REKAPITULASI PEMESANAN OBAT-BMHP

UPT PUSKESMAS PAKISAJI

DINAS KESEHATAN KABUPATEN MALANG

NAMA PBF/ PBF : PT. MITRA MEDITAMA ABADI

ALAMAT : JL. SIMPANG D.LIMBOTO TIMUR II A5-I.32 MALANG
PENANGGUNG JAWAB:
JABATAN : OWNER

TGL NO NAMA BARANG SATUAN JUMLAH HARGA SATUAN

MARET 2019 1 CHLORO ETYL BTL 5 Rp 170,000.00
2 SPUIT 50 CC LB.TEMGAH PCS 100 Rp 3,227.27
3 H2-O2 100ML BTL 5 Rp 4,600.00
4 FEEDING TUBE 06 PCS 10 Rp 4,400.00
5 FEEDING TUBE 08 PCS 10 Rp 38,500.00
6 FEEDING TUBE 10 PCS 10 Rp 4,400.00
7 NGT 12 PCS 10 Rp 33,600.00
8 NGT 14 PCS 10 Rp 33,600.00
9 LOMATUL BOX 10 Rp 130,000.00
10 MESS 11 BOX 2 Rp 360,000.00
11 TERMOMETER DIGITAL PCS 3 Rp 110,000.00
12 JARUM 21G BOX 3 Rp 225,000.00

TOTAL 1
POTONGAN
TOTAL 2
PPN 10%
TOTAL

REKAPITULASI PEMESANAN OBAT-BMHP

UPT PUSKESMAS PAKISAJI
DINAS KESEHATAN KABUPATEN MALANG

NAMA PBF/ PBF : PT. SOLOCONE INDUSTRY

ALAMAT : JL. TAMBAK AJI TIMUR NO.3 SEMARANG
PENANGGUNG JAWAB:
JABATAN : OWNER

TGL NO NAMA BARANG SATUAN JUMLAH HARGA SATUAN

MARET 2019 1 MEDICINE PACKET SI-20-S BOX 1 Rp 1,400,000.00
2
3
4
 5
6
7
8

TOTAL 1
POTONGAN
TOTAL 2
PPN 10%
TOTAL

REKAPITULASI PEMESANAN OBAT-BMHP

UPT PUSKESMAS PAKISAJI
DINAS KESEHATAN KABUPATEN MALANG

NAMA PBF/ PBF : PT. MILLENNIUM PHARMACON INTERNATIONAL TBK

ALAMAT : JL. SUNANDAR PRIYO SUDARMO 20 MALANG
PENANGGUNG JAWAB: AFILUDIN NAZAR
JABATAN : OWNER

TGL NO NAMA BARANG SATUAN JUMLAH HARGA SATUAN

MARET 2019 1 TROGYNOSURGE MEDIUM BOX 1 Rp 1,232,000.00
2
3
4
5
6
7
8

TOTAL 1
POTONGAN
TOTAL 2
PPN 10%
TOTAL
 REKAPITULASI PEMESANAN OBAT-BMHP
UPT PUSKESMAS PAKISAJI
DINAS KESEHATAN KABUPATEN MALANG

NAMA PBF/ PBF : PT. PIEROSCA TERANG SUKSES ABADI

ALAMAT : JL. DARMO PERMAI SELATAN I/5 SURABAYA
PENANGGUNG JAWAB: LIA A
JABATAN : OWNER

TGL NO NAMA BARANG SATUAN JUMLAH HARGA SATUAN

MARET 2019 1 AMINOPHYLIN 200 MG BTL 20 Rp 18,636.00
2 VITAMIN B-6 KLG 2 Rp 60,000.00
3 DEMACOLIN BOX 50 Rp 43,455.00
4
5
6
7
8

TOTAL 1
POTONGAN
TOTAL 2
PPN 10%
TOTAL

REKAPITULASI PEMESANAN OBAT-BMHP

UPT PUSKESMAS PAKISAJI
DINAS KESEHATAN KABUPATEN MALANG

NAMA PBF/ PBF : PT. LAB MEDICA SEJAHTERA

ALAMAT : JL. CIPUNEGARA NO.9 MALANG
PENANGGUNG JAWAB: PARAMITA DEWI
JABATAN : OWNER

TGL NO NAMA BARANG SATUAN JUMLAH HARGA SATUAN

MARET 2019 1 PROFOLAT 400 MCG BOX 50 Rp 22,000.00
2 ACYCLOVIR CR TUBE 150 Rp 3,295.00
3 BRAVODERM CR TUBE 48 Rp 14,500.00
4 BUFACOM CR TUBE 72 Rp 16,500.00
5 CEFADROXIL SYR BTL 50 Rp 7,455.00
 6 CEFIXIM 100 MG BOX 10 Rp 67,500.00
7 CEFTRIAXON BOX 40 Rp 100,000.00
8 GENTAFLEX CR TUBE 136 Rp 3,250.00
9 GENOINT EO TUBE 72 Rp 7,800.00
10 GLYCERIL GUAICOLAT FLS 50 Rp 9,091.00
11 IBUPROFEN 400 MG BOX 50 Rp 48,000.00
12 CLOPIDOGREL 75 MG BOX 6 Rp 151,000.00
13 ERLAMYCETIN EO TUBE 120 Rp 7,150.00
14 ERLAMYCETIN ED FLS 240 Rp 7,100.00
15 XITROL ED FLS 50 Rp 27,250.00
16 MELOXICAM 7.5 MG BOX 60 Rp 19,000.00
17 ENERVIT PLUS SYR BTL 100 Rp 5,909.09
18 CAVIPLEX BOX 50 Rp 46,400.00
19 OBH KIDS BTL 4 Rp 7,803.00
20 OBH KIDS BTL 96 Rp 7,803.00
21 OBH 100 ML BTL 500 Rp 4,930.06
22 ONDANSENTRON 4 MG BOX 10 Rp 42,000.00
23 PIRACETAM 800 MG BOX 20 Rp 38,000.00
24 DOXICYCLINE 100 MG BOX 5 Rp 33,000.00
25 GENTAFLEX CR TUBE 64 Rp 3,250.00
26 DEXTROSE 40% FLS 20 Rp 9,100.00
27

TOTAL 1
POTONGAN
TOTAL 2
PPN 10%
TOTAL
P

HARGA TOTAL
Rp 850,000
Rp 322,727
Rp 23,000
Rp 44,000
Rp 385,000
Rp 44,000
Rp 336,000
Rp 336,000
Rp 1,300,000
Rp 720,000
Rp 330,000
Rp 675,000

Rp 5,365,727
Rp 417,300
Rp 4,948,427
Rp 494,843
Rp 5,443,270

HARGA TOTAL
Rp 1,400,000.00
Rp -
Rp -
Rp -
 Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -

Rp 1,400,000.00
Rp -
Rp 1,400,000.00
Rp 140,000.00
Rp 1,540,000.00

HARGA TOTAL
Rp 1,232,000.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -

Rp 1,232,000.00
Rp 213,629.00
Rp 1,018,371.00
Rp 101,837.10
Rp 1,120,208.10
P

HARGA TOTAL
Rp 372,720.00
Rp 120,000.00
Rp 2,172,750.00
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -

Rp 2,665,470.00

Rp 2,665,470.00
Rp 266,547.00
Rp 2,932,017.00

HARGA DISKON HARGA TOTAL

Rp 1,100,000.00 10.00% Rp 990,000
Rp 494,250.00 7.50% Rp 457,181
Rp 696,000.00 2.50% Rp 678,600
Rp 1,188,000.00 2.50% Rp 1,158,300
Rp 372,750.00 7.50% Rp 344,794
Rp 675,000.00 15.00% Rp 573,750
Rp 4,000,000.00 12.50% Rp 3,500,000
Rp 442,000.00 14.00% Rp 380,120
Rp 561,600.00 6.00% Rp 527,904
Rp 454,550.00 8.00% Rp 418,186
Rp 2,400,000.00 12.50% Rp 2,100,000
Rp 906,000.00 22.50% Rp 702,150
Rp 858,000.00 6.00% Rp 806,520
Rp 1,704,000.00 6.00% Rp 1,601,760
Rp 1,362,500.00 2.00% Rp 1,335,250
Rp 1,140,000.00 12.50% Rp 997,500
Rp 590,909.00 10.00% Rp 531,818
Rp 2,320,000.00 10.00% Rp 2,088,000
Rp 31,212.00 1.00% Rp 30,900
Rp 749,088.00 1.00% Rp 741,597
Rp 2,465,030.00 5.00% Rp 2,341,779
Rp 420,000.00 15.00% Rp 357,000
Rp 760,000.00 15.00% Rp 646,000
Rp 165,000.00 2.50% Rp 160,875
Rp 208,000.00 14.00% Rp 178,880
Rp 182,000.00 0.00% Rp 182,000
Rp - Rp -

Rp 23,830,864

Rp 23,830,864
Rp 2,383,086
Rp 26,213,950
 REKAPITULASI BELANJA OBAT-BMHP
UPT PUSKESMAS PAKIAJI
DINAS KESEHATAN KABUPATEN MALANG

BULAN : MARET 2019

NO NAMA PBF / APOTIK

1 : PT. MITRA MEDITAMA ABADI
2 : PT. SOLOCONE INDUSTRY
3 : PT. MILLENNIUM PHARMACON INTERNATIONAL TBK
4 : PT. PIEROSCA TERANG SUKSES ABADI
5 : PT. LAB MEDICA SEJAHTERA
6

JUMLAH

Mengetahui
Plt. Kepala UPT Puskesmas Pakisaji

drg. DEWI AMINAH

NIP. 19720607 200501 2 008
 NJA OBAT-BMHP
MAS PAKIAJI
BUPATEN MALANG

HARGA TOTAL ( Rp ) PPH 22

Rp 5,443,270 Rp 74,226
Rp 1,540,000 Rp 21,000
Rp 1,120,208 Rp 15,276
Rp 2,932,017 Rp 39,982
Rp 26,213,950 Rp 357,463

37,249,445 507,947

Malang, 26 Maret 2019

Petugas Gudang

DEDI DARMAWAN, Amd.Farm

Nip.19831127 200904 1 002