Sbbk 2019.xlsx
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LAMPIRAN BERITA ACARA SERAH TERIMA OBAT UPT DINAS KESEHATAN PUSKESMAS SUMBER SARI NOMOR : 445/ /PKM-SS/2019 NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14
NAMA OBAT Amlodipine besilate 5 mg amoxicilin 500 mg CTM 4 mg Calcium lactat cotrimoxazole 480 mg dexamethasone 0,5 mg domperidon diclofenac sodium omeperazole Asam Askorbat ( vit C ) 50 mg pirodoxin Thiamin HCL ( VIT B1 ) vitamin B Komplek oralit
SATUAN Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet bungkus
JUMLAH 90 200 200 200 100 200 100 100 60 200 200 200 200 100
KET
NO 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NAMA OBAT ibuprofen syr paracetamol syr cotrimoxazole syr cefadroxil syr ringer laktat glukosa 5 % alkohol 70 % 1 liter lysol konsentrat povidon iodida rivanol 300 ml lidocain inj dexamethasone inj phtomenadion inj
SATUAN botol botol botol botol kolf kolf botol botol botol botol ampul ampul ampul
JUMLAH 5 10 20 10 5 10 1 1 1 5 10 25 30
KET
PENGURUS BARANG UPT DINKES PKM SUMBER SARI
Sumber Sari, 28 Januari 2019 ASISTEN APOTEKER UPT DINKES PKM SUMBER SARI
WISNU, SKM NIP. 19631225 198702 1 003
LILIK MURNI HAYATI, A.Md.Far NIP. 19861129 200902 2 005
MENGETAHUI KEPALA UPT DINKES PKM SUMBER SARI
PENERIMA BARANG
EDI KHAIRIL ISWAN,SKM
MULYANI, SKM
NIP. 19741020 199603 1 002
NIP. 19680629 198912 2 002
LAMPIRAN BERITA ACARA SERAH TERIMA OBAT UPT DINAS KESEHATAN PUSKESMAS SUMBER SARI NOMOR : 445/ /PKM-SS/2019 NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14
NAMA OBAT Amlodipine besilate 5 mg amoxicilin 500 mg CTM 4 mg Calcium lactat cotrimoxazole 480 mg dexamethasone 0,5 mg domperidon diclofenac sodium omeperazole Asam Askorbat ( vit C ) 50 mg pirodoxin Thiamin HCL ( VIT B1 ) vitamin B Komplek oralit
SATUAN Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet bungkus
JUMLAH 90 200 200 200 100 200 100 100 60 200 200 200 200 100
KET
NO 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NAMA OBAT ibuprofen syr paracetamol syr cotrimoxazole syr cefadroxil syr ringer laktat glukosa 5 % alkohol 70 % 1 liter lysol konsentrat povidon iodida rivanol 300 ml lidocain inj dexamethasone inj phtomenadion inj
SATUAN botol botol botol botol kolf kolf botol botol botol botol ampul ampul ampul
JUMLAH 5 10 20 10 5 10 1 1 1 5 10 25 30
KET
PENGURUS BARANG UPT DINKES PKM SUMBER SARI
Sumber Sari, 28 Januari 2019 ASISTEN APOTEKER UPT DINKES PKM SUMBER SARI
WISNU, SKM NIP. 19631225 198702 1 003
LILIK MURNI HAYATI, A.Md.Far NIP. 19861129 200902 2 005
MENGETAHUI KEPALA UPT DINKES PKM SUMBER SARI
PENERIMA BARANG
EDI KHAIRIL ISWAN,SKM
KHAIRANI, Am.Keb
NIP. 19741020 199603 1 002
NIP. 19811204 201705 2 001
LAMPIRAN BERITA ACARA SERAH TERIMA OBAT UPT DINAS KESEHATAN PUSKESMAS SUMBER SARI NOMOR : 445/ /PKM-SS/2019 NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14
NAMA OBAT Amlodipine besilate 5 mg amoxicilin 500 mg CTM 4 mg Calcium lactat cotrimoxazole 480 mg dexamethasone 0,5 mg domperidon diclofenac sodium omeperazole Asam Askorbat ( vit C ) 50 mg pirodoxin Thiamin HCL ( VIT B1 ) vitamin B Komplek oralit
SATUAN Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet bungkus
JUMLAH 90 200 200 200 100 200 100 100 60 200 200 200 200 100
KET
NO 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NAMA OBAT ibuprofen syr paracetamol syr cotrimoxazole syr cefadroxil syr ringer laktat glukosa 5 % alkohol 70 % 1 liter lysol konsentrat povidon iodida rivanol 300 ml lidocain inj dexamethasone inj phtomenadion inj
SATUAN botol botol botol botol kolf kolf botol botol botol botol ampul ampul ampul
JUMLAH 5 10 20 10 5 10 1 1 1 5 10 25 30
KET
PENGURUS BARANG UPT DINKES PKM SUMBER SARI
Sumber Sari, 28 Januari 2019 ASISTEN APOTEKER UPT DINKES PKM SUMBER SARI
WISNU, SKM NIP. 19631225 198702 1 003
LILIK MURNI HAYATI, A.Md.Far NIP. 19861129 200902 2 005
MENGETAHUI KEPALA UPT DINKES PKM SUMBER SARI
PENERIMA BARANG
EDI KHAIRIL ISWAN,SKM
NUGRAENI PL, SKM
NIP. 19741020 199603 1 002
NIP. 19660207 108910 2 001
NAMA OBAT Amlodipine besilate 5 mg amoxicilin 500 mg CTM 4 mg Calcium lactat cotrimoxazole 480 mg dexamethasone 0,5 mg domperidon diclofenac sodium omeperazole Asam Askorbat ( vit C ) 50 mg pirodoxin Thiamin HCL ( VIT B1 ) vitamin B Komplek oralit
SATUAN Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet bungkus
JUMLAH 90 200 200 200 100 200 100 100 60 200 200 200 200 100
KET
NO 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NAMA OBAT ibuprofen syr paracetamol syr cotrimoxazole syr cefadroxil syr ringer laktat glukosa 5 % alkohol 70 % 1 liter lysol konsentrat povidon iodida rivanol 300 ml lidocain inj dexamethasone inj phtomenadion inj
SATUAN botol botol botol botol kolf kolf botol botol botol botol ampul ampul ampul
JUMLAH 5 10 20 10 5 10 1 1 1 5 10 25 30
KET
PENGURUS BARANG UPT DINKES PKM SUMBER SARI
Sumber Sari, 28 Januari 2019 ASISTEN APOTEKER UPT DINKES PKM SUMBER SARI
WISNU, SKM NIP. 19631225 198702 1 003
LILIK MURNI HAYATI, A.Md.Far NIP. 19861129 200902 2 005
MENGETAHUI KEPALA UPT DINKES PKM SUMBER SARI
PENERIMA BARANG
EDI KHAIRIL ISWAN,SKM
MULYANI, SKM
NIP. 19741020 199603 1 002
NIP. 19680629 198912 2 002
LAMPIRAN BERITA ACARA SERAH TERIMA OBAT UPT DINAS KESEHATAN PUSKESMAS SUMBER SARI NOMOR : 445/ /PKM-SS/2019 NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14
NAMA OBAT Amlodipine besilate 5 mg amoxicilin 500 mg CTM 4 mg Calcium lactat cotrimoxazole 480 mg dexamethasone 0,5 mg domperidon diclofenac sodium omeperazole Asam Askorbat ( vit C ) 50 mg pirodoxin Thiamin HCL ( VIT B1 ) vitamin B Komplek oralit
SATUAN Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet bungkus
JUMLAH 90 200 200 200 100 200 100 100 60 200 200 200 200 100
KET
NO 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NAMA OBAT ibuprofen syr paracetamol syr cotrimoxazole syr cefadroxil syr ringer laktat glukosa 5 % alkohol 70 % 1 liter lysol konsentrat povidon iodida rivanol 300 ml lidocain inj dexamethasone inj phtomenadion inj
SATUAN botol botol botol botol kolf kolf botol botol botol botol ampul ampul ampul
JUMLAH 5 10 20 10 5 10 1 1 1 5 10 25 30
KET
PENGURUS BARANG UPT DINKES PKM SUMBER SARI
Sumber Sari, 28 Januari 2019 ASISTEN APOTEKER UPT DINKES PKM SUMBER SARI
WISNU, SKM NIP. 19631225 198702 1 003
LILIK MURNI HAYATI, A.Md.Far NIP. 19861129 200902 2 005
MENGETAHUI KEPALA UPT DINKES PKM SUMBER SARI
PENERIMA BARANG
EDI KHAIRIL ISWAN,SKM
KHAIRANI, Am.Keb
NIP. 19741020 199603 1 002
NIP. 19811204 201705 2 001
LAMPIRAN BERITA ACARA SERAH TERIMA OBAT UPT DINAS KESEHATAN PUSKESMAS SUMBER SARI NOMOR : 445/ /PKM-SS/2019 NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14
NAMA OBAT Amlodipine besilate 5 mg amoxicilin 500 mg CTM 4 mg Calcium lactat cotrimoxazole 480 mg dexamethasone 0,5 mg domperidon diclofenac sodium omeperazole Asam Askorbat ( vit C ) 50 mg pirodoxin Thiamin HCL ( VIT B1 ) vitamin B Komplek oralit
SATUAN Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet bungkus
JUMLAH 90 200 200 200 100 200 100 100 60 200 200 200 200 100
KET
NO 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NAMA OBAT ibuprofen syr paracetamol syr cotrimoxazole syr cefadroxil syr ringer laktat glukosa 5 % alkohol 70 % 1 liter lysol konsentrat povidon iodida rivanol 300 ml lidocain inj dexamethasone inj phtomenadion inj
SATUAN botol botol botol botol kolf kolf botol botol botol botol ampul ampul ampul
JUMLAH 5 10 20 10 5 10 1 1 1 5 10 25 30
KET
PENGURUS BARANG UPT DINKES PKM SUMBER SARI
Sumber Sari, 28 Januari 2019 ASISTEN APOTEKER UPT DINKES PKM SUMBER SARI
WISNU, SKM NIP. 19631225 198702 1 003
LILIK MURNI HAYATI, A.Md.Far NIP. 19861129 200902 2 005
MENGETAHUI KEPALA UPT DINKES PKM SUMBER SARI
PENERIMA BARANG
EDI KHAIRIL ISWAN,SKM
NUGRAENI PL, SKM
NIP. 19741020 199603 1 002
NIP. 19660207 108910 2 001
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