Lplpo Apbd Juli 2019

STOK OPNAME OBAT PUSKESMAS
KUNTO DARUSSALAM
SUMBER DANA APBD ROKAN HULU
PER 31 Desember 2018
SISA STOK 31 TGGL

KODE NAMA OBAT SATUAN No BATCH
DES 2018 KADALUARSA
1 Air Raksa Dental Use Botol - ###

2 Alat Suntik Sekali Pakai 0.05 ml Set
3 Alat Suntik Sekali Pakai 1 ml Set 1,350 171001 Jul-22
4 Alat Suntik Sekali Pakai 2,5 ml Set 200 171001 Jul-22
5 Alat Suntik Sekali Pakai 3 ml Set 693 10317 Jan-22
6 Alat Suntik Sekali Pakai 5 ml Set 1,082 20417 Feb-22
7 Alat suntik Sekali Pakai 10 ml Set - ###
8 Alat suntik Sekali Pakai 20 ml Tablet - ###
9 Albendazole tablet 400 mg Tablet - ###
10 Albion tablet Kotak - ###
11 Alcohol + CHG 0,5% Swab Botol 13 920111 Jan-19
12 Alkacide 1 L -2 Alkacid 10 Tablet - ###
13 Allopurinol tablet 100 mg Tablet - ###
14 Alprazolam tablet 0,5 mg Botol - ###
15 Ambroksol sirup 15 mg/ml Tablet 169 171133184 Nov-19
16 Ambroksol tablet 30 mg Ampul 6,000 180602146 Jun-20
17 Aminofilin injeksi 24 mg/ml - 10 ml Tablet - ###
18 Aminofilin tablet 200 mg Tablet 400 17CH010 Aug-20
19 Amitriptilin HCl tablet 25 mg Tablet 790 1611004 Dec-20
20 Amlodipine tablet 10 mg Tablet 2,130 AE09H021 May-21
21 Amlodipine tablet 5 mg Tablet - ###
22 Amoksisilin kaplet 500 mg Tablet 15,200 HJ018440 Sep-21
23 Amoksisilin kapsul 250 mg Vial - ###
24 Amoksisilin serbuk injeksi 1000 mg/ml Botol - ###
25 Amoksisilin sirup kering 125 mg/5 ml Ampul 269 270156 May-19
26 Ampisilin ijeksi 1000 mg Tablet - ###
27 Ampisilin kaplet 500 mg Botol - ###
28 Ampisilin sirup kering 125 mg / 5 ml Tablet - ###
29 Antalgin (Metampyron) tablet 500 mg Ampul 3,000 60101609 Sep-20
30 Antalgin injeksi 250 mg / ml - 2 ml Botol - ###
31 Antasida Doen suspensi Tablet 191 FJ2441 Oct-21
32 Antasida Doen tablet kombinasi Tube 2,800 KG1279 May-20
33 Antibakteri Doen Kombinasi / Bacitrasin Tube - ###
34 Antifungi Doen Kombinasi Supp 48 165H066A Aug-20
35 Antihaemoroid Doen Kombinasi Tablet - ###
36 Antimigrain Doen Kombinasi Botol - ###
37 Aqua proinjeksi steril, bebas pirogen Set 173 78A47A Jan-20
38 Articulating Paper Tablet - ###
39 Asam Askorbat (Vitamin C) tablet 250 mg Tablet - ###
40 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 6,500 H70077BI Sep-20
SISA STOK 31 TGGL
DES 2018 KADALUARSA
41 Asam Folat Kapsul 900 17TH067 Aug-20

42 Asam Mefenamat kapsul 250 mg Tablet - ###
43 Asam Mefenamat tablet 500 mg Botol 10,500 171875 Aug-19
44 Asam Sulfosalisilat 20 % Ampul - ###
45 Asam Traneksamat injeksi Botol - ###
46 Asam Valproat 250mg/5ml Botol 12 2771058 Jun-19
47 Asering (Asetat Ringer) Tablet - ###
48 Asetosal tablet 100 mg Tablet - ###
49 Asetosal tablet 500 mg Tube - ###
50 Asiklovir krim Tablet 100 J73143J Oct-20
51 Asiklovir tablet 200 mg Tablet 150 6303004 Apr-21
52 Asiklovir tablet 400 mg Ampul 450 6304004 May-20
53 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml Tablet - ###
54 Atropin Sulfat tablet 0,5 mg Botol - ###
55 Atropin Sulfat Tetes Mata 0,5 % Tablet - ###
56 Attapulgit Botol 1,000 SH0091 Aug-21
57 Baby Cough Syr Botol - ###
58 Becefort Syr Tablet - ###
59 Becefort Tablet Tablet - ###
60 Becom C kaplet Tablet - ###
61 Bekarbon tablet 500 mg Tablet - ###
62 Beneuron Vial - ###
63 Benzatin Benzil Penisilin 1,2 juta iu/ vial Vial - ###
64 Benzatin Benzil Penisilin 2,4 juta iu/ vial Tablet - ###
65 Betahistin Mesilat 6 mg tablet Tube - 171385 Jul-20
66 Betametason 1 mg + Neomisin sulfat Tube - ###
67 Betametason krim 0,1 % Tablet 102 G70869T Jul-20
68 Bionemi Tube - ###
69 Bioplasenton krim Tablet - ###
70 Bioron Tube - ###
71 Bismecon Jelly Tablet - ###
72 Bisoprolol tablet 5 mg Set - ###
73 Bisturi Tube - ###
74 Bivalex krim Set - ###
75 Blood Lancet Botol 300 9091688 Aug-21
76 Calostrum Syr Botol - ###
77 Calsidol Sirup Tablet - ###
78 Captopril tablet 12,5 mg Tablet 2,700 6323002 Feb-22
79 Captopril tablet 25 mg Set - ###
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 Set - 20042015 Mar-20
81 Catgut chromic 2/0 75 C 30 M R Set - ###
82 Catgut chromic 2/0 75 C 37 M C Set - ###
83 Catgut chromic 3/0 75 C 22 M R Set - ###
84 Catgut chromic 3/0 75 C 37 M R Botol - ###
85 Caviplex drop Kapsul 4 F.1253002 Jun-21
86 Cefadroksil kapsul 500 mg Botol 2,500 HH038130 Aug-21
SISA STOK 31 TGGL
DES 2018 KADALUARSA
87 Cefadroksil sirup kering 125 mg/ml Botol 386 HH398116 Aug-19

88 Cefadroxil Syrup 250 mg/ml Kapsul - ###
89 Cefiksim kapsul 100 mg Botol 1,320 681990J Jul-20
90 Cefiksim syr kering100 mg/ml Ampul 36 HG358083 Jul-19
91 Cefotaksim injeksi 1000 mg Botol - ###
92 Cendo Xitrol tetes mata Ampul - ###
93 Ceftriakson injeksi Botol - ###
94 Cetrizin Sirup 5 mg/ ml Tablet 164 S.08013AH Aug-20
95 Cetrizin tablet 10 mg Tablet 1,100 T.08031AH Aug-20
96 Cimetidin tablet 200 mg Botol 700 1709079 Sep-19
97 Ciprofloksasin infus Tablet - ###
98 Ciprofloksasin tablet 500 mg Botol 4,800 170535108 May-20
99 Ciprofloksasin tetes telinga Tablet - ###
100 Clindamisin tablet 150 mg Tablet - ###
101 Clindamisin tablet 300 mg Tube 1,850 171056 Jun-19
102 Clobetasol krim 0,05 % Tablet - ###
103 Co-Amoksiklav tablet 625 mg Kapsul - ###
104 Dasabion kapsul Ampul - ###
105 Deksametason injeksi 5 mg/ml - 1 ml Tablet 250 PIL44745 Oct-19
106 Deksametason tablet 0,5 mg Botol 600 00717E0540 May-20
107 Dekstran 70 - larutan infus 6 % steril Botol - ###
108 Dekstrometorfan HBr sirup 10 mg / 5 ml Tablet - ###
109 Dekstrometorfan tablet 15 mg Set - ###
110 Delecto HBS Ag ( Anti Gen) Set - ###
111 Dentin Conditioner Set - ###
112 Devitalisasi pasta (non arsen) Tube - ###
113 Dexocort 0.25% Krim (Desoksimetason 0.25 %) Botol 59 G71804J Jul-20
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine Hcl) Set - ###
115 Diamond Bur Low Speed Ampul - ###
116 Diazepam injeksi 5 mg Tablet - ###
117 Diazepam tablet 2 mg Tablet - ###
118 Diazepam tablet 5 mg Tablet 365 161001 Aug-20
119 Dietilkarbamzin Sitrat tablet 100 mg Ampul - ###
120 Difenhidramin HCl injeksi 10 mg/ml - 1 ml Tablet - ###
121 Digoksin tablet 0,25 mg Tablet 400 A7806DU Apr-21
122 Diltiazem tablet Tablet - ###
123 Dimenhidrinat tablet 50 mg Kapsul 200 E140538B May-19
124 Doksisiklin kapsul 100 mg Botol - ###
125 Domperidon suspensi 5 mg/ml Tablet 224 161108186 Nov-20
126 Domperidon tablet Tablet 2,200 48E 0180 Mar-21
127 Efedrin HCl tablet 25 mg Tablet - ###
128 Ekstrak Belladone tablet 10 mg Set - ###
129 Endometasone N Ampul - ###
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 ml Kapsul - ###
131 Eritromisin kapsul 250 mg Kapsul - ###
132 Eritromisin kapsul 500 mg Botol 50 T09147AF Apr-21
SISA STOK 31 TGGL
DES 2018 KADALUARSA
133 Eritromisin sirup Botol 130 AF920312 Sep-19

134 Erpha Livita Baby Drop Tablet - ###
135 Erya Forte 500 mg Botol - ###
136 Etakridin (Rivanol) larutan 0,1 % Tablet 100 7081788 Jul-20
137 Etambutol HCl tablet 250 mg Tablet - ###
138 Etambutol HCl tablet 500 mg Botol - ###
139 Etanol 70 % Botol - ###
140 Etanol 70 %(1000 ml) Ampul 30 25041788 Mar-21
141 Ethiperan Injeksi Botol - ###
142 Etil Klorida semprot Botol - ###
143 Eugenol cairan Tablet - ###
144 Famotidin tablet 20 mg Tablet - ###
145 Famotidin tablet 40 mg Set - ###
146 Feeding Tube No. 3,5 (35 cm) Set - ###
147 Feeding Tube No. 5 (100 cm) Set - ###
148 Feeding Tube No. 8 (100 cm) Ampul - ###
149 Fenitoin Natrium injeksi 50 mg/ml Kapsul - ###
150 Fenitoin Natrium kapsul 100 mg Kapsul 200 370503 May-20
151 Fenitoin Natrium kapsul 30 mg Ampul - ###
152 Fenobarbital injeksi 50 mg/ml - 2 ml Tablet - ###
153 Fenobarbital tablet 100 mg Tablet - ###
154 Fenobarbital tablet 30 mg Tablet 295 E8109613 Apr-23
155 Fenoksimetil Penisilina tablet 250 mg Tablet - ###
156 Fenoksimetil Penisilina tablet 500 mg Botol - ###
157 Fenol Gliserol tetes telinga 10 % Botol - ###
158 Ferriz Baby Drop Tablet ###
159 FG Troches Box - ###
160 Film IV Dress 67 P Box 300 20160920 Sep-19
161 Film IV Dress 67 S Box - ###
162 Film IV Dress 78 P Ampul - ###
163 Fitomenadion ( Vit k 1 ) injeksi 10 mg/ml - 1 ml Tablet 68 63820061 Jun-20
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg Tablet 500 95381012 Oct-19
165 Flucadek tablet Tablet - ###
166 Fluconazole 150 mg Tube - ###
167 Flucort N cream Tablet - ###
168 Fluoksetin (foransi 10 mg) Set ###
169 Folley Cateter 2 Way 30 cc No. 14 Set - ###
170 Folley Cateter 2 Way 30 cc No. 16 Set - ###
171 Folley Cateter 2 Way 30 cc No. 18 Tablet 33 16G09A Dec-20
172 Fundifar Ampul - ###
173 Furosemida injeksi 10 mg Tablet - ###
174 Furosemida tablet 40 mg Sachet 200 A0406ET May-20
175 Garam Oralit untuk 200 ml air Tube 1,800 95373268CC Jul-19
176 Genoint Salep Mata (Gentamisin 0.1 % Salep Mata) Ampul 24 1453016B Apr-22
177 Gentamicin Injeksi 40 mg/ml Tube - ###
178 Gentamisin salep kulit 0,1 % Botol - ###
SISA STOK 31 TGGL
DES 2018 KADALUARSA
179 Gentamisin sulfat tetes mata 0,3 % Botol 30 O253016 Jun-21

180 Gentian Violet larutan 1 % Tablet 21 S23043 Apr-22
181 Geriavita Set - ###
182 Glass Ionomer Cement Tablet - ###
183 Glibenklamid tablet 5 mg Tablet 700 1802016 Mar-23
184 Glimepirid 1 mg Tablet - ###
185 Gliseril Guaiakolat tablet 100 mg Botol 1,700 180508155 May-22
186 Gliserin Ampul - ###
187 Glukonas Kalsikus Injeksi 10 % Botol - ###
188 Glukosa larutan infus 10 % steril Botol - ###
189 Glukosa larutan infus 40 % steril Botol - ###
190 Glukosa larutan infus 5 % steril Tablet - ###
191 Grahabion tablet Botol - ###
192 Gralysin syr Tablet - ###
193 Griseofulvin tablet 125 mg Tablet 400 1509014 Nov-20
194 Griseofulvin tablet 250 mg (Micostop 250 mg) Set 500 F1701 Jun-20
195 Gutta Perca Ampul - ###
196 Haloperidol Decanoat Inj 50 mg/ml Tablet ###
197 Halloperidol 5mg Tablet 1,270 170507 Apr-19
198 Haloperidol tab 2 mg Tablet ###
199 Haloperidol tablet 1,5 mg Tablet 880 1707159 Jul-20
200 Haloperidol tablet 0,5 mg Botol ###
201 Hand Rub 500 ml Set 7 170308 E Mar-20
202 Hcg Pregnancy Test Tablet 300 5061788 May-20
203 Hemafort Tablet - ###
204 Hidroklorotiazida (HCT) tablet 25 mg Tube 700 E 160425 B May-21
205 Hidrokortison krim 2,5 % Tablet 52 T 61114 T Aug-20
206 Hustab Botol 900 16027015 Jul-20
207 Hustab Syr Tablet - 6028037 Apr-21
208 Hyascine-N- Butil Bromida Ampul - ###
209 Hyoscine Butil Bromida inj Botol - ###
210 Ibuprofen Suspensi 100 mg/ 5 ml Botol - ###
211 Ibuprofen Suspensi 200 mg/ 5 ml Tablet - ###
212 Ibuprofen tablet 200 mg Tablet - ###
213 Ibuprofen tablet 400 mg Set 3,000 B1911921 Sep-21
214 ID Band Red ( Adult) Set - ###
215 ID Band Red ( Child) Botol - ###
216 Imerson Oil Botol - ###
217 Immustrum syr Set - ###
218 Infusion set anak Set 140 11091788 Aug-22
219 Infusion set dewasa Tablet 187 2061788 May-22
220 INH Anak Botol - ###
221 Interzinc Syrup Tablet 2 S 068 G023 Aug-19
222 Intunal Forte Tablet ###
223 Isoniazida tablet 300 mg Tablet - ###
224 Isosorbit Dinitrat tablet subligual 5 mg Botol 800 A 2332 JT Oct-20
SISA STOK 31 TGGL
DES 2018 KADALUARSA
225 Isotic Clearens Botol - ###

226 Isotic Neolyson Set - ###
227 IV cateter No. 16 Set - ###
228 IV cateter No. 18 Set 350 07 2016 Jun-21
229 IV Cateter No. 20 Set 242 07 2016 Jun-21
230 IV cateter No. 22 Set 292 07 2016 Jun-21
231 IV Cateter No. 24 Set 100 07 2016 Jun-21
232 Jarum Extirsipasi Set - ###
233 Jarum File Set - ###
234 Jarum jahit bedah (steri) no 9 s/d 14 Set - ###
235 Kaca Objek ( Objek Glass) Botol - ###
236 KA-EN 1B Botol - ###
237 KA-EN 3A Botol - ###
238 KA-EN 3B Tablet - ###
239 Kalium diklofenak tablet 25 mg Tablet - ###
240 Kalium diklofenak tablet 50 mg Botol 200 HTDPSA82013 Apr-20
241 Kalium Permanganat serbuk Set - ###
242 Kalsium Hidroksi Pasta Tablet - ###
243 Kalsium Laktat (Kalak) tablet Rol 6,300 171395 Jul-19
244 Kapas Berlemak 500 gram Rol - ###
245 Kapas Pembalut / Absorben 250 gram Tablet 19 1091688 Oct-21
246 Karbamazepain tablet 200 mg Rol - ###
247 Kasa 10 x 80 cm Rol 300 ###
248 Kasa 40 x 80 Rol - ###
249 Kasa 5 x 80 cm Rol - ###
250 Kasa Gulung 36 x 80 Set - ###
251 Kasa kompres 40/40 steril Rol 1,200 15121488 Nov-19
252 Kasa Pembalut 2 m x 80 cm Rol - ###
253 Kasa pembalut hidrofil 4 m x 15 cm Rol - ###
254 Kasa pembalut hidrofil 4 m x 3 cm Rol - ###
255 Kasa Pembalut Hidrofil 4 x 10 Kotak - ###
256 Kasa Steril 16 x 16 (Kasa Kotak) Tube 87 15051788 Apr-22
257 Ketoknazole Krim 2 % Tablet 83 F70794 T Jun-21
258 Ketoknazole tablet 200 mg Supp 150 170512103 May-21
259 Ketoprofen Suppositoria 100mg ( Fetik Supp) Tablet 40 R 003 G 067 Aug-19
260 Ketoprofen Tablet 100 mg Tablet - ###
261 Klopidogrel 75 mg Tube - ###
262 Kloramfekort krim Kapsul - ###
263 Kloramfenikol kapsul 500 mg Kapsul 350 T 2388147 Jul-19
264 Kloramfenikol kapsul 250 mg Tube 400 85325003 Feb-20
265 Kloramfenikol salep mata 1 % Botol 104 J7274800 Oct-20
266 Kloramfenikol suspensi Botol - ###
267 Kloramfenikol tetes mata 0,5 % Botol - ###
268 Kloramfenikol Tetes telinga 3 % Tablet 11 D 0652059 May-19
269 Klorfeniramin Maleat (CTM) tablet 4 mg Tube 4,700 160865152 Aug-20
270 Klorfeson krim Tablet - ###
SISA STOK 31 TGGL
DES 2018 KADALUARSA
271 Klorokuin Fosfat tablet 150 mg Tablet - ###

272 Klorokuin tablet 250 mg Ampul - ###
273 Klorpromazin HCl inj. 25 mg/ml - 2 ml Ampul - ###
274 Klorpromazin HCl inj. 5 mg/ml - 2 ml Tablet - ###
275 Klorpromazin HCl tablet salut 100 mg Tablet 100 170375 Apr-19
276 Klorpromazin HCl tablet salut 25 mg Tablet 1,015 95328004 Sep-19
277 Klorpropamid tablet 100 mg Tablet - ###
278 Klozapin 25 mg Tablet ###
279 Kodein HCl tablet 10 mg Tablet - ###
280 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg Tablet - ###
281 Kontrasepsi Injeksi Depoprogestin/Suntik KB 3 Bln Tablet - ###
282 Kotrimoksazol dewasa tablet Tablet 2,100 171023 Jun-19
283 Kotrimoksazol pediatrik tablet Tablet - ###
284 Kotrimoksazol Forte Kombinasi 800 mg/160 mg Botol ###
285 Kotrimoksazol suspensi Tablet 425 2708014 Aug-19
286 Kuinin (Kina) tablet 200 mg Ampul - ###
287 Kuinin Dihidroklorida injeksi 25 % - 2 ml Kapsul - ###
288 Lansoprazol kapsul 30 mg Botol 900 18LP1027 Jul-22
289 Larutan Anisol Botol - ###
290 Larutan Asam Klorida 0,1 N Botol - ###
291 Larutan Benedict Botol - ###
292 Larutan EDTA 10 % Botol - ###
293 Larutan Eosin 2 % Botol - ###
294 Larutan Etanol Asam Botol - ###
295 Larutan Giemsa Stain Botol - ###
296 Larutan Hayem Botol - ###
297 Larutan Iodium 1 % Botol - ###
298 Larutan Karbol Fuksin Botol - ###
299 Larutan Metilen Biru Botol - ###
300 Larutan Na Citrat 3,13 % Botol - ###
301 Larutan Rees Ecker Botol - ###
302 Larutan Turk Botol - ###
303 Larutan Xylol Botol - ###
304 Laxadine Emulsi 30 ml Tablet 18 E 1702 May-20
305 Laxana tablet Supp - ###
306 Laxarec supp Set - ###
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) Set 14 63725709 Aug-19
308 Leukoplast 1625 H ( plaster 7,5 cm x 4,5 M) Botol - ###
309 Levofloksasin 0,5% tetes mata ( Optiflox) Kapsul 17 D 2351001 Apr-19
310 Levofloksasin kapsul 500 mg Botol 300 T SG 27245 Jun-19
311 Lexapram 5mg/5 ml syrup Kaplet - ###
312 Lexavit kaplet Ampul - ###
313 Lidokain (Pehakain) injeksi 2% Ampul - ###
314 Lidokain injeksi 2 % Ampul 200 18IG032 Jul-22
315 Lidokain Kompositum injeksi Kapsul 30 171F003 Jun-21
316 Linkomisin kapsul 250 mg Kapsul - ###
SISA STOK 31 TGGL
DES 2018 KADALUARSA
317 Linkomisin kapsul 500 mg Botol - ###

318 Lisol Tablet - ###
319 Livron B Plex Tablet - ###
320 Loperamida 2 mg tablet Tablet 1,100 70312 Dec-19
321 Loratadine tablet 10 mg Tablet 2,200 TLRTA80094 Jul-21
322 Lorazepam 2 mg Botol ###
323 Lyscavit Syrup Botol ###
324 Lytamin Sirup Ampul - ###
325 Magnesium Sulfat inj (IV) 20% - 25 ml Ampul 141 93 E 47 A May-19
326 Magnesium Sulfat inj (IV) 40% - 25 ml Sachet 120 82 D 47 A Apr-19
327 Magnesium Sulfat serbuk 30 gram Set - ###
328 Masker Set - ###
329 Masker N 95 Set 400 930022 ###
330 Masker Oxygen ( Dewasa) Set - ###
331 Masker Oxygen (Anak) Tube - ###
332 Mebendazol tablet 100 mg Tablet - ###
333 Mebendazole 500 mg (Vermox) Tube - ###
334 Melavita Cream ( Asam Retinoat 0.1 %) Tablet - ###
335 Meloxicam kapsul 15 mg Kapsul - ###
336 Meloxicam kapsul 7,5 mg Tablet - ###
337 Merviton Tablet Tablet ###
338 Metampiron 500 mg, Diazepam 2 mg Botol - ###
339 Metanol Tablet - ###
340 Metformin kapsul 500 mg Tablet 2,500 HTMFNA84094 Aug-20
341 Metil Prednisolon tablet 4 mg Ampul 1,100 MO2AG035 Aug-21
342 Metilergometrin Maleat injeksi 0,200 mg - 1 ml Tablet 180 97 LC 0054 Mar-20
343 Metilergometrin Maleat tablet salut 0,125 mg Tablet 500 DE1082J Apr-20
344 Metilprednisolon 8 mg tablet Ampul - ###
345 Metoklopramide injeksi 5 mg/ml Botol - ###
346 Metoklopramide sirup 5 mg/ml Tablet - ###
347 Metoklopramide tablet 10 mg Botol 700 95485003 Nov-19
348 Metronidazol infus Tablet - ###
349 Metronidazol tablet 250 mg Tablet 2,600 BK91272 Nov-21
350 Metronidazol tablet 500 mg Supp - BG 91275 Jul-21
351 Metronidazole 500 mg Supp ( Vagizol Ovula) Tube 5 G 71575 W Jul-21
352 Miconazol krim 2 % Tablet 158 066103W Jun-20
353 Mixing Pad Tablet - ###
354 Molagit tablet Set 180 WG 030 Aug-19
355 Monoklorkamfer Mentol cairan (CHKM) Tablet - ###
356 Mucohexin tab Botol - ###
357 Muliavit Syr Set ###
358 Mummifying pasta Botol - ###
359 Mycorine Powder ( Miconazole 2 %) Set - ###
360 Nasal Canula (Selang Oksigen) Anak Set - ###
361 Nasal Canula Bayi Set - ###
362 Nasal Canula Dewasa Tablet - ###
SISA STOK 31 TGGL
DES 2018 KADALUARSA
363 Natrium Bikarbonat tablet 500 mg Tablet 1,000 1708165 Aug-21

364 Natrium Diklofenat tablet 25 mg Tablet - ###
365 Natrium Diklofenat tablet 50 mg Botol 3,150 16365039 Jun-21
366 Natrium Klorida larutan infus steril 0,9 % Ampul - ###
367 Natrium Tiosulfat injeksi 25 % - 2ml Tablet - ###
368 Natrium Tiroksin 100 ug Tube - ###
369 Neocenta Gel Kaplet 3 81007 Jul-21
370 Neurosanbe Plus kaplet Ampul - ###
371 Neurovit E tablet Set - ###
372 Nice Care Under Pad Tablet - ###
373 Nipedipin tablet 10 mg Tablet 500 47 N 4191 Jun-20
374 Nistatin 100.000 iu/ g tablet vagina Tablet 600 95372009 Aug-20
375 Nistatin 500.000 iu tablet salut Botol 800 ###
376 Nocandis drop Tablet - ###
377 Nodiar tablet Tablet - ###
378 Noza paket 500 16046012 Aug-22
379 Obat Anti Tuberkuloisi Kategori Anak paket - ###
380 Obat Anti Tuberkulosis Kategori 1 paket - ###
381 Obat Anti Tuberkulosis Kategori 1 (Kombipak) paket - ###
382 Obat Anti Tuberkulosis Kategori 2 paket - ###
383 Obat Anti Tuberkulosis Kategori 2 (Kombipak) paket - ###
384 Obat Anti Tuberkulosis Kategori Sisipan Botol - ###
385 Obat Batuk Hitam (OBH) cairan Botol 195 A19830 Jun-21
386 Obat Batuk Hitam (OBH) Plus cairan Tablet - ###
387 Ofloksasin tablet 200 mg Tablet 100 1707006 Oct-21
388 Ofloxacin tablet 400 mg Ampul 100 1710027 Oct-19
389 Oksitetrasiklin HCl injeksi i.m 50 mg/ml - 10 ml Tube - ###
390 Oksitetrasiklin HCl salap 3 % Tube 70 D81099W Apr-21
391 Oksitetrasiklin HCl salap mata 1 % Ampul - ###
392 Oksitosin injeksi 10 iu/ml - 1ml Tablet 118 97 LD 0019 Apr-20
393 Omedeson 0,5 mg tablet Kapsul - ###
394 Omeprazol kapsul 20 mg Tablet 1,110 KG1268 May-20
395 Orphen Tablet Botol - ###
396 Oxfezin syr Botol - ###
397 Oxycan Botol - ###
398 Parasetamol Drop Botol - ###
399 Parasetamol sirup 120 mg/5 ml Tablet 169 A81626 Aug-20
400 Parasetamol tablet 100 mg Tablet - ###
401 Parasetamol tablet 500 mg Tablet 5,200 171155117 Nov-20
402 Pehavral Set - ###
403 Pembalut Gips Tablet - ###
404 Perfenazin HCl tablet 4 mg Ampul - ###
405 Pethidin HCl injeksi 50 mg / ml - 2 ml Kapsul - ###
406 Pharmaton Formula Tablet - ###
407 Pil KB Kombinasi- Bliss 28 Tab Botol - ###
408 Pilokarpin HCl/Nitrat tetes mata 2 % Ampul - ###
409 Piracetam injeksi 1 g/5 ml Ampul - ###
410 Piracetam injeksi 3 g/5 ml Botol - ###
SISA STOK 31 TGGL
DES 2018 KADALUARSA
411 Piracetam sirup Tablet - ###

412 Piracetam tablet 400 mg Tablet - ###
413 Piracetam tablet 800 mg Tablet - ###
414 Pirantel tablet 125 mg Tablet 80 1710042 Oct-19
415 Pirazinamida tablet 500 mg Tablet - ###
416 Piridoksin HCl tablet 10 mg Tablet 3,000 4 AJ 018 Aug-19
417 Piridoksin HCl tablet 25 mg Kapsul ###
418 Piroksikam kapsul 10 mg Kapsul - ###
419 Piroksikam kapsul 20 mg Rol 3,000 AO645LU Dec-21
420 Plester 5 yard x 2 inch Botol - ###
421 Povidon Iodida larutan 10 % - 30 ml Botol 150 15121688 Nov-19
422 Povidon Iodida larutan 10 % - 300 ml Botol - 7081788 Jul-20
423 Povidone Iodine 10 % 60 ml Tablet - ###
424 Prednison tablet 5 mg Tablet 900 1806096 Jun-20
425 Primakuin tablet 15 mg Kapsul - ###
426 Pritavit Vial - ###
427 Prokain Benzil Penisilin 3 juta iu/vial injeksi Botol - ###
428 Prolysin Syrup Plus Ampul - ###
429 Propanolo HCl tablet 40 mg Tablet - ###
430 Propect tab/Ambroksol Tablet - ###
431 Propitiourasil tablet 100 mg Vial - ###
432 Rabies Immune Globulin (Human) 150 iu/ml Ampul - ###
433 Ranitidin injeksi 25 mg/ml Tablet 245 97MF0028 Jun-21
434 Ranitidin tablet 150 mg Botol 3,300 HTRNTA76340 Dec-20
435 Reagen Golongan Darah Anti A Botol - ###
436 Reagen Golongan Darah Anti B Tablet - ###
437 Reserpin tablet 0,10 mg Tablet - ###
438 Reserpin tablet 0,25 mg Kapsul - ###
439 Retinol (Vitamin A) kapsul 100.000 iu Kapsul - ###
440 Retinol (Vitamin A) kapsul 200.000 iu Kapsul - ###
441 Rifampisin kapsul 300 mg Kapsul - ###
442 Rifampisin kapsul 450 mg Kapsul - ###
443 Rifampisin kapsul 600 mg Botol - ###
444 Ringer laktat larutan infus steril Tablet - ###
445 Risperidone 2 mg Tablet 125 150198 Apr-19
446 Risperidone 1 mg kotak 175 48 D 0136 Mar-20
447 Safety Box Tablet - ###
448 Salbutamol tablet 2 mg Tablet 5,700 6481013 Jul-19
449 Salbutamol tablet 4 mg Tablet 1,400 YE351G May-22
450 Salep 2 - 4 kombinasi Kotak - ###
451 Salisil Bedak 2 % Tablet - ###
452 Sammoxin 500 mg tablet Botol - ###
453 Sanbe Kids Kapsul - ###
454 Sangatonik kapsul Psg - ###
455 Sarung Tangan Obgyn Steril Tube - ###
456 Scabicid krim Tube - ###
457 Scabimite krim - ###
458 Selcom - C kaplet Kaplet - ###
459 Selvi Plex Tablet
460 Semen Seng Fosfat serbuk dan cairan Set - ###
461 Serum anti bisa ular polivalen injeksi 50 mg (ABU) Ampul -
462 Serum anti tetanus inj. 1.500 iu/ampul (a.t.s ) Ampul - ###
463 Serum anti tetanus inj. 20.000 iu/ampul (a.t.s ) Ampul - ###
SISA STOK 31 TGGL
DES 2018 KADALUARSA
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml Ampul 200 16IG011 Jul-19
465 Sianokobalamin (Vitamin B12) tab 50 mcg Tablet 400 17TD007 Apr-22
466 Silk (benang bedah sutera) no. 3/0 Set - 1607148 Jul-21
467 Silver Amalgam serbuk 65 - 75 % Set - ###
468 Simvastatin tablet 10 mg Tablet - ###
471 Soft U Derm Hydro Urea Krim 10% Tube - E 1701 May-20
472 Solvita Plus Syrup Botol - ###
473 Spiramisin tablet 500 mg Tablet - ###
474 Stesolid Suppositoria 10 mg Supp - ###
475 Stesolid Suppositoria 5 mg Supp - ###
476 Stomach tube FG 16 Set - ###
477 Stomach tube FG 18 Set - ###
478 Sulfadimidin tablet 500 mg Tablet - ###
479 Sulfametoksazol 800 mg + Trimetoprim 160 mg Tablet - ###
480 Supra Flu tablet Tablet - ###
481 Suprabion tablet Tablet - ###
482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L Psg - ###
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M Psg - ###
484 Surgical Glove Steril No 6,5 Psg - ###
485 Surgical Gloves Non-Steril No 7 Psg - ###
486 Surgical Gloves Non-Steril No 7,5 Psg - ###
487 Surgical Gloves Steril No 7 Psg - ###
488 Surgical Gloves Steril No 7,5 Psg - ###
489 Surgical Tape 2.5 cm x 910 cm Psg - ###
490 Surgical Tape 5 cm x 10 M (AXIMED) Pcs ###
491 Surgical Tape 5 cm x 10 M (AXIMED) Pcs ###
492 Tablet Tambah Darah Kombinasi Tablet -
493 Tambalan Sementara Set -
494 Tamiflu Tablet - ###
495 Tarivid Otic Solution (Ofloxacin Tetes Telinga) Botol - TVD 0335 Jan-20
496 Temporary stopping Fletcher serbuk dan cairan Set - ###
497 Tetrakain HCl tetes mata Botol - ###
498 Tetrasiklin HCl kapsul 250 mg Kapsul - ###
499 Tetrasiklin HCl kapsul 500 mg Kapsul - ###
500 Thiamphenicol kapsul 250 mg Kapsul - ###
501 Thiamphenicol kapsul 500 mg Kapsul - ###
502 Thramed Kapsul Kapsul - ###
503 Tiamin HCl (Vit B 1) inj. 100 mg/ml - 1 ml Ampul - ###
504 Tiamin HCl monohidrat (Vit B 1) tablet 50 mg Tablet 1,400 170520158 May-21
505 Tramadol injeksi 50 mg / ml Ampul 90 J 10346503 Sep-19
506 Tramadol tablet 50 mg Tablet - 02315 E 0010 May-20
507 Trifastan 500 mg tablet Tablet - ###
508 Trifluoperazin 5 mg Tablet
509 Triheksifenidil Hidroklorida tablet 2 mg Tablet 600 1709032 Sep-19
510 Trikresol Formali (TKF) cairan Set -
511 Ulsidek 500 mg (Sucralfat) Tablet 300 48 C 0594 Feb-21
512 Umbilical Cord Clamp Set 100 UCC 170102 Jan-22
513 Urine Bag non steril Set -
514 Vitalex kapsul Kapsul -
515 Vitamin B komplek tablet Tablet 2,800 18TF013 Jun-21
516 Wing Needle Set 300 5081588 Jul-20
SISA STOK 31 TGGL
DES 2018 KADALUARSA
517 Yodium kapsul Kapsul -

518 Zink Dispersible Tablet 7,300 C 70592 J Mar-19
Mengetahui / Menyetujui Kota Lama, 2 Januari 2019 Yang Menerima

Kepala Puskesmas Kunto Darussalam Penanggung Jawab Obat PKM Kepala Puske
Endang Suhada, SKM Dony Iswandi, S.Farm., Apt (………………

NIP. 19700901 199101 1 001
KODE PUSKESMAS : LAPORAN PEMAKAIAN DAN LEMBAR PERM
PUSKESMAS : KUNTO DARUSSALAM ( LPLPO )
KECAMATAN : KUNTO DARUSSALAM
KABUPATEN : ROKAN HULU
PROVINSI : R I A U
KELAS STOK PERSE- STOK

KODE NAMA OBAT SATUAN PENERIMAAN PEMAKAIAN SISA STOK
TERAPI AWAL DIAAN OPT.
1 Air Raksa Dental Use 14.2 Botol - - 0 -

2 Alat Suntik Sekali Pakai 0.05 ml Botol - - 0 -
3 Alat Suntik Sekali Pakai 1 ml 15.2 Set 1,350 1,350 100 1,250
4 Alat Suntik Sekali Pakai 2,5 ml 16.2 Set 200 200 0 200
5 Alat Suntik Sekali Pakai 3 ml 17.2 Set 693 693 325 368
6 Alat Suntik Sekali Pakai 5 ml 18.2 Set 1,082 1,082 125 957
7 Alat suntik Sekali Pakai 10 ml 19.2 Set - - 0 -
9 Albendazole tablet 400 mg 21.2 Tablet - - 0 -
10 Albion tablet 26.1 Tablet - - 0 -
11 Alcohol + CHG 0,5% Swab 26.1 Kotak 13 13 13 -
12 Alkacide 1 L -2 Alkacid 10 23.2 Botol - - 0 -
13 Allopurinol tablet 100 mg 6.2.1 Tablet - - 0 -
14 Alprazolam tablet 0,5 mg 6.2.1 Tablet - - 0 -
15 Ambroksol sirup 15 mg/ml 6.2.1 Botol 169 169 58 111
16 Ambroksol tablet 30 mg Tablet 6,000 6,000 900 5,100
17 Aminofilin injeksi 24 mg/ml - 10 ml 1.2 Ampul - - 0 -
18 Aminofilin tablet 200 mg 6.2.1 Tablet 400 400 100 300
19 Amitriptilin HCl tablet 25 mg Tablet 790 790 30 760
20 Amlodipine tablet 10 mg 25.1 Tablet 2,130 2,130 990 1,140
21 Amlodipine tablet 5 mg Tablet - - 0 -
22 Amoksisilin kaplet 500 mg 25.3 Tablet 15,200 15,200 2600 12,600
23 Amoksisilin kapsul 250 mg 18.3 Tablet - - 0 -
24 Amoksisilin serbuk injeksi 1000 mg/ml 9 Vial - - 0 -
25 Amoksisilin sirup kering 125 mg/5 ml Botol 269 269 38 231
26 Ampisilin ijeksi 1000 mg 29 Ampul - - 0 -
27 Ampisilin kaplet 500 mg Tablet - - 0 -
28 Ampisilin sirup kering 125 mg / 5 ml 29 Botol - - 0 -
29 Antalgin (Metampyron) tablet 500 mg Tablet 3,000 3,000 300 2,700
30 Antalgin injeksi 250 mg / ml - 2 ml Ampul - - - -
31 Antasida Doen suspensi 1.2 Botol 191 191 83 108
32 Antasida Doen tablet kombinasi 1.2 Tablet 2,800 2,800 2100 700
33 Antibakteri Doen Kombinasi / Bacitrasin 21.2.4 Tube - - 0 -
34 Antifungi Doen Kombinasi Tube 48 48 0 48
35 Antihaemoroid Doen Kombinasi 10.1 Supp - - 0 -
36 Antimigrain Doen Kombinasi 18.4 Tablet - - - -
37 Aqua proinjeksi steril, bebas pirogen Botol 173 173 0 173
38 Articulating Paper 6.3.1 Set - - - -
39 Asam Askorbat (Vitamin C) tablet 250 mg Tablet - - 0 -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 6,500 6,500 700 5,800
41 Asam Folat 11.2 Tablet 900 900 200 700

42 Asam Mefenamat kapsul 250 mg 26.2 Kapsul - - 0 -
43 Asam Mefenamat tablet 500 mg 26.2 Tablet 10,500 10,500 1000 9,500
44 Asam Sulfosalisilat 20 % Botol - - 0 -
45 Asam Traneksamat injeksi Ampul - - 0 -
46 Asam Valproat 250mg/5ml Botol 12 12 8 4
47 Asering (Asetat Ringer) Botol - - 0 -
48 Asetosal tablet 100 mg Tablet - - 0 -
49 Asetosal tablet 500 mg Tablet - - 0 -
50 Asiklovir krim Tube 100 100 30 70
51 Asiklovir tablet 200 mg Tablet 150 150 100 50
52 Asiklovir tablet 400 mg 13.2 Tablet 450 450 0 450
53 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml 6.1.2 Ampul - - 0
54 Atropin Sulfat tablet 0,5 mg 3 Tablet - - 0 -
55 Atropin Sulfat Tetes Mata 0,5 % 17.6 Botol - - 0 -
56 Attapulgit 25.4 Tablet 1,000 1,000 100 900
57 Baby Cough Syr 17.73 Botol - - 0 -
58 Becefort Syr 6.3.2 Botol - - 0 -
59 Becefort Tablet Tablet - - 0 -
60 Becom C kaplet Tablet - - 0 -
61 Bekarbon tablet 500 mg 13.2 Tablet - - 0 -
62 Beneuron Tablet - - 0 -
63 Benzatin Benzil Penisilin 1,2 juta iu/ vial 21 Vial - - 0 -
64 Benzatin Benzil Penisilin 2,4 juta iu/ vial Vial - - 0 -
65 Betahistin Mesilat 6 mg tablet 2.1 Tablet - - 0 -
66 Betametason 1 mg + Neomisin sulfat 14.1 Tube - - 0 -
67 Betametason krim 0,1 % Tube 102 102 13 89
68 Bionemi 5 Tablet - - 0 -
69 Bioplasenton krim 5 Tube - - 0 -
70 Bioron 5 Tablet - - 0 -
71 Bismecon Jelly 6.2.1 Tube - - 0 -
72 Bisoprolol tablet 5 mg 6.2.1 Tablet - - 0 -
73 Bisturi Set - - 0 -
74 Bivalex krim Tube - - 0 -
75 Blood Lancet Set 300 300 0 300
76 Calostrum Syr 10.2 Botol - - 0 -
77 Calsidol Sirup 18.5 Botol - - 0 -
78 Captopril tablet 12,5 mg 14.1 Tablet 2,700 2,700 400 2,300
79 Captopril tablet 25 mg 15 Tablet - - -
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 20.1 Set - - 0 -
81 Catgut chromic 2/0 75 C 30 M R 20.1 Set - - 0 -
82 Catgut chromic 2/0 75 C 37 M C Set - - 0 -
84 Catgut chromic 3/0 75 C 37 M R Set - - 0 -
85 Caviplex drop 16.2.1 Botol 4 4 0 4
86 Cefadroksil kapsul 500 mg 16.2.2 Kapsul 2,500 2,500 500 2,000
87 Cefadroksil sirup kering 125 mg/ml 26.3 Botol 386 386 20 366
88 Cefadroxil Syrup 250 mg/ml 25.6 Botol - - 0 -
89 Cefiksim kapsul 100 mg 20.2 Kapsul 1,320 1,320 280 1,040
90 Cefiksim syr kering100 mg/ml 20.2 Botol 36 36 10 26
91 Cefotaksim injeksi 1000 mg 20.2 Ampul - - 0 -
92 Cendo Xitrol tetes mata 6.4 Botol - - 0 -
93 Ceftriakson injeksi 23.4. Ampul - - 0 -
94 Cetrizin Sirup 5 mg/ ml 23.4 Botol 164 164 23 141
95 Cetrizin tablet 10 mg 17.3 Tablet 1,100 1,100 700 400
96 Cimetidin tablet 200 mg 18.4 Tablet 700 700 200 500
97 Ciprofloksasin infus 1.2 Botol - - 0 -
98 Ciprofloksasin tablet 500 mg 1.2 Tablet 4,800 4,800 100 4,700
99 Ciprofloksasin tetes telinga Botol - - 0 -
100 Clindamisin tablet 150 mg Tablet - - 0 -
101 Clindamisin tablet 300 mg Tablet 1,850 1,850 300 1,550
102 Clobetasol krim 0,05 % 16.2 Tube - - 0 -
103 Co-Amoksiklav tablet 625 mg 17.1 Tablet - - 0 -
104 Dasabion kapsul Kapsul - - 0 -
105 Deksametason injeksi 5 mg/ml - 1 ml 13.1 Ampul 250 250 5 245
106 Deksametason tablet 0,5 mg 14.1 Tablet 600 600 600 -
107 Dekstran 70 - larutan infus 6 % steril 29 Botol - - 0 -
108 Dekstrometorfan HBr sirup 10 mg / 5 ml Botol - - 0 -
109 Dekstrometorfan tablet 15 mg Tablet - - 0 -
110 Delecto HBS Ag ( Anti Gen) Set - - 0 -
111 Dentin Conditioner Set - - 0 -
112 Devitalisasi pasta (non arsen) Set - - 0 -
113 Dexocort 0.25% Krim (Desoksimetason 0.25 %) Tube 59 59 0 59
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine Hcl) Botol - - -
115 Diamond Bur Low Speed Set - - 0 -
116 Diazepam injeksi 5 mg Ampul - - 0 -
117 Diazepam tablet 2 mg Tablet - - 0 -
118 Diazepam tablet 5 mg 2.2 Tablet 365 365 35 330
119 Dietilkarbamzin Sitrat tablet 100 mg 6.3.1 Tablet - - 0 -
120 Difenhidramin HCl injeksi 10 mg/ml - 1 ml Ampul - - 0 -
121 Digoksin tablet 0,25 mg Tablet 400 400 0 400
122 Diltiazem tablet Tablet - - 0 -
123 Dimenhidrinat tablet 50 mg 3 Tablet 200 200 0 200
124 Doksisiklin kapsul 100 mg 6.5.2.2 Kapsul - - 0 -
125 Domperidon suspensi 5 mg/ml Botol 224 224 30 194
126 Domperidon tablet Tablet 2,200 2,200 700 1,500
127 Efedrin HCl tablet 25 mg Tablet - - 0 -
128 Ekstrak Belladone tablet 10 mg Tablet - - 0 -
129 Endometasone N Set - - 0 -
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0, 1.1 Ampul - - 0 -
131 Eritromisin kapsul 250 mg Kapsul - - 0 -
132 Eritromisin kapsul 500 mg 6.2.2.3 Kapsul 50 50 0 50
133 Eritromisin sirup 6.2.2.3 Botol 130 130 3 127

134 Erpha Livita Baby Drop Botol - - 0 -
135 Erya Forte 500 mg 6..2.2.3 Tablet - - 0 -
136 Etakridin (Rivanol) larutan 0,1 % 6..2.2.3 Botol 100 100 0 100
137 Etambutol HCl tablet 250 mg 6..2.2.3 Tablet - - 0 -
138 Etambutol HCl tablet 500 mg Tablet - - 0 -
139 Etanol 70 % Botol - - -
140 Etanol 70 %(1000 ml) Botol 30 30 3 27
141 Ethiperan Injeksi Ampul - - 0 -
142 Etil Klorida semprot Botol - - 0 -
143 Eugenol cairan Botol - - 0 -
144 Famotidin tablet 20 mg Tablet - - 0 -
145 Famotidin tablet 40 mg 14.1 Tablet - - 0 -
146 Feeding Tube No. 3,5 (35 cm) 13.2 Set - - 0 -
147 Feeding Tube No. 5 (100 cm) Set - - 0 -
148 Feeding Tube No. 8 (100 cm) Set - - 0 -
149 Fenitoin Natrium injeksi 50 mg/ml Ampul - - 0 -
150 Fenitoin Natrium kapsul 100 mg 6.1.1 Kapsul 200 200 100 100
151 Fenitoin Natrium kapsul 30 mg Kapsul - - 0 -
152 Fenobarbital injeksi 50 mg/ml - 2 ml 6.1.1 Ampul - - 0 -
153 Fenobarbital tablet 100 mg Tablet - - 0 -
154 Fenobarbital tablet 30 mg Tablet 295 295 150 145
155 Fenoksimetil Penisilina tablet 250 mg Tablet - - 0 -
156 Fenoksimetil Penisilina tablet 500 mg Tablet - - 0 -
157 Fenol Gliserol tetes telinga 10 % Botol - - 0 -
158 Ferriz Baby Drop Botol - -
159 FG Troches Tablet - - 0 -
160 Film IV Dress 67 P Box 300 300 0 300
161 Film IV Dress 67 S 14.1 Box - - 0 -
162 Film IV Dress 78 P 14.1 Box - - 0 -
163 Fitomenadion ( Vit k 1 ) injeksi 10 mg/ml - 1 ml Ampul 68 68 0 68
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg Tablet 500 500 30 470
165 Flucadek tablet Tablet - - 0 -
166 Fluconazole 150 mg 20.2 Tablet - - 0 -
167 Flucort N cream Tube - - 0 -
168 Fluoksetin (foransi 10 mg) Tablet - -
169 Folley Cateter 2 Way 30 cc No. 14 Set - - 0 -
170 Folley Cateter 2 Way 30 cc No. 16 4.1 Set - - 0 -
171 Folley Cateter 2 Way 30 cc No. 18 6.4 Set 33 33 0 33
172 Fundifar Tablet - - 0 -
173 Furosemida injeksi 10 mg Ampul - - 0 -
174 Furosemida tablet 40 mg Tablet 200 200 0 200
175 Garam Oralit untuk 200 ml air Sachet 1,800 1,800 0 1,800
176 Genoint Salep Mata (Gentamisin 0.1 % Sa 2.2 Tube 24 24 3 21
177 Gentamicin Injeksi 40 mg/ml 6.2.2.1 Ampul - - 0 -
178 Gentamisin salep kulit 0,1 % 21.2.2 Tube - - 0 -
179 Gentamisin sulfat tetes mata 0,3 % 21.2.2 Botol 30 30 30 -
180 Gentian Violet larutan 1 % 22.1 Botol 21 21 5 16

181 Geriavita 13.2 Tablet - - 0 -
182 Glass Ionomer Cement 1.2 Set - - 0 -
183 Glibenklamid tablet 5 mg 1.2 Tablet 700 700 100 600
184 Glimepirid 1 mg Tablet - - 0 -
185 Gliseril Guaiakolat tablet 100 mg Tablet 1,700 1,700 400 1,300
186 Gliserin 23.4 Botol - - 0 -
187 Glukonas Kalsikus Injeksi 10 % 23.4 Ampul - - 0 -
188 Glukosa larutan infus 10 % steril 1.1 Botol - - 0 -
189 Glukosa larutan infus 40 % steril 21.2.5 Botol - - 0 -
190 Glukosa larutan infus 5 % steril 6.1.1 Botol - - 0 -
191 Grahabion tablet 29 Tablet - - 0 -
192 Gralysin syr Botol - - 0 -
193 Griseofulvin tablet 125 mg Tablet 400 400 300 100
194 Griseofulvin tablet 250 mg (Micostop 250 mg) Tablet 500 500 0 500
195 Gutta Perca Set - - 0 -
196 Haloperidol Decanoat Inj 50 mg/ml Ampul - -
197 Halloperidol 5mg Tablet 1,270 1,270 30 1,240
198 Haloperidol tab 2 mg Tablet - 0 -
199 Haloperidol tablet 1,5 mg 6.5.2.2 Tablet 880 880 880
200 Haloperidol tablet 0,5 mg Tablet - 0 -
201 Hand Rub 500 ml Botol 7 7 2 5
202 Hcg Pregnancy Test 16.4 Set 300 300 0 300
203 Hemafort Tablet - - 0 -
204 Hidroklorotiazida (HCT) tablet 25 mg 6.2.1 Tablet 700 700 0 700
205 Hidrokortison krim 2,5 % 17.3 Tube 52 52 8 44
206 Hustab 17.3 Tablet 900 900 300 600
207 Hustab Syr 17.3 Botol - - -
208 Hyascine-N- Butil Bromida 20.2 Tablet - - 0 -
209 Hyoscine Butil Bromida inj 29 Ampul - - 0 -
210 Ibuprofen Suspensi 100 mg/ 5 ml 29 Botol - - 0 -
211 Ibuprofen Suspensi 200 mg/ 5 ml 6.3.2 Botol - - 0 -
212 Ibuprofen tablet 200 mg 6.3.2 Tablet - - 0 -
213 Ibuprofen tablet 400 mg 6.3.2 Tablet 3,000 3,000 1100 1,900
214 ID Band Red ( Adult) 26.1 Set - - 0 -
215 ID Band Red ( Child) 18.5 Set - - 0 -
216 Imerson Oil 14.2 Botol - - 0 -
217 Immustrum syr Botol - - 0 -
218 Infusion set anak Set 140 140 5 135
219 Infusion set dewasa Set 187 187 0 187
220 INH Anak 27.1 Tablet - - 0 -
221 Interzinc Syrup 27.1 Botol 2 2 0 2
222 Intunal Forte Tablet - -
223 Isoniazida tablet 300 mg 27.1 Tablet - - 0 -
224 Isosorbit Dinitrat tablet subligual 5 mg 27.1 Tablet 800 800 300 500
225 Isotic Clearens 27.1 Botol - - 0 -
226 Isotic Neolyson 10.1 Botol - - 0 -
227 IV cateter No. 16 Set - - 0 -

228 IV cateter No. 18 Set 350 350 3 347
229 IV Cateter No. 20 14.2 Set 242 242 3 239
230 IV cateter No. 22 6.3.2 Set 292 292 53 239
231 IV Cateter No. 24 6.3.2 Set 100 100 100 -
232 Jarum Extirsipasi 21.2.2 Set - - 0 -
233 Jarum File 14.2 Set - - 0 -
234 Jarum jahit bedah (steri) no 9 s/d 14 21.2.1 Set - - 0 -
235 Kaca Objek ( Objek Glass) Set - - 0 -
236 KA-EN 1B Botol - - 0 -
237 KA-EN 3A Botol - - 0 -
238 KA-EN 3B 6.2.2.1 Botol - - 0 -
239 Kalium diklofenak tablet 25 mg 6.2.2.1 Tablet - - 0 -
240 Kalium diklofenak tablet 50 mg 29 Tablet 200 200 0 200
241 Kalium Permanganat serbuk 29 Botol - - 0 -
242 Kalsium Hidroksi Pasta 2.2 Set - - 0 -
243 Kalsium Laktat (Kalak) tablet 9 Tablet 6,300 6,300 200 6,100
244 Kapas Berlemak 500 gram 14.2 Rol - - 0 -
245 Kapas Pembalut / Absorben 250 gram 27.2 Rol 19 19 0 19
246 Karbamazepain tablet 200 mg 29 Tablet - - 0 -
247 Kasa 10 x 80 cm 13.1 Rol 300 300 0 300
248 Kasa 40 x 80 Rol - - -
249 Kasa 5 x 80 cm Rol - - 0 -
250 Kasa Gulung 36 x 80 Rol - - 0 -
251 Kasa kompres 40/40 steril Set 1,200 1,200 0 1,200
252 Kasa Pembalut 2 m x 80 cm Rol - - 0 -
253 Kasa pembalut hidrofil 4 m x 15 cm Rol - - 0 -
254 Kasa pembalut hidrofil 4 m x 3 cm Rol - - 0 -
255 Kasa Pembalut Hidrofil 4 x 10 Rol - - 0 -
256 Kasa Steril 16 x 16 (Kasa Kotak) Kotak 87 87 10 77
257 Ketoknazole Krim 2 % Tube 83 83 36 47
258 Ketoknazole tablet 200 mg Tablet 150 150 0 150
259 Ketoprofen Suppositoria 100mg ( Fetik Supp) Supp 40 40 0 40
260 Ketoprofen Tablet 100 mg Tablet - - 0 -
261 Klopidogrel 75 mg Tablet - - 0 -
262 Kloramfekort krim Tube - - 0 -
263 Kloramfenikol kapsul 500 mg Kapsul 350 350 300 50
264 Kloramfenikol kapsul 250 mg Kapsul 400 400 0 400
265 Kloramfenikol salep mata 1 % Tube 104 104 27 77
266 Kloramfenikol suspensi Botol - - 0 -
267 Kloramfenikol tetes mata 0,5 % Botol - - 0 -
268 Kloramfenikol Tetes telinga 3 % Botol 11 11 3 8
269 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 4,700 4,700 1000 3,700
270 Klorfeson krim Tube - - 0 -
271 Klorokuin Fosfat tablet 150 mg Tablet - - 0 -
272 Klorokuin tablet 250 mg Tablet - - 0 -
273 Klorpromazin HCl inj. 25 mg/ml - 2 ml Ampul - - 0 -

274 Klorpromazin HCl inj. 5 mg/ml - 2 ml Ampul - - 0 -
275 Klorpromazin HCl tablet salut 100 mg Tablet 100 100 0 100
276 Klorpromazin HCl tablet salut 25 mg Tablet 1,015 1,015 10 1,005
277 Klorpropamid tablet 100 mg Tablet - - 0 -
278 Klozapin 25 mg Tablet - -
279 Kodein HCl tablet 10 mg Tablet - - 0 -
280 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg Tablet - - 0 -
281 Kontrasepsi Injeksi Depoprogestin/Suntik KB 3 Bln Tablet - - 0 -
282 Kotrimoksazol dewasa tablet Tablet 2,100 2,100 400 1,700
283 Kotrimoksazol pediatrik tablet Tablet - - 0 -
284 Kotrimoksazol Forte Kombinasi 800 mg/160 mg Tablet - -
285 Kotrimoksazol suspensi Botol 425 425 8 417
286 Kuinin (Kina) tablet 200 mg Tablet - - 0 -
287 Kuinin Dihidroklorida injeksi 25 % - 2 ml Ampul - - 0 -
288 Lansoprazol kapsul 30 mg Kapsul 900 900 220 680
289 Larutan Anisol Botol - - 0 -
290 Larutan Asam Klorida 0,1 N Botol - - 0 -
291 Larutan Benedict Botol - - 0 -
292 Larutan EDTA 10 % Botol - - 0 -
293 Larutan Eosin 2 % Botol - - 0 -
294 Larutan Etanol Asam Botol - - 0 -
295 Larutan Giemsa Stain Botol - - 0 -
296 Larutan Hayem Botol - - 0 -
297 Larutan Iodium 1 % Botol - - 0 -
298 Larutan Karbol Fuksin Botol - - 0 -
299 Larutan Metilen Biru Botol - - 0 -
300 Larutan Na Citrat 3,13 % Botol - - 0 -
301 Larutan Rees Ecker Botol - - 0 -
302 Larutan Turk Botol - - 0 -
303 Larutan Xylol Botol - - 0 -
304 Laxadine Emulsi 30 ml Botol 18 18 8 10
305 Laxana tablet Tablet - - 0 -
306 Laxarec supp Supp - - 0 -
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) Set 14 14 4 10
308 Leukoplast 1625 H ( plaster 7,5 cm x 4,5 M) Set - - -
309 Levofloksasin 0,5% tetes mata ( Optiflox) Botol 17 17 0 17
310 Levofloksasin kapsul 500 mg Kapsul 300 300 0 300
311 Lexapram 5mg/5 ml syrup Botol - - 0 -
312 Lexavit kaplet Kaplet - - 0 -
313 Lidokain (Pehakain) injeksi 2% Ampul - - 0 -
314 Lidokain injeksi 2 % Ampul 200 200 145 55
315 Lidokain Kompositum injeksi Ampul 30 30 0 30
316 Linkomisin kapsul 250 mg Kapsul - - 0 -
317 Linkomisin kapsul 500 mg Kapsul - - 0 -
318 Lisol Botol - - 0 -
319 Livron B Plex Tablet - - 0 -
320 Loperamida 2 mg tablet Tablet 1,100 1,100 600 500

321 Loratadine tablet 10 mg Tablet 2,200 2,200 0 2,200
322 Lorazepam 2 mg Tablet - -
323 Lyscavit Syrup Botol - -
324 Lytamin Sirup Botol - - -
325 Magnesium Sulfat inj (IV) 20% - 25 ml Ampul 141 141 0 141
326 Magnesium Sulfat inj (IV) 40% - 25 ml Ampul 120 120 0 120
327 Magnesium Sulfat serbuk 30 gram Sachet - - 0 -
328 Masker Set - - -
329 Masker N 95 Set 400 400 0 400
330 Masker Oxygen ( Dewasa) Set - - 0 -
331 Masker Oxygen (Anak) Set - - 0 -
332 Mebendazol tablet 100 mg Tube - - 0 -
333 Mebendazole 500 mg (Vermox) Tablet - - 0 -
334 Melavita Cream ( Asam Retinoat 0.1 %) Tube - - 0 -
335 Meloxicam kapsul 15 mg Tablet - - 0 -
336 Meloxicam kapsul 7,5 mg Kapsul - - 0 -
337 Merviton Tablet Tablet - -
338 Metampiron 500 mg, Diazepam 2 mg Tablet - - 0 -
339 Metanol Botol - - 0 -
340 Metformin kapsul 500 mg Tablet 2,500 2,500 400 2,100
341 Metil Prednisolon tablet 4 mg Tablet 1,100 1,100 750 350
342 Metilergometrin Maleat injeksi 0,200 mg - 1 ml Ampul 180 180 0 180
343 Metilergometrin Maleat tablet salut 0,125 mg Tablet 500 500 0 500
344 Metilprednisolon 8 mg tablet Tablet - - 0 -
345 Metoklopramide injeksi 5 mg/ml Ampul - - 0 -
346 Metoklopramide sirup 5 mg/ml Botol - - 0 -
347 Metoklopramide tablet 10 mg Tablet 700 700 0 700
348 Metronidazol infus Botol - - 0 -
349 Metronidazol tablet 250 mg Tablet 2,600 2,600 300 2,300
350 Metronidazol tablet 500 mg Tablet - - -
351 Metronidazole 500 mg Supp ( Vagizol Ovula) Supp 5 5 0 5
352 Miconazol krim 2 % Tube 158 158 5 153
353 Mixing Pad Tablet - - 0 -
354 Molagit tablet Tablet 180 180 0 180
355 Monoklorkamfer Mentol cairan (CHKM) Set - - 0 -
356 Mucohexin tab Tablet - - 0 -
357 Muliavit Syr Botol - -
358 Mummifying pasta Set - - 0 -
359 Mycorine Powder ( Miconazole 2 %) Botol - - 0 -
360 Nasal Canula (Selang Oksigen) Anak Set - - 0 -
361 Nasal Canula Bayi Set - - 0 -
362 Nasal Canula Dewasa Set - - 0 -
363 Natrium Bikarbonat tablet 500 mg Tablet 1,000 1,000 0 1,000
364 Natrium Diklofenat tablet 25 mg Tablet - - 0 -
365 Natrium Diklofenat tablet 50 mg Tablet 3,150 3,150 1450 1,700
366 Natrium Klorida larutan infus steril 0,9 % Botol - - 0 138
367 Natrium Tiosulfat injeksi 25 % - 2ml Ampul - - 0 -

368 Natrium Tiroksin 100 ug Tablet - - 0 -
369 Neocenta Gel Tube 3 3 0 3
370 Neurosanbe Plus kaplet Kaplet - - 0 -
371 Neurovit E tablet Ampul - - 0 -
372 Nice Care Under Pad Set - - 0 -
373 Nipedipin tablet 10 mg Tablet 500 500 200 300
374 Nistatin 100.000 iu/ g tablet vagina Tablet 600 600 100 500
375 Nistatin 500.000 iu tablet salut Tablet 800 800 200 600
376 Nocandis drop Botol - - 0 -
377 Nodiar tablet Tablet - - 0 -
378 Noza Tablet 500 500 140 360
379 Obat Anti Tuberkuloisi Kategori Anak paket - - 0 -
380 Obat Anti Tuberkulosis Kategori 1 paket - - 0 -
381 Obat Anti Tuberkulosis Kategori 1 (Kombipak) paket - - 0 -
382 Obat Anti Tuberkulosis Kategori 2 paket - - 0 -
383 Obat Anti Tuberkulosis Kategori 2 (Kombipak) paket - - 0 -
384 Obat Anti Tuberkulosis Kategori Sisipan paket - - 0 -
385 Obat Batuk Hitam (OBH) cairan Botol 195 195 40 155
386 Obat Batuk Hitam (OBH) Plus cairan Botol - - 0 -
387 Ofloksasin tablet 200 mg Tablet 100 100 100 -
388 Ofloxacin tablet 400 mg Tablet 100 100 0 100
389 Oksitetrasiklin HCl injeksi i.m 50 mg/ml - 10 ml Ampul - - 0 -
390 Oksitetrasiklin HCl salap 3 % Tube 70 70 49 21
391 Oksitetrasiklin HCl salap mata 1 % Tube - - 0 -
392 Oksitosin injeksi 10 iu/ml - 1ml Ampul 118 118 10 108
393 Omedeson 0,5 mg tablet Tablet - - 0 -
394 Omeprazol kapsul 20 mg Kapsul 1,110 1,110 600 510
395 Orphen Tablet Tablet - - 0 -
396 Oxfezin syr Botol - - 0 -
397 Oxycan Botol - - 0 -
398 Parasetamol Drop Botol - - 0 -
399 Parasetamol sirup 120 mg/5 ml Botol 169 169 65 104
400 Parasetamol tablet 100 mg Tablet - - 0 -
401 Parasetamol tablet 500 mg Tablet 5,200 5,200 3300 1,900
402 Pehavral Tablet - - 0 -
403 Pembalut Gips Set - - 0 -
404 Perfenazin HCl tablet 4 mg Tablet - - 0 -
405 Pethidin HCl injeksi 50 mg / ml - 2 ml Ampul - - 0 -
406 Pharmaton Formula Kapsul - - 0 -
407 Pil KB Kombinasi- Bliss 28 Tab Tablet - - 0 -
408 Pilokarpin HCl/Nitrat tetes mata 2 % Botol - - 0 -
409 Piracetam injeksi 1 g/5 ml Ampul - - 0 -
410 Piracetam injeksi 3 g/5 ml Ampul - - 0 -
411 Piracetam sirup Botol - - 0 -
412 Piracetam tablet 400 mg Tablet - - 0 -
413 Piracetam tablet 800 mg Tablet - - 0 -
414 Pirantel tablet 125 mg Tablet 80 80 0 80

415 Pirazinamida tablet 500 mg Tablet - - 0 -
416 Piridoksin HCl tablet 10 mg Tablet 3,000 3,000 0 3,000
417 Piridoksin HCl tablet 25 mg Tablet - -
418 Piroksikam kapsul 10 mg Kapsul - - 0 -
419 Piroksikam kapsul 20 mg Kapsul 3,000 3,000 700 2,300
420 Plester 5 yard x 2 inch Rol - - 0 -
421 Povidon Iodida larutan 10 % - 30 ml Botol 150 150 55 95
422 Povidon Iodida larutan 10 % - 300 ml Botol - - 0 -
423 Povidone Iodine 10 % 60 ml Botol - - 0 -
424 Prednison tablet 5 mg Tablet 900 900 500 400
425 Primakuin tablet 15 mg Tablet - - 0 -
426 Pritavit Kapsul - - 0 -
427 Prokain Benzil Penisilin 3 juta iu/vial injeksi Vial - - 0 -
428 Prolysin Syrup Plus Botol - - 0 -
429 Propanolo HCl tablet 40 mg Ampul - - 0 -
430 Propect tab/Ambroksol Tablet - - 0 -
431 Propitiourasil tablet 100 mg Tablet - - 0 -
432 Rabies Immune Globulin (Human) 150 iu/ml Vial - - 0 -
433 Ranitidin injeksi 25 mg/ml Ampul 245 245 155 90
434 Ranitidin tablet 150 mg Tablet 3,300 3,300 2000 1,300
435 Reagen Golongan Darah Anti A Botol - - 0 -
436 Reagen Golongan Darah Anti B Botol - - 0 -
437 Reserpin tablet 0,10 mg Tablet - - 0 -
438 Reserpin tablet 0,25 mg Tablet - - 0 -
439 Retinol (Vitamin A) kapsul 100.000 iu Kapsul - - 0 -
440 Retinol (Vitamin A) kapsul 200.000 iu Kapsul - - 0 -
441 Rifampisin kapsul 300 mg Kapsul - - 0 -
444 Ringer laktat larutan infus steril Botol - - 0 -
445 Risperidone 2 mg Tablet 125 125 20 105
446 Risperidone 1 mg Tablet 175 175 100 75
447 Safety Box kotak - - 0 -
448 Salbutamol tablet 2 mg Tablet 5,700 5,700 300 5,400
449 Salbutamol tablet 4 mg Tablet 1,400 1,400 200 1,200
450 Salep 2 - 4 kombinasi Tablet - - 0 -
451 Salisil Bedak 2 % Kotak - - 0 -
452 Sammoxin 500 mg tablet Tablet - - 0 -
453 Sanbe Kids Botol - - 0 -
454 Sangatonik kapsul Kapsul - - 0 -
455 Sarung Tangan Obgyn Steril Psg - - 0 -
456 Scabicid krim Tube - - 0 -
457 Scabimite krim Tube - - 0 -
458 Selcom - C kaplet Kaplet - - 0 -
459 Selvi Plex Tablet
460 Semen Seng Fosfat serbuk dan cairan Set - - 0 -
461 Serum anti bisa ular polivalen injeksi 50 mg (ABU) Ampul - - 0 -
462 Serum anti tetanus inj. 1.500 iu/ampul (a.t.s ) Ampul - - 0 -
463 Serum anti tetanus inj. 20.000 iu/ampul (a.t.s ) Ampul - - 0 -
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml Ampul 200 200 25 175
465 Sianokobalamin (Vitamin B12) tab 50 mcg Tablet 400 400 15 385
466 Silk (benang bedah sutera) no. 3/0 Set - - 0 -
467 Silver Amalgam serbuk 65 - 75 % Set - - 0 -

468 Simvastatin tablet 10 mg Tablet - - 0 -
471 Soft U Derm Hydro Urea Krim 10% Tube - - 0 -
472 Solvita Plus Syrup Botol - - 0 -
473 Spiramisin tablet 500 mg Tablet - - 0 -
474 Stesolid Suppositoria 10 mg Supp - - 0 -
475 Stesolid Suppositoria 5 mg Supp - - 0 -
476 Stomach tube FG 16 Set - - 0 -
477 Stomach tube FG 18 Set - - 0 -
478 Sulfadimidin tablet 500 mg Tablet - - 0 -
479 Sulfametoksazol 800 mg + Trimetoprim 160 mg Tablet - - 0 -
480 Supra Flu tablet Tablet - - 0 -
481 Suprabion tablet Tablet - - 0 -
482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L Psg - - -
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M Psg - - -
484 Surgical Glove Steril No 6,5 Psg - - 0 -
485 Surgical Gloves Non-Steril No 7 Psg - - 0 -
486 Surgical Gloves Non-Steril No 7,5 Psg - - -
487 Surgical Gloves Steril No 7 Psg - - -
488 Surgical Gloves Steril No 7,5 Psg - - 0 -
489 Surgical Tape 2.5 cm x 910 cm Psg - - 0 -
490 Surgical Tape 5 cm x 10 M (AXIMED) Pcs - -
491 Surgical Tape 1.25 cm x 10 M (AXIMED) Pcs - -
492 Tablet Tambah Darah Kombinasi Tablet - - 0 -
493 Tambalan Sementara Set - - 0 -
494 Tamiflu Tablet - - 0 -
495 Tarivid Otic Solution (Ofloxacin Tetes Telinga) Botol - - 0 -
496 Temporary stopping Fletcher serbuk dan cairan Set - - 0 -
497 Tetrakain HCl tetes mata Botol - - 0 -
498 Tetrasiklin HCl kapsul 250 mg Kapsul - - 0 -
499 Tetrasiklin HCl kapsul 500 mg Kapsul - - 0 -
500 Thiamphenicol kapsul 250 mg Kapsul - - 0 -
501 Thiamphenicol kapsul 500 mg Kapsul - - 0 -
502 Thramed Kapsul Kapsul - - 0 -
503 Tiamin HCl (Vit B 1) inj. 100 mg/ml - 1 ml Ampul - - 0 -
504 Tiamin HCl monohidrat (Vit B 1) tablet 50 mg Tablet 1,400 1,400 200 1,200
505 Tramadol injeksi 50 mg / ml Ampul 90 90 0 90
506 Tramadol tablet 50 mg Tablet - - 0 -
507 Trifastan 500 mg tablet Tablet - - 0 -
508 Trifluoperazin 5 mg Tablet - -
509 Triheksifenidil Hidroklorida tablet 2 mg Tablet 600 600 0 600
510 Trikresol Formali (TKF) cairan Set - - 0 -
511 Ulsidek 500 mg (Sucralfat) Tablet 300 300 0 300
512 Umbilical Cord Clamp Set 100 100 0 100
513 Urine Bag non steril Set - - 0 -
514 Vitalex kapsul Kapsul - - 0 -
515 Vitamin B komplek tablet Tablet 2,800 2,800 1800 1,000
516 Wing Needle Set 300 300 0 300
517 Yodium kapsul Kapsul - - 0 -
518 Zink Dispersible Tablet 7,300 7,300 800 6,500
UMUM ASKES JUMLAH

JUMLAH KUNJUNGAN RESEP TIDAK
BAYAR
BAYAR
Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / M

Kepala Dinas Kesehatan Kepala GFK Kepala Puskesm
(……………………………..) (……………………………..) Endang Suhada,

NIP. 19700901 19910
AKAIAN DAN LEMBAR PERMINTAAN OBAT LB. 2
BULAN : 0 1
TAHUN : 12 0 1 9
PEMBERIAN
PERMIN-
KET
TAAN
INPRES ASKES APBD LAIN JUMLAH
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
PEMBERIAN
PERMIN-
KET
TAAN
Yang Menerima / Melapor Yang Menerima

Kepala Puskesmas Petugas Puskesmas
Endang Suhada, SKM Dony Iswandi, S.Farm., Apt

NIP. 19700901 199101 1 001
KODE PUSKESMAS : LB. 2
PUSKESMAS : KUNTO DARUSSALAM LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT Halaman : 1
KECAMATAN : KUNTO DARUSSALAM ( LPLPO )
KABUPATEN : ROKAN HULU BULAN : 0 2
PROVINSI : R I A U TAHUN : 2015
2 0 1 9
PEMBERIAN
KELAS PERSE- STOK PERMIN-
KODE NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN SISA STOK KET
TERAPI DIAAN OPT. TAAN

2 Alat Suntik Sekali Pakai 0.05 ml 15.2 Botol - - 0 -
9 Albendazole tablet 400 mg 21.2 Tablet - 14770 14,770 14770 -
11 Alcohol + CHG 0,5% Swab 23.2 Kotak - 5 5 0 5
13 Allopurinol tablet 100 mg 25.2 Tablet - - 0 -
14 Alprazolam tablet 0,5 mg 26.2 Tablet - - 0 -
15 Ambroksol sirup 15 mg/ml 27.2 Botol 111 150 261 30 231
16 Ambroksol tablet 30 mg 28.2 Tablet 5,100 2000 7,100 900 6,200
18 Aminofilin tablet 200 mg 30.2 Tablet 300 300 0 300
19 Amitriptilin HCl tablet 25 mg 31.2 Tablet 760 760 0 760
20 Amlodipine tablet 10 mg 32.2 Tablet 1,140 1,140 150 990
21 Amlodipine tablet 5 mg 33.2 Tablet - - 0 -
22 Amoksisilin kaplet 500 mg 34.2 Tablet 12,600 5000 17,600 1500 16,100
24 Amoksisilin serbuk injeksi 1000 mg/ml 36.2 Vial - - 0 -
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol 231 231 30 201
26 Ampisilin ijeksi 1000 mg 38.2 Ampul - - 0 -
27 Ampisilin kaplet 500 mg 39.2 Tablet - - 0 -
PEMBERIAN
28 Ampisilin sirup kering 125 mg / 5 ml 40.2 Botol - - 0 -

29 Antalgin (Metampyron) tablet 500 mg 41.2 Tablet 2,700 2,700 300 2,400
30 Antalgin injeksi 250 mg / ml - 2 ml 42.2 Ampul - - 0 -
31 Antasida Doen suspensi 43.2 Botol 108 200 308 30 278
32 Antasida Doen tablet kombinasi 44.2 Tablet 700 3000 3,700 900 2,800
33 Antibakteri Doen Kombinasi / Bacitrasin 45.2 Tube - - 0 -
34 Antifungi Doen Kombinasi 46.2 Tube 48 48 0 48
35 Antihaemoroid Doen Kombinasi 47.2 Supp - - 0 -
36 Antimigrain Doen Kombinasi 48.2 Tablet - - 0 -
37 Aqua proinjeksi steril, bebas pirogen 49.2 Botol 173 173 0 173
38 Articulating Paper 50.2 Set - - 0 -
39 Asam Askorbat (Vitamin C) tablet 250 mg 51.2 Tablet - - 0 -
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 5,800 5,800 300 5,500
44 Asam Sulfosalisilat 20 % 56.2 Botol - - 0 -
45 Asam Traneksamat injeksi 57.2 Ampul - - 0 -
46 Asam Valproat 250mg/5ml 58.2 Botol 4 20 24 0 24
47 Asering (Asetat Ringer) 59.2 Botol - - 0 -
48 Asetosal tablet 100 mg 60.2 Tablet - - 0 -
50 Asiklovir krim 62.2 Tube 70 100 170 0 170
51 Asiklovir tablet 200 mg 63.2 Tablet 50 500 550 0 550
52 Asiklovir tablet 400 mg 64.2 Tablet 450 1000 1,450 0 1,450
53 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml 65.2 Ampul - - 0 -
54 Atropin Sulfat tablet 0,5 mg 66.2 Tablet - - 0 -
56 Attapulgit 68.2 Tablet 900 900 0 900
58 Becefort Syr 70.2 Botol - - 0 -
59 Becefort Tablet 71.2 Tablet - - 0 -
60 Becom C kaplet 72.2 Tablet - - 0 -
PEMBERIAN
62 Beneuron 74.2 Tablet - - 0 -

63 Benzatin Benzil Penisilin 1,2 juta iu/ vial 75.2 Vial - - 0 -
67 Betametason krim 0,1 % 79.2 Tube 89 100 189 20 169
68 Bionemi 80.2 Tablet - - 0 -
69 Bioplasenton krim 81.2 Tube - - 0 -
70 Bioron 82.2 Tablet - - 0 -
71 Bismecon Jelly 83.2 Tube - - 0 -
72 Bisoprolol tablet 5 mg 84.2 Tablet - - 0 -
73 Bisturi 85.2 Set - - 0 -
74 Bivalex krim 86.2 Tube - - 0 -
75 Blood Lancet 87.2 Set 300 300 0 300
78 Captopril tablet 12,5 mg 90.2 Tablet 2,300 2000 4,300 300 4,000
79 Captopril tablet 25 mg 91.2 Tablet - 1000 1,000 900 100
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set - - 0 -
82 Catgut chromic 2/0 75 C 37 M C 94.2 Set - - 0 -
85 Caviplex drop 97.2 Botol 4 4 0 4
86 Cefadroksil kapsul 500 mg 98.2 Kapsul 2,000 2000 4,000 600 3,400
93 Ceftriakson injeksi 105.2 Ampul - - 0 -
94 Cetrizin Sirup 5 mg/ ml 106.2 Botol 141 150 291 10 281
95 Cetrizin tablet 10 mg 107.2 Tablet 400 2000 2,400 200 2,200
PEMBERIAN
96 Cimetidin tablet 200 mg 108.2 Tablet 500 5000 5,500 300 5,200
99 Ciprofloksasin tetes telinga 111.2 Botol - - 0 -
100 Clindamisin tablet 150 mg 112.2 Tablet - - 0 -
101 Clindamisin tablet 300 mg 113.2 Tablet 1,550 1,550 0 1,550
104 Dasabion kapsul 116.2 Kapsul - - 0 -
106 Deksametason tablet 0,5 mg 118.2 Tablet - 3000 3,000 900 2,100
107 Dekstran 70 - larutan infus 6 % steril 119.2 Botol - - 0 -
108 Dekstrometorfan HBr sirup 10 mg / 5 ml 120.2 Botol - - 0 -
109 Dekstrometorfan tablet 15 mg 121.2 Tablet - - 0 -
110 Delecto HBS Ag ( Anti Gen) 122.2 Set - - 0 -
111 Dentin Conditioner 123.2 Set - - 0 -
112 Devitalisasi pasta (non arsen) 124.2 Set - - 0 -
113 Dexocort 0.25% Krim (Desoksimetason 0.25 %) 125.2 Tube 59 59 0 59
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine H 126.2 Botol - - 0 -
115 Diamond Bur Low Speed 127.2 Set - - 0 -
116 Diazepam injeksi 5 mg 128.2 Ampul - - 0 -
117 Diazepam tablet 2 mg 129.2 Tablet - - 0 -
119 Dietilkarbamzin Sitrat tablet 100 mg 131.2 Tablet - - 0 -
120 Difenhidramin HCl injeksi 10 mg/ml - 1 ml 132.2 Ampul - - 0 -
121 Digoksin tablet 0,25 mg 133.2 Tablet 400 400 0 400
122 Diltiazem tablet 134.2 Tablet - - 0 -
123 Dimenhidrinat tablet 50 mg 135.2 Tablet 200 200 0 200
124 Doksisiklin kapsul 100 mg 136.2 Kapsul - - 0 -
125 Domperidon suspensi 5 mg/ml 137.2 Botol 194 194 0 194
126 Domperidon tablet 138.2 Tablet 1,500 1,500 700 800
127 Efedrin HCl tablet 25 mg 139.2 Tablet - - 0 -
128 Ekstrak Belladone tablet 10 mg 140.2 Tablet - - 0 -
129 Endometasone N 141.2 Set - - 0 -
PEMBERIAN
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 m 142.2 Ampul - - 0 -

131 Eritromisin kapsul 250 mg 143.2 Kapsul - - 0 -
132 Eritromisin kapsul 500 mg 144.2 Kapsul 50 50 0 50
133 Eritromisin sirup 145.2 Botol 127 127 10 117
134 Erpha Livita Baby Drop 146.2 Botol - - 0 -
135 Erya Forte 500 mg 147.2 Tablet - - 0 -
136 Etakridin (Rivanol) larutan 0,1 % 148.2 Botol 100 100 0 100
137 Etambutol HCl tablet 250 mg 149.2 Tablet - - 0 -
139 Etanol 70 % 151.2 Botol - - 0 -
140 Etanol 70 %(1000 ml) 152.2 Botol 27 20 47 1 46
141 Ethiperan Injeksi 153.2 Ampul - - 0 -
142 Etil Klorida semprot 154.2 Botol - - 0 -
143 Eugenol cairan 155.2 Botol - - 0 -
147 Feeding Tube No. 5 (100 cm) 159.2 Set - - 0 -
149 Fenitoin Natrium injeksi 50 mg/ml 161.2 Ampul - - 0 -
150 Fenitoin Natrium kapsul 100 mg 162.2 Kapsul 100 300 400 0 400
151 Fenitoin Natrium kapsul 30 mg 163.2 Kapsul - - 0 -
152 Fenobarbital injeksi 50 mg/ml - 2 ml 164.2 Ampul - - 0 -
153 Fenobarbital tablet 100 mg 165.2 Tablet - - 0 -
154 Fenobarbital tablet 30 mg 166.2 Tablet 145 145 0 145
155 Fenoksimetil Penisilina tablet 250 mg 167.2 Tablet - - 0 -
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol - - 0 -
158 Ferriz Baby Drop 170.2 Botol - - -
159 FG Troches 171.2 Tablet - - 0 -
160 Film IV Dress 67 P 172.2 Box 300 300 0 300
162 Film IV Dress 78 P 174.2 Box - - 0 -
163 Fitomenadion ( Vit k 1 ) injeksi 10 mg/ml - 1 ml 175.2 Ampul 68 68 0 68
PEMBERIAN
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 470 1000 1,470 0 1,470
165 Flucadek tablet 177.2 Tablet - - 0 -
167 Flucort N cream 179.2 Tube - - 0 -
168 Fluoksetin (foransi 10 mg) 180.2 Tablet - - -
172 Fundifar 184.2 Tablet - - 0 -
173 Furosemida injeksi 10 mg 185.2 Ampul - - 0 -
174 Furosemida tablet 40 mg 186.2 Tablet 200 1000 1,200 0 1,200
175 Garam Oralit untuk 200 ml air 187.2 Sachet 1,800 1,800 100 1,700
176 Genoint Salep Mata (Gentamisin 0.1 % Salep Mata 188.2 Tube 21 24 45 0 45
177 Gentamicin Injeksi 40 mg/ml 189.2 Ampul - - 0 -
178 Gentamisin salep kulit 0,1 % 190.2 Tube - - 0 -
179 Gentamisin sulfat tetes mata 0,3 % 191.2 Botol - 24 24 0 24
183 Glibenklamid tablet 5 mg 195.2 Tablet 600 2000 2,600 100 2,500
184 Glimepirid 1 mg 196.2 Tablet - - 0 -
185 Gliseril Guaiakolat tablet 100 mg 197.2 Tablet 1,300 1500 2,800 200 2,600
191 Grahabion tablet 203.2 Tablet - - 0 -
192 Gralysin syr 204.2 Botol - - 0 -
193 Griseofulvin tablet 125 mg 205.2 Tablet 100 1000 1,100 100 1,000
194 Griseofulvin tablet 250 mg (Micostop 250 mg) 206.2 Tablet 500 500 0 500
195 Gutta Perca 207.2 Set - - 0 -
196 Haloperidol Decanoat Inj 50 mg/ml 208.2 Ampul - - -
197 Halloperidol 5mg 209.2 Tablet 1,240 1000 2,240 0 2,240
PEMBERIAN
198 Haloperidol tab 2 mg 210.2 Tablet - - -

199 Haloperidol tablet 1,5 mg 211.2 Tablet 880 880 0 880
200 Haloperidol tablet 0,5 mg 212.2 Tablet - - 0 -
201 Hand Rub 500 ml 213.2 Botol 5 5 0 5
203 Hemafort 215.2 Tablet - - 0 -
204 Hidroklorotiazida (HCT) tablet 25 mg 216.2 Tablet 700 700 0 700
205 Hidrokortison krim 2,5 % 217.2 Tube 44 96 140 0 140
206 Hustab 218.2 Tablet 600 900 1,500 0 1,500
207 Hustab Syr 219.2 Botol - - 0 -
209 Hyoscine Butil Bromida inj 221.2 Ampul - - 0 -
210 Ibuprofen Suspensi 100 mg/ 5 ml 222.2 Botol - 100 100 0 100
211 Ibuprofen Suspensi 200 mg/ 5 ml 223.2 Botol - - 0 -
212 Ibuprofen tablet 200 mg 224.2 Tablet - - 0 -
213 Ibuprofen tablet 400 mg 225.2 Tablet 1,900 1,900 800 1,100
214 ID Band Red ( Adult) 226.2 Set - - 0 -
215 ID Band Red ( Child) 227.2 Set - - 0 -
217 Immustrum syr 229.2 Botol - - 0 -
218 Infusion set anak 230.2 Set 135 135 0 135
219 Infusion set dewasa 231.2 Set 187 187 0 187
220 INH Anak 232.2 Tablet - - 0 -
221 Interzinc Syrup 233.2 Botol 2 2 0 2
222 Intunal Forte 234.2 Tablet - - -
227 IV cateter No. 16 239.2 Set - - 0 -
228 IV cateter No. 18 240.2 Set 347 200 547 8 539
229 IV Cateter No. 20 241.2 Set 239 200 439 0 439
230 IV cateter No. 22 242.2 Set 239 200 439 0 439
231 IV Cateter No. 24 243.2 Set - 200 200 0 200
PEMBERIAN
232 Jarum Extirsipasi 244.2 Set - - 0 -

233 Jarum File 245.2 Set - - 0 -
234 Jarum jahit bedah (steri) no 9 s/d 14 246.2 Set - - 0 -
235 Kaca Objek ( Objek Glass) 247.2 Set - - 0 -
236 KA-EN 1B 248.2 Botol - - 0 -
237 KA-EN 3A 249.2 Botol - - 0 -
238 KA-EN 3B 250.2 Botol - - 0 -
239 Kalium diklofenak tablet 25 mg 251.2 Tablet - - 0 -
240 Kalium diklofenak tablet 50 mg 252.2 Tablet 200 200 0 200
241 Kalium Permanganat serbuk 253.2 Botol - - 0 -
243 Kalsium Laktat (Kalak) tablet 255.2 Tablet 6,100 6,100 300 5,800
246 Karbamazepain tablet 200 mg 258.2 Tablet - - 0 -
247 Kasa 10 x 80 cm 259.2 Rol 300 300 0 300
248 Kasa 40 x 80 260.2 Rol - - 0 -
249 Kasa 5 x 80 cm 261.2 Rol - - 0 -
250 Kasa Gulung 36 x 80 262.2 Rol - - 0 -
251 Kasa kompres 40/40 steril 263.2 Set 1,200 1,200 0 1,200
252 Kasa Pembalut 2 m x 80 cm 264.2 Rol - - 0 -
253 Kasa pembalut hidrofil 4 m x 15 cm 265.2 Rol - - 0 -
255 Kasa Pembalut Hidrofil 4 x 10 267.2 Rol - - 0 -
256 Kasa Steril 16 x 16 (Kasa Kotak) 268.2 Kotak 77 77 0 77
257 Ketoknazole Krim 2 % 269.2 Tube 47 100 147 0 147
258 Ketoknazole tablet 200 mg 270.2 Tablet 150 500 650 0 650
259 Ketoprofen Suppositoria 100mg ( Fetik Supp) 271.2 Supp 40 40 0 40
260 Ketoprofen Tablet 100 mg 272.2 Tablet - - 0 -
261 Klopidogrel 75 mg 273.2 Tablet - - 0 -
262 Kloramfekort krim 274.2 Tube - - 0 -
263 Kloramfenikol kapsul 500 mg 275.2 Kapsul 50 50 50 -
264 Kloramfenikol kapsul 250 mg 276.2 Kapsul 400 400 0 400
265 Kloramfenikol salep mata 1 % 277.2 Tube 77 77 20 57
PEMBERIAN
266 Kloramfenikol suspensi 278.2 Botol - - 0 -

267 Kloramfenikol tetes mata 0,5 % 279.2 Botol - - 0 -
268 Kloramfenikol Tetes telinga 3 % 280.2 Botol 8 20 28 0 28
269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 3,700 3,700 900 2,800
270 Klorfeson krim 282.2 Tube - - 0 -
271 Klorokuin Fosfat tablet 150 mg 283.2 Tablet - - 0 -
272 Klorokuin tablet 250 mg 284.2 Tablet - - 0 -
273 Klorpromazin HCl inj. 25 mg/ml - 2 ml 285.2 Ampul - - 0 -
275 Klorpromazin HCl tablet salut 100 mg 287.2 Tablet 100 100 0 100
276 Klorpromazin HCl tablet salut 25 mg 288.2 Tablet 1,005 1,005 0 1,005
277 Klorpropamid tablet 100 mg 289.2 Tablet - - 0 -
278 Klozapin 25 mg 290.2 Tablet - - -
279 Kodein HCl tablet 10 mg 291.2 Tablet - - 0 -
280 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 m 292.2 Tablet - - 0 -
281 Kontrasepsi Injeksi Depoprogestin/Suntik KB 3 Bln 293.2 Tablet - - 0 -
282 Kotrimoksazol dewasa tablet 294.2 Tablet 1,700 1,700 500 1,200
283 Kotrimoksazol pediatrik tablet 295.2 Tablet - - 0 -
284 Kotrimoksazol Forte Kombinasi 800 mg/160 mg 296.2 Tablet - - -
285 Kotrimoksazol suspensi 297.2 Botol 417 417 10 407
286 Kuinin (Kina) tablet 200 mg 298.2 Tablet - - 0 -
287 Kuinin Dihidroklorida injeksi 25 % - 2 ml 299.2 Ampul - - 0 -
288 Lansoprazol kapsul 30 mg 300.2 Kapsul 680 680 0 680
289 Larutan Anisol 301.2 Botol - - 0 -
290 Larutan Asam Klorida 0,1 N 302.2 Botol - - 0 -
291 Larutan Benedict 303.2 Botol - - 0 -
292 Larutan EDTA 10 % 304.2 Botol - - 0 -
293 Larutan Eosin 2 % 305.2 Botol - - 0 -
294 Larutan Etanol Asam 306.2 Botol - - 0 -
295 Larutan Giemsa Stain 307.2 Botol - - 0 -
296 Larutan Hayem 308.2 Botol - - 0 -
297 Larutan Iodium 1 % 309.2 Botol - - 0 -
298 Larutan Karbol Fuksin 310.2 Botol - - 0 -
299 Larutan Metilen Biru 311.2 Botol - - 0 -
PEMBERIAN
300 Larutan Na Citrat 3,13 % 312.2 Botol - - 0 -

301 Larutan Rees Ecker 313.2 Botol - - 0 -
302 Larutan Turk 314.2 Botol - - 0 -
303 Larutan Xylol 315.2 Botol - - 0 -
304 Laxadine Emulsi 30 ml 316.2 Botol 10 10 0 10
305 Laxana tablet 317.2 Tablet - - 0 -
306 Laxarec supp 318.2 Supp - - 0 -
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set 10 20 30 0 30
308 Leukoplast 1625 H ( plaster 7,5 cm x 4,5 M) 320.2 Set - - 0 -
309 Levofloksasin 0,5% tetes mata ( Optiflox) 321.2 Botol 17 17 0 17
310 Levofloksasin kapsul 500 mg 322.2 Kapsul 300 300 0 300
311 Lexapram 5mg/5 ml syrup 323.2 Botol - - 0 -
312 Lexavit kaplet 324.2 Kaplet - - 0 -
313 Lidokain (Pehakain) injeksi 2% 325.2 Ampul - - 0 -
314 Lidokain injeksi 2 % 326.2 Ampul 55 55 0 55
315 Lidokain Kompositum injeksi 327.2 Ampul 30 30 0 30
316 Linkomisin kapsul 250 mg 328.2 Kapsul - - 0 -
318 Lisol 330.2 Botol - - 0 -
319 Livron B Plex 331.2 Tablet - - 0 -
320 Loperamida 2 mg tablet 332.2 Tablet 500 500 0 500
321 Loratadine tablet 10 mg 333.2 Tablet 2,200 2,200 0 2,200
322 Lorazepam 2 mg 334.2 Tablet - - -
323 Lyscavit Syrup 335.2 Botol - 48 48 48
324 Lytamin Sirup 336.2 Botol - - 0 -
325 Magnesium Sulfat inj (IV) 20% - 25 ml 337.2 Ampul 141 141 0 141
327 Magnesium Sulfat serbuk 30 gram 339.2 Sachet - - 0 -
328 Masker 340.2 Set - 1000 1,000 1000 -
329 Masker N 95 341.2 Set 400 400 0 400
330 Masker Oxygen ( Dewasa) 342.2 Set - - 0 -
331 Masker Oxygen (Anak) 343.2 Set - - 0 -
332 Mebendazol tablet 100 mg 344.2 Tube - - 0 -
333 Mebendazole 500 mg (Vermox) 345.2 Tablet - - 0 -
PEMBERIAN
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - - 0 -

335 Meloxicam kapsul 15 mg 347.2 Tablet - - 0 -
336 Meloxicam kapsul 7,5 mg 348.2 Kapsul - - 0 -
337 Merviton Tablet 349.2 Tablet - - -
338 Metampiron 500 mg, Diazepam 2 mg 350.2 Tablet - - 0 -
339 Metanol 351.2 Botol - - 0 -
340 Metformin kapsul 500 mg 352.2 Tablet 2,100 2000 4,100 300 3,800
341 Metil Prednisolon tablet 4 mg 353.2 Tablet 350 2000 2,350 100 2,250
342 Metilergometrin Maleat injeksi 0,200 mg - 1 ml 354.2 Ampul 180 180 0 180
343 Metilergometrin Maleat tablet salut 0,125 mg 355.2 Tablet 500 500 0 500
344 Metilprednisolon 8 mg tablet 356.2 Tablet - - 0 -
345 Metoklopramide injeksi 5 mg/ml 357.2 Ampul - - 0 -
346 Metoklopramide sirup 5 mg/ml 358.2 Botol - - 0 -
347 Metoklopramide tablet 10 mg 359.2 Tablet 700 700 0 700
348 Metronidazol infus 360.2 Botol - - 0 -
349 Metronidazol tablet 250 mg 361.2 Tablet 2,300 2,300 400 1,900
350 Metronidazol tablet 500 mg 362.2 Tablet - - 0 -
351 Metronidazole 500 mg Supp ( Vagizol Ovula) 363.2 Supp 5 5 0 5
352 Miconazol krim 2 % 364.2 Tube 153 153 10 143
353 Mixing Pad 365.2 Tablet - - 0 -
354 Molagit tablet 366.2 Tablet 180 180 100 80
355 Monoklorkamfer Mentol cairan (CHKM) 367.2 Set - - 0 -
356 Mucohexin tab 368.2 Tablet - - 0 -
357 Muliavit Syr 369.2 Botol - - -
358 Mummifying pasta 370.2 Set - - 0 -
359 Mycorine Powder ( Miconazole 2 %) 371.2 Botol - - 0 -
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set - 10 10 0 10
361 Nasal Canula Bayi 373.2 Set - - 0 -
362 Nasal Canula Dewasa 374.2 Set - 20 20 0 20
363 Natrium Bikarbonat tablet 500 mg 375.2 Tablet 1,000 1,000 200 800
364 Natrium Diklofenat tablet 25 mg 376.2 Tablet - - 0 -
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet 1,700 3000 4,700 850 3,850
366 Natrium Klorida larutan infus steril 0,9 % 378.2 Botol 138 300 438 300 138
367 Natrium Tiosulfat injeksi 25 % - 2ml 379.2 Ampul - - 0 -
PEMBERIAN
368 Natrium Tiroksin 100 ug 380.2 Tablet - - 0 -

369 Neocenta Gel 381.2 Tube 3 3 0 3
370 Neurosanbe Plus kaplet 382.2 Kaplet - - 0 -
371 Neurovit E tablet 383.2 Ampul - - 0 -
372 Nice Care Under Pad 384.2 Set - - 0 -
373 Nipedipin tablet 10 mg 385.2 Tablet 300 300 0 300
374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 500 500 0 500
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 600 600 0 600
376 Nocandis drop 388.2 Botol - - 0 -
377 Nodiar tablet 389.2 Tablet - - 0 -
378 Noza 390.2 Tablet 360 500 860 0 860
379 Obat Anti Tuberkuloisi Kategori Anak 391.2 paket - - 0 -
380 Obat Anti Tuberkulosis Kategori 1 392.2 paket - - 0 -
381 Obat Anti Tuberkulosis Kategori 1 (Kombipak) 393.2 paket - - 0 -
384 Obat Anti Tuberkulosis Kategori Sisipan 396.2 paket - - 0 -
385 Obat Batuk Hitam (OBH) cairan 397.2 Botol 155 200 355 10 345
386 Obat Batuk Hitam (OBH) Plus cairan 398.2 Botol - - 0 -
387 Ofloksasin tablet 200 mg 399.2 Tablet - - 0 -
388 Ofloxacin tablet 400 mg 400.2 Tablet 100 100 0 100
389 Oksitetrasiklin HCl injeksi i.m 50 mg/ml - 10 ml 401.2 Ampul - - 0 -
390 Oksitetrasiklin HCl salap 3 % 402.2 Tube 21 100 121 10 111
391 Oksitetrasiklin HCl salap mata 1 % 403.2 Tube - - 0 -
392 Oksitosin injeksi 10 iu/ml - 1ml 404.2 Ampul 108 108 0 108
393 Omedeson 0,5 mg tablet 405.2 Tablet - - 0 -
394 Omeprazol kapsul 20 mg 406.2 Kapsul 510 510 390 120
395 Orphen Tablet 407.2 Tablet - - 0 -
396 Oxfezin syr 408.2 Botol - - 0 -
397 Oxycan 409.2 Botol - - 0 -
398 Parasetamol Drop 410.2 Botol - - 0 -
399 Parasetamol sirup 120 mg/5 ml 411.2 Botol 104 200 304 50 254
400 Parasetamol tablet 100 mg 412.2 Tablet - - 0 -
401 Parasetamol tablet 500 mg 413.2 Tablet 1,900 5000 6,900 3800 3,100
PEMBERIAN
402 Pehavral 414.2 Tablet - - 0 -

403 Pembalut Gips 415.2 Set - - 0 -
404 Perfenazin HCl tablet 4 mg 416.2 Tablet - - 0 -
405 Pethidin HCl injeksi 50 mg / ml - 2 ml 417.2 Ampul - - 0 -
406 Pharmaton Formula 418.2 Kapsul - - 0 -
407 Pil KB Kombinasi- Bliss 28 Tab 419.2 Tablet - - 0 -
408 Pilokarpin HCl/Nitrat tetes mata 2 % 420.2 Botol - - 0 -
409 Piracetam injeksi 1 g/5 ml 421.2 Ampul - - 0 -
411 Piracetam sirup 423.2 Botol - - 0 -
412 Piracetam tablet 400 mg 424.2 Tablet - - 0 -
414 Pirantel tablet 125 mg 426.2 Tablet 80 80 0 80
415 Pirazinamida tablet 500 mg 427.2 Tablet - - 0 -
416 Piridoksin HCl tablet 10 mg 428.2 Tablet 3,000 3,000 0 3,000
417 Piridoksin HCl tablet 25 mg 429.2 Tablet - - -
418 Piroksikam kapsul 10 mg 430.2 Kapsul - - 0 -
419 Piroksikam kapsul 20 mg 431.2 Kapsul 2,300 2000 4,300 400 3,900
420 Plester 5 yard x 2 inch 432.2 Rol - - 0 -
421 Povidon Iodida larutan 10 % - 30 ml 433.2 Botol 95 95 10 85
422 Povidon Iodida larutan 10 % - 300 ml 434.2 Botol - - 0 -
423 Povidone Iodine 10 % 60 ml 435.2 Botol - - 0 -
424 Prednison tablet 5 mg 436.2 Tablet 400 1000 1,400 200 1,200
425 Primakuin tablet 15 mg 437.2 Tablet - - 0 -
426 Pritavit 438.2 Kapsul - - 0 -
427 Prokain Benzil Penisilin 3 juta iu/vial injeksi 439.2 Vial - - 0 -
428 Prolysin Syrup Plus 440.2 Botol - - 0 -
429 Propanolo HCl tablet 40 mg 441.2 Ampul - - 0 -
430 Propect tab/Ambroksol 442.2 Tablet - - 0 -
431 Propitiourasil tablet 100 mg 443.2 Tablet - - 0 -
432 Rabies Immune Globulin (Human) 150 iu/ml 444.2 Vial - - 0 -
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul 90 90 0 90
434 Ranitidin tablet 150 mg 446.2 Tablet 1,300 1000 2,300 800 1,500
435 Reagen Golongan Darah Anti A 447.2 Botol - - 0 -
436 Reagen Golongan Darah Anti B 448.2 Botol - - 0 -
437 Reserpin tablet 0,10 mg 449.2 Tablet - - 0 -
439 Retinol (Vitamin A) kapsul 100.000 iu 451.2 Kapsul - 750 750 0 750
440 Retinol (Vitamin A) kapsul 200.000 iu 452.2 Kapsul - 10850 10,850 0 10,850
PEMBERIAN
441 Rifampisin kapsul 300 mg 453.2 Kapsul - - 0 -

444 Ringer laktat larutan infus steril 456.2 Botol - 300 300 300 -
445 Risperidone 2 mg 457.2 Tablet 105 105 0 105
446 Risperidone 1 mg 458.2 Tablet 75 75 0 75
447 Safety Box 459.2 kotak - - 0 -
448 Salbutamol tablet 2 mg 460.2 Tablet 5,400 5,400 0 5,400
450 Salep 2 - 4 kombinasi 462.2 Tablet - - 0 -
451 Salisil Bedak 2 % 463.2 Kotak - - 0 -
452 Sammoxin 500 mg tablet 464.2 Tablet - - 0 -
453 Sanbe Kids 465.2 Botol - - 0 -
454 Sangatonik kapsul 466.2 Kapsul - - 0 -
455 Sarung Tangan Obgyn Steril 467.2 Psg - - 0 -
456 Scabicid krim 468.2 Tube - - 0 -
457 Scabimite krim 469.2 Tube - - 0 -
458 Selcom - C kaplet 470.2 Kaplet - - 0 -
459 Selvi Plex - 2000 2,000 300 1,700
460 Semen Seng Fosfat serbuk dan cairan 471.2 Set - - 0 -
461 Serum anti bisa ular polivalen injeksi 50 mg (ABU) 472.2 Ampul - - 0 -
462 Serum anti tetanus inj. 1.500 iu/ampul (a.t.s ) 473.2 Ampul - - 0 -
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml 475.2 Ampul 175 175 0 175
465 Sianokobalamin (Vitamin B12) tab 50 mcg 476.2 Tablet 385 385 385 -
466 Silk (benang bedah sutera) no. 3/0 477.2 Set - - 0 -
467 Silver Amalgam serbuk 65 - 75 % 478.2 Set - - 0 -
468 Simvastatin tablet 10 mg 479.2 Tablet - - 0 -
471 Soft U Derm Hydro Urea Krim 10% 482.2 Tube - - 0 -
472 Solvita Plus Syrup 483.2 Botol - - 0 -
473 Spiramisin tablet 500 mg 484.2 Tablet - - 0 -
474 Stesolid Suppositoria 10 mg 485.2 Supp - - 0 -
476 Stomach tube FG 16 487.2 Set - - 0 -
478 Sulfadimidin tablet 500 mg 489.2 Tablet - - 0 -
479 Sulfametoksazol 800 mg + Trimetoprim 160 mg 490.2 Tablet - - 0 -
PEMBERIAN
480 Supra Flu tablet 491.2 Tablet - - 0 -

481 Suprabion tablet 492.2 Tablet - - 0 -
482 Surgcal Gloves Non Steril L/ Handscoen Non Steril 493.2 Psg - - 0 -
483 Surgcal Gloves Non Steril M/Handscoen Non Steril 494.2 Psg - - 0 -
484 Surgical Glove Steril No 6,5 495.2 Psg - - 0 -
485 Surgical Gloves Non-Steril No 7 496.2 Psg - - 0 -
486 Surgical Gloves Non-Steril No 7,5 497.2 Psg - - 0 -
487 Surgical Gloves Steril No 7 498.2 Psg - - 0 -
488 Surgical Gloves Steril No 7,5 499.2 Psg - - 0 -
489 Surgical Tape 2.5 cm x 910 cm 500.2 Psg - - 0 -
490 Surgical Tape 5 cm x 10 M (AXIMED) 501.2 Pcs - - -
491 Surgical Tape 1.25 cm x 10 M (AXIMED) 502.2 Pcs - - -
492 Tablet Tambah Darah Kombinasi 503.2 Tablet - 153578 153,578 0 153,578
493 Tambalan Sementara 504.2 Set - - 0 -
494 Tamiflu 505.2 Tablet - - 0 -
495 Tarivid Otic Solution (Ofloxacin Tetes Telinga) 506.2 Botol - - 0 -
496 Temporary stopping Fletcher serbuk dan cairan 507.2 Set - - 0 -
497 Tetrakain HCl tetes mata 508.2 Botol - - 0 -
498 Tetrasiklin HCl kapsul 250 mg 509.2 Kapsul - - 0 -
500 Thiamphenicol kapsul 250 mg 511.2 Kapsul - - 0 -
502 Thramed Kapsul 513.2 Kapsul - - 0 -
503 Tiamin HCl (Vit B 1) inj. 100 mg/ml - 1 ml 514.2 Ampul - - 0 -
504 Tiamin HCl monohidrat (Vit B 1) tablet 50 mg 515.2 Tablet 1,200 1,200 200 1,000
505 Tramadol injeksi 50 mg / ml 516.2 Ampul 90 90 0 90
506 Tramadol tablet 50 mg 517.2 Tablet - - 0 -
507 Trifastan 500 mg tablet 518.2 Tablet - - 0 -
508 Trifluoperazin 5 mg 519.2 Tablet - - -
509 Triheksifenidil Hidroklorida tablet 2 mg 520.2 Tablet 600 600 0 600
510 Trikresol Formali (TKF) cairan 521.2 Set - - 0 -
511 Ulsidek 500 mg (Sucralfat) 522.2 Tablet 300 300 0 300
512 Umbilical Cord Clamp 523.2 Set 100 100 0 100
513 Urine Bag non steril 524.2 Set - - 0 -
514 Vitalex kapsul 525.2 Kapsul - - 0 -
515 Vitamin B komplek tablet 526.2 Tablet 1,000 3000 4,000 500 3,500
516 Wing Needle 527.2 Set 300 300 0 300
517 Yodium kapsul 528.2 Kapsul - - 0 -
518 Zink Dispersible 529.2 Tablet 6,500 2000 8,500 300 8,200
PEMBERIAN
UMUM ASKES JUMLAH

JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

Kepala Dinas Kesehatan Kepala GFK Kepala Puskesmas Petugas Puskesmas
(……………………………..) (………………………..) Endang Suhada, SKM Dony Iswandi, S.Farm., Apt

NIP. 19700901 199101 1 001
KODE PUSKESMAS :
PUSKESMAS : KUNTO DARUSSALAM LAPORAN PEMAKAIA
KECAMATAN : KUNTO DARUSSALAM
KABUPATEN : ROKAN HULU
PROVINSI : R I A U
KELAS
KODE NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSE-DIAAN
TERAPI
1 Air Raksa Dental Use 14.2 Botol - -

2 Alat Suntik Sekali Pakai 0.05 ml 15.2 Botol - -
3 Alat Suntik Sekali Pakai 1 ml 15.2 Set 1,250 1,250
4 Alat Suntik Sekali Pakai 2,5 ml 16.2 Set 200 200
5 Alat Suntik Sekali Pakai 3 ml 17.2 Set 368 368
6 Alat Suntik Sekali Pakai 5 ml 18.2 Set 957 957
7 Alat suntik Sekali Pakai 10 ml 19.2 Set - -
8 Alat suntik Sekali Pakai 20 ml 20.2 Set - -
9 Albendazole tablet 400 mg 21.2 Tablet - -
10 Albion tablet 22.2 Tablet - -
11 Alcohol + CHG 0,5% Swab 23.2 Kotak 5 5
12 Alkacide 1 L -2 Alkacid 10 24.2 Botol - -
13 Allopurinol tablet 100 mg 25.2 Tablet - -
14 Alprazolam tablet 0,5 mg 26.2 Tablet - -
15 Ambroksol sirup 15 mg/ml 27.2 Botol 231 231
16 Ambroksol tablet 30 mg 28.2 Tablet 6,200 6,200
17 Aminofilin injeksi 24 mg/ml - 10 ml 29.2 Ampul - -
18 Aminofilin tablet 200 mg 30.2 Tablet 300 300
19 Amitriptilin HCl tablet 25 mg 31.2 Tablet 760 760
20 Amlodipine tablet 10 mg 32.2 Tablet 990 990
21 Amlodipine tablet 5 mg 33.2 Tablet - -
22 Amoksisilin kaplet 500 mg 34.2 Tablet 16,100 16,100
23 Amoksisilin kapsul 250 mg 35.2 Tablet - -
24 Amoksisilin serbuk injeksi 1000 mg/ml 36.2 Vial - -
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol 201 201
26 Ampisilin ijeksi 1000 mg 38.2 Ampul - -
27 Ampisilin kaplet 500 mg 39.2 Tablet - -
28 Ampisilin sirup kering 125 mg / 5 ml 40.2 Botol - -
29 Antalgin (Metampyron) tablet 500 mg 41.2 Tablet 2,400 2,400
30 Antalgin injeksi 250 mg / ml - 2 ml 42.2 Ampul - -
31 Antasida Doen suspensi 43.2 Botol 278 278
32 Antasida Doen tablet kombinasi 44.2 Tablet 2,800 2,800
33 Antibakteri Doen Kombinasi / Bacitrasin 45.2 Tube - -
34 Antifungi Doen Kombinasi 46.2 Tube 48 48
35 Antihaemoroid Doen Kombinasi 47.2 Supp - -
36 Antimigrain Doen Kombinasi 48.2 Tablet - -
37 Aqua proinjeksi steril, bebas pirogen 49.2 Botol 173 173
38 Articulating Paper 50.2 Set - -
39 Asam Askorbat (Vitamin C) tablet 250 mg 51.2 Tablet - -
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 5,500 5,500
KELAS
TERAPI
41 Asam Folat 53.2 Tablet 700 700

42 Asam Mefenamat kapsul 250 mg 54.2 Kapsul - -
43 Asam Mefenamat tablet 500 mg 55.2 Tablet 8,600 8,600
44 Asam Sulfosalisilat 20 % 56.2 Botol - -
45 Asam Traneksamat injeksi 57.2 Ampul - -
46 Asam Valproat 250mg/5ml 58.2 Botol 24 24
47 Asering (Asetat Ringer) 59.2 Botol - -
48 Asetosal tablet 100 mg 60.2 Tablet - -
49 Asetosal tablet 500 mg 61.2 Tablet - -
50 Asiklovir krim 62.2 Tube 170 170
51 Asiklovir tablet 200 mg 63.2 Tablet 550 550
52 Asiklovir tablet 400 mg 64.2 Tablet 1,450 1,450
53 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml 65.2 Ampul - -
54 Atropin Sulfat tablet 0,5 mg 66.2 Tablet - -
55 Atropin Sulfat Tetes Mata 0,5 % 67.2 Botol - -
56 Attapulgit 68.2 Tablet 900 900
57 Baby Cough Syr 69.2 Botol - -
58 Becefort Syr 70.2 Botol - -
59 Becefort Tablet 71.2 Tablet - -
60 Becom C kaplet 72.2 Tablet - -
61 Bekarbon tablet 500 mg 73.2 Tablet - -
62 Beneuron 74.2 Tablet - -
63 Benzatin Benzil Penisilin 1,2 juta iu/ vial 75.2 Vial - -
64 Benzatin Benzil Penisilin 2,4 juta iu/ vial 76.2 Vial - -
65 Betahistin Mesilat 6 mg tablet 77.2 Tablet - -
66 Betametason 1 mg + Neomisin sulfat 78.2 Tube - -
67 Betametason krim 0,1 % 79.2 Tube 169 169
68 Bionemi 80.2 Tablet - -
69 Bioplasenton krim 81.2 Tube - -
70 Bioron 82.2 Tablet - -
71 Bismecon Jelly 83.2 Tube - -
72 Bisoprolol tablet 5 mg 84.2 Tablet - -
73 Bisturi 85.2 Set - -
74 Bivalex krim 86.2 Tube - -
75 Blood Lancet 87.2 Set 300 300
76 Calostrum Syr 88.2 Botol - -
77 Calsidol Sirup 89.2 Botol - -
78 Captopril tablet 12,5 mg 90.2 Tablet 4,000 4,000
79 Captopril tablet 25 mg 91.2 Tablet 100 100
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set - -
81 Catgut chromic 2/0 75 C 30 M R 93.2 Set - -
82 Catgut chromic 2/0 75 C 37 M C 94.2 Set - -
85 Caviplex drop 97.2 Botol 4 4
86 Cefadroksil kapsul 500 mg 98.2 Kapsul 3,400 3,400
KELAS
TERAPI
87 Cefadroksil sirup kering 125 mg/ml 99.2 Botol 366 366

88 Cefadroxil Syrup 250 mg/ml 100.2 Botol - -
89 Cefiksim kapsul 100 mg 101.2 Kapsul 1,040 1,040
90 Cefiksim syr kering100 mg/ml 102.2 Botol 26 26
91 Cefotaksim injeksi 1000 mg 103.2 Ampul - -
92 Cendo Xitrol tetes mata 104.2 Botol - -
93 Ceftriakson injeksi 105.2 Ampul - -
94 Cetrizin Sirup 5 mg/ ml 106.2 Botol 281 281
95 Cetrizin tablet 10 mg 107.2 Tablet 2,200 2,200
96 Cimetidin tablet 200 mg 108.2 Tablet 5,200 5,200
97 Ciprofloksasin infus 109.2 Botol - -
98 Ciprofloksasin tablet 500 mg 110.2 Tablet 4,700 4,700
99 Ciprofloksasin tetes telinga 111.2 Botol - -
100 Clindamisin tablet 150 mg 112.2 Tablet - -
101 Clindamisin tablet 300 mg 113.2 Tablet 1,550 1,550
102 Clobetasol krim 0,05 % 114.2 Tube - -
103 Co-Amoksiklav tablet 625 mg 115.2 Tablet - -
104 Dasabion kapsul 116.2 Kapsul - -
105 Deksametason injeksi 5 mg/ml - 1 ml 117.2 Ampul 245 245
106 Deksametason tablet 0,5 mg 118.2 Tablet 2,100 2,100
107 Dekstran 70 - larutan infus 6 % steril 119.2 Botol - -
108 Dekstrometorfan HBr sirup 10 mg / 5 ml 120.2 Botol - -
109 Dekstrometorfan tablet 15 mg 121.2 Tablet - -
110 Delecto HBS Ag ( Anti Gen) 122.2 Set - -
111 Dentin Conditioner 123.2 Set - -
112 Devitalisasi pasta (non arsen) 124.2 Set - -
113 Dexocort 0.25% Krim (Desoksimetason 0.25 %) 125.2 Tube 59 59
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine Hcl) 126.2 Botol - -
115 Diamond Bur Low Speed 127.2 Set - -
116 Diazepam injeksi 5 mg 128.2 Ampul - -
117 Diazepam tablet 2 mg 129.2 Tablet - -
118 Diazepam tablet 5 mg 130.2 Tablet 330 330
119 Dietilkarbamzin Sitrat tablet 100 mg 131.2 Tablet - -
120 Difenhidramin HCl injeksi 10 mg/ml - 1 ml 132.2 Ampul - -
121 Digoksin tablet 0,25 mg 133.2 Tablet 400 400
122 Diltiazem tablet 134.2 Tablet - -
123 Dimenhidrinat tablet 50 mg 135.2 Tablet 200 200
124 Doksisiklin kapsul 100 mg 136.2 Kapsul - -
125 Domperidon suspensi 5 mg/ml 137.2 Botol 194 194
126 Domperidon tablet 138.2 Tablet 800 800
127 Efedrin HCl tablet 25 mg 139.2 Tablet - -
128 Ekstrak Belladone tablet 10 mg 140.2 Tablet - -
129 Endometasone N 141.2 Set - -
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 ml 142.2 Ampul - -
131 Eritromisin kapsul 250 mg 143.2 Kapsul - -
132 Eritromisin kapsul 500 mg 144.2 Kapsul 50 50
KELAS
TERAPI
133 Eritromisin sirup 145.2 Botol 117 117

134 Erpha Livita Baby Drop 146.2 Botol - -
135 Erya Forte 500 mg 147.2 Tablet - -
136 Etakridin (Rivanol) larutan 0,1 % 148.2 Botol 100 100
137 Etambutol HCl tablet 250 mg 149.2 Tablet - -
138 Etambutol HCl tablet 500 mg 150.2 Tablet - -
139 Etanol 70 % 151.2 Botol - -
140 Etanol 70 %(1000 ml) 152.2 Botol 46 46
141 Ethiperan Injeksi 153.2 Ampul - -
142 Etil Klorida semprot 154.2 Botol - -
143 Eugenol cairan 155.2 Botol - -
144 Famotidin tablet 20 mg 156.2 Tablet - -
145 Famotidin tablet 40 mg 157.2 Tablet - -
146 Feeding Tube No. 3,5 (35 cm) 158.2 Set - -
147 Feeding Tube No. 5 (100 cm) 159.2 Set - -
148 Feeding Tube No. 8 (100 cm) 160.2 Set - -
149 Fenitoin Natrium injeksi 50 mg/ml 161.2 Ampul - -
150 Fenitoin Natrium kapsul 100 mg 162.2 Kapsul 400 400
151 Fenitoin Natrium kapsul 30 mg 163.2 Kapsul - -
152 Fenobarbital injeksi 50 mg/ml - 2 ml 164.2 Ampul - -
153 Fenobarbital tablet 100 mg 165.2 Tablet - -
154 Fenobarbital tablet 30 mg 166.2 Tablet 145 145
155 Fenoksimetil Penisilina tablet 250 mg 167.2 Tablet - -
156 Fenoksimetil Penisilina tablet 500 mg 168.2 Tablet - -
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol - -
158 Ferriz Baby Drop 170.2 Botol - -
159 FG Troches 171.2 Tablet - -
160 Film IV Dress 67 P 172.2 Box 300 300
161 Film IV Dress 67 S 173.2 Box - -
162 Film IV Dress 78 P 174.2 Box - -
163 Fitomenadion ( Vit k 1 ) injeksi 10 mg/ml - 1 ml 175.2 Ampul 68 68
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 1,470 1,470
165 Flucadek tablet 177.2 Tablet - -
166 Fluconazole 150 mg 178.2 Tablet - -
167 Flucort N cream 179.2 Tube - -
168 Fluoksetin (foransi 10 mg) 180.2 Tablet - -
169 Folley Cateter 2 Way 30 cc No. 14 181.2 Set - -
170 Folley Cateter 2 Way 30 cc No. 16 182.2 Set - -
171 Folley Cateter 2 Way 30 cc No. 18 183.2 Set 33 33
172 Fundifar 184.2 Tablet - -
173 Furosemida injeksi 10 mg 185.2 Ampul - -
174 Furosemida tablet 40 mg 186.2 Tablet 1,200 1,200
175 Garam Oralit untuk 200 ml air 187.2 Sachet 1,700 1,700
176 Genoint Salep Mata (Gentamisin 0.1 % Salep Mata) 188.2 Tube 45 45
177 Gentamicin Injeksi 40 mg/ml 189.2 Ampul - -
178 Gentamisin salep kulit 0,1 % 190.2 Tube - -
KELAS
TERAPI
179 Gentamisin sulfat tetes mata 0,3 % 191.2 Botol 24 24

180 Gentian Violet larutan 1 % 192.2 Botol 11 11
181 Geriavita 193.2 Tablet - -
182 Glass Ionomer Cement 194.2 Set - -
183 Glibenklamid tablet 5 mg 195.2 Tablet 2,500 2,500
184 Glimepirid 1 mg 196.2 Tablet - -
185 Gliseril Guaiakolat tablet 100 mg 197.2 Tablet 2,600 2,600
186 Gliserin 198.2 Botol - -
187 Glukonas Kalsikus Injeksi 10 % 199.2 Ampul - -
188 Glukosa larutan infus 10 % steril 200.2 Botol - -
191 Grahabion tablet 203.2 Tablet - -
192 Gralysin syr 204.2 Botol - -
193 Griseofulvin tablet 125 mg 205.2 Tablet 1,000 1,000
194 Griseofulvin tablet 250 mg (Micostop 250 mg) 206.2 Tablet 500 500
195 Gutta Perca 207.2 Set - -
196 Haloperidol Decanoat Inj 50 mg/ml 208.2 Ampul - -
197 Halloperidol 5mg 209.2 Tablet 2,240 2,240
198 Haloperidol tab 2 mg 210.2 Tablet - -
199 Haloperidol tablet 1,5 mg 211.2 Tablet 880 880
200 Haloperidol tablet 0,5 mg 212.2 Tablet - -
201 Hand Rub 500 ml 213.2 Botol 5 5
202 Hcg Pregnancy Test 214.2 Set 300 300
203 Hemafort 215.2 Tablet - -
204 Hidroklorotiazida (HCT) tablet 25 mg 216.2 Tablet 700 700
205 Hidrokortison krim 2,5 % 217.2 Tube 140 140
206 Hustab 218.2 Tablet 1,500 1,500
207 Hustab Syr 219.2 Botol - -
208 Hyascine-N- Butil Bromida 220.2 Tablet - -
209 Hyoscine Butil Bromida inj 221.2 Ampul - -
210 Ibuprofen Suspensi 100 mg/ 5 ml 222.2 Botol 100 100
211 Ibuprofen Suspensi 200 mg/ 5 ml 223.2 Botol - -
212 Ibuprofen tablet 200 mg 224.2 Tablet - -
213 Ibuprofen tablet 400 mg 225.2 Tablet 1,100 1,100
214 ID Band Red ( Adult) 226.2 Set - -
215 ID Band Red ( Child) 227.2 Set - -
216 Imerson Oil 228.2 Botol - -
217 Immustrum syr 229.2 Botol - -
218 Infusion set anak 230.2 Set 135 135
219 Infusion set dewasa 231.2 Set 187 187
220 INH Anak 232.2 Tablet - -
221 Interzinc Syrup 233.2 Botol 2 2
222 Intunal Forte 234.2 Tablet - -
223 Isoniazida tablet 300 mg 235.2 Tablet - -
224 Isosorbit Dinitrat tablet subligual 5 mg 236.2 Tablet 500 500
KELAS
TERAPI
225 Isotic Clearens 237.2 Botol - -

226 Isotic Neolyson 238.2 Botol - -
227 IV cateter No. 16 239.2 Set - -
228 IV cateter No. 18 240.2 Set 539 539
229 IV Cateter No. 20 241.2 Set 439 439
230 IV cateter No. 22 242.2 Set 439 439
231 IV Cateter No. 24 243.2 Set 200 200
232 Jarum Extirsipasi 244.2 Set - -
233 Jarum File 245.2 Set - -
234 Jarum jahit bedah (steri) no 9 s/d 14 246.2 Set - -
235 Kaca Objek ( Objek Glass) 247.2 Set - -
236 KA-EN 1B 248.2 Botol - -
237 KA-EN 3A 249.2 Botol - -
238 KA-EN 3B 250.2 Botol - -
239 Kalium diklofenak tablet 25 mg 251.2 Tablet - -
240 Kalium diklofenak tablet 50 mg 252.2 Tablet 200 200
241 Kalium Permanganat serbuk 253.2 Botol - -
242 Kalsium Hidroksi Pasta 254.2 Set - -
243 Kalsium Laktat (Kalak) tablet 255.2 Tablet 5,800 5,800
244 Kapas Berlemak 500 gram 256.2 Rol - -
245 Kapas Pembalut / Absorben 250 gram 257.2 Rol 19 19
246 Karbamazepain tablet 200 mg 258.2 Tablet - -
247 Kasa 10 x 80 cm 259.2 Rol 300 300
248 Kasa 40 x 80 260.2 Rol - -
249 Kasa 5 x 80 cm 261.2 Rol - -
250 Kasa Gulung 36 x 80 262.2 Rol - -
251 Kasa kompres 40/40 steril 263.2 Set 1,200 1,200
252 Kasa Pembalut 2 m x 80 cm 264.2 Rol - -
253 Kasa pembalut hidrofil 4 m x 15 cm 265.2 Rol - -
254 Kasa pembalut hidrofil 4 m x 3 cm 266.2 Rol - -
255 Kasa Pembalut Hidrofil 4 x 10 267.2 Rol - -
256 Kasa Steril 16 x 16 (Kasa Kotak) 268.2 Kotak 77 77
257 Ketoknazole Krim 2 % 269.2 Tube 147 147
258 Ketoknazole tablet 200 mg 270.2 Tablet 650 650
259 Ketoprofen Suppositoria 100mg ( Fetik Supp) 271.2 Supp 40 40
260 Ketoprofen Tablet 100 mg 272.2 Tablet - -
261 Klopidogrel 75 mg 273.2 Tablet - -
262 Kloramfekort krim 274.2 Tube - -
263 Kloramfenikol kapsul 500 mg 275.2 Kapsul - -
264 Kloramfenikol kapsul 250 mg 276.2 Kapsul 400 400
265 Kloramfenikol salep mata 1 % 277.2 Tube 57 57
266 Kloramfenikol suspensi 278.2 Botol - -
267 Kloramfenikol tetes mata 0,5 % 279.2 Botol - -
268 Kloramfenikol Tetes telinga 3 % 280.2 Botol 28 28
269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 2,800 2,800
270 Klorfeson krim 282.2 Tube - -
KELAS
TERAPI
271 Klorokuin Fosfat tablet 150 mg 283.2 Tablet - -

272 Klorokuin tablet 250 mg 284.2 Tablet - -
273 Klorpromazin HCl inj. 25 mg/ml - 2 ml 285.2 Ampul - -
274 Klorpromazin HCl inj. 5 mg/ml - 2 ml 286.2 Ampul - -
275 Klorpromazin HCl tablet salut 100 mg 287.2 Tablet 100 100
276 Klorpromazin HCl tablet salut 25 mg 288.2 Tablet 1,005 1,005
277 Klorpropamid tablet 100 mg 289.2 Tablet - -
278 Klozapin 25 mg 290.2 Tablet - -
279 Kodein HCl tablet 10 mg 291.2 Tablet - -
280 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg 292.2 Tablet - -
281 Kontrasepsi Injeksi Depoprogestin/Suntik KB 3 Bln 293.2 Tablet - -
282 Kotrimoksazol dewasa tablet 294.2 Tablet 1,200 1,200
283 Kotrimoksazol pediatrik tablet 295.2 Tablet - -
284 Kotrimoksazol Forte Kombinasi 800 mg/160 mg 296.2 Tablet - -
285 Kotrimoksazol suspensi 297.2 Botol 407 407
286 Kuinin (Kina) tablet 200 mg 298.2 Tablet - -
287 Kuinin Dihidroklorida injeksi 25 % - 2 ml 299.2 Ampul - -
288 Lansoprazol kapsul 30 mg 300.2 Kapsul 680 680
289 Larutan Anisol 301.2 Botol - -
290 Larutan Asam Klorida 0,1 N 302.2 Botol - -
291 Larutan Benedict 303.2 Botol - -
292 Larutan EDTA 10 % 304.2 Botol - -
293 Larutan Eosin 2 % 305.2 Botol - -
294 Larutan Etanol Asam 306.2 Botol - -
295 Larutan Giemsa Stain 307.2 Botol - -
296 Larutan Hayem 308.2 Botol - -
297 Larutan Iodium 1 % 309.2 Botol - -
298 Larutan Karbol Fuksin 310.2 Botol - -
299 Larutan Metilen Biru 311.2 Botol - -
300 Larutan Na Citrat 3,13 % 312.2 Botol - -
301 Larutan Rees Ecker 313.2 Botol - -
302 Larutan Turk 314.2 Botol - -
303 Larutan Xylol 315.2 Botol - -
304 Laxadine Emulsi 30 ml 316.2 Botol 10 10
305 Laxana tablet 317.2 Tablet - -
306 Laxarec supp 318.2 Supp - -
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set 30 30
308 Leukoplast 1625 H ( plaster 7,5 cm x 4,5 M) 320.2 Set - -
309 Levofloksasin 0,5% tetes mata ( Optiflox) 321.2 Botol 17 17
310 Levofloksasin kapsul 500 mg 322.2 Kapsul 300 300
311 Lexapram 5mg/5 ml syrup 323.2 Botol - -
312 Lexavit kaplet 324.2 Kaplet - -
313 Lidokain (Pehakain) injeksi 2% 325.2 Ampul - -
314 Lidokain injeksi 2 % 326.2 Ampul 55 55
315 Lidokain Kompositum injeksi 327.2 Ampul 30 30
316 Linkomisin kapsul 250 mg 328.2 Kapsul - -
KELAS
TERAPI
317 Linkomisin kapsul 500 mg 329.2 Kapsul - -

318 Lisol 330.2 Botol - -
319 Livron B Plex 331.2 Tablet - -
320 Loperamida 2 mg tablet 332.2 Tablet 500 500
321 Loratadine tablet 10 mg 333.2 Tablet 2,200 2,200
322 Lorazepam 2 mg 334.2 Tablet - -
323 Lyscavit Syrup 335.2 Botol 48 48
324 Lytamin Sirup 336.2 Botol - -
325 Magnesium Sulfat inj (IV) 20% - 25 ml 337.2 Ampul 141 141
326 Magnesium Sulfat inj (IV) 40% - 25 ml 338.2 Ampul 120 120
327 Magnesium Sulfat serbuk 30 gram 339.2 Sachet - -
328 Masker 340.2 Set - -
329 Masker N 95 341.2 Set 400 400
330 Masker Oxygen ( Dewasa) 342.2 Set - -
331 Masker Oxygen (Anak) 343.2 Set - -
332 Mebendazol tablet 100 mg 344.2 Tube - -
333 Mebendazole 500 mg (Vermox) 345.2 Tablet - -
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - -
335 Meloxicam kapsul 15 mg 347.2 Tablet - -
336 Meloxicam kapsul 7,5 mg 348.2 Kapsul - -
337 Merviton Tablet 349.2 Tablet - -
338 Metampiron 500 mg, Diazepam 2 mg 350.2 Tablet - -
339 Metanol 351.2 Botol - -
340 Metformin kapsul 500 mg 352.2 Tablet 3,800 3,800
341 Metil Prednisolon tablet 4 mg 353.2 Tablet 2,250 2,250
342 Metilergometrin Maleat injeksi 0,200 mg - 1 ml 354.2 Ampul 180 180
343 Metilergometrin Maleat tablet salut 0,125 mg 355.2 Tablet 500 500
344 Metilprednisolon 8 mg tablet 356.2 Tablet - -
345 Metoklopramide injeksi 5 mg/ml 357.2 Ampul - -
346 Metoklopramide sirup 5 mg/ml 358.2 Botol - -
347 Metoklopramide tablet 10 mg 359.2 Tablet 700 700
348 Metronidazol infus 360.2 Botol - -
349 Metronidazol tablet 250 mg 361.2 Tablet 1,900 1,900
350 Metronidazol tablet 500 mg 362.2 Tablet - -
351 Metronidazole 500 mg Supp ( Vagizol Ovula) 363.2 Supp 5 5
352 Miconazol krim 2 % 364.2 Tube 143 143
353 Mixing Pad 365.2 Tablet - -
354 Molagit tablet 366.2 Tablet 80 80
355 Monoklorkamfer Mentol cairan (CHKM) 367.2 Set - -
356 Mucohexin tab 368.2 Tablet - -
357 Muliavit Syr 369.2 Botol - -
358 Mummifying pasta 370.2 Set - -
359 Mycorine Powder ( Miconazole 2 %) 371.2 Botol - -
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set 10 10
361 Nasal Canula Bayi 373.2 Set - -
362 Nasal Canula Dewasa 374.2 Set 20 20
KELAS
TERAPI
363 Natrium Bikarbonat tablet 500 mg 375.2 Tablet 800 800

364 Natrium Diklofenat tablet 25 mg 376.2 Tablet - -
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet 3,850 3,850
366 Natrium Klorida larutan infus steril 0,9 % 378.2 Botol 138 138
367 Natrium Tiosulfat injeksi 25 % - 2ml 379.2 Ampul - -
368 Natrium Tiroksin 100 ug 380.2 Tablet - -
369 Neocenta Gel 381.2 Tube 3 3
370 Neurosanbe Plus kaplet 382.2 Kaplet - -
371 Neurovit E tablet 383.2 Ampul - -
372 Nice Care Under Pad 384.2 Set - -
373 Nipedipin tablet 10 mg 385.2 Tablet 300 300
374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 500 500
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 600 600
376 Nocandis drop 388.2 Botol - -
377 Nodiar tablet 389.2 Tablet - -
378 Noza 390.2 Tablet 860 860
379 Obat Anti Tuberkuloisi Kategori Anak 391.2 paket - -
380 Obat Anti Tuberkulosis Kategori 1 392.2 paket - -
381 Obat Anti Tuberkulosis Kategori 1 (Kombipak) 393.2 paket - -
382 Obat Anti Tuberkulosis Kategori 2 394.2 paket - -
383 Obat Anti Tuberkulosis Kategori 2 (Kombipak) 395.2 paket - -
384 Obat Anti Tuberkulosis Kategori Sisipan 396.2 paket - -
385 Obat Batuk Hitam (OBH) cairan 397.2 Botol 345 345
386 Obat Batuk Hitam (OBH) Plus cairan 398.2 Botol - -
387 Ofloksasin tablet 200 mg 399.2 Tablet - -
388 Ofloxacin tablet 400 mg 400.2 Tablet 100 100
389 Oksitetrasiklin HCl injeksi i.m 50 mg/ml - 10 ml 401.2 Ampul - -
390 Oksitetrasiklin HCl salap 3 % 402.2 Tube 111 111
391 Oksitetrasiklin HCl salap mata 1 % 403.2 Tube - -
392 Oksitosin injeksi 10 iu/ml - 1ml 404.2 Ampul 108 108
393 Omedeson 0,5 mg tablet 405.2 Tablet - -
394 Omeprazol kapsul 20 mg 406.2 Kapsul 120 120
395 Orphen Tablet 407.2 Tablet - -
396 Oxfezin syr 408.2 Botol - -
397 Oxycan 409.2 Botol - -
398 Parasetamol Drop 410.2 Botol - -
399 Parasetamol sirup 120 mg/5 ml 411.2 Botol 254 254
400 Parasetamol tablet 100 mg 412.2 Tablet - -
401 Parasetamol tablet 500 mg 413.2 Tablet 3,100 3,100
402 Pehavral 414.2 Tablet - -
403 Pembalut Gips 415.2 Set - -
404 Perfenazin HCl tablet 4 mg 416.2 Tablet - -
405 Pethidin HCl injeksi 50 mg / ml - 2 ml 417.2 Ampul - -
406 Pharmaton Formula 418.2 Kapsul - -
407 Pil KB Kombinasi- Bliss 28 Tab 419.2 Tablet - -
408 Pilokarpin HCl/Nitrat tetes mata 2 % 420.2 Botol - -
409 Piracetam injeksi 1 g/5 ml 421.2 Ampul - -
410 Piracetam injeksi 3 g/5 ml 422.2 Ampul - -
KELAS
TERAPI
411 Piracetam sirup 423.2 Botol - -

412 Piracetam tablet 400 mg 424.2 Tablet - -
413 Piracetam tablet 800 mg 425.2 Tablet - -
414 Pirantel tablet 125 mg 426.2 Tablet 80 80
415 Pirazinamida tablet 500 mg 427.2 Tablet - -
416 Piridoksin HCl tablet 10 mg 428.2 Tablet 3,000 3,000
417 Piridoksin HCl tablet 25 mg 429.2 Tablet - -
418 Piroksikam kapsul 10 mg 430.2 Kapsul - -
419 Piroksikam kapsul 20 mg 431.2 Kapsul 3,900 3,900
420 Plester 5 yard x 2 inch 432.2 Rol - -
421 Povidon Iodida larutan 10 % - 30 ml 433.2 Botol 85 85
422 Povidon Iodida larutan 10 % - 300 ml 434.2 Botol - -
423 Povidone Iodine 10 % 60 ml 435.2 Botol - -
424 Prednison tablet 5 mg 436.2 Tablet 1,200 1,200
425 Primakuin tablet 15 mg 437.2 Tablet - -
426 Pritavit 438.2 Kapsul - -
427 Prokain Benzil Penisilin 3 juta iu/vial injeksi 439.2 Vial - -
428 Prolysin Syrup Plus 440.2 Botol - -
429 Propanolo HCl tablet 40 mg 441.2 Ampul - -
430 Propect tab/Ambroksol 442.2 Tablet - -
431 Propitiourasil tablet 100 mg 443.2 Tablet - -
432 Rabies Immune Globulin (Human) 150 iu/ml 444.2 Vial - -
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul 90 90
434 Ranitidin tablet 150 mg 446.2 Tablet 1,500 1,500
435 Reagen Golongan Darah Anti A 447.2 Botol - -
436 Reagen Golongan Darah Anti B 448.2 Botol - -
437 Reserpin tablet 0,10 mg 449.2 Tablet - -
438 Reserpin tablet 0,25 mg 450.2 Tablet - -
439 Retinol (Vitamin A) kapsul 100.000 iu 451.2 Kapsul 750 750
440 Retinol (Vitamin A) kapsul 200.000 iu 452.2 Kapsul 10,850 10,850
441 Rifampisin kapsul 300 mg 453.2 Kapsul - -
444 Ringer laktat larutan infus steril 456.2 Botol - -
445 Risperidone 2 mg 457.2 Tablet 105 105
446 Risperidone 1 mg 458.2 Tablet 75 75
447 Safety Box 459.2 kotak - -
448 Salbutamol tablet 2 mg 460.2 Tablet 5,400 5,400
449 Salbutamol tablet 4 mg 461.2 Tablet 1,200 1,200
450 Salep 2 - 4 kombinasi 462.2 Tablet - -
451 Salisil Bedak 2 % 463.2 Kotak - -
452 Sammoxin 500 mg tablet 464.2 Tablet - -
453 Sanbe Kids 465.2 Botol - -
454 Sangatonik kapsul 466.2 Kapsul - -
455 Sarung Tangan Obgyn Steril 467.2 Psg - -
456 Scabicid krim 468.2 Tube - -
457 Scabimite krim 469.2 Tube - -
458 Selcom - C kaplet 470.2 Kaplet - -
459 Selvi Plex 471.2 Tablet 1,700 1,700
460 Semen Seng Fosfat serbuk dan cairan 471.2 Set - -
461 Serum anti bisa ular polivalen injeksi 50 mg (ABU) 472.2 Ampul - -
462 Serum anti tetanus inj. 1.500 iu/ampul (a.t.s ) 473.2 Ampul - -
463 Serum anti tetanus inj. 20.000 iu/ampul (a.t.s ) 474.2 Ampul - -
KELAS
TERAPI
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml 475.2 Ampul 175 175
465 Sianokobalamin (Vitamin B12) tab 50 mcg 476.2 Tablet - -
466 Silk (benang bedah sutera) no. 3/0 477.2 Set - -
467 Silver Amalgam serbuk 65 - 75 % 478.2 Set - -
468 Simvastatin tablet 10 mg 479.2 Tablet - -
471 Soft U Derm Hydro Urea Krim 10% 482.2 Tube - -
472 Solvita Plus Syrup 483.2 Botol - -
473 Spiramisin tablet 500 mg 484.2 Tablet - -
474 Stesolid Suppositoria 10 mg 485.2 Supp - -
475 Stesolid Suppositoria 5 mg 486.2 Supp - -
476 Stomach tube FG 16 487.2 Set - -
477 Stomach tube FG 18 488.2 Set - -
478 Sulfadimidin tablet 500 mg 489.2 Tablet - -
479 Sulfametoksazol 800 mg + Trimetoprim 160 mg 490.2 Tablet - -
480 Supra Flu tablet 491.2 Tablet - -
481 Suprabion tablet 492.2 Tablet - -
482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L 493.2 Psg - -
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M 494.2 Psg - -
484 Surgical Glove Steril No 6,5 495.2 Psg - -
485 Surgical Gloves Non-Steril No 7 496.2 Psg - -
486 Surgical Gloves Non-Steril No 7,5 497.2 Psg - -
487 Surgical Gloves Steril No 7 498.2 Psg - -
488 Surgical Gloves Steril No 7,5 499.2 Psg - -
489 Surgical Tape 2.5 cm x 910 cm 500.2 Psg - -
490 Surgical Tape 5 cm x 10 M (AXIMED) 501.2 Pcs - -
491 Surgical Tape 1.25 cm x 10 M (AXIMED) 502.2 Pcs - -
492 Tablet Tambah Darah Kombinasi 503.2 Tablet 153,578 153,578
493 Tambalan Sementara 504.2 Set - -
494 Tamiflu 505.2 Tablet - -
495 Tarivid Otic Solution (Ofloxacin Tetes Telinga) 506.2 Botol - -
496 Temporary stopping Fletcher serbuk dan cairan 507.2 Set - -
497 Tetrakain HCl tetes mata 508.2 Botol - -
498 Tetrasiklin HCl kapsul 250 mg 509.2 Kapsul - -
499 Tetrasiklin HCl kapsul 500 mg 510.2 Kapsul - -
500 Thiamphenicol kapsul 250 mg 511.2 Kapsul - -
501 Thiamphenicol kapsul 500 mg 512.2 Kapsul - -
502 Thramed Kapsul 513.2 Kapsul - -
503 Tiamin HCl (Vit B 1) inj. 100 mg/ml - 1 ml 514.2 Ampul - -
504 Tiamin HCl monohidrat (Vit B 1) tablet 50 mg 515.2 Tablet 1,000 1,000
505 Tramadol injeksi 50 mg / ml 516.2 Ampul 90 90
506 Tramadol tablet 50 mg 517.2 Tablet - -
507 Trifastan 500 mg tablet 518.2 Tablet - -
508 Trifluoperazin 5 mg 519.2 Tablet - -
509 Triheksifenidil Hidroklorida tablet 2 mg 520.2 Tablet 600 600
510 Trikresol Formali (TKF) cairan 521.2 Set - -
511 Ulsidek 500 mg (Sucralfat) 522.2 Tablet 300 300
512 Umbilical Cord Clamp 523.2 Set 100 100
513 Urine Bag non steril 524.2 Set - -
514 Vitalex kapsul 525.2 Kapsul - -
515 Vitamin B komplek tablet 526.2 Tablet 3,500 3,500
516 Wing Needle 527.2 Set 300 300
KELAS
TERAPI
517 Yodium kapsul 528.2 Kapsul - -

518 Zink Dispersible 529.2 Tablet 8,200 8,200
Mengetahui / Menyetujui Yang Menyerahkan

Kepala Dinas Kesehatan Kepala GFK
(……………………………..) (………………………..)
LB. 2
APORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT Halaman : 1
( LPLPO )
BULAN :
TAHUN : 0 3
2 0 1 9
PEMBERIAN
PERMIN-
PEMAKAIAN SISA STOK STOK OPT. KET
TAAN
0 -
0 -
100 1,150
0 200
100 268
0 957
0 -
0 -
0 -
0 -
0 5
0 -
0 -
0 -
65 166
0 6,200
0 -
200 100
40 720
330 660
0 -
1300 14,800
0 -
0 -
35 166
0 -
0 -
0 -
600 1,800
0 -
55 223
1000 1,800
0 -
0 48
0 -
0 -
0 173
0 -
0 -
1000 4,500
PEMBERIAN
PERMIN-
TAAN
200 500
0 -
1000 7,600
0 -
0 -
2 22
0 -
0 -
0 -
0 170
0 550
0 1,450
0 -
0 -
0 -
100 800
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 169
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 300
0 -
0 -
600 3,400
100 -
0 -
0 -
0 -
0 -
0 -
0 4
200 3,200
PEMBERIAN
PERMIN-
TAAN
10 356
0 -
0 1,040
0 26
0 -
0 -
0 -
20 261
400 1,800
1000 4,200
0 -
300 4,400
0 -
0 -
0 1,550
0 -
0 -
0 -
100 145
1100 1,000
0 -
0 -
0 -
0 -
0 -
0 -
0 59
0 -
0 -
0 -
0 -
0 330
0 -
0 -
0 400
0 -
0 200
0 -
10 184
0 800
0 -
0 -
0 -
0 -
0 -
0 50
PEMBERIAN
PERMIN-
TAAN
0 117
0 -
0 -
22 78
0 -
0 -
0 -
5 41
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
100 300
0 -
0 -
0 -
20 125
0 -
0 -
0 -
0 -
0 -
0 300
0 -
0 -
0 68
0 1,470
0 -
0 -
0 -
0 -
0 -
0 -
0 33
0 -
0 -
0 1,200
100 1,600
0 45
0 -
0 -
PEMBERIAN
PERMIN-
TAAN
5 19
0 11
0 -
0 -
900 1,600
0 -
400 2,200
0 -
0 -
0 -
0 -
0 -
0 -
0 -
100 900
0 500
0 -
0 -
30 2,210
0 -
0 880
0 -
0 5
50 250
0 -
0 700
20 120
400 1,100
0 -
0 -
0 -
10 90
0 -
0 -
400 700
0 -
0 -
0 -
0 -
50 85
50 137
0 -
0 2
0 -
0 -
0 500
PEMBERIAN
PERMIN-
TAAN
0 -
0 -
0 -
0 539
0 439
0 439
0 200
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 200
0 -
0 -
600 5,200
0 -
3 16
0 -
300 -
-
0 -
0 -
0 1,200
0 -
0 -
0 -
0 -
10 67
0 147
300 350
0 40
0 -
0 -
0 -
0 -
0 400
15 42
0 -
0 -
3 25
400 2,400
0 -
PEMBERIAN
PERMIN-
TAAN
0 -
0 -
0 -
0 -
0 100
40 965
0 -
0 -
0 -
0 -
0 -
0 1,200
0 -
0 -
20 387
0 -
0 -
160 520
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
3 27
0 -
0 17
0 300
0 -
0 -
0 -
30 25
0 30
0 -
PEMBERIAN
PERMIN-
TAAN
0 -
0 -
0 -
100 400
200 2,000
0 -
15 33
0 -
0 141
0 120
0 -
0 -
0 400
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
800 3,000
500 1,750
0 180
0 500
0 -
0 -
0 -
0 700
0 -
0 1,900
0 -
0 5
10 133
0 -
0 80
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 20
PEMBERIAN
PERMIN-
TAAN
0 800
0 -
1300 2,550
0 138
0 -
0 -
0 3
0 -
0 -
0 -
0 300
0 500
0 600
0 -
0 -
140 720
0 -
0 -
0 -
0 -
0 -
0 -
40 305
0 -
0 -
0 100
0 -
15 96
0 -
5 103
0 -
120 -
0 -
0 -
0 -
0 -
45 209
0 -
2300 800
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
PEMBERIAN
PERMIN-
TAAN
0 -
0 -
0 -
0 80
0 -
0 3,000
0 -
0 -
900 3,000
0 -
10 75
0 -
0 -
200 1,000
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 90
700 800
0 -
0 -
0 -
0 -
0 750
0 10,850
0 -
0 -
0 -
0 -
20 85
0 75
0 -
0 5,400
0 1,200
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
200 1,500
0 -
0 -
0 -
0 -
PEMBERIAN
PERMIN-
TAAN
100 75
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 153,578
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
500 500
0 90
0 -
0 -
0 -
0 600
0 -
0 300
0 100
0 -
0 -
600 2,900
0 300
PEMBERIAN
PERMIN-
TAAN
0 -
300 7,900 6200 1,700 ED
kan Yang Menerima / Melapor Yang Menerima

Kepala Puskesmas Petugas Puskesmas
……..) Endang Suhada, SKM Dony Iswandi, S.Farm., Apt

NIP. 19700901 199101 1 001
KABUPATEN : ROKAN HULU BULAN :
PROVINSI : R I A U TAHUN : 0 4
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
KODE NAMA OBAT KELAS TERAPI SATUAN STOK AWAL PENERIMAAN PEMAKAIAN SISA STOK STOK OPT.
DIAAN TAAN

5 Alat Suntik Sekali Pakai 3 ml 17.2 Set 268 268 100 168 500
11 Alcohol + CHG 0,5% Swab 23.2 Kotak 5 5 5 - 10
13 Allopurinol tablet 100 mg 25.2 Tablet - - 0 - 2000
15 Ambroksol sirup 15 mg/ml 27.2 Botol 166 166 38 128 200
16 Ambroksol tablet 30 mg 28.2 Tablet 6,200 6,200 800 5,400
19 Amitriptilin HCl tablet 25 mg 31.2 Tablet 720 720 160 560 300
20 Amlodipine tablet 10 mg 32.2 Tablet 660 660 570 90 2000
21 Amlodipine tablet 5 mg 33.2 Tablet - - 0 - 1000
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol 166 166 25 141 150
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

32 Antasida Doen tablet kombinasi 44.2 Tablet 1,800 1,800 1200 600 5000
35 Antihaemoroid Doen Kombinasi 47.2 Supp - - 0 - 30
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 4,500 4,500 2500 2,000 2000
43 Asam Mefenamat tablet 500 mg 55.2 Tablet 7,600 7,600 2800 4,800 2000
52 Asiklovir tablet 400 mg 64.2 Tablet 1,450 1,450 600 850 1000
59 Becefort Tablet 71.2 Tablet - - 0 - 1000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
62 Beneuron 74.2 Tablet - - 0 - 1000

65 Betahistin Mesilat 6 mg tablet 77.2 Tablet - - 0 - 1000
68 Bionemi 80.2 Tablet - - 0 - 500
69 Bioplasenton krim 81.2 Tube - - 0 - 10
72 Bisoprolol tablet 5 mg 84.2 Tablet - - 0 - 300
73 Bisturi 85.2 Set - - 0 -
75 Blood Lancet 87.2 Set 300 300 0 300
78 Captopril tablet 12,5 mg 90.2 Tablet 3,400 3,400 3400 - 3000
79 Captopril tablet 25 mg 91.2 Tablet - - - 5000
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set - - 0 - 100
85 Caviplex drop 97.2 Botol 4 4 4 -
86 Cefadroksil kapsul 500 mg 98.2 Kapsul 3,200 3,200 300 2,900
92 Cendo Xitrol tetes mata 104.2 Botol - - 0 - 30
95 Cetrizin tablet 10 mg 107.2 Tablet 1,800 1,800 1300 500 3000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
96 Cimetidin tablet 200 mg 108.2 Tablet 4,200 4,200 800 3,400 500
103 Co-Amoksiklav tablet 625 mg 115.2 Tablet - - 0 - 100
104 Dasabion kapsul 116.2 Kapsul - - 0 - 500
105 Deksametason injeksi 5 mg/ml - 1 ml 117.2 Ampul 145 145 55 90 200
106 Deksametason tablet 0,5 mg 118.2 Tablet 1,000 1,000 1000 - 5000
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine Hcl) 126.2 Botol - - 0 - 50
125 Domperidon suspensi 5 mg/ml 137.2 Botol 184 184 10 174 100
126 Domperidon tablet 138.2 Tablet 800 800 700 100 3000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 ml 142.2 Ampul - - 0 -

139 Etanol 70 % 151.2 Botol - - 0 - 200
140 Etanol 70 %(1000 ml) 152.2 Botol 41 41 0 41
142 Etil Klorida semprot 154.2 Botol - - 0 - 5
150 Fenitoin Natrium kapsul 100 mg 162.2 Kapsul 300 300 0 300
154 Fenobarbital tablet 30 mg 166.2 Tablet 125 125 70 55 200
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol - - 0 - 10
158 Ferriz Baby Drop 170.2 Botol - - 0 - 10
162 Film IV Dress 78 P 174.2 Box - - 0 - 5
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 1,470 1,470 300 1,170
168 Fluoksetin (foransi 10 mg) 180.2 Tablet - - 0 -
174 Furosemida tablet 40 mg 186.2 Tablet 1,200 1,200 100 1,100
176 Genoint Salep Mata (Gentamisin 0.1 % Salep Mata) 188.2 Tube 45 45 5 40
178 Gentamisin salep kulit 0,1 % 190.2 Tube - - 0 - 30
179 Gentamisin sulfat tetes mata 0,3 % 191.2 Botol 19 19 6 13
183 Glibenklamid tablet 5 mg 195.2 Tablet 1,600 1,600 700 900
185 Gliseril Guaiakolat tablet 100 mg 197.2 Tablet 2,200 2,200 400 1,800
192 Gralysin syr 204.2 Botol - - 0 - 20
193 Griseofulvin tablet 125 mg 205.2 Tablet 900 900 200 700
195 Gutta Perca 207.2 Set - - 0 -
196 Haloperidol Decanoat Inj 50 mg/ml 208.2 Ampul - - 0 -
197 Halloperidol 5mg 209.2 Tablet 2,210 2,210 2210 - 1000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
198 Haloperidol tab 2 mg 210.2 Tablet - - 0 -

201 Hand Rub 500 ml 213.2 Botol 5 5 0 5
206 Hustab 218.2 Tablet 1,100 1,100 300 800
207 Hustab Syr 219.2 Botol - - 0 - 50
210 Ibuprofen Suspensi 100 mg/ 5 ml 222.2 Botol 90 90 5 85
213 Ibuprofen tablet 400 mg 225.2 Tablet 700 700 700 - 3000
214 ID Band Red ( Adult) 226.2 Set - - 0 - 50
215 ID Band Red ( Child) 227.2 Set - - 0 - 50
218 Infusion set anak 230.2 Set 85 85 50 35 100
219 Infusion set dewasa 231.2 Set 137 137 50 87 100
220 INH Anak 232.2 Tablet - - 0 -
221 Interzinc Syrup 233.2 Botol 2 2 2 - 20
222 Intunal Forte 234.2 Tablet - - 0 - 500
227 IV cateter No. 16 239.2 Set - - 0 -
228 IV cateter No. 18 240.2 Set 539 539 100 439
229 IV Cateter No. 20 241.2 Set 439 439 100 339
230 IV cateter No. 22 242.2 Set 439 439 100 339
231 IV Cateter No. 24 243.2 Set 200 200 100 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

233 Jarum File 245.2 Set - - 0 -
236 KA-EN 1B 248.2 Botol - - 0 -
237 KA-EN 3A 249.2 Botol - - 0 -
238 KA-EN 3B 250.2 Botol - - 0 -
247 Kasa 10 x 80 cm 259.2 Rol - - 0 - 400
248 Kasa 40 x 80 260.2 Rol - - 0 - 5
249 Kasa 5 x 80 cm 261.2 Rol - - 0 -
250 Kasa Gulung 36 x 80 262.2 Rol - - 0 -
257 Ketoknazole Krim 2 % 269.2 Tube 147 147 25 122
258 Ketoknazole tablet 200 mg 270.2 Tablet 350 350 250 100
260 Ketoprofen Tablet 100 mg 272.2 Tablet - - 0 - 200
263 Kloramfenikol kapsul 500 mg 275.2 Kapsul - - 0 -
265 Kloramfenikol salep mata 1 % 277.2 Tube 42 42 10 32 200
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

268 Kloramfenikol Tetes telinga 3 % 280.2 Botol 25 25 1 24
269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 2,400 2,400 1700 700 5000
276 Klorpromazin HCl tablet salut 25 mg 288.2 Tablet 965 965 40 925 1000
278 Klozapin 25 mg 290.2 Tablet - - 0 - 100
280 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg 292.2 Tablet - - 0 -
282 Kotrimoksazol dewasa tablet 294.2 Tablet 1,200 1,200 200 1,000 1000
284 Kotrimoksazol Forte Kombinasi 800 mg/160 mg 296.2 Tablet - - 0 -
288 Lansoprazol kapsul 30 mg 300.2 Kapsul 520 520 340 180 500
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

304 Laxadine Emulsi 30 ml 316.2 Botol 10 10 10 - 20
306 Laxarec supp 318.2 Supp - - 0 - 5
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set 27 27 27 - 20
314 Lidokain injeksi 2 % 326.2 Ampul 25 25 25 - 200
315 Lidokain Kompositum injeksi 327.2 Ampul 30 30 30 - 200
318 Lisol 330.2 Botol - - 0 -
319 Livron B Plex 331.2 Tablet - - 0 - 500
320 Loperamida 2 mg tablet 332.2 Tablet 400 400 300 100 2000
322 Lorazepam 2 mg 334.2 Tablet - - 0 -
323 Lyscavit Syrup 335.2 Botol 33 33 33 - 50
328 Masker 340.2 Set - - 0 - 5000
329 Masker N 95 341.2 Set 400 400 0 400
330 Masker Oxygen ( Dewasa) 342.2 Set - - 0 - 10
331 Masker Oxygen (Anak) 343.2 Set - - 0 - 10
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - - 0 - 20

335 Meloxicam kapsul 15 mg 347.2 Tablet - - 0 - 1000
337 Merviton Tablet 349.2 Tablet - - 0 -
339 Metanol 351.2 Botol - - 0 -
340 Metformin kapsul 500 mg 352.2 Tablet 3,000 3,000 500 2,500
341 Metil Prednisolon tablet 4 mg 353.2 Tablet 1,750 1,750 200 1,550
350 Metronidazol tablet 500 mg 362.2 Tablet - - 0 - 1000
351 Metronidazole 500 mg Supp ( Vagizol Ovula) 363.2 Supp 5 5 0 5 30
352 Miconazol krim 2 % 364.2 Tube 133 133 7 126 100
357 Muliavit Syr 369.2 Botol - - 0 -
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set 10 10 0 10
362 Nasal Canula Dewasa 374.2 Set 20 20 0 20
363 Natrium Bikarbonat tablet 500 mg 375.2 Tablet 800 800 100 700
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet 2,550 2,550 2550 - 5000
366 Natrium Klorida larutan infus steril 0,9 % 378.2 Botol 138 138 0 138
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

371 Neurovit E tablet 383.2 Ampul - - 0 - 500
372 Nice Care Under Pad 384.2 Set - - 0 - 10
373 Nipedipin tablet 10 mg 385.2 Tablet 300 300 100 200 300
374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 500 500 0 500 500
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 600 600 100 500 500
376 Nocandis drop 388.2 Botol - - 0 - 20
378 Noza 390.2 Tablet 720 720 420 300 500
385 Obat Batuk Hitam (OBH) cairan 397.2 Botol 305 305 22 283
390 Oksitetrasiklin HCl salap 3 % 402.2 Tube 96 96 17 79
394 Omeprazol kapsul 20 mg 406.2 Kapsul - - 0 - 2000
397 Oxycan 409.2 Botol - - 0 -
398 Parasetamol Drop 410.2 Botol - - 0 - 10
401 Parasetamol tablet 500 mg 413.2 Tablet 800 800 800 - 5000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

406 Pharmaton Formula 418.2 Kapsul - - 0 - 100
417 Piridoksin HCl tablet 25 mg 429.2 Tablet - - 0 -
419 Piroksikam kapsul 20 mg 431.2 Kapsul 3,000 3,000 1600 1,400 2000
422 Povidon Iodida larutan 10 % - 300 ml 434.2 Botol - - 0 - 20
424 Prednison tablet 5 mg 436.2 Tablet 1,000 1,000 400 600 2000
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul 90 90 90 - 200
434 Ranitidin tablet 150 mg 446.2 Tablet 800 800 600 200 3000
439 Retinol (Vitamin A) kapsul 100.000 iu 451.2 Kapsul 750 750 750 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
440 Retinol (Vitamin A) kapsul 200.000 iu 452.2 Kapsul 10,850 10,850 10850 -
444 Ringer laktat larutan infus steril 456.2 Botol - - 0 - 200
445 Risperidone 2 mg 457.2 Tablet 85 85 85 - 500
446 Risperidone 1 mg 458.2 Tablet 75 75 75 -
449 Salbutamol tablet 4 mg 461.2 Tablet 1,200 1,200 800 400 2000
451 Salisil Bedak 2 % 463.2 Kotak - - 0 - 100
454 Sangatonik kapsul 466.2 Kapsul - - 0 - 1000
457 Scabimite krim 469.2 Tube - - 0 - 10
459 Selvi Plex 471.2 Tablet 1,500 1,500 500 1,000 1000
465 Sianokobalamin (Vitamin B12) tab 50 mcg 476.2 Tablet - - 0 -
468 Simvastatin tablet 10 mg 479.2 Tablet - - 0 - 500
472 Solvita Plus Syrup 483.2 Botol - - 0 - 20
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L 493.2 Psg - - 0 - 300
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M 494.2 Psg - - 0 - 300
487 Surgical Gloves Steril No 7 498.2 Psg - - -
490 Surgical Tape 5 cm x 10 M (AXIMED) 501.2 Pcs - - 0 -
491 Surgical Tape 1.25 cm x 10 M (AXIMED) 502.2 Pcs - - 0 -
492 Tablet Tambah Darah Kombinasi 503.2 Tablet 153,578 153,578 153578 -
504 Tiamin HCl monohidrat (Vit B 1) tablet 50 mg 515.2 Tablet 500 500 200 300
508 Trifluoperazin 5 mg 519.2 Tablet - - 0 -
515 Vitamin B komplek tablet 526.2 Tablet 2,900 2,900 1400 1,500 2000
516 Wing Needle 527.2 Set 300 300 0 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
518 Zink Dispersible 529.2 Tablet 1,700 1,700 400 1,300

0


NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
-
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

4 Alat Suntik Sekali Pakai 2,5 ml 16.2 Set 200 500 700 0 700
11 Alcohol + CHG 0,5% Swab 23.2 Kotak - 10 10 0 10
15 Ambroksol sirup 15 mg/ml 27.2 Botol 128 128 55 73
19 Amitriptilin HCl tablet 25 mg 31.2 Tablet 560 300 860 0 860
20 Amlodipine tablet 10 mg 32.2 Tablet 90 1980 2,070 300 1,770
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol 141 141 0 141
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

32 Antasida Doen tablet kombinasi 44.2 Tablet 600 5000 5,600 1500 4,100
35 Antihaemoroid Doen Kombinasi 47.2 Supp - 30 30 0 30
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 2,000 2000 4,000 400 3,600
43 Asam Mefenamat tablet 500 mg 55.2 Tablet 4,800 2000 6,800 1400 5,400
52 Asiklovir tablet 400 mg 64.2 Tablet 850 1000 1,850 350 1,500
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

72 Bisoprolol tablet 5 mg 84.2 Tablet - 300 300 0 300
73 Bisturi 85.2 Set - - 0 -
75 Blood Lancet 87.2 Set 300 300 0 300
78 Captopril tablet 12,5 mg 90.2 Tablet - 3000 3,000 1500 1,500
79 Captopril tablet 25 mg 91.2 Tablet - - 0 -
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set - 96 96 0 96
85 Caviplex drop 97.2 Botol - - 0 -
89 Cefiksim kapsul 100 mg 101.2 Kapsul 1,040 1,040 190 850
95 Cetrizin tablet 10 mg 107.2 Tablet 500 3000 3,500 800 2,700
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
96 Cimetidin tablet 200 mg 108.2 Tablet 3,400 500 3,900 300 3,600
105 Deksametason injeksi 5 mg/ml - 1 ml 117.2 Ampul 90 200 290 0 290
106 Deksametason tablet 0,5 mg 118.2 Tablet - 5000 5,000 400 4,600
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine Hcl) 126.2 Botol - - 0 -
126 Domperidon tablet 138.2 Tablet 100 100 0 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

139 Etanol 70 % 151.2 Botol - - 0 -
140 Etanol 70 %(1000 ml) 152.2 Botol 41 41 1 40
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol - 24 24 0 24
158 Ferriz Baby Drop 170.2 Botol - 10 10 5 5
162 Film IV Dress 78 P 174.2 Box - 5 5 0 5
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 1,170 1,170 130 1,040
174 Furosemida tablet 40 mg 186.2 Tablet 1,100 1,100 200 900
195 Gutta Perca 207.2 Set - - 0 -
197 Halloperidol 5mg 209.2 Tablet - - 0 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

201 Hand Rub 500 ml 213.2 Botol 5 5 0 5
206 Hustab 218.2 Tablet 800 800 0 800
214 ID Band Red ( Adult) 226.2 Set - 100 100 0 100
215 ID Band Red ( Child) 227.2 Set - 100 100 0 100
218 Infusion set anak 230.2 Set 35 100 135 1 134
219 Infusion set dewasa 231.2 Set 87 100 187 1 186
220 INH Anak 232.2 Tablet - - 0 -
221 Interzinc Syrup 233.2 Botol - - 0 -
222 Intunal Forte 234.2 Tablet - - 0 -
227 IV cateter No. 16 239.2 Set - - 0 -
228 IV cateter No. 18 240.2 Set 439 439 0 439
229 IV Cateter No. 20 241.2 Set 339 339 0 339
230 IV cateter No. 22 242.2 Set 339 339 50 289
231 IV Cateter No. 24 243.2 Set 100 100 0 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

233 Jarum File 245.2 Set - - 0 -
236 KA-EN 1B 248.2 Botol - - 0 -
237 KA-EN 3A 249.2 Botol - - 0 -
238 KA-EN 3B 250.2 Botol - - 0 -
247 Kasa 10 x 80 cm 259.2 Rol - - 0 -
248 Kasa 40 x 80 260.2 Rol - 5 5 0 5
249 Kasa 5 x 80 cm 261.2 Rol - - 0 -
250 Kasa Gulung 36 x 80 262.2 Rol - - 0 -
258 Ketoknazole tablet 200 mg 270.2 Tablet 100 100 0 100
265 Kloramfenikol salep mata 1 % 277.2 Tube 32 96 128 3 125
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 700 5000 5,700 1300 4,400
278 Klozapin 25 mg 290.2 Tablet - - 0 -
282 Kotrimoksazol dewasa tablet 294.2 Tablet 1,000 1,000 500 500
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

304 Laxadine Emulsi 30 ml 316.2 Botol - 11 11 3 8
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set - 20 20 5 15
314 Lidokain injeksi 2 % 326.2 Ampul - - 0 -
315 Lidokain Kompositum injeksi 327.2 Ampul - 180 180 35 145
318 Lisol 330.2 Botol - - 0 -
320 Loperamida 2 mg tablet 332.2 Tablet 100 100 100 -
323 Lyscavit Syrup 335.2 Botol - 48 48 10 38
328 Masker 340.2 Set - 1000 1,000 100 900
329 Masker N 95 341.2 Set 400 400 0 400
330 Masker Oxygen ( Dewasa) 342.2 Set - 5 5 5 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - 16 16 0 16

339 Metanol 351.2 Botol - - 0 -
340 Metformin kapsul 500 mg 352.2 Tablet 2,500 2,500 100 2,400
341 Metil Prednisolon tablet 4 mg 353.2 Tablet 1,550 1,550 200 1,350
351 Metronidazole 500 mg Supp ( Vagizol Ovula) 363.2 Supp 5 30 35 0 35
352 Miconazol krim 2 % 364.2 Tube 126 96 222 10 212
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set 10 10 0 10
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet - 5600 5,600 1150 4,450
366 Natrium Klorida larutan infus steril 0,9 % 378.2 Botol 138 138 0 138
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

369 Neocenta Gel 381.2 Tube 3 10 13 0 13
373 Nipedipin tablet 10 mg 385.2 Tablet 200 300 500 10 490
374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 500 500 1,000 0 1,000
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 500 500 1,000 0 1,000
378 Noza 390.2 Tablet 300 500 800 400 400
380 Obat Anti Tuberkulosis Kategori 1 392.2 paket - 10 10 10 -
394 Omeprazol kapsul 20 mg 406.2 Kapsul - 1980 1,980 1050 930
397 Oxycan 409.2 Botol - - 0 -
398 Parasetamol Drop 410.2 Botol - 56 56 0 56
401 Parasetamol tablet 500 mg 413.2 Tablet - 5000 5,000 1200 3,800
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN


419 Piroksikam kapsul 20 mg 431.2 Kapsul 1,400 2000 3,400 900 2,500
422 Povidon Iodida larutan 10 % - 300 ml 434.2 Botol - 24 24 0 24
424 Prednison tablet 5 mg 436.2 Tablet 600 600 0 600
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul - 200 200 0 200
434 Ranitidin tablet 150 mg 446.2 Tablet 200 200 200 -
439 Retinol (Vitamin A) kapsul 100.000 iu 451.2 Kapsul - - 0 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

444 Ringer laktat larutan infus steril 456.2 Botol - 200 200 200 -
445 Risperidone 2 mg 457.2 Tablet - - 0 -
446 Risperidone 1 mg 458.2 Tablet - - -
449 Salbutamol tablet 4 mg 461.2 Tablet 400 2000 2,400 0 2,400
451 Salisil Bedak 2 % 463.2 Kotak - 96 96 0 96
459 Selvi Plex 471.2 Tablet 1,000 1000 2,000 800 1,200
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L 493.2 Psg - 300 300 100 200
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M 494.2 Psg - 300 300 0 300
488 Surgical Gloves Steril No 7,5 499.2 Psg - - -
492 Tablet Tambah Darah Kombinasi 503.2 Tablet - - 0 -
515 Vitamin B komplek tablet 526.2 Tablet 1,500 2000 3,500 1100 2,400
516 Wing Needle 527.2 Set 300 300 0 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
518 Zink Dispersible 529.2 Tablet 1,300 1,300 300 1,000

0


NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

3 Alat Suntik Sekali Pakai 1 ml 15.2 Set 1,050 1,050 168 882
11 Alcohol + CHG 0,5% Swab 23.2 Kotak 10 10 4 6
15 Ambroksol sirup 15 mg/ml 27.2 Botol 73 73 73 -
20 Amlodipine tablet 10 mg 32.2 Tablet 1,770 1,770 360 1,410
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol 141 141 141 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

31 Antasida Doen suspensi 43.2 Botol 257 257 87 170
32 Antasida Doen tablet kombinasi 44.2 Tablet 4,100 4,100 800 3,300
35 Antihaemoroid Doen Kombinasi 47.2 Supp 30 30 0 30
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 3,600 3,600 600 3,000
46 Asam Valproat 250mg/5ml 58.2 Botol 28 28 28 -
50 Asiklovir krim 62.2 Tube 231 231 70 161
52 Asiklovir tablet 400 mg 64.2 Tablet 1,500 1,500 100 1,400
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

67 Betametason krim 0,1 % 79.2 Tube 199 199 24 175
72 Bisoprolol tablet 5 mg 84.2 Tablet 300 300 0 300
73 Bisturi 85.2 Set - - 0 -
75 Blood Lancet 87.2 Set 300 300 100 200
78 Captopril tablet 12,5 mg 90.2 Tablet 1,500 1,500 300 1,200
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set 96 96 3 93
89 Cefiksim kapsul 100 mg 101.2 Kapsul 850 850 250 600
95 Cetrizin tablet 10 mg 107.2 Tablet 2,700 2,700 300 2,400
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
96 Cimetidin tablet 200 mg 108.2 Tablet 3,600 3,600 1200 2,400

101 Clindamisin tablet 300 mg 113.2 Tablet 1,550 1,550 1350 200
106 Deksametason tablet 0,5 mg 118.2 Tablet 4,600 4,600 300 4,300
123 Dimenhidrinat tablet 50 mg 135.2 Tablet 200 200 200 -
126 Domperidon tablet 138.2 Tablet 100 100 100 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

132 Eritromisin kapsul 500 mg 144.2 Kapsul 50 50 50 -
139 Etanol 70 % 151.2 Botol - - 0 -
140 Etanol 70 %(1000 ml) 152.2 Botol 40 40 0 40
154 Fenobarbital tablet 30 mg 166.2 Tablet 195 195 0 195
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol 24 24 0 24
158 Ferriz Baby Drop 170.2 Botol 5 5 0 5
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 1,040 1,040 140 900
174 Furosemida tablet 40 mg 186.2 Tablet 900 900 200 700
175 Garam Oralit untuk 200 ml air 187.2 Sachet 1,600 1,600 1600 -
195 Gutta Perca 207.2 Set - - 0 -
197 Halloperidol 5mg 209.2 Tablet - - 0 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

200 Haloperidol tablet 0,5 mg 212.2 Tablet - - -
201 Hand Rub 500 ml 213.2 Botol 5 5 1 4
202 Hcg Pregnancy Test 214.2 Set 250 250 250 -
206 Hustab 218.2 Tablet 800 800 600 200
214 ID Band Red ( Adult) 226.2 Set 100 100 0 100
215 ID Band Red ( Child) 227.2 Set 100 100 0 100
220 INH Anak 232.2 Tablet - - 0 -
221 Interzinc Syrup 233.2 Botol - - 0 -
227 IV cateter No. 16 239.2 Set - - 0 -
228 IV cateter No. 18 240.2 Set 439 439 58 381
229 IV Cateter No. 20 241.2 Set 339 339 0 339
230 IV cateter No. 22 242.2 Set 289 289 239 50
231 IV Cateter No. 24 243.2 Set 100 100 0 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

233 Jarum File 245.2 Set - - 0 -
236 KA-EN 1B 248.2 Botol - - 0 -
237 KA-EN 3A 249.2 Botol - - 0 -
238 KA-EN 3B 250.2 Botol - - 0 -
247 Kasa 10 x 80 cm 259.2 Rol - - 0 -
248 Kasa 40 x 80 260.2 Rol 5 5 3 2
249 Kasa 5 x 80 cm 261.2 Rol - - 0 -
250 Kasa Gulung 36 x 80 262.2 Rol - - 0 -
251 Kasa kompres 40/40 steril 263.2 Set 1,200 1,200 500 700
258 Ketoknazole tablet 200 mg 270.2 Tablet 100 100 100 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 4,400 4,400 400 4,000
275 Klorpromazin HCl tablet salut 100 mg 287.2 Tablet 100 100 100 -
278 Klozapin 25 mg 290.2 Tablet - - 0 -
282 Kotrimoksazol dewasa tablet 294.2 Tablet 500 500 500 -
288 Lansoprazol kapsul 30 mg 300.2 Kapsul 420 420 120 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

304 Laxadine Emulsi 30 ml 316.2 Botol 8 8 0 8
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set 15 15 0 15
309 Levofloksasin 0,5% tetes mata ( Optiflox) 321.2 Botol 17 17 17 -
310 Levofloksasin kapsul 500 mg 322.2 Kapsul 200 200 200 -
314 Lidokain injeksi 2 % 326.2 Ampul - - 0 -
315 Lidokain Kompositum injeksi 327.2 Ampul 145 145 38 107
318 Lisol 330.2 Botol - - 0 -
320 Loperamida 2 mg tablet 332.2 Tablet - - 0 -
321 Loratadine tablet 10 mg 333.2 Tablet 1,350 1,350 600 750
323 Lyscavit Syrup 335.2 Botol 38 38 9 29
325 Magnesium Sulfat inj (IV) 20% - 25 ml 337.2 Ampul 141 141 141 -
326 Magnesium Sulfat inj (IV) 40% - 25 ml 338.2 Ampul 120 120 120 -
328 Masker 340.2 Set 900 900 400 500
329 Masker N 95 341.2 Set 400 400 85 315
330 Masker Oxygen ( Dewasa) 342.2 Set - - 0 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube 16 16 16 -

339 Metanol 351.2 Botol - - 0 -
340 Metformin kapsul 500 mg 352.2 Tablet 2,400 2,400 1500 900
341 Metil Prednisolon tablet 4 mg 353.2 Tablet 1,350 1,350 1350 -
354 Molagit tablet 366.2 Tablet 80 80 80 -
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set 10 10 10 -
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet 4,450 4,450 1650 2,800
366 Natrium Klorida larutan infus steril 0,9 % 378.2 Botol 138 138 138 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 1,000 1,000 60 940
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 1,000 1,000 300 700
378 Noza 390.2 Tablet 400 400 300 100
392 Oksitosin injeksi 10 iu/ml - 1ml 404.2 Ampul 103 103 103 -
397 Oxycan 409.2 Botol - - 0 -
398 Parasetamol Drop 410.2 Botol 56 56 56 -
399 Parasetamol sirup 120 mg/5 ml 411.2 Botol 383 383 115 268
401 Parasetamol tablet 500 mg 413.2 Tablet 3,800 3,800 3100 700
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

419 Piroksikam kapsul 20 mg 431.2 Kapsul 2,500 2,500 600 1,900
424 Prednison tablet 5 mg 436.2 Tablet 600 600 0 600
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul 200 200 100 100
434 Ranitidin tablet 150 mg 446.2 Tablet - - 0 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

444 Ringer laktat larutan infus steril 456.2 Botol - - 0 -
451 Salisil Bedak 2 % 463.2 Kotak 96 96 2 94
459 Selvi Plex 471.2 Tablet 1,200 1,200 0 1,200
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml 475.2 Ampul 70 70 70 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L 493.2 Psg 200 200 0 200
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M 494.2 Psg 300 300 200 100
487 Surgical Gloves Steril No 7 498.2 Psg - - 0 -
515 Vitamin B komplek tablet 526.2 Tablet 2,400 2,400 500 1,900
516 Wing Needle 527.2 Set 300 300 0 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
518 Zink Dispersible 529.2 Tablet 1,000 1,000 400 600


NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

2 Alat Suntik Sekali Pakai 0.05 ml 15.2 Botol - 800 800 0 800
3 Alat Suntik Sekali Pakai 1 ml 15.2 Set 882 119 1,001 119 882
5 Alat Suntik Sekali Pakai 3 ml 17.2 Set 68 119 187 149 38
11 Alcohol + CHG 0,5% Swab 23.2 Kotak 6 9 15 9 6
13 Allopurinol tablet 100 mg 25.2 Tablet - - 0 - 1000
15 Ambroksol sirup 15 mg/ml 27.2 Botol - - 0 - 100
16 Ambroksol tablet 30 mg 28.2 Tablet 4,900 4,900 1400 3,500 1000
20 Amlodipine tablet 10 mg 32.2 Tablet 1,410 1,410 900 510 700
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol - - 0 -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

29 Antalgin (Metampyron) tablet 500 mg 41.2 Tablet 1,500 1,500 700 800
31 Antasida Doen suspensi 43.2 Botol 170 170 170 - 300
32 Antasida Doen tablet kombinasi 44.2 Tablet 3,300 3,300 2400 900 3000
33 Antibakteri Doen Kombinasi / Bacitrasin 45.2 Tube - - 0 - 5
35 Antihaemoroid Doen Kombinasi 47.2 Supp 30 30 30 - 30
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 3,000 3,000 2100 900 2000
43 Asam Mefenamat tablet 500 mg 55.2 Tablet 4,400 4,400 2900 1,500 2000
46 Asam Valproat 250mg/5ml 58.2 Botol - - 0 -
50 Asiklovir krim 62.2 Tube 161 161 8 153
52 Asiklovir tablet 400 mg 64.2 Tablet 1,400 1,400 400 1,000
53 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml 65.2 Ampul - - 0 - 5
56 Attapulgit 68.2 Tablet 200 200 0 200 2000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

67 Betametason krim 0,1 % 79.2 Tube 175 175 0 175
72 Bisoprolol tablet 5 mg 84.2 Tablet 300 300 0 300
73 Bisturi 85.2 Set - 200 200 200 -
75 Blood Lancet 87.2 Set 200 200 200 - 200
78 Captopril tablet 12,5 mg 90.2 Tablet 1,200 1,200 900 300 2000
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set 93 96 189 96 93
86 Cefadroksil kapsul 500 mg 98.2 Kapsul 1,500 1,500 900 600 2000
87 Cefadroksil sirup kering 125 mg/ml 99.2 Botol 190 190 190 - ed
89 Cefiksim kapsul 100 mg 101.2 Kapsul 600 600 100 500
90 Cefiksim syr kering100 mg/ml 102.2 Botol 12 12 5 7 20
92 Cendo Xitrol tetes mata 104.2 Botol - - 0 - 5
95 Cetrizin tablet 10 mg 107.2 Tablet 2,400 2,400 300 2,100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
96 Cimetidin tablet 200 mg 108.2 Tablet 2,400 2,400 900 1,500

101 Clindamisin tablet 300 mg 113.2 Tablet 200 250 450 0 450
103 Co-Amoksiklav tablet 625 mg 115.2 Tablet - - 0 - 100
106 Deksametason tablet 0,5 mg 118.2 Tablet 4,300 4,300 2400 1,900 2000
118 Diazepam tablet 5 mg 130.2 Tablet 274 274 63 211 200
120 Difenhidramin HCl injeksi 10 mg/ml - 1 ml 132.2 Ampul - - 0 - 15
123 Dimenhidrinat tablet 50 mg 135.2 Tablet - - 0 - 200
126 Domperidon tablet 138.2 Tablet - - 0 - 1000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 ml 142.2 Ampul - - 0 - 30

132 Eritromisin kapsul 500 mg 144.2 Kapsul - - 0 - 200
136 Etakridin (Rivanol) larutan 0,1 % 148.2 Botol 73 14 87 15 72
139 Etanol 70 % 151.2 Botol - - 0 -
140 Etanol 70 %(1000 ml) 152.2 Botol 40 14 54 17 37
150 Fenitoin Natrium kapsul 100 mg 162.2 Kapsul 200 200 200 - 300
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol 24 24 0 24
158 Ferriz Baby Drop 170.2 Botol 5 5 0 5
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 900 900 0 900
174 Furosemida tablet 40 mg 186.2 Tablet 700 700 0 700
175 Garam Oralit untuk 200 ml air 187.2 Sachet - - 0 - 1000
177 Gentamicin Injeksi 40 mg/ml 189.2 Ampul - - 0 - 5
178 Gentamisin salep kulit 0,1 % 190.2 Tube - - 0 - 30
183 Glibenklamid tablet 5 mg 195.2 Tablet 100 100 100 - 1000
195 Gutta Perca 207.2 Set - - 0 -
197 Halloperidol 5mg 209.2 Tablet - - 0 - 500
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

201 Hand Rub 500 ml 213.2 Botol 4 4 0 4
202 Hcg Pregnancy Test 214.2 Set - 200 200 0 200
206 Hustab 218.2 Tablet 200 200 0 200 600
207 Hustab Syr 219.2 Botol - - 0 - 30
213 Ibuprofen tablet 400 mg 225.2 Tablet - - - 1000
214 ID Band Red ( Adult) 226.2 Set 100 100 0 100
215 ID Band Red ( Child) 227.2 Set 100 100 0 100
220 INH Anak 232.2 Tablet - - 0 -
221 Interzinc Syrup 233.2 Botol - - 0 - 20
227 IV cateter No. 16 239.2 Set - - 0 -
228 IV cateter No. 18 240.2 Set 381 381 0 381
229 IV Cateter No. 20 241.2 Set 339 339 0 339
230 IV cateter No. 22 242.2 Set 50 50 50 - 200
231 IV Cateter No. 24 243.2 Set 100 100 0 100 200
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

233 Jarum File 245.2 Set - - 0 -
236 KA-EN 1B 248.2 Botol - - 0 -
237 KA-EN 3A 249.2 Botol - - 0 -
238 KA-EN 3B 250.2 Botol - - 0 -
243 Kalsium Laktat (Kalak) tablet 255.2 Tablet 4,800 2000 6,800 4800 2,000
245 Kapas Pembalut / Absorben 250 gram 257.2 Rol 4 5 9 9 - 10
247 Kasa 10 x 80 cm 259.2 Rol - - 0 -
248 Kasa 40 x 80 260.2 Rol 2 2 4 2 2
249 Kasa 5 x 80 cm 261.2 Rol - - 0 -
250 Kasa Gulung 36 x 80 262.2 Rol - - 0 -
251 Kasa kompres 40/40 steril 263.2 Set 700 700 0 700
258 Ketoknazole tablet 200 mg 270.2 Tablet - - 0 -
263 Kloramfenikol kapsul 500 mg 275.2 Kapsul - 300 300 0 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 4,000 4,000 1200 2,800 1000
275 Klorpromazin HCl tablet salut 100 mg 287.2 Tablet - - 0 -
276 Klorpromazin HCl tablet salut 25 mg 288.2 Tablet 875 875 730 145 500
278 Klozapin 25 mg 290.2 Tablet - 500 500 300 200
282 Kotrimoksazol dewasa tablet 294.2 Tablet - - 0 - 1500
285 Kotrimoksazol suspensi 297.2 Botol 363 363 363 - ed 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

304 Laxadine Emulsi 30 ml 316.2 Botol 8 8 8 - 10
306 Laxarec supp 318.2 Supp - - 0 - 5
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set 15 53 68 56 12
309 Levofloksasin 0,5% tetes mata ( Optiflox) 321.2 Botol - - 0 -
310 Levofloksasin kapsul 500 mg 322.2 Kapsul - - 0 -
314 Lidokain injeksi 2 % 326.2 Ampul - - 0 - 30
315 Lidokain Kompositum injeksi 327.2 Ampul 107 96 203 101 102
318 Lisol 330.2 Botol - - 0 -
320 Loperamida 2 mg tablet 332.2 Tablet - - 0 - 1000
321 Loratadine tablet 10 mg 333.2 Tablet 750 750 100 650
323 Lyscavit Syrup 335.2 Botol 29 29 29 - 50
325 Magnesium Sulfat inj (IV) 20% - 25 ml 337.2 Ampul - - 0 - 20
326 Magnesium Sulfat inj (IV) 40% - 25 ml 338.2 Ampul - - 0 - 20
328 Masker 340.2 Set 500 550 1,050 1050 - 2000
329 Masker N 95 341.2 Set 315 315 0 315
330 Masker Oxygen ( Dewasa) 342.2 Set - - 0 - 10
331 Masker Oxygen (Anak) 343.2 Set - - 0 - 5
333 Mebendazole 500 mg (Vermox) 345.2 Tablet - 24 24 0 24
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - - 0 - 10

335 Meloxicam kapsul 15 mg 347.2 Tablet - - 0 - 500
339 Metanol 351.2 Botol - - 0 -
340 Metformin kapsul 500 mg 352.2 Tablet 900 900 300 600 2000
341 Metil Prednisolon tablet 4 mg 353.2 Tablet - 4000 4,000 200 3,800
349 Metronidazol tablet 250 mg 361.2 Tablet 1,000 1,000 700 300 1000
350 Metronidazol tablet 500 mg 362.2 Tablet - - 0 - 1000
354 Molagit tablet 366.2 Tablet - - 0 -
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set - - 0 -
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet 2,800 2,800 2000 800 2500
366 Natrium Klorida larutan infus steril 0,9 % 378.2 Botol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

372 Nice Care Under Pad 384.2 Set - - 0 - 10
374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 940 940 0 940
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 700 700 400 300
376 Nocandis drop 388.2 Botol - - 0 - 24
378 Noza 390.2 Tablet 100 100 100 - 1000
379 Obat Anti Tuberkuloisi Kategori Anak 391.2 paket - 1 1 0 1
380 Obat Anti Tuberkulosis Kategori 1 392.2 paket - 15 15 0 15
385 Obat Batuk Hitam (OBH) cairan 397.2 Botol 158 158 28 130 200
391 Oksitetrasiklin HCl salap mata 1 % 403.2 Tube - - 0 - 10
392 Oksitosin injeksi 10 iu/ml - 1ml 404.2 Ampul - - -
397 Oxycan 409.2 Botol - - 0 -
398 Parasetamol Drop 410.2 Botol - - 0 -
401 Parasetamol tablet 500 mg 413.2 Tablet 700 10000 10,700 2800 7,900
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

413 Piracetam tablet 800 mg 425.2 Tablet - 500 500 0 500
416 Piridoksin HCl tablet 10 mg 428.2 Tablet 1,000 1,000 100 900
419 Piroksikam kapsul 20 mg 431.2 Kapsul 1,900 1,900 1100 1,000 1000
421 Povidon Iodida larutan 10 % - 30 ml 433.2 Botol 67 47 114 55 59
424 Prednison tablet 5 mg 436.2 Tablet 600 600 100 500 500
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul 100 100 200 100 100 200
434 Ranitidin tablet 150 mg 446.2 Tablet - - - 2000
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

444 Ringer laktat larutan infus steril 456.2 Botol - 240 240 80 160 200
445 Risperidone 2 mg 457.2 Tablet - - 0 - 500
450 Salep 2 - 4 kombinasi 462.2 Tablet - - 0 - 12
451 Salisil Bedak 2 % 463.2 Kotak 94 94 8 86
454 Sangatonik kapsul 466.2 Kapsul - - 0 - 500
457 Scabimite krim 469.2 Tube - - 0 - 5
459 Selvi Plex 471.2 Tablet 1,200 1,200 600 600 2000
461 Serum anti bisa ular polivalen injeksi 50 mg (ABU) 472.2 Ampul - - 0 - 5
462 Serum anti tetanus inj. 1.500 iu/ampul (a.t.s ) 473.2 Ampul - - 0 - 5
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml 475.2 Ampul - - 0 - 100
471 Soft U Derm Hydro Urea Krim 10% 482.2 Tube - - 0 - 5
472 Solvita Plus Syrup 483.2 Botol - - 0 - 20
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L 493.2 Psg 200 200 200 - 300
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M 494.2 Psg 100 100 100 - 300
487 Surgical Gloves Steril No 7 498.2 Psg - 119 119 119 -
488 Surgical Gloves Steril No 7,5 499.2 Psg - 119 119 119 -
495 Tarivid Otic Solution (Ofloxacin Tetes Telinga) 506.2 Botol - - 0 - 20
515 Vitamin B komplek tablet 526.2 Tablet 1,900 1,900 1500 400 2000
516 Wing Needle 527.2 Set 300 300 0 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
518 Zink Dispersible 529.2 Tablet 600 600 200 400 1000
0
UMUM ASKES JUMLAH



NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
1 Air Raksa Dental Use 14.2 Botol - - -

2 Alat Suntik Sekali Pakai 0.05 ml 15.2 Botol 800 800 800
3 Alat Suntik Sekali Pakai 1 ml 15.2 Set 882 882 882
4 Alat Suntik Sekali Pakai 2,5 ml 16.2 Set 400 400 400
7 Alat suntik Sekali Pakai 10 ml 19.2 Set - - -
9 Albendazole tablet 400 mg 21.2 Tablet - - -
10 Albion tablet 22.2 Tablet - - -
11 Alcohol + CHG 0,5% Swab 23.2 Kotak 6 6 6
12 Alkacide 1 L -2 Alkacid 10 24.2 Botol - - -
13 Allopurinol tablet 100 mg 25.2 Tablet - - -
14 Alprazolam tablet 0,5 mg 26.2 Tablet - - -
15 Ambroksol sirup 15 mg/ml 27.2 Botol - - -
16 Ambroksol tablet 30 mg 28.2 Tablet 3,500 3,500 3,500
17 Aminofilin injeksi 24 mg/ml - 10 ml 29.2 Ampul - - -
18 Aminofilin tablet 200 mg 30.2 Tablet 100 100 100
19 Amitriptilin HCl tablet 25 mg 31.2 Tablet 800 800 800
20 Amlodipine tablet 10 mg 32.2 Tablet 510 510 510
21 Amlodipine tablet 5 mg 33.2 Tablet - - -
22 Amoksisilin kaplet 500 mg 34.2 Tablet 8,100 8,100 8,100
23 Amoksisilin kapsul 250 mg 35.2 Tablet - - -
24 Amoksisilin serbuk injeksi 1000 mg/ml 36.2 Vial - - -
25 Amoksisilin sirup kering 125 mg/5 ml 37.2 Botol - - -
26 Ampisilin ijeksi 1000 mg 38.2 Ampul - - -
27 Ampisilin kaplet 500 mg 39.2 Tablet - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
28 Ampisilin sirup kering 125 mg / 5 ml 40.2 Botol - - -

29 Antalgin (Metampyron) tablet 500 mg 41.2 Tablet 800 800 800
30 Antalgin injeksi 250 mg / ml - 2 ml 42.2 Ampul - - -
31 Antasida Doen suspensi 43.2 Botol - - -
32 Antasida Doen tablet kombinasi 44.2 Tablet 900 900 900
33 Antibakteri Doen Kombinasi / Bacitrasin 45.2 Tube - - -
34 Antifungi Doen Kombinasi 46.2 Tube 24 24 24
35 Antihaemoroid Doen Kombinasi 47.2 Supp - - -
36 Antimigrain Doen Kombinasi 48.2 Tablet - - -
37 Aqua proinjeksi steril, bebas pirogen 49.2 Botol 143 143 143
38 Articulating Paper 50.2 Set - - -
39 Asam Askorbat (Vitamin C) tablet 250 mg 51.2 Tablet - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg 52.2 Tablet 900 900 900
41 Asam Folat 53.2 Tablet 200 200 200
42 Asam Mefenamat kapsul 250 mg 54.2 Kapsul - - -
43 Asam Mefenamat tablet 500 mg 55.2 Tablet 1,500 1,500 1,500
44 Asam Sulfosalisilat 20 % 56.2 Botol - - -
45 Asam Traneksamat injeksi 57.2 Ampul - - -
46 Asam Valproat 250mg/5ml 58.2 Botol - - -
47 Asering (Asetat Ringer) 59.2 Botol - - -
48 Asetosal tablet 100 mg 60.2 Tablet - - -
50 Asiklovir krim 62.2 Tube 153 153 153
51 Asiklovir tablet 200 mg 63.2 Tablet 450 450 450
52 Asiklovir tablet 400 mg 64.2 Tablet 1,000 1,000 1,000
53 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml 65.2 Ampul - - -
54 Atropin Sulfat tablet 0,5 mg 66.2 Tablet - - -
55 Atropin Sulfat Tetes Mata 0,5 % 67.2 Botol - - -
56 Attapulgit 68.2 Tablet 200 200 200
57 Baby Cough Syr 69.2 Botol - - -
58 Becefort Syr 70.2 Botol - - -
59 Becefort Tablet 71.2 Tablet - - -
60 Becom C kaplet 72.2 Tablet - - -
61 Bekarbon tablet 500 mg 73.2 Tablet - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
62 Beneuron 74.2 Tablet - - -

63 Benzatin Benzil Penisilin 1,2 juta iu/ vial 75.2 Vial - - -
65 Betahistin Mesilat 6 mg tablet 77.2 Tablet - - -
66 Betametason 1 mg + Neomisin sulfat 78.2 Tube - - -
67 Betametason krim 0,1 % 79.2 Tube 175 175 175
68 Bionemi 80.2 Tablet - - -
69 Bioplasenton krim 81.2 Tube - - -
70 Bioron 82.2 Tablet - - -
71 Bismecon Jelly 83.2 Tube - - -
72 Bisoprolol tablet 5 mg 84.2 Tablet 300 300 300
73 Bisturi 85.2 Set - - -
74 Bivalex krim 86.2 Tube - - -
75 Blood Lancet 87.2 Set - - -
76 Calostrum Syr 88.2 Botol - - -
77 Calsidol Sirup 89.2 Botol - - -
78 Captopril tablet 12,5 mg 90.2 Tablet 300 300 300
79 Captopril tablet 25 mg 91.2 Tablet - - -
80 Cat Gut / Benang Bedah No. 2/0 - 3/0 92.2 Set 93 93 93
81 Catgut chromic 2/0 75 C 30 M R 93.2 Set - - -
82 Catgut chromic 2/0 75 C 37 M C 94.2 Set - - -
85 Caviplex drop 97.2 Botol - - -
86 Cefadroksil kapsul 500 mg 98.2 Kapsul 600 600 600
87 Cefadroksil sirup kering 125 mg/ml 99.2 Botol - - -
88 Cefadroxil Syrup 250 mg/ml 100.2 Botol - - -
89 Cefiksim kapsul 100 mg 101.2 Kapsul 500 500 500
90 Cefiksim syr kering100 mg/ml 102.2 Botol 7 7 7
91 Cefotaksim injeksi 1000 mg 103.2 Ampul - - -
92 Cendo Xitrol tetes mata 104.2 Botol - - -
93 Ceftriakson injeksi 105.2 Ampul - - -
94 Cetrizin Sirup 5 mg/ ml 106.2 Botol 240 240 240
95 Cetrizin tablet 10 mg 107.2 Tablet 2,100 2,100 2,100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
96 Cimetidin tablet 200 mg 108.2 Tablet 1,500 1,500 1,500

97 Ciprofloksasin infus 109.2 Botol - - -
98 Ciprofloksasin tablet 500 mg 110.2 Tablet 3,300 3,300 3,300
99 Ciprofloksasin tetes telinga 111.2 Botol - - -
100 Clindamisin tablet 150 mg 112.2 Tablet - - -
101 Clindamisin tablet 300 mg 113.2 Tablet 450 450 450
102 Clobetasol krim 0,05 % 114.2 Tube - - -
103 Co-Amoksiklav tablet 625 mg 115.2 Tablet - - -
104 Dasabion kapsul 116.2 Kapsul - - -
105 Deksametason injeksi 5 mg/ml - 1 ml 117.2 Ampul 200 200 200
106 Deksametason tablet 0,5 mg 118.2 Tablet 1,900 1,900 1,900
107 Dekstran 70 - larutan infus 6 % steril 119.2 Botol - - -
108 Dekstrometorfan HBr sirup 10 mg / 5 ml 120.2 Botol - - -
109 Dekstrometorfan tablet 15 mg 121.2 Tablet - - -
110 Delecto HBS Ag ( Anti Gen) 122.2 Set - - -
111 Dentin Conditioner 123.2 Set - - -
112 Devitalisasi pasta (non arsen) 124.2 Set - - -
113 Dexocort 0.25% Krim (Desoksimetason 0.25 %) 125.2 Tube 47 47 47
114 Dextrofen Syr ( DMP + Dex-CTM + Phenylephrine Hcl) 126.2 Botol - - -
115 Diamond Bur Low Speed 127.2 Set - - -
116 Diazepam injeksi 5 mg 128.2 Ampul - - -
117 Diazepam tablet 2 mg 129.2 Tablet - - -
118 Diazepam tablet 5 mg 130.2 Tablet 211 211 211
119 Dietilkarbamzin Sitrat tablet 100 mg 131.2 Tablet - - -
120 Difenhidramin HCl injeksi 10 mg/ml - 1 ml 132.2 Ampul - - -
121 Digoksin tablet 0,25 mg 133.2 Tablet 400 400 400
122 Diltiazem tablet 134.2 Tablet - - -
123 Dimenhidrinat tablet 50 mg 135.2 Tablet - - -
124 Doksisiklin kapsul 100 mg 136.2 Kapsul - - -
125 Domperidon suspensi 5 mg/ml 137.2 Botol 145 145 145
126 Domperidon tablet 138.2 Tablet - - -
127 Efedrin HCl tablet 25 mg 139.2 Tablet - - -
128 Ekstrak Belladone tablet 10 mg 140.2 Tablet - - -
129 Endometasone N 141.2 Set - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 ml 142.2 Ampul - - -

131 Eritromisin kapsul 250 mg 143.2 Kapsul - - -
133 Eritromisin sirup 145.2 Botol 117 117 117
134 Erpha Livita Baby Drop 146.2 Botol - - -
135 Erya Forte 500 mg 147.2 Tablet - - -
136 Etakridin (Rivanol) larutan 0,1 % 148.2 Botol 72 72 72
137 Etambutol HCl tablet 250 mg 149.2 Tablet - - -
139 Etanol 70 % 151.2 Botol - - -
140 Etanol 70 %(1000 ml) 152.2 Botol 37 37 37
141 Ethiperan Injeksi 153.2 Ampul - - -
142 Etil Klorida semprot 154.2 Botol - - -
143 Eugenol cairan 155.2 Botol - - -
144 Famotidin tablet 20 mg 156.2 Tablet - - -
146 Feeding Tube No. 3,5 (35 cm) 158.2 Set - - -
147 Feeding Tube No. 5 (100 cm) 159.2 Set - - -
149 Fenitoin Natrium injeksi 50 mg/ml 161.2 Ampul - - -
150 Fenitoin Natrium kapsul 100 mg 162.2 Kapsul - - -
152 Fenobarbital injeksi 50 mg/ml - 2 ml 164.2 Ampul - - -
153 Fenobarbital tablet 100 mg 165.2 Tablet - - -
154 Fenobarbital tablet 30 mg 166.2 Tablet 149 149 149
155 Fenoksimetil Penisilina tablet 250 mg 167.2 Tablet - - -
157 Fenol Gliserol tetes telinga 10 % 169.2 Botol 24 24 24
158 Ferriz Baby Drop 170.2 Botol 5 5 5
159 FG Troches 171.2 Tablet - - -
160 Film IV Dress 67 P 172.2 Box 4 4 4
161 Film IV Dress 67 S 173.2 Box - - -
163 Fitomenadion ( Vit k 1 ) injeksi 10 mg/ml - 1 ml 175.2 Ampul 38 38 38
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
164 Fitomenadion ( Vit k 1 ) tablet salut 10 mg 176.2 Tablet 900 900 900
165 Flucadek tablet 177.2 Tablet - - -
166 Fluconazole 150 mg 178.2 Tablet - - -
167 Flucort N cream 179.2 Tube - - -
169 Folley Cateter 2 Way 30 cc No. 14 181.2 Set - - -
171 Folley Cateter 2 Way 30 cc No. 18 183.2 Set 30 30 30
172 Fundifar 184.2 Tablet - - -
173 Furosemida injeksi 10 mg 185.2 Ampul - - -
174 Furosemida tablet 40 mg 186.2 Tablet 700 700 700
175 Garam Oralit untuk 200 ml air 187.2 Sachet - - -
176 Genoint Salep Mata (Gentamisin 0.1 % Salep Mata) 188.2 Tube 36 36 36
177 Gentamicin Injeksi 40 mg/ml 189.2 Ampul - - -
178 Gentamisin salep kulit 0,1 % 190.2 Tube - - -
179 Gentamisin sulfat tetes mata 0,3 % 191.2 Botol 12 12 12
180 Gentian Violet larutan 1 % 192.2 Botol 11 11 11
181 Geriavita 193.2 Tablet - - -
182 Glass Ionomer Cement 194.2 Set - - -
183 Glibenklamid tablet 5 mg 195.2 Tablet - - -
184 Glimepirid 1 mg 196.2 Tablet - - -
185 Gliseril Guaiakolat tablet 100 mg 197.2 Tablet 1,400 1,400 1,400
186 Gliserin 198.2 Botol - - -
187 Glukonas Kalsikus Injeksi 10 % 199.2 Ampul - - -
188 Glukosa larutan infus 10 % steril 200.2 Botol - - -
191 Grahabion tablet 203.2 Tablet - - -
192 Gralysin syr 204.2 Botol - - -
193 Griseofulvin tablet 125 mg 205.2 Tablet 400 400 400
194 Griseofulvin tablet 250 mg (Micostop 250 mg) 206.2 Tablet 400 400 400
195 Gutta Perca 207.2 Set - - -
197 Halloperidol 5mg 209.2 Tablet - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

199 Haloperidol tablet 1,5 mg 211.2 Tablet 880 880 880
201 Hand Rub 500 ml 213.2 Botol 4 4 4
202 Hcg Pregnancy Test 214.2 Set 200 200 200
203 Hemafort 215.2 Tablet - - -
204 Hidroklorotiazida (HCT) tablet 25 mg 216.2 Tablet 700 700 700
205 Hidrokortison krim 2,5 % 217.2 Tube 211 211 211
206 Hustab 218.2 Tablet 200 200 200
208 Hyascine-N- Butil Bromida 220.2 Tablet - - -
209 Hyoscine Butil Bromida inj 221.2 Ampul - - -
210 Ibuprofen Suspensi 100 mg/ 5 ml 222.2 Botol 63 63 63
211 Ibuprofen Suspensi 200 mg/ 5 ml 223.2 Botol - - -
212 Ibuprofen tablet 200 mg 224.2 Tablet - - -
214 ID Band Red ( Adult) 226.2 Set 100 100 100
215 ID Band Red ( Child) 227.2 Set 100 100 100
216 Imerson Oil 228.2 Botol - - -
217 Immustrum syr 229.2 Botol - - -
218 Infusion set anak 230.2 Set 134 134 134
219 Infusion set dewasa 231.2 Set 186 186 186
220 INH Anak 232.2 Tablet - - -
221 Interzinc Syrup 233.2 Botol - - -
223 Isoniazida tablet 300 mg 235.2 Tablet - - -
224 Isosorbit Dinitrat tablet subligual 5 mg 236.2 Tablet 500 500 500
225 Isotic Clearens 237.2 Botol - - -
226 Isotic Neolyson 238.2 Botol - - -
227 IV cateter No. 16 239.2 Set - - -
228 IV cateter No. 18 240.2 Set 381 381 381
229 IV Cateter No. 20 241.2 Set 339 339 339
230 IV cateter No. 22 242.2 Set - - -
231 IV Cateter No. 24 243.2 Set 100 100 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
232 Jarum Extirsipasi 244.2 Set - - -

233 Jarum File 245.2 Set - - -
234 Jarum jahit bedah (steri) no 9 s/d 14 246.2 Set - - -
235 Kaca Objek ( Objek Glass) 247.2 Set - - -
236 KA-EN 1B 248.2 Botol - - -
237 KA-EN 3A 249.2 Botol - - -
238 KA-EN 3B 250.2 Botol - - -
239 Kalium diklofenak tablet 25 mg 251.2 Tablet - - -
240 Kalium diklofenak tablet 50 mg 252.2 Tablet 150 150 150
241 Kalium Permanganat serbuk 253.2 Botol - - -
242 Kalsium Hidroksi Pasta 254.2 Set - - -
243 Kalsium Laktat (Kalak) tablet 255.2 Tablet 2,000 2,000 2,000
244 Kapas Berlemak 500 gram 256.2 Rol - - -
245 Kapas Pembalut / Absorben 250 gram 257.2 Rol - - -
246 Karbamazepain tablet 200 mg 258.2 Tablet - - -
247 Kasa 10 x 80 cm 259.2 Rol - - -
248 Kasa 40 x 80 260.2 Rol 2 2 2
249 Kasa 5 x 80 cm 261.2 Rol - - -
250 Kasa Gulung 36 x 80 262.2 Rol - - -
251 Kasa kompres 40/40 steril 263.2 Set 700 700 700
252 Kasa Pembalut 2 m x 80 cm 264.2 Rol - - -
253 Kasa pembalut hidrofil 4 m x 15 cm 265.2 Rol - - -
255 Kasa Pembalut Hidrofil 4 x 10 267.2 Rol - - -
256 Kasa Steril 16 x 16 (Kasa Kotak) 268.2 Kotak 32 32 32
257 Ketoknazole Krim 2 % 269.2 Tube 80 80 80
258 Ketoknazole tablet 200 mg 270.2 Tablet - - -
259 Ketoprofen Suppositoria 100mg ( Fetik Supp) 271.2 Supp 40 40 40
260 Ketoprofen Tablet 100 mg 272.2 Tablet - - -
261 Klopidogrel 75 mg 273.2 Tablet - - -
262 Kloramfekort krim 274.2 Tube - - -
263 Kloramfenikol kapsul 500 mg 275.2 Kapsul 300 300 300
265 Kloramfenikol salep mata 1 % 277.2 Tube 98 98 98
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
266 Kloramfenikol suspensi 278.2 Botol - - -

267 Kloramfenikol tetes mata 0,5 % 279.2 Botol - - -
268 Kloramfenikol Tetes telinga 3 % 280.2 Botol 19 19 19
269 Klorfeniramin Maleat (CTM) tablet 4 mg 281.2 Tablet 2,800 2,800 2,800
270 Klorfeson krim 282.2 Tube - - -
271 Klorokuin Fosfat tablet 150 mg 283.2 Tablet - - -
272 Klorokuin tablet 250 mg 284.2 Tablet - - -
273 Klorpromazin HCl inj. 25 mg/ml - 2 ml 285.2 Ampul - - -
275 Klorpromazin HCl tablet salut 100 mg 287.2 Tablet - - -
276 Klorpromazin HCl tablet salut 25 mg 288.2 Tablet 145 145 145
277 Klorpropamid tablet 100 mg 289.2 Tablet - - -
278 Klozapin 25 mg 290.2 Tablet 200 200 200
279 Kodein HCl tablet 10 mg 291.2 Tablet - - -
280 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg 292.2 Tablet - - -
281 Kontrasepsi Injeksi Depoprogestin/Suntik KB 3 Bln 293.2 Tablet - - -
282 Kotrimoksazol dewasa tablet 294.2 Tablet - - -
283 Kotrimoksazol pediatrik tablet 295.2 Tablet - - -
285 Kotrimoksazol suspensi 297.2 Botol - - -
286 Kuinin (Kina) tablet 200 mg 298.2 Tablet - - -
287 Kuinin Dihidroklorida injeksi 25 % - 2 ml 299.2 Ampul - - -
288 Lansoprazol kapsul 30 mg 300.2 Kapsul 180 180 180
289 Larutan Anisol 301.2 Botol - - -
290 Larutan Asam Klorida 0,1 N 302.2 Botol - - -
291 Larutan Benedict 303.2 Botol - - -
292 Larutan EDTA 10 % 304.2 Botol - - -
293 Larutan Eosin 2 % 305.2 Botol - - -
294 Larutan Etanol Asam 306.2 Botol - - -
295 Larutan Giemsa Stain 307.2 Botol - - -
296 Larutan Hayem 308.2 Botol - - -
297 Larutan Iodium 1 % 309.2 Botol - - -
298 Larutan Karbol Fuksin 310.2 Botol - - -
299 Larutan Metilen Biru 311.2 Botol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
300 Larutan Na Citrat 3,13 % 312.2 Botol - - -

301 Larutan Rees Ecker 313.2 Botol - - -
302 Larutan Turk 314.2 Botol - - -
303 Larutan Xylol 315.2 Botol - - -
304 Laxadine Emulsi 30 ml 316.2 Botol - - -
305 Laxana tablet 317.2 Tablet - - -
306 Laxarec supp 318.2 Supp - - -
307 Leukoplast 1622 H ( plaster 2,5 cm x 4,5 M) 319.2 Set 12 12 12
308 Leukoplast 1625 H ( plaster 7,5 cm x 4,5 M) 320.2 Set - - -
309 Levofloksasin 0,5% tetes mata ( Optiflox) 321.2 Botol - - -
310 Levofloksasin kapsul 500 mg 322.2 Kapsul - - -
311 Lexapram 5mg/5 ml syrup 323.2 Botol - - -
312 Lexavit kaplet 324.2 Kaplet - - -
313 Lidokain (Pehakain) injeksi 2% 325.2 Ampul - - -
314 Lidokain injeksi 2 % 326.2 Ampul - - -
315 Lidokain Kompositum injeksi 327.2 Ampul 102 102 102
316 Linkomisin kapsul 250 mg 328.2 Kapsul - - -
318 Lisol 330.2 Botol - - -
319 Livron B Plex 331.2 Tablet - - -
320 Loperamida 2 mg tablet 332.2 Tablet - - -
321 Loratadine tablet 10 mg 333.2 Tablet 650 650 650
323 Lyscavit Syrup 335.2 Botol - - -
324 Lytamin Sirup 336.2 Botol - - -
325 Magnesium Sulfat inj (IV) 20% - 25 ml 337.2 Ampul - - -
327 Magnesium Sulfat serbuk 30 gram 339.2 Sachet - - -
328 Masker 340.2 Set - - -
329 Masker N 95 341.2 Set 315 315 315
330 Masker Oxygen ( Dewasa) 342.2 Set - - -
331 Masker Oxygen (Anak) 343.2 Set - - -
332 Mebendazol tablet 100 mg 344.2 Tube - - -
333 Mebendazole 500 mg (Vermox) 345.2 Tablet 24 24 24
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - - -

335 Meloxicam kapsul 15 mg 347.2 Tablet - - -
336 Meloxicam kapsul 7,5 mg 348.2 Kapsul - - -
338 Metampiron 500 mg, Diazepam 2 mg 350.2 Tablet - - -
339 Metanol 351.2 Botol - - -
340 Metformin kapsul 500 mg 352.2 Tablet 600 600 600
341 Metil Prednisolon tablet 4 mg 353.2 Tablet 3,800 3,800 3,800
342 Metilergometrin Maleat injeksi 0,200 mg - 1 ml 354.2 Ampul 180 180 180
343 Metilergometrin Maleat tablet salut 0,125 mg 355.2 Tablet 500 500 500
344 Metilprednisolon 8 mg tablet 356.2 Tablet - - -
345 Metoklopramide injeksi 5 mg/ml 357.2 Ampul - - -
346 Metoklopramide sirup 5 mg/ml 358.2 Botol - - -
347 Metoklopramide tablet 10 mg 359.2 Tablet 300 300 300
348 Metronidazol infus 360.2 Botol - - -
349 Metronidazol tablet 250 mg 361.2 Tablet 300 300 300
350 Metronidazol tablet 500 mg 362.2 Tablet - - -
351 Metronidazole 500 mg Supp ( Vagizol Ovula) 363.2 Supp 35 35 35
352 Miconazol krim 2 % 364.2 Tube 128 128 128
353 Mixing Pad 365.2 Tablet - - -
354 Molagit tablet 366.2 Tablet - - -
355 Monoklorkamfer Mentol cairan (CHKM) 367.2 Set - - -
356 Mucohexin tab 368.2 Tablet - - -
358 Mummifying pasta 370.2 Set - - -
359 Mycorine Powder ( Miconazole 2 %) 371.2 Botol - - -
360 Nasal Canula (Selang Oksigen) Anak 372.2 Set - - -
361 Nasal Canula Bayi 373.2 Set - - -
362 Nasal Canula Dewasa 374.2 Set 20 20 20
363 Natrium Bikarbonat tablet 500 mg 375.2 Tablet 500 500 500
364 Natrium Diklofenat tablet 25 mg 376.2 Tablet - - -
365 Natrium Diklofenat tablet 50 mg 377.2 Tablet 800 800 800
367 Natrium Tiosulfat injeksi 25 % - 2ml 379.2 Ampul - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
368 Natrium Tiroksin 100 ug 380.2 Tablet - - -

369 Neocenta Gel 381.2 Tube 2 2 2
370 Neurosanbe Plus kaplet 382.2 Kaplet - - -
371 Neurovit E tablet 383.2 Ampul - - -
372 Nice Care Under Pad 384.2 Set - - -
373 Nipedipin tablet 10 mg 385.2 Tablet 490 490 490
374 Nistatin 100.000 iu/ g tablet vagina 386.2 Tablet 940 940 940
375 Nistatin 500.000 iu tablet salut 387.2 Tablet 300 300 300
376 Nocandis drop 388.2 Botol - - -
377 Nodiar tablet 389.2 Tablet - - -
378 Noza 390.2 Tablet - - -
379 Obat Anti Tuberkuloisi Kategori Anak 391.2 paket 1 1 1
380 Obat Anti Tuberkulosis Kategori 1 392.2 paket 15 15 15
381 Obat Anti Tuberkulosis Kategori 1 (Kombipak) 393.2 paket - - -
382 Obat Anti Tuberkulosis Kategori 2 394.2 paket - - -
384 Obat Anti Tuberkulosis Kategori Sisipan 396.2 paket - - -
385 Obat Batuk Hitam (OBH) cairan 397.2 Botol 130 130 130
386 Obat Batuk Hitam (OBH) Plus cairan 398.2 Botol - - -
387 Ofloksasin tablet 200 mg 399.2 Tablet - - -
388 Ofloxacin tablet 400 mg 400.2 Tablet 100 100 100
389 Oksitetrasiklin HCl injeksi i.m 50 mg/ml - 10 ml 401.2 Ampul - - -
390 Oksitetrasiklin HCl salap 3 % 402.2 Tube 17 17 17
391 Oksitetrasiklin HCl salap mata 1 % 403.2 Tube - - -
393 Omedeson 0,5 mg tablet 405.2 Tablet - - -
394 Omeprazol kapsul 20 mg 406.2 Kapsul 570 570 570
395 Orphen Tablet 407.2 Tablet - - -
396 Oxfezin syr 408.2 Botol - - -
397 Oxycan 409.2 Botol - - -
398 Parasetamol Drop 410.2 Botol - - -
399 Parasetamol sirup 120 mg/5 ml 411.2 Botol 124 124 124
400 Parasetamol tablet 100 mg 412.2 Tablet - - -
401 Parasetamol tablet 500 mg 413.2 Tablet 7,900 7,900 7,900
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
402 Pehavral 414.2 Tablet - - -

403 Pembalut Gips 415.2 Set - - -
404 Perfenazin HCl tablet 4 mg 416.2 Tablet - - -
405 Pethidin HCl injeksi 50 mg / ml - 2 ml 417.2 Ampul - - -
406 Pharmaton Formula 418.2 Kapsul - - -
407 Pil KB Kombinasi- Bliss 28 Tab 419.2 Tablet - - -
408 Pilokarpin HCl/Nitrat tetes mata 2 % 420.2 Botol - - -
409 Piracetam injeksi 1 g/5 ml 421.2 Ampul - - -
411 Piracetam sirup 423.2 Botol - - -
412 Piracetam tablet 400 mg 424.2 Tablet - - -
413 Piracetam tablet 800 mg 425.2 Tablet 500 500 500
414 Pirantel tablet 125 mg 426.2 Tablet 64 64 64
415 Pirazinamida tablet 500 mg 427.2 Tablet - - -
416 Piridoksin HCl tablet 10 mg 428.2 Tablet 900 900 900
418 Piroksikam kapsul 10 mg 430.2 Kapsul - - -
419 Piroksikam kapsul 20 mg 431.2 Kapsul 1,000 1,000 1,000
420 Plester 5 yard x 2 inch 432.2 Rol - - -
421 Povidon Iodida larutan 10 % - 30 ml 433.2 Botol 59 59 59
423 Povidone Iodine 10 % 60 ml 435.2 Botol - - -
424 Prednison tablet 5 mg 436.2 Tablet 500 500 500
425 Primakuin tablet 15 mg 437.2 Tablet - - -
426 Pritavit 438.2 Kapsul - - -
427 Prokain Benzil Penisilin 3 juta iu/vial injeksi 439.2 Vial - - -
428 Prolysin Syrup Plus 440.2 Botol - - -
429 Propanolo HCl tablet 40 mg 441.2 Ampul - - -
430 Propect tab/Ambroksol 442.2 Tablet - - -
431 Propitiourasil tablet 100 mg 443.2 Tablet - - -
432 Rabies Immune Globulin (Human) 150 iu/ml 444.2 Vial - - -
433 Ranitidin injeksi 25 mg/ml 445.2 Ampul 100 100 100
434 Ranitidin tablet 150 mg 446.2 Tablet - - -
435 Reagen Golongan Darah Anti A 447.2 Botol - - -
436 Reagen Golongan Darah Anti B 448.2 Botol - - -
437 Reserpin tablet 0,10 mg 449.2 Tablet - - -
439 Retinol (Vitamin A) kapsul 100.000 iu 451.2 Kapsul - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

441 Rifampisin kapsul 300 mg 453.2 Kapsul - - -
444 Ringer laktat larutan infus steril 456.2 Botol 160 160 160
447 Safety Box 459.2 kotak - - -
448 Salbutamol tablet 2 mg 460.2 Tablet 3,100 3,100 3,100
450 Salep 2 - 4 kombinasi 462.2 Tablet - - -
451 Salisil Bedak 2 % 463.2 Kotak 86 86 86
452 Sammoxin 500 mg tablet 464.2 Tablet - - -
453 Sanbe Kids 465.2 Botol - - -
454 Sangatonik kapsul 466.2 Kapsul - - -
455 Sarung Tangan Obgyn Steril 467.2 Psg - - -
456 Scabicid krim 468.2 Tube - - -
457 Scabimite krim 469.2 Tube - - -
458 Selcom - C kaplet 470.2 Kaplet - - -
459 Selvi Plex 471.2 Tablet 600 600 600
460 Semen Seng Fosfat serbuk dan cairan 471.2 Set - - -
461 Serum anti bisa ular polivalen injeksi 50 mg (ABU) 472.2 Ampul - - -
462 Serum anti tetanus inj. 1.500 iu/ampul (a.t.s ) 473.2 Ampul - - -
464 Sianokobalamin (Vitamin B12) injeksi 500 mcg/ml 475.2 Ampul - - -
465 Sianokobalamin (Vitamin B12) tab 50 mcg 476.2 Tablet - - -
466 Silk (benang bedah sutera) no. 3/0 477.2 Set - - -
467 Silver Amalgam serbuk 65 - 75 % 478.2 Set - - -
468 Simvastatin tablet 10 mg 479.2 Tablet - - -
471 Soft U Derm Hydro Urea Krim 10% 482.2 Tube - - -
472 Solvita Plus Syrup 483.2 Botol - - -
473 Spiramisin tablet 500 mg 484.2 Tablet - - -
474 Stesolid Suppositoria 10 mg 485.2 Supp - - -
476 Stomach tube FG 16 487.2 Set - - -
478 Sulfadimidin tablet 500 mg 489.2 Tablet - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
479 Sulfametoksazol 800 mg + Trimetoprim 160 mg 490.2 Tablet - - -

480 Supra Flu tablet 491.2 Tablet - - -
481 Suprabion tablet 492.2 Tablet - - -
482 Surgcal Gloves Non Steril L/ Handscoen Non Steril L 493.2 Psg - - -
483 Surgcal Gloves Non Steril M/Handscoen Non Steril M 494.2 Psg - - -
484 Surgical Glove Steril No 6,5 495.2 Psg - - -
485 Surgical Gloves Non-Steril No 7 496.2 Psg - - -
486 Surgical Gloves Non-Steril No 7,5 497.2 Psg - - -
489 Surgical Tape 2.5 cm x 910 cm 500.2 Psg - - -
492 Tablet Tambah Darah Kombinasi 503.2 Tablet - - -
493 Tambalan Sementara 504.2 Set - - -
494 Tamiflu 505.2 Tablet - - -
495 Tarivid Otic Solution (Ofloxacin Tetes Telinga) 506.2 Botol - - -
496 Temporary stopping Fletcher serbuk dan cairan 507.2 Set - - -
497 Tetrakain HCl tetes mata 508.2 Botol - - -
498 Tetrasiklin HCl kapsul 250 mg 509.2 Kapsul - - -
500 Thiamphenicol kapsul 250 mg 511.2 Kapsul - - -
502 Thramed Kapsul 513.2 Kapsul - - -
503 Tiamin HCl (Vit B 1) inj. 100 mg/ml - 1 ml 514.2 Ampul - - -
504 Tiamin HCl monohidrat (Vit B 1) tablet 50 mg 515.2 Tablet 100 100 100
505 Tramadol injeksi 50 mg / ml 516.2 Ampul 90 90 90
506 Tramadol tablet 50 mg 517.2 Tablet - - -
507 Trifastan 500 mg tablet 518.2 Tablet - - -
509 Triheksifenidil Hidroklorida tablet 2 mg 520.2 Tablet 570 570 570
510 Trikresol Formali (TKF) cairan 521.2 Set - - -
511 Ulsidek 500 mg (Sucralfat) 522.2 Tablet 200 200 200
512 Umbilical Cord Clamp 523.2 Set 100 100 100
513 Urine Bag non steril 524.2 Set - - -
514 Vitalex kapsul 525.2 Kapsul - - -
515 Vitamin B komplek tablet 526.2 Tablet 400 400 400
516 Wing Needle 527.2 Set 300 300 300
517 Yodium kapsul 528.2 Kapsul - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
518 Zink Dispersible 529.2 Tablet 400 400 400
UMUM ASKES JUMLAH



NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

139 Etanol 70 % 151.2 Botol - - -
140 Etanol 70 %(1000 ml) 152.2 Botol 37 37 37
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

201 Hand Rub 500 ml 213.2 Botol 4 4 4
206 Hustab 218.2 Tablet 200 200 200
227 IV cateter No. 16 239.2 Set - - -
228 IV cateter No. 18 240.2 Set 381 381 381
229 IV Cateter No. 20 241.2 Set 339 339 339
230 IV cateter No. 22 242.2 Set - - -
231 IV Cateter No. 24 243.2 Set 100 100 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

236 KA-EN 1B 248.2 Botol - - -
237 KA-EN 3A 249.2 Botol - - -
238 KA-EN 3B 250.2 Botol - - -
247 Kasa 10 x 80 cm 259.2 Rol - - -
248 Kasa 40 x 80 260.2 Rol 2 2 2
249 Kasa 5 x 80 cm 261.2 Rol - - -
250 Kasa Gulung 36 x 80 262.2 Rol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

318 Lisol 330.2 Botol - - -
328 Masker 340.2 Set - - -
329 Masker N 95 341.2 Set 315 315 315
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

378 Noza 390.2 Tablet - - -
397 Oxycan 409.2 Botol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

516 Wing Needle 527.2 Set 300 300 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
UMUM ASKES JUMLAH



NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

139 Etanol 70 % 151.2 Botol - - -
140 Etanol 70 %(1000 ml) 152.2 Botol 37 37 37
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

201 Hand Rub 500 ml 213.2 Botol 4 4 4
206 Hustab 218.2 Tablet 200 200 200
227 IV cateter No. 16 239.2 Set - - -
228 IV cateter No. 18 240.2 Set 381 381 381
229 IV Cateter No. 20 241.2 Set 339 339 339
230 IV cateter No. 22 242.2 Set - - -
231 IV Cateter No. 24 243.2 Set 100 100 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

236 KA-EN 1B 248.2 Botol - - -
237 KA-EN 3A 249.2 Botol - - -
238 KA-EN 3B 250.2 Botol - - -
247 Kasa 10 x 80 cm 259.2 Rol - - -
248 Kasa 40 x 80 260.2 Rol 2 2 2
249 Kasa 5 x 80 cm 261.2 Rol - - -
250 Kasa Gulung 36 x 80 262.2 Rol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

318 Lisol 330.2 Botol - - -
328 Masker 340.2 Set - - -
329 Masker N 95 341.2 Set 315 315 315
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

378 Noza 390.2 Tablet - - -
397 Oxycan 409.2 Botol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

516 Wing Needle 527.2 Set 300 300 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
UMUM ASKES JUMLAH



NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
12 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

139 Etanol 70 % 151.2 Botol - - -
140 Etanol 70 %(1000 ml) 152.2 Botol 37 37 37
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

201 Hand Rub 500 ml 213.2 Botol 4 4 4
206 Hustab 218.2 Tablet 200 200 200
227 IV cateter No. 16 239.2 Set - - -
228 IV cateter No. 18 240.2 Set 381 381 381
229 IV Cateter No. 20 241.2 Set 339 339 339
230 IV cateter No. 22 242.2 Set - - -
231 IV Cateter No. 24 243.2 Set 100 100 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

236 KA-EN 1B 248.2 Botol - - -
237 KA-EN 3A 249.2 Botol - - -
238 KA-EN 3B 250.2 Botol - - -
247 Kasa 10 x 80 cm 259.2 Rol - - -
248 Kasa 40 x 80 260.2 Rol 2 2 2
249 Kasa 5 x 80 cm 261.2 Rol - - -
250 Kasa Gulung 36 x 80 262.2 Rol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

318 Lisol 330.2 Botol - - -
328 Masker 340.2 Set - - -
329 Masker N 95 341.2 Set 315 315 315
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

378 Noza 390.2 Tablet - - -
397 Oxycan 409.2 Botol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

516 Wing Needle 525.2 Set 300 300 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
UMUM ASKES JUMLAH



NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
0
Handscoon Non Steril M
KET
KET
KET
KET
2 0 1 9
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

139 Etanol 70 % 151.2 Botol - - -
140 Etanol 70 %(1000 ml) 152.2 Botol 37 37 37
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

201 Hand Rub 500 ml 213.2 Botol 4 4 4
206 Hustab 218.2 Tablet 200 200 200
227 IV cateter No. 16 239.2 Set - - -
228 IV cateter No. 18 240.2 Set 381 381 381
229 IV Cateter No. 20 241.2 Set 339 339 339
230 IV cateter No. 22 242.2 Set - - -
231 IV Cateter No. 24 243.2 Set 100 100 100
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

236 KA-EN 1B 248.2 Botol - - -
237 KA-EN 3A 249.2 Botol - - -
238 KA-EN 3B 250.2 Botol - - -
247 Kasa 10 x 80 cm 259.2 Rol - - -
248 Kasa 40 x 80 260.2 Rol 2 2 2
249 Kasa 5 x 80 cm 261.2 Rol - - -
250 Kasa Gulung 36 x 80 262.2 Rol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

318 Lisol 330.2 Botol - - -
328 Masker 340.2 Set - - -
329 Masker N 95 341.2 Set 315 315 315
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

378 Noza 390.2 Tablet - - -
397 Oxycan 409.2 Botol - - -
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN

516 Wing Needle 525.2 Set 300 300 300
PEMBERIAN
PERSE- PERMIN-
DIAAN TAAN
UMUM ASKES JUMLAH



NIP. 19700901 199101 1 001
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET
KET

Lplpo Apbd Juli 2019

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Lplpo Apbd Juli 2019

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STOK OPNAME OBAT PUSKESMAS

SISA STOK 31 TGGL

1 Air Raksa Dental Use Botol - ###

41 Asam Folat Kapsul 900 17TH067 Aug-20

87 Cefadroksil sirup kering 125 mg/ml Botol 386 HH398116 Aug-19

133 Eritromisin sirup Botol 130 AF920312 Sep-19

179 Gentamisin sulfat tetes mata 0,3 % Botol 30 O253016 Jun-21

225 Isotic Clearens Botol - ###

271 Klorokuin Fosfat tablet 150 mg Tablet - ###

317 Linkomisin kapsul 500 mg Botol - ###

363 Natrium Bikarbonat tablet 500 mg Tablet 1,000 1708165 Aug-21

411 Piracetam sirup Tablet - ###

517 Yodium kapsul Kapsul -

Mengetahui / Menyetujui Kota Lama, 2 Januari 2019 Yang Menerima

Endang Suhada, SKM Dony Iswandi, S.Farm., Apt (………………

KELAS STOK PERSE- STOK

1 Air Raksa Dental Use 14.2 Botol - - 0 -

41 Asam Folat 11.2 Tablet 900 900 200 700

133 Eritromisin sirup 6.2.2.3 Botol 130 130 3 127

180 Gentian Violet larutan 1 % 22.1 Botol 21 21 5 16

227 IV cateter No. 16 Set - - 0 -

273 Klorpromazin HCl inj. 25 mg/ml - 2 ml Ampul - - 0 -

320 Loperamida 2 mg tablet Tablet 1,100 1,100 600 500

367 Natrium Tiosulfat injeksi 25 % - 2ml Ampul - - 0 -

414 Pirantel tablet 125 mg Tablet 80 80 0 80

467 Silver Amalgam serbuk 65 - 75 % Set - - 0 -

UMUM ASKES JUMLAH

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / M

(……………………………..) (……………………………..) Endang Suhada,

Yang Menerima / Melapor Yang Menerima

Endang Suhada, SKM Dony Iswandi, S.Farm., Apt

1 Air Raksa Dental Use 14.2 Botol - - 0 -

28 Ampisilin sirup kering 125 mg / 5 ml 40.2 Botol - - 0 -

62 Beneuron 74.2 Tablet - - 0 -

130 Epinefrin HCl/bitatrat (Adrenalin) injeksi 0,1 % - 1 m 142.2 Ampul - - 0 -

198 Haloperidol tab 2 mg 210.2 Tablet - - -

232 Jarum Extirsipasi 244.2 Set - - 0 -

266 Kloramfenikol suspensi 278.2 Botol - - 0 -

300 Larutan Na Citrat 3,13 % 312.2 Botol - - 0 -

334 Melavita Cream ( Asam Retinoat 0.1 %) 346.2 Tube - - 0 -

368 Natrium Tiroksin 100 ug 380.2 Tablet - - 0 -

402 Pehavral 414.2 Tablet - - 0 -

441 Rifampisin kapsul 300 mg 453.2 Kapsul - - 0 -

480 Supra Flu tablet 491.2 Tablet - - 0 -

UMUM ASKES JUMLAH

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

(……………………………..) (………………………..) Endang Suhada, SKM Dony Iswandi, S.Farm., Apt

1 Air Raksa Dental Use 14.2 Botol - -

41 Asam Folat 53.2 Tablet 700 700

87 Cefadroksil sirup kering 125 mg/ml 99.2 Botol 366 366

133 Eritromisin sirup 145.2 Botol 117 117

179 Gentamisin sulfat tetes mata 0,3 % 191.2 Botol 24 24

225 Isotic Clearens 237.2 Botol - -

271 Klorokuin Fosfat tablet 150 mg 283.2 Tablet - -

317 Linkomisin kapsul 500 mg 329.2 Kapsul - -

363 Natrium Bikarbonat tablet 500 mg 375.2 Tablet 800 800

411 Piracetam sirup 423.2 Botol - -

517 Yodium kapsul 528.2 Kapsul - -

Mengetahui / Menyetujui Yang Menyerahkan

kan Yang Menerima / Melapor Yang Menerima

……..) Endang Suhada, SKM Dony Iswandi, S.Farm., Apt

1 Air Raksa Dental Use 14.2 Botol - - 0 -

28 Ampisilin sirup kering 125 mg / 5 ml 40.2 Botol - - 0 -

62 Beneuron 74.2 Tablet - - 0 - 1000