostan) 24 ktk 24 buah 0 0 0 0 24 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
537 Sulfadimidin Tab. 500 mg 1,000 btl 1000 0 0 0 0 1,000 0 0 0
538 Sulfasetamid Natrium Tetes mata 0,5% 1 btl 0 0 0 0 25 0 0 0
539 Slide 72 Set 45,000 72 0 72 72 0 45,000 DAU 2012 0
540 Slide 72 Set 0 0 0 0 0 0 0
541 Slide Box 1 Set 80,000 1 0 1 1 0 80,000 DAU 2010 0
542 Slide Box 1 Set 0 0 0 0 0 0 0
543 SGOT 4x50+4x10 ml (80x50) 1 Kit 0 0 0 0 0 0 0
544 SGOT 4x50+4x10 ml (80x50) 1 KIt 0 0 0 0 0 0 0
545 Silk (benang bedah sutera) No.3/0 12 Ktk 12 set 0 0 0 0 0 0 0
546 Tablet Tambah Darah 3,000 ktk 3000 tab 0 0 0 0 0 0 0
547 Temporary Stopping Fletcher 1 set 6,862 0 1 1 1 1 0 6,862 BUFFER 0
548 Tetracain HCl Tetes Mata 0,5% 1 btl 0 0 0 0 20 0 0 0
549 Tetrasiklin HCl kaps. 250 mg 1,000 btl 1000 167,200 0 0 0 0 0 0 DAK 2011 0
550 Tetrasiklin HCl kaps. 250 mg 1,000 btl 1000 0 0 0 0 0 0 0
551 Tetrasiklin HCl Kaps. 500 mg 100 ktk 100 0 0 0 0 0 0 0
552 Tiamfenikol 500 mg 100 Ktk 100 61,600 100 0 100 100 300 0 61,600 DAK 2012 0
553 Tiamfenikol 500 mg 100 Ktk 100 0 0 0 0 0 0 0
555 Tiamin HCl (Vit. B1) Inj. 30 ktk 30 amp 25,300 30 0 30 30 0 120 0 0 DAK 2013 0
556 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 37,800 0 0 0 0 0 0 DAK 2012 0
557 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 2,000 0 2,000 1,000 1,000 0 0 0
558 Tensigar 30 Ktk /30 0 0 0 0 300 0 0 0
559 Triheksifenidil HCl Tab. 2 mg 100 ktk 100, strip 4,485 0 0 0 0 0 0 DAK 2010 0
560 Triheksifenidil HCl Tab. 2 mg 100 ktk 100, strip 100 0 100 100 100 0 0 DAK 2013 0
561 Trigelicerides 4 x 100 ml 1 kit 0 0 0 0 0 0 0
562 Hemoglobin 500 ml 1 btl 0 0 0 0 0 0 0
563 Trisulfa Tab. 500 mg 1,000 btl 1000 0 0 0 0 0 0 0
564 Tramadol Tab 50 Ktk 18,500 50 0 50 50 0 18,500 0
565 Tramadol inj 50 mg/ml 5 ktk 5 ampul 32,010 0 0 0 0 0 0 DAK 2012 0
566 Test Narkoba 5 Multi Acon Strip 1 Ktk 25 strip 0 0 0 0 0 0 0
567 Uric acid (asam urat) 4 x 100 ml 1 kit 0 0 0 0 0 0 0
568 Urine Bag 1 pcs 11,500 0 0 0 0 0 0 DAU 2012 0
569 Urine Bag 1 pcs 0 0 0 0 0 0 0
570 Ulsikur Inj 5 ktk 5Ampul 0 0 0 0 0 0 0
571 Vaccine Carrrier 1 buah 0 0 0 0 0 0 0
572 Vaksin Anti Rabies (Verorab) 1 Kur/ Set 0 0 0 0 0 0 0
573 Vitamin B Kompleks tab. 1,000 btl 1000 22,200 0 0 0 0 0 0 DAK 2012 0
574 Vitamin B Kompleks tab. 1,000 btl 1000 24,419 0 1,000 1,000 1,000 0 0 0 BEFFER 0
575 Vitamin B Kompleks tab. 1,000 btl 1000 0 0 0 0 3,000 0 0 0
576 Wing Needle No.21 G 1 pcs 3,500 0 0 0 0 0 0 BUFFER 0
577 Wing Needle No.21 G 1 Ktk/100 buah 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
584 Yodium Povidon Lar. 10% 1 btl 1000 46,201 1 0 1 1 0 46,201 DAK 2011 0
585 Yodium Povidon Lar. 10% 1 btl 1000 0 0 0 0 0 0 0
586 Yodium Povidon Lar. 10% 1 btl 30 ml 2,200 13 0 13 13 0 20 0 0 DAK 2011 0
587 Yodium Povidon Lar. 10% 1 btl 30 ml 2,400 0 0 0 0 0 0 DAK 2012 0
588 Yodium Povidon Lar. 10% 1 btl 30 ml 0 0 0 0 0 0 0
589 Yodium Povidon Lar. 10% 1 btl 300 ml 14,500 1 0 1 1 0 0 0 DAK 2012 0
591 Zinc Tablet 100 Ktk 100 0 0 0 0 0 0 0
592 CHKM 1 Btl 10 ml 145,500 0 0 0 0 1 0 0 DAU 2012 0
593 Neurovit-E 60 Ktk 60 55,428 0 400 400 400 0 500 0 0 DAU 2013
594 Prenatin Plus 100 Ktk 100 67,195 0 500 500 500 0 500 0 0 DAU 2013
595 Wibrom syr 1 Btl 6,880 0 20 20 20 0 20 0 0 DAU 2013
596
597
598
599
600
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
TOTAL HARGA 8,116,738 0
Umum
Tidak Bayar ASKES JUMLAH 10 Penyakit Terbesar
Bayar
Jamkesmas dll NO Nama Penyakit Kode Jumlah
Jumlah Pasien / Resep
1 ISPA 1702 203
52 259 0 176 487 2 Dermatitis Alergi 2802 46
3 R.A 29 43
4 Gastritis 2001 40
5 Hipertensi 14 330
6 Diabetes Melitus 802 21

7 Tonsilitis 1701 20
8 Diare 102 16
9 Kecelakaan 2601 15
10 Konjungtivitis 1205 13
Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kepala Dinas Kesehatan Kepala Gudang Farmasi Kepala Puskesmas Pengelola Obat
Kabupaten Poso Kabupaten Poso Lawanga Puskesmas Lawanga
dr. Asnah Awad MH. MARS Sri Agus Purwati.S. SE dr. Intan Sariana Tompo Silvi Salu S.Farm
NIP. 19571119 198702 2 001 NIP. 19630817 198411 2 005 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
Kode Puskesmas : 720401201 Pelaporan Bulan : Januari 2014

Puskesmas : Lawanga Permintaan Bulan : Februari 2014
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 Abbocath N0. 18 1 buah 0 0 0 0 0 0 0
4 Abbocath No. 20 ` 1 buah 19,500 0 0 0 0 20 0 0 DAK 2012 0
5 Abbocath No. 20 1 buah 0 0 0 0 0 0 0
6 Abbocath N0. 22 1 buah 19,500 0 0 0 0 20 0 DAK 2012 0
8 Abbocath N0. 22 1 buah 0 0 0 0 0 0 0
9 Abbocath N0. 24 1 buah 19,500 16 0 16 2 14 0 273,000 DAK 2012 0
10 Abbocath N0. 24 1 buah 0 0 0 0 0 0 0
13 Alat suntik sekali pakai 1 ml 100 ktk 100 pcs 136,500 0 0 0 0 200 0 0 DAU 2012 0
15 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 118,200 0 0 0 0 300 0 0 DAU 2012 0
16 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 103,800 100 0 100 100 0 0 0 DAK 201`3 0
17 Alat suntik sekali pakai 5 ml 1 Pcs 1,042 0 0 0 0 100 0 0 BUFFER 0
24 Allopurinol Tab. 100 mg 100 ktk 100 14,518 0 0 0 0 0 0 BUFFER 0
25 Allopurinol Tab. 100 mg 100 ktk 100 14,518 200 0 200 200 300 0 29,036 DAK 2013 0
28 Albotil 1 Btl 10 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
33 Ambroksol 30 mg 100 ktk 100 0 0 0 0 300 0 0 0
37 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 200 0 200 200 0 26,402 DAK 2013 0
40 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 3,700 0 0 0 0 0 DAK 2012 0
41 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 4,070 23 0 23 23 0 60 0 0 DAK 2013 0
42 Amoksisilin Kapsul 250 mg 100 ktk 100 28,740 0 1,500 1,500 600 900 1,000 0 258,660 DAK 2102 0
44 Amoksisilin Kaplet 500 mg 100 ktk 100 37,000 500 3,000 3,500 1,300 2,200 2,000 0 DAK 2012 0
54 Antasida DOEN, Tab. kombinasi 100 ktk 100 16,200 500 1,000 1,500 1,500 0 0 DAK 2012 0
57 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 3,850 12 0 12 9 3 20 0 11,550 DAK 2012 0
62 Asiklovir 400 mg 100 Ktk 100 0 0 0 0 0 0 0
64 Asiklovir 200 mg 30 Ktk 30 0 0 0 0 0 0 0
66 Asiklovir salep 1 tube 3,463 25 0 25 25 0 25 0 0 DAK 2013 0
67 Anti Bakteri Doen Slp Kombinasi 25 Ktk/25 tube 69,212 0 0 0 0 25 0 DAK 2013 0
68 Anti fungi Doen 24 Ktk/24 45,372 0 0 0 0 24 0 0 0
70 AntiHemoroid DOEN komb. 10 ktk 10 supp 22,000 10 0 10 10 0 0 0 DAK 2011 0
71 AntiHemoroid DOEN komb. 10 ktk 10 supp 0 10 10 10 0 0 DAK 2013 0
74 Aquadest steril 25 ml 10 ktk 10 btl 15,000 70 0 70 70 0 105,000 BUFFER 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
78 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 35,200 0 2,000 2,000 1,000 1,000 1,000 0 35,200 DAK 2013 0
82 Asam Mefenamat Tab. 500 mg 100 ktk 100 19,350 100 500 600 300 300 500 0 58,050 DAK 2013 0
88 Acetosal 100 mg 100 ktk/100 0 0 0 0 0 0 0
96 Betamidon 1 Vial 0 0 0 0 0 0 0
110 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,909 0 24 24 24 24 0 290,909 DAK 2012 0
115 Cetirizine 10 mg 30 ktk/30 0 180 180 180 300 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
120 Ciprofloxacin 500mg 100 ktk 100 31,240 0 500 500 100 400 0 124,960 DAK 2013 0
122 Clonidine 0.15 mg 100 Ktk/100 0 0 0 0 500 0 0 0
124 Dasabion 100 Ktk/100 0 0 0 0 500 0 0 0
128 Deksametason Tab. 0,5 mg 100 Ktk 100 9,349 0 2,000 2,000 700 1,300 1,000 0 121,537 BUFFER 0
130 Deksametason Tab. 0,5 mg 100 Ktk 100 9,560 0 0 0 0 1,000 0 0 DAK 2013 0
132 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 3,152 0 0 0 0 20 0 0 DAK 2013 0
134 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 11,000 0 0 0 0 1,000 0 0 DAK 2012 0
135 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 10,890 400 0 400 400 0 1,000 0 0 BUFFER 0
136 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 0 0 0 0 0 0 0
154 Diltiazem 30 mg 100 Ktk 101 0 0 0 0 0 0 0
155 Doxyciclin 100 ktk 100 55,660 0 0 0 0 0 0 0
156 Doxyciclin 100 ktk 100 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
159 Domperidon syr 1 Btl 60 ml 12,650 10 0 10 10 0 126,500 DAU 2012 0
161 Ergotamin tartrat + kofein 100 Btl/100 10,367 100 0 100 100 0 10,367 DAK 2011 0
163 Efedrin HCl tab. 25 mg 250 btl 250 28,500 0 0 0 0 1,000 0 0 DAK 2011 0
165 Ekstrak Belladon Tab. 100 btl 1000 17,892 0 0 0 0 1,000 0 0 BUFFER 0
167 Erithromisin Kapsul 250mg 120 ktk 120 60,000 360 0 360 360 0 600 0 0 DAK 2012 0
175 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 4 0 4 4 0 0 DAK 2013 0
178 Etanol 70% 1 Btl 300 ml 11,990 2 3 5 5 0 59,950 DAU 2013 0
179 Etanol 70% 1 btl 1000 ml 45,000 0 0 0 0 5 0 DAK 2011 0
180 Etanol 70% 1 btl 1000 ml 0 0 0 0 0 0 0
181 Etanol 70% 1 btl 100 ml 0 0 0 0 0 0 0
194 Fenobarbital tab. 30 mg 100 btl 1000 60,355 1,000 0 1,000 1,000 0 603,550 DAK 2013 0
200 Ferrous Sulfat Tab. 1,000 btl 1000 0 0 0 0 1,000 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
204 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 68,062 0 0 0 0 200 0 0 DAK 2012 0
213 Garam Oralit untuk 200 ml air 100 ktk 100 sach 41,800 200 0 200 200 200 0 83,600 DAK 2013 0
217 Gentamisin Inj. 5 ampul 20,328 0 0 0 0 10 0 0 DAK 2013 0
224 Gliserin 1 Btl 100 ml 0 0 0 0 1 0 0 0
227 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 30,690 0 3,000 3,000 1,000 2,000 1,000 0 61,380 DAK 2013 0
228 Glukosa 4 x 100 ml 1 kit 0 0 0 0 0 0 0
233 Griseofulvin tab. 125 mg, micronized 100 btl 100 24,000 0 0 0 0 500 0 0 DAK 2012 0
234 Griseofulvin tab. 125 mg, micronized 100 btl 100 24,600 0 0 0 0 0 0 0
235 Hanschoend steril No. 6,5 1 Pcs 0 10 10 10 10 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
245 Hub Cutter 1 buah 0 0 0 0 0 0 0
250 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 39,930 0 0 0 0 0 0 DAK 2011 0
253 Hidrokortison krim 2,5% 24 ktk 24 tube 78,650 0 24 24 24 24 0 78,650 DAK 2013 0
255 Hemafort 100 ktk 100 0 0 0 0 500 0 0 0
259 Ibuprofen tab. 400 mg 100 btl 100 19,799 0 0 0 0 1,000 0 0 BUFFER 0
265 Infus Set Dewasa 1 set 12,500 4 0 4 4 0 20 0 0 DAU 2012 0
267 Infus Set Dewasa 1 set 0 0 0 0 0 0 0
269 Iodium Tes 1 btl 10 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
289 Kalsium laktat 1,000 btl 1000 57,200 0 3,000 3,000 1,000 2,000 1,000 0 114,400 DAK 2013 0
293 Kapas 250 g 1 bungkus 13,670 0 0 0 0 0 136,700 DAK 2011 0
294 Kapas 250 g 1 bungkus 0 0 0 0 0 0 0
296 Karbamazepin Tab. 200 mg 100 ktk 100, strip 200 0 200 200 0 0 DAK 2013 0
298 Kasa pembalut hdrofil 4 m x 10 cm 1 rol/50 0 50 50 50 0 50 0 0 0
316 Kloramfenikol Kaps. 250 mg 250 Btl/250 57,750 1,000 0 1,000 1,000 0 231,000 DAK 2011 0
323 Kloramfenikol Sirup 1 btl 60 ml 4,950 48 0 48 48 0 237,600 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
327 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 0 3,000 3,000 1,000 2,000 1,000 0 52,800 DAK 2013 0
335 Klorpromazin HCl Tab. 100 mg 1,000 btl 1000 91,509 1,000 0 1,000 1,000 0 1,000 0 0 BUFFER 0
341 Kotrimoksazol pediatrik tab. 120 mg 100 btl 100 7,590 0 0 0 0 0 0 DAK 2012 0
345 Kotrimoksazol suspensi 1 btl 60 ml 4,356 0 0 0 0 60 0 0 DAK 2013 0
347 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 18,149 200 300 500 500 0 90,745 DAK 2013 0
355 Lar. Eosin 2% 1 btl 100 ml 0 0 0 0 0 0 0
362 Lar. Turk 1 btl 100 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
369 Lisol 1 btl 1000 ml 45,000 0 0 0 0 10 0 0 DAU 2012 0
370 Lisol 1 btl 1000 ml 0 0 0 0 0 0 0
373 Magnesium Sulfat Inj. (IV) 20%-25ml 10 ktk 10 16,931 0 0 0 0 0 0 DAK 2011 0
378 Masker 50 ktk 50 68,500 50 0 50 50 0 50 0 0 DAU 2012 0
379 Masker 50 ktk 50 0 0 0 0 0 0 0
380 Metanol 1 Btl 100 ml 0 0 0 0 0 0 0
399 Metilergometrin maleat inj. 0,200 mg - 1 ml 10 ktk 10 amp 16,390 20 0 20 20 0 32,780 DAK 2013 0
0 2012/BUFFER 0
407 Metronidazol tab. 500 mg 100 ktk 100, strip 24,200 100 500 600 100 500 0 121,000 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
419 Natrium klorida lar. infus steril 0,9% 1 500 ml 5,390 0 0 0 0 20 0 0 DAK 2011 0
420 Natrium klorida lar. infus steril 0,9% 1 500 ml 0 0 0 0 0 0 0
423 Nifedipin Tab. 10 mg 100 ktk 100 12,900 100 0 100 100 0 300 0 0 DAK 2013 0
426 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 47,200 0 300 300 300 0 141,600 DAK 2013 0
428 Nistatin tab. 500.000 iu/g 100 ktk 100 66,000 0 0 0 0 0 0 DAK 2013 0
437 OBH Plus 1 btl 100 ml 0 0 0 0 0 0 0
441 Oksitetrasiklin salep mata 25 ktk 25 tube 52,800 25 0 25 25 0 50 0 0 DAK 2011 0
443 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 53,550 10 0 10 10 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
455 Parasetamol sirup 120 mg/5 ml 1 btl 60 ml 2,529 0 0 0 0 30 0 0 DAK 2013 0
457 Parasetamol tab. 500 mg 100 Ktk 100 11,550 0 0 0 0 0 0 BUFFER 0
458 Parasetamol tab. 500 mg 100 ktk 100 11,544 500 1,000 1,500 1,500 2,000 0 173,160 DAK 2013 0
463 Pehavral 100 ktk 100 96,500 0 0 0 0 500 0 0 DAU 2012 0
464 Pehavral 100 ktk 100 0 0 0 0 0 0 0
466 Petidin inj 5 ktk/5 64,250 0 0 0 0 0 0 0
467 Petidin inj 10 ktk/10 0 0 0 0 0 0 0
469 Pirantel pamoat tab. 365 mg 60 ktk 100 20,450 100 0 100 100 0 34,083 DAK 2013 0
475 Piroxicam Tab. 100 Ktk 100 11,552 100 0 100 100 500 0 11,552 DAK 2013 0
479 Plester 1 rol 50,200 0 0 0 0 6 0 DAU 2012 0
481 Plester 1 rol 25,980 1 5 6 1 5 0 129,900 DAU 2013 0
482 Pot sputum 1 pot 0 0 0 0 0 0 0
483 Prednison tab. 5 mg 1,000 btl 1000 68,750 0 0 0 0 3,000 0 275,000 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
496 Ranitidin Tab. 150 mg 100 ktk 100 24,200 0 500 500 300 200 300 0 48,400 DAK 2013 0
506 Reagen TB 2 N 1 Kit 0 0 0 0 0 0 0
509 Ringer laktat (RL) lar. Steril 1 500 ml 5,717 8 0 8 2 6 10 0 34,302 DAK 2013 0
514 Salep 2-4 Komb 24 Ktk/24 Pot 32,450 0 24 24 24 24 0 32,450 DAK 2013 0
517 Salisil bedak 2% 1 50 g 0 0 0 0 0 0 0
529 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 14,412 2,000 0 2,000 2,000 0 3,000 0 0 0
532 Simvastatin 10 mg 30 Ktk 30 15,390 0 150 150 150 150 0 76,950 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
539 Slide 72 Set 45,000 72 0 72 72 0 45,000 DAU 2012 0
540 Slide 72 Set 0 0 0 0 0 0 0
541 Slide Box 1 Set 80,000 1 0 1 1 0 80,000 DAU 2010 0
542 Slide Box 1 Set 0 0 0 0 0 0 0
543 SGOT 4x50+4x10 ml (80x50) 1 Kit 0 0 0 0 0 0 0
544 SGOT 4x50+4x10 ml (80x50) 1 KIt 0 0 0 0 0 0 0
552 Tiamfenikol 500 mg 100 Ktk 100 61,600 100 0 100 100 0 300 0 61,600 DAK 2012 0
555 Tiamin HCl (Vit. B1) Inj. 30 ktk 30 amp 25,300 0 0 0 0 120 0 0 DAK 2013 0
557 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 1,000 0 1,000 1,000 0 3,000 0 0 0
558 Tensigar 30 Ktk /30 0 0 0 0 300 0 0 0
560 Triheksifenidil HCl Tab. 2 mg 100 ktk 100, strip 100 0 100 100 0 200 0 0 DAK 2013 0
564 Tramadol Tab 50 Ktk 18,500 50 0 50 50 0 100 0 0 0
568 Urine Bag 1 pcs 11,500 0 0 0 0 0 0 DAU 2012 0
569 Urine Bag 1 pcs 0 0 0 0 0 0 0
574 Vitamin B Kompleks tab. 1,000 btl 1000 24,419 0 0 0 0 0 0 BEFFER 0
575 Vitamin B Kompleks tab. 1,000 btl 1000 0 3,000 3,000 3,000 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
584 Yodium Povidon Lar. 10% 1 btl 1000 46,201 1 0 1 1 0 0 0 DAK 2011 0
585 Yodium Povidon Lar. 10% 1 btl 1000 0 20 20 1 19 0 0 0
591 Zinc Tablet 100 Ktk 100 0 0 0 0 0 0 0
592 CHKM 1 Btl 10 ml 145,500 0 0 0 0 1 0 0 DAU 2012 0
593 Neurovit-E 60 Ktk 60 55,428 0 0 0 0 500 0 0 DAU 2013
594 Prenatin Plus 100 Ktk 100 67,195 0 0 0 0 500 0 0 DAU 2013
595 Wibrom syr 1 Btl 6,880 0 25 25 15 10 10 0 68,800 DAU 2013
596 Selvitron Ktk 100 0 0 500 500 300 200 200 0 0 DAU 2013
597 Hemorogard Ktk 30 0 0 300 300 30 270 0 0 DAU 2013
598 Noza Ktk 100 0 0 300 300 200 100 200 0 0 DAU 2013
599 Sohhobion Inj Ktk 10 0 0 20 20 10 10 0 0 DAU 2013
600 Atropin tetes mata Btl 0 0 20 20 20 0 20 0 0 DAU 2013
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
Umum
Bayar
1 ISPA 1702 198
76 295 1 229 601 2 Gastritis 2001 29
3 Hipertensi 14 27
4 D. Alergi 2802 23
5 R.A 29 22
6 Hipotensi 1603 22
7 Diare 102 16
8 Penyakit kulit infeksi 2801 16
9 Thypoid 104 15
10 DM 802 14

Kepala Dinas Kesehatan Kepala Gudang Farmasi Kepala Puskesmas Pengelola Obat
dr. Asnah Awad MH. MARS Sri Agus Purwati.S. SE dr. Intan Sariana Tompo Silvi Salu S.Farm
NIP. 19571119 198702 2 001 NIP. 19630817 198411 2 005 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
Kode Puskesmas : 720401201 Pelaporan Bulan : Februari 2014

Puskesmas : Lawanga Permintaan Bulan : Maret 2014
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 Abbocath N0. 18 1 buah 0 0 0 0 0 0 0
5 Abbocath No. 20 1 buah 0 0 0 0 0 0 0
8 Abbocath N0. 22 1 buah 0 0 0 0 0 0 0
10 Abbocath N0. 24 1 buah 0 0 0 0 0 0 0
15 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 118,200 0 100 100 100 0 118,200 DAU 2013 0
16 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 103,800 0 0 0 0 0 0 DAK 201`3 0
17 Alat suntik sekali pakai 5 ml 1 Pcs 1,042 0 100 100 100 0 104,200 BUFFER 0
22 Albendazole Tab. 400 mg 100 ktk 30 12,200 2,300 0 2,300 300 2,000 0 244,000 BUFFER 0
25 Allopurinol Tab. 100 mg 100 ktk 100 14,518 200 0 200 200 0 29,036 DAK 2013 0
26 Alprazolam 0,5 mg 100 ktk 100 0 0 0 0 0 0 0
27 Albotil 1 Btl 10 ml 40,909 0 0 0 0 0 0 DAK 2012 0
28 Albotil 1 Btl 10 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
33 Ambroksol 30 mg 100 ktk 100 0 0 0 0 0 0 0
37 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 200 0 200 100 100 0 13,201 DAK 2013 0
38 Amlodipin Tab 50 Ktk 50 52,800 0 0 0 0 0 0 0
40 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 3,700 0 20 20 10 10 0 37,000 BUFFER 0
41 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 4,070 0 0 0 0 0 0 DAK 2013 0
42 Amoksisilin Kapsul 250 mg 100 ktk 100 28,740 900 1,000 1,900 1,900 0 546,060 DAK 2102 0
44 Amoksisilin Kaplet 500 mg 100 ktk 100 37,000 2,200 1,000 3,200 1,500 1,700 0 DAK 2012 0
54 Antasida DOEN, Tab. kombinasi 100 ktk 100 16,200 1,500 0 1,500 1,500 0 0 DAK 2012 0
57 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 3,850 3 0 3 3 0 0 0 DAK 2012 0
62 Asiklovir 400 mg 100 Ktk 100 0 0 0 0 0 0 0
64 Asiklovir 200 mg 30 Ktk 30 0 0 0 0 0 0 0
66 Asiklovir salep 1 tube 3,463 0 0 0 0 0 0 DAK 2013 0
67 Anti Bakteri Doen Slp Kombinasi 25 Ktk/25 tube 69,212 0 25 25 25 69,212 BUFFER 0
68 Anti fungi Doen 24 Ktk/24 45,372 0 0 0 0 0 0 0
70 AntiHemoroid DOEN komb. 10 ktk 10 supp 22,000 0 0 0 0 0 0 DAK 2011 0
74 Aquadest steril 25 ml 10 ktk 10 btl 15,000 70 0 70 30 40 0 60,000 BUFFER 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
76 Asam askorbat (Vit. C) tab. 250 mg 250 btl 250 0 0 0 0 0 0 0
78 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 35,200 1,000 1,000 2,000 1,000 1,000 0 35,200 DAK 2013 0
82 Asam Mefenamat Tab. 500 mg 100 ktk 100 19,350 300 300 600 300 300 0 58,050 DAK 2013 0
84 Atropin Sulfat Inj 0,25 mg/ml 30 ktk 30 amp 36,300 90 0 90 30 60 0 72,600 DAK 2011 0
88 Acetosal 100 mg 100 ktk/100 0 0 0 0 0 0 0
95 Betamidon 1 Vial 11,500 0 0 0 0 0 0 DAU 2012 0
96 Betamidon 1 Vial 0 0 0 0 0 0 0
97 Betadryl Injeksi 1 Vial 9,500 0 0 0 0 0 DAU 2012 0
100 Betametason krim 0,1% 1 Tube 2,053 0 0 0 0 0 0 BUFFER 0
102 Bioplasenton 1 Tube 27,045 0 0 0 0 0 0 DAU 2012 0
105 Captopril Tab. 12,5 mg 100 ktk 100 0 0 0 0 0 0 0
108 Captopril Tab. 25 mg 100 ktk 100 15,133 500 0 500 500 0 75,665 DAK 2013 0
110 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,909 24 24 48 48 0 581,818 DAK 2012 0
115 Cetirizine 10 mg 30 ktk/30 180 0 180 180 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
118 Cimetidin Tab. 100 ktk 100 11,490 0 0 0 0 0 0 DAK 2012 0
120 Ciprofloxacin 500mg 100 ktk 100 31,240 400 0 400 400 0 124,960 DAK 2013 0
122 Clonidine 0.15 mg 100 Ktk/100 0 0 0 0 0 0 0
123 Calcidol B12+DHA Sirup 1 Btl/60 ml 0 0 0 0 0 0 0
124 Dasabion 100 Ktk/100 0 0 0 0 0 0 0
128 Deksametason Tab. 0,5 mg 100 Ktk 100 9,349 1,300 0 1,300 600 700 0 65,443 BUFFER 0
132 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 3,152 0 20 20 20 0 63,040 DAK 2013 0
134 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 11,000 0 0 0 0 0 0 DAK 2012 0
135 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 10,890 0 0 0 0 0 0 BUFFER 0
136 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 0 1,000 1,000 1,000 0 0 0
137 Devitalisasi Pasta Non Arsen (Devitasol) 1 ktk/btl 0 0 0 0 0 0 0
154 Diltiazem 30 mg 100 Ktk 101 0 0 0 0 0 0 0
155 Doxyciclin 100 ktk 100 55,660 0 0 0 0 0 0 0
156 Doxyciclin 100 ktk 100 0 0 0 0 0 0 0
157 Domperidon Tab 10 mg 100 Ktk 100 44,031 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
159 Domperidon syr 1 Btl 60 ml 12,650 10 0 10 10 0 0 0 DAU 2012 0
161 Ergotamin tartrat + kofein 100 Btl/100 10,367 100 0 100 100 0 0 0 DAK 2011 0
163 Efedrin HCl tab. 25 mg 250 btl 250 28,500 0 0 0 0 0 0 DAK 2011 0
165 Ekstrak Belladon Tab. 100 btl 1000 17,892 0 0 0 0 0 0 BUFFER 0
167 Erithromisin Kapsul 250mg 120 ktk 120 60,000 0 0 0 0 0 0 DAK 2012 0
171 Eritromisin Syr. 200 mg/ 5 ml 1 btl 60 ml 7,732 0 0 0 0 0 0 DAK 2012 0
175 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 4 0 4 4 0 0 DAK 2013 0
177 Etanol 70% 1 Btl 300 ml 6,820 0 0 0 0 0 0 BUFFER 0
178 Etanol 70% 1 Btl 300 ml 11,990 5 3 8 4 4 0 47,960 DAU 2013 0
179 Etanol 70% 1 btl 1000 ml 45,000 0 0 0 0 0 DAK 2011 0
180 Etanol 70% 1 btl 1000 ml 0 0 0 0 0 0 0
181 Etanol 70% 1 btl 100 ml 0 0 0 0 0 0 0
186 Eugenol Cairan 12 bks 12 btl 0 0 0 0 0 0 0
187 Fenilbutason Tab 1,000 Btl 1000 89,100 0 0 0 0 0 0 BUFFER 0
194 Fenobarbital tab. 30 mg 100 btl 1000 60,355 1,000 0 1,000 1,000 0 0 0 DAK 2013 0
198 Fenol gliserol tetes telinga 10% 24 ktk 24 btl 0 0 0 0 0 0 0
200 Ferrous Sulfat Tab. 1,000 btl 1000 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
201 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 47,250 0 0 0 0 0 0 0
204 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 68,062 0 0 0 0 0 0 DAK 2012 0
206 Fluor Tab. 0,5 mg 100 btl 100 tab. 0 0 0 0 0 0 0
207 Forinokresol (Pengganti TKF) 1 btl 10 ml 0 0 0 0 0 0 0
213 Garam Oralit untuk 200 ml air 100 ktk 100 sach 41,800 200 0 200 200 0 83,600 DAK 2013 0
218 Gentamisin Salep 1 ktk 25 25 0 25 25 0 0 DAK 2013 0
221 Glass Ionomer Cement (gc ix) 1 set 0 0 0 0 0 0 0
224 Gliserin 1 Btl 100 ml 0 0 0 0 0 0 0
227 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 30,690 2,000 0 2,000 2,000 0 61,380 DAK 2013 0
228 Glukosa 4 x 100 ml 1 kit 0 0 0 0 0 0 0
229 Glukosa lar. infus 5% steril 1 500 ml 8,272 15 0 15 2 13 0 107,536 DAK 2012 0
233 Griseofulvin tab. 125 mg, micronized 100 btl 100 24,000 0 0 0 0 0 0 DAK 2012 0
234 Griseofulvin tab. 125 mg, micronized 100 btl 100 0 0 500 500 500 0 0 BUFFER 0
235 Hanschoend steril No. 6,5 1 Pcs 10 0 10 10 0 0 0
238 Hanschoend steril No. 7,5 1 Pcs 8,200 0 0 0 0 0 0 DAU 2012 0
240 Hanschoend steril No. 8 1 Pcs 8,200 0 0 0 0 0 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
245 Hub Cutter 1 buah 0 0 0 0 0 0 0
253 Hidrokortison krim 2,5% 24 ktk 24 tube 78,650 24 0 24 24 0 0 0 DAK 2013 0
255 Hemafort 100 ktk 100 0 0 0 0 0 0 0
256 Ibuprofen suspensi 1 Btl 60 ml 4,500 0 0 0 0 0 0 DAK 2012 0
259 Ibuprofen tab. 400 mg 100 btl 100 19,799 0 0 0 0 0 0 BUFFER 0
265 Infus Set Dewasa 1 set 12,500 0 0 0 0 0 0 DAU 2012 0
267 Infus Set Dewasa 1 set 0 10 10 10 0 0 DAK 2013 0
269 Iodium Tes 1 btl 10 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
286 Kalsium Hidroksida Pasta 2 Ktk 2 tube 0 0 0 0 0 0 0
287 Kalium Diklopenac 25 mg 50 ktk /50 0 0 0 0 0 0 0
289 Kalsium laktat 1,000 btl 1000 57,200 2,000 0 2,000 2,000 0 114,400 DAK 2013 0
290 Kanamycin Base 1g Inj. 1 Vial 4,650 0 0 0 0 0 0 BUFFER 0
294 Kapas 250 g 1 bungkus 0 0 0 0 0 0 0
296 Karbamazepin Tab. 200 mg 100 ktk 100, strip 200 0 200 100 100 0 0 DAK 2013 0
298 Kasa pembalut hdrofil 4 m x 10 cm 1 rol/50 0 50 50 50 0 0 0
304 Kasa Hidrofil 40 x 80 cm 1 rol 172,500 0 0 0 0 0 0 DAU 2012 0
305 Kasa Hidrofil 40 x 80 cm 1 rol 172,850 0 0 0 0 0 0 DAK 2012 0
311 Ketokonazol krim 2% 1 tube 15 gr 7,000 0 0 0 0 0 0 DAK 2012 0
316 Kloramfenikol Kaps. 250 mg 250 Btl/250 57,750 1,000 0 1,000 500 500 0 115,500 DAK 2011 0
321 Kloramfenikol Salep Mata 1% 25 ktk 25 tube 0 0 0 0 0 0 0
323 Kloramfenikol Sirup 1 btl 60 ml 4,950 48 0 48 26 22 0 108,900 DAK 2013 0
324 Kloramfenikol Tetes Telinga 24 ktk 24 btl 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
327 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 2,000 0 2,000 1,000 1,000 0 26,400 DAK 2013 0
335 Klorpromazin HCl Tab. 100 mg 1,000 btl 1000 91,509 0 1,000 1,000 1,000 0 91,509 DAK 2013 0
338 Kodein Fosfat Tab. 10 mg 250 btl 250 106,820 0 0 0 0 0 0 DAK 2011 0
347 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 18,149 500 0 500 500 0 90,745 DAK 2013 0
355 Lar. Eosin 2% 1 btl 100 ml 0 0 0 0 0 0 0
362 Lar. Turk 1 btl 100 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
369 Lisol 1 btl 1000 ml 45,000 0 0 0 0 0 0 DAU 2012 0
370 Lisol 1 btl 1000 ml 0 0 0 0 0 0 0
371 levofloksasin 30 Ktk 30 33,200 0 0 0 0 0 0 DAK 2012 0
378 Masker 50 ktk 50 68,500 0 0 0 0 0 0 DAU 2012 0
379 Masker 50 ktk 50 0 0 0 0 0 0 0
380 Metanol 1 Btl 100 ml 0 0 0 0 0 0 0
382 Mata Pisau Carbon No.10 1 pcs 6,750 0 0 0 0 0 0 DAU 2012 0
388 Mata Pisau Carbon No. 20 1 pcs 6,750 0 0 0 0 0 0 0
394 Mebendazol Sirup 100 mg/5 ml 1 btl 30 ml 0 0 0 0 0 0 0
401 Metilergometrin maleat tab. salut 0,125 mg 100 ktk 100 12,096 0 0 0 0 0 0 BUFFER 0
402 Metoklorpropamid Tab. 10 mg 100 ktk 100 11,000 0 0 0 0 0 0 DAK 2012 0
0 2012/BUFFER 0
407 Metronidazol tab. 500 mg 100 ktk 100, strip 24,200 500 0 500 500 0 121,000 DAK 2013 0
409 Metil prednisolon tab 100 ktk 100 44,055 0 0 0 0 0 0 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
411 Mikonazole Krim 1 tube 3,000 0 0 0 0 0 0 DAK 2013 0
414 Mummifying Pasta 1 btl 0 0 0 0 0 0 0
417 Natrium Diklofenak Tab. 50 mg 50 ktk 50 8,384 0 0 0 0 0 0 DAK 2012 0
419 Natrium klorida lar. infus steril 0,9% 1 500 ml 5,390 0 0 0 0 0 0 DAK 2011 0
420 Natrium klorida lar. infus steril 0,9% 1 500 ml 0 10 10 10 0 0 BUFFER 0
423 Nifedipin Tab. 10 mg 100 ktk 100 12,900 0 0 0 0 0 0 DAK 2013 0
435 Obat Batuk Hitam (OBH) 1 Btl 0 0 0 0 0 0 0
436 OBH Plus 1 btl 100 ml 9,750 0 0 0 0 0 0 DAU 2012 0
437 OBH Plus 1 btl 100 ml 0 0 0 0 0 0 0
439 Oksitetrasiklin HCl Salep Kulit 3% 1 tube 1,843 0 0 0 0 0 0 0
440 Oksitetrasiklin salep mata 25 ktk 25 tube 48,000 0 25 25 25 0 48,000 DAK 2012 0
443 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 53,550 0 0 0 0 0 0 DAK 2012 0
446 Omeprazol kapsul 20 mg 30 Ktk 30 12,250 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
456 Parasetamol Tab. 100 mg 100 btl 100 0 0 0 0 0 0 0
458 Parasetamol tab. 500 mg 100 ktk 100 11,544 1,500 0 1,500 1,500 0 173,160 DAK 2013 0
461 Parasetamol drop 1 Btl 15 ml 5,280 0 0 0 0 0 0 DAK 2012 0
463 Pehavral 100 ktk 100 96,500 0 0 0 0 0 0 DAU 2012 0
464 Pehavral 100 ktk 100 0 0 0 0 0 0 0
466 Petidin inj 5 ktk/5 64,250 0 0 0 0 0 0 0
467 Petidin inj 10 ktk/10 0 0 0 0 0 0 0
475 Piroxicam Tab. 100 Ktk 100 11,552 100 0 100 100 0 11,552 DAK 2013 0
478 Plastik Obat 1 bks 100Sach 5,455 60 0 60 60 0 327,300 DAK 2012 0
479 Plester 1 rol 50,200 0 0 0 0 0 DAU 2012 0
481 Plester 1 rol 25,980 5 0 5 5 0 129,900 DAU 2013 0
482 Pot sputum 1 pot 0 0 0 0 0 0 0
483 Prednison tab. 5 mg 1,000 btl 1000 68,750 0 0 0 0 0 275,000 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
495 Ranitidin Tab. 150 mg 100 ktk 100 22,000 0 0 0 0 0 0 DAK 2012 0
496 Ranitidin Tab. 150 mg 100 ktk 100 24,200 200 0 200 200 0 48,400 DAK 2013 0
497 Ranitidin inj 25 ktk 25 ampul 64,250 0 0 0 0 0 0 DAK 2012 0
499 Reserpin Tab. 0,10 mg 250 btl/250 11,500 0 0 0 0 0 0 BUFFER 0
506 Reagen TB 2 N 1 Kit 0 0 0 0 0 0 0
509 Ringer laktat (RL) lar. Steril 1 500 ml 5,717 6 0 6 6 0 34,302 DAK 2013 0
514 Salep 2-4 Komb 24 Ktk/24 Pot 32,450 24 0 24 24 0 32,450 DAK 2013 0
517 Salisil bedak 2% 1 50 g 0 0 0 0 0 0 0
520 Sefadroksil 500 mg 100 Ktk 100 84,000 0 0 0 0 0 0 DAK 2012 0
522 Sefadroksil syr 1 Btl 60 ml 0 0 0 0 0 0 0
529 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 14,412 0 0 0 0 0 0 0
532 Simvastatin 10 mg 30 Ktk 30 15,390 150 0 150 150 0 76,950 DAK 2012 0
535 Semen Seng Fosfat (Doriden) 1 Set 30gram 0 0 0 0 0 0 0
536 Spons Gelatin Cubicles (Spongostan) 24 ktk 24 buah 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
537 Sulfadimidin Tab. 500 mg 1,000 btl 1000 0 0 0 0 0 0 0
538 Sulfasetamid Natrium Tetes mata 0,5% 1 btl 0 0 0 0 0 0 0
539 Slide 72 Set 45,000 72 0 72 72 0 45,000 DAU 2012 0
540 Slide 72 Set 0 0 0 0 0 0 0
541 Slide Box 1 Set 80,000 1 0 1 1 0 80,000 DAU 2010 0
542 Slide Box 1 Set 0 0 0 0 0 0 0
543 SGOT 4x50+4x10 ml (80x50) 1 Kit 0 0 0 0 0 0 0
544 SGOT 4x50+4x10 ml (80x50) 1 KIt 0 0 0 0 0 0 0
547 Temporary Stopping Fletcher 1 set 6,862 1 0 1 1 0 6,862 BUFFER 0
548 Tetracain HCl Tetes Mata 0,5% 1 btl 0 0 0 0 0 0 0
552 Tiamfenikol 500 mg 100 Ktk 100 61,600 0 0 0 0 0 61,600 DAK 2012 0
555 Tiamin HCl (Vit. B1) Inj. 30 ktk 30 amp 25,300 0 0 0 0 0 0 DAK 2013 0
557 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 41,580 0 2,000 2,000 2,000 0 83,160 0
558 Tensigar 30 Ktk /30 0 0 0 0 0 0 0
560 Triheksifenidil HCl Tab. 2 mg 100 ktk 100, strip 0 0 0 0 0 0 DAK 2013 0
564 Tramadol Tab 50 Ktk 18,500 0 0 0 0 0 0 0
568 Urine Bag 1 pcs 11,500 0 0 0 0 0 0 DAU 2012 0
569 Urine Bag 1 pcs 0 0 0 0 0 0 0
575 Vitamin B Kompleks tab. 1,000 btl 1000 3,000 0 3,000 1,000 2,000 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
584 Yodium Povidon Lar. 10% 1 btl 1000 46,201 0 0 0 0 0 0 DAK 2011 0
591 Zinc Tablet 100 Ktk 100 0 0 0 0 0 0 0
592 CHKM 1 Btl 10 ml 145,500 0 0 0 0 0 0 DAU 2012 0
593 Neurovit-E 60 Ktk 60 55,428 0 0 0 0 0 0 DAU 2013
594 Prenatin Plus 100 Ktk 100 67,195 0 0 0 0 0 0 DAU 2013
595 Wibrom syr 1 Btl 6,880 10 10 20 20 0 137,600 DAU 2013
596 Selvitron Ktk 100 0 200 100 300 300 0 0 DAU 2013
597 Hemorogard Ktk 30 0 270 0 270 270 0 0 DAU 2013
598 Noza Ktk 100 0 100 100 200 200 0 0 DAU 2013
599 Sohhobion Inj Ktk 10 0 10 0 10 10 0 0 DAU 2013
600 Atropin tetes mata Btl 0 0 20 20 20 0 0 DAU 2013
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
Umum
Bayar
1 ISPA 1702 198
76 295 1 229 601 2 Gastritis 2001 29
3 Hipertensi 14 27
4 D. Alergi 2802 23
5 R.A 29 22
6 Hipotensi 1603 22
7 Diare 102 16
8 Penyakit kulit infeksi 2801 16
9 Thypoid 104 15
10 DM 802 14

Plt. Kepala Dinas Kesehatan Kepala Gudang Farmasi Kepala Puskesmas Pengelola Obat
P.Rama Tandawuya,SE.M.Si Moh. Alchudri Mohidin,S.Farm.Msi,Apt dr. Intan Sariana Tompo Silvi Salu S.Farm
NIP. 19610219 198303 1 014 NIP. 19780505 200502 1 007 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
284
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT Lembar Putih : Gudang Farmasi
Kode Puskesmas : 720401201 Pelaporan Bulan : Maret 2014

Puskesmas : Lawanga Permintaan Bulan : April 2014
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 Abbocath N0. 18 1 buah 19,500 0 0 0 0 20 20 0 0 DAK 2012 0
3 Abbocath N0. 18 1 buah 0 0 0 0 0 0 0
4 Abbocath No. 20 ` 1 buah 19,500 0 0 0 0 20 0 0 DAK 2012 0
5 Abbocath No. 20 1 buah 0 0 0 0 0 0 0
8 Abbocath N0. 22 1 buah 0 0 0 0 0 0 0
10 Abbocath N0. 24 1 buah 0 0 0 0 0 0 0
15 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 118,200 100 0 100 100 0 118,200 DAU 2013 0
17 Alat suntik sekali pakai 5 ml 1 Pcs 1,042 100 0 100 100 0 104,200 BUFFER 0
25 Allopurinol Tab. 100 mg 100 ktk 100 14,518 200 0 200 200 0 29,036 DAK 2013 0
28 Albotil 1 Btl 10 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
33 Ambroksol 30 mg 100 ktk 100 0 0 0 0 600 0 0 0
37 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 100 0 100 100 0 300 0 0 DAK 2013 0
40 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 3,700 10 0 10 10 0 60 0 0 BUFFER 0
42 Amoksisilin Kapsul 250 mg 100 ktk 100 28,740 1,900 0 1,900 200 1,700 0 488,580 DAK 2102 0
44 Amoksisilin Kaplet 500 mg 100 ktk 100 37,000 1,700 0 1,700 500 1,200 2,000 0 DAK 2012 0
54 Antasida DOEN, Tab. kombinasi 100 ktk 100 16,200 1,500 0 1,500 200 1,300 0 0 DAK 2012 0
57 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 3,850 0 0 0 0 31 0 0 DAK 2012 0
61 Asiklovir 400 mg 30 ktk /30 57,133 0 0 0 0 300 0 0 DAK 2012 0
62 Asiklovir 400 mg 100 Ktk 100 0 0 0 0 0 0 0
64 Asiklovir 200 mg 30 Ktk 30 0 0 0 0 0 0 0
66 Asiklovir salep 1 tube 3,463 0 0 0 0 25 0 0 DAK 2013 0
67 Anti Bakteri Doen Slp Kombinasi 25 Ktk/25 tube 69,212 25 0 25 25 0 25 0 BUFFER 0
68 Anti fungi Doen 24 Ktk/24 45,372 0 0 0 0 0 0 0
74 Aquadest steril 25 ml 10 ktk 10 btl 15,000 40 0 40 10 30 0 45,000 BUFFER 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
78 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 35,200 1,000 0 1,000 1,000 0 3,000 0 0 DAK 2013 0
82 Asam Mefenamat Tab. 500 mg 100 ktk 100 19,350 300 0 300 300 0 1,000 0 0 DAK 2013 0
88 Acetosal 100 mg 100 ktk/100 0 0 0 0 0 0 0
95 Betamidon 1 Vial 11,500 0 0 0 0 0 0 DAU 2012 0
96 Betamidon 1 Vial 0 0 0 0 0 0 0
97 Betadryl Injeksi 1 Vial 9,500 0 0 0 0 0 DAU 2012 0
105 Captopril Tab. 12,5 mg 100 ktk 100 0 0 0 0 0 0 0
108 Captopril Tab. 25 mg 100 ktk 100 15,133 500 0 500 100 400 0 60,532 DAK 2013 0
110 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,909 48 0 48 48 0 581,818 DAK 2012 0
113 Cetoconazole tab 50 ktk/50 22,550 250 0 250 50 200 0 90,200 DAK 2013 0
115 Cetirizine 10 mg 30 ktk/30 180 0 180 180 0 360 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
120 Ciprofloxacin 500mg 100 ktk 100 31,240 400 0 400 100 300 200 0 93,720 DAK 2013 0
122 Clonidine 0.15 mg 100 Ktk/100 0 0 0 0 300 0 0 0
124 Dasabion 100 Ktk/100 0 0 0 0 300 0 0 0
128 Deksametason Tab. 0,5 mg 100 Ktk 100 9,349 700 0 700 500 200 1,500 0 18,698 BUFFER 0
132 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 3,152 20 0 20 20 0 63,040 DAK 2013 0
134 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 11,000 0 0 0 0 0 0 DAK 2012 0
135 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 10,890 0 0 0 0 0 0 BUFFER 0
136 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 1,000 0 1,000 1,000 0 0 0
143 Diazepam tab. 2 mg 1,000 btl 1000 35,090 1,000 0 1,000 1,000 0 1,000 0 0 DAK 2013 0
148 Difenhidramin HCl inj. 10 mg/ml-1 ml 30 ktk 30 amp 13,787 0 0 0 0 0 60 0 0 BUFFER 0
154 Diltiazem 30 mg 100 Ktk 101 0 0 0 0 0 0 0
155 Doxyciclin 100 ktk 100 55,660 0 0 0 0 0 0 0
156 Doxyciclin 100 ktk 100 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
161 Ergotamin tartrat + kofein 100 Btl/100 10,367 0 0 0 0 200 0 0 DAK 2011 0
163 Efedrin HCl tab. 25 mg 250 btl 250 28,500 0 0 0 0 250 0 0 DAK 2011 0
165 Ekstrak Belladon Tab. 100 btl 1000 17,892 0 0 0 0 0 0 BUFFER 0
167 Erithromisin Kapsul 250mg 120 ktk 120 60,000 0 0 0 0 0 0 DAK 2012 0
168 Erithromisin Kapsul 250mg 120 ktk 120 480 0 480 480 0 480 0 0 0
175 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 4 0 4 4 10 0 0 DAK 2013 0
177 Etanol 70% 1 Btl 300 ml 6,820 0 0 0 0 0 0 BUFFER 0
178 Etanol 70% 1 Btl 300 ml 11,990 4 0 4 1 3 5 0 35,970 DAU 2013 0
179 Etanol 70% 1 btl 1000 ml 45,000 0 0 0 0 0 DAK 2011 0
180 Etanol 70% 1 btl 1000 ml 0 0 0 0 0 0 0
181 Etanol 70% 1 btl 100 ml 0 0 0 0 0 0 0
186 Eugenol Cairan 12 bks 12 btl 0 0 0 0 0 0 0
193 Fenobarbital tab. 30 mg 100 btl 100 5,115 0 0 0 0 300 0 0 BUFFER 0
194 Fenobarbital tab. 30 mg 100 btl 1000 60,355 0 0 0 0 0 0 DAK 2013 0
195 Fenobarbital tab. 30 mg 1,000 btl 1000 34,100 0 0 0 0 1,000 0 0 DAK 2010 0
200 Ferrous Sulfat Tab. 1,000 btl 1000 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
204 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 68,062 0 0 0 0 0 0 DAK 2012 0
206 Fluor Tab. 0,5 mg 100 btl 100 tab. 0 0 0 0 0 0 0
207 Forinokresol (Pengganti TKF) 1 btl 10 ml 0 0 0 0 0 0 0
208 Furosemid tab. 40 mg 200 ktk 200 19,800 200 0 200 200 0 200 0 0 DAK 2011 0
213 Garam Oralit untuk 200 ml air 100 ktk 100 sach 41,800 200 0 200 200 0 83,600 DAK 2013 0
224 Gliserin 1 Btl 100 ml 0 0 0 0 1 0 0 0
227 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 30,690 2,000 0 2,000 2,000 0 61,380 DAK 2013 0
228 Glukosa 4 x 100 ml 1 kit 0 0 0 0 0 0 0
233 Griseofulvin tab. 125 mg, micronized 100 btl 100 24,000 0 0 0 0 0 0 DAK 2012 0
234 Griseofulvin tab. 125 mg, micronized 100 btl 100 0 500 0 500 200 300 0 0 BUFFER 0
235 Hanschoend steril No. 6,5 1 Pcs 10 0 10 10 0 0 0
240 Hanschoend steril No. 8 1 Pcs 8,200 0 0 0 0 0 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
245 Hub Cutter 1 buah 0 0 0 0 0 0 0
255 Hemafort 100 ktk 100 0 0 0 0 500 0 0 0
259 Ibuprofen tab. 400 mg 100 btl 100 19,799 0 0 0 0 1,500 0 0 BUFFER 0
265 Infus Set Dewasa 1 set 12,500 0 0 0 0 0 0 DAU 2012 0
267 Infus Set Dewasa 1 set 10 0 10 3 7 0 0 DAK 2013 0
269 Iodium Tes 1 btl 10 ml 0 0 0 0 0 0 0
274 Isoniasid (INH) Tab. 300 mg 100 ktk 100 0 0 0 0 0 0 0 284
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
287 Kalium Diklopenac 25 mg 50 ktk /50 0 0 0 0 0 0 0
289 Kalsium laktat 1,000 btl 1000 57,200 2,000 0 2,000 2,000 0 114,400 DAK 2013 0
290 Kanamycin Base 1g Inj. 1 Vial 4,650 0 0 0 0 0 0 BUFFER 0
294 Kapas 250 g 1 bungkus 0 0 0 0 0 0 0
296 Karbamazepin Tab. 200 mg 100 ktk 100, strip 100 0 100 100 0 0 DAK 2013 0
304 Kasa Hidrofil 40 x 80 cm 1 rol 172,500 0 0 0 0 0 0 DAU 2012 0
305 Kasa Hidrofil 40 x 80 cm 1 rol 172,850 0 0 0 0 0 0 DAK 2012 0
306 Kasa Hidrofil 36 x 80 cm 1 rol 1 0 1 1 0 1 0 0 DAK 2013 0
311 Ketokonazol krim 2% 1 tube 15 gr 7,000 0 0 0 0 0 0 DAK 2012 0
316 Kloramfenikol Kaps. 250 mg 250 Btl/250 57,750 500 0 500 500 0 115,500 DAK 2011 0
321 Kloramfenikol Salep Mata 1% 25 ktk 25 tube 0 0 0 0 0 0 0
323 Kloramfenikol Sirup 1 btl 60 ml 4,950 22 0 22 22 0 108,900 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
327 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 1,000 0 1,000 1,000 0 3,000 0 0 DAK 2013 0
335 Klorpromazin HCl Tab. 100 mg 1,000 btl 1000 91,509 1,000 0 1,000 1,000 0 91,509 DAK 2013 0
342 Kotrimoksazol pediatrik tab. 120 mg 100 btl 100 500 0 500 200 300 0 0 0
347 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 18,149 500 0 500 1,000 -500 0 -90,745 DAK 2013 0
355 Lar. Eosin 2% 1 btl 100 ml 0 0 0 0 0 0 0
362 Lar. Turk 1 btl 100 ml 0 0 0 0 0 0 0
365 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 60 0 60 30 30 0 34,099 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
369 Lisol 1 btl 1000 ml 45,000 0 0 0 0 10 0 0 DAU 2012 0
370 Lisol 1 btl 1000 ml 0 0 0 0 0 0 0
378 Masker 50 ktk 50 68,500 0 0 0 0 50 0 0 DAU 2012 0
379 Masker 50 ktk 50 0 0 0 0 0 0 0
380 Metanol 1 Btl 100 ml 0 0 0 0 0 0 0
0 2012/BUFFER 0
405 Metformin tab 100 ktk 100 100 0 100 100 0 500 0 0 0
407 Metronidazol tab. 500 mg 100 ktk 100, strip 24,200 500 0 500 100 400 0 96,800 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
419 Natrium klorida lar. infus steril 0,9% 1 500 ml 5,390 0 0 0 0 0 0 DAK 2011 0
420 Natrium klorida lar. infus steril 0,9% 1 500 ml 10 0 10 10 0 20 0 0 BUFFER 0
423 Nifedipin Tab. 10 mg 100 ktk 100 12,900 0 0 0 0 300 0 0 DAK 2013 0
437 OBH Plus 1 btl 100 ml 0 0 0 0 0 0 0
443 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 53,550 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
458 Parasetamol tab. 500 mg 100 ktk 100 11,544 1,500 0 1,500 1,500 2,000 0 173,160 DAK 2013 0
463 Pehavral 100 ktk 100 96,500 0 0 0 0 500 0 0 DAU 2012 0
464 Pehavral 100 ktk 100 0 0 0 0 0 0 0
466 Petidin inj 5 ktk/5 64,250 0 0 0 0 0 0 0
467 Petidin inj 10 ktk/10 0 0 0 0 0 0 0
471 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 15,725 4,000 0 4,000 2,000 2,000 0 15,725 DAK 2011 0
475 Piroxicam Tab. 100 Ktk 100 11,552 100 0 100 100 0 1,000 0 0 DAK 2013 0
478 Plastik Obat 1 bks 100Sach 5,455 60 0 60 60 0 327,300 DAK 2012 0
479 Plester 1 rol 50,200 0 0 0 0 6 0 DAU 2012 0
481 Plester 1 rol 25,980 5 0 5 2 3 0 77,940 DAU 2013 0
482 Pot sputum 1 pot 0 0 0 0 0 0 0
483 Prednison tab. 5 mg 1,000 btl 1000 68,750 0 0 0 0 3,000 0 275,000 DAK 2013 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
506 Reagen TB 2 N 1 Kit 0 0 0 0 0 0 0
509 Ringer laktat (RL) lar. Steril 1 500 ml 5,717 6 0 6 6 0 20 0 0 DAK 2013 0
514 Salep 2-4 Komb 24 Ktk/24 Pot 32,450 24 0 24 24 24 0 32,450 DAK 2013 0
517 Salisil bedak 2% 1 50 g 0 0 0 0 0 0 0
529 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 14,412 0 0 0 0 3,000 0 0 0
532 Simvastatin 10 mg 30 Ktk 30 15,390 150 0 150 60 90 60 0 46,170 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
539 Slide 72 Set 45,000 72 0 72 72 0 45,000 DAU 2012 0
540 Slide 72 Set 0 0 0 0 0 0 0
541 Slide Box 1 Set 80,000 1 0 1 1 0 80,000 DAU 2010 0
542 Slide Box 1 Set 0 0 0 0 0 0 0
543 SGOT 4x50+4x10 ml (80x50) 1 Kit 0 0 0 0 0 0 0
544 SGOT 4x50+4x10 ml (80x50) 1 KIt 0 0 0 0 0 0 0
552 Tiamfenikol 500 mg 100 Ktk 100 61,600 0 0 0 0 300 0 61,600 DAK 2012 0
555 Tiamin HCl (Vit. B1) Inj. 30 ktk 30 amp 25,300 0 0 0 0 120 0 0 DAK 2013 0
557 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 41,580 2,000 0 2,000 2,000 0 83,160 0
558 Tensigar 30 Ktk /30 0 0 0 0 300 0 0 0
564 Tramadol Tab 50 Ktk 18,500 0 0 0 0 100 0 0 0
568 Urine Bag 1 pcs 11,500 0 0 0 0 0 0 DAU 2012 0
569 Urine Bag 1 pcs 0 0 0 0 0 0 0
575 Vitamin B Kompleks tab. 1,000 btl 1000 2,000 0 2,000 1,000 1,000 2,000 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
584 Yodium Povidon Lar. 10% 1 btl 1000 46,201 0 0 0 0 0 0 DAK 2011 0
586 Yodium Povidon Lar. 10% 1 btl 30 ml 2,200 19 0 19 13 6 0 13,200 0
591 Zinc Tablet 100 Ktk 100 0 0 0 0 0 0 0
592 CHKM 1 Btl 10 ml 145,500 0 0 0 0 1 0 0 DAU 2012 0
594 Prenatin Plus 100 Ktk 100 67,195 0 0 0 0 500 0 0 DAU 2013
595 Wibrom syr 1 Btl 6,880 20 0 20 20 0 30 0 0 DAU 2013
596 Selvitron Ktk 100 0 300 0 300 300 0 500 0 0 DAU 2013
597 Hemorogard Ktk 30 0 270 0 270 30 240 0 0 DAU 2013
598 Noza Ktk 100 0 200 0 200 200 0 500 0 0 DAU 2013
599 Sohhobion Inj Ktk 10 0 10 0 10 10 0 0 DAU 2013
600 Atropin tetes mata Btl 0 20 0 20 20 0 0 DAU 2013
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
Umum
Bayar
1 ISPA 1702 205
27 287 1 212 527 2 Dermatitis Al;ergi 2802 599
3 Gastritis 2001 56
4 RA 29 28
5 Caries Gigi 1901 25
6 Hipertensi 14 21
7 Diare 102 19
8 Pulpitis 19 16
9 Hipotensi 1603 16
10 Diabetes melitus 802 15

NIP. 19610219 198303 1 014 NIP. 19780505 200502 1 007 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
Lembar Merah : Dinkes Kab.
( LPLPO ) Lembar Kuning: Puskesmas
Kode Puskesmas : 720401201 Pelaporan Bulan : April 2014

Puskesmas : Lawanga Permintaan Bulan : Mei 2014
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 Abbocath N0. 18 1 buah 0 20 20 10 10 20 10 0 0 0
5 Abbocath No. 20 1 buah 0 20 20 10 10 20 10 0 0 0
8 Abbocath N0. 22 1 buah 0 20 20 20 20 0 0 0 0
9 Abbocath N0. 24 1 buah 19,500 14 0 14 14 20 6 0 273,000 DAK 2012 0
10 Abbocath N0. 24 1 buah 0 0 0 0 0 0 0
13 Alat suntik sekali pakai 1 ml 100 ktk 100 pcs 136,500 0 0 0 0 200 200 0 0 DAU 2012 0
15 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 118,200 100 0 100 100 200 100 0 118,200 DAU 2013 0
17 Alat suntik sekali pakai 5 ml 1 Pcs 1,042 100 0 100 100 200 100 0 104,200 BUFFER 0
22 Albendazole Tab. 400 mg 100 ktk 30 12,200 2,000 0 2,000 2,000 2,000 0 0 244,000 BUFFER 0
25 Allopurinol Tab. 100 mg 100 ktk 100 14,518 200 0 200 200 300 100 0 29,036 DAK 2013 0
26 Alprazolam 0,5 mg 100 ktk 100 0 0 0 0 94 94 0 0 0
27 Albotil 1 Btl 10 ml 40,909 0 0 0 0 30 30 0 0 DAK 2012 0
28 Albotil 1 Btl 10 ml 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
33 Ambroksol 30 mg 100 ktk 100 0 0 0 0 600 600 0 0 0
37 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 0 200 200 100 100 300 200 0 13,201 DAK 2013 0
38 Amlodipin Tab 50 Ktk 50 52,800 0 0 0 0 312 312 0 0 0
40 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 3,700 0 20 20 17 3 62 59 0 11,100 BUFFER 0
42 Amoksisilin Kapsul 250 mg 100 ktk 100 28,740 1,700 0 1,700 700 1,000 1,092 92 0 287,400 DAK 2102 0
44 Amoksisilin Kaplet 500 mg 100 ktk 100 37,000 1,200 0 1,200 1,000 200 3,744 3,544 0 DAK 2012 0
45 Amoksisilin Kaplet 500 mg 100 Ktk 100 0 500 500 500 0 18,720 DAK 2013 0
50 Anemolat Tab 1 mg 100 Ktk 100 15,000 0 0 0 0 0 0 0 DAK 2011 0
54 Antasida DOEN, Tab. kombinasi 100 ktk 100 16,200 1,300 0 1,300 1,100 200 1,560 1,360 0 0 DAK 2012 0
57 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 3,850 0 0 0 0 93 93 0 0 DAK 2012 0
62 Asiklovir 400 mg 100 Ktk 100 0 0 0 0 0 0 0
63 Asiklovir 200 mg 100 ktk 100 42,700 0 0 0 0 0 0 0 DAK 2011 Exp Sep'13
64 Asiklovir 200 mg 30 Ktk 30 0 300 300 200 100 312 212 0 0 0
65 Asiklovir salep 25 ktk 25 75,000 0 0 0 0 0 0 0 0 DAK 2012 0
68 Anti fungi Doen 24 Ktk/24 45,372 0 0 0 0 0 0 0 0 0
69 Anti fungi Doen 24 Ktk/24 0 0 0 0 0 0 0 0 0
71 AntiHemoroid DOEN komb. 10 ktk 10 supp 10 0 10 10 0 20 20 0 0 DAK 2013 0
74 Aquadest steril 25 ml 10 ktk 10 btl 15,000 30 0 30 30 30 0 0 45,000 BUFFER 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
76 Asam askorbat (Vit. C) tab. 250 mg 250 btl 250 0 0 0 0 0 0 0 0
77 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 30,250 0 0 0 0 0 0 0 BUFFER 0
78 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 35,200 0 3,000 3,000 3,000 1,872 0 0 105,600 DAK 2013 0
80 Asam Mefenamat Tab. 500 mg 100 ktk 100 17,050 0 0 0 0 0 0 0 BUFFER 0
81 Asam Mefenamat Tab. 500 mg 100 ktk 100 17,600 0 0 0 0 0 0 0 DAK 2012 0
82 Asam Mefenamat Tab. 500 mg 100 ktk 100 19,350 0 1,000 1,000 400 600 1,560 960 0 116,100 DAK 2013 0
88 Acetosal 100 mg 100 ktk/100 0 0 0 0 0 0 0
96 Betamidon 1 Vial 0 0 0 0 0 0 0 0
98 Betadryl Injeksi 1 Vial 0 0 0 0 0 0 0 0
99 Betametason krim 0,1% 25 Ktk 25 tube 51,310 0 0 0 0 0 0 0 DAK 2011 0
100 Betametason krim 0,1% 1 Tube 2,053 0 0 0 0 64 64 0 0 BUFFER 0
101 Betametason krim 0,1% 1 Tube 0 0 0 0 0 0 0 0
102 Bioplasenton 1 Tube 27,045 0 0 0 0 26 26 0 0 DAU 2012 0
103 Bioplasenton 1 Tube 0 0 0 0 0 0 0 0
106 Captopril Tab. 25 mg 100 ktk 100 13,775 0 0 0 0 0 0 0 DAK 2012 0
107 Captopril Tab. 25 mg 100 ktk 100 15,153 0 0 0 0 0 0 0 BUFFER 0
109 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 320,000 0 0 0 0 0 0 0 BUFFER 0
110 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,909 48 0 48 24 24 24 0 0 290,909 DAK 2012 0
111 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,000 0 0 0 0 0 0 0 DAK 2011 0
112 Catgut/benang bedah no. 2/0-3/1 24 ktk 24 0 0 0 0 0 0 0 0
113 Cetoconazole tab 50 ktk/50 22,550 200 0 200 50 150 150 0 0 67,650 DAK 2013 0
114 Cholesterol 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
116 Cetirizine 10 mg 50 ktk 50 15,675 0 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
117 Cetirizine 10 mg 50 ktk 50 0 0 0 0 0 0 0 0
119 Cimetidin Tab. 100 ktk 100 0 0 0 0 0 0 0 0
120 Ciprofloxacin 500mg 100 ktk 100 31,240 300 200 500 400 100 1,560 1,460 0 31,240 DAK 2013 0
122 Clonidine 0.15 mg 100 Ktk/100 0 0 0 0 0 0 0 0
124 Dasabion 100 Ktk/100 0 0 0 0 0 0 0 0
127 Deksametason Tab. 0,5 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
128 Deksametason Tab. 0,5 mg 100 Ktk 100 9,349 200 0 200 200 0 2,964 0 0 0 BUFFER 0
129 Deksametason Tab. 0,5 mg 100 Ktk 100 17,400 0 0 0 0 0 0 0 DAK 2012 0
130 Deksametason Tab. 0,5 mg 100 Ktk 100 9,560 0 800 800 400 400 2,964 2,564 0 38,240 DAK 2013 0
132 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 3,152 20 0 20 12 8 -8 0 25,216 DAK 2013 0
133 Dekstrometorfan HBr tab. 15 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
134 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 11,000 0 0 0 0 0 0 0 DAK 2012 0
135 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 10,890 0 0 0 0 0 0 0 BUFFER 0
136 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 1,000 0 1,000 400 600 468 0 0 0 0
137 Devitalisasi Pasta Non Arsen (Devitasol) 1 ktk/btl 0 0 0 0 1 1 0 0 0
138 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 78,147 0 0 0 0 0 0 0 BUFFER 0
139 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 26,049 0 0 0 0 0 0 0 0
140 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
141 Diazepam tab. 2 mg 100 btl 1000 27,000 0 0 0 0 0 0 0 DAK 2011 0
142 Diazepam tab. 2 mg 100 btl 1000 35,090 0 0 0 0 0 0 0 BUFFER 0
143 Diazepam tab. 2 mg 1,000 btl 1000 35,090 0 1,000 1,000 1,000 93 0 0 35,090 DAK 2013 0
144 Diazepam tab. 2 mg 100 Btl 100 0 0 0 0 0 0 0 0
145 Diazepam tab. 5 mg 250 btl 250 0 0 0 0 0 0 0 0
146 Dietilkarbamazin Sitrat tab. 100 mg/5 ml 100 ktk 100 10,725 14,300 0 14,300 14,300 0 0 1,533,675 0
147 Dietilkarbamazin Sitrat tab. 100 mg/5 ml 100 ktk 100 0 0 0 0 0 0 0 0
149 Difenhidramin HCl inj. 10 mg/ml-1 ml 30 ktk 30 amp 0 60 60 30 30 30 0 0 0 0
150 Dextran 70 lar. Infus 1 Btl 500 ml 0 0 0 0 0 0 0 0
151 Digoxin Tab.0,25 mg 100 ktk 100 14,300 0 0 0 0 0 0 0 DAK 2012 0
152 Digoxin Tab.0,25 mg 100 ktk 101 0 0 0 0 0 0 0 0
153 Diltiazem 30 mg 100 Ktk 100 15,163 200 0 200 200 0 0 30,326 DAK 2012 0
154 Diltiazem 30 mg 100 Ktk 101 0 0 0 0 0 0 0 0
155 Doxyciclin 100 ktk 100 55,660 0 0 0 0 0 0 0 0
156 Doxyciclin 100 ktk 100 0 0 0 0 0 0 0 0
158 Domperidon Tab 10 mg 100 Ktk 100 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
160 Domperidon syr 1 Btl 60 ml 0 0 0 0 0 0 0 0
161 Ergotamin tartrat + kofein 100 Btl/100 10,367 0 0 0 0 156 156 0 0 DAK 2011 0
162 Ergotamin tartrat + kofein 100 Btl/100 0 0 0 0 0 0 0 0
163 Efedrin HCl tab. 25 mg 250 btl 250 28,500 0 0 0 0 93 93 0 0 DAK 2011 0
164 Efedrin HCl tab. 25 mg 250 btl 250 0 0 0 0 0 0 0 0
165 Ekstrak Belladon Tab. 100 btl 1000 17,892 0 0 0 0 0 0 0 BUFFER 0
166 Epinefrin HCl Inj. 0,1% 30 ktk 30 amp 0 0 0 0 0 0 0 0
167 Erithromisin Kapsul 250mg 120 ktk 120 60,000 0 0 0 0 0 0 0 DAK 2012 0
169 Erithromisin Kapsul 500mg 100 ktk 100, strip 78,100 0 0 0 0 0 0 0 DAK 2011 0
170 Erithromisin Kapsul 500mg 100 ktk 100, strip 0 0 0 0 0 0 0 0
172 Eritromisin Syr. 200 mg/ 5 ml 1 btl 60 ml 0 0 0 0 0 0 0 0
175 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 4 0 4 1 3 2 0 0 0 DAK 2013 0
176 Etambutol Tab. 100 ktk 100 52,580 100 0 100 100 0 0 52,580 DAK 2011 0
178 Etanol 70% 1 Btl 300 ml 11,990 3 2 5 2 3 2 0 0 35,970 DAU 2013 0
179 Etanol 70% 1 btl 1000 ml 45,000 0 0 0 0 0 0 DAK 2011 0
180 Etanol 70% 1 btl 1000 ml 0 0 0 0 0 0 0 0
181 Etanol 70% 1 btl 100 ml 0 0 0 0 0 0 0 0
182 Etil klorida semprot 1 btl 100 ml 181,000 0 0 0 0 0 0 0 DAU 2012 0
183 Etil klorida semprot 1 btl 100 ml 115,490 1 0 1 1 0 1 1 0 0 DAU 2013 0
184 Entrasol susu 1 ktk 185 gr 0 0 0 0 0 0 0 0
185 Ethigent injeksi 80 mg/ml 1 ktk 1 vial 2 ml 0 0 0 0 0 0 0 0
187 Fenilbutason Tab 1,000 Btl 1000 89,100 0 0 0 0 0 0 0 BUFFER 0
188 Fenitoin Natrium Inj.g/ml 1 btl 1000 0 0 0 0 0 0 0 0
189 Fenitoin Natrium kap 100mg 100 btl 100 0 0 0 0 0 0 0 0
190 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
191 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 20,100 0 0 0 0 0 0 0 BUFFER 0
192 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 42,899 0 0 0 0 0 0 0 0
194 Fenobarbital tab. 30 mg 100 btl 1000 60,355 0 0 0 0 0 0 0 DAK 2013 0
195 Fenobarbital tab. 30 mg 1,000 btl 1000 34,100 0 1,000 1,000 1,000 312 0 0 34,100 DAK 2010 0
196 Fenobarbital tab. 100 mg 250 btl 250 0 0 0 0 0 0 0 0
197 Fenoksimetil Penisilina Tab. 500 mg 100 btl 100 tab. 45,650 0 0 0 0 0 0 0 DAK 2011 0
199 Ferrolat Tab. 30 ktk 30 tab 0 0 0 0 0 0 0 0
200 Ferrous Sulfat Tab. 1,000 btl 1000 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
202 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 47,850 0 0 0 0 0 0 0 DAK 2011 0
203 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
205 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 74,868 200 0 200 200 156 0 0 149,736 DAK 2013 0
208 Furosemid tab. 40 mg 200 ktk 200 19,800 0 200 200 200 0 0 19,800 DAK 2011 0
209 Furosemid tab. 40 mg 200 ktk 200 15,844 0 0 0 0 0 0 0 DAK 2010 0
210 Furosemid tab. 40 mg 200 ktk 200 0 0 0 0 0 0 0 0
211 Gameksan Emulsi 1% 1 btl 30 ml 0 0 0 0 0 0 0 0
212 Gentamisin Sulfat tetes mata 1 Botol 5 ml 3,630 0 0 0 0 0 0 0 DAK 2013 0
213 Garam Oralit untuk 200 ml air 100 ktk 100 sach 41,800 200 0 200 200 93 0 0 83,600 DAK 2013 0
214 Garam Oralit untuk 200 ml air 25 ktk 25 sach 10,026 0 0 0 0 0 0 0 DAK 2011 0
215 Garam Oralit untuk 200 ml air 25 ktk 25 sach 0 0 0 0 0 0 0 0
218 Gentamisin Salep 1 ktk 25 0 0 0 0 0 0 0 DAK 2013 0
219 Gentian violet larutan 1% 1 btl 10 ml 1,930 0 0 0 0 0 0 0 DAK 2012 0
220 Gentian violet larutan 1% 1 btl 10 ml 0 0 0 0 0 0 0 0
222 Glibenklamid Tab. 2 mg 100 ktk 100 7,200 400 0 400 200 200 156 0 0 14,400 DAK 2012 0
223 Glibenklamid Tab. 2 mg 100 ktk 100 0 0 0 0 0 0 0 0
224 Gliserin 1 Btl 100 ml 0 0 0 0 0 0 0 0
225 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 25,563 0 0 0 0 0 0 0 BUFFER 0
226 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 27,900 0 0 0 0 0 0 0 DAK 2012 0
227 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 30,690 2,000 0 2,000 1,000 1,000 2,808 1,808 0 30,690 DAK 2013 0
228 Glukosa 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
229 Glukosa lar. infus 5% steril 1 500 ml 8,272 13 0 13 6 7 18 11 0 57,904 DAK 2012 0
230 Glukosa lar. infus 5% steril 1 500 ml 0 0 0 0 0 0 0 0
231 Glukosa lar. infus 10% steril 1 btl 500 ml 0 0 0 0 0 0 0 0
232 Glukosa lar. infus 40% steril 10 Ktk 10 0 0 0 0 0 0 0 0
234 Griseofulvin tab. 125 mg, micronized 100 btl 100 0 300 0 300 300 312 0 0 0 BUFFER 0
235 Hanschoend steril No. 6,5 1 Pcs 10 0 10 8 2 10 8 0 0 0
236 Hanschoend steril No. 7 1 Pcs 8,200 0 0 0 0 10 10 0 0 DAU 2012 0
237 Hanschoend steril No. 7 1 Pcs 0 0 0 0 0 0 0 0
238 Hanschoend steril No. 7,5 1 Pcs 8,200 0 0 0 0 10 10 0 0 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
243 Hustab P Syrup 1 btl 60 ml 11,500 0 0 0 0 31 31 0 0 DAU 2011 0
244 Hustab P Syrup 1 btl 60 ml 0 0 0 0 0 0 0 0
245 Hub Cutter 1 buah 0 0 0 0 0 0 0 0
246 Haloperidol Tab. 0,5 mg 100 ktk 100 0 0 0 0 0 0 0 0
248 Haloperidol Tab.5 mg 100 ktk 100 12,229 100 0 100 100 0 0 12,229 DAK 2012 0
249 Haloperidol Tab.5 mg 100 ktk 100 0 0 0 0 0 0 0 0
250 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 39,930 0 0 0 0 0 0 0 DAK 2011 0
251 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
254 Hemaglobin 500 ml 1 btl 0 0 0 0 0 0 0 0
255 Hemafort 100 ktk 100 0 0 0 0 624 624 0 0 0
257 Ibuprofen suspensi 1 Btl 60 ml 0 0 0 0 0 0 0 0
258 Ibuprofen tab. 200 mg 100 btl 100 0 0 0 0 468 468 0 0 0
259 Ibuprofen tab. 400 mg 100 btl 100 19,799 0 0 0 0 0 0 0 BUFFER 0
260 Ibuprofen tab. 400 mg 100 btl 100 20,476 0 0 0 0 468 468 0 0 DAK 2012 0
261 Ibuprofen tab. 400 mg 100 btl 100 0 0 0 0 0 0 0 0
262 Infus Set Anak 1 set 7,000 6 0 6 6 18 12 0 42,000 DAK 2012 0
263 Infus Set Anak 1 set 14,500 0 0 0 0 0 0 0 DAU 2012 0
264 Infus Set Anak 1 set 0 0 0 0 0 0 0 0
265 Infus Set Dewasa 1 set 12,500 0 0 0 0 0 0 0 DAU 2012 0
266 Infus Set Dewasa 1 set 7,000 0 0 0 0 0 0 0 DAK 2012 0
267 Infus Set Dewasa 1 set 7 0 7 7 18 11 0 0 DAK 2013 0
268 Insulin Inj. 10 ml 1 Vial 0 0 0 0 0 0 0 0
269 Iodium Tes 1 btl 10 ml 0 0 0 0 0 0 0 0
270 Iodiol Kapsul lunak 100 btl 100 102,300 0 0 0 0 0 0 0 DAK 2011 0
271 Iodiol Kapsul lunak 100 btl 100 0 0 0 0 0 0 0 0
272 Isoniasid (INH) Tab. 100 mg 100 ktk 100 40,700 0 0 0 0 0 0 0 DAK 2011 0
274 Isoniasid (INH) Tab. 300 mg 100 ktk 100 0 0 0 0 0 0 0 0 284
275 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 41,000 0 0 0 0 0 0 0 DAK 2012 0
276 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 8,910 0 0 0 0 0 0 0 BUFFER 0
277 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 0 0 0 0 0 0 0 0
278 Isi ulang oksigen tabung besar 1 tabung 0 0 0 0 0 0 0 0
279 Isi ulang oksigen tabung kecil 1 tabung 0 0 0 0 0 0 0 0
280 Isi ulang oksigen tabung sedang 1 tabung 0 0 0 0 0 0 0 0
281 Jarum Hecting Jar. Otot no 7 12 lusin 113,500 0 0 0 0 0 0 0 DAU 2012 0
282 Jarum Hecting kulit no 5 12 lusin 113,500 0 0 0 0 0 0 0 DAU 2012 0
283 Jarum hecting kulit no 7 12 lusin 113,500 0 0 0 0 0 0 0 DAU 2012 0
284 Jarum otot no 5 12 lusin 113,500 12 0 12 12 -12 0 113,500 DAU 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
285 Kalium Permanganat Serbuk 1 ktk 20 btl 0 0 0 0 0 0 0 0
288 Kalsium laktat 1,000 btl 1000 57,200 0 0 0 0 0 0 0 DAK 2011 0
289 Kalsium laktat 1,000 btl 1000 57,200 2,000 0 2,000 2,000 2,184 184 0 114,400 DAK 2013 0
291 Kanamycin Base 1g Inj. 1 Vial 0 0 0 0 0 0 0 0
292 Kapas 250 g 1 bungkus 27,500 0 0 0 0 0 0 0 DAU 2012 0
294 Kapas 250 g 1 bungkus 0 0 0 0 0 0 0 0
295 Karbamazepin Tab. 200 mg 100 ktk 100, strip 24,645 0 0 0 0 0 0 0 DAK 2012 0
296 Karbamazepin Tab. 200 mg 100 ktk 100, strip 100 100 200 200 144 0 0 0 DAK 2013 0
297 Kasa kompres 40/40 steril 1 bks 0 0 0 0 0 0 0 0
298 Kasa pembalut hdrofil 4 m x 10 cm 1 rol/50 0 50 50 50 0 93 93 0 0 0
299 Kasa Pembalut Hidrofil 4 x 3 cm 1 rol 0 0 0 0 0 0 0 0
300 Kasa Pembalut Hidrofil 16 x 16 cm 1 ktk 0 0 0 0 0 0 0 0
301 Kasa Pembalut 2 x 80cm 1 Rol 16,500 0 0 0 0 0 0 0 DAU 2012 0
302 Kasa Pembalut 2 x 80cm 1 Rol 0 0 0 0 0 0 0 0
303 Kasa Steril 18 x 22 cm 16 ktk 16 lbr 0 0 0 0 0 0 0 0
307 Kasa pembalut hdrofil 3,6 m x 5 cm 1 rol 2,500 0 0 0 0 0 0 0 DAU 2012 0
308 Kasa pembalut hdrofil 3,6 m x 5 cm 1 rol 0 0 0 0 0 0 0 0
312 Ketokonazol krim 2% 1 tube 15 gr 0 0 0 0 0 0 0 0
313 Ketokonazol Tablet 200 mg 50 Ktk 50 20,473 0 0 0 0 0 0 0 DAK 2012 0
315 Ketoprofen Tablet 100 Ktk 100 68,826 0 0 0 0 0 0 0 DAU 2012 0
316 Kloramfenikol Kaps. 250 mg 250 Btl/250 57,750 500 0 500 500 0 0 115,500 DAK 2011 0
317 Kloramfenikol Kaps. 250 mg 250 Btl/250 0 0 0 0 0 0 0 0
318 Kloramfenikol Kaps. 250 mg 1,000 Btl 1000 57,750 0 0 0 0 0 0 0 DAK 2011 0
320 Kloramfenikol Kaps. 250 mg 1,000 Btl 1000 0 0 0 0 0 0 0 0
322 Kloramfenikol Sirup 1 btl 60 ml 4,400 0 0 0 0 0 0 0 DAK 2011 0
323 Kloramfenikol Sirup 1 btl 60 ml 4,950 22 0 22 20 2 31 29 0 9,900 DAK 2013 0
324 Kloramfenikol Tetes Telinga 24 ktk 24 btl 0 0 0 0 26 26 0 0 0
325 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 0 0 0 0 0 0 79,200 DAK 2011 0
326 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 24,000 0 0 0 0 0 0 0 DAK 2012 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
327 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 0 2,000 2,000 2,000 0 3,558 3,558 0 0 DAK 2013 0
328 Klorokuin fosfat tab. 150 mg 1,000 btl 1000 85,000 0 0 0 0 0 0 0 DAK 2012 0
330 Klorokuin fosfat tab. 150 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
331 Klorpromazin HCl Inj. 5mg/ml - 2ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
332 Klorpromazin HCl Inj. 25ml/ml-2ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
333 Klorpromazin HCl Tab. 25 mg 1,000 btl 1000 26,895 0 0 0 0 0 0 0 DAK 2010 0
334 Klorpromazin HCl Tab. 25 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
335 Klorpromazin HCl Tab. 100 mg 1,000 btl 1000 91,509 1,000 0 1,000 1,000 0 0 91,509 DAK 2013 0
336 Klorpromazin HCl Tab. 100 mg 250 btl 250 153,000 0 0 0 0 0 0 0 0
337 Klorpropamid Tab. 100 mg 250 btl 500 0 0 0 0 0 0 0 0
338 Kodein Fosfat Tab. 10 mg 250 btl 250 106,820 0 0 0 0 60 60 0 0 DAK 2011 0
339 Kodein Fosfat Tab. 10 mg 250 btl 250 0 0 0 0 0 0 0 0
340 Komb. pirimetamin 25mg + sulfadoksin500mg 100 ktk 100 52,030 0 0 0 0 0 0 0 DAK 2011 0
342 Kotrimoksazol pediatrik tab. 120 mg 100 btl 100 300 0 300 100 200 35 0 0 0 0
344 Kotrimoksazol suspensi 1 btl 60 ml 3,850 0 20 20 20 0 187 187 0 0 BUFFER 0
346 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 16,500 0 0 0 0 0 0 0 DAK 2012 0
347 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 18,149 400 0 400 400 0 936 936 0 0 DAK 2013 0
348 Kuinin dihidroklorida inj. - 2 ml 30 ktk 30 amp 126,800 0 0 0 0 0 0 0 DAK 2012 0
349 Kuinin dihidroklorida inj. - 2 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
350 Kuinin Sulfat Tab. 222 mg 60 ktk 60 49,700 0 0 0 0 0 0 0 DAK 2012 0
351 Kuinin Sulfat Tab. 222 mg 60 ktk 60 0 0 0 0 0 0 0 0
352 Lar. benedict 1 btl 100 ml 28,324 0 0 0 0 0 0 0 DAU 2010 0
353 Lar. benedict 1 btl 100 ml 0 0 0 0 0 0 0 0
354 Lar. Eosin 2% 1 btl 100 ml 66,000 0 0 0 0 0 0 0 DAU 2010 0
355 Lar. Eosin 2% 1 btl 100 ml 0 0 0 0 0 0 0 0
356 Lar. Etanol Asam 1 btl 100 ml 0 0 0 0 0 0 0 0
357 Lar. Giemsa Stain 1 btl 100 ml 0 0 0 0 0 0 0 0
358 Lar. Karbol Fuchsin 1 btl 100 ml 0 0 0 0 0 0 0 0
359 Lar. Metanol 1 btl 100 ml 0 0 0 0 0 0 0 0
360 Lar. Turk 1 btl 100 ml 16,254 0 0 0 0 0 0 0 BUFFER 0
361 Lar. Turk 1 btl 100 ml 32,500 0 0 0 0 0 0 0 DAK 2010 0
362 Lar. Turk 1 btl 100 ml 0 0 0 0 0 0 0 0
363 Lidokain Komp. Inj. 30 ktk 30 amp 101,000 0 0 0 0 0 0 0 DAK 2012 0
364 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 0 0 0 0 0 0 0 BUFFER 0
365 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 30 0 30 30 0 62 62 0 0 DAK 2013 0
366 Lidokain Inj. 100 ktk 100 amp 101,000 0 0 0 0 0 0 0 DAK 2012 0
367 Lidokain Inj. 100 ktk 100 amp 101,750 0 0 0 0 0 0 0 BUFFER 0
368 Lidokain Inj. 100 ktk 100 amp 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
369 Lisol 1 btl 1000 ml 45,000 0 0 0 0 5 5 0 0 DAU 2012 0
370 Lisol 1 btl 1000 ml 0 0 0 0 0 0 0 0
372 levofloksasin 50 Ktk 50 0 0 0 0 0 0 0 0
374 Magnesium Sulfat Inj. (IV) 20%-25ml 10 ktk 10 0 0 0 0 0 0 0 0
375 Magnesium Sulfat Inj. (IV) 40%-25ml 1 btl 25 ml 19,479 0 0 0 0 0 0 0 DAK 2012 0
376 Magnesium Sulfat Inj. (IV) 40%-25ml 1 btl 25 ml 0 0 0 0 0 0 0 0
377 Magnesium Sulfat serbuk 30 g 10 Ktk 10 Bks 0 0 0 0 0 0 0 0
378 Masker 50 ktk 50 68,500 0 0 0 0 62 62 0 0 DAU 2012 0
379 Masker 50 ktk 50 0 0 0 0 0 0 0 0
380 Metanol 1 Btl 100 ml 0 0 0 0 0 0 0 0
381 Malasiqrin 10 ktk 10 sase 0 0 0 0 0 0 0 0
383 Mata Pisau Carbon No.10 1 pcs 0 0 0 0 26 26 0 0 0
385 Mata Pisau Carbon No.11 1 pcs 0 0 0 0 0 0 0 0
389 Mata Pisau Carbon No. 20 1 pcs 0 0 0 0 0 0 0 0
392 Mata Pisau Carbon No.22 1 pcs 6,750 0 0 0 0 0 0 0 0
395 Mebendazol Tab. 100 mg 30 ktk 30, strip 0 0 0 0 0 0 0 0
396 Metampiron Tab 500 mg 100 Ktk 100 14,900 0 0 0 0 0 0 0 0
397 Metampiron Tab 500 mg 100 Ktk 100 0 0 0 0 0 0 0 0
398 Metilergometrin maleat inj. 0,200 mg - 1 ml 30 ktk 30 amp 45,100 0 0 0 0 0 0 0 0
400 Metilergometrin maleat tab. salut 0,125 mg 100 ktk 100 0 0 0 0 0 0 0 0
402 Metoklorpropamid Tab. 10 mg 100 ktk 100 11,000 0 0 0 0 312 312 0 0 DAK 2012 0
403 Metoklorpropamid Tab. 10 mg 100 ktk 100 0 0 0 0 0 0 0 0
404 Metformin tab 100 ktk 100 18,150 0 0 0 0 0 0 DAK
0 2012/BUFFER 0
406 Metronidazol tab. 250 mg 100 ktk 100, strip 0 0 0 0 0 0 0 0
407 Metronidazol tab. 500 mg 100 ktk 100, strip 24,200 400 0 400 100 300 468 168 0 72,600 DAK 2013 0
409 Metil prednisolon tab 100 ktk 100 44,055 0 0 0 0 312 312 0 0 DAU 2012 0
410 Metil prednisolon tab 100 ktk 100 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
411 Mikonazole Krim 1 tube 3,000 0 0 0 0 31 31 0 0 DAK 2013 0
412 Mikonazole Krim 1 tube 0 0 0 0 0 0 0 0
413 Monoklor Kamfer Mentol (CHKM) 1 btl 10 ml 0 0 0 0 0 0 0 0
415 Natrium bikarbonat tab. 1,000 btl 1000 15,730 0 0 0 0 0 0 0 DAK 2011 0
416 Natrium bikarbonat tab. 1,000 btl 1000 0 0 0 0 0 0 0 0
417 Natrium Diklofenak Tab. 50 mg 50 ktk 50 8,384 0 0 0 0 50 50 0 0 DAK 2012 0
418 Natrium Diklofenak Tab. 50 mg 50 ktk 50 0 0 0 0 0 0 0 0
420 Natrium klorida lar. infus steril 0,9% 1 500 ml 0 0 0 0 0 0 0 BUFFER 0
421 Natrium Tiosulfat Inj.25%-10 ml 10 ktk 10 amp 16,359 0 0 0 0 0 0 0 BUFFER 0
422 Nifedipin Tab. 10 mg 100 ktk 100 37,000 0 0 0 0 0 0 0 0
424 Nifedipin Tab. 10 mg 100 ktk 100 0 0 0 0 0 0 0 0
425 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 37,000 0 0 0 0 0 0 0 DAK 2012 0
426 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 47,200 300 0 300 300 0 0 141,600 DAK 2013 0
429 Novadryl Inj. 1 Vial 0 0 0 0 0 0 0 0
430 Novamydon Inj. 1 Vial 0 0 0 0 0 0 0 0
431 Obat antituberkulosis kategori I 1 Paket 0 0 0 0 0 0 0 0
432 Obat antituberkulosis kategori II 1 Paket 0 0 0 0 0 0 0 0
433 Obat antituberkulosis kategori III 1 Paket 0 0 0 0 0 0 0 0
434 Obat antituberkulosis kategori anak 1 Paket 0 0 0 0 0 0 0 0
436 OBH Plus 1 btl 100 ml 9,750 0 0 0 0 31 31 0 0 DAU 2012 0
437 OBH Plus 1 btl 100 ml 0 0 0 0 0 0 0 0
438 Oksitetrasiklin HCl Inj. 50 mg/ml - 10 ml 10 ktk 10 vial 34,100 0 0 0 0 0 0 0 DAK 2013 0
439 Oksitetrasiklin HCl Salep Kulit 3% 1 tube 1,843 0 0 0 0 31 31 0 0 0
440 Oksitetrasiklin salep mata 25 ktk 25 tube 48,000 0 0 0 0 0 0 0 DAK 2012 0
442 Oksitetrasiklin salep mata 25 ktk 25 tube 0 0 0 0 0 0 0 0
444 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 0 0 0 0 31 31 0 0 0
445 Oksitosin inj. 10 iu/ml - 1 ml 30 Ktk 30 amp 0 0 0 0 0 0 0 0
446 Omeprazol kapsul 20 mg 30 Ktk 30 12,250 0 0 0 0 30 30 0 0 DAK 2012 0
447 Omeprazol kapsul 20 mg 30 Ktk 30 13,475 0 0 0 0 0 0 0 BUFFER 0
448 Omeprazol kapsul 20 mg 30 Ktk 30 0 0 0 0 0 0 0 0
449 Papaverin tab 1,000 btl 1000 99,500 1,000 0 1,000 1,000 0 0 99,500 DAK 2012 0
450 Papaverin tab 1,000 btl 1000 0 0 0 0 0 0 0 0
451 Papaverin injeksi 100 ktk 100 0 0 0 0 0 0 0 0
452 Paramidon Inj. 1 Vial 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
454 Parasetamol sirup 120 mg/5 ml 1 btl 60 ml 2,529 0 0 0 0 0 0 0 BUFFER 0
456 Parasetamol Tab. 100 mg 100 btl 100 0 0 0 0 0 0 0 0
458 Parasetamol tab. 500 mg 100 ktk 100 11,544 1,500 500 2,000 700 1,300 3,744 2,444 0 150,072 DAK 2013 0
459 Parasetamol tab. 500 mg 120 Ktk 120 12,600 0 0 0 0 0 0 0 DAK 2012 0
460 Parasetamol tab. 500 mg 120 Ktk 120 0 0 0 0 0 0 0 0
461 Parasetamol drop 1 Btl 15 ml 5,280 0 0 0 0 10 10 0 0 DAK 2012 0
462 Parasetamol drop 1 Btl 15 ml 0 0 0 0 0 0 0 0
463 Pehavral 100 ktk 100 96,500 0 0 0 0 0 0 0 DAU 2012 0
464 Pehavral 100 ktk 100 0 0 0 0 624 624 0 0 0
465 Petidin inj 10 ktk/10 131,904 0 0 0 0 0 0 0 DAK 2011 0
466 Petidin inj 5 ktk/5 64,250 0 0 0 0 0 0 0 0
467 Petidin inj 10 ktk/10 0 0 0 0 0 0 0 0
468 Pembalut Gips 1 rol 42,500 0 0 0 0 0 0 0 BUFFER 0
469 Pirantel pamoat tab. 365 mg 60 ktk 100 20,450 100 0 100 100 0 124 124 0 0 DAK 2013 0
470 Pirantel pamoat tab. 365 mg 60 ktk 60 0 0 0 0 0 0 0 0
471 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 15,725 2,000 0 2,000 2,000 624 0 0 15,725 DAK 2011 0
472 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
473 Pilokarpin tetes mata (HCL/nitrat) 1 btl 5 ml 0 0 0 0 0 0 0 0
474 Piroxicam Tab. 100 Ktk 100 8,400 0 0 0 0 936 936 0 0 DAK 2012 0
475 Piroxicam Tab. 100 Ktk 100 11,552 0 0 0 0 0 0 0 DAK 2013 0
476 Piroxicam Tab. 100 Ktk 120 0 0 0 0 0 0 0 0
477 Pirasetam Kaplet 1200 mg 100 KTK 100 129,360 0 0 0 0 0 0 0 DAK 2012 0
479 Plester 1 rol 50,200 0 0 0 0 0 0 DAU 2012 0
480 Plester 1 rol 3,964 0 0 0 0 0 0 0 BUFFER 0
481 Plester 1 rol 25,980 3 2 5 2 3 3 0 0 77,940 DAU 2013 0
482 Pot sputum 1 pot 0 0 0 0 0 0 0 0
483 Prednison tab. 5 mg 1,000 btl 1000 68,750 0 0 0 0 0 0 275,000 DAK 2013 0
484 Prednison tab. 5 mg 1,000 btl 1000 62,500 0 0 0 0 0 0 0 DAK 2012 0
485 Prednison tab. 5 mg 1,000 btl 1000 63,250 0 0 0 0 0 0 0 BUFFER 0
486 Primakina tab. 15 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
487 Prokain Benzil Penisilin Inj. 3 juta 1 Vial 198,550 0 0 0 0 0 0 0 0
488 Propil Tiourasil Tab. 100 mg 100 btl 100 29,957 100 0 100 100 0 0 29,957 DAK 2012 0
489 Propil Tiourasil Tab. 100 mg 100 btl 100 0 0 0 0 0 0 0 0
490 Pytogin injk 10 IUml/ml-2 10 ktk 10 0 0 0 0 0 0 0 0
491 Propranolol HCl Tab. 40 mg 100 btl 100 13,310 0 0 0 0 0 0 0 BUFFER 0
493 Propranolol HCl Tab. 40 mg 100 btl 100 0 0 0 0 0 0 0 0
494 Rapit test kit 1 Ktk 25 strip 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
498 Ranitidin inj 25 ktk 25 ampul 0 0 0 0 0 0 0 0
500 Reserpin Tab. 0,10 mg 250 btl/250 0 0 0 0 0 0 0 0
501 Reserpin Tab. 0,25 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
502 Retinol (Vit. A) kaps. 100.000 IU 50 btl 50 0 0 0 0 0 0 0 0
504 Rifampisin Kaps. 450 mg 100 ktk 100 49,500 0 0 0 0 0 0 0 DAK 2010 0
505 Rifampisin Kaps. 450 mg 100 ktk 100 60,500 200 0 200 200 -200 0 121,000 DAK 2011 0
506 Reagen TB 2 N 1 Kit 0 0 0 0 0 0 0 0
508 Ringer laktat (RL) lar. Steril 1 500 ml 5,720 0 0 0 0 0 0 0 DAK 2011 0
510 Salbutamol Tab. 4 mg 100 ktk 100 9,000 0 0 0 0 0 0 0 0
511 Salbutamol Tab. 2 mg 100 ktk 100 0 0 0 0 0 0 0 0
512 Salbutamol Tab. 4 mg 100 ktk 100 9,749 200 0 200 200 0 468 468 0 0 DAK 2012 0
514 Salep 2-4 Komb 24 Ktk/24 Pot 32,450 24 0 24 24 26 2 0 32,450 DAK 2013 0
517 Salisil bedak 2% 1 50 g 0 0 0 0 20 20 0 0 0
518 Salisil spritus 10 % 1 ktk 10 btl 0 0 0 0 0 0 0 0
519 Sefadroksil 250 mg 100 Ktk 100 0 0 0 0 0 0 0 0
520 Sefadroksil 500 mg 100 Ktk 100 84,000 0 0 0 0 468 468 0 0 DAK 2012 0
522 Sefadroksil syr 1 Btl 60 ml 0 0 0 0 31 31 0 0 0
523 Serum ATS Inj. 10 ktk 10 vial 0 0 0 0 0 0 0 0
524 Sefotaksim Inj 1 gram 2 Ktk 2 Vial 69,300 0 0 0 0 0 0 0 DAK 2012 0
525 Sefotaksim Inj 1 gram 2 Ktk 2 Vial 0 0 0 0 0 0 0 0
527 Sianokobalamin (Vit. B12) inj. 500 mcg/ml 100 ktk100amp 114,070 0 0 0 0 62 62 0 0 DAK 2013 0
528 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 13,102 0 0 0 0 0 0 0 DAK 2012 0
529 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 14,412 0 0 0 0 1,716 1,716 0 0 0
530 Silk (benang bedah sutera) no. 3/0 36 ktk 36 pcs 818,182 36 0 36 36 0 26 26 0 0 DAK 2012 0
531 Silk (benang bedah sutera) no. 3/0 100m 36 ktk 36 pcs 0 0 0 0 0 0 0 0
532 Simvastatin 10 mg 30 Ktk 30 15,390 90 0 90 90 312 222 0 46,170 DAK 2012 0
533 Simvastatin 10 mg 30 Ktk 30 15,250 0 0 0 0 0 0 0 DAU 2012 0
534 Simvastatin 10 mg 30 Ktk 30 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
537 Sulfadimidin Tab. 500 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
538 Sulfasetamid Natrium Tetes mata 0,5% 1 btl 0 0 0 0 26 26 0 0 0
539 Slide 72 Set 45,000 72 0 72 72 -72 0 45,000 DAU 2012 0
540 Slide 72 Set 0 0 0 0 0 0 0 0
541 Slide Box 1 Set 80,000 1 0 1 1 -1 0 80,000 DAU 2010 0
542 Slide Box 1 Set 0 0 0 0 0 0 0 0
543 SGOT 4x50+4x10 ml (80x50) 1 Kit 0 0 0 0 0 0 0 0
544 SGOT 4x50+4x10 ml (80x50) 1 KIt 0 0 0 0 0 0 0 0
545 Silk (benang bedah sutera) No.3/0 12 Ktk 12 set 0 0 0 0 0 0 0 0
546 Tablet Tambah Darah 3,000 ktk 3000 tab 0 0 0 0 0 0 0 0
547 Temporary Stopping Fletcher 1 set 6,862 1 0 1 1 -1 0 6,862 BUFFER 0
549 Tetrasiklin HCl kaps. 250 mg 1,000 btl 1000 167,200 0 0 0 0 0 0 0 DAK 2011 0
550 Tetrasiklin HCl kaps. 250 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
551 Tetrasiklin HCl Kaps. 500 mg 100 ktk 100 0 0 0 0 0 0 0 0
553 Tiamfenikol 500 mg 100 Ktk 100 0 0 0 0 0 0 0 0
555 Tiamin HCl (Vit. B1) Inj. 30 ktk 30 amp 25,300 0 30 30 30 30 0 0 25,300 BUFFER 0
556 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 37,800 0 0 0 0 0 0 0 DAK 2012 0
557 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 41,580 2,000 0 2,000 1,000 1,000 1,560 560 0 41,580 0
558 Tensigar 30 Ktk /30 0 0 0 0 0 0 0 0
559 Triheksifenidil HCl Tab. 2 mg 100 ktk 100, strip 4,485 0 0 0 0 60 60 0 0 DAK 2010 0
561 Trigelicerides 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
562 Hemoglobin 500 ml 1 btl 0 0 0 0 0 0 0 0
563 Trisulfa Tab. 500 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
564 Tramadol Tab 50 Ktk 18,500 0 0 0 0 50 50 0 0 0
565 Tramadol inj 50 mg/ml 5 ktk 5 ampul 32,010 0 0 0 0 0 0 0 DAK 2012 0
566 Test Narkoba 5 Multi Acon Strip 1 Ktk 25 strip 0 0 0 0 0 0 0 0
567 Uric acid (asam urat) 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
568 Urine Bag 1 pcs 11,500 0 0 0 0 0 0 0 DAU 2012 0
569 Urine Bag 1 pcs 0 0 0 0 0 0 0 0
570 Ulsikur Inj 5 ktk 5Ampul 0 0 0 0 0 0 0 0
571 Vaccine Carrrier 1 buah 0 0 0 0 0 0 0 0
572 Vaksin Anti Rabies (Verorab) 1 Kur/ Set 0 0 0 0 0 0 0 0
573 Vitamin B Kompleks tab. 1,000 btl 1000 22,200 0 0 0 0 0 0 0 DAK 2012 0
574 Vitamin B Kompleks tab. 1,000 btl 1000 24,419 0 0 0 0 0 0 0 BEFFER 0
575 Vitamin B Kompleks tab. 1,000 btl 1000 1,000 1,000 2,000 2,000 1,716 0 0 0 0
576 Wing Needle No.21 G 1 pcs 3,500 0 0 0 0 0 0 0 BUFFER 0
577 Wing Needle No.21 G 1 Ktk/100 buah 0 0 0 0 0 0 0 0
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
585 Yodium Povidon Lar. 10% 1 btl 1000 0 0 0 0 1 1 0 0 0
586 Yodium Povidon Lar. 10% 1 btl 30 ml 2,200 6 0 6 6 5 0 0 13,200 DAK 2011 0
588 Yodium Povidon Lar. 10% 1 btl 30 ml 0 0 0 0 0 0 0 0
590 Yodium Povidon Lar. 10% 1 btl 300 ml 0 0 0 0 0 0 0 0
591 Zinc Tablet 100 Ktk 100 0 0 0 0 0 0 0 0
592 CHKM 1 Btl 10 ml 145,500 0 0 0 0 1 1 0 0 DAU 2012 0
594 Prenatin Plus 100 Ktk 100 67,195 0 500 500 200 300 312 12 0 201,585 DAU 2013
595 Wibrom syr 1 Btl 6,880 0 30 30 26 4 62 58 0 27,520 DAU 2013
596 Selvitron Ktk 100 0 0 500 500 300 200 312 112 0 0 DAU 2013
597 Hemorogard Ktk 30 0 240 0 240 60 180 30 0 0 0 DAU 2013
598 Noza Ktk 100 0 0 500 500 200 300 312 0 0 0 DAU 2013
600 Atropin tetes mata Btl 0 20 0 20 20 0 0 0 DAU 2013
601 0
602 0
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
KEMASAN PEMBERIAN
HARGA
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
Umum
Bayar
1 ISPA 1702 95
70 318 4 232 624 2 Dermatitis Al;ergi 2802 68
3 R.A 29 41
4 Gastritis 2001 39
5 Pulpitis 1902 39
6 Hipertensi 14 29
7 Hipotensi 1603 28
8 Diare 102 23
10 Thypoid 104 21

NIP. 19610219 198303 1 014 NIP. 19780505 200502 1 007 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
Kode Puskesmas : 720401201 Pelaporan Bulan : Mei 2014

Puskesmas : Lawanga Permintaan Bulan :
KEMASAN HARGA PEMBERIAN

$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 Abbocath N0. 18 1 buah 10 10 20 20 20 0 0 0 0
5 Abbocath No. 20 1 buah 10 10 20 20 20 0 0 0 0
8 Abbocath N0. 22 1 buah 20 20 40 40 20 0 0 0 0
9 Abbocath N0. 24 1 buah 19,500 14 0 14 14 20 6 0 273,000 DAK 2012 0
10 Abbocath N0. 24 1 buah 0 0 0 0 0 0 0
13 Alat suntik sekali pakai 1 ml 100 ktk 100 pcs 136,500 0 0 0 0 200 200 0 0 DAU 2012 0
14 Alat suntik sekali pakai 1 ml 100 ktk 100 pcs 0 100 100 100 0 0 BUFFER 0
15 Alat suntik sekali pakai 2,5 ml 100 ktk 100 pcs 118,200 100 0 100 100 200 100 0 118,200 DAU 2013 0
17 Alat suntik sekali pakai 5 ml 1 Pcs 1,042 100 0 100 100 200 100 0 104,200 BUFFER 0
22 Albendazole Tab. 400 mg 100 ktk 30 12,200 2,000 0 2,000 2,000 30 0 0 244,000 BUFFER 0
25 Allopurinol Tab. 100 mg 100 ktk 100 14,518 200 0 200 200 271 71 0 29,036 DAK 2013 0
26 Alprazolam 0,5 mg 100 ktk 100 0 0 0 0 30 30 0 0 0
27 Albotil 1 Btl 10 ml 40,909 0 0 0 0 10 10 0 0 DAK 2012 0
28 Albotil 1 Btl 10 ml 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
33 Ambroksol 30 mg 100 ktk 100 0 0 0 0 542 542 0 0 0
37 Amitriptilin HCl Tab. 25 mg 100 Ktk 10strip 13,201 100 100 200 200 271 71 0 26,402 DAK 2013 0
38 Amlodipin Tab 50 Ktk 50 52,800 0 0 0 0 271 271 0 0 0
39 Amlodipin Tab 50 Ktk 50 0 120 120 30 90 271 181 0 0 0
40 Amoksisilin sirup kering 125 mg/5 ml 1 btl 60 ml 3,700 3 13 16 16 0 62 62 0 0 BUFFER 0
42 Amoksisilin Kapsul 250 mg 100 ktk 100 28,740 1,000 0 1,000 700 300 948 648 0 86,220 DAK 2102 0
44 Amoksisilin Kaplet 500 mg 100 ktk 100 37,000 200 0 200 200 0 2,439 2,439 0 DAK 2012 0
45 Amoksisilin Kaplet 500 mg 100 Ktk 100 500 2,000 2,500 1,200 1,300 2,440 1,140 0 31,707 DAK 2013 0
50 Anemolat Tab 1 mg 100 Ktk 100 15,000 0 0 0 0 0 0 0 DAK 2011 0
54 Antasida DOEN, Tab. kombinasi 100 ktk 100 16,200 200 0 200 200 0 1,355 1,355 0 0 DAK 2012 0
56 Antasida DOEN, Tab. kombinasi 100 ktk 100 0 1,300 1,300 300 1,000 0 0 0
57 Antasida DOEN Suspensi,Kombinasi 1 Btl 60 ml 3,850 0 0 0 0 93 93 0 0 DAK 2012 0
62 Asiklovir 400 mg 100 Ktk 100 0 0 0 0 0 0 0
63 Asiklovir 200 mg 100 ktk 100 42,700 0 0 0 0 0 0 0 DAK 2011
64 Asiklovir 200 mg 30 Ktk 100 100 200 300 300 312 12 0 0 0
65 Asiklovir salep 25 ktk 25 75,000 0 0 0 0 0 0 0 0 DAK 2012 0
68 Anti fungi Doen 24 Ktk/24 45,372 0 0 0 0 0 0 0 0 0
69 Anti fungi Doen 24 Ktk/24 0 0 0 0 0 0 0 0 0
71 AntiHemoroid DOEN komb. 10 ktk 10 supp 0 0 0 0 20 20 0 0 DAK 2013 0
74 Aquadest steril 25 ml 10 ktk 10 btl 15,000 30 0 30 30 30 0 0 45,000 BUFFER 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
76 Asam askorbat (Vit. C) tab. 250 mg 250 btl 250 0 0 0 0 0 0 0 0
77 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 30,250 0 0 0 0 0 0 0 BUFFER 0
78 Asam askorbat (Vit. C) tab. 50 mg 1,000 btl 1000 35,200 3,000 0 3,000 1,000 2,000 2,710 710 0 70,400 DAK 2013 0
80 Asam Mefenamat Tab. 500 mg 100 ktk 100 17,050 0 0 0 0 0 0 0 BUFFER 0
81 Asam Mefenamat Tab. 500 mg 100 ktk 100 17,600 0 0 0 0 0 0 0 DAK 2012 0
82 Asam Mefenamat Tab. 500 mg 100 ktk 100 19,350 600 600 1,200 800 400 1,355 955 0 77,400 DAK 2013 0
88 Acetosal 100 mg 100 ktk/100 0 0 0 0 0 0 0
95 Betamidon 1 Vial 11,500 0 0 0 0 16 16 0 0 DAU 2012 0
96 Betamidon 1 Vial 0 0 0 0 0 0 0 0
97 Betadryl Injeksi 1 Vial 9,500 0 0 0 0 16 16 0 DAU 2012 0
98 Betadryl Injeksi 1 Vial 0 0 0 0 0 0 0 0
99 Betametason krim 0,1% 25 Ktk 25 tube 51,310 0 0 0 0 0 0 0 DAK 2011 0
100 Betametason krim 0,1% 1 Tube 2,053 0 0 0 0 54 54 0 0 BUFFER 0
101 Betametason krim 0,1% 1 Tube 0 0 0 0 0 0 0 0
102 Bioplasenton 1 Tube 27,045 0 0 0 0 10 10 0 0 DAU 2012 0
103 Bioplasenton 1 Tube 0 0 0 0 0 0 0 0
106 Captopril Tab. 25 mg 100 ktk 100 13,775 0 0 0 0 0 0 0 DAK 2012 0
107 Captopril Tab. 25 mg 100 ktk 100 15,153 0 0 0 0 0 0 0 BUFFER 0
108 Captopril Tab. 25 mg 100 ktk 100 15,133 400 0 400 100 300 406 106 0 45,399 DAK 2013 0
109 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 320,000 0 0 0 0 0 0 0 BUFFER 0
110 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,909 24 0 24 24 0 20 20 0 0 DAK 2012 0
111 Catgut/benang bedah no. 2/0-3/0 24 ktk 24 290,000 0 0 0 0 0 0 0 DAK 2011 0
112 Catgut/benang bedah no. 2/0-3/1 24 ktk 24 0 0 0 0 0 0 0 0
113 Cetoconazole tab 50 ktk/50 22,550 150 0 150 150 30 0 0 67,650 DAK 2013 0
114 Cholesterol 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
116 Cetirizine 10 mg 50 ktk 50 15,675 0 0 0 0 0 0 0 DAK 2012 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
117 Cetirizine 10 mg 50 ktk 50 0 0 0 0 242 242 0 0 0
119 Cimetidin Tab. 100 ktk 100 0 0 0 0 0 0 0 0
120 Ciprofloxacin 500mg 100 ktk 100 31,240 100 1,000 1,100 700 400 1,355 955 0 124,960 DAK 2013 0
122 Clonidine 0.15 mg 100 Ktk/100 0 0 0 0 0 0 0 0
124 Dasabion 100 Ktk/100 0 0 0 0 0 0 0 0
125 Deksametason Inj. 5 mg/ml-1 ml 100 ktk 100 amp 200,200 0 0 0 0 216 216 0 0 DAK 2012 0
127 Deksametason Tab. 0,5 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
128 Deksametason Tab. 0,5 mg 100 Ktk 100 9,349 0 0 0 0 1,761 0 0 0 BUFFER 0
129 Deksametason Tab. 0,5 mg 100 Ktk 100 17,400 0 0 0 0 0 0 0 DAK 2012 0
130 Deksametason Tab. 0,5 mg 100 Ktk 100 9,560 400 600 1,000 600 400 1,761 1,361 0 38,240 DAK 2013 0
132 Dekstrometorfan HBr sirup 10 mg/5 ml 1 btl 60 ml 3,152 8 10 18 18 27 9 0 56,736 DAK 2013 0
133 Dekstrometorfan HBr tab. 15 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
134 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 11,000 0 0 0 0 0 0 0 DAK 2012 0
135 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 10,890 0 0 0 0 0 0 0 BUFFER 0
136 Dekstrometorfan HBr tab. 15 mg 100 Ktk 100 600 0 600 600 406 0 0 0 0
137 Devitalisasi Pasta Non Arsen (Devitasol) 1 ktk/btl 0 0 0 0 1 1 0 0 0
138 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 78,147 0 0 0 0 0 0 0 BUFFER 0
139 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 26,049 0 0 0 0 0 0 0 0
140 Diazepam Inj. 5 mg/ml-2 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
141 Diazepam tab. 2 mg 100 btl 1000 27,000 0 0 0 0 0 0 0 DAK 2011 0
142 Diazepam tab. 2 mg 100 btl 1000 35,090 0 0 0 0 0 0 0 BUFFER 0
143 Diazepam tab. 2 mg 1,000 btl 1000 35,090 1,000 0 1,000 1,000 81 0 0 35,090 DAK 2013 0
144 Diazepam tab. 2 mg 100 Btl 100 0 0 0 0 0 0 0 0
145 Diazepam tab. 5 mg 250 btl 250 0 0 0 0 0 0 0 0
146 Dietilkarbamazin Sitrat tab. 100 mg/5 ml 100 ktk 100 10,725 14,300 0 14,300 14,300 0 0 1,533,675 0
147 Dietilkarbamazin Sitrat tab. 100 mg/5 ml 100 ktk 100 0 0 0 0 0 0 0 0
149 Difenhidramin HCl inj. 10 mg/ml-1 ml 30 ktk 30 amp 30 0 30 30 54 24 0 0 0
150 Dextran 70 lar. Infus 1 Btl 500 ml 0 0 0 0 0 0 0 0
151 Digoxin Tab.0,25 mg 100 ktk 100 14,300 0 0 0 0 0 0 0 DAK 2012 0
152 Digoxin Tab.0,25 mg 100 ktk 101 0 0 0 0 0 0 0 0
153 Diltiazem 30 mg 100 Ktk 100 15,163 200 0 200 200 0 0 30,326 DAK 2012 0
154 Diltiazem 30 mg 100 Ktk 101 0 0 0 0 0 0 0 0
155 Doxyciclin 100 ktk 100 55,660 0 0 0 0 0 0 0 0
156 Doxyciclin 100 ktk 100 0 0 0 0 0 0 0 0
158 Domperidon Tab 10 mg 100 Ktk 100 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
160 Domperidon syr 1 Btl 60 ml 0 0 0 0 0 0 0 0
161 Ergotamin tartrat + kofein 100 Btl/100 10,367 0 0 0 0 26 26 0 0 DAK 2011 0
162 Ergotamin tartrat + kofein 100 Btl/100 0 0 0 0 0 0 0 0
163 Efedrin HCl tab. 25 mg 250 btl 250 28,500 0 0 0 0 135 135 0 0 DAK 2011 0
164 Efedrin HCl tab. 25 mg 250 btl 250 0 0 0 0 0 0 0 0
165 Ekstrak Belladon Tab. 100 btl 1000 17,892 0 0 0 0 0 0 0 BUFFER 0
166 Epinefrin HCl Inj. 0,1% 30 ktk 30 amp 0 0 0 0 0 0 0 0
167 Erithromisin Kapsul 250mg 120 ktk 120 60,000 0 0 0 0 0 0 0 DAK 2012 0
169 Erithromisin Kapsul 500mg 100 ktk 100, strip 78,100 0 0 0 0 0 0 0 DAK 2011 0
170 Erithromisin Kapsul 500mg 100 ktk 100, strip 0 0 0 0 0 0 0 0
172 Eritromisin Syr. 200 mg/ 5 ml 1 btl 60 ml 0 0 0 0 0 0 0 0
175 Etakridin (Rivanol) Lar. 0,1% 1 botol 300 ml 3 0 3 3 5 2 0 0 DAK 2013 0
176 Etambutol Tab. 100 ktk 100 52,580 100 0 100 100 0 0 52,580 DAK 2011 0
178 Etanol 70% 1 Btl 300 ml 11,990 3 0 3 3 5 2 0 35,970 DAU 2013 0
179 Etanol 70% 1 btl 1000 ml 45,000 0 0 0 0 0 0 DAK 2011 0
180 Etanol 70% 1 btl 1000 ml 0 0 0 0 0 0 0 0
181 Etanol 70% 1 btl 100 ml 0 0 0 0 0 0 0 0
182 Etil klorida semprot 1 btl 100 ml 181,000 0 0 0 0 0 0 0 DAU 2012 0
183 Etil klorida semprot 1 btl 100 ml 115,490 0 1 1 1 3 2 0 115,490 DAU 2013 0
184 Entrasol susu 1 ktk 185 gr 0 0 0 0 0 0 0 0
185 Ethigent injeksi 80 mg/ml 1 ktk 1 vial 2 ml 0 0 0 0 0 0 0 0
187 Fenilbutason Tab 1,000 Btl 1000 89,100 0 0 0 0 0 0 0 BUFFER 0
188 Fenitoin Natrium Inj.g/ml 1 btl 1000 0 0 0 0 0 0 0 0
189 Fenitoin Natrium kap 100mg 100 btl 100 0 0 0 0 0 0 0 0
190 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
191 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 20,100 0 0 0 0 0 0 0 BUFFER 0
192 Fenobarbital inj. 50 mg/ml - 2 ml 30 ktk 30 amp 42,899 0 0 0 0 0 0 0 0
194 Fenobarbital tab. 30 mg 100 btl 1000 60,355 0 0 0 0 0 0 0 DAK 2013 0
195 Fenobarbital tab. 30 mg 1,000 btl 1000 34,100 1,000 0 1,000 1,000 0 271 271 0 0 DAK 2010 0
196 Fenobarbital tab. 100 mg 250 btl 250 0 0 0 0 0 0 0 0
197 Fenoksimetil Penisilina Tab. 500 mg 100 btl 100 tab. 45,650 0 0 0 0 0 0 0 DAK 2011 0
198 Fenol gliserol tetes telinga 10% 24 ktk 24 btl 0 0 0 0 26 26 0 0 0
199 Ferrolat Tab. 30 ktk 30 tab 0 0 0 0 0 0 0 0
200 Ferrous Sulfat Tab. 1,000 btl 1000 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
202 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 47,850 0 0 0 0 20 20 0 0 DAK 2011 0
203 Fitomenadion (Vit. K) inj. 10 mg/ml - 1 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
205 Fitomenadion (Vit. K) tablet salut 10 mg 100 btl 100 74,868 200 0 200 200 26 0 0 149,736 DAK 2013 0
208 Furosemid tab. 40 mg 200 ktk 200 19,800 200 0 200 200 0 0 19,800 DAK 2011 0
209 Furosemid tab. 40 mg 200 ktk 200 15,844 0 0 0 0 0 0 0 DAK 2010 0
210 Furosemid tab. 40 mg 200 ktk 200 0 0 0 0 0 0 0 0
211 Gameksan Emulsi 1% 1 btl 30 ml 0 0 0 0 0 0 0 0
212 Gentamisin Sulfat tetes mata 1 Botol 5 ml 3,630 0 10 10 10 0 27 27 0 0 BUFFER 0
213 Garam Oralit untuk 200 ml air 100 ktk 100 sach 41,800 200 0 200 200 81 0 0 83,600 DAK 2013 0
214 Garam Oralit untuk 200 ml air 25 ktk 25 sach 10,026 0 0 0 0 0 0 0 DAK 2011 0
215 Garam Oralit untuk 200 ml air 25 ktk 25 sach 0 0 0 0 0 0 0 0
216 Gentamisin Inj. 1 ampul 18,480 0 0 0 0 27 27 0 0 DAK 2011 0
218 Gentamisin Salep 1 ktk 25 0 0 0 0 0 0 0 DAK 2013 0
219 Gentian violet larutan 1% 1 btl 10 ml 1,930 0 0 0 0 2 2 0 0 DAK 2012 0
220 Gentian violet larutan 1% 1 btl 10 ml 0 0 0 0 0 0 0 0
222 Glibenklamid Tab. 2 mg 100 ktk 100 7,200 200 0 200 200 135 0 0 14,400 DAK 2012 0
223 Glibenklamid Tab. 2 mg 100 ktk 100 0 0 0 0 0 0 0 0
224 Gliserin 1 Btl 100 ml 0 0 0 0 0 0 0 0
225 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 25,563 0 0 0 0 0 0 0 BUFFER 0
226 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 27,900 0 0 0 0 0 0 0 DAK 2012 0
227 Gliseril Guaiakolat tab. 100 mg (GG) 1,000 btl 1000 30,690 1,000 2,000 3,000 1,000 2,000 2,439 439 0 61,380 DAK 2013 0
228 Glukosa 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
229 Glukosa lar. infus 5% steril 1 500 ml 8,272 7 0 7 7 8 1 0 57,904 DAK 2012 0
230 Glukosa lar. infus 5% steril 1 500 ml 0 0 0 0 0 0 0 0
231 Glukosa lar. infus 10% steril 1 btl 500 ml 0 0 0 0 0 0 0 0
232 Glukosa lar. infus 40% steril 10 Ktk 10 0 0 0 0 0 0 0 0
234 Griseofulvin tab. 125 mg, micronized 100 btl 100 0 300 0 300 300 312 0 0 0 BUFFER 0
235 Hanschoend steril No. 6,5 1 Pcs 2 0 2 2 0 0 0 0 0
236 Hanschoend steril No. 7 1 Pcs 8,200 0 0 0 0 162 162 0 0 DAU 2012 0
237 Hanschoend steril No. 7 1 Pcs 0 0 0 0 0 0 0 0
238 Hanschoend steril No. 7,5 1 Pcs 8,200 0 0 0 0 0 0 0 0 DAU 2012 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
243 Hustab P Syrup 1 btl 60 ml 11,500 0 0 0 0 27 27 0 0 DAU 2011 0
244 Hustab P Syrup 1 btl 60 ml 0 0 0 0 0 0 0 0
245 Hub Cutter 1 buah 0 0 0 0 0 0 0 0
248 Haloperidol Tab.5 mg 100 ktk 100 12,229 100 0 100 100 0 0 12,229 DAK 2012 0
249 Haloperidol Tab.5 mg 100 ktk 100 0 0 0 0 0 0 0 0
250 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 39,930 0 0 0 0 0 0 0 DAK 2011 0
251 Hidroklortiasid (HCT) Tab. 25 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
254 Hemaglobin 500 ml 1 btl 0 0 0 0 0 0 0 0
255 Hemafort 100 ktk 100 0 0 0 0 542 542 0 0 0
256 Ibuprofen suspensi 1 Btl 60 ml 4,500 0 0 0 0 27 27 0 0 DAK 2012 0
257 Ibuprofen suspensi 1 Btl 60 ml 0 0 0 0 0 0 0 0
259 Ibuprofen tab. 400 mg 100 btl 100 19,799 0 0 0 0 677 677 0 0 BUFFER 0
260 Ibuprofen tab. 400 mg 100 btl 100 20,476 0 0 0 0 0 0 0 DAK 2012 0
262 Infus Set Anak 1 set 7,000 6 0 6 6 8 2 0 42,000 DAK 2012 0
263 Infus Set Anak 1 set 14,500 0 0 0 0 0 0 0 DAU 2012 0
264 Infus Set Anak 1 set 0 0 0 0 0 0 0 0
265 Infus Set Dewasa 1 set 12,500 0 0 0 0 16 16 0 0 DAU 2012 0
266 Infus Set Dewasa 1 set 7,000 0 0 0 0 0 0 0 DAK 2012 0
267 Infus Set Dewasa 1 set 7 0 7 2 5 16 11 0 0 DAK 2013 0
268 Insulin Inj. 10 ml 1 Vial 0 0 0 0 0 0 0 0
269 Iodium Tes 1 btl 10 ml 0 0 0 0 0 0 0 0
270 Iodiol Kapsul lunak 100 btl 100 102,300 0 0 0 0 0 0 0 DAK 2011 0
271 Iodiol Kapsul lunak 100 btl 100 0 0 0 0 0 0 0 0
272 Isoniasid (INH) Tab. 100 mg 100 ktk 100 40,700 0 0 0 0 0 0 0 DAK 2011 0
274 Isoniasid (INH) Tab. 300 mg 100 ktk 100 0 0 0 0 0 0 0 0 284
275 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 41,000 0 0 0 0 0 0 0 DAK 2012 0
276 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 8,910 0 0 0 0 0 0 0 BUFFER 0
277 Isosorbid Dinitrat Tab. 5 mg 100 ktk 100 0 0 0 0 0 0 0 0
278 Isi ulang oksigen tabung besar 1 tabung 0 0 0 0 0 0 0 0
279 Isi ulang oksigen tabung kecil 1 tabung 0 0 0 0 0 0 0 0
280 Isi ulang oksigen tabung sedang 1 tabung 0 0 0 0 0 0 0 0
281 Jarum Hecting Jar. Otot no 7 12 lusin 113,500 0 0 0 0 0 0 0 DAU 2012 0
282 Jarum Hecting kulit no 5 12 lusin 113,500 0 0 0 0 0 0 0 DAU 2012 0
283 Jarum hecting kulit no 7 12 lusin 113,500 0 0 0 0 0 0 0 DAU 2012 0
284 Jarum otot no 5 12 lusin 113,500 12 0 12 12 -12 0 113,500 DAU 2012 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
285 Kalium Permanganat Serbuk 1 ktk 20 btl 0 0 0 0 0 0 0 0
288 Kalsium laktat 1,000 btl 1000 57,200 0 0 0 0 0 0 0 DAK 2011 0
289 Kalsium laktat 1,000 btl 1000 57,200 2,000 0 2,000 2,000 2,439 439 0 114,400 DAK 2013 0
291 Kanamycin Base 1g Inj. 1 Vial 0 0 0 0 0 0 0 0
292 Kapas 250 g 1 bungkus 27,500 0 0 0 0 0 0 0 DAU 2012 0
294 Kapas 250 g 1 bungkus 0 0 0 0 0 0 0 0
295 Karbamazepin Tab. 200 mg 100 ktk 100, strip 24,645 0 0 0 0 0 0 0 DAK 2012 0
296 Karbamazepin Tab. 200 mg 100 ktk 100, strip 200 0 200 100 100 124 0 0 0 DAK 2013 0
297 Kasa kompres 40/40 steril 1 bks 0 0 0 0 0 0 0 0
299 Kasa Pembalut Hidrofil 4 x 3 cm 1 rol 0 0 0 0 0 0 0 0
300 Kasa Pembalut Hidrofil 16 x 16 cm 1 ktk 0 0 0 0 0 0 0 0
301 Kasa Pembalut 2 x 80cm 1 Rol 16,500 0 0 0 0 0 0 0 DAU 2012 0
302 Kasa Pembalut 2 x 80cm 1 Rol 0 0 0 0 0 0 0 0
303 Kasa Steril 18 x 22 cm 16 ktk 16 lbr 0 0 0 0 0 0 0 0
312 Ketokonazol krim 2% 1 tube 15 gr 0 0 0 0 0 0 0 0
315 Ketoprofen Tablet 100 Ktk 100 68,826 0 0 0 0 0 0 0 DAU 2012 0
316 Kloramfenikol Kaps. 250 mg 250 Btl/250 57,750 500 0 500 250 250 271 21 0 57,750 DAK 2011 0
317 Kloramfenikol Kaps. 250 mg 250 Btl/250 0 0 0 0 0 0 0 0
320 Kloramfenikol Kaps. 250 mg 1,000 Btl 1000 0 0 0 0 0 0 0 0
322 Kloramfenikol Sirup 1 btl 60 ml 4,400 0 0 0 0 0 0 0 DAK 2011 0
323 Kloramfenikol Sirup 1 btl 60 ml 4,950 2 0 2 2 10 8 0 9,900 DAK 2013 0
324 Kloramfenikol Tetes Telinga 24 ktk 24 btl 0 0 0 0 10 10 0 0 0
325 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 0 0 0 0 0 0 79,200 DAK 2011 0
326 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 24,000 0 0 0 0 0 0 0 DAK 2012 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
327 Klorfeniramin maleat (CTM) tab. 4 mg 1,000 btl 1000 26,400 0 0 0 0 3,116 3,116 0 0 DAK 2013 0
330 Klorokuin fosfat tab. 150 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
331 Klorpromazin HCl Inj. 5mg/ml - 2ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
332 Klorpromazin HCl Inj. 25ml/ml-2ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
333 Klorpromazin HCl Tab. 25 mg 1,000 btl 1000 26,895 0 0 0 0 0 0 0 DAK 2010 0
334 Klorpromazin HCl Tab. 25 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
335 Klorpromazin HCl Tab. 100 mg 1,000 btl 1000 91,509 1,000 0 1,000 1,000 60 0 0 91,509 DAK 2013 0
336 Klorpromazin HCl Tab. 100 mg 250 btl 250 153,000 0 0 0 0 0 0 0 0
337 Klorpropamid Tab. 100 mg 250 btl 500 0 0 0 0 0 0 0 0
338 Kodein Fosfat Tab. 10 mg 250 btl 250 106,820 0 0 0 0 60 60 0 0 DAK 2011 0
339 Kodein Fosfat Tab. 10 mg 250 btl 250 0 0 0 0 0 0 0 0
340 Komb. pirimetamin 25mg + sulfadoksin500mg 100 ktk 100 52,030 0 0 0 0 0 0 0 DAK 2011 0
342 Kotrimoksazol pediatrik tab. 120 mg 100 btl 100 200 0 200 200 35 0 0 0 0
344 Kotrimoksazol suspensi 1 btl 60 ml 3,850 0 0 0 0 27 27 0 0 BUFFER 0
346 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 16,500 0 0 0 0 0 0 0 DAK 2012 0
347 Kotrimoksazol dewasa tab. 480 mg 100 btl 100 18,149 0 0 0 0 813 813 0 0 DAK 2013 0
348 Kuinin dihidroklorida inj. - 2 ml 30 ktk 30 amp 126,800 0 0 0 0 0 0 0 DAK 2012 0
349 Kuinin dihidroklorida inj. - 2 ml 30 ktk 30 amp 0 0 0 0 0 0 0 0
350 Kuinin Sulfat Tab. 222 mg 60 ktk 60 49,700 0 0 0 0 0 0 0 DAK 2012 0
351 Kuinin Sulfat Tab. 222 mg 60 ktk 60 0 0 0 0 0 0 0 0
352 Lar. benedict 1 btl 100 ml 28,324 0 0 0 0 0 0 0 DAU 2010 0
353 Lar. benedict 1 btl 100 ml 0 0 0 0 0 0 0 0
354 Lar. Eosin 2% 1 btl 100 ml 66,000 0 0 0 0 0 0 0 DAU 2010 0
355 Lar. Eosin 2% 1 btl 100 ml 0 0 0 0 0 0 0 0
356 Lar. Etanol Asam 1 btl 100 ml 0 0 0 0 0 0 0 0
357 Lar. Giemsa Stain 1 btl 100 ml 0 0 0 0 0 0 0 0
358 Lar. Karbol Fuchsin 1 btl 100 ml 0 0 0 0 0 0 0 0
359 Lar. Metanol 1 btl 100 ml 0 0 0 0 0 0 0 0
360 Lar. Turk 1 btl 100 ml 16,254 0 0 0 0 0 0 0 BUFFER 0
361 Lar. Turk 1 btl 100 ml 32,500 0 0 0 0 0 0 0 DAK 2010 0
362 Lar. Turk 1 btl 100 ml 0 0 0 0 0 0 0 0
363 Lidokain Komp. Inj. 30 ktk 30 amp 101,000 0 0 0 0 0 0 0 DAK 2012 0
364 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 0 0 0 0 0 0 0 BUFFER 0
365 Lidokain Komp. Inj. 30 ktk 30 amp 34,099 0 60 60 60 54 -6 0 68,198 DAK 2013 0
366 Lidokain Inj. 100 ktk 100 amp 101,000 0 0 0 0 0 0 0 DAK 2012 0
367 Lidokain Inj. 100 ktk 100 amp 101,750 0 0 0 0 0 0 0 BUFFER 0
368 Lidokain Inj. 100 ktk 100 amp 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
369 Lisol 1 btl 1000 ml 45,000 0 0 0 0 1 1 0 0 DAU 2012 0
370 Lisol 1 btl 1000 ml 0 0 0 0 0 0 0 0
372 levofloksasin 50 Ktk 50 0 0 0 0 0 0 0 0
374 Magnesium Sulfat Inj. (IV) 20%-25ml 10 ktk 10 0 0 0 0 0 0 0 0
375 Magnesium Sulfat Inj. (IV) 40%-25ml 1 btl 25 ml 19,479 0 0 0 0 0 0 0 DAK 2012 0
376 Magnesium Sulfat Inj. (IV) 40%-25ml 1 btl 25 ml 0 0 0 0 0 0 0 0
377 Magnesium Sulfat serbuk 30 g 10 Ktk 10 Bks 0 0 0 0 0 0 0 0
378 Masker 50 ktk 50 68,500 0 0 0 0 130 130 0 0 DAU 2012 0
379 Masker 50 ktk 50 0 0 0 0 0 0 0 0
380 Metanol 1 Btl 100 ml 0 0 0 0 0 0 0 0
381 Malasiqrin 10 ktk 10 sase 0 0 0 0 0 0 0 0
383 Mata Pisau Carbon No.10 1 pcs 0 0 0 0 26 26 0 0 0
389 Mata Pisau Carbon No. 20 1 pcs 0 0 0 0 0 0 0 0
392 Mata Pisau Carbon No.22 1 pcs 6,750 0 0 0 0 0 0 0 0
395 Mebendazol Tab. 100 mg 30 ktk 30, strip 0 0 0 0 0 0 0 0
396 Metampiron Tab 500 mg 100 Ktk 100 14,900 0 0 0 0 0 0 0 0
397 Metampiron Tab 500 mg 100 Ktk 100 0 0 0 0 0 0 0 0
398 Metilergometrin maleat inj. 0,200 mg - 1 ml 30 ktk 30 amp 45,100 0 0 0 0 0 0 0 0
400 Metilergometrin maleat tab. salut 0,125 mg 100 ktk 100 0 0 0 0 0 0 0 0
402 Metoklorpropamid Tab. 10 mg 100 ktk 100 11,000 0 0 0 0 20 20 0 0 DAK 2012 0
403 Metoklorpropamid Tab. 10 mg 100 ktk 100 0 0 0 0 0 0 0 0
404 Metformin tab 100 ktk 100 18,150 0 0 0 0 0 0 DAK
0 2012/BUFFER 0
406 Metronidazol tab. 250 mg 100 ktk 100, strip 0 0 0 0 0 0 0 0
407 Metronidazol tab. 500 mg 100 ktk 100, strip 24,200 300 200 500 500 406 0 0 121,000 DAK 2013 0
409 Metil prednisolon tab 100 ktk 100 44,055 0 0 0 0 406 406 0 0 DAU 2012 0
410 Metil prednisolon tab 100 ktk 100 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
411 Mikonazole Krim 1 tube 3,000 0 0 0 0 27 27 0 0 DAK 2013 0
412 Mikonazole Krim 1 tube 0 0 0 0 0 0 0 0
413 Monoklor Kamfer Mentol (CHKM) 1 btl 10 ml 0 0 0 0 0 0 0 0
415 Natrium bikarbonat tab. 1,000 btl 1000 15,730 0 0 0 0 0 0 0 DAK 2011 0
416 Natrium bikarbonat tab. 1,000 btl 1000 0 0 0 0 0 0 0 0
417 Natrium Diklofenak Tab. 50 mg 50 ktk 50 8,384 0 0 0 0 271 271 0 0 DAK 2012 0
418 Natrium Diklofenak Tab. 50 mg 50 ktk 50 0 0 0 0 0 0 0 0
420 Natrium klorida lar. infus steril 0,9% 1 500 ml 0 0 0 0 0 0 0 BUFFER 0
421 Natrium Tiosulfat Inj.25%-10 ml 10 ktk 10 amp 16,359 0 0 0 0 0 0 0 BUFFER 0
422 Nifedipin Tab. 10 mg 100 ktk 100 37,000 0 0 0 0 0 0 0 0
424 Nifedipin Tab. 10 mg 100 ktk 100 0 0 0 0 0 0 0 0
425 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 37,000 0 0 0 0 0 0 0 DAK 2012 0
426 Nistatin tab. vaginal 100.000 iu/g 100 ktk 100 47,200 300 0 300 300 0 0 141,600 DAK 2013 0
429 Novadryl Inj. 1 Vial 0 0 0 0 0 0 0 0
430 Novamydon Inj. 1 Vial 0 0 0 0 0 0 0 0
431 Obat antituberkulosis kategori I 1 Paket 0 0 0 0 0 0 0 0
432 Obat antituberkulosis kategori II 1 Paket 0 0 0 0 0 0 0 0
433 Obat antituberkulosis kategori III 1 Paket 0 0 0 0 0 0 0 0
434 Obat antituberkulosis kategori anak 1 Paket 0 0 0 0 0 0 0 0
436 OBH Plus 1 btl 100 ml 9,750 0 0 0 0 27 27 0 0 DAU 2012 0
437 OBH Plus 1 btl 100 ml 0 0 0 0 0 0 0 0
438 Oksitetrasiklin HCl Inj. 50 mg/ml - 10 ml 10 ktk 10 vial 34,100 0 0 0 0 0 0 0 DAK 2013 0
439 Oksitetrasiklin HCl Salep Kulit 3% 1 tube 1,843 0 25 25 25 27 2 0 46,075 BUFFER 0
442 Oksitetrasiklin salep mata 25 ktk 25 tube 0 0 0 0 0 0 0 0
444 Oksitosin/ pitogin inj. 10 iu/ml - 1 ml 10 ktk 10 amp 0 0 0 0 20 20 0 0 0
445 Oksitosin inj. 10 iu/ml - 1 ml 30 Ktk 30 amp 0 0 0 0 0 0 0 0
446 Omeprazol kapsul 20 mg 30 Ktk 30 12,250 0 0 0 0 30 30 0 0 DAK 2012 0
447 Omeprazol kapsul 20 mg 30 Ktk 30 13,475 0 0 0 0 54 54 0 0 BUFFER 0
448 Omeprazol kapsul 20 mg 30 Ktk 30 0 0 0 0 0 0 0 0
449 Papaverin tab 1,000 btl 1000 99,500 1,000 0 1,000 1,000 0 0 99,500 DAK 2012 0
450 Papaverin tab 1,000 btl 1000 0 0 0 0 0 0 0 0
451 Papaverin injeksi 100 ktk 100 0 0 0 0 0 0 0 0
452 Paramidon Inj. 1 Vial 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
454 Parasetamol sirup 120 mg/5 ml 1 btl 60 ml 2,529 0 13 13 13 0 0 0 0 BUFFER 0
456 Parasetamol Tab. 100 mg 100 btl 100 0 0 0 0 0 0 0 0
458 Parasetamol tab. 500 mg 100 ktk 100 11,544 1,300 700 2,000 800 1,200 2,710 1,510 0 138,528 DAK 2013 0
459 Parasetamol tab. 500 mg 120 Ktk 120 12,600 0 0 0 0 0 0 0 DAK 2012 0
460 Parasetamol tab. 500 mg 120 Ktk 120 0 0 0 0 0 0 0 0
461 Parasetamol drop 1 Btl 15 ml 5,280 0 0 0 0 10 10 0 0 DAK 2012 0
462 Parasetamol drop 1 Btl 15 ml 0 0 0 0 0 0 0 0
463 Pehavral 100 ktk 100 96,500 0 0 0 0 0 0 0 DAU 2012 0
464 Pehavral 100 ktk 100 0 0 0 0 271 271 0 0 0
465 Petidin inj 10 ktk/10 131,904 0 0 0 0 0 0 0 DAK 2011 0
466 Petidin inj 5 ktk/5 64,250 0 0 0 0 0 0 0 0
467 Petidin inj 10 ktk/10 0 0 0 0 0 0 0 0
468 Pembalut Gips 1 rol 42,500 0 0 0 0 0 0 0 BUFFER 0
469 Pirantel pamoat tab. 365 mg 60 ktk 100 20,450 0 0 0 0 20 20 0 0 DAK 2013 0
470 Pirantel pamoat tab. 365 mg 60 ktk 60 0 0 0 0 0 0 0 0
471 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 15,725 2,000 0 2,000 2,000 1,355 0 0 15,725 DAK 2011 0
472 Piridoksin HCl (Vit. B6) tab. 10 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
473 Pilokarpin tetes mata (HCL/nitrat) 1 btl 5 ml 0 0 0 0 0 0 0 0
474 Piroxicam Tab. 100 Ktk 100 8,400 0 0 0 0 542 542 0 0 DAK 2012 0
475 Piroxicam Tab. 100 Ktk 100 11,552 0 0 0 0 0 0 0 DAK 2013 0
476 Piroxicam Tab. 100 Ktk 120 0 0 0 0 0 0 0 0
477 Pirasetam Kaplet 1200 mg 100 KTK 100 129,360 0 0 0 0 0 0 0 DAK 2012 0
478 Plastik Obat 1 bks 100Sach 5,455 60 0 60 20 40 0 0 218,200 DAK 2012 0
479 Plester 1 rol 50,200 0 0 0 0 0 0 DAU 2012 0
480 Plester 1 rol 3,964 0 0 0 0 0 0 0 BUFFER 0
481 Plester 1 rol 25,980 3 0 3 3 3 0 0 77,940 DAU 2013 0
482 Pot sputum 1 pot 0 0 0 0 0 0 0 0
483 Prednison tab. 5 mg 1,000 btl 1000 68,750 0 0 0 0 0 0 275,000 DAK 2013 0
484 Prednison tab. 5 mg 1,000 btl 1000 62,500 0 0 0 0 0 0 0 DAK 2012 0
485 Prednison tab. 5 mg 1,000 btl 1000 63,250 0 0 0 0 1,897 1,897 0 0 BUFFER 0
486 Primakina tab. 15 mg 1,000 btl 1000 0 0 0 0 0 0 0 0 0
487 Prokain Benzil Penisilin Inj. 3 juta 1 Vial 198,550 0 0 0 0 0 0 0 0
488 Propil Tiourasil Tab. 100 mg 100 btl 100 29,957 100 0 100 100 0 0 29,957 DAK 2012 0
489 Propil Tiourasil Tab. 100 mg 100 btl 100 0 500 500 500 0 0 0 BUFFER 0
490 Pytogin injk 10 IUml/ml-2 10 ktk 10 0 0 0 0 0 0 0 0
493 Propranolol HCl Tab. 40 mg 100 btl 100 0 0 0 0 0 0 0 0
494 Rapit test kit 1 Ktk 25 strip 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
498 Ranitidin inj 25 ktk 25 ampul 0 0 0 0 0 0 0 0
500 Reserpin Tab. 0,10 mg 250 btl/250 0 0 0 0 0 0 0 0
501 Reserpin Tab. 0,25 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
504 Rifampisin Kaps. 450 mg 100 ktk 100 49,500 0 0 0 0 0 0 0 DAK 2010 0
505 Rifampisin Kaps. 450 mg 100 ktk 100 60,500 200 0 200 200 0 0 121,000 DAK 2011 0
506 Reagen TB 2 N 1 Kit 0 0 0 0 0 0 0 0
510 Salbutamol Tab. 4 mg 100 ktk 100 9,000 0 0 0 0 0 0 0 0
512 Salbutamol Tab. 4 mg 100 ktk 100 9,749 0 0 0 0 100 100 0 0 DAK 2012 0
513 Salbutamol Tab. 4 mg 100 ktk 100 0 500 500 100 400 200 0 0 0 DAK 2013 0
514 Salep 2-4 Komb 24 Ktk/24 Pot 32,450 24 0 24 24 28 4 0 32,450 DAK 2013 0
517 Salisil bedak 2% 1 50 g 0 0 0 0 20 20 0 0 0
518 Salisil spritus 10 % 1 ktk 10 btl 0 0 0 0 0 0 0 0
521 Sefadroksil 500 mg 100 Ktk 100 0 0 0 0 271 271 0 0 0
522 Sefadroksil syr 1 Btl 60 ml 0 0 0 0 27 27 0 0 0
523 Serum ATS Inj. 10 ktk 10 vial 0 0 0 0 0 0 0 0
524 Sefotaksim Inj 1 gram 2 Ktk 2 Vial 69,300 0 0 0 0 0 0 0 DAK 2012 0
525 Sefotaksim Inj 1 gram 2 Ktk 2 Vial 0 0 0 0 0 0 0 0
527 Sianokobalamin (Vit. B12) inj. 500 mcg/ml 100 ktk100amp 114,070 0 100 100 100 54 0 0 114,070 DAK 2013 0
528 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 13,102 0 0 0 0 0 0 0 DAK 2012 0
529 Sianokobalamin (Vit. B12) Tab. 1,000 btl 1000 14,412 0 0 0 0 1,490 1,490 0 0 0
530 Silk (benang bedah sutera) no. 3/0 36 ktk 36 pcs 818,182 0 0 0 0 30 30 0 0 DAK 2012 0
531 Silk (benang bedah sutera) no. 3/0 100m 36 ktk 36 pcs 0 36 36 36 30 -6 0 0 DAK 2013 0
532 Simvastatin 10 mg 30 Ktk 30 15,390 90 0 90 60 30 135 105 0 15,390 DAK 2012 0
533 Simvastatin 10 mg 30 Ktk 30 15,250 0 0 0 0 0 0 0 DAU 2012 0
534 Simvastatin 10 mg 30 Ktk 30 0 0 0 0 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
537 Sulfadimidin Tab. 500 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
538 Sulfasetamid Natrium Tetes mata 0,5% 1 btl 0 0 0 0 10 10 0 0 0
539 Slide 72 Set 45,000 72 0 72 72 0 0 45,000 DAU 2012 0
540 Slide 72 Set 0 0 0 0 0 0 0 0
541 Slide Box 1 Set 80,000 1 0 1 1 -1 0 80,000 DAU 2010 0
542 Slide Box 1 Set 0 0 0 0 0 0 0 0
543 SGOT 4x50+4x10 ml (80x50) 1 Kit 0 0 0 0 0 0 0 0
544 SGOT 4x50+4x10 ml (80x50) 1 KIt 0 0 0 0 0 0 0 0
545 Silk (benang bedah sutera) No.3/0 12 Ktk 12 set 0 0 0 0 0 0 0 0
546 Tablet Tambah Darah 3,000 ktk 3000 tab 0 0 0 0 0 0 0 0
549 Tetrasiklin HCl kaps. 250 mg 1,000 btl 1000 167,200 0 0 0 0 0 0 0 DAK 2011 0
550 Tetrasiklin HCl kaps. 250 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
551 Tetrasiklin HCl Kaps. 500 mg 100 ktk 100 0 0 0 0 0 0 0 0
555 Tiamin HCl (Vit. B1) Inj. 30 ktk 30 amp 25,300 30 30 60 60 30 0 0 50,600 BUFFER 0
556 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 37,800 0 0 0 0 0 0 0 DAK 2012 0
557 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg 1,000 btl 1000 41,580 1,000 1,000 2,000 1,000 1,000 1,355 355 0 41,580 0
558 Tensigar 30 Ktk /30 0 0 0 0 0 0 0 0
559 Triheksifenidil HCl Tab. 2 mg 100 ktk 100, strip 4,485 0 0 0 0 60 60 0 0 DAK 2010 0
561 Trigelicerides 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
562 Hemoglobin 500 ml 1 btl 0 0 0 0 0 0 0 0
563 Trisulfa Tab. 500 mg 1,000 btl 1000 0 0 0 0 0 0 0 0
564 Tramadol Tab 50 Ktk 18,500 0 0 0 0 50 50 0 0 0
565 Tramadol inj 50 mg/ml 5 ktk 5 ampul 32,010 0 0 0 0 0 0 0 DAK 2012 0
566 Test Narkoba 5 Multi Acon Strip 1 Ktk 25 strip 0 0 0 0 0 0 0 0
567 Uric acid (asam urat) 4 x 100 ml 1 kit 0 0 0 0 0 0 0 0
568 Urine Bag 1 pcs 11,500 0 0 0 0 0 0 0 DAU 2012 0
569 Urine Bag 1 pcs 0 0 0 0 0 0 0 0
570 Ulsikur Inj 5 ktk 5Ampul 0 0 0 0 0 0 0 0
571 Vaccine Carrrier 1 buah 0 0 0 0 0 0 0 0
572 Vaksin Anti Rabies (Verorab) 1 Kur/ Set 0 0 0 0 0 0 0 0
573 Vitamin B Kompleks tab. 1,000 btl 1000 22,200 0 0 0 0 0 0 0 DAK 2012 0
574 Vitamin B Kompleks tab. 1,000 btl 1000 24,419 0 0 0 0 0 0 0 BEFFER 0
575 Vitamin B Kompleks tab. 1,000 btl 1000 2,000 0 2,000 2,000 2,032 0 0 0 0
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
585 Yodium Povidon Lar. 10% 1 btl 1000 0 0 0 0 1 1 0 0 0
586 Yodium Povidon Lar. 10% 1 btl 30 ml 2,200 6 0 6 6 5 0 0 13,200 DAK 2011 0
588 Yodium Povidon Lar. 10% 1 btl 30 ml 0 24 24 24 0 0 0 DAK 2013 0
590 Yodium Povidon Lar. 10% 1 btl 300 ml 0 5 5 5 -5 0 0 0
591 Zinc Tablet 100 Ktk 100 0 0 0 0 0 0 0 0
592 CHKM 1 Btl 10 ml 145,500 0 0 0 0 1 1 0 0 DAU 2012 0
594 Prenatin Plus 100 Ktk 100 67,195 300 100 400 200 200 312 112 0 134,390 DAU 2013
595 Wibrom syr 1 Btl 6,880 4 58 62 34 28 62 34 0 192,640 DAU 2013
596 Selvitron Ktk 100 0 200 200 400 200 200 312 112 0 0 DAU 2013
597 Hemorogard Ktk 30 0 180 0 180 180 30 0 0 0 DAU 2013
598 Noza Ktk 100 0 300 0 300 100 200 108 0 0 0 DAU 2013
600 Atropin tetes mata Btl 0 20 0 20 20 0 0 0 DAU 2013
601 0
602 0
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
Umum BPJS Jamkesda Jumlah

10 Penyakit Terbesar
Jumlah Pasien / Resep NO Nama Penyakit Kode Jumlah
42 425 62 529 1 ISPA 1702 253

2 Gastritis 2001 56
3 Dermatitis Alergi 2802 53
4 Hipertensi 14 40
5 R.A 29 33
6 Caries 1901 28
7 Diare 102 23
8 Thypoid 104 23
9 Puilpitis 1902 22
10 Hipotensi 1603 16

NIP. 19610219 198303 1 014 NIP. 19780505 200502 1 007 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
Kode Puskesmas : 720401201 Pelaporan Bulan : Juni 2014

Puskesmas : Lawanga Permintaan Bulan : Juli 2014
PEMBERIAN
NO NAMA OBAT KEMASAN HARGA SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN TOTAL HARGA KET
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Abbocath N0. 18 buah 19,500 0 0 0 0 0 0 0 DAK 2012 #VALUE!
2 Abbocath N0. 18 buah 21,800 0 0 0 0 0 0 0 DAU 2012 #VALUE!
3 Abbocath N0. 18 buah 21,990 20 0 20 20 20 0 0 439,800 DAU 2013 #VALUE!
4 Abbocath No. 18 ` buah 7,784 0 0 0 0 0 0 DAU 2013 #VALUE!
5 Abbocath No. 18 buah 0 0 0 0 0 0 0 0 #VALUE!
6 Abbocath N0. 20 buah 19,500 0 0 0 0 0 0 DAK 2012 #VALUE!
7 Abbocath N0. 20 buah 21,990 20 0 20 5 15 20 0 329,850 DAU 2013 #VALUE!
8 Abbocath N0. 20 buah 0 0 0 0 0 0 0 0 #VALUE!
9 Abbocath N0. 20 buah 7,784 0 0 0 0 0 0 0 0 DAU 2013 #VALUE!
10 Abbocath N0. 20 buah 0 0 0 0 0 0 0 #VALUE!
11 Abbocath N0. 22 buah 19,500 0 0 0 0 0 0 DAK 2012 #VALUE!
12 Abbocath No. 22 buah 21,800 0 0 0 0 0 0 DAU 2012 #VALUE!
13 Abbocath No. 22 buah 21,990 40 0 40 16 24 20 0 0 527,760 DAU 2013 #VALUE!
15 Abbocath No. 22 buah 0 0 0 0 0 0 0 0 #VALUE!
16 Abbocath No. 24 buah 19,500 14 0 14 8 6 20 14 0 117,000 DAK 2012 #VALUE!
17 Abbocath No. 24 buah 21,990 0 0 0 0 0 0 0 0 DAU 2013 #VALUE!
19 Abbocath No. 24 buah 0 0 0 0 0 0 #VALUE!
20 Aethylis Carbonas Chinie (Eukinin tab ) btl 1000 137,500 0 0 0 0 0 0 #VALUE!
21 Air Raksa Dental Use btl 100 g 0 0 0 0 0 0 #VALUE!
22 Alat suntik sekali pakai 1 ml ktk 100 pcs 136,500 0 0 0 0 0 0 0 0 DAU 2012 #VALUE!
23 Alat suntik sekali pakai 1 ml ktk 100 pcs 100 0 100 100 81 -19 0 0 BUFFER #VALUE!
24 Alat suntik sekali pakai 1 ml ktk 100 pcs 0 0 0 0 0 0 #VALUE!
25 Alat suntik sekali pakai 2,5 ml ktk 100 pcs 118,200 0 0 0 0 0 0 0 0 DAU 2012 #VALUE!
26 Alat suntik sekali pakai 2,5 ml ktk 100 pcs 0 0 0 0 0 0 0 0 BUFFER #VALUE!
27 Alat suntik sekali pakai 2,5 ml ktk 100 pcs 100 0 100 100 0 243 243 0 0 #VALUE!
28 Alat suntik sekali pakai 3 ml ktk 100 pcs 103,800 0 0 0 0 0 0 DAK 2013 #VALUE!
29 Alat suntik sekali pakai 3 ml ktk 100 pcs 114,079 0 0 0 0 0 0 DAU 2013 #VALUE!
30 Alat suntik sekali pakai 3 ml ktk 100 pcs 0 0 0 0 0 0 #VALUE!
31 Alat suntik sekali pakai 5 ml pcs 0 0 0 0 0 0 BUFFER #VALUE!
32 Alat suntik sekali pakai 5 ml ktk 100 pcs 145,455 0 0 0 0 0 0 DAU 2012 #VALUE!
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Alat suntik sekali pakai 5 ml ktk 100 pcs 189,488 0 0 0 0 0 0 0 DAU 2013
34 Alat suntik sekali pakai 5 ml ktk 100 pcs 0 0 0 0 0 0
35 Albendazole Tab. 400 mg ktk 20 pcs 227,275 0 0 0 0 0 0 0 0 DAU 2012
36 Albendazole Tab. 400 mg ktk 30 12,200 2,000 0 2,000 2,000 30 0 0 24,400,000 BUFFER
37 Allopurinol Tab. 100 mg ktk 30 0 0 0 0 0 0 0 0
38 Allopurinol Tab. 100 mg ktk 100 13,200 0 0 0 0 0 0 DAK 2010
39 Allopurinol Tab. 100 mg ktk 100 14,518 200 0 200 200 271 71 0 2,903,600 DAK 2013
40 Allopurinol Tab. 100 mg ktk 100 0 0 0 0 0 0 0 0 BUFFER
41 Allopurinol Tab. 100 mg ktk 100 0 0 0 0 0 0 0 0
42 Alprazolam 0,5 mg ktk 100 0 0 0 0 30 0 0
43 Albotil Btl 10 ml 40,909 0 0 0 0 10 0 0 DAK 2012
44 Albotil Btl 10 ml 0 0 0 0 0 0
45 Aminofilin Inj. ktk 10 amp 35,744 10 0 10 10 0 0 0 357,440
46 Aminofilin Inj. ktk 30 amp 90,000 0 0 0 0 0 0 DAK 2012
47 Aminofilin Inj. ktk 30 amp 99,000 0 0 0 0 0 0 0 0 DAK 2013
48 Aminofilin Inj. ktk 30 amp 0 0 0 0 0 0
49 Phaminov inj ktk 10 amp 42,500 0 0 0 0 0 0 0 0 DAK 2011
50 Ambroksol 30 mg ktk 100 0 0 0 0 542 542 0 0
51 Aminofilin tab. 200 mg Btl 100 11,330 0 0 0 0 0 0 DAK 2012
52 Aminofilin tab. 200 mg Btl 100 12,463 0 0 0 0 0 0 DAK 2013
53 Aminofilin tab. 200 mg Btl 100 0 0 0 0 0 0
54 Amitriptilin HCl tab. 25 mg ktk 10 strip 13,201 200 0 200 200 271 71 0 2,640,200
55 Amitriptilin HCl tab. 25 mg ktk 10 strip 0 0 0 0 0 0
56 Amlodipin Tab ktk 50 52,800 0 0 0 0 0 0
57 Amlodipin Tab ktk 50 90 0 90 30 60 271 211 0 0
58 Amoksisilin sirup kering 125 mg/5 ml btl 60 ml 3,700 0 0 0 0 54 54 0 0 DAK 2012
59 Amoksisilin sirup kering 125 mg/5 ml btl 60 ml 4,070 0 0 0 0 0 0 0 0 DAK 2013
60 Amoksisilin sirup kering 125 mg/5 ml btl 60 ml 0 0 0 0 0 0
61 Amoksisilin Kapsul 250 mg ktk 100 28,740 300 0 300 300 0 948 948 0 0 DAK 2012
62 Amoksisilin Kapsul 250 mg ktk 100 38,115 0 0 0 0 0 0 DAK 2013
63 Amoksisilin Kapsul 250 mg ktk 100 0 0 0 0 0 0 0 0
64 Amoksisilin Kaplet 500 mg ktk 100 37,000 0 0 0 0 0 0 DAK 2012
65 Amoksisilin Kaplet 500 mg ktk 100 450690 1,300 0 1,300 1,100 200 2,439 2,239 0 90,138,000 DAK 2013
66 Amoksisilin Kaplet 500 mg ktk 100 0 0 0 0 0 0
67 Ampisillin sirup kering 125 mg/5 ml btl 100 0 0 0 0 0 0
68 Ampisillin serbuk inj. 1000 mg/ml ktk 10 vial 52250 0 0 0 0 0 0 DAK 2011
69 Ampisillin serbuk inj. 1000 mg/ml ktk 10 vial 53680 0 0 0 0 0 0 DAK 2012
70 Ampisillin serbuk inj. 1000 mg/ml ktk 10 vial 0 0 0 0 0 0 0 0
71 Anemolat Tab 1 mg ktk 100 15000 0 0 0 0 0 0 DAK 2011
72 Antalgin (metempiron) tab. 500 mg btl 1000 191279 0 0 0 0 0 0 DAK 2012
73 Antalgin (metempiron) tab. 500 mg ktk 100 0 0 0 0 0 0
74 Antalgin inj. 250 mg/ml-2 ml ampul 3300 0 0 0 0 0 0 DAU 2013
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
75 Antalgin inj. 250 mg/ml-2 ml ktk 30 amp 0 0 0 0 0 0 0
76 Antasida DOEN, Tab. Kombinasi ktk 100 14,850 0 0 0 0 0 0 DAK 2011
77 Antasida DOEN, Tab. Kombinasi ktk 100 16,200 0 0 0 0 0 0 0 0 DAK 2012
78 Antasida DOEN, Tab. ` ktk 100 17,820 1,000 0 1,000 1,000 0 1,355 1,355 0 0 DAK 2013
79 Antasida DOEN, Tab. Kombinasi ktk 100 0 0 0 0 0 0 0 0
80 Antasida DOEN Suspensi, Kombinasi btl 60 ml 3,850 0 0 0 0 81 81 0 0 DAK 2012
81 Antasida DOEN Suspensi, Kombinasi btl 60 ml 0 0 0 0 0 0 0
82 Antihaemorodial folium ktk/30 0 0 0 0 0 0 0 0
83 Anti Parkinson DOEN Tab. Komb ktk/100 0 0 0 0 0 0 0 0
84 Asiklovir 400 mg ktk/30 57,133 0 0 0 0 0 0 0 DAK 2012
85 Asiklovir 400 mg ktk 100 0 0 0 0 0 0
86 Asiklovir 200 mg ktk 100 42,700 0 0 0 0 0 0 DAK 2011
87 Asiklovir 200 mg ktk 100 42,700 0 0 0 0 0 0 0 0 DAK 2013
88 Asiklovir 200 mg ktk 100 300 0 300 300 271 0 0 0
89 Asiklovir salep ktk 25 75,000 0 0 0 0 0 0 0 0 DAK 2012
90 Asiklovir salep tube 3,465 0 0 0 0 27 27 0 0 DAK 2013
91 Asiklovir salep tube 0 0 0 0 0 0 0 0
92 Anti bakteri Doen Slp kombinasi ktk/25 tube 0 0 0 0 54 54 0 0 BUFFER
93 Anti bakteri Doen Slp kombinasi ktk/25 tube 69,212 0 0 0 0 0 0 DAK 2013
94 Anti Fungi Doen ktk/24 45,372 0 0 0 0 0 0
95 Anti Fungi Doen ktk/24 0 0 0 0 54 54 0 0
96 AntiHemoroid DOEN komb ktk 10 supp 22,000 0 0 0 0 20 20 0 0 DAK 2011
97 AntiHemoroid DOEN komb ktk 10 supp 22,000 0 0 0 0 0 0 DAK 2013
98 AntiHemoroid DOEN komb ktk 10 supp 0 0 0 0 0 0
99 Asam folat tab 1 mg btl 100 0 0 0 0 0 0 0 0
100 Aquadest steril 25 ml vial 0 0 0 0 0 0 0 0
101 Aquadest steril 25 ml ktk 10 btl 15,000 30 0 30 30 30 0 0 450,000 BUFFER
102 Aquadest steril 25 ml ktk 10 btl 60,500 0 0 0 0 0 0
103 Asam ascorbat (Vit C) tab. 250 mg btl 250 0 0 0 0 0 0
104 Asam ascorbat (Vit C) tab. 50 mg btl 1000 30,250 0 0 0 0 0 0 BUFFER
105 Asam ascorbat (Vit C) tab. 250 mg btl 250 0 0 0 0 0 0 0 0
106 Asam ascorbat (Vit C) tab. 50 mg btl 1000 35,200 2,000 0 2,000 1,000 1,000 2,710 1,710 0 35,200,000 DAK 2013
107 Asam Klorida 0,1 N btl 60 ml 0 0 0 0 0 0
108 Asam Mefenamat Tab. 500 mg ktk 100 17,050 0 0 0 0 0 0 BUFFER
109 Asam Mefenamat Tab. 500 mg ktk 100 17,600 0 0 0 0 0 0 DAK 2012
110 Asam Mefenamat Tab. 500 mg ktk 100 19,350 400 0 400 400 0 1,355 1,355 0 0 DAK 2013
111 Asam Mefenamat Tab. 500 mg ktk 100 0 0 0 0 0 0
112 Atropin Sulfat Tetes mata ktk/24 0 0 0 0 0 0 0 0
113 Atropin Sulfat inj 0,25 mg/ml ktk 30 amp 36,300 60 0 60 60 0 2,178,000 DAK 2011
114 Atropin sulffat inj 0,25 mg/ml ktk 30 amp 0 0 0 0 0 0
115 Atripin sulfat tab. 0,5 mg btl 500 14,410 0 0 0 0 0 0 DAK 2010
116 Atropin sulfat tab. 0,5 mg btl 500 0 0 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
117 Acetosal 100 mg ktk/100 0 0 0 0 0 0 0
118 Baloon cateter no. 18 set 0 0 0 0 0 0
119 Baloon cateter no. 22 set 0 0 0 0 0 0 0 0
120 Baloon cateter no. 20 ` set 0 0 0 0 0 0
121 Baloon cateter no. 24 set 0 0 0 0 0 0 0 0
122 Benzatin benzil penisillin inj. 1,2 jutq IU/vial ktk 10 vial 79,200 0 0 0 0 0 0 DAK 2011
123 Besi II sulfat 200 mg ktk/100 buah 0 0 0 0 0 0 0
124 Betamidon vial 11,500 0 0 0 0 16 16 0 0 DAU 2012
125 Betamidon vial 0 0 0 0 0 0 0 0
126 Betadryl Injeksi vial 9,500 0 0 0 0 16 0 0 DAU 2012
127 Betadryl Injeksi vial 0 0 0 0 0 0
128 Betametason krim 0,1% ktk 25 tube 51,310 0 0 0 0 0 0 DAK 2011
129 Betametason krim 0,1% tube 2,053 0 0 0 0 54 54 0 0 BUFFER
130 Betametason krim 0,1% tube 0 0 0 0 0 0
131 Bioplasenton tube 27,045 0 0 0 0 10 10 0 0 DAU 2012
132 Bioplasenton tube 0 0 0 0 0 0
133 Calcii Glukonas inj ktk 24 amp 0 0 0 0 0 0 0 0
134 Captopril Tab. 12,5 mg ktk 100 0 0 0 0 0 0
135 Captopril Tab.25 mg ktk 100 13,775 0 0 0 0 0 0 DAK 2012
136 Captopril Tab. 25 mg ktk 100 15,133 300 0 300 100 200 406 206 0 3,026,600 DAK 2013
137 Captopril Tab. 25 mg ktk 100 15,153 0 0 0 0 0 0 BUFFER
138 Captopril Tab. 25 mg ktk 100 0 0 0 0 0 0 0 0
139 Catgut/benang bedah bedah no. 2/0-3/0 ktk 24 320,000 0 0 0 0 0 0 BUFFER
140 Catgut/benang bedah bedah no. 2/0-3/0 ktk 24 290,909 0 0 0 0 24 24 0 0 DAK 2012
141 Catgut/benang bedah bedah no. 2/0-3/0 ktk 24 290,000 0 0 0 0 0 0 0 0 DAK 2011
142 Catgut/benang bedah bedah no. 2/0-3/0 ktk 24 703,800 0 0 0 0 0 0 0 0 DAU 2013
143 Catgut/benang bedah bedah no. 2/0-3/0 ktk 24 703,780 0 0 0 0 0 0 0 0 DAU 2013
144 Catgut/benang bedah bedah no. 2/0-3/1 ktk 24 0 0 0 0 0 0
145 Cetoconazole tab ktk/50 150 0 150 150 30 0 0 0
146 Cholesterol 4 x 100 ml kit 0 0 0 0 0 0
147 Cetrizine 10 mg ktk/30 10,890 0 0 0 0 243 243 0 0 DAK 2013
148 Cetrizine 10 mg ktk/30 0 0 0 0 0 0
149 Cetrizine 10 mg ktk 50 15675 0 0 0 0 0 0 DAK 2012
150 Cetrizine 10 mg ktk 50 0 0 0 0 0 0
151 Cimetidin tab ktk 100 11,490 0 0 0 0 0 0 DAK 2012
152 Cimetidin tab ktk 100 0 0 0 0 0 0
153 Ciprofloxacin 500 mg ktk 100 31,240 400 0 400 400 0 1,355 1,355 0 0 DAK 2013
154 Ciprofloxacin 500 mg ktk 100 0 0 0 0 0 0 0 0
155 Cendo Fluorecin ktk/24 0 0 0 0 0 0
156 Clonidine 0,15 mg ktk/10 0 0 0 0 0 0
157 Calsidol B12+DHA Sirup btl/60 ml 0 0 0 0 0 0
158 CHKM btl 10 ml 145500 0 0 0 0 0 0 DAU 2012
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
159 Dasabion ktk/100 0 0 0 0 0 0 0
160 Deksametason Inj. 5 mg/ml-1 ml ktk 100 amp 200,200 0 0 0 0 216 216 0 0 DAK 2012
161 Deksametason Inj. 5 mg/ml-1 ml ktk 100 amp 220,220 0 0 0 0 0 0 0 0 DAK 2013
162 Deksametason Inj. 5 mg/ml-1 ml ktk 100 amp 0 0 0 0 0 0
163 Deksametason Tab. 0,5 mg btl 1000 0 0 0 0 0 0 0 0
164 Deksametason Tab. 0,5 mg ktk 100 9,349 0 0 0 0 0 0 BUFFER
165 Deksametason Tab. 0,5 mg ktk 100 9,560 400 0 400 400 0 1,761 1,761 0 0 DAK 20113
166 Deksametason Tab. 0,5 mg ktk 100 0 0 0 0 0 0 0 0
167 Dekstrometorfan HBr Sirup 10 mg/5 ml btl 60 ml 2,970 0 0 0 0 0 0 0 0 DAK 2011
168 Dekstrometorfan HBr Sirup 10 mg/5 ml btl 60 ml 3,152 18 0 18 18 27 9 0 56,736 DAK 2013
169 Dekstrometorfan HBr Sirup 10 mg/5 ml btl 60 ml 0 0 0 0 0 0
170 Dekstrometorfan HBr tab. 15 mg btl 1000 0 0 0 0 0 0
171 Dekstrometorfan HBr tab. 15 mg ktk 100 11,000 0 0 0 0 0 0 0 0 DAK 2012
172 Dekstrometorfan HBr tab. 15 mg ktk 100 10,890 0 0 0 0 0 0 BUFFER
173 Dekstrometorfan HBr tab. 15 mg ktk 100 12,100 600 0 600 100 500 406 0 0 6,050,000 DAK 2013
174 Dekstrometorfan HBr tab. 15 mg ktk 100 0 0 0 0 0 0
175 Devitalisasi Paste Non Arsen (Devvitasol) ktk/btl 0 0 0 0 1 1 0 0
176 Diazepam Inj. 5 mg/ml-2 ml ktk 30 amp 78,147 0 0 0 0 0 0 BUFFER
177 Diazepam Inj. 5 mg/ml-2 ml ktk 30 amp 78,147 0 0 0 0 0 0 DAK 2013
178 Diazepam Inj. 5 mg/ml-2 ml ktk 30 amp 0 0 0 0 0 0
179 Diazepam tab. 2 mg btl 1000 27,000 0 0 0 0 0 0 DAK 2011
180 Diazepam tab. 2 mg btl 1000 35,090 0 0 0 0 0 0 0 0 BUFFER
181 Diazepam tab. 2 mg btl 1000 35,090 1,000 0 1,000 1,000 81 -919 0 35,090,000 DAK 2013
182 Diazepam tab. 2 mg btl 1000 0 0 0 0 0 0
183 Diazepam tab. 2 mg btl 100 0 0 0 0 0 0 0 0
184 Diazepam tab. 5 mg btl 250 0 0 0 0 0 0 0 0
185 Dietilkarbamazin Sitrat tab. 100 mg/5ml ktk 100 10,725 14,300 0 14,300 14,300 0 0 0 153,367,500
186 Dietilkarbamazin Sitrat tab. 100 mg/5ml ktk 100 0 0 0 0 0 0
187 Difenhidramin HCl inj. 10 mg/ml-1 ml ktk 30 amp 13,787 0 0 0 0 0 0 BUFFER
188 Difenhidramin HCl inj. 10 mg/ml-1 ml ktk 30 amp 30 0 30 30 0 54 54 0 0
189 Dextran 70 lar. Infus btl 500 ml 0 0 0 0 0 0 0 0
190 Digoxin Tab. 0,25 mg ktk 100 14,300 0 0 0 0 0 0 DAK 2012
191 Digoxin Tab. 0,25 mg ktk 50 15,730 0 0 0 0 0 0 DAK 2013
192 Digoxin Tab. 0,25 mg ktk 50 0 0 0 0 0 0
193 Diltiazem 30 mg ktk 100 15,163 200 0 200 200 0 3,032,600 DAK 2012
194 Diltiazem 30 mg ktk 100 0 0 0 0 0 0
195 Doxyciclin ktk 100 55,660 0 0 0 0 0 0
196 Doxyciclin ktk 100 0 0 0 0 0 0 0 0
197 Domperidon Tab. 10 mg ktk 100 44,031 0 0 0 0 0 0 DAK 2012
198 Domperidon Tab. 10 mg ktk 100 0 0 0 0 0 0
199 Domperidon syr btl 60 ml 12,650 0 0 0 0 0 0 DAU 2012
200 Domperidon syr btl 60 ml 0 0 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
201 Ergotamin tartrat + kafein btl/100 10,367 0 0 0 0 27 27 0 0 DAK 2011
202 Ergotamin tartrat + kafein btl /100 0 0 0 0 0 0
203 Efedrin HCl tab. 25 mg btl 250 28,500 0 0 0 0 135 135 0 0 DAK 2011
204 Efedrin HCl tab. 25 mg btl 250 0 0 0 0 0 0
205 Ekstrak Belladon Tab btl 1000 17,892 0 0 0 0 0 0 0 0 BUFFER
206 Epinefrin Cl Inj. 0,1 % ktk 30 amp 40,920 0 0 0 0 0 0 DAK 2013
207 Epinefrin Cl Inj. 0,1 % ktk 30 amp 0 0 0 0 0 0 0
208 Erithromisin Kapsul 250 mg ktk 120 60,000 0 0 0 0 0 0 0 0 DAK 2012
209 Erithromisin Kapsul 250 mg ktk 120 66,000 240 0 240 240 271 31 0 DAK 2013
210 Erithromisin Kapsul 250 mg ktk 120 0 0 0 0 0 0 0
211 Erithromisin Kapsul 500 mg ktk 100, strip 78,100 0 0 0 0 0 0 DAK 2011
212 Erithromisin Kapsul 500 mg ktk 100, strip 102,300 0 0 0 0 0 0 DAK 2013
213 Erithromisin Kapsul 500 mg ktk 100, strip 0 0 0 0 0 0 0 0
214 Erithromisin Syr. 200 mg/5 ml btl 60 ml 7,732 0 0 0 0 0 0 DAK 2012
215 Erithromisin Syr. 200 mg/5 ml btl 60 ml 0 0 0 0 0 0 0 0
216 Etakridin (Rivanol) Lar. 0,1 % botol 300 ml 1,981 0 0 0 0 0 0 DAK 2011
217 Etakridin (Rivanol) Lar. 0,1 % botol 300 ml 1,800 0 0 0 0 0 0 0 0 DAK 2012
218 Etakridin (Rivanol) Lar. 0,1 % botol 300 ml 1,980 3 0 3 3 5 2 0 5,940 DAK 2013
219 Etakridin (Rivanol) Lar. 0,1 % botol 300 ml 0 0 0 0 0 0
220 Etambutol Tab ktk 100 52,580 0 0 0 0 0 0 DAK 2011
221 Etanol 70 % btl 300 ml 6,820 0 0 0 0 0 0 BUFFER
222 Etanol 70 % btl 300 ml 11,990 3 0 3 1 2 5 3 0 23,980 DAU 2013
223 Etanol 70 % btl 300 ml 0 0 0 0 0 0
224 Etanol 70 % btl 1000 ml 45,000 0 0 0 0 0 0 DAK 2011
225 Etanol 70 % btl 1000 ml 0 0 0 0 0 0 0 0
226 Etanol 70 % btl 100 ml 0 0 0 0 0 0 0 0
227 Etil Klorida Semprot btl 100 ml 181,000 0 0 0 0 0 0 0 0 DAU 2012
228 Etil Klorida Semprot btl 100 ml 115,490 1 0 1 1 0 3 3 0 0 DAU 2013
229 Etil Klorida Semprot btl 100 ml 0 0 0 0 0 0
230 Entrasol susu ktk 185 gr 0 0 0 0 0 0
231 Ethigent injeksi 80 mg/ml ktk 1 vial 2 ml 0 0 0 0 0 0 0 0
232 Eugenol cairan Fenilbutason Tab bks 12 btl 0 0 0 0 0 0
233 Fenilbutason Tab btl 1000 89,100 0 0 0 0 135 135 0 0 BUFFER
234 Fenitoin Natrium Inj. g/ml btl 1000 0 0 0 0 0 0
235 fenitoin Natrium Kap 100 mg btl 100 0 0 0 0 0 0
236 Fenobarbital inj. 50 mg/ml ktk 30 amp 0 0 0 0 0 0
237 Fenobarbital inj. 50 mg/ml ktk 30 amp 20,100 0 0 0 0 0 0 BUFFER
238 Fenobarbital inj. 50 mg/ml ktk 30 amp 42,899 0 0 0 0 0 0 0 0
239 Fenobarbital tab. 30 mg btl 100 5,115 0 0 0 0 0 0 BUFFER
240 Fenobarbital tab. 30 mg btl 100 0 0 0 0 0 0
241 Fenobarbital tab. 30 mg btl 1000 34,100 0 0 0 0 0 0 DAK 2010
242 Fenobarbital tab. 30 mg btl 1000 60,355 0 0 0 0 271 271 0 0 DAK 2013
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
243 Fenobarbital tab. 30 mg btl 1000 37,162 0 0 0 0 0 0 0 DAU 2013
244 Fenobarbital tab. 30 mg btl 1000 0 0 0 0 0 0
245 fenobarbital tab. 100 mg btl 250 0 0 0 0 0 0 0 0
246 fenoksimetil Penisilina Tab. 500 mg btl 100 tab 45,650 0 0 0 0 0 0 DAK 2011
247 Fenol gliserol tetes telinga 10 % ktk 24 btl 0 0 0 0 26 26 0 0
248 Ferrolat tab ktk 30 tab 0 0 0 0 0 0
249 Ferrous Sulfat Tab btl 1000 0 0 0 0 0 0 0
250 Fitomenadion (Vit K) inj. 10 mg/ml-1 ml ktk 30 amp 47,250 0 0 0 0 0 0 0 0
251 Fitomenadion (Vit K) inj. 10 mg/ml-1 ml ktk 30 amp 47,850 0 0 0 0 20 20 0 0 DAK 2011
252 Fitomenadion (Vit K) inj. 10 mg/ml-1 ml ktk 30 amp 0 0 0 0 0 0 0
253 Fitomenadion (Vit K) tablet salut 10 mg btl 100 68,062 0 0 0 0 0 0 DAK 2012
254 Fitomenadion (Vit K) tablet salut 10 mg btl 100 74,868 200 0 200 200 26 0 0 14,973,600 DAK 2013
255 Fitomenadion (Vit K) tablet salut 10 mg btl 100 0 0 0 0 0 0 0 0
256 Fluor Tab. 0,5 mg btl 100 0 0 0 0 0 0
257 Forinokresol (Pengganti TKF) btl 100 tab 0 0 0 0 0 0 0 0
258 Furosemid tab. 40 mg btl 10 ml 19,800 200 0 200 200 0 0 0 DAK 2011
259 Furosemid tab. 40 mg ktk 200 15,844 0 0 0 0 0 0 0 0 DAK 2010
260 Furosemid tab. 40 mg ktk 200 0 0 0 0 0 0
261 Gameksan emulsi 1 % btl 30 ml 0 0 0 0 0 0
262 Gentamisin Sulfat tetes mata botol 5 ml 0 0 0 0 0 0
263 Garam oralit untuk 200 ml air kotak 100 sach 41,800 200 0 200 200 81 0 8,360,000 DAK 2013
264 Garam oralit untuk 200 ml air ktk 100 sach 0 0 0 0 0 0 0 0
265 Garam oralit untuk 200 ml air ktk 25 sach 10,026 0 0 0 0 0 0 DAK 2011
266 Garam oralit untuk 200 ml air ktk 25 sach 0 0 0 0 0 0
267 Gentamisin inj ktk 5 amp 18,480 0 0 0 0 0 0 0 0 DAK 2011
268 Gentamisin inj ktk 5 amp 20,328 0 0 0 0 27 27 0 0 DAK 2013
269 Gentamisin inj ktk 5 amp 0 0 0 0 0 0 0 0
270 Gentamisin Salep ktk 25 tube 50,518 0 0 0 0 0 0 DAK 2013
271 Gentamisin Salep ktk 25 tube 0 0 0 0 0 0
272 Gentamisin Sulfat tetes mata 0,3 % btl 5 ml 3,630 0 0 0 0 27 27 0 0 DAK 2013
273 Gentian violet larutan 1 % btl 10 ml 1,930 0 0 0 0 5 5 0 0 DAK 2012
274 Gentian violet larutan 1 % btl 10 ml 0 0 0 0 0 0
275 Glass Ionomer Cement (gc ix) set 0 0 0 0 0 0
276 Glibenklamid Tab. 5 mg ktk 100 7,200 200 0 200 200 135 0 0 1,440,000 DAK 2012
277 Glibenklamid Tab. 5 mg ktk 100 7,950 0 0 0 0 0 0 DAK 2013
278 Glibenklamid Tab. 5 mg ktk 100 0 0 0 0 0 0
279 Gliserin btl 100 ml 0 0 0 0 0 0
280 Gliseril Guaiakolat tab. 100 mg (GG) btl 1000 25,563 0 0 0 0 0 0 0 0 BUFFER
281 Gliseril Guaiakolat tab. 100 mg (GG) btl 1000 27,900 0 0 0 0 0 0 DAK 2012
282 Gliseril Guaiakolat tab. 100 mg (GG) btl 1000 30,690 2,000 0 2,000 2,000 0 2,439 2,439 0 0 DAK 2013
283 Gliseril Guaiakolat tab. 100 mg (GG) btl 1000 0 0 0 0 0 0
284 Glukosa 4 x 100 ml kit 0 0 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
285 Glukosa lar. Infus 5 % steril 500 ml 8,272 7 0 7 7 8 1 0 57,904 DAK 2012
286 Glukosa lar. Infus 5 % steril 500 ml 5,566 0 0 0 0 0 0 DAK 20133
287 Glukosa lar. Infus 5 % steril 500 ml 0 0 0 0 0 0 0 0
288 Glukosa lar. Infus 10 % steril btl 500 ml 0 0 0 0 0 0
289 Glukosa lar. Infus 40 % steril ktk 10 0 0 0 0 0 0 0 0
290 Griseofulvin tab. 125 mg, micronized btl 100 24,000 0 0 0 0 0 0 DAK 2012
291 Griseofulvin tab. 125 mg, micronized btl 100 26,400 0 0 0 0 0 0 0 DAK 2013
292 Griseofulvin tab. 125 mg, micronized btl 100 300 0 300 300 135 -165 0 90,000
293 Handscoend steril No. 6,5 pcs 4,675 0 0 0 0 0 0 0 0 DAU 2013
294 Handscoend steril No. 6,5 pcs 0 0 0 0 0 0 0
295 Handscoend steril No. 7 pcs 8,200 0 0 0 0 162 162 0 0 DAU 2012
296 Handscoend steril No. 7 pcs 4,675 0 0 0 0 0 0 DAU 2013
297 Handscoend steril No. 7 pcs 0 0 0 0 0 0 0 0
298 Handscoend steril No. 7,5 pcs 8,200 0 0 0 0 0 0 DAU 2012
299 Handscoend steril No. 7,5 pcs 4,675 0 0 0 0 0 0 0 0 DAU 2013
300 Handscoend steril No. 7,5 pcs 0 0 0 0 0 0
301 Handscoend steril No. 8 pcs 8,200 0 0 0 0 135 135 0 0 DAU 2012
302 Handscoend steril No. 8 pcs 4,675 0 0 0 0 0 0 DAU 2013
303 Handscoend steril No. 8 pcs 0 0 0 0 0 0
304 Hustab P Syrup btl 60 ml 10,000 0 0 0 0 27 27 0 0 DAU 2012
305 Hustab P Syrup btl 60 ml 11,500 0 0 0 0 0 0 DAU 2011
306 Hustab P Syrup btl 60 ml 0 0 0 0 0 0 0 0
307 Hub Cutter buah 0 0 0 0 0 0
308 Haloperidol Tab. 0,5 mg ktk 100 0 0 0 0 0 0
309 Haloperidol Tab. 1,5 mg ktk 100 9,084 0 0 0 0 0 0 0 0 DAK 2013
310 Haloperidol Tab. 1,5 mg ktk 100 0 0 0 0 0 0 0 0
311 Haloperidol Tab. 5 mg ktk 100 12,229 100 0 100 100 0 0 0 1,222,900 DAK 2012
312 Haloperidol Tab. 5 mg ktk 100 13,452 0 0 0 0 0 0 DAK 2013
313 Haloperidol Tab. 5 mg ktk 100 0 0 0 0 0 0
314 Hidroklortiasid (HCT) Tab. 25 mg ktk 100 39,930 0 0 0 0 0 0 DAK 2011
315 Hidroklortiasid (HCT) Tab. 25 mg btl 1000 0 0 0 0 0 0 0 0
316 Hidrokortison krim 2,5 % btl 1000 71,500 0 0 0 0 0 0 DAK 2012
317 Hidrokortison krim 2,5 % ktk 24 tube 78650 0 0 0 0 54 54 0 0 DAK 2013
318 Hidrokortison krim 2,5 % ktk 24 tube 0 0 0 0 0 0
319 Hemaglobin 500 ml btl 0 0 0 0 0 0
320 Hemafort ktk 100 0 0 0 0 542 542 0 0
321 Hemogard ktk 30 tab 51150 0 0 0 0 0 0 DAU 2013
322 Hemogard ktk 30 tab 0 0 0 0 0 0 0 0
323 Ibuprofen Suspensi btl 60 ml 4500 0 0 0 0 27 27 0 0 DAK 2012
324 Ibuprofen Suspensi btl 60 ml 0 0 0 0 0 0
325 Ibuprofen tab. 200 mg btl 100 0 0 0 0 0 0
326 Ibuprofen tab. 400 mg btl 100 19799 0 0 0 0 677 677 0 0 BUFFER
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
327 Ibuprofen tab. 400 mg btl 100 20,476 0 0 0 0 0 0 0 DAK 2012
328 Ibuprefen tab. 400 mg btl 100 22,544 0 0 0 0 0 0 DAK 2013
329 Ibuprofen tab. 400 mg btl 100 0 0 0 0 0 0 0 0
330 Infus Set Anak set 7,000 6 0 6 4 2 8 6 0 14,000 DAK 2012
331 Infus Set Anak set 14,500 0 0 0 0 0 0 0 0 DAU 2012
332 Infus Set Anak set 4,400 0 0 0 0 0 0 DAK 2013
333 Infus Set Anak set 4,400 0 0 0 0 0 0 0 DAU 2013
334 Infus Set Anak set 0 0 0 0 0 0 0 0
335 Infus Set Dewasa set 12,500 0 0 0 0 0 0 0 0 DAU 2012
336 Infus Set Dewasa set 7,000 0 0 0 0 0 0 0 DAK 2013
337 Infus Set Dewasa set 3,850 5 0 5 3 2 16 14 0 7,700 DAK 2013
338 Infus Set Dewasa set 3,850 0 0 0 0 0 0 DAU 2013
339 Infus Set Dewasa set 0 0 0 0 0 0 0 0
340 Insulin Inj. 10 ml Vial btl 10 ml 0 0 0 0 0 0
341 Iodium Tes btl 100 0 0 0 0 0 0 0 0
342 Iodiol Kapsul lunak btl 100 102,300 0 0 0 0 0 0 DAK 2011
343 Iodiol Kapsul lunak ktk 100 0 0 0 0 0 0 0 0
344 Isoniasid (INH) Tab. 100 mg ktk 100 40,700 0 0 0 0 0 0 DAK 2011
345 Isoniasid (INH) Tab. 100 mg ktk 100 0 0 0 0 0 0
346 Isoniasid (INH) Tab. 300 mg ktk 100 0 0 0 0 0 0
347 Isosorbid Dinitrat Tab. 5 mg ktk 100 41,000 0 0 0 0 0 0 DAK 2012
348 Isosorbid Dinitrat Tab. 5 mg ktk 100 10,709 0 0 0 0 0 0 0 0 DAK 2013
349 Isosorbid Dinitrat Tab. 5 mg ktk 100 8,910 0 0 0 0 0 0 BUFFER
350 Isosorbid Dinitrat Tab. 5 mg ktk 100 0 0 0 0 0 0
351 Isi ulang oksigen tabung besar tabung 0 0 0 0 0 0 0 0
352 Isi ulang oksigen tabung kecil tabung 0 0 0 0 0 0 0 0
353 Isi ulang oksigen tabung sedang tabung 0 0 0 0 0 0 0 0
354 Jarum Hecting Jar. Otot no. 7 lusin 113,500 0 0 0 0 0 0 DAU 2012
355 Jarum Hecting kulit no. 5 lusin 113,500 0 0 0 0 0 0 DAU 2012
356 Jarum Hecting kulit no. 7 lusin 113,500 0 0 0 0 0 0 DAU 2012
357 Jarum Otot no 5 lusin 113,500 12 0 12 12 0 0 0 1,362,000 DAU 2012
358 Kalium Permanganat serbuk ktk 20 btl 0 0 0 0 0 0
359 Kalsium Hidroksida Pasta ktk 2 tube 0 0 0 0 0 0
360 Kalium Diklopenac 25 mg ktk/50 0 0 0 0 0 0
361 Kalsium Laktat btl 1000 57,200 0 0 0 0 0 0 DAK 2011
362 Kalsium Laktat btl 1000 57,200 2,000 0 2,000 2,000 0 2,439 2,439 0 0 DAK 2013
363 Kalsium Laktat btl 1000 0 0 0 0 0 0
364 Kanamycin Base 1 g Inj Vial 4,675 0 0 0 0 0 0 0 0 BUFFER
365 Kanamycin Base 1 g Inj Vial 0 0 0 0 0 0
366 Kapas 250 g bungkus 13,670 0 0 0 0 0 0 DAU 2013
367 Kapas 250 g bungkus 27,500 0 0 0 0 0 0 DAK 2012
368 Kapas 250 g bungkus 8,250 0 0 0 0 5 5 0 0 DAK 2013
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
369 Kapas 250 g bungkus 0 0 0 0 0 0 0
370 Karbamazepin Tab. 200 mg kt, 100, strip 24,645 0 0 0 0 0 0 DAK 2012
371 Karbamazepin Tab. 200 mg ktk 100, strip 27,110 100 0 100 100 124 24 0 2,711,000 DAK 2013
372 Karbamazepin Tab. 200 mg ktk 100, strip 0 0 0 0 0 0
373 Kasa Kompres 40/40 steril bks 0 0 0 0 0 0 0 0
374 Kasa Pembalut Hidrofil 36 m x 80 cm rol 60,720 1 0 1 1 1 0 0 60,720 DAK 2013
375 Kasa Pembalut Hidrofil 4 m x 15 cm rol 0 0 0 0 0 0 0
376 Kasa Pembalut Hidrofil 4 x 3 cm rol 0 0 0 0 0 0 0 0
377 Kasa Pembalut Hidrofil 16 x 16 cm rol 0 0 0 0 0 0 0 0
378 Kasa Pembalut 2 x 80 cm rol 16,500 0 0 0 0 0 0 0 DAU 2012
379 Kasa Pembalut 2 x 80 cm rol 0 0 0 0 0 0
380 Kasa Steril 18 x 22 cm ktk 16 lbr 0 0 0 0 0 0
381 Kasa Hidrofil 40 x 80 cm rol 172,500 0 0 0 0 0 0 0 0 DAU 2012
382 Kasa Hidrofil 40 x 80 cm rol 172,500 0 0 0 0 0 0 DAK 2012
383 Kasa Hidrofil 40 x 80 cm rol 0 0 0 0 0 0 0 0
384 Kasa Pembalut Hidrofil 3,6 m x 5 cm rol 2,500 0 0 0 0 0 0 DAU 2012
385 Kasa Pembalut Hidrofil 3,6 m x 5 cm rol 0 0 0 0 0 0 0 0
386 Kasa Pembalut Hidrofil 3,6 m x 15 cm rol 6,750 0 0 0 0 0 0 DAU 2012
387 Kasa Pembalut Hidrofil 4 m x 10 cm rol 33,385 100 0 100 50 50 81 31 0 1,669,250 DAK 2013
388 Ketoconazol Krim, 2 % tube 15 g 7,000 0 0 0 0 0 0 DAK 2012
389 Ketoconazol Krim, 2 % tube 15 g 0 0 0 0 0 0
390 Ketoconazol Tablet 200 mg ktk 50 20,473 0 0 0 0 0 0 0 0 DAK 2012
391 Ketoconazol Tablet 200 mg ktk 50 22,550 0 0 0 0 0 0 DAK 2013
392 Ketoconazol Tablet 200 mg ktk 50 0 0 0 0 0 0
393 Ketoprofen Tablet ktk 100 68,826 0 0 0 0 0 0 0 0 DAU 2012
394 Kloramfenikol Kaps. 250 mg btl/250 57,750 0 0 0 0 0 0 0 0 DAK 2011
395 Kloramfenikol Kaps. 250 mg btl/250 63,525 0 0 0 0 0 0 0 0 DAK 2013
396 Kloramfenikol Kaps. 250 mg btl/250 0 0 0 0 0 0
397 Kloramfenikol Kaps. 250 mg btl 1000 57,750 250 0 250 250 0 271 271 0 0 DAK 2011
398 Kloramfenikol Kaps. 250 mg btl 1000 227,273 0 0 0 0 0 0 DAK 2012
399 Kloramfenikol Kaps. 250 mg btl 1000 0 0 0 0 0 0 0 0
400 Kloramfenikol Salep mata 1 % ktk 25 tube 0 0 0 0 0 0
401 Kloramfenikol Sirup btl 60 ml 4,400 0 0 0 0 0 0 DAK 2011
402 Kloramfenikol Sirup btl 60 ml 4,950 2 0 2 2 10 8 0 9,900 DAK 2013
403 Kloramfenikol Sirup btl 60 ml 0 0 0 0 0 0
404 Kloramfenikol Tetes telinga ktk 24 btl 0 0 0 0 10 10 0 0
405 Klorfeniramin maleat (CTM) tab. 4 mg btl 1000 26,400 0 0 0 0 0 0 DAK 2011
406 Klorfeniramin maleat (CTM) tab. 4 mg btl 1000 24,000 0 0 0 0 0 0 0 0 DAK 2012
407 Klorfeniramin maleat (CTM) tab. 4 mg btl 1000 26,400 0 0 0 0 3,116 3,116 0 0 DAK 2013
408 Klorfeniramin maleat (CTM) tab. 4 mg btl 1000 0 0 0 0 0 0
409 Klorokuin fosfst tab. 150 mg btl 1000 85,000 0 0 0 0 0 0 DAK 2012
410 Klorokuin fosfst tab. 150 mg btl 1000 93,500 0 0 0 0 0 0 DAK 2011
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
411 Klorokuin fosfst tab. 150 mg btl 1000 0 0 0 0 0 0 0
412 Klorpromazin HCl Inj. 5 mg/ml-2 ml ktk 30 amp 0 0 0 0 0 0
413 Klorpromazin HCl Inj. 5 mg/ml-2 ml ktk 30 amp 0 0 0 0 0 0 0 0
414 Klorpromazin HCl Tab. 25 mg btl 1000 26,895 0 0 0 0 0 0 DAK 2010
415 Klorpromazin HCl Tab. 25 mg btl 1000 134,200 0 0 0 0 0 0 0 0 DAK 2013
416 Klorpromazin HCl Tab. 25 mg btl 1000 0 0 0 0 0 0
417 Klorpromazin HCl tab.100 mg btl 1000 91,509 1,000 0 1,000 1,000 0 60 60 0 0 BUFFER
418 Klorpromazin HCl tab. 100 mg btl 250 153,000 0 0 0 0 0 0 0 0
419 Klorpropamid Tab. 100 mg btl 500 0 0 0 0 0 0 0 0
420 Kodein fosfat Tab. 10 mg btl 250 106,820 0 0 0 0 0 0 0 DAK 2011
421 Kodein fosfat Tab. 10 mg btl 250 0 0 0 0 60 60 0 0
422 Komb. Pirimetamin 25 mg + sulfadoksin 500 mg ktk 100 52,030 0 0 0 0 0 0 DAK 2011
423 Kotrimoksazol pediatrik tab. 120 mg btl 100 7,590 0 0 0 0 0 0 0 0 DAK 2012
424 Kotrimoksazol pediatrik tab. 120 mg btl 100 8,347 0 0 0 0 0 0 DAK 2013
425 Kotrimoksazol pediatrik tab. 120 mg btl 100 200 0 200 200 35 0 0 0
426 Kotrimoksazol suspensi btl 60 ml 3,958 0 0 0 0 0 0 DAK 2012
427 Kotrimoksazol suspensi btl 60 ml 3,850 0 0 0 0 27 27 0 0 BUFFER
428 Kotrimoksazol suspensi btl 60 ml 4,356 0 0 0 0 0 0 DAK 2013
429 Kotrimoksazol suspensi btl 60 ml 0 0 0 0 0 0
430 Kotrimoksazol dewasa ta. 480 mg btl 100 16,500 0 0 0 0 0 0 DAK 2012
431 Kotrimoksazol dewasa ta. 480 mg btl 100 18,249 0 0 0 0 813 813 0 0 DAK 2013
432 Kotrimoksazol dewasa ta. 480 mg btl 100 0 0 0 0 0 0 0 0
433 Kuinin dihidoklorida inj.-2 ml ktk 30 amp 126,800 0 0 0 0 0 0 DAK 2012
434 Kuinin dihidoklorida inj.-2 ml ktk 30 amp 0 0 0 0 0 0
435 Kuinin tab. 222 mg ktk 60 49,700 0 0 0 0 0 0 0 0 DAK 2012
436 Kuinin tab. 222 mg ktk 60 0 0 0 0 0 0 0 0
437 Lar. Benedict btl 100 ml 28,324 0 0 0 0 0 0 0 0 DAU 2010
438 Lar. Benedict btl 100 ml 0 0 0 0 0 0
439 Lar. Eosin 2 % btl 100 ml 66,000 0 0 0 0 0 0 DAU 2010
440 Lar. Eosin 2 % btl 100 ml 0 0 0 0 0 0
441 Lar. Etanol Asam btl 100 ml 0 0 0 0 0 0 0 0
442 Lar. Giemsa Stain btl 100 ml 0 0 0 0 0 0
443 Lar. Karbol Fuchsin btl 100 ml 0 0 0 0 0 0
444 Lar. Metanol btl 100 ml 0 0 0 0 0 0
445 Lar. Turk btl 100 ml 16,254 0 0 0 0 0 0 BUFFER
446 Lar. Turk btl 100 ml 32,500 0 0 0 0 0 0 DAK 2010
447 Lar. Turk btl 100 ml 0 0 0 0 0 0
448 Lidokain Komp. Inj ktk 30 amp 101,000 0 0 0 0 0 0 0 0 DAK 2012
449 Lidokain Komp. Inj ktk 30 amp 34,099 60 0 60 30 30 54 24 0 1,022,970 DAK 2013
450 Lidokain Komp. Inj ktk 30 amp 34,099 0 0 0 0 0 0 BUFFER
451 Lidokain Komp. Inj ktk 30 amp 0 0 0 0 0 0
452 lidokain . Inj ktk 100 amp 101,000 0 0 0 0 0 0 DAK 2012
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
453 Lidokain Inj ktk 100 amp 111,100 0 0 0 0 0 0 0 DAK 2013
454 Lidokain Inj ktk 100 amp 101,750 0 0 0 0 0 0 BUFFER
455 Lidokain Inj ktk 100 amp 0 0 0 0 0 0 0 0
456 Lisol btl 1000 ml 45,000 0 0 0 0 1 1 0 0 DAU 2012
457 Lisol btl 1000 ml 0 0 0 0 0 0 0 0
458 Levofloksasin ktk 30 33,200 0 0 0 0 0 0 DAK 2012
459 Levofloksasin ktk 50 0 0 0 0 0 0 0
460 Magnesium Sulfat Inj. (IV) 20%-25 ml ktk 10 16,931 0 0 0 0 0 0 0 0 DAK 2011
461 Magnesium Sulfat Inj. (IV) 20%-25 ml ktk 10 21,427 0 0 0 0 0 0 0 0 DAK 2013
462 Magnesium Sulfat Inj. (IV) 20%-25 ml ktk 10 0 0 0 0 0 0 0
463 Magnesium Sulfat Inj. (IV) 40%-25 ml ktk 10 19,479 0 0 0 0 0 0 DAK 2012
464 Magnesium Sulfat Inj. (IV) 40%-25 ml btl 25 ml 0 0 0 0 0 0
465 Magnesium Sulfat ser No. 10 btl 25 ml 0 0 0 0 0 0 0 0
466 Masker ktk 10 bks 68,500 0 0 0 0 135 135 0 0 DAU 2012
467 Masker ktk 50 0 0 0 0 0 0 0 0
468 Metanol ktk 50 0 0 0 0 0 0
469 Malasiqrin btl 100 ml 0 0 0 0 0 0 0 0
470 Mata Pisau Carbon No. 10 ktk 100 sase 6,750 0 0 0 0 27 27 0 0 DAU 2012
471 Mata Pisau Carbon No. 10 pcs 0 0 0 0 0 0
472 Mata Pisau Carbon No. 11 pcs 6,750 0 0 0 0 0 0 DAU 2012
474 Mata Pisau Carbon No. 15 pcs 6,750 0 0 0 0 0 0 0 0 DAU 2012
476 Mata Pisau Carbon No. 20 pcs 6,750 0 0 0 0 0 0
477 Mata Pisau Carbon No. 20 pcs 0 0 0 0 0 0 0 0
478 Mata Pisau Carbon No. 21 pcs 6,750 0 0 0 0 0 0 0 0 DAU 2012
479 Mata Pisau Carbon No. 21 pcs 0 0 0 0 0 0 0 0
480 Mata Pisau Carbon No. 22 pcs 6,750 0 0 0 0 0 0
482 Mebendazol Sirup 100 mg/5 ml btl 30 ml 0 0 0 0 0 0
483 Mebendazol Tab. 100 mg ktk 30, strip 0 0 0 0 0 0 0 0
484 Metampiron Tab. 500 mg ktk 100 14,900 0 0 0 0 0 0
485 Metampiron Tab. 500 mg ktk 100 0 0 0 0 0 0
486 Metilergometrin maleat inj. 0,200 mg-1 ml ktk 30 amp 45,100 0 0 0 0 0 0
487 Metilergometrin maleat inj. 0,200 mg-1 ml ktk 10 amp 16,390 20 0 20 20 0 327,800 DAK 2013
488 Metilergometrin maleat inj. 0,200 mg-1 ml ktk 10 amp 0 0 0 0 0 0
489 Metilergometrin maleat tab. Salut 0,125 mg ktk 100 0 0 0 0 0 0
490 Metilergometrin maleat tab. Salut 0,125 mg ktk 100 12,096 0 0 0 0 0 0 0 0 BUFFER
491 Metoklorpropamid Tab. 10 mg ktk 100 11,000 0 0 0 0 0 0 DAK 2012
492 Metoklorpropamid Tab. 10 mg ktk 100 0 0 0 0 0 0
493 Metformin tab 500 mg ktk 100 18,150 0 0 0 0 0 0 DAK 2012
494 Metformin tab 500 mg ktk 100 18,150 0 0 0 0 271 271 0 0 DAK 2013
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
495 Metformin tab 500 mg ktk 100 19,965 0 0 0 0 0 0 0 BUFFER
496 Metformin tab 500 mg ktk 100 0 0 0 0 0 0
497 Metronidazol tab. 250 mg ktk 100, strip 0 0 0 0 0 0 0 0
498 Metronidazol tab. 500 mg ktk 100, strip 22,000 0 0 0 0 0 0 DAK 2012
499 Metronidazol tab. 500 mg ktk 100, strip 24,200 500 0 500 300 200 406 206 0 4,840,000 DAK 2013
500 Metronidazol tab. 500 mg ktk 100, strip 0 0 0 0 0 0
501 Metil Prednisolon tab ktk 100 44,055 0 0 0 0 406 0 0 DAU 2012
502 Metil Prednisolon tab ktk 100 0 0 0 0 0 0 0 0
503 Mikonazole Krim tube 3,000 0 0 0 0 27 27 0 0 DAK 2012
504 Mikonazole Krim tube 3,300 0 0 0 0 0 0 0 DAK 2013
505 Mikonazole Krim tube 0 0 0 0 0 0
506 Monoklor Kamfer Mentol (CHKM) btl 10 ml 0 0 0 0 0 0
507 Mummifying Pasta btl 0 0 0 0 0 0 0 0
508 Natrium bikarbonat tab. btl 1000 15,730 0 0 0 0 0 0 DAK 2011
509 Natrium bikarbonat tab. btl 1000 0 0 0 0 0 0 0 0
510 Natrium Diklofenak Tab. 50 mg ktk 50 8,384 0 0 0 0 271 271 0 0 DAK 2012
511 Natrium Diklofenak Tab. 50 mg ktk 50 0 0 0 0 0 0 0 0
512 Natrium Klorida lar. Infus steril 0,9 % 500 ml 5,390 0 0 0 0 0 0 DAK 2011
513 Natrium Klorida lar. Infus steril 0,9 % 500 ml 5,390 0 0 0 0 22 22 0 0 DAK 2013
514 Natrium Klorida lar. Infus steril 0,9 % 500 ml 5,390 0 0 0 0 0 0 BUFFER
515 Natrium Klorida lar. Infus steril 0,9 % 500 ml 0 0 0 0 0 0
516 Natrium Tiosulfat Inj. 25%-10 ml ktk 10 amp 16,359 0 0 0 0 0 0 0 0 BUFFER
517 NeuroVit E ktk 60 55,428 0 0 0 0 0 0 DAU 2013
518 Nifedipin Tab. 10 mg ktk 100 12,900 0 0 0 0 406 406 0 0 DAK 2012
519 Nifedipin Tab. 10 mg ktk 100 14,189 0 0 0 0 0 0 0 0 DAK 2013
520 Nifedipin Tab. 10 mg ktk 100 0 0 0 0 0 0 0 0
521 Nistatin tab. Vaginal 100.000 iu/g ktk 100 37,000 0 0 0 0 0 0 0 0 DAK 2012
522 Nistatin tab. Vaginal 100.000 iu/g ktk 100 40,700 300 0 300 300 0 12,210,000 DAK 20143
523 Nistatin tab. Vaginal 100.000 iu/g ktk 100 0 0 0 0 0 0
524 Nistatin tab. 500.000 iu/g ktk 100 60,074 0 0 0 0 0 0 DAK 2012
525 Nistatin tab. 500.000 iu/g ktk 100 66,000 0 0 0 0 0 0 0 0 DAK 2013
526 Nistatin tab. 500.000 iu/g ktk 100 0 0 0 0 0 0
527 Noza ktk 100 43,855 200 0 200 100 100 108 8 0 4,385,500 DAU 2013
528 Novadryl Inj vial 0 0 0 0 0 0
529 Novamidon Inj vial 0 0 0 0 0 0
530 Obat antituberkulosis kategori I paket 0 0 0 0 0 0
531 Obat antituberkulosis kategori II paket 0 0 0 0 0 0
532 Obat antituberkulosis kategori III paket 0 0 0 0 0 0 0 0
533 Obat antituberkulosis kategori anak paket 0 0 0 0 0 0
534 Obat Batuk Hitam (OBH) btl 0 0 0 0 0 0
535 OBH Plus btl 100 ml 9,750 0 0 0 0 27 27 0 0 DAU 2012
536 OBH Plus btl 100 ml 0 0 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
537 Oksitettrasiklin HCl Inj. 50 mg/ml-10 ml ktk 10 vial 34,100 0 0 0 0 0 0 0 DAK 2013
538 Oksitettrasiklin HCl Inj. 50 mg/ml-10 ml ktk 10 vial 0 0 0 0 0 0
539 Oksitettrasiklin HCl Salep Kulit 3 % tube 5 gram 1,843 0 0 0 0 0 0 0 0 DAK 2013
540 Oksitettrasiklin HCl Salep Kulit 3 % tube 5 gram 1,843 25 0 25 25 0 27 27 0 0
541 Oksitettrasiklin salep mata ktk 25 tube 48,000 0 0 0 0 0 0 0 0 DAK 2012
542 Oksitettrasiklin salep mata ktk 25 tube 52,800 0 0 0 0 27 27 0 0 DAK 2011
543 Oksitettrasiklin salep mata ktk 25 tube 0 0 0 0 0 0 0
544 Oksitosin/pitogin inj. 10 iu/ml-1 ml ktk 10 amp 53,550 0 0 0 0 20 20 0 0 DAK 2012
545 Oksitosin/pitogin inj. 10 iu/ml-1 ml ktk 10 amp 0 0 0 0 0 0 0 0
546 Oksitosin inj. 10 iu/ml- 1 ml ktk 30 amp 0 0 0 0 0 0 0
547 Omeprazol kapsul 20 mg ktk 30 12,250 0 0 0 0 0 0 DAK 2012
548 Omeprazol kapsul 20 mg ktk 30 13,475 0 0 0 0 30 30 0 0 BUFFER
549 Omeprazol kapsul 20 mg ktk 30 0 0 0 0 0 0 0 0
550 Papaverin tab btl 1000 99,500 1,000 0 1,000 1,000 0 99,500,000 DAK 2012
551 Papaverin tab btl 1000 109,450 0 0 0 0 0 0 0 0 DAK 2013
552 Papaverin tab btl 1000 0 0 0 0 0 0
553 papaverin injeksi ktk 100 0 0 0 0 0 0 0 0
554 Paramidon Inj vial 0 0 0 0 0 0
555 Parasetamol sirup 120 mg/5 ml btl 60 ml 2,300 0 0 0 0 0 0 DAK 2012
556 Parasetamol sirup 120 mg/5 ml btl 60 ml 2,529 0 0 0 0 135 135 0 0 DAK 2013
557 Parasetamol sirup 120 mg/5 ml btl 60 ml 2,529 0 0 0 0 0 0 BUFFER
558 Parasetamol sirup 120 mg/5 ml btl 60 ml 0 0 0 0 0 0 0 0
559 Parasetamol Tab. 100 mg btl 100 0 0 0 0 0 0
560 Parasetamol tab. 500 mg btl 1000 50,050 0 0 0 0 0 0 BUFFER
561 Parasetamol tab. 500 mg ktk 100 11,544 1,200 0 1,200 1,200 0 2,710 2,710 0 0 DAK 2013
562 Parasetamol tab. 500 mg ktk 100 0 0 0 0 0 0 0 0
563 Parasetamol tab. 500 mg ktk 120 12,600 0 0 0 0 0 0 0 0 DAK 2012
564 Parasetamol tab. 500 mg ktk 120 0 0 0 0 0 0
565 Parasetamol drop btl 15 ml 5,280 0 0 0 0 10 10 0 0 DAK 2012
566 Parasetamol drop btl 15 ml 0 0 0 0 0 0
567 Pehavral ktk 100 96,500 0 0 0 0 271 271 0 0 DAU 2012
568 Pehavral ktk 100 0 0 0 0 0 0
569 Petidin inj ktk/10 131,904 0 0 0 0 0 0 DAK 2011
570 Petidin inj ktk/50 64,250 0 0 0 0 0 0
571 Petidin inj ktk/10 0 0 0 0 0 0
572 Pembalut Gips rol 42,500 0 0 0 0 0 0 BUFFER
573 Pirantel pamoat tab. 365 mg ktk 60 20,450 0 0 0 0 20 20 0 0 DAK 2011
574 Pirantel pamoat tab. 365 mg ktk 60 0 0 0 0 0 0 0 0
575 Pirantel pamoat tab. 365 mg ktk 100 35,200 0 0 0 0 0 0 DAK 2013
576 Pirantel pamoat tab. 365 mg ktk 100 35,200 0 0 0 0 0 0
577 Piridoksin HCl (Vit B6) tab. 10 mg btl 1000 15,752 2,000 0 2,000 2,000 1,355 -645 0 31,504,000 DAK 2011
578 Piridoksin HCl (Vit B6) tab. 10 mg btl 1000 19,140 0 0 0 0 0 0 DAK 2013
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
579 Piridoksin HCl (Vit B6) tab. 10 mg btl 1000 0 0 0 0 0 0 0
580 Piridoksin HCl (Vit B6) tab. 10 mg ktk 100 ampul 289,179 0 0 0 0 0 0 DAU 2013
581 Piridoksin HCl (Vit B6) tab. 10 mg ktk 100 ampul 0 0 0 0 0 0 0 0
582 Pilokarpin tetes mata (HCL/nitrat) btl 5 ml 0 0 0 0 0 0
583 Piroxicam Tab. ktk 120 11,110 0 0 0 0 542 542 0 0 DAK 2013
584 Piroxicam Tab. ktk 120 0 0 0 0 0 0
585 Piroxicam Tab. ktk 100 8,400 0 0 0 0 0 0 0 DAK 2012
586 Piroxicam Tab. ktk 100 11,552 0 0 0 0 0 0 0 0 BUFFER
587 Piroxicam Tab. ktk 100 0 0 0 0 0 0 0 0
588 Pirasetam Kaplet 1200 mg ktkk 100 129,360 0 0 0 0 0 0 0 DAK 2012
589 Plastik obat bks 100 sach 5,455 40 0 40 40 0 218,200 DAK 2012
590 Plester 5 cm x 4,5 cm rol 50,200 0 0 0 0 0 0 DAU 2012
591 Plester 5 cm x 4,5 cm rol 33,551 0 0 0 0 0 0 0 0 DAU 2013
592 Plester 5 yard x 2 inch rol 25,980 3 0 3 1 2 3 1 0 51,960 DAU 2013
593 Plester rol 3,964 0 0 0 0 0 0 0 0 BUFFER
594 Plester rol 0 0 0 0 0 0
595 Pot sputum pot 0 0 0 0 0 0 0 0
596 Prednison tab. 5 mg btl 1000 62,500 0 0 0 0 0 0 DAK 2012
597 Prednison tab. 5 mg b tl 1000 68,750 0 0 0 0 0 0 DAK 2013
598 Prednison tab. 5 mg btl 1000 0 0 0 0 0 0
599 Prednison tab. 5 mg btl 1000 63,250 0 0 0 0 1,897 1,897 0 0 BUFFER
600 Prenatin Plus ktk 100 67,195 200 0 200 100 100 406 306 0 6,719,500 DAU 2013
601 Primakina tab. 15 mg btl 1000 0 0 0 0 0 0
602 Prokain Benzil Penisilin Inj. 3 juta vial 198,550 0 0 0 0 0 0
603 Propil Tiourasil Tab. 100 mg btl 100 29,957 100 0 100 100 0 0 0 2,995,700 DAK 2012
604 Propil Tiourasil Tab. 100 mg btl 100 32,953 500 0 500 500 0 0 0 16,476,500 DAK 2013
605 Propil Tiourasil Tab. 100 mg btl 100 0 0 0 0 0 0 0 0
606 Pytogin injk 10 Iuml/ml-2 ktk 10 0 0 0 0 0 0
607 Propranolol HCl tab. 40 mg btl 100 13,310 0 0 0 0 0 0 BUFFER
608 Propranolol HCl tab. 40 mg btl 100 8,218 0 0 0 0 0 0 BUFFER
609 Propranolol HCl tab. 40 mg btl 100 0 0 0 0 0 0 0 0
610 Rapit test kit ktk 25 strip 0 0 0 0 0 0 DAK 2012
611 Ranitidin tab. 150 mg ktk 100 22,000 0 0 0 0 0 0 DAK 2013
612 Ranitidin tab. 150 mg ktk 100 24,100 0 0 0 0 542 542 0 0
613 Ranitidin tab. 150 mg ktk 100 0 0 0 0 0 0 DAK 2012
614 Ranitidin inj ktk 25 ampul 64,250 0 0 0 0 0 0
615 Ranitidin inj ktk 25 ampul 0 0 0 0 0 0 BUFFER
616 Reserpin tab. 0,10 mg btl/250 11,500 0 0 0 0 0 0 0 0
617 Reserpin tab. 0,10 mg btl/250 0 0 0 0 0 0
618 Reserpin tab. 0,25mg btl 1000 0 0 0 0 0 0
619 Retinol (Vit A) kaps. 100.000 IU btl 50 0 0 0 0 0 0
620 Retinol (Vit A) kaps. 100.000 IU btl 50 0 0 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
621 Recodryl Inj vial 4,396 0 0 0 0 0 0 0 DAU 2013
622 Rifampisin Kaps. 450 mg ktk 100 49,500 0 0 0 0 0 0 DAK 2010
623 Rifampisin Kaps. 450 mg ktk 100 60,500 200 0 200 200 0 -200 0 12,100,000 DAK 2011
624 Reagen TB 2 N kit 0 0 0 0 0 0
625 Ringer Laktat (RL) lar. Steril 500 ml 5,720 0 0 0 0 0 0 0 0 DAK 2011
626 Ringer Laktat (RL) lar. Steril 500 ml 9,000 0 0 0 0 20 20 0 0 DAK 2012
627 Ringer Laktat (RL) lar. Steril 500 ml 5,717 0 0 0 0 0 0 0 DAK 2013
628 Ringer Laktat (RL) lar. Steril 500 ml 0 0 0 0 0 0 0 0
629 Salbutamol Tab. 2 mg ktk 100 0 0 0 0 81 81 0 0
630 Salbutamol Tab. 4 mg ktk 100 9,749 0 0 0 0 0 0 0 DAK 2012
631 Salbutamol Tab. 4 mg ktk 100 10,724 400 0 400 100 300 104 -196 0 3,217,200 DAK 2013
632 Salbutamol Tab. 4 mg ktk 100 0 0 0 0 0 0
633 Salep 2-4 Kom ktk/24 pot 34,250 24 0 24 24 0 27 27 0 0 DAK 2013
634 Salep 2-4 Kom ktk/24 pot 0 0 0 0 0 0
635 Salisil bedak 2 % 50 g 1,430 0 0 0 0 20 20 0 0 DAK 2013
636 Salisil bedak 2 % 50 g 1,210 0 0 0 0 0 0
637 Salisil bedak 2 % 50 g 0 0 0 0 0 0 0 0 DAK 2012
638 salisil spritus 10 % ktk 10 btl 0 0 0 0 0 0 DAK 2011
639 Sefadroksil 250 mg ktk 100 0 0 0 0 0 0
640 Sefadroksil 500 mg ktk 100 84,000 0 0 0 0 0 0
641 Sefadroksil 500 mg ktk 100 92,398 0 0 0 0 271 271 0 0
642 Sefadroksil 500 mg ktk 100 0 0 0 0 0 0 0 0 DAK 2012
643 Sefadroksil syr btl 60 ml 0 0 0 0 27 27 0 0 DAK 2013
644 Serum ATS inj ktk 10 vial 0 0 0 0 0 0
645 Sefoktasim Inj 1 gram ktk 2 vial 69,300 0 0 0 0 0 0 0 0
646 Sefoktasim Inj 1 gram ktk 2 vial 0 0 0 0 0 0 0 0
647 Sianokobalamin (Vit B12) inj. 500 mcg/ml ktk 100 amp 103,700 0 0 0 0 0 0 0 0 DAK 2012
648 Sianokobalamin (Vit B12) inj. 500 mcg/ml ktk 100 amp 114,070 100 0 100 100 54 0 0 11,407,000
649 Sianokobalamin (Vit B12) inj. 500 mcg/ml ktk 100 amp 0 0 0 0 0 0 DAK 2012
650 Sianokobalamin (Vit B12) Tab btl 1000 13,102 0 0 0 0 0 0 DAK 2013
651 Sianokobalamin (Vit B12) Tab btl 1000 14,412 0 0 0 0 1,490 1,490 0 0
652 Sianokobalamin (Vit B12) Tab btl 1000 0 0 0 0 0 0 DAK 2012
653 Silk (benang bedah sutra) no. 3/0 ktk 36 pcs 818,182 0 0 0 0 0 0
654 Silk (benang bedah sutra) no. 3/0 100 m ktk 36 pcs 0 0 0 0 0 0 DAU 2013
655 Silk (benang bedah sutra) no. 3/0 ktk 12 pcs 276,525 0 0 0 0 0 0
656 Silk (benang bedah sutra) no. 3/0 ktk 12 pcs 36 0 36 36 0 27 27 0 0 DAK 2012
657 Simvastatin 10 mg ktk 30 15,390 30 0 30 30 135 105 0 461,700 DAU 2012
658 Simvastatin 10 mg ktk 30 15,250 0 0 0 0 0 0 0 0
659 Simvastatin 10 mg ktk 30 0 0 0 0 0 0
660 Semen Seng Fosfat (Doriden) set 30 g 0 0 0 0 0 0 DAU 2013
661 Sohobion inj ktk 10 amp 60,450 0 0 0 0 0 0 DAU 2013
662 Sohobion inj ktk 10 amp 54,992 10 0 10 10 0 549,920 DAU 2013
663 Solvitron ktk 100 49440 200 0 200 200 271
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
664 Spon Gelatin Cubidles (Spongostan) ktk 24 buah 0 0 0 0 0 0 0
665 Sulfadimidin Tab. 500 mg btl 1000 0 0 0 0 0 0
666 Sulfasetamid Natrium tetes mata 0,5 % btl 0 0 0 0 10 10 0 0
667 Slide Set 45,000 72 0 72 72 0 3,240,000 DAU 2012
668 Slide Set 0 0 0 0 0 0 0 0
669 Slide Box Set 80,000 1 0 1 1 0 80,000 DAU 2010
670 Slide Box Set 0 0 0 0 0 0 0
671 SGOT 4 x 50-4 x 10 ml (80 x 50) Kit 0 0 0 0 0 0 0 0
672 SGOT 4 x 50-4 x 10 ml (80 x 50) kit 0 0 0 0 0 0 0 0
673 Silk (benang bedah sutra) no. 3/0 ktk 12 set 0 0 0 0 0 0 0
674 Tablet tambah darah ktk 3000 tab 0 0 0 0 0 0
675 Temporary Stopping Fletcher set 6,862 1 0 1 1 0 6,862 BUFFER
676 Tetracain HCl Ttetes mata 0,5 % btl 0 0 0 0 0 0 0 0
677 Tetrasiklin HCl kaps. 250 mg btl 1000 167,200 0 0 0 0 0 0 DAK 2011
678 Tetrasiklin HCl kaps. 250 mg btl 1000 183,425 0 0 0 0 0 0 0 0 DAK 2013
679 Tetrasiklin HCl kaps. 250 mg btl 1000 0 0 0 0 0 0
680 tetrasiklin HCl kaps. 500 mg ktk 100 0 0 0 0 0 0 0 0
681 Tiamfenikol 500 mg ktk 100 61,600 0 0 0 0 135 135 0 0 DAK 2012
682 Tiamfenikol 500 mg ktk 100 0 0 0 0 0 0
683 Tiamfenikol 250 mg ktk 100 0 0 0 0 0 0
684 Tiamin HCl (Vit. B1) inj ktk 30 amp 25,300 60 0 60 60 30 0 0 1,518,000 DAK 2013
685 Tiamin HCl (Vit. B1) inj ktk 30 amp 0 0 0 0 0 0 0 0
686 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg btl 1000 37,800 0 0 0 0 0 0 DAK 2012
687 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg btl 1000 41,580 1,000 0 1,000 1,000 1,355 355 0 41,580,000 DAK 2013
688 Tiamin HCl (Vit. B1) mononitrat tab. 50 mg btl 1000 0 0 0 0 0 0 0 0
689 Tensigar ktk/30 0 0 0 0 0 0 0 0
690 Triheksifenidil HCl Tab. 2 mg ktk 100, strip 4,485 0 0 0 0 0 0 0 0 DAK 2010
691 Triheksifenidil HCl Tab. 2 mg ktk 100, strip 4,538 0 0 0 0 60 60 0 0 DAK 2013
692 Triheksifenidil HCl Tab. 2 mg ktk 100, strip 0 0 0 0 0 0
693 Triglicerides 4 x 100 ml kit 0 0 0 0 0 0
694 Hemoglobin 500 ml btl 0 0 0 0 0 0 0 0
695 Trisulfa Tab. 500 mg btl 1000 0 0 0 0 0 0
696 Tramadol Tab ktk 18,500 0 0 0 0 50 50 0 0
697 Tramadol inj 50 mg/ml ktk 5 amp 0 0 0 0 0 0 DAK 2012
698 Test Narkoba 5 Multi Acon Strip ktk 25 strip 0 0 0 0 0 0
699 Urid acid (asam urat) 4 x 100 ml kit 0 0 0 0 0 0
700 Urine Bag pcs 0 0 0 0 0 0 DAU 2012
701 Urine Bag pcs 0 0 0 0 0 0 0 0
702 Ulsikur inj ktk 5 amp 0 0 0 0 0 0
703 Vaccine Carrrier buah 0 0 0 0 0 0
704 Vaksin Anti Rabies 9Verorab) Kur/set 0 0 0 0 0 0
705 Wibron Syr btl 60 ml 6,880 28 0 28 28 0 54 54 0 0 DAU 2013
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
706 Vitamin B Kompleks tab. btl 1000 22,200 0 0 0 0 0 0 0 DAK 2012
707 Vitamin B Kompleks tab. btl 1000 24,419 0 0 0 0 0 0 0 BUFFER
708 Vitamin B Kompleks tab. btl 1000 24,410 2,000 0 2,000 2,000 0 2,032 2,032 0 0 DAU 2013
709 Vitamin B Kompleks tab. btl 1000 0 0 0 0 0 0
710 Wing Needle No. 21 G pcs 3,500 0 0 0 0 0 0 0 0 BUFFER
711 Wing Needle No. 21 G ktk/100 buah 0 0 0 0 0 0
712 Wing Needle No. 23G pcs 3,500 0 0 0 0 0 0 0 BUFFER
713 Wing Needle No. 23 G ktk/100 buah 0 0 0 0 0 0 0 0
714 Wing Needle No. 25 G pcs 3,500 0 0 0 0 0 0 0 0 BUFFER
715 Wing Needle No. 25 G ktk/100 buah 0 0 0 0 0 0 0
716 Wing Needle No. 27 G pcs 3,500 0 0 0 0 0 0 BUFFER
717 Wing Needle No. 27 G ktk/100 buah 0 0 0 0 0 0
718 Yodium Povidon Lar. 10 % btl 1000 46,201 0 0 0 0 1 1 0 0 DAK 2011
719 Yodium Povidon Lar. 10 % btl 1000 0 0 0 0 0 0
720 Yodium Povidon Lar. 10 % brl 30 ml 2,200 0 0 0 0 0 0 0 0 DAK 2011
721 Yodium Povidon Lar. 10 % btl 30 ml 2,400 0 0 0 0 0 0 DAK 2012
722 Yodium Povidon Lar. 10 % btl 30 ml 2,640 24 0 24 6 18 12 0 0 47,520 DAK 2013
723 Yodium Povidon Lar. 10 % btl 30 ml 0 0 0 0 0 0
724 Yodium Povidon Lar. 10 % btl 300 ml 14,500 0 0 0 0 0 0 DAK 2012
725 Yodium Povidon Lar. 10 % btl 300 ml 15,960 5 0 5 1 4 0 63,840 DAK 2013
726 Yodium Povidon Lar. 10 % btl 300 ml 25,300 0 0 0 0 0 0
727 Zinc Tablet ktk 100 0 0 0 0 0 0 0 0
728 0 0
729 0 0
730 0 0
731 0 0
732 0 0
733 0 0
734 0 0
735 0 0
736 0 0
737 0 0
738 0 0
739 0 0
740 0 0
741 0 0
742 0 0
743 0 0
744 0 0
745 0 0
746 0 0
747 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
748
749
750
751
752
753
754
755
756
757
758
Umum BPJS Jamkesda Jumlah

10 Penyakit Terbesar
No Nama Penyakit Kode Jumlah
Jumlah Pasien/Resep 1 Ispa 1702 238
62 427 84 573 2 Dermatitis Alergi 2802 68
3 Gastritis 2001 63
4 R.A 29 54
5 Hipertensi 14 39
6 Diare 102 25
7 Diabetes Melitus 803 22
8 Penyakit lain-lain 1104 18
10 Pulpitis 1902 17

P. Rama Tandawuya,SE.M.Si Moh. Alchudri Mohidin,S.Farm.,M.Si,Apt dr. Intan S Tompo Silvi Salu,S.Farm
NIP. 19610219 198303 1 014 NIP. 19780505 200502 1 007 NIP. 19780203 200701 2 020 NIP. 19830514 201001 2 008
( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : November, Desember 2018
Puskesmas : Lawanga Permintaan Bulan : -
PEMBERIAN
NO NAMA OBAT KEMASAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN TOTAL HARGA KET
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
#REF!
ANALEGESI, ANTIPIRETIK,
A #REF!
ANTIINFLAMASI NON STEROID (Nsaid's)
1 Analgesik Narkotik #REF!
1 Petidin Inj 50 mg/ml Ampul - - - #REF!
#REF!
2 Analgesik Non Narkotika #REF!
2 Asam Mefenamat Tab. 500 mg Tablet 1,000 1,500 2,500 1,100 1,400 #REF!
3 Betamidon Inj Vial 0 0 #REF!
4 Ibuprofen 200 mg Tablet 0 0 #REF!
5 Ibuprofen 400 mg Tablet 0 3,800 3,800 2,600 1,200 #REF!
6 Ibuprofen susp. 100 mg/ml Botol 80 150 230 130 100 #REF!
7 Ibuprofen susp. 100 mg/ml Botol 0 0 #REF!
8 Ketoprofen 100 mg Tablet 0 0 #REF!
9 Ketoprofen suppositoria 10 mg Suppositoria 0 0 #REF!
10 Ketorolak Inj 30 mg/ml Ampul 0 0 #REF!
11 Metampiron Tab 500 mg Tablet 0 0 #REF!
12 Metampiron Inj Vial 0 0 #REF!
13 Natrium Diklofenak 25 mg Tablet 2,000 2,000 1,900 100 #REF!
14 Natrium Diklofenak 50 mg Tablet 0 0 #REF!
15 Parasetamol 500 mg Tablet 1,000 1,000 1,000 0 #REF!
16 Parasetamol Syrup 120 mg/ml Botol 300 300 300 0 #REF!
17 Parasetamol drops 100 mg/ml Botol 0 0 #REF!
18 Parasetamol Infus Buah 0 0 #REF!
19 Piroksikam 10 mg Tablet 0 2,000 2,000 2,000 0 #REF!
20 Piroksikam 20 mg Tablet 500 2,000 2,500 2,500 0 #REF!
21 Tramadol Tablet 0 0 #REF!
22 Tramadol Inj. 50 mg/ml Ampul 0 0 #REF!
#REF!
B ANTI PIRAI #REF!
23 Allopurinol Tab. 100 mg Tablet 0 1,000 1,000 300 700 #REF!
24 Allopurinol Tab .300 mg 0 0 #REF!
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
C ANTI BAKTERI
25 Amoksisilin sirup kering 125 mg/5 ml Botol 100 100 100 0
26 Amoksisilin Kapsul 250 mg Kapsul 700 3,200 3,900 1,900 2,000
27 Amoksisilin Kaplet 500 mg Kaplet 5,500 5,500 5,500 0
28 Ampisilin Sirup Kering 125 mg/5 ml Botol 0 0
29 Ampisilin Serbuk Inj. 1000 mg/ml Vial 0 0
30 Benzatin benzil penisilin inj. 1,2 juta IU/vial Vial 0 0
31 Ciprofloksasin 500 mg Tablet 700 500 1,200 1,200 0
32 Doksisiklin Kapsul 100 mg Kapsul 0 0
33 Erithromisin Kapsul 250 mg Kapsul 500 500 500 0
34 Erithromisin Kapsul 500 mg Kapsul 0 0
35 Erithromisin Syr. 200 mg/ 5 ml Botol 20 20 20 0
36 Fenoksimetil Penisilina Tab. 500 mg Tablet 0 0
37 Gentamisin Inj Ampul 10 10 10 0
38 Kanamisin Serb. Inj. 1000 mg Vial 0 0
39 Kloramfenicol Kaps. 250 mg Kapsul 1,000 1,000 1,000 0
40 Kloramfenicol Sirup Botol 0 0
41 Kotrimoksazol pediatrik tab. 120 mg Tablet 1,000 1,000 1,000 0
42 Kotrimoksazol suspensi Botol 18 18 18 0
43 Kotrimoksazol dewasa tab. 480 mg Tablet 500 800 1,300 1,300 0
44 Levofloksasin tablet 500 mg Tablet 0 0
45 Oksitetrasiklin HCl Inj. 50 mg/ml-10 ml Vial 0 0
46 Prokain Benzil Penisilin Inj. 3 juta Vial 0 0
47 Sefadroksil 250 mg Tablet 0 0
49 Sefadroksil syrup Botol 17 17 17 0
50 Sefotaksim inj 1 gram Vial 0 0
51 Seftriakson inj. 1 g Vial 0 0
52 Tetrasiklin HCl kaps. 250 mg Kapsul 0 0
54 Tiamfenikol 500 mg Tablet 1,500 1,500 1,500 0
D ANTI AMUBA DAN ANTIGIARDIASIS

55 Metronidazol tab. 250 mg Tablet 0 0
56 Metronidazol tab. 500 mg Tablet 1,000 1,000 400 600
57 Metronidazol infus Buah 0 0
58 Metronidazol susp. 125 mg/5 ml Botol 0 0
E ANTELMENTIK
59 Albendazole 400 mg Tablet 0 0
60 Mebendazol Tab. 100 mg 0 0
62 Mebendazol sir. 100 mg/ml 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
63 Pirantel pamoat tab. 125 mg Tablet 500 500 500 0
64 Pirantel pamoat tab. 250 mg Tablet 0 0
65 Pirantel pamoat susp 125 mg/ml Botol 0 0
F ANTI FILARIA
66 Dietilkarbamazepin tab. 100 mg Tablet 0 0
G ANTI SCHISTOSOMIASIS
67 Prazikuantel tab. 600 mg Tablet 0 0
H ANTI TUBERKOLOSIS
68 Etambutol 400 mg Tablet 0 0
69 Isoniazid 100 mg Tablet 0 0
71 OAT FDC Kategori I Paket 0 0
72 OAT FDC Kategori II Paket 0 0
73 OAT FDC Kategori Anak Paket 0 0
74 OAT Kombipak Kategori I Paket 0 0
75 Rimpafisin Kaps. 450 mg Kapsul 0 0
I ANTI MALARIA
76 Artemeter Inj 80 mg/ml Vial 0 0
77 Artesunat Inj 60 mg/ml Vial 0 0
78 Dosksisilin Kaps. 100 kapsul 0 0
79 Kuinin Tab Tablet 0 0
80 Kuinin Inj 25% Ampul 0 0
81 Kombinasi Sulfadoksin Pirimetamin Tablet 0 0
82 Kloroquin Tab. 250 mg Tablet 0 0
83 Kombinasi DHP + piperakuin Tablet 0 0
84 Primakuin tab. 15 mg Tablet 0 0
J OBAT UNTUK SALURAN CERNA

85 Antasida DOEN. Tab. Kombinasi Tablet 300 300 600 600 0
86 Antasida DOEN. Suspensi. Kombinasi Botol 0 250 250 250 0
87 Omeprazol kaps. 20 mg Kapsul 0 0
88 Ranitidin Tab. 150 mg Tablet 3,100 3,100 2,400 700
89 Ranitidin Inj. 25 mg/ml Ampul 0 0
90 Simetidin 200 mg Tablet 0 0
K ANTISPASMODIK
91 Atropin tab 0,5 mg Tablet 0 0
92 Ekstrak Belladon Tablet 0 0
93 Hiosina Butilbromida tab 10 mg Tablet 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
94 Hiosina Butilbromida Inj. 20 mg/ml / Buscopan Ampul 0 0
95 Papaverin Tab Tablet 0 0
96 Papaverin Inj Ampul 0 0
L OBAT UNTUK DIARE

97 Atapulgit tab Tablet 0 0
98 Garam Oralit Komb Sachet 0 0
99 Kombinasi kaolin 550 mg + pektin 20 mg Tablet 0 0
100 Loperamid 2 mg Tablet 2,000 2,000 2,000 0
101 Zink tab. Dispersibble 20 mg Tablet 0 0
102 Zink sir. 20 mg/ml Botol 0 0
M KATARTIK
103 Bisakodill tab 5 mg Tablet 0 0
104 Bisakodill suppos 5 mg Suppositoria 0 0
106 Gliserin drops 10 mg/ml Botol 0 0
107 Larutan Gliserin 100 mg/ml Botol 0 0
N ANTIHEMORROID
108 Antihemoroid DOEN Komb Suppositoria 100 100 100 0
109 Hemorogard Kapsul 0 0
O ANTI EMETIK
110 Dimenhidrinat tab 50 mg Tablet 0 0
111 Domperidon syr Botol 0 0
112 Domperidon Tab 10 mg Tablet 400 600 1,000 300 700
113 Domperidon drops 5 mg/ml Botol 0 0
114 Metoklopramid tab 10 mg Tablet 400 400 400
115 Metoklopramid Inj Ampul 0 0
P ANTI ALERGI
116 Betadryl Injeksi Vial 0 0
117 Difenhidramin inj 10 mg/ml Ampul 0 0
118 Klorfeniramin Maleat 4 mg Tablet 2,000 2,000 4,000 4,000 0
119 Loratadin tab 10 mg Tablet 2,000 2,000 2,000 0
120 Seterizine 10 mg Tablet 900 800 1,700 600 1,100
121 Seterizine syr. 5 mg/ml 0 0
Q ANTI VIRUS
122 Asiklovir 200 mg Tablet 100 100 100 0
123 Asiklovir 400 mg Tablet 1,000 1,000 1,000 0
124 Asiklovir Krim Tube 50 50 50 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
R ANTI FUNGI
125 Griseofulvin 125 mg Tablet 1,000 1,000 1,000 0
126 Griseofulvin 250 mg Tablet 0 0
127 Gentian Violet 1 % Botol 10 10 10 0
128 Ketokonazol 200 mg Tablet 400 800 1,200 1,200 0
129 Nistatin tab. Vaginal 100.000 iu/g Tablet 200 200 0 200
130 Nistatin tab. 500.000 iu/g Tablet 100 100 100
S ANTI EPILEPSI - ANTI KONVULSI

131 Diazepam Inj 5 mg/2,5 ml Ampul 0 0
132 Fenobarbital Tab 30 mg Tablet 0 0
134 Fenobarbital Inj 50 mg/5 ml Botol 0 0
135 Fenitoin Kaps. 30 mg Kapsul 0 0
137 Fenitoin Inj 50 mg/ml Ampul 0 0
138 Karbamazepin Tab 200 mg Tablet 0 0
139 Magnesium Sulfat Inj. (IV) 20% - 25 ml Botol 20 20 20 0
140 Magnesium Sulfat Inj. (IV) 40% - 25 ml Botol 0 0
T ANTI PARKINSON
141 Anti Parkinson DOEN Tab Tablet 0 0
142 Triheksilfenidil 2 mg Tablet 0 0
143 Kombinasi benserazid 25 mg, Levedopa 100 mg Tablet 0 0
ANTIDOTUM DAN OBAT LAINNYA

U
UNTUK KERACUNAN
144 Atropin Inj 0,25 mg/ml Ampul 0 0
145 Kalsium Glukonat Inj. 10 % Ampul 0 0
146 Natrium Bikarbonat Tab 500 mg Tablet 0 0
147 Natrium Tiosulfat inj 25% Ampul 0 0
V ANTI MIGREN
148 Ergotamin Tablet 0 0
149 Kombinasi Ergotamin 1 mg + Kefein 50 mg Tablet 0 0
W ANTI ANEMI
150 Asam Folat 0,4 mg Tablet 0 0
151 Asam Folat 1 mg Tablet 0 0
152 Ferro Sulfat tab. Salut 300 mg Tablet 0 0
153 Komb. Ferro sulfat + Asam Sulfat Tablet 0 0
154 Tablet Tambah Darah Tablet 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
OBAT YANG MEMPENGARUHI

X
KOAGULASI
155 Asam Traneksamat tab 500 mg Tablet 0 0
156 Asam Traneksamat inj 50 mcg/ml Ampul 0 0
157 Fitomenadion Tab 10 mg Tablet 100 100 100 0
158 Fitomenadion Inj 2 mg/ml Ampul 0 0
159 Fitomenadion inj 10 mg/ml Ampul 90 90 90
Y ANTI DIABET
160 Glibenklamid tab 5 mg Tablet 1,000 1,000 1,000 0
161 Glimepirid 1 mg Tablet 0 0
162 Glimepirid 2 mg Tablet 250 250 250 0
163 Glipizid tab 5 mg Tablet 0 0
164 Metformin 500 mg Tablet 300 300 300 0
165 Metformin 850 mg Tablet 0 0
Z ANTI ANGINA
166 Diltiazem tab 30 mg Tablet 0 0
167 Isosorbid Dinitrat tab 5 mg Tablet 0 0
AA ANTI ARITMIA
168 Digoksin tab 0,25 mg Tablet 0 0
169 Propanolol tab 10 mg Tablet 100 100 100 0
170 Propanolol tab 40 mg Tablet 0 0
AB ANTI HIPERTENSI
171 Amlodipin 5 mg Tablet 3,000 3,000 3,000 0
172 Amlodipin 10 mg Tablet 0 0
173 Kaptopril 12,5 mg Tablet 1,400 1,400 1,400 0
174 Kaptopril 25 mg Tablet 0 0
175 Nifedipin tab 10 mg Tablet 0 0
176 Reserpin tab 0,10 mg Tablet 0 0
AC DIURETIK
178 Furosemid tab 40 mg Tablet 0 0
179 Furosemid Inj 10 mg/ml Ampul 0 0
180 Hidroklortiazid tab 25 mg Tablet 100 100 100 0
181 Spironolakton tab 25 mg Tablet 0 0
AD ANTI AGREGASI PLATELET

182 Asam Asetil Salisilat tab 80 mg Tablet 0 0
183 Asam Asetil Salisilat tab 100 mg Tablet
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
AE ANTI HIPERLIPIDEMIA
184 Gemfibrozil 600 mg Tablet 0 0
185 Simvastatin tab 10 mg Tablet 1,080 1,080 570 510
186 Simvastatin tab 20 mg Tablet 100 100 100 0
AF OBAT UNTUK SYOK KARDIOGENIK

187 Epinefrin 0,1 % Inj Ampul 0 0
AG KORTIKOSTEROID
188 Dexamethason 0,5 mg Tablet 5,000 5,000 5,000 0
189 Dexamethason inj 5 mg/ml Ampul 10 100 110 11 99
190 Metilprednisolon 4 mg Tablet 3,000 3,000 3,000 0
191 Metilprednisolon 8 mg Tablet 0 0
192 Prednison 5 mg Tablet 1,500 1,500 1,500 0
AH PSIKOFARMAKA
1 Anti Ansietas
193 Alprazolam 0,5 mg Tablet 0 0
194 Diazepam tab 2 mg Tablet 200 200 200 0
195 Diazepam tab 5 mg Tablet 0 0
196 Diazepam inj 5 mg/ml Ampul 0 0
2 Anti Depresi
197 Amitriptilin tab 25 mg Tablet 0 0
3 Anti Psikosis
198 Haloperidol tab 0,5 mg Tablet 0 0
200 Haloperidol tab 2 mg Tablet 0 0
202 Klorpromazin tab 25 mg Tablet 0 0
204 Klorpromazin HCl Inj 5 mg/ml - 2 ml Ampul 0 0
205 Risperidon tab 2 mg Tablet 0 0
4 Anti obsesi Kompulsi
206 Fluoksetin Kaps 20 mg Kapsul 0 0
5 Obat Untuk Gangguan Bipolar

207 Valproat tab 500 mg Tablet 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
AI OBAT UNTUK SALURAN NAFAS
1 Anti asma
209 Aminofilin 150 mg Tablet 0 0
210 Aminofilin tab 200 mg Tablet 0 0
211 Aminofilin Inj Ampul 0 0
212 Salbutamol tab 2 mg Tablet 100 100 100 0
213 Salbutamol tab 4mg Tablet 0 0
2 Antitusif
214 Kodein Tab 10 mg Tablet 0 0
3 Ekspektoran
215 Gliseril Guaikolat tab 100 mg Tablet 0 0
216 N - Asetil Sistein Kaps 200 mg Tablet 0 0
217 Guaifenesin Tablet 0 0
4 Mukolitik
218 Ambroxol 30 mg Tablet 1,000 1,000 500 500
219 Ambroxol sirup 15 mg/ 5 ml Botol 0 0
220 Bromheksin 8 mg Tablet 0 0
221 Bromheksin sirup 4 mg/ml Botol 0 0
222 Obat Batuk Hitam (OBH) Botol 0 0
223 OBH Plus Botol 0 0
224 Wibrom Syr Botol 60 60 60 0
5 Simpatomimetik
225 Efedrin HCl tab 25 mg Tablet 0 0
226 Eflin Tablet 2,000 2,000 2,000 0
6 Obat Untuk Penyakit Paru Obstruksi kronis
227 Ipratropium Bromida Aerosol 20 mcg/semprot Buah 0 0

228 Ipratropium Bromida Cairan inhalasi 0,025% Buah 0 0
229 Komb. Ipratropium Bromida 0,5 mg + Salbutamol Buah 0 0
AJ ANTISEPTIK
230 Albothyl Botol 0 0
231 Hidrogen Peroksida lar. 30% (H2O2 3%) Botol 0 0
232 Povidon Iodin Larutan 10 % Btl 30 ml 0 0
233 Povidon Iodin Larutan 10 % Btl 300 ml 10 10 10 0
235 Hand Rub Botol 0 0
236 Serbuk PK Buah 20 20 20 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
AK BAKTERIOSTATIK
237 Etakridin (Rivanol) lar 0,1 % Botol 5 5 5 0
AL DESINFEKTAN
238 Etanol 70% Botol 40 40 7 33
239 Paraformaldehid Tab 1 g Tablet 0 0
240 Alkohol Swab Box 140 140 140
AM OBAT DAN BAHAN UNTUK GIGI

241 Bahan Tumpatan Sementara Buah 0 0
242 Flour Tab 0,5 mg Tablet 0 0
243 Glass Ionomer ART Botol 0 0
244 Kalsium Hidroksida Botol 0 0
245 Klorfenol Kamfer Mentol (CHKM) Botol 0 0
246 Komposit Resin Buah 0 0
247 Kalsium Hidroksida Pasta Buah 0 0
248 Larutan Eugenol Botol 0 0
249 Larutan Formokresol Botol 0 0
250 Pasta Devitalisasi (non Arsen) Buah 0 0
251 Surgical ginggival pack Buah 0 0
252 Semen Seng Fosfat (Doriden) Buah 0 0
253 Temporary Stopping Fletcher Buah 0 0
AN ANESTESI LOKAL
254 Etil klorida spray 100 ml Botol 0 0
255 Lidokain inj 2% Ampul 20 100 120 78 42
256 Lidokain 2% + Epinefrin Inj Ampul 0 0
257 Cathejel Lidokain 2% & CHG 0,05% Tube 0 0
258 Xylocaine Jelly Tube 0 0
AO ANTI TIROID
259 Propiltiourasil tab 100 mg Tablet 0 0
AP OBAT UNTUK MIASTENIA GRAVIS

260 Mestinon Tablet 0 0
261 Neostigmin inj 0,5 mg/ml Ampul 0 0
262 Piridostigmin tab. 60 mg Tablet 0 0
AQ OBAT TOPIKAL UNTUK KULIT

1. Anti Bakteri 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
Anti Bakteri Doen Slp Kombinasi Bacitrasin 500

263 Pot 0
IU/g & Polimiksin B 10.000 IU/g 200 200 200
264 Bioplasenton Tube 0 0
265 Gentamisin Salep Kulit 0,1% Tube 100 100 100 0
266 Kloramfenikol Salep Kulit 2% Tube 0 0
267 Oksitetrasiklin HCl Salep Kulit 3% Tube 0 0
2 Anti Fungi
268 Anti Fungi Doen Kombinasi Pot 0 0
269 Ketokonazol krim 2% Tube 0 0
270 Mikonazole krim 2% Tube 0 0
271 Nistatin Tab Vaginal 100.000 IU Tablet 0 0
3 Anti Inflamasi dan Antipruritik

272 Betametason krim 0,05 % Tube 0 0
273 Hidrokortison Krim 1% Tube 0 0
4 Antiskabies dan Antipedikulosis

274 Gameksan Emulsi 1% Buah 0 0
275 Salep 2-4 Kombinasi Pot 0 0
5 Lain- lain
276 Bedak Salicyl 2% Buah 5 35 40 28 12
AR OBAT UNTUK MATA

1 Anastesi Lokal
277 Tetrakain tts mata 0,5% Botol 0 0
2 Antimikroba
278 Gentamisin Salep Mata 0,3% Tube 0 0
279 Gentamisin tetes Mata 0,3% Botol 0 0
280 Kloramfenikol tts mata 0,5% Botol 0 0
281 Kloramfenikol tts mata 1% Botol 0 0
282 Kloramfenikol salep mata 1% Tube 0 0
283 Oksitetrasiklin salep mata Tube 0 0
284 Sulfasetamid Natrium Tetes Mata 0,5% Botol 0 0
3 Antiinflamasi
285 Betametason tts mata 1 mg/ml Botol 0 0
4 Miotik dan Antiglaukoma

286 Pilokarpin tts mata 2% Botol 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
5 Midriatik
287 Atropin Sulfat tetes Mata Botol
6 Tes Fungsi mata

288 Flouresein tetes mata 2,5 mg/ml Botol
OBAT UNTUK HIDUNG, TENGGOROKAN,

AS
DAN TELINGA
289 Fenol gliserol tetes telinga 10% Botol
290 Karbogliserin tetes telinga 10% Botol
291 Kloramfenikol tetes telinga Botol
292 Oksimetazolin tetes hidung 0,025 % Botol
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet
295 Metilergometrin Inj 0,2 mg/ml Ampul
296 Oksitoksin Inj 10 IU/ml Ampul
LARUTAN ELEKTROLIT, NUTRISI DAN

AU
LAIN-LAIN
297 Glukosa lar Infus 5% Botol
300 Natrium Klorida 0,9% Botol
301 Ringer Laktat Botol 17 17 17
OBAT YANG MEMPENGARUHI SISTEM
AV
IMUN
302 Hepatitis B Imunologlubin (HBIG) Inj Vial
303 Human tetanus Imunologlubin Inj Vial
304 Serum Anti Bisa Ular (ABU I) Vial
305 Serum Anti Difteri Inj Vial
306 Serum Anti tetanus (ATS) Vial
307 Vaksin Anti Rabies Ampul
AW VITAMIN DAN MINERAL

308 Asam Ascorbat tab 50 mg Tablet 2,500 2,000 4,500 3,100 1,400
309 Asam Ascorbat tab 250 mg Tablet 5,000 5,000 5,000 0
310 Asta Plus Tablet 0 0
311 Bionemi Tablet 800 800 800 0
312 Hemafort Tablet 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
313 Imufor Tablet 1,000 1,000 1,000 0
314 Kalsium Glukonat Inj 10% Vial 0 0
315 Kalsium karbonat Tab. 500 mg Tablet 0 0
316 Kalsium Laktat Tab. 500 mg Tablet 2,000 2,000 1,600 400
317 Pehavral Tablet 0 0
318 Piridoksin Tab. 10 mg Tablet 5,000 5,000 5,000 0
319 Piridoksin Inj. 100 mg/ml Ampul 0 0
320 Retinol Kaps. Lunak 100.000 IU Kapsul 0 0
322 Selesbion Tablet 0 0
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 4,000 4,000 4,000 0
324 Sianokobalamin Inj Ampul 0 0
325 Tiamin HCl (Vit.B1) Inj Ampul 100 100 100 0
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 0 0
327 Truvit syr Botol 0 0
328 Vit B Kompleks Tablet 0 0
329 Vit B Kompleks Inj Ampul 0 0
AX TERAPI NOOTROPIK
330 Pirasetam Kaplet 800 mg Tablet 0 0
331 Pirasetam Kaplet 1200mg Tablet 0 0
332 Pirasetam inj 3 gr Ampul 0 0
AY BAHAN HABIS PAKAI

333 Abbocath No 18 Buah 25 25 25 0
336 Abbocath No 24 Buah 0 0
337 Alat suntik sekali pakai 0,5 ml Buah 0 0
339 Alat suntik sekali pakai 1 ml Buah 100 100 100 0
340 Alat suntik sekali pakai 3 ml Buah 100 200 300 210 90
342 Alat suntik sekali pakai 10 ml Buah 0 0
344 Autodisable 3 ml dgn jarum Buah 0 0
346 Air Raksa Dental Use Buah 0 0
347 Baloon cateter 2 w no. 16 Buah 0 0
348 Baloon cateter 2 w no. 18 Buah 7 7 7 0
351 Benechek Uric test strip Buah 2 2 2
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
352 Benechek Glukosa test strip Botol 2 2 2
353 Benechek Kolesterol tast strip Botol 1 1 1
354 Blood Lancet Botol 0 0
355 Catgut/benang bedah no 2/0-3/0 Buah 0 0
356 Catgut/benang bedah no 3/0 Buah 0 0
357 Cholestrol 4 x 100 ml Kit 0 0
358 Folley Cateter 2 way no 18 Buah 0 0
359 Folley Cateter 2 way cateter no 20 Buah 0 0
360 Gips 4 Inc Buah 0 0
361 Handschoend steril No 6,5 Buah 0 0
362 Handschoend steril No 7 Buah 100 100 100 0
363 Handschoend steril No 7,5 Buah 100 100 100 0
365 Handschoend Ukuran S Buah 200 200 200 0
366 Handschoend Ukuran M Buah 200 200 200 0
367 Handschoend Ukuran L Buah 0 0
368 Handschoend obgyn steril Pasang 0 0
369 Handschoend obgyn steril 6 1/2 Pasang 0 0
370 Handschoend obgyn steril No 7 Pasang 0 0
372 Hub Cutter Buah 0 0
373 Infus set Anak Buah 15 15 15
374 Infus set Dewasa Buah 20 20 20 0
375 Isi Ulang Oksigen tabung besar Buah 0 0
376 Isi Ulang Oksigen tabung kecil Buah 0 0
377 Isi Ulang Oksigen tabung sedang Buah 0 0
378 Jarum Otot no 5 Buah 0 0
380 Jarum Hecting Jar. Otot no 7 Buah 0 0
382 Jarum Hecting Kulit no 5 Buah 0 0
384 Jarum Kulit no 12 Buah 0 0
385 Kantong Mayat Buah 0 0
386 Kpas 250 mg Buah 5 5 5 0
387 Kapas 500 mg Buah 0 0
388 Kasa Kompres 40/40 Rol 0 0
389 Kasa Pembalut hidrofil 4 m x 15 cm Rol 0 0
394 Kasa Pembalut hidrofil 3,6 m x 5 cm Rol 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
395 Kasa Pembalut Hidrofil 40 x 80 cm Rol 2 2 2
396 Kasa Steril 16 x 16 Rol 0 0
398 Mata Pisau Carbon No. 10 Buah 0 0
404 Masker Buah 300 300 300
405 Masker N 95 Buah 0 0
406 Neckcolar Buah 0 0
407 Pembalut Gips Buah 0 0
408 Pembalut Gips Softban 10 x 4,5 cm Buah 0 0
409 Plastik Obat Bks 100 sachet 0 0
410 Plastik Obat Besar Bks 100 sachet 0 0
411 Plastik Obat Sedang Bks 100 sachet 0 0
412 Plastik Obat Kecil Bks 100 sachet 0 0
413 Plester 5 yard Rol 0 0
414 Plester 2 inc Rol 0 0
415 Plester Rol 50 50 50
416 Pot Sputum Buah 0 0
417 Polifix 5 cm x 1m Rol 11 11 11
418 Rapit test protein Buah 0 0
419 Spalak Buah 0 0
420 Silk (benang bedah sutera) no. 3/0 Buah 2 2 2
421 Silk (benang bedah sutera) no. 3/0 100 m Buah 0 0
422 Slide Set 0 0
423 Slide Box Set 0 0
424 Transfusi Set Buah 0 0
425 Triangular Perban Buah 0 0
426 test Narkoba 5 Multi Acon Strip Botol 0 0
427 urin Strip untuk protein dan gula Buah 0 0
428 Urine Bag Buah 0 0
429 Wing Needle No. 23 G Buah 0 0
431 Wing Needle No. 25G Buah 0 0
AZ DAN LAIN LAIN

433 Asam Klorida 0,1 N Botol 0 0
434 Aquadest steril Botol 0 0
435 Control Normal CBC - ST Plus R & D Botol 1 1 1
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
436 Diluent BCC - 3600 1 x 20 L Galon 1 1 1
437 Glukosa 4 x 100 ml Botol 4 4 4
438 Glucose Liquid 3 x 100 Kit 1 1 1
439 Hemaglobin 500 ml Botol 0 0
440 Iodium Tes Botol 0 0
441 Iodiol Kapsul Lunak Botol 0 0
442 Kolestrol 4 x 100 ml Kit 4 4 4
443 Lar. Benedict Botol 0 0
444 Lar. Eosin 2% Botol 0 0
445 Lar. Etanol Asam Botol 0 0
446 Lar. Giemsa Stain Botol 0 0
447 Lar. Karbol Fuchsin Botol 0 0
448 Lar. Metanol Botol 0 0
449 Lar. Turk Botol 0 0
450 Larutan HCl Botol 0 0
451 Lisol Botol 0 0
452 Lisol Botol 0 0
453 Lyse BCC - Dirui Botol 1 1 1
454 Object Glass Frosted Box 0 0
455 Probe Cleanser BCC - Dirui Botol 1 1 1
456 Reagen TB 2 N Botol 0 0
457 Reagen Widal Botol 0 0
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0
459 Trigelicerides 4 x 100 ml Botol 0 0
460 Uric acid (Asam Urat) 4 x 100 ml Botol 4 4 4
461 Uric acid (Asam Urat) 3 x 100 ml Kit 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17
Umum
Bayar
Jamkesda BPJS Jumlah 10 Penyakit Terbesar
DLL No Nama Penyakit Kode Jumlah
Jumlah Pasien/Resep 1
2
3
4
5
6
7
8
9
10

Kepala Dinas Kesehatan kepala Instalasi Farmasi Kepala Puskesmas Ketua Pengelola Obat
Kabupaten Poso Kabupaten Poso Lawanga Tim Perencana Obat Puskesmas Puskesmas Lawanga
dr. N. Taufan Karwur Moh. Alchudri,S.Farm.,M.Si.,Apt dr. Intan S Tompo Irma.S. Pakaya,S.Kep.,Ns Silvi Salu,S.Farm
NIP. 19670527 199803 1 005 NIP. 19780505 200502 1 007 NIP. 19780203 200701 2 020 NIP. 19810215 200701 2 004 NIP. 19830514 201001 2 008
( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : Maret 2018
PEMBERIAN
NO NAMA OBAT KEMASAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN KET
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A
1 Analgesik Narkotik
1 Petidin Inj 50 mg/ml Ampul - - -
2 Analgesik Non Narkotika

2 Asam Mefenamat Tab. 500 mg Tablet 2,300 2,300 600 1,700 650
3 Betamidon Inj Vial 0 0
4 Ibuprofen 200 mg Tablet 0 0
5 Ibuprofen 400 mg Tablet 1,900 1,900 1,100 800 1,300 2,000
6 Ibuprofen susp. 100 mg/ml Botol 80 80 80 0 95 200
7 Ibuprofen susp. 100 mg/ml Botol 0 0
8 Ketoprofen 100 mg Tablet 0 0
9 Ketoprofen suppositoria 10 mg Suppositoria 0 0
10 Ketorolak Inj 30 mg/ml Ampul 0 0
11 Metampiron Tab 500 mg Tablet 0 0
12 Metampiron Inj Vial 0 0
13 Natrium Diklofenak 25 mg Tablet 0 0
14 Natrium Diklofenak 50 mg Tablet 100 100 100 1`000
15 Parasetamol 500 mg Tablet 600 600 600 0 3,000
16 Parasetamol Syrup 120 mg/ml Botol 110 110 110
17 Parasetamol drops 100 mg/ml Botol 12 12 12
18 Parasetamol Infus Buah 0 0
19 Piroksikam 10 mg Tablet 800 800 500 300 1,000
20 Piroksikam 20 mg Tablet 500 500 500 0
21 Tramadol Tablet 0 0
22 Tramadol Inj. 50 mg/ml Ampul 0 0
B ANTI PIRAI
23 Allopurinol Tab. 100 mg Tablet 1,600 1,600 500 1,100
24 Allopurinol Tab .300 mg 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
25 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0 0 200
26 Amoksisilin Kapsul 250 mg Kapsul 1,000 1,000 1,000
27 Amoksisilin Kaplet 500 mg Kaplet 4,400 4,400 1,000 3,400 2,000
28 Ampisilin Sirup Kering 125 mg/5 ml Botol 0 0
29 Ampisilin Serbuk Inj. 1000 mg/ml Vial 0 0
30 Benzatin benzil penisilin inj. 1,2 juta IU/vial Vial 0 0
31 Ciprofloksasin 500 mg Tablet 200 200 200 500
32 Doksisiklin Kapsul 100 mg Kapsul 0 0
33 Erithromisin Kapsul 250 mg Kapsul 200 200 100 100 500
34 Erithromisin Kapsul 500 mg Kapsul 0 0
35 Erithromisin Syr. 200 mg/ 5 ml Botol 0 0 100
36 Fenoksimetil Penisilina Tab. 500 mg Tablet 0 0
37 Gentamisin Inj Ampul 0 0 50
38 Kanamisin Serb. Inj. 1000 mg Vial 0 0
39 Kloramfenicol Kaps. 250 mg Kapsul 620 620 620
40 Kloramfenicol Sirup Botol 0 0
41 Kotrimoksazol pediatrik tab. 120 mg Tablet 200 200 200
42 Kotrimoksazol suspensi Botol 0 0
43 Kotrimoksazol dewasa tab. 480 mg Tablet 200 200 200 500
44 Levofloksasin tablet 500 mg Tablet 0 0
45 Oksitetrasiklin HCl Inj. 50 mg/ml-10 ml Vial 0 0
46 Prokain Benzil Penisilin Inj. 3 juta Vial 0 0
48 Sefadroksil 500 mg Tablet 0 0 2,000
49 Sefadroksil syrup Botol 0 0 100
50 Sefotaksim inj 1 gram Vial 0 0
51 Seftriakson inj. 1 g Vial 0 0
54 Tiamfenikol 500 mg Tablet 400 400 400

55 Metronidazol tab. 250 mg Tablet 0 0
56 Metronidazol tab. 500 mg Tablet 200 4,000 4,200 4,200
57 Metronidazol infus Buah 0 0
58 Metronidazol susp. 125 mg/5 ml Botol 0 0
E ANTELMENTIK
59 Albendazole 400 mg Tablet 0 0
62 Mebendazol sir. 100 mg/ml 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
64 Pirantel pamoat tab. 250 mg Tablet 0 0
65 Pirantel pamoat susp 125 mg/ml Botol 0 0
F ANTI FILARIA
66 Dietilkarbamazepin tab. 100 mg Tablet 0 0
67 Prazikuantel tab. 600 mg Tablet 0 0
H ANTI TUBERKOLOSIS
68 Etambutol 400 mg Tablet 0 0
71 OAT FDC Kategori I Paket 0 0
72 OAT FDC Kategori II Paket 0 0
73 OAT FDC Kategori Anak Paket 0 0
74 OAT Kombipak Kategori I Paket 0 0
75 Rimpafisin Kaps. 450 mg Kapsul 0 0
I ANTI MALARIA
76 Artemeter Inj 80 mg/ml Vial 0 0
77 Artesunat Inj 60 mg/ml Vial 0 0
78 Dosksisilin Kaps. 100 kapsul 0 0
79 Kuinin Tab Tablet 0 0
80 Kuinin Inj 25% Ampul 0 0
81 Kombinasi Sulfadoksin Pirimetamin Tablet 0 0
82 Kloroquin Tab. 250 mg Tablet 0 0
83 Kombinasi DHP + piperakuin Tablet 0 0
84 Primakuin tab. 15 mg Tablet 0 0

85 Antasida DOEN. Tab. Kombinasi Tablet 300 300 300 5,000
86 Antasida DOEN. Suspensi. Kombinasi Botol 0 0 0 50
87 Omeprazol kaps. 20 mg Kapsul 0 0
88 Ranitidin Tab. 150 mg Tablet 0 4,000 4,000 1,000 3,000
89 Ranitidin Inj. 25 mg/ml Ampul 0 0
90 Simetidin 200 mg Tablet 0 0
K ANTISPASMODIK
91 Atropin tab 0,5 mg Tablet 0 0
92 Ekstrak Belladon Tablet 0 0
93 Hiosina Butilbromida tab 10 mg Tablet 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
94 Hiosina Butilbromida Inj. 20 mg/ml / Buscopan Ampul 0 0
95 Papaverin Tab Tablet 600 2,000 2,600 800 1,800
96 Papaverin Inj Ampul 0 0
L OBAT UNTUK DIARE

97 Atapulgit tab Tablet 0 0
98 Garam Oralit Komb Sachet 0 0 300
99 Kombinasi kaolin 550 mg + pektin 20 mg Tablet 0 0
100 Loperamid 2 mg Tablet 400 2,000 2,400 100 2,300
101 Zink tab. Dispersibble 20 mg Tablet 0 0 200
102 Zink sir. 20 mg/ml Botol 0 0
M KATARTIK
103 Bisakodill tab 5 mg Tablet 0 0
106 Gliserin drops 10 mg/ml Botol 0 0
107 Larutan Gliserin 100 mg/ml Botol 0 0
N ANTIHEMORROID
108 Antihemoroid DOEN Komb Suppositoria 7 120 127 18 109
109 Hemorogard Kapsul 0 0
O ANTI EMETIK
110 Dimenhidrinat tab 50 mg Tablet 0 0
111 Domperidon syr Botol 0 0
112 Domperidon Tab 10 mg Tablet 1,600 1,600 600 1,000
113 Domperidon drops 5 mg/ml Botol 0 0
114 Metoklopramid tab 10 mg Tablet 400 400 400
115 Metoklopramid Inj Ampul 0 0
P ANTI ALERGI
116 Betadryl Injeksi Vial 0 0
117 Difenhidramin inj 10 mg/ml Ampul 0 0
118 Klorfeniramin Maleat 4 mg Tablet 0 6,000 6,000 1,000 5,000
119 Loratadin tab 10 mg Tablet 300 1,000 1,300 700 600
120 Seterizine 10 mg Tablet 400 400 400 0 1,500
121 Seterizine syr. 5 mg/ml 0 0
Q ANTI VIRUS
122 Asiklovir 200 mg Tablet 0 0
123 Asiklovir 400 mg Tablet 1,700 1,700 400 1,300
124 Asiklovir Krim Tube 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI
125 Griseofulvin 125 mg Tablet 800 800 800
126 Griseofulvin 250 mg Tablet 0 0
127 Gentian Violet 1 % Botol 0 0
128 Ketokonazol 200 mg Tablet 500 500 500
130 Nistatin tab. 500.000 iu/g Tablet 0 0 500

131 Diazepam Inj 5 mg/2,5 ml Ampul 0 0
132 Fenobarbital Tab 30 mg Tablet 100 100 100
134 Fenobarbital Inj 50 mg/5 ml Botol 30 30 30
137 Fenitoin Inj 50 mg/ml Ampul 0 0
138 Karbamazepin Tab 200 mg Tablet 0 0 300
T ANTI PARKINSON
141 Anti Parkinson DOEN Tab Tablet 0 0
142 Triheksilfenidil 2 mg Tablet 0 0 100
143 Kombinasi benserazid 25 mg, Levedopa 100 mg Tablet 0 0

U
UNTUK KERACUNAN
144 Atropin Inj 0,25 mg/ml Ampul 0 0
145 Kalsium Glukonat Inj. 10 % Ampul 0 0
146 Natrium Bikarbonat Tab 500 mg Tablet 0 0
147 Natrium Tiosulfat inj 25% Ampul 0 0
V ANTI MIGREN
148 Ergotamin Tablet 0 0
149 Kombinasi Ergotamin 1 mg + Kefein 50 mg Tablet 0 0
W ANTI ANEMI
150 Asam Folat 0,4 mg Tablet 0 0
151 Asam Folat 1 mg Tablet 2,400 2,400 2,400
152 Ferro Sulfat tab. Salut 300 mg Tablet 0 0
153 Komb. Ferro sulfat + Asam Sulfat Tablet 0 0
154 Tablet Tambah Darah Tablet 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
155 Asam Traneksamat tab 500 mg Tablet 0 0
156 Asam Traneksamat inj 50 mcg/ml Ampul 0 0
158 Fitomenadion Inj 2 mg/ml Ampul 0 0
159 Fitomenadion inj 10 mg/ml Ampul 120 120 30 90
Y ANTI DIABET
160 Glibenklamid tab 5 mg Tablet 400 400 400
163 Glipizid tab 5 mg Tablet 0 0
164 Metformin 500 mg Tablet 1,700 1,700 500 1,200
165 Metformin 850 mg Tablet 0 0
Z ANTI ANGINA
166 Diltiazem tab 30 mg Tablet 0 0
167 Isosorbid Dinitrat tab 5 mg Tablet 0 0
AA ANTI ARITMIA
168 Digoksin tab 0,25 mg Tablet 0 0
AB ANTI HIPERTENSI
171 Amlodipin 5 mg Tablet 1,290 1,290 990 300 2,700
172 Amlodipin 10 mg Tablet 1,350 1,350 630 720 2,100
173 Kaptopril 12,5 mg Tablet 0 0
174 Kaptopril 25 mg Tablet 0 0
175 Nifedipin tab 10 mg Tablet 0 0
AC DIURETIK
178 Furosemid tab 40 mg Tablet 0 0 500
179 Furosemid Inj 10 mg/ml Ampul 0 0
180 Hidroklortiazid tab 25 mg Tablet 100 100 100
181 Spironolakton tab 25 mg Tablet 0 0

182 Asam Asetil Salisilat tab 80 mg Tablet 0 0
183 Asam Asetil Salisilat tab 100 mg Tablet
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
184 Gemfibrozil 600 mg Tablet 0 0
185 Simvastatin tab 10 mg Tablet 0 0 900
186 Simvastatin tab 20 mg Tablet 350 1,000 1,350 200 1,150

187 Epinefrin 0,1 % Inj Ampul 0 0
AG KORTIKOSTEROID
188 Dexamethason 0,5 mg Tablet 300 300 300 0 5,000
189 Dexamethason inj 5 mg/ml Ampul 45 45 45 0
190 Metilprednisolon 4 mg Tablet 300 300 300 0 5,000
191 Metilprednisolon 8 mg Tablet 0 0
192 Prednison 5 mg Tablet 2,000 2,000 2,000
AH PSIKOFARMAKA
1 Anti Ansietas
193 Alprazolam 0,5 mg Tablet 100 100 100 0 300
194 Diazepam tab 2 mg Tablet 200 200 200
195 Diazepam tab 5 mg Tablet 0 0
196 Diazepam inj 5 mg/ml Ampul 0 0
2 Anti Depresi
197 Amitriptilin tab 25 mg Tablet 200 200 200 0 300
3 Anti Psikosis
201 Haloperidol tab 5 mg Tablet 300 300 300
204 Klorpromazin HCl Inj 5 mg/ml - 2 ml Ampul 0 0
205 Risperidon tab 2 mg Tablet 0 0

206 Fluoksetin Kaps 20 mg Kapsul 0 0

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
209 Aminofilin 150 mg Tablet 0 0
210 Aminofilin tab 200 mg Tablet 0 0
211 Aminofilin Inj Ampul 0 0
212 Salbutamol tab 2 mg Tablet 0 0
213 Salbutamol tab 4mg Tablet 600 600 600
2 Antitusif
214 Kodein Tab 10 mg Tablet 0 0
3 Ekspektoran
215 Gliseril Guaikolat tab 100 mg Tablet 0 0 4,000
216 N - Asetil Sistein Kaps 200 mg Tablet 0 0
217 Guaifenesin Tablet 0 0
4 Mukolitik
218 Ambroxol 30 mg Tablet 200 200 200 0 1,500
219 Ambroxol sirup 15 mg/ 5 ml Botol 0 0 50
220 Bromheksin 8 mg Tablet 0 0
221 Bromheksin sirup 4 mg/ml Botol 0 0
222 Obat Batuk Hitam (OBH) Botol 0 0 30
223 OBH Plus Botol 0 0
224 Wibrom Syr Botol 0 0 30
5 Simpatomimetik
225 Efedrin HCl tab 25 mg Tablet 0 0
226 Eflin Tablet 0 0 2,000
227 Ipratropium Bromida Aerosol 20 mcg/semprot Buah 0 0

228 Ipratropium Bromida Cairan inhalasi 0,025% Buah 0 0
229 Komb. Ipratropium Bromida 0,5 mg + Salbutamol Buah 0 0
AJ ANTISEPTIK
230 Albothyl Botol 0 0 30
231 Hidrogen Peroksida lar. 30% (H2O2 3%) Botol 0 0
233 Povidon Iodin Larutan 10 % Btl 300 ml 6 6 6
235 Hand Rub Botol 5 5 5
236 Serbuk PK Buah 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
AL DESINFEKTAN
238 Etanol 70% Botol 82 82 6 76
239 Paraformaldehid Tab 1 g Tablet 0 0
240 Alkohol Swab Box 260 260 160 100

241 Bahan Tumpatan Sementara Buah 0 0
242 Flour Tab 0,5 mg Tablet 0 0
243 Glass Ionomer ART Botol 0 0
244 Kalsium Hidroksida Botol 0 0
245 Klorfenol Kamfer Mentol (CHKM) Botol 0 0
246 Komposit Resin Buah 0 0
247 Kalsium Hidroksida Pasta Buah 0 0
248 Larutan Eugenol Botol 1 1 1 0
249 Larutan Formokresol Botol 0 0
250 Pasta Devitalisasi (non Arsen) Buah 0 0
251 Surgical ginggival pack Buah 0 0
252 Semen Seng Fosfat (Doriden) Buah 0 0
253 Temporary Stopping Fletcher Buah 0 0
AN ANESTESI LOKAL
254 Etil klorida spray 100 ml Botol 0 0 3
255 Lidokain inj 2% Ampul 190 190 3 187
256 Lidokain 2% + Epinefrin Inj Ampul 0 0
257 Cathejel Lidokain 2% & CHG 0,05% Tube 0 0
258 Xylocaine Jelly Tube 0 0
AO ANTI TIROID
259 Propiltiourasil tab 100 mg Tablet 0 0

260 Mestinon Tablet 0 0
261 Neostigmin inj 0,5 mg/ml Ampul 0 0
262 Piridostigmin tab. 60 mg Tablet 0 0

1. Anti Bakteri 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

263 Pot 0 50
IU/g & Polimiksin B 10.000 IU/g 0
264 Bioplasenton Tube 8 8 8 0 30
265 Gentamisin Salep Kulit 0,1% Tube 20 20 20
266 Kloramfenikol Salep Kulit 2% Tube 0 0
267 Oksitetrasiklin HCl Salep Kulit 3% Tube 0 0
2 Anti Fungi
268 Anti Fungi Doen Kombinasi Pot 3 3 3 0
269 Ketokonazol krim 2% Tube 38 38 28 10
270 Mikonazole krim 2% Tube 36 36 24 12
271 Nistatin Tab Vaginal 100.000 IU Tablet 0 0

272 Betametason krim 0,05 % Tube 0 0 100
273 Hidrokortison Krim 1% Tube 109 109 48 61

274 Gameksan Emulsi 1% Buah 0 0
275 Salep 2-4 Kombinasi Pot 0 0
5 Lain- lain
276 Bedak Salicyl 2% Buah 22 22 10 12
AR OBAT UNTUK MATA

1 Anastesi Lokal
277 Tetrakain tts mata 0,5% Botol 0 0
2 Antimikroba
278 Gentamisin Salep Mata 0,3% Tube 0 0 50
279 Gentamisin tetes Mata 0,3% Botol 0 0 50
280 Kloramfenikol tts mata 0,5% Botol 0 0 50
281 Kloramfenikol tts mata 1% Botol 0 0 50
282 Kloramfenikol salep mata 1% Tube 0 0
283 Oksitetrasiklin salep mata Tube 0 0 50
284 Sulfasetamid Natrium Tetes Mata 0,5% Botol 0 0
3 Antiinflamasi
285 Betametason tts mata 1 mg/ml Botol 0 0 50

286 Pilokarpin tts mata 2% Botol 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
287 Atropin Sulfat tetes Mata Botol
6 Tes Fungsi mata

288 Flouresein tetes mata 2,5 mg/ml Botol

AS
DAN TELINGA
289 Fenol gliserol tetes telinga 10% Botol
290 Karbogliserin tetes telinga 10% Botol
291 Kloramfenikol tetes telinga Botol 50
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet
295 Metilergometrin Inj 0,2 mg/ml Ampul
296 Oksitoksin Inj 10 IU/ml Ampul

AU
LAIN-LAIN
300 Natrium Klorida 0,9% Botol 32 32 5 27
301 Ringer Laktat Botol 0 0 60
AV
IMUN
302 Hepatitis B Imunologlubin (HBIG) Inj Vial
303 Human tetanus Imunologlubin Inj Vial
304 Serum Anti Bisa Ular (ABU I) Vial
305 Serum Anti Difteri Inj Vial
306 Serum Anti tetanus (ATS) Vial
307 Vaksin Anti Rabies Ampul

308 Asam Ascorbat tab 50 mg Tablet 1,500 1,500 700 800 1,500
309 Asam Ascorbat tab 250 mg Tablet 540 540 40 500 500
310 Asta Plus Tablet 0 0
311 Bionemi Tablet 0 0 2,000
312 Hemafort Tablet 0 0 2,000
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 2,000
314 Kalsium Glukonat Inj 10% Vial 0 0
315 Kalsium karbonat Tab. 500 mg Tablet 0 0
316 Kalsium Laktat Tab. 500 mg Tablet 900 900 600 300 2,500
317 Pehavral Tablet 0 0
318 Piridoksin Tab. 10 mg Tablet 1,500 1,500 500 1,000 500
319 Piridoksin Inj. 100 mg/ml Ampul 0 0
322 Selesbion Tablet 1,400 1,400 600 800 3,000
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 1,100 1,100 1,100
324 Sianokobalamin Inj Ampul 0 0
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 0 0 4,000
327 Truvit syr Botol 0 0
328 Vit B Kompleks Tablet 0 0 5,000
329 Vit B Kompleks Inj Ampul 0 0
AX TERAPI NOOTROPIK
330 Pirasetam Kaplet 800 mg Tablet 0 0
331 Pirasetam Kaplet 1200mg Tablet 0 0
332 Pirasetam inj 3 gr Ampul 0 0

334 Abbocath No 20 Buah 0 0 70
342 Alat suntik sekali pakai 10 ml Buah 0 0 200
346 Air Raksa Dental Use Buah 0 0
351 Benechek Uric test strip Buah 1 1 1 0 5
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
352 Benechek Glukosa test strip Botol 2 2 1 1 5
353 Benechek Kolesterol tast strip Botol 0 0 10
354 Blood Lancet Botol 0 0 4
355 Catgut/benang bedah no 2/0-3/0 Buah 0 0 50
356 Catgut/benang bedah no 3/0 Buah 0 0 50
357 Cholestrol 4 x 100 ml Kit 0 0
358 Folley Cateter 2 way no 18 Buah 0 0
359 Folley Cateter 2 way cateter no 20 Buah 0 0
360 Gips 4 Inc Buah 0 0
361 Handschoend steril No 6,5 Buah 0 0
363 Handschoend steril No 7,5 Buah 140 140 140
365 Handschoend Ukuran S Buah 0 0
366 Handschoend Ukuran M Buah 0 0
367 Handschoend Ukuran L Buah 0 0
368 Handschoend obgyn steril Pasang 0 0
370 Handschoend obgyn steril No 7 Pasang 0 0
372 Hub Cutter Buah 0 0
373 Infus set Anak Buah 2 2 2 0 20
374 Infus set Dewasa Buah 0 0 50
375 Isi Ulang Oksigen tabung besar Buah 0 0
376 Isi Ulang Oksigen tabung kecil Buah 0 0
377 Isi Ulang Oksigen tabung sedang Buah 0 0
380 Jarum Hecting Jar. Otot no 7 Buah 0 0
384 Jarum Kulit no 12 Buah 0 0
385 Kantong Mayat Buah 0 0
386 Kpas 250 mg Buah 10 10 2 8
387 Kapas 500 mg Buah 0 0
388 Kasa Kompres 40/40 Rol 0 0
394 Kasa Pembalut hidrofil 3,6 m x 5 cm Rol 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
395 Kasa Pembalut Hidrofil 40 x 80 cm Rol 0 0 5
398 Mata Pisau Carbon No. 10 Buah 0 0 20
404 Masker Buah 355 355 55 300
405 Masker N 95 Buah 0 0
406 Neckcolar Buah 0 0
407 Pembalut Gips Buah 0 0
408 Pembalut Gips Softban 10 x 4,5 cm Buah 0 0
409 Plastik Obat Bks 100 sachet 0 0
410 Plastik Obat Besar Bks 100 sachet 0 0 10
411 Plastik Obat Sedang Bks 100 sachet 0 0 40
412 Plastik Obat Kecil Bks 100 sachet 0 0 50
413 Plester 5 yard Rol 0 0
414 Plester 2 inc Rol 0 0
415 Plester Rol 19 19 4 15
416 Pot Sputum Buah 0 0
417 Polifix 5 cm x 1m Rol 3 20 23 23
418 Rapit test protein Buah 0 0
419 Spalak Buah 0 0
420 Silk (benang bedah sutera) no. 3/0 Buah 2 2 2 0 100
421 Silk (benang bedah sutera) no. 3/0 100 m Buah 0 0
422 Slide Set 0 0
423 Slide Box Set 0 0
424 Transfusi Set Buah 0 0
425 Triangular Perban Buah 0 0
426 test Narkoba 5 Multi Acon Strip Botol 0 0
427 urin Strip untuk protein dan gula Buah 0 0
428 Urine Bag Buah 0 0
431 Wing Needle No. 25G Buah 0 0
AZ DAN LAIN LAIN

433 Asam Klorida 0,1 N Botol 0 0
434 Aquadest steril Botol 0 0
435 Control Normal CBC - ST Plus R & D Botol 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
436 Diluent BCC - 3600 1 x 20 L Galon 0 0
437 Glukosa 4 x 100 ml Botol 0 0
438 Glucose Liquid 3 x 100 Kit 0 0
439 Hemaglobin 500 ml Botol 0 0
440 Iodium Tes Botol 0 0
441 Iodiol Kapsul Lunak Botol 0 0
442 Kolestrol 4 x 100 ml Kit 0 0
443 Lar. Benedict Botol 0 0
444 Lar. Eosin 2% Botol 0 0
445 Lar. Etanol Asam Botol 0 0
446 Lar. Giemsa Stain Botol 0 0
447 Lar. Karbol Fuchsin Botol 0 0
448 Lar. Metanol Botol 1 1 1 0
449 Lar. Turk Botol 0 0
450 Larutan HCl Botol 0 0
451 Lisol Botol 2 2 2
452 Lisol Botol 0 0
453 Lyse BCC - Dirui Botol 0 0
454 Object Glass Frosted Box 0 0
455 Probe Cleanser BCC - Dirui Botol 0 0
456 Reagen TB 2 N Botol 0 0
457 Reagen Widal Botol 0 0
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0
459 Trigelicerides 4 x 100 ml Botol 0 0
460 Uric acid (Asam Urat) 4 x 100 ml Botol 0 0
461 Uric acid (Asam Urat) 3 x 100 ml Kit 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
Bayar
Jumlah Pasien/Resep 1 INFLUENZA 101 163
2 HIPERTENSI 68 118
93 209 816 1118
3 GASTRITIS 25 70
Jumlah Pasien/Resep
93 209 816 1118

4 DERMATITIS 120 35
5 FEBRIS 167 32
6 GANGGUAN GIGI DAN JARINGAN PENYANGGA 156 28
7 DIABETES MELITUS 132 26
8 KECELAKAAN DAN RUDA PAKSA 17 25
9 GASTROENTRITIS 28 20
10 ARTRITHIS RHEUMATIK 16 20

dr. N. Taufan Karwur Moh. Alchudri Mohidin, S.Farm.,M.Si.,Apt dr. Intan S Tompo Irma.S. Pakaya,S.Kep.,Ns Silvi Salu,S.Farm
( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : April 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A
1 Petidin Inj 50 mg/ml Ampul - - -

2 Asam Mefenamat Tab. 500 mg Tablet 1,700 1,700 1,500 200 1,650 3,300
3 Betamidon Inj Vial 0 0 0 0
4 Ibuprofen 200 mg Tablet 0 0 0 0
5 Ibuprofen 400 mg Tablet 800 800 500 300 550 1,100
6 Ibuprofen susp. 100 mg/ml Botol 80 80 20 60 22
7 Ibuprofen susp. 100 mg/ml Botol 0 0 0 0
8 Ketoprofen 100 mg Tablet 0 0 0 0
9 Ketoprofen suppositoria 10 mg Suppositoria 0 0 0 0
10 Ketorolak Inj 30 mg/ml Ampul 0 0 0 0
11 Metampiron Tab 500 mg Tablet 0 0 0 0
12 Metampiron Inj Vial 0 0 0 0
13 Natrium Diklofenak 25 mg Tablet 0 0 0 0
14 Natrium Diklofenak 50 mg Tablet 100 100 100 0 110 1,000
15 Parasetamol 500 mg Tablet 0 0 0 0 5,000
16 Parasetamol Syrup 120 mg/ml Botol 110 110 80 30 88
17 Parasetamol drops 100 mg/ml Botol 12 12 12 0
18 Parasetamol Infus Buah 0 0 0 0
19 Piroksikam 10 mg Tablet 300 300 300 0 330 1,000
21 Tramadol Tablet 0 0 0 0
22 Tramadol Inj. 50 mg/ml Ampul 0 0 0 0
B ANTI PIRAI
23 Allopurinol Tab. 100 mg Tablet 1,100 1,100 500 600 550
24 Allopurinol Tab .300 mg 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
25 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0 0 0 200
26 Amoksisilin Kapsul 250 mg Kapsul 1,000 1,000 1,000 0 1,100
27 Amoksisilin Kaplet 500 mg Kaplet 3,400 3,400 2,000 1,400 2,200 2,000
28 Ampisilin Sirup Kering 125 mg/5 ml Botol 0 0 0 0
29 Ampisilin Serbuk Inj. 1000 mg/ml Vial 0 0 0 0
30 Benzatin benzil penisilin inj. 1,2 juta IU/vial Vial 0 0 0 0
31 Ciprofloksasin 500 mg Tablet 200 500 700 100 600 110
32 Doksisiklin Kapsul 100 mg Kapsul 0 0 0 0
35 Erithromisin Syr. 200 mg/ 5 ml Botol 0 100 100 100 0
36 Fenoksimetil Penisilina Tab. 500 mg Tablet 0 0 0 0
37 Gentamisin Inj Ampul 0 0 0 0 50
38 Kanamisin Serb. Inj. 1000 mg Vial 0 0 0 0
39 Kloramfenicol Kaps. 250 mg Kapsul 620 620 620 0
40 Kloramfenicol Sirup Botol 0 0 0 0
41 Kotrimoksazol pediatrik tab. 120 mg Tablet 200 200 200 0
43 Kotrimoksazol dewasa tab. 480 mg Tablet 200 500 700 700 0
44 Levofloksasin tablet 500 mg Tablet 0 0 0 0
45 Oksitetrasiklin HCl Inj. 50 mg/ml-10 ml Vial 0 0 0 0
46 Prokain Benzil Penisilin Inj. 3 juta Vial 0 0 0 0
47 Sefadroksil 250 mg Tablet 0 0 0 0
48 Sefadroksil 500 mg Tablet 0 0 0 0 2,000
49 Sefadroksil syrup Botol 0 0 0 0 100
50 Sefotaksim inj 1 gram Vial 0 0 0 0
51 Seftriakson inj. 1 g Vial 0 0 0 0
52 Tetrasiklin HCl kaps. 250 mg Kapsul 0 0 0 0
54 Tiamfenikol 500 mg Tablet 400 400 400 0

55 Metronidazol tab. 250 mg Tablet 0 0 0 0
56 Metronidazol tab. 500 mg Tablet 4,200 4,200 200 4,000 220
57 Metronidazol infus Buah 0 0 0 0
58 Metronidazol susp. 125 mg/5 ml Botol 0 0 0 0
E ANTELMENTIK
59 Albendazole 400 mg Tablet 0 0 0 0
60 Mebendazol Tab. 100 mg Tablet 0 0 0 0
62 Mebendazol sir. 100 mg/ml Botol 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
65 Pirantel pamoat susp 125 mg/ml Botol 0 0 0 0
F ANTI FILARIA
66 Dietilkarbamazepin tab. 100 mg Tablet 0 0 0 0
67 Prazikuantel tab. 600 mg Tablet 0 0 0 0
H ANTI TUBERKOLOSIS
68 Etambutol 400 mg Tablet 0 0 0 0
69 Isoniazid 100 mg Tablet 0 0 0 0
71 OAT FDC Kategori I Paket 0 0 0 0
72 OAT FDC Kategori II Paket 0 0 0 0
73 OAT FDC Kategori Anak Paket 0 0 0 0
74 OAT Kombipak Kategori I Paket 0 0 0 0
75 Rimpafisin Kaps. 450 mg Kapsul 0 0 0 0
I ANTI MALARIA
76 Artemeter Inj 80 mg/ml Vial 0 0 0 0
77 Artesunat Inj 60 mg/ml Vial 0 0 0 0
78 Dosksisilin Kaps. 100 kapsul 0 0 0 0
79 Kuinin Tab Tablet 0 0 0 0
80 Kuinin Inj 25% Ampul 0 0 0 0
81 Kombinasi Sulfadoksin Pirimetamin Tablet 0 0 0 0
82 Kloroquin Tab. 250 mg Tablet 0 0 0 0
83 Kombinasi DHP + piperakuin Tablet 0 0 0 0
84 Primakuin tab. 15 mg Tablet 0 0 0 0

85 Antasida DOEN. Tab. Kombinasi Tablet 300 300 300 0 330 3,000
87 Omeprazol kaps. 20 mg Kapsul 0 0 0 0
88 Ranitidin Tab. 150 mg Tablet 3,000 3,000 1,100 1,900 1,210
89 Ranitidin Inj. 25 mg/ml Ampul 0 0 0 0
90 Simetidin 200 mg Tablet 0 0 0 0
K ANTISPASMODIK
91 Atropin tab 0,5 mg Tablet 0 0 0 0
92 Ekstrak Belladon Tablet 0 0 0 0
93 Hiosina Butilbromida tab 10 mg Tablet 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
94 Hiosina Butilbromida Inj. 20 mg/ml / Buscopan Ampul 0 0 0
95 Papaverin Tab Tablet 1,800 1,800 1,800 0
96 Papaverin Inj Ampul 0 0 0 0
L OBAT UNTUK DIARE

97 Atapulgit tab Tablet 0 0 0 0
98 Garam Oralit Komb Sachet 0 0 0 0 300
99 Kombinasi kaolin 550 mg + pektin 20 mg Tablet 0 0 0 0
100 Loperamid 2 mg Tablet 2,300 2,300 500 1,800 550
101 Zink tab. Dispersibble 20 mg Tablet 0 0 0 0 200
102 Zink sir. 20 mg/ml Botol 0 0 0 0
M KATARTIK
103 Bisakodill tab 5 mg Tablet 0 0 0 0
104 Bisakodill suppos 5 mg Suppositoria 0 0 0 0
106 Gliserin drops 10 mg/ml Botol 0 0 0 0
107 Larutan Gliserin 100 mg/ml Botol 0 0 0 0
N ANTIHEMORROID
109 Hemorogard Kapsul 0 0 0 0
O ANTI EMETIK
110 Dimenhidrinat tab 50 mg Tablet 0 0 0 0
111 Domperidon syr Botol 0 0 0 0
112 Domperidon Tab 10 mg Tablet 1,000 1,000 100 900 110
113 Domperidon drops 5 mg/ml Botol 0 0 0 0
114 Metoklopramid tab 10 mg Tablet 400 400 400 0
115 Metoklopramid Inj Ampul 0 0 0 0
P ANTI ALERGI
116 Betadryl Injeksi Vial 0 0 0 0
117 Difenhidramin inj 10 mg/ml Ampul 0 0 0 0
118 Klorfeniramin Maleat 4 mg Tablet 5,000 5,000 1,500 3,500 1,650
119 Loratadin tab 10 mg Tablet 600 600 600 0
121 Seterizine syr. 5 mg/ml 0 0 0 0
Q ANTI VIRUS
123 Asiklovir 400 mg Tablet 1,300 1,300 1,300 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI
125 Griseofulvin 125 mg Tablet 800 800 800 0
128 Ketokonazol 200 mg Tablet 500 500 300 200 330
129 Nistatin tab. Vaginal 100.000 iu/g Tablet 500 500 100 400 110
130 Nistatin tab. 500.000 iu/g Tablet 0 0 0 0 500

131 Diazepam Inj 5 mg/2,5 ml Ampul 0 0 0 0
132 Fenobarbital Tab 30 mg Tablet 100 100 100 0
134 Fenobarbital Inj 50 mg/5 ml Botol 30 30 30 0
135 Fenitoin Kaps. 30 mg Kapsul 0 0 0 0
137 Fenitoin Inj 50 mg/ml Ampul 0 0 0 0
138 Karbamazepin Tab 200 mg Tablet 0 300 300 100 200 110
T ANTI PARKINSON
141 Anti Parkinson DOEN Tab Tablet 0 0 0 0
142 Triheksilfenidil 2 mg Tablet 0 0 0 0 200
143 Kombinasi benserazid 25 mg, Levedopa 100 mg Tablet 0 0 0 0

U
UNTUK KERACUNAN
144 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0
145 Kalsium Glukonat Inj. 10 % Ampul 0 0 0 0
146 Natrium Bikarbonat Tab 500 mg Tablet 0 0 0 0
147 Natrium Tiosulfat inj 25% Ampul 0 0 0 0
V ANTI MIGREN
148 Ergotamin Tablet 0 0 0 0
149 Kombinasi Ergotamin 1 mg + Kefein 50 mg Tablet 0 0 0 0
W ANTI ANEMI
150 Asam Folat 0,4 mg Tablet 0 0 0 0
151 Asam Folat 1 mg Tablet 2,400 2,400 2,400 0
152 Ferro Sulfat tab. Salut 300 mg Tablet 0 0 0 0
153 Komb. Ferro sulfat + Asam Sulfat Tablet 0 0 0 0
154 Tablet Tambah Darah Tablet 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
155 Asam Traneksamat tab 500 mg Tablet 0 0 0 0
156 Asam Traneksamat inj 50 mcg/ml Ampul 0 0 0 0
158 Fitomenadion Inj 2 mg/ml Ampul 0 0 0 0
Y ANTI DIABET
160 Glibenklamid tab 5 mg Tablet 400 400 400 0
163 Glipizid tab 5 mg Tablet 0 0 0 0
164 Metformin 500 mg Tablet 1,200 1,200 1,200 0
Z ANTI ANGINA
166 Diltiazem tab 30 mg Tablet 0 0 0 0
167 Isosorbid Dinitrat tab 5 mg Tablet 0 0 0 0
AA ANTI ARITMIA
168 Digoksin tab 0,25 mg Tablet 0 0 0 0
AB ANTI HIPERTENSI
171 Amlodipin 5 mg Tablet 300 300 300 0 330 2,700
172 Amlodipin 10 mg Tablet 720 720 720 0 792 2,100
173 Kaptopril 12,5 mg Tablet 0 0 0 0
174 Kaptopril 25 mg Tablet 0 0 0 0
175 Nifedipin tab 10 mg Tablet 0 0 0 0
176 Reserpin tab 0,10 mg Tablet 0 0 0 0
AC DIURETIK
178 Furosemid tab 40 mg Tablet 0 0 0 0 500
179 Furosemid Inj 10 mg/ml Ampul 0 0 0 0
180 Hidroklortiazid tab 25 mg Tablet 100 100 100 0 110
181 Spironolakton tab 25 mg Tablet 0 0 0 0

182 Asam Asetil Salisilat tab 80 mg Tablet 0 0 0 0
183 Asam Asetil Salisilat tab 100 mg Tablet 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
184 Gemfibrozil 600 mg Tablet 0 0 0 0
185 Simvastatin tab 10 mg Tablet 0 0 0 0 900
186 Simvastatin tab 20 mg Tablet 1,150 1,150 700 450 770 300

187 Epinefrin 0,1 % Inj Ampul 0 0 0 0
AG KORTIKOSTEROID
191 Metilprednisolon 8 mg Tablet 0 0 0 0
AH PSIKOFARMAKA
1 Anti Ansietas
194 Diazepam tab 2 mg Tablet 200 200 100 100 110
196 Diazepam inj 5 mg/ml Ampul 0 0 0 0
2 Anti Depresi
3 Anti Psikosis
198 Haloperidol tab 0,5 mg Tablet 0 0 0 0
200 Haloperidol tab 2 mg Tablet 0 0 0 0
201 Haloperidol tab 5 mg Tablet 300 300 300 0 330 300 Exp Mar-18
202 Klorpromazin tab 25 mg Tablet 0 0 0 0
203 Klorpromazin tab 100 mg Tablet 0 0 0 0 1,000
204 Klorpromazin HCl Inj 5 mg/ml - 2 ml Ampul 0 0 0 0
205 Risperidon tab 2 mg Tablet 0 0 0 0

206 Fluoksetin Kaps 20 mg Kapsul 0 0 0 0

207 Valproat tab 500 mg Tablet 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
209 Aminofilin 150 mg Tablet 0 0 0 0
210 Aminofilin tab 200 mg Tablet 0 0 0 0
211 Aminofilin Inj Ampul 0 0 0 0
213 Salbutamol tab 4mg Tablet 600 600 600 0 660 1,000
2 Antitusif
214 Kodein Tab 10 mg Tablet 0 0 0 0
3 Ekspektoran
215 Gliseril Guaikolat tab 100 mg Tablet 0 0 0 0 3,000
216 N - Asetil Sistein Kaps 200 mg Tablet 0 0 0 0
217 Guaifenesin Tablet 0 0 0 0
4 Mukolitik
219 Ambroxol sirup 15 mg/ 5 ml Botol 0 0 0 0 50
220 Bromheksin 8 mg Tablet 0 0 0 0
221 Bromheksin sirup 4 mg/ml Botol 0 0 0 0
222 Obat Batuk Hitam (OBH) Botol 0 0 0 0 30
223 OBH Plus Botol 0 0 0 0
224 Wibrom Syr Botol 0 0 0 0 30
5 Simpatomimetik
225 Efedrin HCl tab 25 mg Tablet 0 0 0 0
226 Eflin Tablet 0 0 0 0 2,000
227 Ipratropium Bromida Aerosol 20 mcg/semprot Buah 0 0 0 0

228 Ipratropium Bromida Cairan inhalasi 0,025% Buah 0 0 0 0
229 Komb. Ipratropium Bromida 0,5 mg + Salbutamol Buah 0 0 0 0
AJ ANTISEPTIK
230 Albothyl Botol 0 10 10 10 0
231 Hidrogen Peroksida lar. 30% (H2O2 3%) Botol 0 0 0 0
235 Hand Rub Botol 5 5 2 3 2
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
AL DESINFEKTAN
238 Etanol 70% Botol 76 76 7 69 8
239 Paraformaldehid Tab 1 g Tablet 0 0 0 0
240 Alkohol Swab Box 100 100 100 0 110 500

241 Bahan Tumpatan Sementara Buah 0 0 0 0
242 Flour Tab 0,5 mg Tablet 0 0 0 0
243 Glass Ionomer ART Botol 0 0 0 0
244 Kalsium Hidroksida Botol 0 0 0 0
245 Klorfenol Kamfer Mentol (CHKM) Botol 0 0 0 0
246 Komposit Resin Buah 0 0 0 0
247 Kalsium Hidroksida Pasta Buah 0 0 0 0
249 Larutan Formokresol Botol 0 0 0 0
250 Pasta Devitalisasi (non Arsen) Buah 0 0 0 0
251 Surgical ginggival pack Buah 0 0 0 0
252 Semen Seng Fosfat (Doriden) Buah 0 0 0 0
253 Temporary Stopping Fletcher Buah 0 0 0 0
AN ANESTESI LOKAL
254 Etil klorida spray 100 ml Botol 0 0 0 0 3
256 Lidokain 2% + Epinefrin Inj Ampul 0 0 0 0
257 Cathejel Lidokain 2% & CHG 0,05% Tube 0 0 0 0
258 Xylocaine Jelly Tube 0 0 0 0
AO ANTI TIROID
259 Propiltiourasil tab 100 mg Tablet 0 0 0 0

260 Mestinon Tablet 0 0 0 0
261 Neostigmin inj 0,5 mg/ml Ampul 0 0 0 0
262 Piridostigmin tab. 60 mg Tablet 0 0 0 0

1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

263 Pot 0 0 50
264 Bioplasenton Tube 0 10 10 2 8 2
265 Gentamisin Salep Kulit 0,1% Tube 20 20 20 0
266 Kloramfenikol Salep Kulit 2% Tube 0 0 0 0 25
267 Oksitetrasiklin HCl Salep Kulit 3% Tube 0 0 0 0 25
2 Anti Fungi
268 Anti Fungi Doen Kombinasi Pot 0 0 0 0 25
269 Ketokonazol krim 2% Tube 10 10 10 0 11 25
270 Mikonazole krim 2% Tube 12 12 12 0 25
271 Nistatin Tab Vaginal 100.000 IU Tablet 0 0 0 0

272 Betametason krim 0,05 % Tube 0 0 0 0 50

274 Gameksan Emulsi 1% Buah 0 0 0 0
275 Salep 2-4 Kombinasi Pot 0 0 0 0 25
5 Lain- lain
276 Bedak Salicyl 2% Buah 12 12 12 0
AR OBAT UNTUK MATA
1 Anastesi Lokal
277 Tetrakain tts mata 0,5% Botol 0 0 0 0
2 Antimikroba
278 Gentamisin Salep Mata 0,3% Tube 0 0 0 0 25
279 Gentamisin tetes Mata 0,3% Botol 0 0 0 0 25
280 Kloramfenikol tts mata 0,5% Botol 0 0 0 0 25
281 Kloramfenikol tts mata 1% Botol 0 0 0 0
282 Kloramfenikol salep mata 1% Tube 0 25 25 25 0
283 Oksitetrasiklin salep mata Tube 0 0 0 0 50
284 Sulfasetamid Natrium Tetes Mata 0,5% Botol 0 0 0 0
3 Antiinflamasi
285 Betametason tts mata 1 mg/ml Botol 0 0 0 0 25

286 Pilokarpin tts mata 2% Botol 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
287 Atropin Sulfat tetes Mata Botol 0
6 Tes Fungsi mata

288 Flouresein tetes mata 2,5 mg/ml Botol 0

AS
DAN TELINGA
289 Fenol gliserol tetes telinga 10% Botol 0
290 Karbogliserin tetes telinga 10% Botol 0
291 Kloramfenikol tetes telinga Botol 0 50
292 Oksimetazolin tetes hidung 0,025 % Botol 0
0
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet 0
295 Metilergometrin Inj 0,2 mg/ml Ampul 0
296 Oksitoksin Inj 10 IU/ml Ampul 0

AU
LAIN-LAIN
AU
LAIN-LAIN
297 Glukosa lar Infus 5% Botol 0
300 Natrium Klorida 0,9% Botol 27 27 5 22 6
301 Ringer Laktat Botol 0 0 0 0 20

AV 0
IMUN
302 Hepatitis B Imunologlubin (HBIG) Inj Vial 0
303 Human tetanus Imunologlubin Inj Vial 0
304 Serum Anti Bisa Ular (ABU I) Vial 0
305 Serum Anti Difteri Inj Vial 0
306 Serum Anti tetanus (ATS) Vial 0
307 Vaksin Anti Rabies Ampul 0

308 Asam Ascorbat tab 50 mg Tablet 800 800 800 0 880 1,500
309 Asam Ascorbat tab 250 mg Tablet 500 500 1,000 100 900 110
310 Asta Plus Tablet 0 0 0 0
311 Bionemi Tablet 0 0 0 0 2,000
312 Hemafort Tablet 0 0 0 0 2,000
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 0 0 2,000
314 Kalsium Glukonat Inj 10% Vial 0 0 0 0
315 Kalsium karbonat Tab. 500 mg Tablet 0 0 0 0
316 Kalsium Laktat Tab. 500 mg Tablet 300 2,500 2,800 800 2,000 880
317 Pehavral Tablet 0 0 0 0
318 Piridoksin Tab. 10 mg Tablet 1,000 1,000 2,000 2,000 0
319 Piridoksin Inj. 100 mg/ml Ampul 0 0 0 0
320 Retinol Kaps. Lunak 100.000 IU Kapsul 0 0 0 0
322 Selesbion Tablet 800 3,000 3,800 1,800 2,000 1,980
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 1,100 1,100 1,100 0
324 Sianokobalamin Inj Ampul 0 0 0 0
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 0 0 0 0 4,000
327 Truvit syr Botol 0 0 0 0 30
328 Vit B Kompleks Tablet 0 0 0 0 3,000
329 Vit B Kompleks Inj Ampul 0 0 0 0
AX TERAPI NOOTROPIK
330 Pirasetam Kaplet 800 mg Tablet 0 0 0 0
331 Pirasetam Kaplet 1200mg Tablet 0 0 0 0
332 Pirasetam inj 3 gr Ampul 0 0 0 0

334 Abbocath No 20 Buah 0 50 50 5 45 6
335 Abbocath No 22 Buah 0 50 50 5 45 6
336 Abbocath No 24 Buah 0 50 50 50 0
337 Alat suntik sekali pakai 0,5 ml Buah 0 0 0 0
340 Alat suntik sekali pakai 3 ml Buah 18 500 518 218 300 240
344 Autodisable 3 ml dgn jarum Buah 0 0 0 0
346 Air Raksa Dental Use Buah 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
352 Benechek Glukosa test strip Botol 1 1 1 0 1 5
353 Benechek Kolesterol tast strip Botol 0 0 0 0 10
354 Blood Lancet Botol 0 2 2 2 0
355 Catgut/benang bedah no 2/0-3/0 Buah 0 36 36 36 0
356 Catgut/benang bedah no 3/0 Buah 0 0 0 0
357 Cholestrol 4 x 100 ml Kit 0 0 0 0
358 Folley Cateter 2 way no 18 Buah 0 0 0 0
359 Folley Cateter 2 way cateter no 20 Buah 0 0 0 0
360 Gips 4 Inc Buah 0 0 0 0
362 Handschoend steril No 7 Buah 100 100 5 95 6
363 Handschoend steril No 7,5 Buah 140 140 20 120 22
367 Handschoend Ukuran L Buah 0 0 0 0
368 Handschoend obgyn steril Pasang 0 0 0 0
369 Handschoend obgyn steril 6 1/2 Pasang 0 0 0 0
370 Handschoend obgyn steril No 7 Pasang 0 0 0 0
372 Hub Cutter Buah 0 0 0 0
373 Infus set Anak Buah 0 20 20 2 18 2 20
374 Infus set Dewasa Buah 0 50 50 5 45 6 50
375 Isi Ulang Oksigen tabung besar Buah 0 0 0 0
376 Isi Ulang Oksigen tabung kecil Buah 0 0 0 0
377 Isi Ulang Oksigen tabung sedang Buah 0 0 0 0
378 Jarum Otot no 5 Buah 0 0 0 0
380 Jarum Hecting Jar. Otot no 7 Buah 0 0 0 0
382 Jarum Hecting Kulit no 5 Buah 0 0 0 0
384 Jarum Kulit no 12 Buah 0 0 0 0
385 Kantong Mayat Buah 0 0 0 0
386 Kpas 250 mg Buah 8 8 8 0
387 Kapas 500 mg Buah 0 0 0 0
388 Kasa Kompres 40/40 Rol 0 0 0 0
389 Kasa Pembalut hidrofil 4 m x 15 cm Rol 0 0 0 0
394 Kasa Pembalut hidrofil 3,6 m x 5 cm Rol 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
395 Kasa Pembalut Hidrofil 40 x 80 cm Rol 0 0 0 0 3
396 Kasa Steril 16 x 16 Rol 0 0 0 0
398 Mata Pisau Carbon No. 10 Buah 0 0 0 0 20
404 Masker Buah 300 300 100 200 110
405 Masker N 95 Buah 0 0 0 0
406 Neckcolar Buah 0 0 0 0
407 Pembalut Gips Buah 0 0 0 0
408 Pembalut Gips Softban 10 x 4,5 cm Buah 0 0 0 0
409 Plastik Obat Bks 100 sachet 0 0 0 0
410 Plastik Obat Besar Bks 100 sachet 0 0 0 0 10
411 Plastik Obat Sedang Bks 100 sachet 0 0 0 0 40
412 Plastik Obat Kecil Bks 100 sachet 0 0 0 0 50
413 Plester 5 yard Rol 0 0 0 0
414 Plester 2 inc Rol 0 0 0 0
415 Plester Rol 15 15 1 14 1
416 Pot Sputum Buah 0 0 0 0
417 Polifix 5 cm x 1m Rol 23 23 2 21 2
418 Rapit test protein Buah 0 0 0 0
419 Spalak Buah 0 0 0 0
420 Silk (benang bedah sutera) no. 3/0 Buah 0 36 36 12 24 13
421 Silk (benang bedah sutera) no. 3/0 100 m Buah 0 0 0 0
422 Slide Set 0 0 0 0
423 Slide Box Set 0 0 0 0
424 Transfusi Set Buah 0 0 0 0
425 Triangular Perban Buah 0 0 0 0
426 test Narkoba 5 Multi Acon Strip Botol 0 0 0 0
427 urin Strip untuk protein dan gula Buah 0 0 0 0
428 Urine Bag Buah 0 0 0 0
429 Wing Needle No. 23 G Buah 0 0 0 0
431 Wing Needle No. 25G Buah 0 0 0 0
AZ DAN LAIN LAIN

433 Asam Klorida 0,1 N Botol 0 0 0 0
434 Aquadest steril Botol 0 0 0 0
435 Control Normal CBC - ST Plus R & D Botol 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
436 Diluent BCC - 3600 1 x 20 L Galon 0 0 0 0
437 Glukosa 4 x 100 ml Botol 0 0 0 0
438 Glucose Liquid 3 x 100 Kit 0 0 0 0
439 Hemaglobin 500 ml Botol 0 0 0 0
440 Iodium Tes Botol 0 0 0 0
441 Iodiol Kapsul Lunak Botol 0 0 0 0
442 Kolestrol 4 x 100 ml Kit 0 0 0 0
443 Lar. Benedict Botol 0 0 0 0
444 Lar. Eosin 2% Botol 0 0 0 0
445 Lar. Etanol Asam Botol 0 0 0 0
446 Lar. Giemsa Stain Botol 0 0 0 0
447 Lar. Karbol Fuchsin Botol 0 0 0 0
449 Lar. Turk Botol 0 0 0 0
450 Larutan HCl Botol 0 0 0 0
451 Lisol Botol 2 2 1 1 1 5
452 Lisol Botol 0 0 0 0
453 Lyse BCC - Dirui Botol 0 0 0 0
454 Object Glass Frosted Box 0 0 0 0
455 Probe Cleanser BCC - Dirui Botol 0 0 0 0
456 Reagen TB 2 N Botol 0 0 0 0
457 Reagen Widal Botol 0 0 0 0
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
459 Trigelicerides 4 x 100 ml Botol 0 0 0 0
460 Uric acid (Asam Urat) 4 x 100 ml Botol 0 0 0 0
461 Uric acid (Asam Urat) 3 x 100 ml Kit 0 0 0 0
462 Cuticell pcs 5 5 5 0
PEMBERIAN
NO NAMA OBAT KEMASAN STOK AWAL PENERIMAANPERSEDIAAN PEMAKAIAN SISA STOK STOK OPTPERMINTAAN KET
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
Bayar
Jumlah Pasien/Resep 1 INFLUENZA 101 177
2 HIPERTENSI 68 118
137 179 959 1275
3 GASTRITIS 26 84
4 DERMATITIS 120 53
6 DIABETES MELITUS 132 41
7 ABSES 163 39
8 GANGGUAN GIGI DAN JARINGAN PENYANGGA 157 34
9 HIPERCOLESTROL 162 34
10 FEBRIS 178 34

( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : Mei 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A
1 Petidin Inj 50 mg/ml Ampul - -

2 Asam Mefenamat Tab. 500 mg Tablet 200 3,300 3,500 200 3,300 220
5 Ibuprofen 400 mg Tablet 300 300 300 0 330
15 Parasetamol 500 mg Tablet 0 5,000 5,000 1,600 3,400 1,760
16 Parasetamol Syrup 120 mg/ml Botol 30 50 80 5 75 6
17 Parasetamol drops 100 mg/ml Botol 12 12 1 11 1
B ANTI PIRAI
23 Allopurinol Tab. 100 mg Tablet 600 600 300 300 330
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
26 Amoksisilin Kapsul 250 mg Kapsul 0 1,000 1,000 1,000 0
27 Amoksisilin Kaplet 500 mg Kaplet 1,400 2,000 3,400 400 3,000 440
39 Kloramfenicol Kaps. 250 mg Kapsul 620 620 120 500 132

E ANTELMENTIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
F ANTI FILARIA
H ANTI TUBERKOLOSIS
I ANTI MALARIA

85 Antasida DOEN. Tab. Kombinasi Tablet 0 0 0 0
86 Antasida DOEN. Suspensi. Kombinasi Botol 0 50 50 50 0 55
88 Ranitidin Tab. 150 mg Tablet 1,900 1,900 900 1,000 990
K ANTISPASMODIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
0
L OBAT UNTUK DIARE
97 Atapulgit tab Tablet 0 0 0
98 Garam Oralit Komb Sachet 0 0 0 0
101 Zink tab. Dispersibble 20 mg Tablet 0 200 200 200 0 220
0
M KATARTIK
103 Bisakodill tab 5 mg Tablet 0 0 0
0
N ANTIHEMORROID
0
O ANTI EMETIK
110 Dimenhidrinat tab 50 mg Tablet 0 0 0
111 Domperidon syr Botol 0 0 0 0
112 Domperidon Tab 10 mg Tablet 900 900 200 700 220
P ANTI ALERGI
116 Betadryl Injeksi Vial 0 0 0
118 Klorfeniramin Maleat 4 mg Tablet 3,500 3,500 300 3,200 330
120 Seterizine 10 mg Tablet 0 0 0 0
121 Seterizine syr. 5 mg/ml 0 0 0 0
0
Q ANTI VIRUS
122 Asiklovir 200 mg Tablet 0 0 0
123 Asiklovir 400 mg Tablet 1,300 1,300 100 1,200 110
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI
128 Ketokonazol 200 mg Tablet 200 200 200 0
130 Nistatin tab. 500.000 iu/g Tablet 0 0 0 0

132 Fenobarbital Tab 30 mg Tablet 100 100 100 0 110
138 Karbamazepin Tab 200 mg Tablet 200 200 200 0
T ANTI PARKINSON
142 Triheksilfenidil 2 mg Tablet 0 0 0 0

U
UNTUK KERACUNAN
V ANTI MIGREN
149 Kombinasi Ergotamin 1 mg + Kefein 50 mg Tablet 0 0 0 0
W ANTI ANEMI
151 Asam Folat 1 mg Tablet 2,400 2,400 1,100 1,300 1,210
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
157 Fitomenadion Tab 10 mg Tablet 100 100 100 0 110
Y ANTI DIABET
164 Metformin 500 mg Tablet 1,200 1,200 500 700 550
Z ANTI ANGINA
AA ANTI ARITMIA
AB ANTI HIPERTENSI
171 Amlodipin 5 mg Tablet 0 0 0 0
175 Nifedipin tab 10 mg Tablet 0 0 0 0
AC DIURETIK
178 Furosemid tab 40 mg Tablet 0 0 0 0

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
184 Gemfibrozil 600 mg Tablet 0 0 0 0

AG KORTIKOSTEROID
188 Dexamethason 0,5 mg Tablet 0 0 0 0
AH PSIKOFARMAKA
1 Anti Ansietas
193 Alprazolam 0,5 mg Tablet 0 0 0 0
2 Anti Depresi
197 Amitriptilin tab 25 mg Tablet 0 0 0 0
3 Anti Psikosis
203 Klorpromazin tab 100 mg Tablet 0 1,000 1,000 1,000 0


PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
213 Salbutamol tab 4mg Tablet 0 1,000 1,000 1,000 0
2 Antitusif
3 Ekspektoran
215 Gliseril Guaikolat tab 100 mg Tablet 0 0 0 0
217 Guaifenesin Tablet 0 0 0 0
4 Mukolitik
218 Ambroxol 30 mg Tablet 0 0 0 0
219 Ambroxol sirup 15 mg/ 5 ml Botol 0 0 0 0
220 Bromheksin 8 mg Tablet 0 0 0 0
221 Bromheksin sirup 4 mg/ml Botol 0 0 0 0
222 Obat Batuk Hitam (OBH) Botol 0 0 0 0
223 OBH Plus Botol 0 0 0 0
224 Wibrom Syr Botol 0 0 0 0
5 Simpatomimetik
226 Eflin Tablet 0 0 0 0

AJ ANTISEPTIK
230 Albothyl Botol 10 10 6 4 7
233 Povidon Iodin Larutan 10 % Btl 300 ml 6 6 2 4 2
235 Hand Rub Botol 3 3 1 2 1
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
237 Etakridin (Rivanol) lar 0,1 % Botol 17 17 16 1 18
AL DESINFEKTAN
238 Etanol 70% Botol 69 69 11 58 12
240 Alkohol Swab Box 0 5 5 5 0

AN ANESTESI LOKAL
254 Etil klorida spray 100 ml Botol 0 0 0 0
AO ANTI TIROID
259 Propiltiourasil tab 100 mg Tablet 0 0 0 0


1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 12 13 14 15 16

263 Pot 0 0 0
265 Gentamisin Salep Kulit 0,1% Tube 20 20 20 0 22
266 Kloramfenikol Salep Kulit 2% Tube 0 0 0 0
267 Oksitetrasiklin HCl Salep Kulit 3% Tube 0 0 0 0
2 Anti Fungi
268 Anti Fungi Doen Kombinasi Pot 0 24 24 1 23 1
270 Mikonazole krim 2% Tube 12 24 36 17 19 19

272 Betametason krim 0,05 % Tube 0 0 0 0
273 Hidrokortison Krim 1% Tube 61 61 38 23 42

275 Salep 2-4 Kombinasi Pot 0 0 0 0
5 Lain- lain
AR OBAT UNTUK MATA
1 Anastesi Lokal
277 Tetrakain tts mata 0,5% Botol 0 0 0 0
2 Antimikroba
278 Gentamisin Salep Mata 0,3% Tube 0 0 0 0
279 Gentamisin tetes Mata 0,3% Botol 0 0 0 0
280 Kloramfenikol tts mata 0,5% Botol 0 0 0 0
283 Oksitetrasiklin salep mata Tube 0 0 0 0
3 Antiinflamasi
285 Betametason tts mata 1 mg/ml Botol 0 0 0 0

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
287 Atropin Sulfat tetes Mata Botol 0
6 Tes Fungsi mata


AS
DAN TELINGA
290 Karbogliserin tetes telinga 10% Botol 0
291 Kloramfenikol tetes telinga Botol 0
0
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet 0

AU
LAIN-LAIN

AV 0
IMUN

308 Asam Ascorbat tab 50 mg Tablet 0 0 0 0
311 Bionemi Tablet 0 0 0 0
312 Hemafort Tablet 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 0 0
316 Kalsium Laktat Tab. 500 mg Tablet 2,000 2,000 500 1,500 550
317 Pehavral Tablet 0 0 0 0
322 Selesbion Tablet 2,000 2,000 600 1,400 660
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 1,100 1,100 300 800 330
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 0 0 0 0
327 Truvit syr Botol 0 0 0 0
328 Vit B Kompleks Tablet 0 0 0 0
AX TERAPI NOOTROPIK

334 Abbocath No 20 Buah 45 45 2 43 2
335 Abbocath No 22 Buah 45 45 2 43 2
336 Abbocath No 24 Buah 50 50 2 48 2
351 Benechek Uric test strip Buah 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
352 Benechek Glukosa test strip Botol 0 0 0 0
353 Benechek Kolesterol tast strip Botol 0 0 0 0
354 Blood Lancet Botol 2 2 2 0
355 Catgut/benang bedah no 2/0-3/0 Buah 36 36 36 0
367 Handschoend Ukuran L Buah 0 0 0 0
374 Infus set Dewasa Buah 45 50 95 5 90 6
386 Kpas 250 mg Buah 8 8 1 7 1
387 Kapas 500 mg Buah 0 0 0 0
PEMBERIAN
NO NAMA OBAT KEMASAN STOK AWAL PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN KET
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
398 Mata Pisau Carbon No. 10 Buah 0 0 0 0
404 Masker Buah 200 200 105 95 116
405 Masker N 95 Buah 0 0 0 0
410 Plastik Obat Besar Bks 100 sachet 0 0 0 0
411 Plastik Obat Sedang Bks 100 sachet 0 0 0 0
412 Plastik Obat Kecil Bks 100 sachet 0 0 0 0
415 Plester Rol 14 14 6 8 7
417 Polifix 5 cm x 1m Rol 21 21 9 12 10
420 Silk (benang bedah sutera) no. 3/0 Buah 24 24 24 0
422 Slide Set 0 0 0 0
AZ DAN LAIN LAIN

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
462 Cuticell pcs 5 5 5 0 6
463 Star D Plus Dengue Combo 1cs pcs 25 25 25 0 28
464 Lanzoprazole 30 mg Kaplet 140 140 20 120 22
Betahistine Mesylate Tablet 1,000 1,000 400 600 440
PEMBERIAN
NO NAMA OBAT KEMASAN STOK AWAL PENERIMAANPERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN KET
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
BPJS Jumlah
Jumlah Pasien/Resep
Bayar
1 INFEKSI AKUT LAIN PADA SALURAN PERNAPASAN 1701 211
Jumlah Pasien/Resep
PENYAKIT PADA SISTEM OTOT DAN JARINGAN
2 PENYAKAT (TULANG BELULANG, RADANG SENDI, 29 147
102 195 848 1145 REMATIK)
3 PENYAKIT TEKANAN DARAH TINGGI 14 109
4 PENYAKIT KULIT ALERGI 2802 73
5 GASTRITIS 2001 73
6 PENYAKIT RONGGA MULUT 19 59
7 PENYAKIT SUSUNAN SARAF LAINNYA 1104 51
8 KENCING MANIS (DIABETES MELITUS) 802 37
9 KECELAKAAN RUDA PAKSA 2601 31
10 ANEMIA 2701 22

( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : Juni 2018
Puskesmas : Lawanga Permintaan Bulan : Juli 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A

2 Asam Mefenamat Tab. 500 mg Tablet 3,300 3,300 100 3,200 110
15 Parasetamol 500 mg Tablet 3,400 3,400 200 3,200 220
B ANTI PIRAI
23 Allopurinol Tab. 100 mg Tablet 300 300 300 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
26 Amoksisilin Kapsul 250 mg Kapsul 1,000 1,000 1,000 0
27 Amoksisilin Kaplet 500 mg Kaplet 3,000 3,000 1,300 1,700 1,430 1,500

56 Metronidazol tab. 500 mg Tablet 3,600 3,600 3,600 0
E ANTELMENTIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
F ANTI FILARIA
H ANTI TUBERKOLOSIS
I ANTI MALARIA

88 Ranitidin Tab. 150 mg Tablet 1,000 1,000 1,000 0 1,100 1,500
K ANTISPASMODIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
L OBAT UNTUK DIARE

100 Loperamid 2 mg Tablet 1,500 1,500 1,500 0
M KATARTIK
N ANTIHEMORROID
O ANTI EMETIK
111 Domperidon syr Botol 0 0 0 0 50
112 Domperidon Tab 10 mg Tablet 700 700 700 0
P ANTI ALERGI
116 Betadryl Injeksi Vial 0 0 0 0 20
117 Difenhidramin inj 10 mg/ml Ampul 0 0 0 0 30
118 Klorfeniramin Maleat 4 mg Tablet 3,200 3,200 100 3,100 110
119 Loratadin tab 10 mg Tablet 600 600 300 300 330
121 Seterizine syr. 5 mg/ml 0 0 0 0 30
Q ANTI VIRUS
123 Asiklovir 400 mg Tablet 1,200 1,200 850 350 935
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI

138 Karbamazepin Tab 200 mg Tablet 200 200 200 0
T ANTI PARKINSON

U
UNTUK KERACUNAN
V ANTI MIGREN
149 Kombinasi Ergotamin 1 mg + Kefein 50 mg Tablet 0 0 0 0 200
W ANTI ANEMI
151 Asam Folat 1 mg Tablet 1,300 1,300 100 1,200 110
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
Y ANTI DIABET
162 Glimepirid 2 mg Tablet 0 0 0 0 500
Z ANTI ANGINA
167 Isosorbid Dinitrat tab 5 mg Tablet 0 0 0 0 400
AA ANTI ARITMIA
AB ANTI HIPERTENSI
172 Amlodipin 10 mg Tablet 0 0 0 0 900
173 Kaptopril 12,5 mg Tablet 0 0 0 0 500
174 Kaptopril 25 mg Tablet 0 0 0 0 500
175 Nifedipin tab 10 mg Tablet 0 0 0 0 500
AC DIURETIK
181 Spironolakton tab 25 mg Tablet 0 0 0 0 300

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
184 Gemfibrozil 600 mg Tablet 0 0 0 0 500

187 Epinefrin 0,1 % Inj Ampul 0 0 0 0 30
AG KORTIKOSTEROID
AH PSIKOFARMAKA
1 Anti Ansietas
2 Anti Depresi
3 Anti Psikosis
201 Haloperidol tab 5 mg Tablet 0 0 0 0 300
203 Klorpromazin tab 100 mg Tablet 1,000 1,000 1,000 0


PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
209 Aminofilin 150 mg Tablet 0 0 0 0 200
210 Aminofilin tab 200 mg Tablet 0 0 0 0 200
213 Salbutamol tab 4mg Tablet 1,000 1,000 1,000 0
2 Antitusif
3 Ekspektoran
217 Guaifenesin Tablet 0 0 0 0 3,000
4 Mukolitik
220 Bromheksin 8 mg Tablet 0 0 0 0 2,000
221 Bromheksin sirup 4 mg/ml Botol 0 0 0 0 2,000
223 OBH Plus Botol 0 0 0 0 50
5 Simpatomimetik
226 Eflin Tablet 0 0 0 0 3,000

AJ ANTISEPTIK
230 Albothyl Botol 4 4 4 0
233 Povidon Iodin Larutan 10 % Btl 300 ml 4 4 1 3 1 5
235 Hand Rub Botol 2 2 2 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
AL DESINFEKTAN
238 Etanol 70% Botol 58 58 2 56 2

AN ANESTESI LOKAL
256 Lidokain 2% + Epinefrin Inj Ampul 0 0 0 0 50
AO ANTI TIROID
259 Propiltiourasil tab 100 mg Tablet 0 0 0 0 100


1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 12 13 14 15 16

263 Pot 0 0 0 100
264 Bioplasenton Tube 2 2 2 0
2 Anti Fungi
269 Ketokonazol krim 2% Tube 23 23 3 20 3
270 Mikonazole krim 2% Tube 19 19 5 14 6


5 Lain- lain
AR OBAT UNTUK MATA
1 Anastesi Lokal
277 Tetrakain tts mata 0,5% Botol 0 0 0 0 20
2 Antimikroba
3 Antiinflamasi

286 Pilokarpin tts mata 2% Botol 0 0 0 0 20
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
287 Atropin Sulfat tetes Mata Botol 0 20
6 Tes Fungsi mata


AS
DAN TELINGA
290 Karbogliserin tetes telinga 10% Botol 0 30
292 Oksimetazolin tetes hidung 0,025 % Botol 0 10
0
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet 0 300

AU
LAIN-LAIN
AU
LAIN-LAIN

AV 0
IMUN

308 Asam Ascorbat tab 50 mg Tablet 0 0 0 0 3,000
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 0 0 1,000
316 Kalsium Laktat Tab. 500 mg Tablet 1,500 1,500 1,500 0
317 Pehavral Tablet 0 0 0 0 1,000
322 Selesbion Tablet 1,400 1,400 400 1,000 440 2,000
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 800 800 800 0
AX TERAPI NOOTROPIK

334 Abbocath No 20 Buah 43 43 5 38 6
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
365 Handschoend Ukuran S Buah 0 0 0 0 100
366 Handschoend Ukuran M Buah 0 0 0 0 100
367 Handschoend Ukuran L Buah 0 0 0 0 100
373 Infus set Anak Buah 38 38 38 0
386 Kpas 250 mg Buah 7 7 7 0
387 Kapas 500 mg Buah 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
404 Masker Buah 95 95 95 0 105 500
405 Masker N 95 Buah 0 0 0 0
409 Plastik Obat Bks 100 sachet 0 0 0 0 100
415 Plester Rol 8 8 5 3 6 10
417 Polifix 5 cm x 1m Rol 12 12 1 11 1
422 Slide Set 0 0 0 0
AZ DAN LAIN LAIN

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
463 Star D Plus Dengue Combo 1cs pcs 0 0 0 0
464 Lanzoprazole 30 mg Kaplet 120 120 120 0
Betahistine Mesylate Tablet 600 600 100 500 110
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
BPJS Jumlah
Jumlah Pasien/Resep
Bayar
1 INFEKSI AKUT LAIN PADA SALURAN PERNAPASAN 1701 186
Jumlah Pasien/Resep 2 HIPERTENSI 14 66
91 148 675 914 3 GASTRITIS 20.01 52
PENYAKIT JARINGAN OTOT DAN JARINGAN

4 PENYAKAT (PENYAKIT TULANG, RADANG SENDI 29 45
DAN RHEUMATIK
5 PENYAKIT KULIT ALERGI 28.02 29
6 KECELAKAAN RUDA PAKSA 26.01 28
7 HIPOTENSI 16.01 22
8 PENYAKIT KULIT INFEKSI 28.01 19
9 GINGIVITIS PENYAKIT PERIODENITAL 19.05 18
10 DIABETES MELITUS 08.02 14

( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : Juli 2018
Puskesmas : Lawanga Permintaan Bulan : 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A

2 Asam Mefenamat Tab. 500 mg Tablet 3,200 3,200 2,000 1,200 2,200 2,000
15 Parasetamol 500 mg Tablet 3,200 3,200 2,000 1,200 2,200
16 Parasetamol Syrup 120 mg/ml Botol 40 40 80 70 10 77 77
17 Parasetamol drops 100 mg/ml Botol 11 11 11 0 12 15
20 Piroksikam 20 mg Tablet 0 0 0 0 500
B ANTI PIRAI
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
26 Amoksisilin Kapsul 250 mg Kapsul 1,000 1,000 1,000 0 1,100 2,000
27 Amoksisilin Kaplet 500 mg Kaplet 1,700 1,700 1,400 300 1,540 1,500
31 Ciprofloksasin 500 mg Tablet 600 600 100 500 110

E ANTELMENTIK
59 Albendazole 400 mg Tablet 0 0 0 0 100
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
63 Pirantel pamoat tab. 125 mg Tablet 58 58 58 0 64 100
F ANTI FILARIA
H ANTI TUBERKOLOSIS
I ANTI MALARIA

88 Ranitidin Tab. 150 mg Tablet 0 1,500 1,500 1,500 0 1,650 2,500
89 Ranitidin Inj. 25 mg/ml Ampul 0 100 100 10 90 11
K ANTISPASMODIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Hiosina Butilbromida Inj. 20 mg/ml / Buscopan Ampul 0 0 0 0
95 Papaverin Tab Tablet 1,800 1,800 300 1,500 330
L OBAT UNTUK DIARE

101 Zink tab. Dispersibble 20 mg Tablet 0 500 500 300 200 330 500
M KATARTIK
N ANTIHEMORROID
109 Hemorogard Kapsul 0 0 0 0 500
O ANTI EMETIK
111 Domperidon syr Botol 0 50 50 15 35 17
114 Metoklopramid tab 10 mg Tablet 400 400 100 300 110
P ANTI ALERGI
118 Klorfeniramin Maleat 4 mg Tablet 3,100 3,100 1,400 1,700 1,540
Q ANTI VIRUS
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI
125 Griseofulvin 125 mg Tablet 800 800 100 700 110

138 Karbamazepin Tab 200 mg Tablet 200 200 200 0 220 300
T ANTI PARKINSON

U
UNTUK KERACUNAN
V ANTI MIGREN
W ANTI ANEMI
151 Asam Folat 1 mg Tablet 1,200 1,200 400 800 440
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
Y ANTI DIABET
160 Glibenklamid tab 5 mg Tablet 400 400 100 300 110
Z ANTI ANGINA
167 Isosorbid Dinitrat tab 5 mg Tablet 0 300 300 300 0
AA ANTI ARITMIA
AB ANTI HIPERTENSI
172 Amlodipin 10 mg Tablet 0 900 900 480 420 528 540
AC DIURETIK

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

AG KORTIKOSTEROID
190 Metilprednisolon 4 mg Tablet 0 3,000 3,000 1,400 1,600 1,540 1,000
192 Prednison 5 mg Tablet 2,000 2,000 1,000 1,000 1,100
AH PSIKOFARMAKA
1 Anti Ansietas
2 Anti Depresi
3 Anti Psikosis


PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
209 Aminofilin 150 mg Tablet 0 0 0 0 200
210 Aminofilin tab 200 mg Tablet 0 0 0 0 200
213 Salbutamol tab 4mg Tablet 1,000 1,000 300 700 330
2 Antitusif
3 Ekspektoran
4 Mukolitik
5 Simpatomimetik
225 Efedrin HCl tab 25 mg Tablet 0 0 0 0 100
226 Eflin Tablet 0 0 0 0 3,000

AJ ANTISEPTIK
233 Povidon Iodin Larutan 10 % Btl 300 ml 3 3 3 0 5
235 Hand Rub Botol 2 2 2 0 2 10
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
AL DESINFEKTAN
238 Etanol 70% Botol 56 56 19 37 21
240 Alkohol Swab Box 4 4 4 0

241 Bahan Tumpatan Sementara Buah 0 0 0 0 1
244 Kalsium Hidroksida Botol 0 0 0 0 1
245 Klorfenol Kamfer Mentol (CHKM) Botol 0 0 0 0 1
246 Komposit Resin Buah 0 0 0 0 1
247 Kalsium Hidroksida Pasta Buah 0 0 0 0 1
248 Larutan Eugenol Botol 0 0 0 0 1
249 Larutan Formokresol Botol 0 0 0 0 1
250 Pasta Devitalisasi (non Arsen) Buah 0 0 0 0 1
252 Semen Seng Fosfat (Doriden) Buah 0 0 0 0 1
253 Temporary Stopping Fletcher Buah 0 0 0 0 1
AN ANESTESI LOKAL
AO ANTI TIROID


1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 12 13 14 15 16

263 Pot 0 0 0 100
2 Anti Fungi

273 Hidrokortison Krim 1% Tube 23 23 23 0 25 50

5 Lain- lain
AR OBAT UNTUK MATA
1 Anastesi Lokal
2 Antimikroba
282 Kloramfenikol salep mata 1% Tube 5 30 35 1 34 1
3 Antiinflamasi

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
6 Tes Fungsi mata


AS
DAN TELINGA
290 Karbogliserin tetes telinga 10% Botol 0 30 30 30 0
0
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet 300 300 300 0

AU
LAIN-LAIN
300 Natrium Klorida 0,9% Botol 12 20 32 11 21 12 20
301 Ringer Laktat Botol 15 15 15 0 17 40

AV 0
IMUN

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 0 0 1,000
316 Kalsium Laktat Tab. 500 mg Tablet 1,500 1,500 600 900 660
320 Retinol Kaps. Lunak 100.000 IU Kapsul 0 50 50 50 0
322 Selesbion Tablet 1,000 1,000 900 100 990 2,000
AX TERAPI NOOTROPIK

333 Abbocath No 18 Buah 14 14 5 9 6
334 Abbocath No 20 Buah 38 38 17 21 19
335 Abbocath No 22 Buah 43 43 17 26 19
336 Abbocath No 24 Buah 48 48 15 33 17
340 Alat suntik sekali pakai 3 ml Buah 0 300 300 200 100 220 300
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
362 Handschoend steril No 7 Buah 50 50 50 0 55 100
363 Handschoend steril No 7,5 Buah 115 115 104 11 114 100
365 Handschoend Ukuran S Buah 0 0 0 0 100
366 Handschoend Ukuran M Buah 0 0 0 0 100
367 Handschoend Ukuran L Buah 0 0 0 0 100
374 Infus set Dewasa Buah 90 90 29 61 32
386 Kpas 250 mg Buah 7 7 1 6 1
387 Kapas 500 mg Buah 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
404 Masker Buah 0 500 500 200 300 220
405 Masker N 95 Buah 0 0 0 0
415 Plester Rol 3 10 13 3 10 3 10
417 Polifix 5 cm x 1m Rol 11 11 11 0
422 Slide Set 0 0 0 0
AZ DAN LAIN LAIN

435 Control Normal CBC - ST Plus R & D Botol 0 1 1 1 0 1
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
465 Selcom C Tablet 0 3,000 3,000 1,500 1,500 1,650
Betahistine Mesylate Tablet 500 500 500 0 550
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
Bayar
Jumlah Pasien/Resep
BPJS Jumlah
Bayar
1 INFLUENSA 1702 241
Jumlah Pasien/Resep
2 HIPERTENSI 14 128
106 184 936 1226 PENYAKIT PADA SISTIM OTOT PADA JARINGAN
3 29 93
PENYEKAT
4 GASTRITIS 2001 82
6 DIARE 102 46
7 HIPOTENSI 1603 46
8 GANGGUAN PULPA DAN PERIPIKAL 1902 32
9 KECELAKAAN, RUDAPAKSA 2601 27
PENYAKIT LAIN PADA SALURAN PERNAPASAN
10 17 23
ATAS

( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : Agustus 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A

2 Asam Mefenamat Tab. 500 mg Tablet 1,200 2,000 3,200 2,000 1,200 2,200 2,000
13 Natrium Diklofenak 25 mg Tablet 0 0 0 0 1,000
14 Natrium Diklofenak 50 mg Tablet 0 0 0 0 1,000
15 Parasetamol 500 mg Tablet 1,200 1,200 2,000 -800 2,200 3,000
17 Parasetamol drops 100 mg/ml Botol 0 15 15 11 4 12
18 Parasetamol Infus Buah 0 0 0 0 5
B ANTI PIRAI
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
26 Amoksisilin Kapsul 250 mg Kapsul 0 2,000 2,000 1,000 1,000 1,100
27 Amoksisilin Kaplet 500 mg Kaplet 300 300 1,400 -1,100 1,540 3,000
43 Kotrimoksazol dewasa tab. 480 mg Tablet 700 700 700 0 EXP 08-18

E ANTELMENTIK
62 Mebendazol sir. 100 mg/ml Botol 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
63 Pirantel pamoat tab. 125 mg Tablet 0 0 58 -58 64 100
F ANTI FILARIA
H ANTI TUBERKOLOSIS
I ANTI MALARIA

85 Antasida DOEN. Tab. Kombinasi Tablet 0 0 0 0 3,000
88 Ranitidin Tab. 150 mg Tablet 0 2,500 2,500 1,500 1,000 1,650 2,800
K ANTISPASMODIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
94 Hiosina Butilbromida Inj. 20 mg/ml / Buscopan Ampul 0 0 0 0
L OBAT UNTUK DIARE

99 Kombinasi kaolin 550 mg + pektin 20 mg Tablet 0 0 0 0 300
100 Loperamid 2 mg Tablet 1,000 1,000 500 500 550
M KATARTIK
N ANTIHEMORROID
O ANTI EMETIK
114 Metoklopramid tab 10 mg Tablet 300 300 100 200 110
P ANTI ALERGI
118 Klorfeniramin Maleat 4 mg Tablet 1,700 1,700 1,400 300 1,540 1,300
Q ANTI VIRUS
124 Asiklovir Krim Tube 0 0 0 0 100
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI
129 Nistatin tab. Vaginal 100.000 iu/g Tablet 400 500 900 900 0

138 Karbamazepin Tab 200 mg Tablet 0 300 300 200 100 220 500
139 Magnesium Sulfat Inj. (IV) 20% - 25 ml Botol 0 0 0 0 5
T ANTI PARKINSON

U
UNTUK KERACUNAN
V ANTI MIGREN
W ANTI ANEMI
151 Asam Folat 1 mg Tablet 800 800 400 400 440
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
159 Fitomenadion inj 10 mg/ml Ampul 90 90 90 0 60 EXP 08-18
Y ANTI DIABET
160 Glibenklamid tab 5 mg Tablet 300 300 100 200 110
Z ANTI ANGINA
AA ANTI ARITMIA
AB ANTI HIPERTENSI
172 Amlodipin 10 mg Tablet 420 540 960 480 480 528 300
AC DIURETIK

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

AG KORTIKOSTEROID
188 Dexamethason 0,5 mg Tablet 0 3,000 3,000 3,000 0 2,700
190 Metilprednisolon 4 mg Tablet 1,600 1,000 2,600 1,400 1,200 1,540 1,000
192 Prednison 5 mg Tablet 1,000 1,000 1,000 0 1,100
AH PSIKOFARMAKA
1 Anti Ansietas
2 Anti Depresi
3 Anti Psikosis
199 Haloperidol tab 1,5 mg Tablet 0 300 300 300 0


PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
213 Salbutamol tab 4mg Tablet 700 700 300 400 330
2 Antitusif
214 Kodein Tab 10 mg Tablet 0 0 0 0 300
3 Ekspektoran
4 Mukolitik
5 Simpatomimetik
226 Eflin Tablet 0 0 0 0 3,000

AJ ANTISEPTIK
235 Hand Rub Botol 0 10 10 2 8 2 5
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
AL DESINFEKTAN
238 Etanol 70% Botol 37 37 19 18 21

AN ANESTESI LOKAL
AO ANTI TIROID


1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 12 13 14 15 16

263 Pot 0 0 0 100
2 Anti Fungi
269 Ketokonazol krim 2% Tube 0 25 25 20 5 22 25
270 Mikonazole krim 2% Tube 0 25 25 14 11 15 25

273 Hidrokortison Krim 1% Tube 0 0 23 -23 25 50

5 Lain- lain
AR OBAT UNTUK MATA
1 Anastesi Lokal
2 Antimikroba
3 Antiinflamasi

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
6 Tes Fungsi mata


AS
DAN TELINGA
290 Karbogliserin tetes telinga 10% Botol 30 30 30 0
0
AT OKSITOKSIK

AU
LAIN-LAIN
300 Natrium Klorida 0,9% Botol 21 20 41 11 30 12
301 Ringer Laktat Botol 0 40 40 15 25 17 20

AV 0
IMUN

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 0 0 1,000
316 Kalsium Laktat Tab. 500 mg Tablet 900 900 600 300 660
322 Selesbion Tablet 100 100 900 -800 990 2,000
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 0 0 0 0 3,000
AX TERAPI NOOTROPIK

333 Abbocath No 18 Buah 9 9 5 4 6
334 Abbocath No 20 Buah 21 21 17 4 19
335 Abbocath No 22 Buah 26 26 17 9 19
336 Abbocath No 24 Buah 33 33 15 18 17
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
362 Handschoend steril No 7 Buah 0 100 100 50 50 55
363 Handschoend steril No 7,5 Buah 11 100 111 104 7 114
365 Handschoend Ukuran S (6,5) Buah 0 50 50 50 0 100
366 Handschoend Ukuran M (7) Buah 0 50 50 50 0 100
367 Handschoend Ukuran L (7,5) Buah 0 50 50 50 0 100
386 Kpas 250 mg Buah 6 6 1 5 1
387 Kapas 500 mg Buah 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
395 Kasa Pembalut Hidrofil 40 x 80 cm Rol 1 1 1 0 1 3
404 Masker Buah 300 300 200 100 220 200
405 Masker N 95 Buah 0 0 0 0
415 Plester Rol 10 10 20 3 17 3
417 Polifix 5 cm x 1m Rol 11 11 11 0
422 Slide Set 0 0 0 0
AZ DAN LAIN LAIN

435 Control Normal CBC - ST Plus R & D Botol 0 0 1 -1 1
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
464 Lanzoprazole 30 mg Kaplet 0 0 120 -120 132 400
465 Selcom C Tablet 1,500 1,500 1,500 0 1,650 2,000
467 Betahistine Mesylate Tablet 0 0 500 -500 550 500
468 RDT Malaria pcs 50
469 Tabung Vacum Tutup Ungu pcs 200
470 Tabung Vacum Tutup Merah pcs 200
471
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
Bayar
Jumlah Pasien/Resep
BPJS Jumlah
Bayar
1 INFEKSI AKUT LAIN PADA SALURAN PERNAFASAN 1702 194
Jumlah Pasien/Resep
94 191 808 1093 PENYAKIT PADA SISTEM OTOT DAN JARINGAN

3 PENYAKAT (PENYAKIT TULANG BELULANG, 29 97
RADANG SENDI, REMATIK)
4 GASTRITIS 2001 82
5 DIARE 102 51
6 KECELAKAAN, RUDAPAKSA 2601 40
7 HYPOTENSI 1603 37
8 KENCING MANIS 802 36
10 GINGIVITAS DAN PENYAKIT PERIODONTAL 1903 28

( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : September 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A

2 Asam Mefenamat Tab. 500 mg Tablet 1,200 2,000 3,200 800 2,400 880 2,000
6 Ibuprofen susp. 100 mg/ml Botol 44 44 40 4 44 50
14 Natrium Diklofenak 50 mg Tablet 0 1,000 1,000 550 450 605 650
15 Parasetamol 500 mg Tablet 0 3,000 3,000 1,200 1,800 1,320 1,400
B ANTI PIRAI
23 Allopurinol Tab. 100 mg Tablet 200 200 200 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
26 Amoksisilin Kapsul 250 mg Kapsul 1,900 1,900 300 1,600 330
27 Amoksisilin Kaplet 500 mg Kaplet 0 3,000 3,000 2,000 1,000 2,200 2,200
30 Benzatin benzil penisilin inj. 1,2 juta IU/vial Vial 0 0 0 0 5
38 Kanamisin Serb. Inj. 1000 mg Vial 0 0 0 0 5
54 Tiamfenikol 500 mg Tablet 400 400 300 100 330 300

E ANTELMENTIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
63 Pirantel pamoat tab. 125 mg Tablet 0 100 100 100 0
F ANTI FILARIA
H ANTI TUBERKOLOSIS
I ANTI MALARIA

88 Ranitidin Tab. 150 mg Tablet 0 2,800 2,800 300 2,500 330
K ANTISPASMODIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
L OBAT UNTUK DIARE

100 Loperamid 2 mg Tablet 1,000 1,000 500 500 550
M KATARTIK
N ANTIHEMORROID
O ANTI EMETIK
P ANTI ALERGI
118 Klorfeniramin Maleat 4 mg Tablet 600 800 1,400 1,000 400 1,100 1,300
Q ANTI VIRUS
124 Asiklovir Krim Tube 0 0 0 0 100
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI

138 Karbamazepin Tab 200 mg Tablet 0 500 500 365 135 402 400
T ANTI PARKINSON

U
UNTUK KERACUNAN
V ANTI MIGREN
W ANTI ANEMI
151 Asam Folat 1 mg Tablet 700 700 700 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
159 Fitomenadion inj 10 mg/ml Ampul 0 60 60 60 0 66 90
Y ANTI DIABET
Z ANTI ANGINA
AA ANTI ARITMIA
AB ANTI HIPERTENSI
172 Amlodipin 10 mg Tablet 420 420 420 0 462 480
AC DIURETIK
178 Furosemid tab 40 mg Tablet 0 200 200 200 0 220 400

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
186 Simvastatin tab 20 mg Tablet 150 150 50 100 55 200

AG KORTIKOSTEROID
188 Dexamethason 0,5 mg Tablet 600 2,200 2,800 900 1,900 990
190 Metilprednisolon 4 mg Tablet 1,100 1,000 2,100 100 2,000 110
192 Prednison 5 mg Tablet 0 0 0 0
AH PSIKOFARMAKA
1 Anti Ansietas
194 Diazepam tab 2 mg Tablet 100 100 80 20 88 200
2 Anti Depresi
197 Amitriptilin tab 25 mg Tablet 300 300 300 0 330 400
3 Anti Psikosis


PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
213 Salbutamol tab 4mg Tablet 700 700 700 0
2 Antitusif
3 Ekspektoran
4 Mukolitik
5 Simpatomimetik
226 Eflin Tablet 0 0 0 0 3,000

AJ ANTISEPTIK
235 Hand Rub Botol 3 10 13 3 10 3
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
AL DESINFEKTAN
238 Etanol 70% Botol 23 23 13 10 14 20
240 Alkohol Swab Box 8 8 8 0 9 10

AN ANESTESI LOKAL
AO ANTI TIROID


1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 12 13 14 15 16

263 Pot 0 0 0 100
2 Anti Fungi

272 Betametason krim 0,05 % Tube 0 100 100 25 75 28

5 Lain- lain
276 Bedak Salicyl 2% Buah 5 5 5 0 6 20
AR OBAT UNTUK MATA
1 Anastesi Lokal
2 Antimikroba
282 Kloramfenikol salep mata 1% Tube 24 24 24 0
3 Antiinflamasi

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
6 Tes Fungsi mata


AS
DAN TELINGA
0
AT OKSITOKSIK
295 Metilergometrin Inj 0,2 mg/ml Ampul 0 0 0
296 Oksitoksin Inj 10 IU/ml Ampul 0 100 100 4 96 4

AU
LAIN-LAIN
299 Glukosa lar Infus 40% Botol 0 20
300 Natrium Klorida 0,9% Botol 21 21 21 0

AV 0
IMUN

308 Asam Ascorbat tab 50 mg Tablet 0 3,000 3,000 1,400 1,600 1,540
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 0 0 0 1,000
316 Kalsium Laktat Tab. 500 mg Tablet 800 800 500 300 550 1,000
322 Selesbion Tablet 0 0 0 0 2,000
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 700 700 100 600 110
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 0 3,000 3,000 1,500 1,500 1,650 500
328 Vit B Kompleks Tablet 0 3,000 3,000 1,000 2,000 1,100
AX TERAPI NOOTROPIK

334 Abbocath No 20 Buah 19 19 19 0 21 30
335 Abbocath No 22 Buah 18 18 13 5 14 20
336 Abbocath No 24 Buah 32 32 6 26 7
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

355 Catgut/benang bedah no 2/0-3/0 Buah 12 12 12 0 13 24
366 Handschoend Ukuran M (7) Buah 0 100 100 50 50 55 100
386 Kpas 250 mg Buah 5 5 5 0
387 Kapas 500 mg Buah 0 0 0 0
389 Kasa Pembalut hidrofil 4 m x 15 cm Rol 0 30 30 15 15 17
390 Kasa Pembalut hidrofil 4 m x 10 cm Rol 0 20 20 20 0
393 Kasa Pembalut hidrofil 2 m x 80 cm Rol 0 20 20 20 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
396 Kasa Steril 16 x 16 Rol 0 20 20 8 12 9
404 Masker Buah 100 200 300 150 150 165 200
405 Masker N 95 Buah 0 0 0 0
415 Plester Rol 16 16 3 13 3
417 Polifix 5 cm x 1m Rol 11 11 11 0
422 Slide Set 0 0 0 0
AZ DAN LAIN LAIN

434 Aquadest steril Botol 0 0 0 0 20
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
465 Selcom C Tablet 400 400 200 200 220 2,000
467 Betahistine Mesylate Tablet 0 600 600 600 0
468 RDT Malaria pcs 0 0 0 50
469 Tabung Vacum Tutup Ungu pcs 0 0 0 200
470 Tabung Vacum Tutup Merah pcs 0 0 0 200
471 Amoksisilin sirup 250 mg/ml Botol 0 90 90 30 60 33
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
Bayar
Jumlah Pasien/Resep
BPJS Jumlah
Bayar
INFEKSI AKUT LAIN PADA SALURAN PERNAFASAN
1 1702 258
BAGIAN ATAS
Jumlah Pasien/Resep
4 GASTRITIS 2001 74
8 PENYAKIT MATA LAINNYA (CONJUNGTIVITIS) 1205 33
9 CARIES 1901 31
10 HYPOTENSI 1603 10

( LPLPO )
Kode Puskesmas : 720401201 Pelaporan Bulan : Oktober 2018
PEMBERIAN
DAK DAU LAIN-2 JML
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16
A

2 Asam Mefenamat Tab. 500 mg Tablet 2,400 2,000 4,400 2,400 2,000 2,640 3,000
14 Natrium Diklofenak 50 mg Tablet 450 650 1,100 500 600 550 1,000
15 Parasetamol 500 mg Tablet 1,800 1,400 3,200 2,000 1,200 2,200 3,000
16 Parasetamol Syrup 120 mg/ml Botol 10 50 60 55 5 61 130
19 Piroksikam 10 mg Tablet 0 1,000 1,000 500 500 550 2,000
20 Piroksikam 20 mg Tablet 0 500 500 500 0 550 1,200
B ANTI PIRAI
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
C ANTI BAKTERI
25 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0
26 Amoksisilin Kapsul 250 mg Kapsul 1,600 1,600 600 1,000 660 500
27 Amoksisilin Kaplet 500 mg Kaplet 1,000 2,200 3,200 2,800 400 3,080 5,500
30 Benzatin benzil penisilin inj. 1,2 juta IU/vial Vial 0 0 0 0 10
38 Kanamisin Serb. Inj. 1000 mg Vial 0 0 0 0 5
39 Kloramfenicol Kaps. 250 mg Kapsul 500 500 300 200 330
40 Kloramfenicol Sirup Botol 0 0 0 0 20
43 Kotrimoksazol dewasa tab. 480 mg Tablet 0 0 0 0 200
54 Tiamfenikol 500 mg Tablet 100 300 400 400 0

E ANTELMENTIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
F ANTI FILARIA
H ANTI TUBERKOLOSIS
72 OAT FDC Kategori II Paket 0 0 0 0 2
73 OAT FDC Kategori Anak Paket 0 0 0 0 1
I ANTI MALARIA
83 Kombinasi DHP + piperakuin Tablet 0 0 0 0 50
84 Primakuin tab. 15 mg Tablet 0 0 0 0 100

87 Omeprazol kaps. 20 mg Kapsul 0 0 0 0 1,000
88 Ranitidin Tab. 150 mg Tablet 2,500 2,500 1,100 1,400 1,210 3,000
K ANTISPASMODIK
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
L OBAT UNTUK DIARE

100 Loperamid 2 mg Tablet 500 500 500 0
102 Zink sir. 20 mg/ml Botol 0 0 0 0 30
M KATARTIK
N ANTIHEMORROID
109 Hemorogard Kapsul 0 300 300 120 180 132 300
O ANTI EMETIK
111 Domperidon syr Botol 33 33 33 0 20
112 Domperidon Tab 10 mg Tablet 300 300 300 0 330 1,000
P ANTI ALERGI
116 Betadryl Injeksi/Recodryl Injeksi Vial 0 3 3 1 2 1
118 Klorfeniramin Maleat 4 mg Tablet 400 1,000 1,400 500 900 550 2,500
119 Loratadin tab 10 mg Tablet 300 300 100 200 110
Q ANTI VIRUS
123 Asiklovir 400 mg Tablet 350 350 150 200 165
124 Asiklovir Krim Tube 0 50 50 25 25 28 50
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
R ANTI FUNGI
127 Gentian Violet 1 % Botol 0 0 0 0 10

138 Karbamazepin Tab 200 mg Tablet 135 400 535 500 35 550 1,500
T ANTI PARKINSON

U
UNTUK KERACUNAN
V ANTI MIGREN
W ANTI ANEMI
151 Asam Folat 1 mg Tablet 700 700 400 300 440 800
154 Tablet Tambah Darah Tablet 0 0 0 0 500
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16

X
KOAGULASI
155 Asam Traneksamat tab 500 mg Tablet 0 0 0 0 100
157 Fitomenadion Tab 10 mg Tablet 0 0 0 0 200
159 Fitomenadion inj 10 mg/ml Ampul 0 90 90 30 60 33 60
Y ANTI DIABET
165 Metformin 850 mg Tablet 700 100 800 700 100 770 1,800
Z ANTI ANGINA
AA ANTI ARITMIA
AB ANTI HIPERTENSI
172 Amlodipin 10 mg Tablet 0 480 480 360 120 396 1,200
174 Kaptopril 25 mg Tablet 400 400 400 0 440 1,000
AC DIURETIK
178 Furosemid tab 40 mg Tablet 0 400 400 200 200 220 800

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
185 Simvastatin tab 10 mg Tablet 0 0 0 0 1,000
186 Simvastatin tab 20 mg Tablet 100 100 100 0 110 1,000

AG KORTIKOSTEROID
188 Dexamethason 0,5 mg Tablet 1,900 1,900 300 1,600 330 1,500
189 Dexamethason inj 5 mg/ml Ampul 100 100 5 95 6 100
190 Metilprednisolon 4 mg Tablet 2,000 2,000 100 1,900 110 1,000
192 Prednison 5 mg Tablet 0 0 0 0
AH PSIKOFARMAKA
1 Anti Ansietas
194 Diazepam tab 2 mg Tablet 20 200 220 220 0 200
2 Anti Depresi
197 Amitriptilin tab 25 mg Tablet 0 400 400 400 0 440 1,000
3 Anti Psikosis
199 Haloperidol tab 1,5 mg Tablet 220 220 70 150 77
201 Haloperidol tab 5 mg Tablet 0 0 0 0 1,000


PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
1 Anti asma
213 Salbutamol tab 4mg Tablet 700 700 700 0
2 Antitusif
3 Ekspektoran
215 Gliseril Guaikolat tab 100 mg Tablet 0 0 0 0
217 Guaifenesin Tablet 0 3,000 3,000 600 2,400 660 1,500
4 Mukolitik
218 Ambroxol 30 mg Tablet 0 3,000 3,000 1,500 1,500 1,650 3,500
219 Ambroxol sirup 15 mg/ 5 ml Botol 0 50 50 12 38 13 20
221 Bromheksin sirup 4 mg/ml Botol 0 0 0 0 30
5 Simpatomimetik
226 Eflin Tablet 0 3,000 3,000 900 2,100 990 2,500

AJ ANTISEPTIK
235 Hand Rub Botol 10 10 2 8 2 5
PEMBERIAN
NO NAMA OBAT KEMASAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT \ KET
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
AK BAKTERIOSTATIK
237 Etakridin (Rivanol) lar 0,1 % Botol 16 16 2 14 2
AL DESINFEKTAN
238 Etanol 70% Botol 10 10 8 2 9 40

AN ANESTESI LOKAL
AO ANTI TIROID
259 Propiltiourasil tab 100 mg Tablet 0 100 100 100 0 200


1. Anti Bakteri
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 12 13 14 15 16

263 Pot 0 0 0 100
267 Oksitetrasiklin HCl Salep Kulit 3% Tube 0 50 50 50 0 100
2 Anti Fungi

272 Betametason krim 0,05 % Tube 75 75 25 50 28 25

5 Lain- lain
276 Bedak Salicyl 2% Buah 0 20 20 20 0 20
AR OBAT UNTUK MATA
1 Anastesi Lokal
2 Antimikroba
282 Kloramfenikol salep mata 1% Tube 24 24 24 0
3 Antiinflamasi

PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
5 Midriatik
6 Tes Fungsi mata


AS
DAN TELINGA
291 Kloramfenikol tetes telinga/Erlamycetin Botol 0 30 30 10 20 11
0
AT OKSITOKSIK
294 Metilergometrin tab Selaput 0,125 mg Tablet 200 200 100 100 110 300
295 Metilergometrin Inj 0,2 mg/ml Ampul 0 0 0 0
296 Oksitoksin Inj 10 IU/ml Ampul 96 96 19 77 21

AU
LAIN-LAIN
299 Glukosa lar Infus 40% Botol 0 10
300 Natrium Klorida 0,9% Botol 21 21 0 21 0 40

AV 0
IMUN

308 Asam Ascorbat tab 50 mg Tablet 1,600 1,600 1,500 100 1,650 3,400
311 Bionemi Tablet 0 500 500 150 350 165 350
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
313 Imufor Tablet 0 500 500 350 150 385 1,000
316 Kalsium Laktat Tab. 500 mg Tablet 300 1,000 1,300 1,100 200 1,210 2,800
320 Retinol Kaps. Lunak 100.000 IU Kapsul 50 50 50 0 \
322 Selesbion Tablet 0 0 0 0 2,000
323 Sianokobalamin (Vitamin B 12) Tab. 50 mg Tablet 600 600 200 400 220 200
326 Tiamin HCl (Vit.B1) mononitrat tab. 50 mg Tablet 1,500 500 2,000 1,600 400 1,760 1,500
327 Truvit syr Botol 0 30 30 20 10 22 30
328 Vit B Kompleks Tablet 2,000 2,000 1,600 400 1,760 3,500
AX TERAPI NOOTROPIK

334 Abbocath No 20 Buah 0 30 30 30 0
335 Abbocath No 22 Buah 5 20 25 25 0
337 Alat suntik sekali pakai 0,5 ml Buah 0 100 100 100 0
338 Alat suntik sekali pakai 0,05 ml Buah 0 100 100 100 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
355 Catgut/benang bedah no 2/0-3/0 Buah 0 24 24 12 12 13 38
366 Handschoend Ukuran M (7) Buah 50 50 50 0 55 150
386 Kpas 250 mg Buah 5 5 3 2 3 6
387 Kapas 500 mg Buah 0 0 0 0
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
396 Kasa Steril 16 x 16 Rol 12 12 2 10 2 10
401 Mata Pisau Carbon No. 20 Buah 0 100 100 5 95 6
404 Masker Buah 150 200 350 150 200 165 400
405 Masker N 95 Buah 0 0 0 0
410 Plastik Obat Besar Bks 100 sachet 0 1,000 1,000 1,000 0 1,100 4,000
411 Plastik Obat Sedang Bks 100 sachet 0 1,000 1,000 1,000 0 1,100 4,000
412 Plastik Obat Kecil Bks 100 sachet 0 1,000 1,000 1,000 0 1,100 4,000
415 Plester Rol 13 13 4 9 4
417 Polifix 5 cm x 1m Rol 11 11 11 0
422 Slide Set 0 0 0 0
AZ DAN LAIN LAIN

434 Aquadest steril Botol 0 20 20 2 18 2
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
451 Lisol Botol 1 1 1 0 5
458 SGOT 4 x 50 + 4 x 10 ml (80x50) Botol 0 0 0 0
465 Selcom C Tablet 200 200 200 0 220 4,000
467 Betahistine Mesylate Tablet 600 600 300 300 330 300
468 RDT Malaria pcs 50
469 Tabung Vacum Tutup Ungu pcs 200
470 Tabung Vacum Tutup Merah pcs 200
471 Amoksisilin sirup 250 mg/ml Botol 60 100 160 67 93 74 50
472 Solvitron Tablet 0 1,000 1,000 500 500 550 1,500
473 Citicolin Tablet 0 60 60 30 30 33
474 Etanol Liter 0 5 5 2 3 2 3
475 Scabimite Cream Tube 0 2 2 2 0 2 10
476 Poiliwash Botol 0 4 4 4 0 4 10
477 Biocombin Ampul 0 40 40 10 30 11 50
PEMBERIAN
DAK DAU LAIN-2 JML
$ 2 3 5 6 7 8 9 10 11 12 13 14 15 16
Umum
Bayar
Jumlah Pasien/Resep
BPJS Jumlah
Bayar
INFEKSI AKUT LAIN PADA SALURAN
1 1702 258
PERNAFASAN BAGIAN ATAS
Jumlah Pasien/Resep
5 GASTRITIS 2001 67
7 KARIES GIGI 1901 44
9 DIARE ( TERMASUK TERSANGKA KOLERA) 0102 35
10 PENYAKIT MATA LAINNYA 1205 35


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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

Lembar Putih : Gudang Farmasi

Kode Puskesmas : 720401201 Pelaporan Bulan : Desemberr 2013

6 Diabetes Melitus 802 21

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kode Puskesmas : 720401201 Pelaporan Bulan : Januari 2014

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kode Puskesmas : 720401201 Pelaporan Bulan : Februari 2014

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kode Puskesmas : 720401201 Pelaporan Bulan : Maret 2014

5 Caries Gigi 1901 25

10 Diabetes melitus 802 15

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kode Puskesmas : 720401201 Pelaporan Bulan : April 2014

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kode Puskesmas : 720401201 Pelaporan Bulan : Mei 2014

KEMASAN HARGA PEMBERIAN

Umum BPJS Jamkesda Jumlah

Jumlah Pasien / Resep NO Nama Penyakit Kode Jumlah

42 425 62 529 1 ISPA 1702 253

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

Kode Puskesmas : 720401201 Pelaporan Bulan : Juni 2014

Umum BPJS Jamkesda Jumlah

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

D ANTI AMUBA DAN ANTIGIARDIASIS

J OBAT UNTUK SALURAN CERNA

L OBAT UNTUK DIARE

S ANTI EPILEPSI - ANTI KONVULSI

ANTIDOTUM DAN OBAT LAINNYA

OBAT YANG MEMPENGARUHI

AD ANTI AGREGASI PLATELET

AF OBAT UNTUK SYOK KARDIOGENIK

5 Obat Untuk Gangguan Bipolar

6 Obat Untuk Penyakit Paru Obstruksi kronis

227 Ipratropium Bromida Aerosol 20 mcg/semprot Buah 0 0

AM OBAT DAN BAHAN UNTUK GIGI

AP OBAT UNTUK MIASTENIA GRAVIS

AQ OBAT TOPIKAL UNTUK KULIT

Anti Bakteri Doen Slp Kombinasi Bacitrasin 500

3 Anti Inflamasi dan Antipruritik

4 Antiskabies dan Antipedikulosis

AR OBAT UNTUK MATA

4 Miotik dan Antiglaukoma

6 Tes Fungsi mata

OBAT UNTUK HIDUNG, TENGGOROKAN,

LARUTAN ELEKTROLIT, NUTRISI DAN

AW VITAMIN DAN MINERAL

AY BAHAN HABIS PAKAI

AZ DAN LAIN LAIN

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Membuat Laporan

2 Analgesik Non Narkotika

D ANTI AMUBA DAN ANTIGIARDIASIS

J OBAT UNTUK SALURAN CERNA

L OBAT UNTUK DIARE

S ANTI EPILEPSI - ANTI KONVULSI

ANTIDOTUM DAN OBAT LAINNYA

OBAT YANG MEMPENGARUHI

AD ANTI AGREGASI PLATELET

AF OBAT UNTUK SYOK KARDIOGENIK

4 Anti obsesi Kompulsi

5 Obat Untuk Gangguan Bipolar

6 Obat Untuk Penyakit Paru Obstruksi kronis

227 Ipratropium Bromida Aerosol 20 mcg/semprot Buah 0 0