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DINAS KESEHATAN KABUPATEN INDRAMAYU
UPTD PUSKESMAS TUKDANA Jl Raya Lajer - Tukdana - Inramayu 45272
BERITA ACARA STOK OPNAME OBAT DAN ALKES DI UPTD PUSKESMAS TUKDANA PER 30 September 2017 NOMOR : Pada hari ini sabtu tanggal tiga puluh bulan september tahun dua ribu tujuh belas ( 30-09-2017 ), yang bertanda tangan dibawah ini : 1 H. Suaedi : Ka UPTD Puskesmas Tukdana NIP : 19600323198105 1 001 2 Mulyadi,Skm : Kasubag Tu NIP : 19761012200501 1 003 3 Nurhaeti,AMK : Petugas Pengelola Obat NIP : 19790923200808 2 008 4 Soplaah S,SST : Petugas Pengelola Obat Program KIA NIP : 19660307198603 2 009 5 dr,Widodo Firmansyah : Petugas Pengelola Obat Program BP NIP : 19811207.201412.1.001
Telah melaksanakan Stok Opname terhadap Obat-obatan dan Alat Kesehatan pada UPTD Puskesmas Tukdana Dinas Kesehatan Kabupaten Indramayu dan telah ditemukan saldo sebesar Rp. 39.974.385,07 dengan perincian sebagai berikut :
OBAT DAN BMHP
NO
1
2 1
Satuan Terkecil 3
SALDO AWAL JULI 2017 Harga Satuan
VOL
4
5
PENERIMAAN
PENGELUARAN
Jumlah
Harga Satuan
VOL
Jumlah
Harga Satuan
VOL
Jumlah
6
7
8
9
10
11
12
FARMASI
1 Alopurinol tab 100 mg
Tablet
0
0
0
90.00
2,500.00
225,000.00
90.00
1,000.00
90,000.00
2 Aminofilin tab 200 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
3 Amitriptilin tab sal 25 mg
Tablet
0.00
0
0
0.00
0
0
0.00
0
0
4 Amlodipin tab 5 mg
Tablet
146.70
330
48,412.58
146.70
450
66,017.16
146.70
570
83,621.73 112,860.00
5 Amoksisilin sir kering 125 mg/5 ml
Botol
0
0
0
1,881.00
480
902,880.00
1,881.00
60
6 Amoksisilin tab 250 mg
Kapsul
0
0
0
0.00
0
0
0.00
0
0
7 Amoksisilin tab 500 mg
Tablet
203.43
2,800.00
569,600.00
232.00
10,000.00
2,320,000.00
232.00
7,900.00
1,832,800.00
8 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium hidroksida 200 mg 9 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g
Tablet
62.00
2,200.00
136,400.00
62.00
10,000.00
620,000.00
62.00
7,200.00
446,400.00
3045.00
20
60,900.00
3,045.00
50
152,250.00
3,045.00
50
152,250.00
Sup
10 Asam askorbat (vitamin C) tab 50 mg
Tablet
98.92
5,700.00
563,820.06
98.92
6,000.00
593,494.80
98.92
8,100.00
801,217.98
11 Asiklovir tab 200 mg
Tablet
238.87
100
23,886.57
0.00
0
0
238.87
100
23,886.57
12 Atapulgit
Tablet
0
0
0
0.00
0
0
0.00
0
0
13 Betametason krim 0,1%
Tube
0
0
0
1,226.00
150
183,900.00
1,226.00
25
30,650.00
14 Deksametason tab 0,5 mg
Tablet
44.00
1,800.00
79,200.00
42.80
5,000.00
214,000.00
44.00
3,900.00
171,600.00
15 Deksametason inj 5 mg/ml (i.v./i.m.)
Ampul
0
0
0
0.00
0
0
0.00
0
0
16 Diazepam tab 5 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
17 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.)
Ampul
2204.00
60
132,240.00
2,204.00
30
66,120.00
2,204.00
90
198,360.00
18 Etanol 70% cairan 70%
Botol
0
0
0
0.00
0
0
0.00
0
0
19 Fitomenadion (vitamin K 1) tab sal 10 mg
Tablet
0
0
0
656.31
300
196,893.48
656.31
100
65,631.16
20 Furosemid tab 40 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
21 Haloperidol tab 0,5 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
22 Hidroklorotiazid tab 25 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
23 Hidrokortison krim 2,5%
Tube
0
0
0
2,399.00
120
287,880.00
2,399.00
24
57,576.00
24 Ibuprofen tab 200 mg
Tablet
105.00
300
31,500.00
92.73
3,000.00
278,190.00
97.33
800
77,865.00
25 Ibuprofen tab 400 mg
Tablet
0
0
0
0.00
0
0
26 Kalsium laktat (kalk) tab 500 mg
Tablet
0
0
0
56.00
5,000.00
280,000.00
27 Kaptopril tab 12,5 mg
Tablet
61.63
500
30,817.30
61.63
2,000.00
28 Kaptopril tab 25 mg
Tablet
0
0
0
76.46
2,000.00
29 Karbamazepin tab 200 mg
Tablet
270.00
100
27,000.00
0.00
30 Kloramfenikol salep mata 1%
Tube
0
0
0
31 Klorfeniramin tab 4 mg
Tablet
42.00
2,700.00
32 Klorpromazin tab sal 25 mg
Tablet
0
33 Obat Anti Tuberculosis FDC Kategori I
Paket
0
34 Obat Anti Tuberculosis FDC Kategori Anak
Paket
35 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim 80 mg 36 Ringer Laktat Larutan 37 Glukosa Larutan Infus 5% steril
0
0
56.00
1,000.00
56,000.00
123,269.20
61.63
1,500.00
92,451.90
152,920.40
76.46
800
61,168.16
0
0
270.00
100
27,000.00
1,645.00
120
197,400.00
1,645.00
24
39,480.00
113,400.00
42.00
10,000.00
420,000.00
42.00
6,300.00
264,600.00
0
0
0.00
0
0
0.00
0
0
0
0
0.00
0
0
0.00
0
0
0
0
0
0.00
0
0
0.00
0
0
Tablet
151.00
1,000.00
151,000.00
151.00
3,000.00
453,000.00
151.00
2,000.00
302,000.00
Botol
5200.00
6
31,200.00
7,150.00
20
143,000.00
5,687.50
8
45,500.00
Botol
0
0
0
6,900.00
20
138,000.00
0.00
0
0
38 Glukosa Larutan Infus 10% steril
Botol
0
0
0
7,500.00
20
150,000.00
0.00
0
0
39 NaCl 0,9% Larutan
Botol
0
0
0
6,410.00
5
32,050.00
6,410.00
5
32,050.00
40 Lidokain inj 2% (hcl)
Ampul
1845.00
200
369,000.00
0.00
0
0
1,845.00
100
184,500.00
41 Metformin tab 500 mg
Tablet
100.00
2,200.00
220,000.00
100.00
3,000.00
300,000.00
100.00
1,800.00
180,000.00
42 Metilergometrin inj 0,2 mg/ml
Ampul
0
0
0
0.00
0
0
0.00
0
0
43 Metronidazol sir 125 mg/5 Ml
Botol
0
0
0
3,800.00
300
1,140,000.00
3,800.00
150
570,000.00
44 Mikonazol krim 2%
Tube
3198.67
42
134,343.93
3,198.67
240
767,679.60
3,198.67
138
441,415.77
45 Natrium bikarbonat tab 500 mg
Tablet
0
0
0
46.00
1,000.00
46,000.00
46.00
1,000.00
46,000.00
46 Nifedipin kaps 10 mg
Tablet
100.00
1,000.00
100,000.00
0.00
0
0
100.00
500
50,000.00
47 Nistatin tab salut 500.000 UI
Tablet
0
0
0
719.85
200
143,969.58
719.85
100
71,984.79
48 Nistatin tab vaginal 100.000 UI
Tablet
0
0
0
518.22
200
103,644.44
518.22
100
51,822.22
49 Oksitosin inj 10 UI/ml
Ampul
0
0
0
1,900.00
100
190,000.00
0.00
0
0
50 Parasetamol sir 120 mg/5 ml
Botol
1438.00
561
806,718.00
1,438.00
1,260.00
1,811,880.00
1,438.00
845
1,215,110.00
51 Parasetamol tab 500 mg
Tablet
0
0
0
0.00
0
0
0
0
52 Piridoksin (vitamin B6) tab 10 mg
Tablet
0
0
0
53 Prednison tab 5 mg
Tablet
96.00
5,500.00
528,000.00
54 Retinol (vitamin A) kaps lunak 100.000 UI
Kapsul
0
0
0
56 Retinol (vitamin A) kaps lunak 200.000 UI
Kapsul
0
0
0
57 Salbutamol tab 2 mg
Tablet
0
0
0
58 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.)
Ampul
110000.00
5
550,000.00
59 Tetrasiklin kaps 500 mg
Kapsul
0
0
60 Tiamin (vitamin B1) tab 50 mg
Tablet
0
0
61 Zinc tab disp 20 mg
Tablet
0
62 Vitamin B kompleks
Tablet
115.00
63 Gliseril Guayakolat Tablet 100mg
Tablet
0
0
0
64 Kotrimoksazol suspensi 240mg
Botol
0
0
0
65 Ethanol 70% (100ml)
107.00
7,000.00
749,000.00
107.00
1,000.00
107,000.00
0
0
96.00
1,600.00
153,600.00
300
85,200.00
284.00
300
85,200.00
0
0
0.00
0
0
66.00
300
19,800.00
66.00
100
6,600.00
0
0
110,000.00
3
330,000.00
0
310.00
1,200.00
372,000.00
310.00
200
62,000.00
0
74.00
5,000.00
370,000.00
74.00
4,500.00
333,000.00
0
0
461.82
2,000.00
923,636.20
461.82
500
230,909.05
3,300.00
379,500.00
110.29
7,000.00
772,000.00
115.00
7,200.00
828,000.00
0
0
0.00
0
0
300
642,000.00
2,140.00
50
107,000.00 15,000.00
284.00
2,140.00
Botol
2500.00
27
67,500.00
0
0
2,500.00
6
66 Hemograd Kapsul
Kapsul
455.60
120
54,672.00
0
0
455.60
120
54,672.00
67 Multivit ibu hamil
Tablet
750.00
11,700.00
8,775,000.00
20.11
25,730.00
517,430.30
750.00
7,800.00
5,850,000.00
68 Garam Oralit 200ml Air
Sachet
264.00
1,000.00
264,000.00
264.00
700
184,800.00
0
0
8,550.00
365
3,120,750.00 225,000.00
0
0
0
69 Dextral Syrup
Botol
8550.00
430
3,676,500.00
70 Gliseril Guaiakolat 100mg tab
Tablet
45.00
1,000.00
45,000.00
45.00
7,000.00
315,000.00
45.00
5,000.00
71 Cat Gut 3/0
Pcs
0
0
0
34,170.00
60
2,050,200.00
34,170.00
20
683,400.00
72 Silk 3/0
Pcs
17626.79
72
1,269,128.94
0
0
17,626.79
72
1,269,128.94
73 Infus Set Anak
Set
0
0
0
5
32,000.00
6,400.00
5
32,000.00
74 Infus Set Dewasa
Set
8245.45
57
469,990.65
0
0
8,245.45
6
49,472.70
75 Kapas 250 gr
Roll
12500.00
1
12,500.00
12,500.00
3
37,500.00
12,500.00
2
25,000.00
76 Kasa Steril 16 x 16
Roll
359.40
464
166,761.60
359.40
160
57,504.00
359.40
464
166,761.60
77 Plester yard
Roll
39217.00
2
78,434.00
39,217.00
8
313,736.00
39,217.00
5
196,085.00
78 Alat Suntik Sekali Pakai 1ml
Set
752.44
80
60,195.12
752.44
200
150,487.80
752.44
60
45,146.34
79 Alat Suntik Sekali Pakai 2,5ml
Set
826.19
80
66,095.54
826.19
200
165,238.84
826.19
70
57,833.59
80 Alat Suntik Sekali Pakai 5ml
Set
0
0
0
895.90
300
268,770.48
0.00
0
0
81 Kasa Pembalut Hidrofil 4m x 10cm
Roll
0
0
0
0
0
0.00
0
0
82 Kasa Pembalut Hidrofil 4m x 5cm
Roll
0
0
0
0
0
0.00
0
0
83 IV Catheter No 18 G
Set
0
0
0
0
0
0.00
0
0
84 Handscoon Non Steril L
Pcs
0
0
0
200
117,832.00
589.16
100
58,916.00
6,400.00
589.16
85 Silk(Benang Bedah Sutra) No.3/0 86 Handscoon Steril No 7
Pcs
6983.00
26
181,558.00
0
0
0
Pasang
6,300.00
0
0
6,983.00
26
200
1,260,000.00
6,300.00
100
20,010,274.29
22,182,774.28
181,558.00 630,000.00 22,964,634.50
JKN Kloramfenikol tts mata 0,5%
Botol
43181.818182
22
950,000.00
0.00
0
0
0.00
22
0
Kapsul
1300
500
650,000.00
0.00
0
0
0.00
500
0
89 Klorfeniramin tab 4 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
90 Parasetamol tab 500 mg
Tablet
0
0
0
50.91
15,000.00
763,650.00
50.91
15,000.00
763,650.00
91 Tiamin (vitamin B1) tab 50 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
92 Asiclovir Cream
Tube
0
0
350,000.00
0.00
0
0
0.00
0
0
93 Povidone Iodine 10% @60ml
Botol
6550
3
19,650.00
0.00
0
0
6,550.00
3
19,650.00
87
88
Kloramfenikol kaps 250 mg
1,969,650.00
763,650.00
783,300.00
NON APBD 94 Albendazol tab 400 mg
Tablet
0
95 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g 96 Obat Anti Tuberculosis FDC Kategori I
Sachet
292
Paket
0
Vial
1
Ampul
59950
97 Medroksi progesteron asetat inj depo 150 mg 98 Vaksin BCG inj (i.k) 99 Vaksin campak inj (s.k.)
0
0
1,356.00
5,051.00
6,849,156.00
1,356.00
5,051.00
6,849,156.00
280
81,760.00
0.00
0
0
0.00
0
0
0
0
359,985.00
10
3,599,850.00
359,985.00
10
3,599,850.00
837
837
1.00
600
600
1.00
211
211
19
1,139,050.00
59,950.00
60
3,597,000.00
59,950.00
30
1,798,500.00
Vial
28204
46
1,297,384.00
0.00
0
0
28,204.00
46
1,297,384.00
100 Vaksin kombinasi DPT + hepatitis B inj (i.m.)
Vial
76285
29
2,212,265.00
76,285.00
80
6,102,800.00
76,285.00
43
3,280,255.00
101 Vaksin polio drops 10 dosis
Vial
19954
12
239,448.00
19,954.00
60
1,197,240.00
19,954.00
33
658,482.00
102 Tambah Darah
Tablet
367
3,000.00
1,101,000.00
0.00
0
0
367.00
3,000.00
1,101,000.00
103 Iodina Test Garam
Botol
0
0
0
0.00
0
0
0.00
0
0
Vial
16500
13
214,500.00
16,500.00
80
1,320,000.00
16,500.00
39
643,500.00
105 Vaksin Polio (IPV)
Vial
245025
2
490,050.00
245,025.00
10
2,450,250.00
245,025.00
8
1,960,200.00
106 Vaksin HB Uniject
Paunch
20900
33
689,700.00
20,900.00
120
2,508,000.00
20,900.00
60
1,254,000.00
Vial
0
0
0
149,820.00
919
137,684,580.00
149,820.00
879
131,691,780.00
108 Disposible Syringer 0,5 ml
Buah
0
0
0
1,195.00
7,000.00
8,365,000.00
1,195.00
7,000.00
8,365,000.00
109 Disposible Syringer 3,0 ml
Buah
1
837
837
1.00
600
600
1.00
211
211
110 Disposible Syringer 5 ml
Buah
0
0
0
1,640.00
1,000.00
1,640,000.00
1,640.00
909
1,490,760.00
111 Pil KB
Strip
1
3,061.00
3,061.00
1.00
1,500.00
1,500.00
1.00
208
104 Vaksin TD
107 Vaksin MR
208
7,469,892.00
175,316,576.00
163,990,497.00
29,449,816.29
198,263,000.28
187,738,431.50 Indramayu, 30 september 2017
Kepala Dinas Kesehatan Kabupaten Indramayu
dr. H. Deden Bonnikoswara,MM Pembina Utama Muda NIP. 19740110 200212 1 001
Mengetahui, Kepala UPTD Puskesmas Tukdana
H. Suaedi, Amd.Kep NIP. 19600323 198105 1 001
1 Mulyadi NIP 2 Nurhaeti NIP 3 Soplaah S NIP 4 dr.Widodo.F
1 2 3 4
NIP
SALDO AKHIR SEPTEMBER 2017 Harga Satuan
VOL
Jumlah
13
14
15
90.00
1,500.00
135,000.00
0.00
0
0
0.00
0
0
146.70
210
30,808.01
1,881.00
420
790,020.00
0.00
0
0
215.67
4,900.00
1,056,800.00
62.00
5,000.00
310,000.00
3,045.00
20
60,900.00
98.92
3,600.00
356,096.88
0.00
0
0
0.00
0
0
1,226.00
125
153,250.00
41.93
2,900.00
121,600.00
0.00
0
0
0.00
0
0
0.00
0
0
0.00
0
0
656.31
200
131,262.32
0.00
0
0
0.00
0
0
0.00
0
0
2,399.00
96
230,304.00
92.73
2,500.00
231,825.00
0
0
56.00
4,000.00
224,000.00
61.63
1,000.00
61,634.60
76.46
1,200.00
91,752.24
0.00
0
0
1,645.00
96
157,920.00
42.00
6,400.00
268,800.00
0.00
0
0
0.00
0
0
0.00
0
0
151.00
2,000.00
302,000.00
7,150.00
18
128,700.00
6,900.00
20
138,000.00
7,500.00
20
150,000.00
0.00
0
0
1,845.00
100
184,500.00
100.00
3,400.00
340,000.00
0.00
0
0
3,800.00
150
570,000.00
3,198.67
144
460,607.76
0.00
0
0
100.00
500
50,000.00
719.85
100
71,984.79
518.22
100
51,822.22
1,900.00
100
190,000.00
1,438.00
976
1,403,488.00
0.00
0
0
107.00
6,000.00
642,000.00
96.00
3,900.00
374,400.00
0.00
0
0
0.00
0
0
66.00
200
13,200.00
110,000.00
2
220,000.00
310.00
1,000.00
310,000.00
74.00
500
37,000.00
461.82
1,500.00
692,727.15
104.35
3,100.00
323,500.00
0.00
0
0
2,140.00
250
535,000.00
2,500.00
21
52,500.00
0.00
0
0
116.18
29,630.00
3,442,430.30
264.00
300
79,200.00
8,550.00
65
555,750.00
45.00
3,000.00
135,000.00
34,170.00
40
1,366,800.00
0.00
0
0
0.00
0
0
8,245.45
51
420,517.95
12,500.00
2
25,000.00
359.40
160
57,504.00
39,217.00
5
196,085.00
752.44
220
165,536.58
826.19
210
173,500.79
895.90
300
268,770.48
0.00
0
0
0.00
0
0
0.00
0
0
589.16
100
58,916.00
0.00
0
0
6,300.00
100
630,000.00 19,228,414.07
0.00
0
950,000.00
0.00
0
650,000.00
0.00
0
0
0.00
0
0
0.00
0
0
0.00
0
350,000.00
0.00
0
0
1,950,000.00 0.00
0
0
292.00
280
81,760.00
0.00
0
0
1.00
1,226.00
1,226.00
59,950.00
49
2,937,550.00
0.00
0
0
76,285.00
66
5,034,810.00
19,954.00
39
778,206.00
0.00
0
0
0.00
0
0
16,500.00
54
891,000.00
245,025.00
4
980,100.00
20,900.00
93
1,943,700.00
149,820.00
40
5,992,800.00
0.00
0
0
1.00
1,226.00
1,226.00
1,640.00
91
149,240.00
1.00
4,353.00
4,353.00 18,795,971.00
39,974,385.07
UPTD PUSKESMAS TUKDANA Jl Raya Lajer - Tukdana - Inramayu 45272
BERITA ACARA STOK OPNAME OBAT DAN ALKES DI UPTD PUSKESMAS TUKDANA PER 30 September 2017 NOMOR : Pada hari ini sabtu tanggal tiga puluh bulan september tahun dua ribu tujuh belas ( 30-09-2017 ), yang bertanda tangan dibawah ini : 1 H. Suaedi : Ka UPTD Puskesmas Tukdana NIP : 19600323198105 1 001 2 Mulyadi,Skm : Kasubag Tu NIP : 19761012200501 1 003 3 Nurhaeti,AMK : Petugas Pengelola Obat NIP : 19790923200808 2 008 4 Soplaah S,SST : Petugas Pengelola Obat Program KIA NIP : 19660307198603 2 009 5 dr,Widodo Firmansyah : Petugas Pengelola Obat Program BP NIP : 19811207.201412.1.001
Telah melaksanakan Stok Opname terhadap Obat-obatan dan Alat Kesehatan pada UPTD Puskesmas Tukdana Dinas Kesehatan Kabupaten Indramayu dan telah ditemukan saldo sebesar Rp. 39.974.385,07 dengan perincian sebagai berikut :
OBAT DAN BMHP
NO
1
2 1
Satuan Terkecil 3
SALDO AWAL JULI 2017 Harga Satuan
VOL
4
5
PENERIMAAN
PENGELUARAN
Jumlah
Harga Satuan
VOL
Jumlah
Harga Satuan
VOL
Jumlah
6
7
8
9
10
11
12
FARMASI
1 Alopurinol tab 100 mg
Tablet
0
0
0
90.00
2,500.00
225,000.00
90.00
1,000.00
90,000.00
2 Aminofilin tab 200 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
3 Amitriptilin tab sal 25 mg
Tablet
0.00
0
0
0.00
0
0
0.00
0
0
4 Amlodipin tab 5 mg
Tablet
146.70
330
48,412.58
146.70
450
66,017.16
146.70
570
83,621.73 112,860.00
5 Amoksisilin sir kering 125 mg/5 ml
Botol
0
0
0
1,881.00
480
902,880.00
1,881.00
60
6 Amoksisilin tab 250 mg
Kapsul
0
0
0
0.00
0
0
0.00
0
0
7 Amoksisilin tab 500 mg
Tablet
203.43
2,800.00
569,600.00
232.00
10,000.00
2,320,000.00
232.00
7,900.00
1,832,800.00
8 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium hidroksida 200 mg 9 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g
Tablet
62.00
2,200.00
136,400.00
62.00
10,000.00
620,000.00
62.00
7,200.00
446,400.00
3045.00
20
60,900.00
3,045.00
50
152,250.00
3,045.00
50
152,250.00
Sup
10 Asam askorbat (vitamin C) tab 50 mg
Tablet
98.92
5,700.00
563,820.06
98.92
6,000.00
593,494.80
98.92
8,100.00
801,217.98
11 Asiklovir tab 200 mg
Tablet
238.87
100
23,886.57
0.00
0
0
238.87
100
23,886.57
12 Atapulgit
Tablet
0
0
0
0.00
0
0
0.00
0
0
13 Betametason krim 0,1%
Tube
0
0
0
1,226.00
150
183,900.00
1,226.00
25
30,650.00
14 Deksametason tab 0,5 mg
Tablet
44.00
1,800.00
79,200.00
42.80
5,000.00
214,000.00
44.00
3,900.00
171,600.00
15 Deksametason inj 5 mg/ml (i.v./i.m.)
Ampul
0
0
0
0.00
0
0
0.00
0
0
16 Diazepam tab 5 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
17 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.)
Ampul
2204.00
60
132,240.00
2,204.00
30
66,120.00
2,204.00
90
198,360.00
18 Etanol 70% cairan 70%
Botol
0
0
0
0.00
0
0
0.00
0
0
19 Fitomenadion (vitamin K 1) tab sal 10 mg
Tablet
0
0
0
656.31
300
196,893.48
656.31
100
65,631.16
20 Furosemid tab 40 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
21 Haloperidol tab 0,5 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
22 Hidroklorotiazid tab 25 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
23 Hidrokortison krim 2,5%
Tube
0
0
0
2,399.00
120
287,880.00
2,399.00
24
57,576.00
24 Ibuprofen tab 200 mg
Tablet
105.00
300
31,500.00
92.73
3,000.00
278,190.00
97.33
800
77,865.00
25 Ibuprofen tab 400 mg
Tablet
0
0
0
0.00
0
0
26 Kalsium laktat (kalk) tab 500 mg
Tablet
0
0
0
56.00
5,000.00
280,000.00
27 Kaptopril tab 12,5 mg
Tablet
61.63
500
30,817.30
61.63
2,000.00
28 Kaptopril tab 25 mg
Tablet
0
0
0
76.46
2,000.00
29 Karbamazepin tab 200 mg
Tablet
270.00
100
27,000.00
0.00
30 Kloramfenikol salep mata 1%
Tube
0
0
0
31 Klorfeniramin tab 4 mg
Tablet
42.00
2,700.00
32 Klorpromazin tab sal 25 mg
Tablet
0
33 Obat Anti Tuberculosis FDC Kategori I
Paket
0
34 Obat Anti Tuberculosis FDC Kategori Anak
Paket
35 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim 80 mg 36 Ringer Laktat Larutan 37 Glukosa Larutan Infus 5% steril
0
0
56.00
1,000.00
56,000.00
123,269.20
61.63
1,500.00
92,451.90
152,920.40
76.46
800
61,168.16
0
0
270.00
100
27,000.00
1,645.00
120
197,400.00
1,645.00
24
39,480.00
113,400.00
42.00
10,000.00
420,000.00
42.00
6,300.00
264,600.00
0
0
0.00
0
0
0.00
0
0
0
0
0.00
0
0
0.00
0
0
0
0
0
0.00
0
0
0.00
0
0
Tablet
151.00
1,000.00
151,000.00
151.00
3,000.00
453,000.00
151.00
2,000.00
302,000.00
Botol
5200.00
6
31,200.00
7,150.00
20
143,000.00
5,687.50
8
45,500.00
Botol
0
0
0
6,900.00
20
138,000.00
0.00
0
0
38 Glukosa Larutan Infus 10% steril
Botol
0
0
0
7,500.00
20
150,000.00
0.00
0
0
39 NaCl 0,9% Larutan
Botol
0
0
0
6,410.00
5
32,050.00
6,410.00
5
32,050.00
40 Lidokain inj 2% (hcl)
Ampul
1845.00
200
369,000.00
0.00
0
0
1,845.00
100
184,500.00
41 Metformin tab 500 mg
Tablet
100.00
2,200.00
220,000.00
100.00
3,000.00
300,000.00
100.00
1,800.00
180,000.00
42 Metilergometrin inj 0,2 mg/ml
Ampul
0
0
0
0.00
0
0
0.00
0
0
43 Metronidazol sir 125 mg/5 Ml
Botol
0
0
0
3,800.00
300
1,140,000.00
3,800.00
150
570,000.00
44 Mikonazol krim 2%
Tube
3198.67
42
134,343.93
3,198.67
240
767,679.60
3,198.67
138
441,415.77
45 Natrium bikarbonat tab 500 mg
Tablet
0
0
0
46.00
1,000.00
46,000.00
46.00
1,000.00
46,000.00
46 Nifedipin kaps 10 mg
Tablet
100.00
1,000.00
100,000.00
0.00
0
0
100.00
500
50,000.00
47 Nistatin tab salut 500.000 UI
Tablet
0
0
0
719.85
200
143,969.58
719.85
100
71,984.79
48 Nistatin tab vaginal 100.000 UI
Tablet
0
0
0
518.22
200
103,644.44
518.22
100
51,822.22
49 Oksitosin inj 10 UI/ml
Ampul
0
0
0
1,900.00
100
190,000.00
0.00
0
0
50 Parasetamol sir 120 mg/5 ml
Botol
1438.00
561
806,718.00
1,438.00
1,260.00
1,811,880.00
1,438.00
845
1,215,110.00
51 Parasetamol tab 500 mg
Tablet
0
0
0
0.00
0
0
0
0
52 Piridoksin (vitamin B6) tab 10 mg
Tablet
0
0
0
53 Prednison tab 5 mg
Tablet
96.00
5,500.00
528,000.00
54 Retinol (vitamin A) kaps lunak 100.000 UI
Kapsul
0
0
0
56 Retinol (vitamin A) kaps lunak 200.000 UI
Kapsul
0
0
0
57 Salbutamol tab 2 mg
Tablet
0
0
0
58 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.)
Ampul
110000.00
5
550,000.00
59 Tetrasiklin kaps 500 mg
Kapsul
0
0
60 Tiamin (vitamin B1) tab 50 mg
Tablet
0
0
61 Zinc tab disp 20 mg
Tablet
0
62 Vitamin B kompleks
Tablet
115.00
63 Gliseril Guayakolat Tablet 100mg
Tablet
0
0
0
64 Kotrimoksazol suspensi 240mg
Botol
0
0
0
65 Ethanol 70% (100ml)
107.00
7,000.00
749,000.00
107.00
1,000.00
107,000.00
0
0
96.00
1,600.00
153,600.00
300
85,200.00
284.00
300
85,200.00
0
0
0.00
0
0
66.00
300
19,800.00
66.00
100
6,600.00
0
0
110,000.00
3
330,000.00
0
310.00
1,200.00
372,000.00
310.00
200
62,000.00
0
74.00
5,000.00
370,000.00
74.00
4,500.00
333,000.00
0
0
461.82
2,000.00
923,636.20
461.82
500
230,909.05
3,300.00
379,500.00
110.29
7,000.00
772,000.00
115.00
7,200.00
828,000.00
0
0
0.00
0
0
300
642,000.00
2,140.00
50
107,000.00 15,000.00
284.00
2,140.00
Botol
2500.00
27
67,500.00
0
0
2,500.00
6
66 Hemograd Kapsul
Kapsul
455.60
120
54,672.00
0
0
455.60
120
54,672.00
67 Multivit ibu hamil
Tablet
750.00
11,700.00
8,775,000.00
20.11
25,730.00
517,430.30
750.00
7,800.00
5,850,000.00
68 Garam Oralit 200ml Air
Sachet
264.00
1,000.00
264,000.00
264.00
700
184,800.00
0
0
8,550.00
365
3,120,750.00 225,000.00
0
0
0
69 Dextral Syrup
Botol
8550.00
430
3,676,500.00
70 Gliseril Guaiakolat 100mg tab
Tablet
45.00
1,000.00
45,000.00
45.00
7,000.00
315,000.00
45.00
5,000.00
71 Cat Gut 3/0
Pcs
0
0
0
34,170.00
60
2,050,200.00
34,170.00
20
683,400.00
72 Silk 3/0
Pcs
17626.79
72
1,269,128.94
0
0
17,626.79
72
1,269,128.94
73 Infus Set Anak
Set
0
0
0
5
32,000.00
6,400.00
5
32,000.00
74 Infus Set Dewasa
Set
8245.45
57
469,990.65
0
0
8,245.45
6
49,472.70
75 Kapas 250 gr
Roll
12500.00
1
12,500.00
12,500.00
3
37,500.00
12,500.00
2
25,000.00
76 Kasa Steril 16 x 16
Roll
359.40
464
166,761.60
359.40
160
57,504.00
359.40
464
166,761.60
77 Plester yard
Roll
39217.00
2
78,434.00
39,217.00
8
313,736.00
39,217.00
5
196,085.00
78 Alat Suntik Sekali Pakai 1ml
Set
752.44
80
60,195.12
752.44
200
150,487.80
752.44
60
45,146.34
79 Alat Suntik Sekali Pakai 2,5ml
Set
826.19
80
66,095.54
826.19
200
165,238.84
826.19
70
57,833.59
80 Alat Suntik Sekali Pakai 5ml
Set
0
0
0
895.90
300
268,770.48
0.00
0
0
81 Kasa Pembalut Hidrofil 4m x 10cm
Roll
0
0
0
0
0
0.00
0
0
82 Kasa Pembalut Hidrofil 4m x 5cm
Roll
0
0
0
0
0
0.00
0
0
83 IV Catheter No 18 G
Set
0
0
0
0
0
0.00
0
0
84 Handscoon Non Steril L
Pcs
0
0
0
200
117,832.00
589.16
100
58,916.00
6,400.00
589.16
85 Silk(Benang Bedah Sutra) No.3/0 86 Handscoon Steril No 7
Pcs
6983.00
26
181,558.00
0
0
0
Pasang
6,300.00
0
0
6,983.00
26
200
1,260,000.00
6,300.00
100
20,010,274.29
22,182,774.28
181,558.00 630,000.00 22,964,634.50
JKN Kloramfenikol tts mata 0,5%
Botol
43181.818182
22
950,000.00
0.00
0
0
0.00
22
0
Kapsul
1300
500
650,000.00
0.00
0
0
0.00
500
0
89 Klorfeniramin tab 4 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
90 Parasetamol tab 500 mg
Tablet
0
0
0
50.91
15,000.00
763,650.00
50.91
15,000.00
763,650.00
91 Tiamin (vitamin B1) tab 50 mg
Tablet
0
0
0
0.00
0
0
0.00
0
0
92 Asiclovir Cream
Tube
0
0
350,000.00
0.00
0
0
0.00
0
0
93 Povidone Iodine 10% @60ml
Botol
6550
3
19,650.00
0.00
0
0
6,550.00
3
19,650.00
87
88
Kloramfenikol kaps 250 mg
1,969,650.00
763,650.00
783,300.00
NON APBD 94 Albendazol tab 400 mg
Tablet
0
95 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g 96 Obat Anti Tuberculosis FDC Kategori I
Sachet
292
Paket
0
Vial
1
Ampul
59950
97 Medroksi progesteron asetat inj depo 150 mg 98 Vaksin BCG inj (i.k) 99 Vaksin campak inj (s.k.)
0
0
1,356.00
5,051.00
6,849,156.00
1,356.00
5,051.00
6,849,156.00
280
81,760.00
0.00
0
0
0.00
0
0
0
0
359,985.00
10
3,599,850.00
359,985.00
10
3,599,850.00
837
837
1.00
600
600
1.00
211
211
19
1,139,050.00
59,950.00
60
3,597,000.00
59,950.00
30
1,798,500.00
Vial
28204
46
1,297,384.00
0.00
0
0
28,204.00
46
1,297,384.00
100 Vaksin kombinasi DPT + hepatitis B inj (i.m.)
Vial
76285
29
2,212,265.00
76,285.00
80
6,102,800.00
76,285.00
43
3,280,255.00
101 Vaksin polio drops 10 dosis
Vial
19954
12
239,448.00
19,954.00
60
1,197,240.00
19,954.00
33
658,482.00
102 Tambah Darah
Tablet
367
3,000.00
1,101,000.00
0.00
0
0
367.00
3,000.00
1,101,000.00
103 Iodina Test Garam
Botol
0
0
0
0.00
0
0
0.00
0
0
Vial
16500
13
214,500.00
16,500.00
80
1,320,000.00
16,500.00
39
643,500.00
105 Vaksin Polio (IPV)
Vial
245025
2
490,050.00
245,025.00
10
2,450,250.00
245,025.00
8
1,960,200.00
106 Vaksin HB Uniject
Paunch
20900
33
689,700.00
20,900.00
120
2,508,000.00
20,900.00
60
1,254,000.00
Vial
0
0
0
149,820.00
919
137,684,580.00
149,820.00
879
131,691,780.00
108 Disposible Syringer 0,5 ml
Buah
0
0
0
1,195.00
7,000.00
8,365,000.00
1,195.00
7,000.00
8,365,000.00
109 Disposible Syringer 3,0 ml
Buah
1
837
837
1.00
600
600
1.00
211
211
110 Disposible Syringer 5 ml
Buah
0
0
0
1,640.00
1,000.00
1,640,000.00
1,640.00
909
1,490,760.00
111 Pil KB
Strip
1
3,061.00
3,061.00
1.00
1,500.00
1,500.00
1.00
208
104 Vaksin TD
107 Vaksin MR
208
7,469,892.00
175,316,576.00
163,990,497.00
29,449,816.29
198,263,000.28
187,738,431.50 Indramayu, 30 september 2017
Kepala Dinas Kesehatan Kabupaten Indramayu
dr. H. Deden Bonnikoswara,MM Pembina Utama Muda NIP. 19740110 200212 1 001
Mengetahui, Kepala UPTD Puskesmas Tukdana
H. Suaedi, Amd.Kep NIP. 19600323 198105 1 001
1 Mulyadi NIP 2 Nurhaeti NIP 3 Soplaah S NIP 4 dr.Widodo.F
1 2 3 4
NIP
SALDO AKHIR SEPTEMBER 2017 Harga Satuan
VOL
Jumlah
13
14
15
90.00
1,500.00
135,000.00
0.00
0
0
0.00
0
0
146.70
210
30,808.01
1,881.00
420
790,020.00
0.00
0
0
215.67
4,900.00
1,056,800.00
62.00
5,000.00
310,000.00
3,045.00
20
60,900.00
98.92
3,600.00
356,096.88
0.00
0
0
0.00
0
0
1,226.00
125
153,250.00
41.93
2,900.00
121,600.00
0.00
0
0
0.00
0
0
0.00
0
0
0.00
0
0
656.31
200
131,262.32
0.00
0
0
0.00
0
0
0.00
0
0
2,399.00
96
230,304.00
92.73
2,500.00
231,825.00
0
0
56.00
4,000.00
224,000.00
61.63
1,000.00
61,634.60
76.46
1,200.00
91,752.24
0.00
0
0
1,645.00
96
157,920.00
42.00
6,400.00
268,800.00
0.00
0
0
0.00
0
0
0.00
0
0
151.00
2,000.00
302,000.00
7,150.00
18
128,700.00
6,900.00
20
138,000.00
7,500.00
20
150,000.00
0.00
0
0
1,845.00
100
184,500.00
100.00
3,400.00
340,000.00
0.00
0
0
3,800.00
150
570,000.00
3,198.67
144
460,607.76
0.00
0
0
100.00
500
50,000.00
719.85
100
71,984.79
518.22
100
51,822.22
1,900.00
100
190,000.00
1,438.00
976
1,403,488.00
0.00
0
0
107.00
6,000.00
642,000.00
96.00
3,900.00
374,400.00
0.00
0
0
0.00
0
0
66.00
200
13,200.00
110,000.00
2
220,000.00
310.00
1,000.00
310,000.00
74.00
500
37,000.00
461.82
1,500.00
692,727.15
104.35
3,100.00
323,500.00
0.00
0
0
2,140.00
250
535,000.00
2,500.00
21
52,500.00
0.00
0
0
116.18
29,630.00
3,442,430.30
264.00
300
79,200.00
8,550.00
65
555,750.00
45.00
3,000.00
135,000.00
34,170.00
40
1,366,800.00
0.00
0
0
0.00
0
0
8,245.45
51
420,517.95
12,500.00
2
25,000.00
359.40
160
57,504.00
39,217.00
5
196,085.00
752.44
220
165,536.58
826.19
210
173,500.79
895.90
300
268,770.48
0.00
0
0
0.00
0
0
0.00
0
0
589.16
100
58,916.00
0.00
0
0
6,300.00
100
630,000.00 19,228,414.07
0.00
0
950,000.00
0.00
0
650,000.00
0.00
0
0
0.00
0
0
0.00
0
0
0.00
0
350,000.00
0.00
0
0
1,950,000.00 0.00
0
0
292.00
280
81,760.00
0.00
0
0
1.00
1,226.00
1,226.00
59,950.00
49
2,937,550.00
0.00
0
0
76,285.00
66
5,034,810.00
19,954.00
39
778,206.00
0.00
0
0
0.00
0
0
16,500.00
54
891,000.00
245,025.00
4
980,100.00
20,900.00
93
1,943,700.00
149,820.00
40
5,992,800.00
0.00
0
0
1.00
1,226.00
1,226.00
1,640.00
91
149,240.00
1.00
4,353.00
4,353.00 18,795,971.00
39,974,385.07
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