SURAT BUKTI BARANG KELUAR (SBBK)

INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : sopi
Bulan : desember 2018

No Nama Obat/Barang SATUAN Jumlah Distribusi Harga (Rp) Jumlah (Rp)

1 ALPRAZOLAM 0.5 MG TAB (MERSI) TAB 2500 97.00 242,500.00

2 AMOXICILLIN 250 MG TAB TAB0 10000 212.00 2,120,000.00
3 ANTASIDA DOEN SUSPENSI 200 MG/5ML BOTOL 920 2,257.00 2,076,440.00
4 ANTASIDA DOEN TAB MERSI TAB 12000 58.00 696,000.00
5 ASAM FOLAT 1 MG TAB TAB 1500 88.00 132,000.00
6 ASAM MEFENAMAT CAPTABS 9600 139.00 1,334,400.00
CEFTRIAXONE SODIUM SERBUK INJ 1G 5,143.00
7 (RAMA) VIAL 170 874,310.00
CETIRIZINE HCL SIRUP 5MG/5ML 3,192.00
8 (RAMA) BOTOL 50 159,600.00
9 CETIRIZINE HCL TAB 10MG (RAMA) TAB 21400 103.00 2,204,200.00
10 CHLORAMPHENICOL 60N ML BOTOL 1500 5,413.00 8,119,500.00
11 CIPROFLOXACIN 500 MG TAB @ 100 TAB 5000 305.00 1,525,000.00
12 DEXAMETASON INJEKSI 5MG/ML AMPUL 580 1,378.00 799,240.00
13 DEXAMETHASONE 0.5 MG TAB TAB 61300 37.00 2,268,100.00
14 DIAZEPAM INJ 5MG/ML AMPUL 500 2,150.00 1,075,000.00
15 DOMPERIDON SYRUP 60 ML BOTOL 20 3,105.00 62,100.00
16 FENOBARBITAL 30 MG TAB TAB 1000 214.00 214,000.00
17 FLUCONAZOLE 150 MG TAB TAB 100 23,400.00 2,340,000.00
18 GLIMEPIRIDE 2 MG TAB TAB 4000 216.00 864,000.00
19 IBUPROFEN TAB 200 MG (NOVA) TAB 4800 121.00 580,800.00
20 KETOCONAZOLE 200 MG TAB TAB 3500 311.00 1,088,500.00
21 KF ACYCLOVIR 400 MG TAB TAB 5000 742.72 3,713,600.00
22 KF AMLODIPIN 5 MG TAB TAB 2500 960.00 2,400,000.00
23 KF ANTALGIN TAB 10800 256.74 2,772,792.00
24 KF CALCIUM LACTATE TAB 25200 196.90 4,961,880.00
25 KF COTRIMOXSAZOL ADULT TAB 7000 247.72 1,734,040.00
26 KF CEFADROXYL KAP KAP 1250 1,483.68 1,854,600.00
27 KF ERYTHROMICIN 250 MG TAB TAB 2500 809.38 2,023,450.00
28 KF. ATORVASTATIN 10 MG TAB TAB 1350 1,914.00 2,583,900.00
29 KF. HARNAL 0.4 MG TAB 14 17,731.00 248,234.00
30 KF. ANTASIDA SYRUP BOTOL 200 5,082.00 1,016,400.00
31 KF. CANDERSATAN 16 MG TAB TAB 840 1,848.00 1,552,320.00
32 KF. RANITIDIN TAB TAB 400 264.00 105,600.00
33 KF. DUMIN SUPPO 250 MG SUPPO 45 23,639.00 1,063,755.00
34 KF. IBUPROFEN TAB 200 MG TAB 2000 242.00 484,000.00
35 KF. CATGUT CROMIC 2/0 HR 26 PIECES 24 32,800.00 787,200.00
36 KF. KASA STERIL 16x16 PIECES 150 8,000.00 1,200,000.00
37 KF. KASA yd 40x80 ROLL 20 105,000.00 2,100,000.00
38 KF. MASKER TIE ON BOX 40 17,900.00 716,000.00
39 KF. POVIDONE IODINE 10% 1 LTR BOTOL 10 135,000.00 1,350,000.00
40 KF. HANDSCOON NON STERIL BOX 20 58,300.00 1,166,000.00
42 KF. HANDSCOON STERIL PIECES 250 20,000.00 5,000,000.00
43 LANSOPRAZOL 30 MG TAB TAB 4800 359.00 1,723,200.00
44 METHYLERGOMETRINE TAB 4000 267.00 1,068,000.00
45 MEROPENEM INJ. 0,5 GR 1 VIAL VIAL 70 27,160.00 1,901,200.00
46 METOCLOPRAMIDE TAB 10 MG TAB 700 93.00 65,100.00
47 MINIASPI 80 MG TAB (MERSI) TAB 4600 104.00 478,400.00
48 OMEPRAZOL 20 MG KAP @ 30(NOVA) KAP 6390 150.00 958,500.00
49 PARACETAMOL CAPTABS 16800 126.00 2,116,800.00
50 PREDNISON 5 MG TAB TABLET 10000 81.00 810,000.00
51 PROTOFEN SUPPO SUPPO 220 2,420.00 532,400.00
52 PYRANTEL 125 MG (DUS 100 TAB) TAB 1700 361.00 613,700.00
53 SALBUTAMOL 4 MG TAB TABLET 8000 81.00 648,000.00
54 SALEP 2-4 30 GR POT 960 3,274.00 3,143,040.00
55 SIMVASTATIN 20 MG TAB TABLET 1200 240.00 288,000.00
56 SUKRALFAT SYRUP 500 MG/5ML BOTOL 100 8,178.00 817,800.00
57 TENOFOVIR 300 MG TAB TAB 630 10,530.00 6,633,900.00
58 VERAPAMIL TAB TAB 5500 393.00 2,161,500.00
59 VITAMIN B12 INJEKSI (CYANOCOBALAMIN) AMPUL 200 1,335.00 267,000.00
60 VITAMIN B12 50 MCG TABLET (MARIN) TAB 31800 53.00 1,685,400.00
61 ZINK DISPERSIBEL TAB 5000 658.00 3,290,000.00
total 96,811,401.00

Yang menerima

Herlin Nur Cahyani,AMK

KETERANGAN

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 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Doku :
Unit Penerim: pkk

Jumlah
No Nama Obat/Barang Harga (Rp) Jumlah (Rp) Keterangan
Distribusi
1 alkohol 1 liter 54 29,410.00 1,588,140.00 APBD 2016
2 amoxicillin 500 mg 150 28,800.00 4,320,000.00 APBD 2016
3 amoxicillin syrup 25 2,790.00 69,750.00 APBD 2016
4 antasida tablet 6000 87.00 522,000.00 APBD 2017
5 asam ascorbat 50 747.00 37,350.00 APBD 2016
6 Asam mefenamat 10000 139.00 1,390,000.00 APBD 2017
7 becefort syrup 200 18,500.00 3,700,000.00 APBD 2017
8 becefort tab 1300 1,600.00 2,080,000.00 APBD 2017
9 dexametason inj 600 2,818.00 1,690,800.00 APBD 2017
10 dispo 1 6 82,200.00 493,200.00 APBD 2016
11 dispo 3 5 86,200.00 431,000.00 APBD 2016
12 domperidone suspensi 2 3,833.00 7,666.00 APBD 2016
13 handscoon 10 254,696.00 2,546,960.00 APBD 2014
14 hemafort 13 89,265.00 1,160,445.00 APBD 2016
15 ibuprofen 400 mg 18 17,100.00 307,800.00 APBD 2016
16 kasa steril 16x16 76 10,200.00 775,200.00 APBD 2014
17 leukoplast 2x5 50 28,950.00 1,447,500.00 APBD 2016
18 pehacain 560 3,250.00 1,820,000.00 APBD 2017
19 povidon 300 ml 20 37,430.00 748,600.00 APBD 2017
20 povidon 1000ml 1 112,000.00 112,000.00 APBD 2017
total 25,248,411.00
januari 2018
Yang menerima
kurnia
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Doku :
Unit Penerim: pemda
Bulan : Februari 2018

Jumlah
No Nama Obat/Barang Harga (Rp) Jumlah (Rp) Keterangan
Distribusi
1 alkohol 1 liter 20 29,410.00 588,200.00 APBD 2016
2 ambroxol syrup 19 5,882.00 111,758.00 APBD 2017
3 amoxcillin 500 mg tab 80 28,800.00 2,304,000.00 APBD 2016
4 antasida syrup 250 2,409.00 602,250.00 APBD 2016
5 antasida tab 10000 87.00 870,000.00 APBD 2017
6 asam mefenamat 10000 139.00 1,390,000.00 APBD 2017
7 becefort tab 3000 1,600.00 4,800,000.00 APBD 2017
8 cefadroxil tab 2500 988.00 2,470,000.00 APBD 2017
9 clindamycin 300 200 678.00 135,600.00 APBD 2017
10 dexametason inj 500 2,818.00 1,409,000.00 APBD 2017
11 domperidon syrup 5 3,833.00 19,165.00 APBD 2016
12 handscoon 6 254,696.00 1,528,176.00 APBD 2014
13 hemafort 20 89,265.00 1,785,300.00 APBD 2016
14 kasa steril 60 10,200.00 612,000.00 APBD 2014
15 leukoplast 2x5 11 28,950.00 318,450.00 APBD 2016
16 natrium diklofenak 25 mg 3000 160.00 480,000.00 APBD 2017
17 omeprazole kap 50 7,200.00 360,000.00 APBD 2016
18 paracetamol tab 5000 126.00 630,000.00 APBD 2017
19 pehacain 400 3,250.00 1,300,000.00 APBD 2017
20 piroxicam 20 mg 1000 229.00 229,000.00 APBD 2017
21 povidon 300 ml 1 37,430.00 37,430.00 APBD 2017
22 salbutamol 2 mg 18 9,167.27 165,010.86 APBD 2014
23 verban elastis 3 7,000.00 21,000.00 APBD 2017
 total 22,166,339.86
februari 2018
Yang menerima

kurnia
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : tiley
Bulan : DESEMBER 2018

No Nama Obat/Barang SATUAN Jumlah Distribusi Harga (Rp) Jumlah (Rp) KETERANGAN

1 ALPRAZOLAM 0.5 MG TAB (MERSI) TAB 2500 97.00 242,500.00 APBD 2018
2 AMOXICILLIN 250 MG TAB TAB0 10000 212.00 2,120,000.00 APBD 2018
3 ANTASIDA DOEN SUSPENSI 200 MG/5ML BOTOL 920 2,257.00 2,076,440.00 APBD 2018
4 ANTASIDA DOEN TAB MERSI TAB 12000 58.00 696,000.00 APBD 2018
5 ASAM FOLAT 1 MG TAB TAB 2000 88.00 176,000.00 APBD 2018
6 ASAM MEFENAMAT CAPTABS 9600 139.00 1,334,400.00 APBD 2017
7 CALCIUM LACTATE 500 MG TABLET TAB 28800 62.00 1,785,600.00 APBD 2018
CEFTRIAXONE SODIUM SERBUK INJ 5,143.00
8 1G (RAMA) VIAL 170 874,310.00 APBD 2018
CETIRIZINE HCL SIRUP 5MG/5ML 3,192.00
9 (RAMA) BOTOL 50 159,600.00 APBD 2018

CETIRIZINE HCL TAB 10MG (RAMA) 103.00

10 TAB 21400 2,204,200.00 APBD 2018
11 CHLORAMPHENICOL 60N ML BOTOL 1500 5,413.00 8,119,500.00 APBD 018
12 CIPROFLOXACIN 500 MG TAB @ 100 TAB 6000 305.00 1,830,000.00 APBD 2018
13 COSMOMED SYIRINGE 10 CC pieces 200 1,142.73 228,546.00 APBD 2018
14 DEXAMETASON INJEKSI 5MG/ML AMPUL 580 1,378.00 799,240.00 APBD 2018
15 DEXAMETHASONE 0.5 MG TAB TAB 61300 37.00 2,268,100.00 APBD 2018
16 DIAZEPAM INJ 5MG/ML AMPUL 500 2,150.00 1,075,000.00 APBD 2018
17 DISPO 3CC pieces 200 946.00 189,200.00 APBD 2018
18 DOMPERIDON SYRUP 60 ML BOTOL 30 3,105.00 93,150.00 APBD 2018
19 FENOBARBITAL 30 MG TAB TAB 500 214.00 107,000.00 APBD 2018
20 FLUCONAZOLE 150 MG TAB TAB 100 23,400.00 2,340,000.00 APBD 2018
21 GLIMEPIRIDE 2 MG TAB TAB 4000 216.00 864,000.00 APBD 2018
IBUPROFEN SUSP 100MG/5ML 2,856.00
22 (RAMA) BOTOL 950 2,713,200.00 APBD 2018
23 IBUPROFEN TAB 200 MG (NOVA) TAB 4800 121.00 580,800.00 APBD 2018
24 KETOCONAZOLE 200 MG TAB TAB 3500 311.00 1,088,500.00 APBD 2018
25 KF ACYCLOVIR 400 MG TAB TAB 5000 742.72 3,713,600.00 APBD 2018
26 KF AMLODIPIN 5 MG TAB TAB 2500 960.00 2,400,000.00 APBD 2018
27 KF ANTALGIN TAB 18800 256.74 4,826,712.00 APBD 2018
28 KF COTRIMOXSAZOL ADULT TAB 7000 247.72 1,734,040.00 APBD 2018
29 KF CEFADROXYL KAP KAP 1250 1,483.68 1,854,600.00 APBD 2018
30 KF ERYTHROMICIN 250 MG TAB TAB 2500 809.38 2,023,450.00 APBD 2018
31 KF. ATORVASTATIN 10 MG TAB TAB 1350 1,914.00 2,583,900.00 APBD 2018
32 KF. HARNAL 0.4 MG TAB 14 17,731.00 248,234.00 APBD 2018
33 KF. ANTASIDA SYRUP BOTOL 200 5,082.00 1,016,400.00 APBD 2018
34 KF. RANITIDIN TAB TAB 4000 264.00 1,056,000.00 APBD 2018
35 KF. DUMIN SUPPO 250 MG SUPPO 25 23,639.00 590,975.00 APBD 2018
36 KF. IBUPROFEN TAB 200 MG TAB 3000 242.00 726,000.00 APBD 2018
37 KF. CATGUT CROMIC 2/0 HR 26 PIECES 24 32,800.00 787,200.00 APBD 2018
38 KF. KASA STERIL 16x16 PIECES 200 8,000.00 1,600,000.00 APBD 2018
39 KF. KASA yd 40x80 ROLL 20 105,000.00 2,100,000.00 APBD 2018
40 KF. MASKER TIE ON BOX 35 17,900.00 626,500.00 APBD 2018
41 KF. POVIDONE IODINE 10% 1 LTR BOTOL 15 135,000.00 2,025,000.00 APBD 2018
42 KF. HANDSCOON NON STERIL BOX 25 58,300.00 1,457,500.00 APBD 2018
43 KF. HANDSCOON STERIL PIECES 250 20,000.00 5,000,000.00 APBD 2018
44 LANSOPRAZOL 30 MG TAB TAB 4800 359.00 1,723,200.00 APBD 2018
45 METHYLERGOMETRINE TAB 4000 267.00 1,068,000.00 APBD 2018
46 MEROPENEM INJ. 0,5 GR 1 VIAL VIAL 70 27,160.00 1,901,200.00 APBD 2018
47 METOCLOPRAMIDE TAB 10 MG TAB 700 93.00 65,100.00 APBD 2018
48 MINIASPI 80 MG TAB (MERSI) TAB 4600 104.00 478,400.00 APBD 2018
49 OMEPRAZOL 20 MG KAP @ 30(NOVA KAP 6390 150.00 958,500.00 APBD 2018
50 PARACETAMOL CAPTABS 16800 126.00 2,116,800.00 APBD 2017
51 PREDNISON 5 MG TAB TABLET 10000 81.00 810,000.00 APBD 2018
52 PROTOFEN SUPPO SUPPO 220 2,420.00 532,400.00 APBD 2018
 361.00
53 PYRANTEL 125 MG (DUS 100 TAB) TAB 1700 613,700.00 APBD 2018
54 SALBUTAMOL 4 MG TAB TABLET 8000 81.00 648,000.00 APBD 2018
55 SALEP 2-4 30 GR POT 960 3,274.00 3,143,040.00 APBD 2018
56 SIMVASTATIN 20 MG TAB TABLET 1200 240.00 288,000.00 APBD 2018
57 SUKRALFAT SYRUP 500 MG/5ML BOTOL 100 8,178.00 817,800.00 APBD 2018
58 TENOFOVIR 300 MG TAB TAB 630 10,530.00 6,633,900.00 APBD 2018
59 VERAPAMIL TAB TAB 5500 393.00 2,161,500.00 APBD 2018
60 VITAMIN B12 INJEKSI (CYANOCOBALAMI AMPUL 200 1,335.00 267,000.00 APBD 2018
61 VITAMIN B12 50 MCG TABLET (MARIN) TAB 31800 53.00 1,685,400.00 APBD 2018
62 ZINK DISPERSIBEL TAB 5000 658.00 3,290,000.00 APBD 2018
63 TOTAL 99,537,337.00

Yang menerima

Gina
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : sangowo
Bulan : DESEMBER 2018

Jumlah
No Nama Obat/Barang SATUAN Harga (Rp) Jumlah (Rp) KETERANGAN
Distribusi
1 ALPRAZOLAM 0.5 MG TAB (MERSI) TAB 2500 97.00 242,500.00 APBD 2018
2 AMOXICILLIN 250 MG TAB TAB0 10000 212.00 2,120,000.00 APBD 2018
3 ANTASIDA DOEN SUSPENSI 200 MG/5M BOTOL 920 2,257.00 2,076,440.00 APBD 2018
4 ANTASIDA DOEN TAB MERSI TAB 12000 58.00 696,000.00 APBD 2018
5 ASAM FOLAT 1 MG TAB TAB 1500 88.00 132,000.00 APBD 2018
6 ASAM MEFENAMAT CAPTABS 9600 139.00 1,334,400.00 APBD 2017
CEFTRIAXONE SODIUM SERBUK 5,143.00
7 INJ 1G (RAMA) VIAL 170 874,310.00 APBD 2018
CETIRIZINE HCL SIRUP 5MG/5ML 3,192.00
8 (RAMA) BOTOL 50 159,600.00 APBD 2018
CETIRIZINE HCL TAB 10MG 103.00
9 (RAMA) TAB 21400 2,204,200.00 APBD 2018
10 CHLORAMPHENICOL 60N ML BOTOL 1500 5,413.00 8,119,500.00 APBD 018
11 CIPROFLOXACIN 500 MG TAB @ 10 TAB 5000 305.00 1,525,000.00 APBD 2018
12 DEXAMETASON INJEKSI 5MG/ML AMPUL 580 1,378.00 799,240.00 APBD 2018
13 DEXAMETHASONE 0.5 MG TAB TAB 61300 37.00 2,268,100.00 APBD 2018
14 DIAZEPAM INJ 5MG/ML AMPUL 500 2,150.00 1,075,000.00 APBD 2018
15 DOMPERIDON SYRUP 60 ML BOTOL 20 3,105.00 62,100.00 APBD 2018
16 FENOBARBITAL 30 MG TAB TAB 1000 214.00 214,000.00 APBD 2018
17 FLUCONAZOLE 150 MG TAB TAB 100 23,400.00 2,340,000.00 APBD 2018
18 GLIMEPIRIDE 2 MG TAB TAB 4000 216.00 864,000.00 APBD 2018
IBUPROFEN SUSP 100MG/5ML 2,856.00
19 (RAMA) BOTOL 950 2,713,200.00 APBD 2018
20 IBUPROFEN TAB 200 MG (NOVA) TAB 4800 121.00 580,800.00 APBD 2018
21 KETOCONAZOLE 200 MG TAB TAB 3500 311.00 1,088,500.00 APBD 2018
22 KF ACYCLOVIR 400 MG TAB TAB 5000 742.72 3,713,600.00 APBD 2018
23 KF AMLODIPIN 5 MG TAB TAB 2500 960.00 2,400,000.00 APBD 2018
24 KF ANTALGIN TAB 10800 256.74 2,772,792.00 APBD 2018
25 KF CALCIUM LACTATE TAB 25200 196.90 4,961,880.00 APBD 2018
26 KF COTRIMOXSAZOL ADULT TAB 7000 247.72 1,734,040.00 APBD 2018
27 KF CEFADROXYL KAP KAP 1250 1,483.68 1,854,600.00 APBD 2018
28 KF ERYTHROMICIN 250 MG TAB TAB 2500 809.38 2,023,450.00 APBD 2018
29 KF. ATORVASTATIN 10 MG TAB TAB 1350 1,914.00 2,583,900.00 APBD 2018
30 KF. HARNAL 0.4 MG TAB 14 17,731.00 248,234.00 APBD 2018
31 KF. ANTASIDA SYRUP BOTOL 200 5,082.00 1,016,400.00 APBD 2018
32 KF. CANDERSATAN 16 MG TAB TAB 840 1,848.00 1,552,320.00 APBD 2018
33 KF. RANITIDIN TAB TAB 400 264.00 105,600.00 APBD 2018
34 KF. IBUPROFEN TAB 200 MG TAB 2000 242.00 484,000.00 APBD 2018
35 KF. CATGUT CROMIC 2/0 HR 26 PIECES 24 32,800.00 787,200.00 APBD 2018
36 KF. KASA STERIL 16x16 PIECES 100 8,000.00 800,000.00 APBD 2018
37 KF. KASA yd 40x80 ROLL 20 105,000.00 2,100,000.00 APBD 2018
38 KF. MASKER TIE ON BOX 20 17,900.00 358,000.00 APBD 2018
39 KF. POVIDONE IODINE 10% 1 LTR BOTOL 10 135,000.00 1,350,000.00 APBD 2018
40 KF. HANDSCOON NON STERIL BOX 20 58,300.00 1,166,000.00 APBD 2018
41 KF. HANDSCOON STERIL PIECES 250 20,000.00 5,000,000.00 APBD 2018
42 LARUTAN RINGER LAKTAT INFUS 6,240.00 - APBD 2017
43 LANSOPRAZOL 30 MG TAB TAB 4800 359.00 1,723,200.00 APBD 2018
44 METHYLERGOMETRINE TAB 4000 267.00 1,068,000.00 APBD 2018
45 MEROPENEM INJ. 0,5 GR 1 VIAL VIAL 70 27,160.00 1,901,200.00 APBD 2018
46 METOCLOPRAMIDE TAB 10 MG TAB 700 93.00 65,100.00 APBD 2018
47 MINIASPI 80 MG TAB (MERSI) TAB 4600 104.00 478,400.00 APBD 2018
48 OMEPRAZOL 20 MG KAP @ 30(NO KAP 6390 150.00 958,500.00 APBD 2018
49 PARACETAMOL CAPTABS 19800 126.00 2,494,800.00 APBD 2017
50 PREDNISON 5 MG TAB TABLET 10000 81.00 810,000.00 APBD 2018
51 PROTOFEN SUPPO SUPPO 220 2,420.00 532,400.00 APBD 2018
 PYRANTEL 125 MG (DUS 100 361.00
52 TAB) TAB 1700 613,700.00 APBD 2018
53 SALBUTAMOL 4 MG TAB TABLET 8000 81.00 648,000.00 APBD 2018
54 SALEP 2-4 30 GR POT 960 3,274.00 3,143,040.00 APBD 2018
55 SIMVASTATIN 20 MG TAB TABLET 1200 240.00 288,000.00 APBD 2018
56 SUKRALFAT SYRUP 500 MG/5ML BOTOL 100 8,178.00 817,800.00 APBD 2018
57 TENOFOVIR 300 MG TAB TAB 630 10,530.00 6,633,900.00 APBD 2018
58 VERAPAMIL TAB TAB 5500 393.00 2,161,500.00 APBD 2018
59 VITAMIN B12 INJEKSI (CYANOCOBALAM AMPUL 200 1,335.00 267,000.00 APBD 2018
60 VITAMIN B12 50 MCG TABLET (MARIN) TAB 31800 53.00 1,685,400.00 APBD 2018
61 ZINK DISPERSIBEL TAB 5000 658.00 3,290,000.00 APBD 2018
TOTAL 98,080,846.00

Yang menerima

RIRIN
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : posi-posi
Bulan : OKTOBER 2018

Jumlah
No Nama Obat/Barang SATUAN Harga (Rp) Jumlah (Rp) KETERANGAN
Distribusi
1 ALPRAZOLAM 0.5 MG TAB (MERSI) TAB 2500 97.00 242,500.00 APBD 2018
2 AMOXICILLIN 250 MG TAB TAB0 10000 212.00 2,120,000.00 APBD 2018
3 ANTASIDA DOEN SUSPENSI 200 MG/5ML BOTOL 920 2,257.00 2,076,440.00 APBD 2018
4 ANTASIDA DOEN TAB MERSI TAB 12000 58.00 696,000.00 APBD 2018
5 ASAM FOLAT 1 MG TAB TAB 1500 88.00 132,000.00 APBD 2018
6 ASAM MEFENAMAT CAPTABS 9600 139.00 1,334,400.00 APBD 2017
CEFTRIAXONE SODIUM SERBUK INJ 1G 5,143.00
7 (RAMA) VIAL 170 874,310.00 APBD 2018
CETIRIZINE HCL SIRUP 5MG/5ML 3,192.00
8 (RAMA) BOTOL 50 159,600.00 APBD 2018
9 CETIRIZINE HCL TAB 10MG (RAMA) TAB 21400 103.00 2,204,200.00 APBD 2018
10 CHLORAMPHENICOL 60N ML BOTOL 1500 5,413.00 8,119,500.00 APBD 018
11 CIPROFLOXACIN 500 MG TAB @ 100 TAB 5000 305.00 1,525,000.00 APBD 2018
12 DEXAMETASON INJEKSI 5MG/ML AMPUL 580 1,378.00 799,240.00 APBD 2018
13 DEXAMETHASONE 0.5 MG TAB TAB 61300 37.00 2,268,100.00 APBD 2018
14 DIAZEPAM INJ 5MG/ML AMPUL 500 2,150.00 1,075,000.00 APBD 2018
15 DOMPERIDON SYRUP 60 ML BOTOL 20 3,105.00 62,100.00 APBD 2018
16 FENOBARBITAL 30 MG TAB TAB 1000 214.00 214,000.00 APBD 2018
17 FLUCONAZOLE 150 MG TAB TAB 100 23,400.00 2,340,000.00 APBD 2018
18 GLIMEPIRIDE 2 MG TAB TAB 4000 216.00 864,000.00 APBD 2018

IBUPROFEN SUSP 100MG/5ML (RAMA) 2,856.00

19 BOTOL 950 2,713,200.00 APBD 2018
20 IBUPROFEN TAB 200 MG (NOVA) TAB 4800 121.00 580,800.00 APBD 2018
21 KETOCONAZOLE 200 MG TAB TAB 3500 311.00 1,088,500.00 APBD 2018
22 KF ACYCLOVIR 400 MG TAB TAB 5000 742.72 3,713,600.00 APBD 2018
23 KF AMLODIPIN 5 MG TAB TAB 2500 960.00 2,400,000.00 APBD 2018
24 KF ANTALGIN TAB 10800 256.74 2,772,792.00 APBD 2018
25 KF CALCIUM LACTATE TAB 25200 196.90 4,961,880.00 APBD 2018
26 KF COTRIMOXSAZOL ADULT TAB 7000 247.72 1,734,040.00 APBD 2018
27 KF CEFADROXYL KAP KAP 1250 1,483.68 1,854,600.00 APBD 2018
28 KF ERYTHROMICIN 250 MG TAB TAB 2500 809.38 2,023,450.00 APBD 2018
29 KF. ATORVASTATIN 10 MG TAB TAB 1350 1,914.00 2,583,900.00 APBD 2018
30 KF. HARNAL 0.4 MG TAB 14 17,731.00 248,234.00 APBD 2018
31 KF. ANTASIDA SYRUP BOTOL 200 5,082.00 1,016,400.00 APBD 2018
32 KF. CANDERSATAN 16 MG TAB TAB 840 1,848.00 1,552,320.00 APBD 2018
33 KF. RANITIDIN TAB TAB 400 264.00 105,600.00 APBD 2018
34 KF. DUMIN SUPPO 250 MG SUPPO 45 23,639.00 1,063,755.00 APBD 2018
35 KF. IBUPROFEN TAB 200 MG TAB 2000 242.00 484,000.00 APBD 2018
36 KF. CATGUT CROMIC 2/0 HR 26 PIECES 24 32,800.00 787,200.00 APBD 2018
37 KF. KASA STERIL 16x16 PIECES 150 8,000.00 1,200,000.00 APBD 2018
38 KF. KASA yd 40x80 ROLL 20 105,000.00 2,100,000.00 APBD 2018
39 KF. MASKER TIE ON BOX 40 17,900.00 716,000.00 APBD 2018
40 KF. POVIDONE IODINE 10% 1 LTR BOTOL 10 135,000.00 1,350,000.00 APBD 2018
41 KF. HANDSCOON NON STERIL BOX 20 58,300.00 1,166,000.00 APBD 2018
42 KF. SILK NO 3/0+JARUM PIECES 110,000.00 - APBD 2018
43 KF. HANDSCOON STERIL PIECES 250 20,000.00 5,000,000.00 APBD 2018
44 LANSOPRAZOL 30 MG TAB TAB 4800 359.00 1,723,200.00 APBD 2018
45 METHYLERGOMETRINE TAB 4000 267.00 1,068,000.00 APBD 2018
46 MEROPENEM INJ. 0,5 GR 1 VIAL VIAL 70 27,160.00 1,901,200.00 APBD 2018
47 METOCLOPRAMIDE TAB 10 MG TAB 700 93.00 65,100.00 APBD 2018
48 MINIASPI 80 MG TAB (MERSI) TAB 4600 104.00 478,400.00 APBD 2018
49 OMEPRAZOL 20 MG KAP @ 30(NOVA) KAP 6390 150.00 958,500.00 APBD 2018
50 PARACETAMOL CAPTABS 16800 126.00 2,116,800.00 APBD 2017
51 PREDNISON 5 MG TAB TABLET 10000 81.00 810,000.00 APBD 2018
52 PROTOFEN SUPPO SUPPO 220 2,420.00 532,400.00 APBD 2018
53 PYRANTEL 125 MG (DUS 100 TAB) TAB 1700 361.00 613,700.00 APBD 2018
54 SALBUTAMOL 4 MG TAB TABLET 8000 81.00 648,000.00 APBD 2018
55 SALEP 2-4 30 GR POT 960 3,274.00 3,143,040.00 APBD 2018
56 SIMVASTATIN 20 MG TAB TABLET 1200 240.00 288,000.00 APBD 2018
57 SUKRALFAT SYRUP 500 MG/5ML BOTOL 100 8,178.00 817,800.00 APBD 2018
58 TENOFOVIR 300 MG TAB TAB 630 10,530.00 6,633,900.00 APBD 2018
59 VERAPAMIL TAB TAB 5500 393.00 2,161,500.00 APBD 2018
60 VITAMIN B12 INJEKSI (CYANOCOBALAMIN AMPUL 200 1,335.00 267,000.00 APBD 2018
61 VITAMIN B12 50 MCG TABLET (MARIN) TAB 31800 53.00 1,685,400.00 APBD 2018
62 ZINK DISPERSIBEL TAB 5000 658.00 3,290,000.00 APBD 2018
total 99,524,601.00

Yang menerima

Anjar Bachtiar, AMK

 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : bere-bere
Bulan : DESEMBER 2018

Jumlah
No Nama Obat/Barang SATUAN Harga (Rp) Jumlah (Rp) KETERANGAN
Distribusi
1 ALPRAZOLAM 0.5 MG TAB (MERSI) TAB 2500 97.00 242,500.00 APBD 2018
2 AMOXICILLIN 250 MG TAB TAB0 10000 212.00 2,120,000.00 APBD 2018
3 ANTASIDA DOEN SUSPENSI 200 MG/5ML BOTOL 920 2,257.00 2,076,440.00 APBD 2018
4 ANTASIDA DOEN TAB MERSI TAB 12000 58.00 696,000.00 APBD 2018
5 ASAM FOLAT 1 MG TAB TAB 1500 88.00 132,000.00 APBD 2018
6 ASAM MEFENAMAT CAPTABS 9600 139.00 1,334,400.00 APBD 2017
CEFTRIAXONE SODIUM SERBUK INJ 1G 5,143.00
7 (RAMA) VIAL 170 874,310.00 APBD 2018

CETIRIZINE HCL SIRUP 5MG/5ML (RAMA) 3,192.00

8 BOTOL 50 159,600.00 APBD 2018
9 CETIRIZINE HCL TAB 10MG (RAMA) TAB 21400 103.00 2,204,200.00 APBD 2018
10 CHLORAMPHENICOL 60N ML BOTOL 1500 5,413.00 8,119,500.00 APBD 018
11 CIPROFLOXACIN 500 MG TAB @ 100 TAB 5000 305.00 1,525,000.00 APBD 2018
12 DEXAMETASON INJEKSI 5MG/ML AMPUL 580 1,378.00 799,240.00 APBD 2018
13 DEXAMETHASONE 0.5 MG TAB TAB 61300 37.00 2,268,100.00 APBD 2018
14 DIAZEPAM INJ 5MG/ML AMPUL 500 2,150.00 1,075,000.00 APBD 2018
15 DOMPERIDON SYRUP 60 ML BOTOL 20 3,105.00 62,100.00 APBD 2018
16 FENOBARBITAL 30 MG TAB TAB 400 214.00 85,600.00 APBD 2018
17 FLUCONAZOLE 150 MG TAB TAB 100 23,400.00 2,340,000.00 APBD 2018
18 GLIMEPIRIDE 2 MG TAB TAB 4000 216.00 864,000.00 APBD 2018

IBUPROFEN SUSP 100MG/5ML (RAMA) 2,856.00

19 BOTOL 950 2,713,200.00 APBD 2018
20 IBUPROFEN TAB 200 MG (NOVA) TAB 4800 121.00 580,800.00 APBD 2018
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : wayabula
Bulan : OKTOBER 2018

Jumlah
No Nama Obat/Barang SATUAN Harga (Rp) Jumlah (Rp) KETERANGAN
Distribusi
1 ALPRAZOLAM 0.5 MG TAB (MTAB 2500 97.00 242,500.00 APBD 2018
2 ALKOHOL 70% 100ML Botol 100 ml 45 6,256.00 281,520.00 APBD 2017
3 AMLODIPIN 5 MG TAB Tablet 2500 83.00 207,500.00 APBD 2018
4 AMOXICILLIN 250 MG TAB TAB0 10000 212.00 2,120,000.00 APBD 2018
5 Amoxicillin Kaplet 500 mg Kotak 10 x10 100 28,800.00 2,880,000.00 APBD 2016
6 ANTASIDA DOEN SUSPENSI BOTOL 920 2,257.00 2,076,440.00 APBD 2018
7 ANTASIDA DOEN TAB MERSI TAB 16000 58.00 928,000.00 APBD 2018
8 ASAM FOLAT 1 MG TAB TAB 1500 88.00 132,000.00 APBD 2018
9 ASAM MEFENAMAT CAPTABS 38400 139.00 5,337,600.00 APBD 2017
10 CEFADROXYL SIRUP KERING BOTOL 60 4,581.00 274,860.00 APBD 2018
11 CEFTRIAXONE SODIUM SERBU VIAL 170 5,143.00 874,310.00 APBD 2018
12 CETIRIZINE HCL SIRUP 5MG BOTOL 50 3,192.00 159,600.00 APBD 2018
13 CETIRIZINE HCL TAB 10MG ( TAB 21400 103.00 2,204,200.00 APBD 2018
14 CHLORAMPHENICOL 60N MLBOTOL 1500 5,413.00 8,119,500.00 APBD 018
15 CIMETIDIN 200 MG TAB Tablet 2000 210.00 420,000.00 APBD 2017
16 CIPROFLOXACIN 500 MG TABTAB 5000 305.00 1,525,000.00 APBD 2018
17 DEXAMETASON INJEKSI 5MGAMPUL 580 1,378.00 799,240.00 APBD 2018
18 DEXAMETHASONE 0.5 MG T TAB 61300 37.00 2,268,100.00 APBD 2018
19 DIAZEPAM INJ 5MG/ML AMPUL 500 2,150.00 1,075,000.00 APBD 2018
20 DOMPERIDON SYRUP 60 ML BOTOL 20 3,105.00 62,100.00 APBD 2018
21 FENOBARBITAL 30 MG TAB TAB 1000 214.00 214,000.00 APBD 2018
22 FLUCONAZOLE 150 MG TAB TAB 100 23,400.00 2,340,000.00 APBD 2018
23 GLIMEPIRIDE 2 MG TAB TAB 4000 216.00 864,000.00 APBD 2018
24 IBUPROFEN SUSP 100MG/5MBOTOL 1100 2,856.00 3,141,600.00 APBD 2018
25 IBUPROFEN TAB 200 MG (NOTAB 4800 121.00 580,800.00 APBD 2018
26 KETOCONAZOLE 200 MG TABTAB 3500 311.00 1,088,500.00 APBD 2018
27 KF ACYCLOVIR 400 MG TAB TAB 5000 742.72 3,713,600.00 APBD 2018
28 KF AMLODIPIN 5 MG TAB TAB 2500 960.00 2,400,000.00 APBD 2018
29 KF ANTALGIN TAB 10800 256.74 2,772,792.00 APBD 2018
30 KF CALCIUM LACTATE TAB 34200 196.90 6,733,980.00 APBD 2018
31 KF COTRIMOXSAZOL ADULT TAB 9000 247.72 2,229,480.00 APBD 2018
32 KF CEFADROXYL KAP KAP 1250 1,483.68 1,854,600.00 APBD 2018
33 KF ERYTHROMICIN 250 MG TTAB 2500 809.38 2,023,450.00 APBD 2018
34 KF. ATORVASTATIN 10 MG TATAB 1350 1,914.00 2,583,900.00 APBD 2018
35 KF. HARNAL 0.4 MG TAB 14 17,731.00 248,234.00 APBD 2018
36 KF. ANTASIDA SYRUP BOTOL 270 5,082.00 1,372,140.00 APBD 2018
37 KF. CANDERSATAN 16 MG TATAB 840 1,848.00 1,552,320.00 APBD 2018
38 KF. CIPROFLOXACIN 500 MG TAB 1000 568.00 568,000.00 APBD 2018
39 KF. RANITIDIN TAB TAB 1000 264.00 264,000.00 APBD 2018
40 KF. DUMIN SUPPO 250 MG SUPPO 95 23,639.00 2,245,705.00 APBD 2018
41 KF. IBUPROFEN TAB 200 MG TAB 4000 242.00 968,000.00 APBD 2018
42 KF. CATGUT CROMIC 2/0 HR PIECES 24 32,800.00 787,200.00 APBD 2018
43 KF. KASA STERIL 16x16 PIECES 150 8,000.00 1,200,000.00 APBD 2018
44 KF. KASA yd 40x80 ROLL 30 105,000.00 3,150,000.00 APBD 2018
45 KF. MASKER TIE ON BOX 80 17,900.00 1,432,000.00 APBD 2018
46 KF. POVIDONE IODINE 10% 1BOTOL 25 135,000.00 3,375,000.00 APBD 2018
47 KF. HANDSCOON NON STERILBOX 50 58,300.00 2,915,000.00 APBD 2018
48 KF. HANDSCOON STERIL PIECES 250 20,000.00 5,000,000.00 APBD 2018
49 LANSOPRAZOL 30 MG TAB TAB 4800 359.00 1,723,200.00 APBD 2018
50 METHYLERGOMETRINE TAB 4000 267.00 1,068,000.00 APBD 2018
51 MEROPENEM INJ. 0,5 GR 1 VVIAL 70 27,160.00 1,901,200.00 APBD 2018
52 METOCLOPRAMIDE TAB 10 TAB 700 93.00 65,100.00 APBD 2018
53 MINIASPI 80 MG TAB (MERSITAB 4600 104.00 478,400.00 APBD 2018
54 OMEPRAZOL 20 MG KAP @ 3KAP 6390 150.00 958,500.00 APBD 2018
55 PARACETAMOL CAPTABS 16800 126.00 2,116,800.00 APBD 2017
56 Parasetamol Syrup Botol 60 ml 750 1,675.00 1,256,250.00 APBD 2016
57 PREDNISON 5 MG TAB TABLET 11000 81.00 891,000.00 APBD 2018
58 PROTOFEN SUPPO SUPPO 600 2,420.00 1,452,000.00 APBD 2018
59 PYRANTEL 125 MG (DUS 100TAB 1700 361.00 613,700.00 APBD 2018
60 SALBUTAMOL 4 MG TAB TABLET 8000 81.00 648,000.00 APBD 2018
61 SALEP 2-4 30 GR POT 1104 3,274.00 3,614,496.00 APBD 2018
62 SIMVASTATIN 20 MG TAB TABLET 8700 240.00 2,088,000.00 APBD 2018
63 SUKRALFAT SYRUP 500 MG/ BOTOL 175 8,178.00 1,431,150.00 APBD 2018
64 TENOFOVIR 300 MG TAB TAB 630 10,530.00 6,633,900.00 APBD 2018
65 VERAPAMIL TAB TAB 5500 393.00 2,161,500.00 APBD 2018
66 VITAMIN B12 INJEKSI (CYA AMPUL 200 1,335.00 267,000.00 APBD 2018
67 VITAMIN B12 50 MCG TABLETTAB
(MARIN) 31800 53.00 1,685,400.00 APBD 2018
68 ZINK DISPERSIBEL TAB 5000 658.00 3,290,000.00 APBD 2018
TOTAL 123,949,367.00

Yang menerima

SARTIKA AMELIA
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : KB
bulan : AGUSTUS 2018

Jumlah
No Nama Obat/Barang Harga (Rp) Jumlah (Rp) Keterangan
Distribusi
1 Amoxicillin Kaplet 500 mg Kotak 10 x10 10 28,800.00 APBD 2016
2 ASAM MEFENAMAT CAPTABS 1000 139.00 APBD 2017
3 KAPAS PEMBALUT ALAT KESEHATAN 5 7,500.00 APBD 2017
TOTAL 36,439.00

AGUSTUS 2018
Yang menerima

Umar Baba. S.Sos

 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : RSUD MOROTAI
Bulan :Desember 2018

Jumlah
No Nama Obat/Barang Satuan Harga (Rp) Jumlah (Rp) Keterangan
Distribusi
1 ABBOCATH NO 20 pieces 150 14000 2,100,000.00 APBD 2018
2 Amoxicillin Syrup Botol 60 ml 600 2790 1,674,000.00 APBD 2016
3 CALCIUM LACTATE 500 MG TABLET TAB 3600 62 223,200.00 APBD 2018
4 Cairan NaCL 0,9 % Botol 1900 6410 12,179,000.00 APBD 2016
5 COSMOMED INFUSET ADULT pieces 2000 4099.788 8,199,576.00 APBD 2018
6 COSMOMED INFUSET CHILD pieces 400 4400 1,760,000.00 APBD 2018
7 IV CATHETER NO 24 TERUMO 1800 7787.5 14,017,500.00 APBD 2017
8 LARUTAN RINGER LAKTAT INFUS 2400 6240 14,976,000.00 APBD 2017
9 ONEMED Disposable Syringe 1 ml 10000 1092.5 10,925,000.00 APBD 2017
10 ONEMED Disposable Syringe 2.5 ml with Needle 10000 1038 10,380,000.00 APBD 2017
total 76,434,276.00

Yang menerima

AZRIL DAMIYANTO HASAN

 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : daruba
Bulan : DESEMBER 2018

Jumlah
No Nama Obat/Barang SATUAN Harga (Rp) Jumlah (Rp) KETERANGAN
Distribusi

CETIRIZINE HCL TAB 10MG (RAMA) 103.00

TAB 4000 412,000.00 APBD 2018

Yang menerima

cici prasmini .,Amd.Far

 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : POLRES
bulan : JULI 2018

Jumlah
No Nama Obat/Barang Satuan Harga (Rp) Jumlah (Rp) Keterangan
Distribusi
1 Alkohol 70% Btl 1 Liter 14 29,410.00 411,740.00 APBD 2016
2 Amoxicillin Kaplet 500 mg
Kotak 10 x10 30 28,800.00 864,000.00 APBD 2016
3 Amoxicillin Syrup Botol 60 ml 347 2,790.00 968,130.00 APBD 2016
4 BECEFORT SYRUP Botol 60 18,500.00 1,110,000.00 APBD 2017
5 Cat Gut Chromik2/0 Hr pieces 16 32,800.00 524,800.00 APBD 2016
6 Catgut No. 2/0 Kotak x 24 4 768,000.00 3,072,000.00 APBD 2014
7 CEFIXIM SYRUP 30 ML BOTOL 50 19,410.00 970,500.00 APBD 2017
8 GENTAMICIN SALEP KULI Kotak 25 Tube 50 1,962.00 98,100.00 APBD 2017
9 Handscoon Kotak 27 254,696.00 6,876,792.00 APBD 2014
10 ONEMED Disposable Syringe 2.5 ml 500 1,038.00 519,000.00 APBD 2017
11 PARACETAMOL CAPTABS 29400 126.00 3,704,400.00 APBD 2017
12 Parasetamol Syrup Botol 60 ml 300 1,675.00 502,500.00 APBD 2016
13 PEHACAIN INJEKSI Ampul 60 3,250.00 195,000.00 APBD 2017
14 POVIDON IODINE 1000 M Botol 1000ml 6 112,000.00 672,000.00 APBD 2017
15 VITAMIN C 50 MG TAB TAB 500 131.00 65,500.00 APBD 2018
TOTAL 20,554,462.00

yang menerima
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Do:
Unit Pener: P2PL Vaksin
Bulan : OKTOBER' 2018

Jumlah
No Nama Obat/Barang satuan Harga (Rp) Jumlah (Rp)
Distribusi
1 vaksin flu bio dua 50.00 98,802.00 4,940,100.00
total 4,940,100.00

Yang Menerima
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor D:
Unit Pen : GALO-GALO
Bulan : JULI 2018

satuan Jumlah Harga

No Nama Obat/Barang Jumlah (Rp) Keterangan
Distribusi (Rp)
1 Alkohol 70% Btl 1 Liter 1 29,410.00 29,410.00 APBD 2016
2 ALKOHOL 70% 100ML Botol 100 ml 7 6,256.00 43,792.00 APBD 2017
3 AMBROXOL SYRUP Botol 35 5,882.00 205,870.00 APBD 2017
4 AMBROXOL TAB. Tablet 1000 261.00 261,000.00 APBD 2017
5 AMLODIPIN 10 MG TAB TAB 500 99.00 49,500.00 APBD 2018
6 Amoxicillin Kaplet 500 mg Kotak 10 x10 13 28,800.00 374,400.00 APBD 2016
7 Amoxicillin Syrup Botol 60 ml 200 2,790.00 558,000.00 APBD 2016
8 Antasida Suspensi Botol 60 ml 5 2,409.00 12,045.00 APBD 2016
9 ASAM MEFENAMAT CAPTABS 2000 139.00 278,000.00 APBD 2017
10 CAPTOPRIL 12,5 MG TAB TABLET 2000 1,130.00 2,260,000.00 APBD 2017
11 CEFIXIM SYRUP 30 ML BOTOL 64 19,410.00 1,242,240.00 APBD 2017
12 CHLORAMPENICOL 1%SALEP TUBE 2 2,160.00 4,320.00 APBD 2018
13 DEXAMETASON INJEKSI 5MG AMPUL 10 1,378.00 13,780.00 APBD 2018
14 EPINEPHRINE INJEKSI Ampul 30 7,800.00 234,000.00 APBD 2017
15 Garam Oralit Kotak 100 scht 10 34,600.00 346,000.00 APBD 2016
16 GLIBENCLAMIDE 5 MG TAB Tablet 700 129.00 90,300.00 APBD 2017
17 Glukosa Larutan Infus 5 % Botol 20 6,900.00 138,000.00 APBD 2016
18 Guaifenesin 100 mg tab Kotak 10 X 10 Tab 5 39,380.00 196,900.00 APBD 2016
19 Halloperidol 0,5 mg Kotak 10 X 10 Tab 5 6,454.55 32,272.75 APBD 2014
20 Handscoon Kotak 20 254,696.00 5,093,920.00 APBD 2014
21 Hemafort Kotak 10x10 151 89,265.00 13,479,015.00 APBD 2016
22 IV CATHETER NO 20 SHORT TERUMO 50 7,787.50 389,375.00 APBD 2017
23 IV CATHETER NO 22 TERUMO 50 7,787.50 389,375.00 APBD 2017
24 IV CATHETER NO 24 TERUMO 200 7,787.50 1,557,500.00 APBD 2017
25 Leukoplast 1624 (2x5 yard) Roll 5 28,950.00 144,750.00 APBD 2016
26 LIVRON B PLEX TAB Tablet 200 257.00 51,400.00 APBD 2017
27 Metformin 500 mg tab Kotak 10 X 10 Tab 25 25,620.00 640,500.00 APBD 2016
28 METOCLOPRAMIDE TAB 10 M TAB 100 93.00 9,300.00 APBD 2018
29 OBH SYRUP. Botol 100 ml 90 7,647.00 688,230.00 APBD 2017
30 ONEMED Disposable Syringe 2.5 ml with Needl 200 1,038.00 207,600.00 APBD 2017
31 ONEMED Disposable Syringe 5 ml 400 1,038.00 415,200.00 APBD 2017
32 PAPAVERIN 400 MG TABLET Tablet 1600 321.00 513,600.00 APBD 2017
33 Papaverine 40 mg tab botol 1000 50 21,741.00 1,087,050.00 APBD 2016
34 PARACETAMOL CAPTABS 20000 126.00 2,520,000.00 APBD 2017
 35 Piracetam 800 mg tab Kotak 10 X 10 Tab 4 85,800.00 343,200.00 APBD 2016
36 PIROXICAM 10 MG TAB TAB 400 210.00 84,000.00 APBD 2017
37 Ringer Laktat Botol 20 7,150.00 143,000.00 APBD 2016
38 Salbutamol 2 mg Kotak 10 X 10 Tab 9 7,100.00 63,900.00 APBD 2016
39 VERBAN ELASTIS ALAT KESEHATAN 3 7,000.00 21,000.00 APBD 2017
40 VITAMIN C 50 MG TAB TAB 500 131.00 65,500.00 APBD 2018
TOTAL HARGA 34,277,244.75

SURAT BUKTI BARANG KELUAR (SBBK)

INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor D:
Unit Pen : GALO-GALO
Bulan : AGUSTUS 2018

Jumlah Harga
No Nama Obat/Barang satuan Jumlah (Rp) Keterangan
Distribusi (Rp)
1 Alkohol 70% Btl 1 Liter 1 29,410.00 29,410.00 APBD 2016
2 AMBROXOL SYRUP Botol 35 5,882.00 205,870.00 APBD 2017
3 AMBROXOL TAB. Tablet 1000 261.00 261,000.00 APBD 2017
4 AMLODIPIN 10 MG TAB TAB 500 99.00 49,500.00 APBD 2018
5 Amoxicillin Kaplet 500 mg Kotak 10 x10 13 28,800.00 374,400.00 APBD 2016
6 Amoxicillin Syrup Botol 60 ml 114 2,790.00 318,060.00 APBD 2016
7 Antasida Suspensi Botol 60 ml 5 2,409.00 12,045.00 APBD 2016
8 ASAM MEFENAMAT CAPTABS 2000 139.00 278,000.00 APBD 2017
9 Cairan NaCL 0,9 % Botol 400 6,410.00 2,564,000.00 APBD 2016
10 CAPTOPRIL 12,5 MG TAB TABLET 2000 1,130.00 2,260,000.00 APBD 2017
11 CEFIXIM SYRUP 30 ML BOTOL 64 19,410.00 1,242,240.00 APBD 2017
12 CHLORAMPENICOL 1%SALEP TUBE 2 2,160.00 4,320.00 APBD 2018
13 DEXAMETASON INJEKSI 5MG AMPUL 10 1,378.00 13,780.00 APBD 2018
14 EPINEPHRINE INJEKSI Ampul 30 7,800.00 234,000.00 APBD 2017
15 Garam Oralit Kotak 100 scht 10 34,600.00 346,000.00 APBD 2016
16 GLIBENCLAMIDE 5 MG TAB Tablet 700 129.00 90,300.00 APBD 2017
17 Guaifenesin 100 mg tab Kotak 10 X 10 Tab 5 39,380.00 196,900.00 APBD 2016
18 Halloperidol 0,5 mg Kotak 10 X 10 Tab 5 6,454.55 32,272.75 APBD 2014
19 Handscoon Kotak 20 254,696.00 5,093,920.00 APBD 2014
20 Hemafort Kotak 10x10 151 89,265.00 13,479,015.00 APBD 2016
21 IV CATHETER NO 20 SHORT TERUMO 50 7,787.50 389,375.00 APBD 2017
22 IV CATHETER NO 22 TERUMO 50 7,787.50 389,375.00 APBD 2017
23 IV CATHETER NO 24 TERUMO 200 7,787.50 1,557,500.00 APBD 2017
24 Leukoplast 1624 (2x5 yard) Roll 5 28,950.00 144,750.00 APBD 2016
25 LIVRON B PLEX TAB Tablet 1900 257.00 488,300.00 APBD 2017
26 Metformin 500 mg tab Kotak 10 X 10 Tab 31 25,620.00 794,220.00 APBD 2016
27 METOCLOPRAMIDE TAB 10 M TAB 100 93.00 9,300.00 APBD 2018
28 MICONAZOLE 2% CREAM TUBE 150 4,268.00 640,200.00 APBD 2018
29 OBH SYRUP. Botol 100 ml 90 7,647.00 688,230.00 APBD 2017
30 ONEMED Disposable Syringe 2.5 ml with Needl 200 1,038.00 207,600.00 APBD 2017
31 ONEMED Disposable Syringe 5 ml 400 1,038.00 415,200.00 APBD 2017
32 PAPAVERIN 400 MG TABLET Tablet 1600 321.00 513,600.00 APBD 2017
33 Papaverine 40 mg tab botol 1000 50 21,741.00 1,087,050.00 APBD 2016
34 PARACETAMOL CAPTABS 20000 126.00 2,520,000.00 APBD 2017
35 PARACETAMOL SIRUP 729 1,675.00 1,221,075.00 APBD 2017
36 Piracetam 800 mg tab Kotak 10 X 10 Tab 4 85,800.00 343,200.00 APBD 2016
37 PIROXICAM 10 MG TAB TAB 400 210.00 84,000.00 APBD 2017
38 Ringer Laktat Botol 350 7,150.00 2,502,500.00 APBD 2016
39 Salbutamol 2 mg Kotak 10 X 10 Tab 9 7,100.00 63,900.00 APBD 2016
40 SALBUTAMOL 4 MG TAB TABLET 500 81.00 40,500.00 APBD 2018
41 SIMVASTATIN 20 MG TAB TABLET 1000 240.00 240,000.00 APBD 2018
42 VERBAN ELASTIS ALAT KESEHATAN 3 7,000.00 21,000.00 APBD 2017
43 VITAMIN C 50 MG TAB TAB 500 131.00 65,500.00 APBD 2018
TOTAL 41,511,407.75
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI
Nomor D :
Unit PeneTILEY
Bulan : JULI 2018

No Nama Obat/Barang satuan Jumlah Distribusi Harga (Rp) Jumlah (Rp) Keterangan
1 ABBOCATH NO 16 pieces 150 16,027.00 2,404,050.00 APBD 2018
2 ABBOCATH NO 18 pieces 300 16,027.00 4,808,100.00 APBD 2018
3 ABBOCATH NO 20 pieces 150 16,027.00 2,404,050.00 APBD 2018
4 ABBOCATH NO 22 pieces 150 16,027.00 2,404,050.00 APBD 2018
5 ABBOCATH NO 24 pieces 150 16,027.00 2,404,050.00 APBD 2018
6 ABBOCATH NO 26 pieces 200 19,503.00 3,900,600.00 APBD 2018
7 CATGUT CROMIC NO.2/0 HR 26MM pieces 350 32,890.00 11,511,500.00 APBD 2018
8 CATGUT CROMIC NO.3/0 HR 26MM pieces 150 32,890.00 4,933,500.00 APBD 2018
9 CATGUT PLAIN NO 01 HR 37 pieces 110 38,683.70 4,255,207.00 APBD 2018
10 E-CARE SURGICAL TAPE 0.5'' KOTAK 22 117,000.40 2,574,008.80 APBD 2018
11 FOLLEY CHATETER NO 16 pieces 53 12,045.00 638,385.00 APBD 2018
12 FOLLEY CHATETER NO 18 pieces 75 12,499.00 937,425.00 APBD 2018
13 FOLLEY CHATETER NO 20 pieces 80 12,499.00 999,920.00 APBD 2018
14 KAPAS PEMBALUT . ROLL 305 28,908.00 8,816,940.00 APBD 2018
15 KASSA STERIL 16x16 KOTAK 380 8,000.30 3,040,114.00 APBD 2018
16 KASSA YD 40x80 ROLL 100 105,000.50 10,500,050.00 APBD 2018
17 MASKER TIE ON KOTAK 100 17,900.30 1,790,030.00 APBD 2018
18 MASKER EARLOOP KOTAK 65 18,304.00 1,189,760.00 APBD 2018
19 PEMBALUT ELASTIS 7.5x4.55 M ROLL 35 27,659.50 968,082.50 APBD 2018
20 PEMBALUT ELASTIS 10 CMx4.55 M ROLL 60 32,892.20 1,973,532.00 APBD 2018
21 PEMBALUT ELASTIS 15 CMx4.55 M ROLL 100 41,870.40 4,187,040.00 APBD 2018
22 PLESTER ROLL KAIN ROLL 85 31,265.30 2,657,550.50 APBD 2018
TOTAL 79,297,944.80

Morotai 30 JULI 2018

JULI 2018 Yang menyerahkan
Yang menerima
Ernawati M, Amd.,Keb Oktavia P
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor D :
Unit PeneTILEY'
Bulan : AGUSTUS 2018

Jumlah
No Nama Obat/Barang satuan Harga (Rp)
Distribusi
1 ALKOHOL 70% 1 LITER BOTOL 80 24,999.70
2 ALKOHOL SWAB KOTAK 280 30,761.50
3 AQUA GELL STERILL 82 GRAM TUBE 45 34,588.40
4 CHLOR ETHYL SPRAY BOTOL BOTOL 40 143,000.00
5 DISPOSIBLE 1 CC pieces 800 646.80
6 DISPOSIBLE 3 CC pieces 2000 679.80
7 DISPOSIBLE 5 CC pieces 1600 777.70
8 HANDSCOON NON STERIL KOTAK 45 58,300.00
9 HANDSCOON STERIL FAIR 550 7,000.40
10 INFUSET ANAK PIECES 350 3,500.20
11 INFUSET DEWASA PIECES 300 3,199.90
12 MASKER OKSIGEN BAYI PIECES 29 14,520.00
13 MASKER OKSIGEN ANAK PIECES 20 24,640.00
14 MASKER OKSIGEN DEWASA PIECES 15 24,640.00
15 POVIDONE IODINE 10% 5 LITER GALON 10 629,999.70
16 POVIDONE IODINE 10% 1 LITER BOTOL 15 134,999.70
17 POVIDONE IODINE 10% 300 ML BOTOL 30 18,063.10
18 RIVANOL 300 CC BOTOL 350 2,999.70
19 URINE BAG 2000 CC PIECES 200 8,069.60
20 PLESTERIN NON WOVEN 10CMx5M(HYPA ROLL 170 41,360.00
TOTAL

AGUSTUS 2018 Morotai, 10 AGUSTUS 2018

Yang menerima Yang menyerahkan

Ernawati M, Amd.,Keb Oktavia P

 Jumlah (Rp) Keterangan
1,999,976.00 APBD 2018
8,613,220.00 APBD 2018
1,556,478.00 APBD 2018
5,720,000.00 APBD 2018
517,440.00 APBD 2018
1,359,600.00 APBD 2018
1,244,320.00 APBD 2018
2,623,500.00 APBD 2018
3,850,220.00 APBD 2018
1,225,070.00 APBD 2018
959,970.00 APBD 2018
421,080.00 APBD 2018
492,800.00 APBD 2018
369,600.00 APBD 2018
6,299,997.00 APBD 2018
2,024,995.50 APBD 2018
541,893.00 APBD 2018
1,049,895.00 APBD 2018
1,613,920.00 APBD 2018
7,031,200.00 APBD 2018
49,515,174.50

2018
 SURAT BUKTI BARANG KELUAR (SBBK)

INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :

Unit Penerima : LANAL

bulan : AGUSTUS 2018

Jumlah
No Nama Obat/Barang Satuan Distribusi Harga (Rp) Jumlah (Rp) Keterangan

1 AMBROXOL TAB. Tablet 600 261.00 156,600.00 APBD 2017

2 Amoxicillin Kaplet 500 mg Kotak 10 x10 92 28,800.00 2,649,600.00 APBD 2016

3 Antasida Suspensi Botol 60 ml 28 2,409.00 67,452.00 APBD 2016

4 ANTI HEMOROID SUPPO SUPPO 200 3,959.00 791,800.00 APBD 2018

5 AZITHROMYCIN 500 MG TABlet 120 1,778.00 213,360.00 APBD 2018

6 BECEFORT SYRUP Botol 8 18,500.00 148,000.00 APBD 2017

7 Cairan NaCL 0,9 % Botol 45 6,410.00 288,450.00 APBD 2016

8 CEFOTAXIM INJEKSI Vial 216 12,840.00 2,773,440.00 APBD 2017

9 CHLORAMPENICOL 1%SALEP MATA TUBE 34 2,160.00 73,440.00 APBD 2018

10 CIMETIDIN 200 MG TAB Tablet 400 210.00 84,000.00 APBD 2017

11 COSMOMED GLOVE STERIL 7/7.5/8 Box 4 204,989.40 819,957.60 APBD 2018

12 COSMOMED INFUSET ADULT pieces 800 4,099.79 3,279,830.40 APBD 2018

13 COSMOMED URINE BAG STERIL STA pieces 200 4,700.30 940,060.00 APBD 2018

14 COSMOMED OXYGEN MASK ADULT pieces 100 9,499.60 949,960.00 APBD 2018

15 COSMOMED OXYGEN MASK CHILD pieces 100 9,499.60 949,960.00 APBD 2018

16 COSMOMED SYIRINGE 3 CC pieces 200 717.27 143,454.00 APBD 2018

17 DEXAMETASON INJEKSI 5MG/ML AMPUL 280 1,378.00 385,840.00 APBD 2018

18 DIMENHYDRINATE 50 MG TAB TABLET 500 131.00 65,500.00 APBD 2018

19 EPINEPHRINE INJEKSI Ampul 30 7,800.00 234,000.00 APBD 2017

20 FENOBARBITAL INJEKSI 440 2,160.00 950,400.00 APBD 2017

21 FENOBARBITAL 30 MG TAB TAB 200 214.00 42,800.00 APBD 2018

22 FUROSEMIDE TAB 40 MG TAB 1100 88.00 96,800.00 APBD 2018

23 GENTAMICIN SALEP KULIT 0,1 %@25Kotak 25 Tube 25 1,962.00 49,050.00 APBD 2017

24 GENTAMICIN TETES MATA 5 ML 0.3% BOTOL 24 5,315.00 127,560.00 APBD 2018

25 GLIBENCLAMIDE 5 MG TAB Tablet 1000 129.00 129,000.00 APBD 2017

26 GLIMEPIRIDE 2 MG TAB TAB 250 216.00 54,000.00 APBD 2018

27 Guaifenesin 100 mg tab Kotak 10 X 10 Tab 2 39,380.00 78,760.00 APBD 2016

28 Halloperidol 0,5 mg Kotak 10 X 10 Tab 8 6,454.55 51,636.40 APBD 2014

29 HYDROCLORTIAZID 25 MG TAB TAB 500 194.00 97,000.00 APBD 2018

30 HYDROCORTISONE 2,5% CREAM @2 TUBE 102 2,846.00 290,292.00 APBD 2018

31 KAPAS PEMBALUT ALAT KESEHATAN 31 7,500.00 232,500.00 APBD 2017

32 Leukoplast 1624 (2x5 yard) Roll 103 28,950.00 2,981,850.00 APBD 2016

33 LIVRON B PLEX TAB Tablet 2500 257.00 642,500.00 APBD 2017

34 MAGNESIUM SULFATE CAIRAN INJEKSI 10 3,650.00 36,500.00 APBD 2017

35 Metformin 500 mg tab Kotak 10 X 10 Tab 1 25,620.00 25,620.00 APBD 2016

36 METOCLOPRAMIDE TAB 10 MG TAB 500 93.00 46,500.00 APBD 2018

37 MICONAZOLE 2% CREAM TUBE 202 4,268.00 862,136.00 APBD 2018

38 NISTATIN TABLET VAGINAL 90 576.00 51,840.00 APBD 2017

39 Nystatin 100,000 IU Kotak 20 52,364.00 1,047,280.00 APBD2015

40 OBH SYRUP. Botol 100 ml 71 7,647.00 542,937.00 APBD 2017

41 ONEMED Disposable Syringe 1 ml 200 1,092.50 218,500.00 APBD 2017

42 Papaverine 40 mg tab botol 1000 50 21,741.00 1,087,050.00 APBD 2016

43 PARACETAMOL CAPTABS 17700 126.00 2,230,200.00 APBD 2017

44 PARACETAMOL SIRUP 1000 1,675.00 1,675,000.00 APBD 2017

45 PEHACAIN INJEKSI Ampul 80 3,250.00 260,000.00 APBD 2017

46 Piracetam 800 mg tab Kotak 10 X 10 Tab 18 85,800.00 1,544,400.00 APBD 2016

47 PIRACETAM INJEKSI 1 GR/5ML Ampul 30 6,470.00 194,100.00 APBD 2017

48 Prednisone tab Kotak 10 x 10 1000 12,900.00 12,900,000.00 APBD2015

49 Ringer Laktat Botol 1000 7,150.00 7,150,000.00 APBD 2016

50 Salbutamol 2 mg Kotak 10 X 10 Tab 3 7,100.00 21,300.00 APBD 2016

51 SALBUTAMOL 4 MG TAB TABLET 2500 81.00 202,500.00 APBD 2018

52 SALEP 2-4 kotak 2 48,000.00 96,000.00 APBD 2014

53 SIMVASTATIN 20 MG TAB TABLET 2030 240.00 487,200.00 APBD 2018

54 SUKRALFAT SYRUP 500 MG/5ML BOTOL 63 8,178.00 515,214.00 APBD 2018

55 VITAMIN B6 TAB TAB 600 154.00 92,400.00 APBD 2018

56 VITAMIN C 50 MG TAB TAB 900 131.00 117,900.00 APBD 2018

TOTAL 52,243,429.40

Yang Menerima
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : SANGOWO
bulan : SEPTEMBER 2018

Jumlah Harga (Rp)

No Nama Obat/Barang Satuan Distribusi Jumlah (Rp)

1 ANTASIDA TAB TABLET 100 85 8,500.00

2 ARTEM (ARTEMERTER) AMPUL 4 868.00 3,472.00
3 CEFADROXYL TAB 500 MG TABLET 100 587 58,700.00
4 COTRIMOXSAZOL TAB 480 MG TABLET 100 165 16,500.00
5 CTM TABLET 500 30 15,000.00
6 DEXAMETHASON 0.5 MG TAB TABLET 100 75 7,500.00
7 DIPSO 0,05 ML PIECES 100 750.00 75,000.00
8 DIAZEPAM INJEKSI AMPUL 60 2842 170,520.00
9 DIAZEPAM TAB TABLET 100 0 -
10 GARAM ORALIT sacchet 1100 346.00 380,600.00
11 INFUSET ANAK PIECES 20 3,500.00 70,000.00
12 ISONIAZID 100 mg KOTAK 1x1 3 7,800.00 23,400.00
13 MASKER PIECES 300 500 150,000.00
14 POVIDON IODINE 300 ML BOTOL 2 2590 5,180.00
15 PRIMAQUIN TABLET 300 123 36,900.00
16 Retinol (Vit.A) 100.000 IU Kapsul 3500 312.00 1,092,000.00
17 Retinol (VIT.A) 200.000 IU Kapsul 5000 407.00 2,035,000.00
18 SARUNG TANGAN NON STERIL PIECES 300 496.10 148,830.00
19 Tamblet Tambah Darah FE TABLET 15300 367.00 5,615,100.00
20 ZINK TABLET 1000 568 568,000.00
TOTAL 10,480,202.00

Yang menerima

ZULFIKAR SIBUA
 SURAT BUKTI BARANG KELUAR (SBBK)
INSTALASI FARMASI KABUPATEN PULAU MOROTAI

Nomor Dokumen :
Unit Penerima : SIAGA NATAL DAN TAHUN BARU 2019
bulan : DESEMBER 2018

Jumlah
No Nama Obat/Barang Satuan Harga (Rp) Jumlah (Rp)
Distribusi
1 ALKOHOL 70% 100ML Botol 100 ml 2 6,256.00 APBD 2017
2 Amoxicillin Kaplet 500 mg Kotak 10 x10 1 28,800.00 APBD 2016
3 Amoxicillin Syrup Botol 60 ml 200 2,790.00 APBD 2016
4 ANTASIDA DOEN TAB MERSI TAB 100 58.00 APBD 2018
5 ASAM MEFENAMAT CAPTABS 100 139.00 APBD 2017
6 Cairan NaCL 0,9 % Botol 83 6,410.00 APBD 2016
CETIRIZINE HCL TAB 10MG 103.00
7 (RAMA) TAB 700 APBD 2018
8 GENTAMICIN SALEP KULIT 0,1 Kotak 25 Tube 25 1,962.00 APBD 2017
9 HANDSCOON CIO BOX BOX 3 247,500.00 APBD 2018
10 KETOKONAZOLE CREAM 2% TUBE 5 2,893.00 APBD 2018
11 KF ANTALGIN TAB 600 256.74 APBD 2018
12 KF CETIRIZINE TAB TAB 90 462.00 APBD 2018
13 KF COTRIMOXSAZOL ADULT TAB 247.72 APBD 2018
14 KF CEFADROXYL KAP KAP 400 1,483.68 APBD 2018
15 KF ERYTHROMICIN 250 MG TAB TAB 100 809.38 APBD 2018
16 KF. ATORVASTATIN 10 MG TAB TAB 60 1,914.00 APBD 2018
17 KF. KASA STERIL 16x16 PIECES 50 8,000.00 APBD 2018
18 KF. KASA yd 40x80 ROLL 5 105,000.00 APBD 2018
19 KF. MASKER TIE ON BOX 10 17,900.00 APBD 2018
20 KF. HANDSCOON NON STERIL BOX 5 58,300.00 APBD 2018
21 MASKER BOX. BOX 6 15,999.50 APBD 2018
22 PARACETAMOL CAPTABS 100 126.00 APBD 2017
23 PARACETAMOL SIRUP 58 1,675.00 APBD 2017
TOTAL 509,085.02