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DAFTAR BMN SAMPAI DENGAN TAHUN 2016

UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG


Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3010304003 (Stationary Generating Set)
1 Whaichi Kondisi Rusak 1 01-01-2009 25,760,000
2 perkins - 2 31-03-2013 non 183,700,000
3010305010 (Pompa Air)
1 pompa air 1 21-08-2013 460,000
2 2 23-08-2013 810,000
3 3 27-02-2014 Pembelian 499,750
4 4 27-02-2014 Pembelian 499,750
5 dapur 5 24-06-2014 Pembelian 550,000
6 6 30-06-2014 725,000
7 7 31-12-2014 875,000
8 8 31-12-2014 875,000
9 san-el ipal 9 10-04-2015 blu 650,000
10 san-el ipal 10 10-04-2015 blu 650,000
11 shimitsu dpr 11 26-09-2015 blu 1,050,000
3010314011 (Tandu Lipat)
1 YDC-1A4/RESCUE. RRC 1 17-12-2012 DROPPING PUSDOKKES 1,474,000
3020102999 (Kendaraan Bermotor Penumpang Lainnya)
1 SUZUKI APV 1 30-12-2006 NON 123,000,000
2 apv opsnal 2 01-01-2013 - 185,691,550
3 toyota innova 3 31-07-2014 299,889,000
3020104001 (Sepeda Motor)
1 HONDA GRAND 1 01-01-2010 4,900,000
2 HONDA SUPRA X PENDISTRIBUSIAN RANMOR 2 20-05-2016 Bidkeu Polda Jatim 15,550,000
3020105001 (Mobil Ambulance)
1 1 31-12-2006 DROPPING 250,000,000
2 2 31-12-2006 DROPPING 11,800,000
3 ISUZU ELF/MOBIL GIGI 3 01-01-2009 RS BHAY TL AGUNG 104,000,000
4 Suzuki APV Ambulance 4 21-12-2015 BRI Cab Lumajang 102,000,000
3020201002 (Gerobak Dorong)
1 - trolly brg 1 01-03-2016 blu 365,000
3020201010 (Meja Dorong Saji/Trolley Saji)
1 trolly makan 1 31-12-2014 5,107,816
3030101018 (Mesin Kompresor)
1 - p.gigi 1 30-06-2013 non 2,517,600
3030102002 (Mesin Bor Tangan)
1 m2100cc 1 14-07-2014 pembl 320,000
3030103999 (Perkakas Bengkel Listrik Lainnya (Alat Bengkel Bermesin))
1 nfb 150A 1 11-02-2013 1,100,000
3030202999 (Perkakas Bengkel Listrik Lainnya (Alat Bengkel Tak Bermesin))
1 MCB 1 10-01-2014 Pembelian 480,000
2 panel box lt2 2 18-12-2015 blu 7,400,000
3030204001 (Dongkrak Mekanik)
Tgl Cetak : 27-04-2017 Halaman : 1
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 dongkrak 1 28-09-2014 pembl 500,000
3030303999 (Alat Ukur / Test Alat Kepribadian Lainnya)
1 flow meter ipal 1 30-06-2015 blu 3,300,000
3030399999 (Alat Ukur Lainnya)
1 mcb mcb-igd 1 16-03-2015 blu 600,000
3050101002 (Mesin Ketik Manual Standard (14-16 Inci))
1 1 31-12-2006 SWADAYA 120,000
2 Kondisi Rusak 2 31-12-2006 58,000
3 Kondisi Rusak 3 31-12-2006 58,000
3050101004 (Mesin Ketik Listrik)
1 1 11-10-2013 2,417,181
3050104001 (Lemari Besi/Metal)
1 1 31-12-2006 SWADAYA 559,000
2 2 31-12-2006 SWADAYA 559,000
3 Datascrip Lemari arsip Putar 4 tk.R.staf 3 19-05-2016 blu 25,645,000
4 Pintu aluminium lemari 4 14-10-2016 blu 559,350
bawah Lab.
5 Pintu aluminium lemari 5 14-10-2016 blu 559,350
bawah Lab.
6 Pintu aluminium lemari 6 14-10-2016 blu 559,350
bawah Lab.
7 Pintu aluminium lemari 7 14-10-2016 blu 559,350
bawah Lab.
8 - Lemari morfiny Stainlees 8 14-10-2016 blu 765,050
Apt.
3050104002 (Lemari Kayu)
1 1 31-12-2006 SWADAYA 2,200,000
2 2 31-12-2006 SWADAYA 2,200,000
3 3 31-12-2006 SWADAYA 2,200,000
4 4 31-12-2006 SWADAYA 2,200,000
5 5 31-12-2006 SWADAYA 2,200,000
6 6 31-12-2006 SWADAYA 2,200,000
7 7 31-12-2006 SWADAYA 2,200,000
8 8 31-12-2006 SWADAYA 2,200,000
9 9 31-12-2006 SWADAYA 2,200,000
10 10 31-12-2006 SWADAYA 2,200,000
11 11 31-12-2006 SWADAYA 2,200,000
12 12 06-05-2013 185,000
13 13 06-05-2013 185,000
14 14 06-05-2013 185,000
15 kasir 15 19-09-2013 500,000
16 16 04-11-2013 2,050,000
17 17 04-11-2013 2,050,000
18 18 29-05-2013 3,093,750
Tgl Cetak : 27-04-2017 Halaman : 2
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
19 19 29-05-2013 3,093,750
20 20 29-05-2013 3,093,750
21 21 29-05-2013 3,093,750
22 L doc 22 26-05-2014 Pembelian 1,750,000
23 lemari baju 23 31-05-2014 1,100,000
24 lemari baju 24 31-05-2014 1,100,000
25 25 31-01-2014 2,000,000
26 vip baru 26 30-12-2014 950,000
27 vip baru 27 30-12-2014 950,000
28 vip baru 28 30-12-2014 950,000
29 vip baru 29 30-12-2014 950,000
30 vip baru 30 30-12-2014 950,000
31 vip baru 31 30-12-2014 950,000
32 vip baru 32 30-12-2014 950,000
33 vip baru 33 30-12-2014 950,000
34 RSG 4 susun combinasi poli gigi 34 30-08-2016 blu 280,000
35 Taurus bar cabinet poli gigi 35 30-08-2016 blu 2,240,000
3050104003 (Rak Besi)
1 rak dispenser 1 17-05-2013 50,000
2 rak atk art 2 21-01-2014 Pembelian 2,600,000
3 RM 3 24-10-2014 pembelian 3,500,000
4 RM 4 24-10-2014 pembelian 3,500,000
5 rak les rm 5 01-09-2015 blu 1,000,000
3050104004 (Rak Kayu)
1 rak tv 1 28-01-2013 non 400,000
3050104005 (Filing Cabinet Besi)
1 1 31-12-2006 SWADAYA 2,400,000
2 2 31-12-2006 SWADAYA 2,400,000
3 3 31-12-2006 SWADAYA 2,400,000
4 rm 4 25-01-2016 blu 6,593,900
5 rm 5 25-01-2016 blu 6,593,900
6 rm 6 25-01-2016 blu 6,593,900
7 rm 7 25-01-2016 blu 6,593,900
8 rm 8 25-01-2016 blu 6,593,900
9 rm 9 25-01-2016 blu 6,593,900
3050104006 (Filing Cabinet Kayu)
1 desk kayu doc 1 25-03-2016 blu 575,000
2 desk kayu doc 2 25-03-2016 blu 575,000
3 desk kayu doc 3 25-03-2016 blu 575,000
4 desk kayu doc 4 25-03-2016 blu 575,000
3050104007 (Brandkas)
1 1 31-12-2006 SWADAYA 931,000

Tgl Cetak : 27-04-2017 Halaman : 3


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
2 2 31-12-2006 SWADAYA 931,000
3050104015 (Locker)
1 L locker 1 30-05-2014 Pembelian 3,100,000
3050104020 (Lemari Display)
1 lemari aluminium 1 10-09-2013 4,400,000
2 - 2 08-09-2014 pembl 2,450,000
3 - 3 08-09-2014 pembl 2,450,000
4 laborat 4 05-09-2014 1,500,000
5 pos 2 5 05-09-2014 3,400,000
6 - lmr tmpel dokpol 6 13-04-2015 blu 2,100,000
3050104022 (Folding Container Box)
1 2 16-10-2014 300,000
2 3 16-10-2014 300,000
3 container box cssd 4 23-09-2016 blu 45,837
4 container box cssd 5 23-09-2016 blu 45,833
5 container box cssd 6 23-09-2016 blu 45,833
6 container box cssd 7 23-09-2016 blu 45,833
7 container box cssd 8 23-09-2016 blu 45,833
8 container box cssd 9 23-09-2016 blu 45,833
9 container box cssd 10 23-09-2016 blu 45,833
10 container box cssd 11 23-09-2016 blu 45,833
11 container box cssd 12 23-09-2016 blu 45,833
12 container box cssd 13 23-09-2016 blu 45,833
13 container box cssd 14 23-09-2016 blu 45,833
14 container box cssd 15 23-09-2016 blu 45,833
3050105007 (CCTV - Camera Control Television System)
1 - set 1 25-07-2014 pembl 23,500,000
2 psg+tmbah cam 2 19-09-2016 blu 6,625,000
3 psg+tmbah cam 3 19-09-2016 blu 6,625,000
4 psg+tmbah cam 4 19-09-2016 blu 6,625,000
5 psg+tmbah cam 5 19-09-2016 blu 6,625,000
3050105008 (Papan Visual/Papan Nama)
1 neon box icu 1 12-09-2013 950,000
2 2 04-11-2013 10,100,000
3 billboard pos 1 3 17-02-2014 Pembelian 1,675,000
4 pos1 4 31-12-2014 2,075,000
5 - Neon Box 5 20-01-2015 blu 1,000,000
6 p. gigi neon box 6 14-03-2016 blu 1,320,000
7 ursimrm neon box 7 14-03-2016 blu 1,760,000
8 p kia anak neon box 8 14-03-2016 blu 2,310,000
9 hd neon box 9 14-03-2016 blu 3,080,000
10 bersama berubah neon box 10 14-03-2016 blu 3,080,000

Tgl Cetak : 27-04-2017 Halaman : 4


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
11 p sp p umum neon box 11 14-03-2016 blu 3,520,000
12 bersama berubah neon box 12 14-03-2016 blu 4,400,000
13 kamar obat neon box 13 14-03-2016 blu 880,000
14 dokpol neon box 14 14-03-2016 blu 880,000
15 set neonbox utama depan igd 15 09-09-2016 blu 17,325,000
depan
16 emergency nurse call box pos 1,2,3,satpam 16 09-09-2016 blu 275,000
17 emergency nurse call box pos 1,2,3,satpam 17 09-09-2016 blu 275,000
18 emergency nurse call box pos 1,2,3,satpam 18 09-09-2016 blu 275,000
19 emergency nurse call box pos 1,2,3,satpam 19 09-09-2016 blu 275,000
20 neonbox/roomname gizi ,Ro 20 18-10-2016 blu 2,722,500
21 neonbox/roomname gizi ,Ro 21 18-10-2016 blu 2,722,500
3050105015 (Alat Penghancur Kertas)
1 - keu 1 01-07-2014 pembl non 1,184,000
3050105017 (Mesin Absensi)
1 1 26-09-2013 3,800,000
3050105045 (Penangkal Petir)
1 Tombak/blacksem Lt.2 Staf/poli/anggrek 1 10-10-2016 blu 16,830,000
3050105048 (LCD Projector/Infocus)
1 Benq mx812st 1 30-01-2015 blu 10,500,000
3050105056 (Panic Button System, Alarm Indicator)
1 - code blue/red/black 1 07-09-2016 blu 12,405,800
3050201001 (Meja Kerja Besi/Metal)
1 1 31-12-2006 SWADAYA 500,000
2 2 31-12-2006 SWADAYA 500,000
3 3 31-12-2006 SWADAYA 500,000
4 4 31-12-2006 SWADAYA 500,000
5 5 31-12-2006 SWADAYA 500,000
3050201002 (Meja Kerja Kayu)
1 1 31-12-2006 SWADAYA 400,000
2 2 31-12-2006 SWADAYA 400,000
3 3 31-12-2006 SWADAYA 400,000
4 4 31-12-2006 SWADAYA 400,000
5 5 31-12-2006 SWADAYA 400,000
6 6 31-12-2006 SWADAYA 400,000
7 7 31-12-2006 SWADAYA 400,000
8 8 31-12-2006 SWADAYA 400,000
9 9 31-12-2006 SWADAYA 400,000
10 10 31-12-2006 SWADAYA 400,000
11 11 31-12-2006 SWADAYA 400,000
12 12 31-12-2006 SWADAYA 400,000
13 13 31-12-2006 SWADAYA 400,000
14 14 31-12-2006 SWADAYA 400,000
Tgl Cetak : 27-04-2017 Halaman : 5
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
15 Olimpic 15 01-01-2009 Pembelian 400,000
16 Olimpic 16 01-01-2009 Pembelian 400,000
17 Olimpic 17 01-01-2009 Pembelian 400,000
18 Olimpic 18 01-01-2009 Pembelian 400,000
19 Olimpic 19 01-01-2009 Pembelian 400,000
20 Olimpic 20 01-01-2009 Pembelian 400,000
21 - ok 21 31-03-2013 - 2,075,000
22 - ok 22 31-03-2013 - 2,075,000
23 - ok 23 31-03-2013 - 2,075,000
24 - ok 24 31-03-2013 - 2,075,000
25 - ok 25 31-03-2013 - 2,075,000
26 - ok 26 31-03-2013 - 2,075,000
27 melody keu 27 15-04-2013 500,000
28 28 16-05-2013 600,000
29 29 26-02-2013 2,200,000
30 30 26-02-2013 2,200,000
31 lab 31 10-09-2014 pembl 1,600,000
32 - p.anak 32 03-04-2015 blu 1,100,000
33 apt,icu 33 12-05-2015 blu 1,150,000
34 apt,icu 34 12-05-2015 blu 1,150,000
35 olmp 35 25-03-2016 blu 750,000
36 olmp 36 25-03-2016 blu 750,000
37 olmp 37 25-03-2016 blu 750,000
38 olmp 38 25-03-2016 blu 750,000
39 Alpha 120 Melody Meja satpam F.O 39 22-06-2016 blu 800,000
40 Alpa 120 melody Stafkeu wanti, pket mako 40 23-06-2016 blu 784,002
41 Alpa 120 melody Stafkeu wanti, pket mako 41 23-06-2016 blu 784,002
42 alpha 120 melody poli gigi 42 30-08-2016 blu 784,000
3050201003 (Kursi Besi/Metal)
1 1 31-12-2006 SWADAYA 150,000
2 2 31-12-2006 SWADAYA 150,000
3 3 31-12-2006 SWADAYA 150,000
4 4 31-12-2006 SWADAYA 150,000
5 kursi bandara/tunggu 5 30-12-2014 1,300,000
6 tiger TII anggrek 1-8 6 10-03-2015 blu 500,000
7 tiger TII anggrek 1-8 7 10-03-2015 blu 500,000
8 tiger TII anggrek 1-8 8 10-03-2015 blu 500,000
9 tiger TII anggrek 1-8 9 10-03-2015 blu 500,000
10 tiger TII anggrek 1-8 10 10-03-2015 blu 500,000
11 tiger TII anggrek 1-8 11 10-03-2015 blu 500,000
12 tiger TII anggrek 1-8 12 10-03-2015 blu 500,000
13 tiger TII anggrek 1-8 13 10-03-2015 blu 500,000

Tgl Cetak : 27-04-2017 Halaman : 6


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
14 tiger T3 pos 3 14 10-03-2015 blu 600,000
15 tiger T1 mtkes,wka 15 10-04-2015 blu 650,000
16 tiger T1 mtkes,wka 16 10-04-2015 blu 650,000
17 kursi tunggu r tunggu poli 17 22-03-2016 blu 1,870,000
18 kursi tunggu r tunggu poli 18 22-03-2016 blu 1,870,000
19 kursi tunggu r tunggu poli 19 22-03-2016 blu 1,870,000
20 kursi tunggu r tunggu poli 20 22-03-2016 blu 1,870,000
21 kursi tunggu r tunggu poli 21 22-03-2016 blu 1,870,000
22 fukuda susun fukuda biru poli 22 25-03-2016 blu 2,750,000
23 PT. home center ind kursi Ka 23 30-03-2016 blu 2,884,000
24 lipat Futura Hitam 3staff,1gdang matkes,1mako 24 23-06-2016 291,200
25 lipat Futura Hitam 3staff,1gdang matkes,1mako 25 23-06-2016 291,200
26 lipat Futura Hitam 3staff,1gdang matkes,1mako 26 23-06-2016 291,200
27 lipat Futura Hitam 3staff,1gdang matkes,1mako 27 23-06-2016 291,200
28 lipat Futura Hitam 3staff,1gdang matkes,1mako 28 23-06-2016 291,200
29 kursi tunggu 4 Seat/pcs R tunggu poli 29 08-06-2016 blu 2,199,000
30 kursi tunggu 4 Seat/pcs R tunggu poli 30 08-06-2016 blu 2,199,000
3050201004 (Kursi Kayu)
1 Kondisi Rusak 1 31-12-2006 25,000
2 2 31-12-2006 25,000
3 3 31-12-2006 SWADAYA 25,000
4 4 31-12-2006 SWADAYA 25,000
5 5 31-12-2006 SWADAYA 25,000
6 6 31-12-2006 SWADAYA 25,000
7 7 31-12-2006 SWADAYA 25,000
8 8 31-12-2006 SWADAYA 25,000
9 9 31-12-2006 SWADAYA 25,000
10 10 31-12-2006 SWADAYA 25,000
11 11 31-12-2006 SWADAYA 25,000
12 12 31-12-2006 SWADAYA 25,000
13 13 31-12-2006 SWADAYA 25,000
14 14 31-12-2006 SWADAYA 25,000
15 15 31-12-2006 SWADAYA 25,000
16 16 31-12-2006 SWADAYA 25,000
17 17 31-12-2006 SWADAYA 25,000
18 18 31-12-2006 SWADAYA 25,000
19 19 31-12-2006 SWADAYA 25,000
20 20 31-12-2006 SWADAYA 25,000
21 21 31-12-2006 SWADAYA 25,000
22 22 31-12-2006 SWADAYA 25,000
23 23 31-12-2006 SWADAYA 25,000
24 24 31-12-2006 SWADAYA 25,000

Tgl Cetak : 27-04-2017 Halaman : 7


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
25 25 31-12-2006 SWADAYA 25,000
26 26 31-12-2006 SWADAYA 25,000
27 27 31-12-2006 SWADAYA 25,000
28 28 31-12-2006 SWADAYA 25,000
29 29 31-12-2006 SWADAYA 25,000
30 30 31-12-2006 SWADAYA 25,000
31 31 31-12-2006 SWADAYA 25,000
32 32 31-12-2006 SWADAYA 25,000
33 33 31-12-2006 SWADAYA 25,000
34 34 31-12-2006 SWADAYA 25,000
35 35 31-12-2006 SWADAYA 25,000
36 36 31-12-2006 SWADAYA 25,000
37 37 31-12-2006 SWADAYA 25,000
38 38 31-12-2006 SWADAYA 25,000
3050201005 (Sice)
1 1 01-01-2009 Pembelian 700,000
2 vip baru 2 30-12-2014 1,700,000
3 vip baru 3 30-12-2014 1,700,000
4 vip baru 4 30-12-2014 1,700,000
5 vip baru 5 30-12-2014 1,700,000
6 vip baru 6 30-12-2014 1,700,000
7 vip baru 7 30-12-2014 1,700,000
8 vip baru 8 30-12-2014 1,700,000
9 vip baru 9 30-12-2014 1,700,000
3050201006 (Bangku Panjang Besi/Metal)
1 1 06-05-2013 850,000
3050201009 (Meja Komputer)
1 trolley meja printer 1 10-09-2014 pembl 250,000
3050201010 (Tempat Tidur Besi)
1 1 31-12-2006 DROPPING 565,000
2 2 31-12-2006 DROPPING 565,000
3 3 31-12-2006 DROPPING 565,000
4 4 31-12-2006 DROPPING 565,000
5 5 31-12-2006 DROPPING 565,000
6 6 31-12-2006 DROPPING 565,000
7 7 31-12-2006 DROPPING 565,000
8 8 31-12-2006 DROPPING 565,000
9 9 31-12-2006 DROPPING 565,000
10 10 31-12-2006 DROPPING 565,000
11 11 31-12-2006 DROPPING 565,000
12 12 31-12-2006 DROPPING 565,000
13 13 31-12-2006 DROPPING 565,000

Tgl Cetak : 27-04-2017 Halaman : 8


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
14 14 31-12-2006 DROPPING 565,000
15 15 31-12-2006 DROPPING 565,000
16 16 31-12-2006 DROPPING 565,000
17 17 31-12-2006 DROPPING 565,000
18 18 31-12-2006 DROPPING 565,000
19 19 31-12-2006 DROPPING 565,000
20 20 31-12-2006 DROPPING 565,000
21 21 31-12-2006 DROPPING 565,000
22 22 31-12-2006 DROPPING 565,000
23 23 31-12-2006 DROPPING 565,000
24 24 31-12-2006 DROPPING 565,000
25 25 31-12-2006 DROPPING 565,000
26 26 31-12-2006 DROPPING 565,000
27 27 31-12-2006 DROPPING 565,000
28 28 31-12-2006 DROPPING 565,000
29 29 31-12-2006 DROPPING 565,000
30 30 31-12-2006 DROPPING 565,000
31 31 31-12-2006 DROPPING 565,000
32 32 31-12-2006 DROPPING 565,000
33 33 31-12-2006 DROPPING 565,000
34 34 31-12-2006 DROPPING 565,000
35 35 31-12-2006 DROPPING 565,000
36 36 31-12-2006 DROPPING 565,000
37 37 31-12-2006 DROPPING 565,000
38 38 31-12-2006 DROPPING 565,000
39 ABS 2 CR OM (BH) 39 31-10-2016 blu 4,401,782
40 ABS 2 CR OM (BH) set bed/side px klas 1 40 31-10-2016 blu 4,401,786
41 ABS 2 CR OM (BH) set bed/side px klas 1 41 31-10-2016 blu 4,401,786
42 ABS 2 CR OM (BH) set bed/side px klas 1 42 31-10-2016 blu 4,401,786
43 ABS 2 CR OM (BH) set bed/side px klas 1 43 31-10-2016 blu 4,401,786
44 ABS 2 CR OM (BH) set bed/side px klas 1 44 31-10-2016 blu 4,401,786
45 ABS 2 CR OM (BH) set bed/side px klas 1 45 31-10-2016 blu 4,401,786
46 ABS 2 CR OM (BH) set bed/side px klas 1 46 31-10-2016 blu 4,401,786
47 ABS 2 CR OM (BH) set bed/side px klas 1 47 31-10-2016 blu 4,401,786
48 ABS 2 CR OM (BH) set bed/side px klas 1 48 31-10-2016 blu 4,401,786
49 ABS 2 CR OM (BH) set bed/side px klas 1 49 31-10-2016 blu 4,401,786
50 ABS 2 CR OM (BH) set bed/side px klas 1 50 31-10-2016 blu 4,401,786
51 ABS 2 CR OM (BH) set bed/side px klas 1 51 31-10-2016 blu 4,401,786
52 ABS 2 CR OM (BH) set bed/side px klas 1 52 31-10-2016 blu 4,401,786
3050201013 (Meja Telepon)
1 M printer urmin 1 31-05-2014 Pembelian 800,000
3050201014 (Meja Resepsionis)

Tgl Cetak : 27-04-2017 Halaman : 9


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 1 26-02-2015 BLU 3,500,000
3050201016 (Kasur/Spring Bed)
1 1 31-12-2006 SWADAYA 200,000
2 2 31-12-2006 SWADAYA 200,000
3 3 31-12-2006 SWADAYA 200,000
4 4 31-12-2006 SWADAYA 200,000
5 5 31-12-2006 SWADAYA 200,000
6 6 31-12-2006 SWADAYA 200,000
7 7 31-12-2006 SWADAYA 200,000
8 8 31-12-2006 SWADAYA 200,000
9 9 31-12-2006 SWADAYA 200,000
10 10 31-12-2006 SWADAYA 200,000
11 11 31-12-2006 SWADAYA 200,000
12 12 31-12-2006 SWADAYA 200,000
13 13 31-12-2006 SWADAYA 200,000
14 14 31-12-2006 SWADAYA 200,000
15 15 31-12-2006 SWADAYA 200,000
16 16 31-12-2006 SWADAYA 200,000
17 17 31-12-2006 SWADAYA 200,000
18 18 31-12-2006 SWADAYA 200,000
19 19 31-12-2006 SWADAYA 200,000
20 20 31-12-2006 SWADAYA 200,000
21 21 31-12-2006 SWADAYA 200,000
22 22 31-12-2006 SWADAYA 200,000
23 23 31-12-2006 SWADAYA 200,000
24 24 31-12-2006 SWADAYA 200,000
25 25 31-12-2006 SWADAYA 200,000
26 26 31-12-2006 SWADAYA 200,000
27 27 31-12-2006 SWADAYA 200,000
28 28 31-12-2006 SWADAYA 200,000
29 29 31-12-2006 SWADAYA 200,000
30 30 31-12-2006 SWADAYA 200,000
3050201020 (Kursi Fiber Glas/Plastik)
1 keu 1 10-04-2014 pembelian 50,000
2 keu 2 10-04-2014 pembelian 50,000
3 keu 3 10-04-2014 pembelian 50,000
4 keu 4 10-04-2014 pembelian 50,000
5 keu 5 10-04-2014 pembelian 50,000
6 keu 6 10-04-2014 pembelian 50,000
3050201022 (Partisi)
1 HPL finishing paket partisi r.staf,aula,r.Ka 1 13-05-2016 blu 160,892,000
2 hpl finishing partisi front office 2 27-05-2016 blu 54,653,000

Tgl Cetak : 27-04-2017 Halaman : 10


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3050201999 (Meubelair Lainnya)
1 L baju 1 31-05-2014 Pembelian 725,000
2 L baju 2 31-05-2014 Pembelian 725,000
3 L baju pos 4 3 31-05-2014 Pembelian 750,000
4 rak kayu ambal keu 4 16-03-2016 blu 970,000
3050202001 (Jam Mekanis)
1 1 31-12-2006 SWADAYA 25,000
2 2 31-12-2006 SWADAYA 25,000
3 3 31-12-2006 SWADAYA 25,000
4 4 31-12-2006 SWADAYA 25,000
5 5 31-12-2006 SWADAYA 25,000
6 6 31-12-2006 SWADAYA 25,000
3050203001 (Mesin Penghisap Debu/Vacuum Cleaner)
1 1 10-09-2014 pembl 300,000
2 - - 2 01-07-2015 blu 540,000
3050203004 (Mesin Cuci)
1 1 31-12-2006 SWADAYA 598,000
2 2 31-12-2010 PEMBELIAN 12,000,000
3 - loundry 3 30-06-2013 non 1,898,000
4 - lndry 4 02-08-2015 blu 2,850,000
3050203999 (Alat Pembersih Lainnya)
1 kain pel 1 11-11-2014 8,000
2 kain pel 2 11-11-2014 8,000
3 kain pel 3 11-11-2014 8,000
4 kain pel 4 11-11-2014 8,000
5 kain pel 5 11-11-2014 8,000
6 kain pel 6 11-11-2014 8,000
7 kain pel 7 11-11-2014 8,000
8 kain pel 8 11-11-2014 8,000
9 kain pel 9 11-11-2014 8,000
10 kain pel 10 11-11-2014 8,000
11 stik pel 11 11-11-2014 170,000
12 stik pel 12 11-11-2014 170,000
3050204001 (Lemari Es)
1 1 31-12-2006 SWADAYA 598,000
2 2 31-12-2006 SWADAYA 598,000
3 3 31-12-2006 SWADAYA 598,000
4 4 31-12-2006 SWADAYA 598,000
5 5 31-12-2010 598,000
6 6 31-12-2010 598,000
7 p anak 7 18-03-2014 Pembelian 1,500,000
8 - aptek 8 10-09-2014 pembl 2,600,000
9 polytron vip baru 9 31-12-2014 2,100,000
Tgl Cetak : 27-04-2017 Halaman : 11
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
10 polytron vip baru 10 31-12-2014 2,100,000
11 polytron vip baru 11 31-12-2014 2,100,000
12 polytron vip baru 12 31-12-2014 2,100,000
13 polytron vip baru 13 31-12-2014 2,100,000
14 polytron vip baru 14 31-12-2014 2,100,000
15 polytron vip baru 15 31-12-2014 2,100,000
16 polytron vip baru 16 31-12-2014 2,100,000
17 Toshiba 17 05-02-2015 blu 1,700,000
18 Sharp 2 pintu lemari es gizi 18 18-10-2016 blu 4,246,000
3050204004 (A.C. Split)
1 1 31-12-2006 SWADAYA 798,000
2 2 31-12-2006 SWADAYA 798,000
3 3 31-12-2006 SWADAYA 798,000
4 4 31-12-2006 SWADAYA 798,000
5 5 31-12-2006 SWADAYA 798,000
6 6 31-12-2006 SWADAYA 798,000
7 7 31-12-2006 SWADAYA 798,000
8 8 31-12-2006 SWADAYA 798,000
9 9 31-12-2006 SWADAYA 798,000
10 10 31-12-2006 SWADAYA 798,000
11 11 31-12-2006 SWADAYA 798,000
12 12 31-12-2006 SWADAYA 798,000
13 13 31-12-2006 SWADAYA 798,000
14 14 30-12-2010 saldo awal 798,000
15 15 30-12-2010 saldo awal 798,000
16 16 30-12-2010 saldo awal 798,000
17 17 30-12-2010 saldo awal 798,000
18 18 30-12-2010 saldo awal 798,000
19 19 30-12-2010 saldo awal 798,000
20 20 30-12-2010 saldo awal 798,000
21 21 30-12-2010 saldo awal 798,000
22 22 30-12-2010 saldo awal 798,000
23 23 30-12-2010 saldo awal 798,000
24 24 30-12-2010 saldo awal 798,000
25 25 30-12-2010 saldo awal 798,000
26 26 30-12-2010 saldo awal 798,000
27 27 30-12-2010 saldo awal 798,000
28 28 30-12-2010 saldo awal 798,000
29 29 30-12-2010 saldo awal 798,000
30 30 30-12-2010 saldo awal 798,000
31 31 30-12-2010 saldo awal 798,000
32 32 30-12-2010 saldo awal 798,000

Tgl Cetak : 27-04-2017 Halaman : 12


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
33 33 30-12-2010 saldo awal 798,000
34 34 30-12-2010 saldo awal 798,000
35 35 30-12-2010 saldo awal 798,000
36 36 30-12-2010 saldo awal 798,000
37 37 30-12-2010 saldo awal 798,000
38 lg 38 31-05-2013 non 2,550,000
39 - - 39 31-03-2013 - 2,500,000
40 - - 40 31-03-2013 - 2,500,000
41 - - 41 31-03-2013 - 2,500,000
42 LG 1/2 pk 42 16-07-2013 2,450,000
43 sharp vip baru 43 29-09-2014 pembelian 4,000,000
44 sharp vip baru 44 29-09-2014 pembelian 4,000,000
45 sharp vip baru 45 29-09-2014 pembelian 4,000,000
46 sharp vip baru 46 29-09-2014 pembelian 4,000,000
47 sharp vip baru 47 29-09-2014 pembelian 4,000,000
48 sharp vip baru 48 29-09-2014 pembelian 4,000,000
49 sharp vip baru 49 29-09-2014 pembelian 4,000,000
50 sharp vip baru 50 29-09-2014 pembelian 4,000,000
51 radiologi 51 31-10-2014 3,500,000
52 panasonic 52 18-11-2014 5,900,000
53 LG 53 18-11-2014 5,150,000
54 54 31-12-2014 5,265,000
55 55 31-12-2014 5,265,000
56 56 31-12-2014 5,265,000
57 57 31-12-2014 5,265,000
58 58 31-12-2014 5,265,000
59 LG mel 2,5, mw 2 59 02-04-2015 blu 3,150,000
60 LG mel 2,5, mw 2 60 02-04-2015 blu 3,150,000
61 LG mel 2,5, mw 2 61 02-04-2015 blu 3,150,000
62 krg pndga 62 10-02-2016 blu 11,062,833
63 krg pndga 63 10-02-2016 blu 11,062,833
64 krg pndga 64 10-02-2016 blu 11,062,833
65 krg pndga 65 10-02-2016 blu 11,062,833
66 krg pndga 66 10-02-2016 blu 11,062,833
67 67 10-02-2016 blu 11,062,835
68 LG09NLA poli lt2 68 19-04-2016 blu 4,059,000
69 LG09NLA poli lt2 69 19-04-2016 blu 4,059,000
70 LG09NLA poli lt2 70 19-04-2016 blu 4,059,000
71 LG09NLA poli lt2 71 19-04-2016 blu 4,059,000
72 LG09NLA poli lt2 72 19-04-2016 blu 4,059,000
73 LG18NLA ac 2 pk ur sim &rm 73 19-04-2016 blu 7,205,000
3050204006 (Kipas Angin)

Tgl Cetak : 27-04-2017 Halaman : 13


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3 3 31-12-2006 SWADAYA 100,000
4 4 31-12-2006 SWADAYA 100,000
5 5 31-12-2006 SWADAYA 100,000
6 6 31-12-2006 SWADAYA 100,000
7 7 31-12-2006 SWADAYA 100,000
8 8 31-12-2006 SWADAYA 100,000
9 9 31-12-2006 SWADAYA 100,000
10 10 31-12-2006 SWADAYA 100,000
11 11 31-12-2006 SWADAYA 100,000
12 12 31-12-2006 SWADAYA 100,000
13 13 31-12-2006 SWADAYA 100,000
14 14 31-12-2006 SWADAYA 100,000
15 15 31-12-2006 SWADAYA 100,000
16 16 31-12-2006 SWADAYA 100,000
17 17 31-12-2006 SWADAYA 100,000
18 18 31-12-2006 SWADAYA 100,000
19 19 31-12-2006 SWADAYA 100,000
20 20 31-12-2006 SWADAYA 100,000
21 21 31-12-2006 SWADAYA 100,000
22 22 31-12-2006 SWADAYA 100,000
23 23 31-12-2006 SWADAYA 100,000
24 wallfan 24 08-04-2013 250,000
25 wallfan 25 08-04-2013 250,000
26 26 23-04-2013 250,000
27 wallfan 27 02-05-2013 250,000
28 wallfan 28 02-05-2013 250,000
29 wallfan 29 06-05-2013 250,000
30 30 10-05-2013 250,000
31 wallfan 31 21-06-2013 250,000
32 wallfan 32 04-09-2013 250,000
33 33 17-09-2013 230,000
34 34 30-10-2013 265,000
35 35 17-01-2014 Pembelian 270,000
36 ra 1 36 27-03-2014 Pembelian 250,000
37 37 25-04-2014 Pembelian 250,000
38 wallfan r perawatan 38 30-05-2014 Pembelian 250,000
39 wallfan r perawatan 39 30-05-2014 Pembelian 250,000
40 wallfan r perawatan 40 30-05-2014 Pembelian 250,000
41 wallfan r perawatan 41 30-05-2014 Pembelian 250,000
42 wallfan r perawatan 42 30-05-2014 Pembelian 250,000

Tgl Cetak : 27-04-2017 Halaman : 14


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
43 wallfan r perawatan 43 30-05-2014 Pembelian 250,000
44 44 16-09-2014 pembl 100,000
45 wallfan 45 30-04-2014 pembelian 265,000
46 wallfan 46 02-05-2014 250,000
47 wallfan 47 15-10-2014 275,000
48 wallfan 48 15-10-2014 275,000
49 wallfan 49 15-10-2014 275,000
50 wallfan 50 15-10-2014 275,000
51 51 30-05-2014 250,000
52 Maspion wallfan 52 05-02-2015 blu 330,000
53 Maspion wallfan 53 05-02-2015 blu 330,000
54 maspion 2d-mushla 54 20-05-2015 blu 330,000
55 maspion 2d-mushla 55 20-05-2015 blu 330,000
56 wf mush+IID 56 05-11-2015 blu 385,000
57 wf mush+IID 57 05-11-2015 blu 385,000
58 des14 58 14-12-2015 blu 378,000
59 des14 59 14-12-2015 blu 378,000
60 maspion nov20 60 20-11-2015 blu 345,000
61 maspion nov26 61 26-11-2015 blu 340,000
62 maspion nov26 62 26-11-2015 blu 340,000
63 sekoi nov26 63 26-11-2015 blu 305,000
64 des12 64 12-12-2015 blu 345,000
65 des12 65 12-12-2015 blu 345,000
66 sekai standfan 66 04-03-2016 blu 550,000
67 standfan blend igd 67 23-03-2016 blu 825,000
68 baling2 r tunggu poli 68 25-03-2016 blu 685,000
69 baling2 r tunggu poli 69 25-03-2016 blu 685,000
3050204007 (Exhause Fan)
1 1 21-01-2013 350,000
2 2 16-07-2013 300,000
3 3 29-08-2013 350,000
4 4 28-02-2014 Pembelian 275,000
5 panasonic 5 23-06-2014 Pembelian 420,000
6 panasonic 6 23-06-2014 Pembelian 420,000
7 panasonic 7 23-06-2014 Pembelian 420,000
8 exhausefan 8 30-06-2015 blu 400,000
3050205002 (Kompor Gas (Alat Dapur))
1 1 31-12-2006 SWADAYA 136,000
2 2 31-12-2006 SWADAYA 136,000
3 rinnai 3 25-04-2014 Pembelian 300,000
3050205005 (Rice Cooker (Alat Dapur))
1 - 1 13-08-2014 pembl 225,000

Tgl Cetak : 27-04-2017 Halaman : 15


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
2 gizi 2 31-12-2014 240,000
3 cosmos3231 3 14-06-2014 300,000
4 miyako gizi 4 23-07-2016 blu 240,000
3050205008 (Kitchen Set)
1 kitchen set 1 20-10-2016 blu 120,874,571
3050205009 (Tabung Gas)
1 - dapur 1 25-07-2014 pembl 250,000
2 - dapur 2 25-07-2014 pembl 250,000
3050205011 (Treng Air/Tandon Air)
1 tsv 1000 tandon 1 30-01-2013 2,400,000
3050205015 (Rak Piring Alumunium)
1 1 25-11-2013 2,050,000
3050205018 (Blender)
1 1 11-04-2013 325,000
2 2 31-10-2014 670,000
3 maspion dokpol 3 05-11-2015 blu 350,000
3050206002 (Televisi)
1 1 31-12-2006 SWADAYA 598,000
2 2 31-12-2006 SWADAYA 598,000
3 3 31-12-2006 SWADAYA 598,000
4 4 31-12-2006 SWADAYA 598,000
5 5 31-12-2006 SWADAYA 598,000
6 ok 6 28-05-2014 Pembelian 3,000,000
7 lg 7 28-05-2014 3,000,000
8 toshiba led vip baru 8 30-09-2014 pembelian 2,600,000
9 toshiba led vip baru 9 30-09-2014 pembelian 2,600,000
10 toshiba led vip baru 10 30-09-2014 pembelian 2,600,000
11 toshiba led vip baru 11 30-09-2014 pembelian 2,600,000
12 toshiba led vip baru 12 30-09-2014 pembelian 2,600,000
13 toshiba led vip baru 13 30-09-2014 pembelian 2,600,000
14 toshiba led vip baru 14 30-09-2014 pembelian 2,600,000
15 toshiba led vip baru 15 30-09-2014 pembelian 2,600,000
16 Toshiba led 32" R Ka 16 18-10-2016 blu 3,355,000
3050206004 (Tape Recorder (Alat Rumah Tangga Lainnya ( Home Use )))
1 1 31-12-2006 SWADAYA 319,000
3050206008 (Sound System)
1 matkes 1 30-05-2014 Pembelian 1,400,000
3050206014 (Microphone)
1 musholla 1 30-11-2014 160,000
3050206019 (Stabilisator)
1 Igawa Stafolt 1 17-02-2015 BLU 350,000
3050206032 (Seterika)
1 1 31-12-2006 SWADAYA 100,000
Tgl Cetak : 27-04-2017 Halaman : 16
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3050206036 (Dispenser)
1 miyako 1 08-04-2013 275,000
2 cosmos 2 17-05-2013 260,000
3 3 12-11-2013 1,100,000
4 miyako 4 02-01-2014 Pembelian 290,000
5 5 12-05-2014 Pembelian 200,000
6 satpam 6 30-05-2014 Pembelian 175,000
7 7 25-06-2014 Pembelian 175,000
8 polytron keu 8 12-08-2014 pembl 1,600,000
9 miyako bpjs 9 20-05-2015 blu 360,000
10 yongma pos1 10 05-11-2015 blu 575,000
3050206041 (Mesin Pengering Pakaian)
1 - pengering Linen Loundry 1 07-09-2016 blu 6,849,999
3050206052 (Manequin (Boneka))
1 dokpol 1 16-03-2013 1,000,000
3050206055 (Heater (Alat Rumah Tangga Lainnya ( Home Use )))
1 - water heater 9 25-07-2014 pembl 3,000,000
3050206058 (Gordyin/Kray)
1 1 05-02-2014 Pembelian 531,200
2 2 05-02-2014 Pembelian 531,200
3 3 05-02-2014 Pembelian 531,200
4 gordyn set kacafilm 4 24-05-2016 blu 8,193,645
5 gordyn set kacafilm 5 24-05-2016 blu 8,193,645
6 gordyn set kacafilm 6 24-05-2016 blu 8,193,645
7 poli set R jalan 7 24-05-2016 blu 8,193,647
3050206059 (Kabel Roll)
1 1 30-05-2014 150,000
3050206061 (Keset Kaki)
1 keset 1 11-11-2014 12,000
2 keset 2 11-11-2014 12,000
3 keset 3 11-11-2014 12,000
4 keset 4 11-11-2014 12,000
3050206065 (Mesin Pengering Tangan)
1 1 30-06-2014 629,667
2 2 30-06-2014 629,667
3 3 30-06-2014 629,667
4 4 30-06-2014 629,667
5 5 30-06-2014 629,667
6 6 30-06-2014 629,667
3050206072 (Lampu)
1 lampu cas 1 02-08-2013 150,000
3050206073 (Jemuran)
1 rak jemuran 1 31-05-2014 200,000
Tgl Cetak : 27-04-2017 Halaman : 17
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
2 rak jemuran 2 31-05-2014 200,000
3 rak jemuran 3 31-05-2014 200,000
4 rak jemuran 4 31-05-2014 200,000
5 rak jemuran 5 31-05-2014 200,000
3050206999 (Alat Rumah Tangga Lainnya ( Home Use ))
1 tempt linen 1 31-05-2014 Pembelian 400,000
2 tempt linen 2 31-05-2014 Pembelian 400,000
3 tempt linen 3 31-05-2014 Pembelian 400,000
4 - lemari musholla 9 12-08-2014 pembl 2,000,000
5 Kopana top gas regulator elpiji 10 27-02-2015 BLU 459,000
6 Kopana top gas regulator elpiji 11 27-02-2015 BLU 459,000
7 Kopana top gas regulator elpiji 12 27-02-2015 BLU 459,000
3050299999 (Alat Rumah Tangga Lainnya)
1 rak dispenser 1 31-05-2014 145,000
2 tempat sampah 2 30-09-2014 400,000
3 tempat sampah 3 30-09-2014 400,000
4 tempat sampah 4 30-09-2014 400,000
5 wastafel set 5 24-10-2014 500,000
6 wastafel set 6 24-10-2014 500,000
7 wastafel set 7 24-10-2014 500,000
8 wastafel set 8 24-10-2014 500,000
9 tempat sampah 9 11-11-2014 300,000
10 tempat sampah 10 11-11-2014 300,000
11 tempat sampah 11 11-11-2014 300,000
12 tempat sampah 12 11-11-2014 300,000
13 13 30-09-2014 150,000
14 kursi KBI 14 30-12-2014 650,000
15 tiger1 15 30-12-2014 900,000
16 tiger1 16 30-12-2014 900,000
17 tiger1 17 30-12-2014 900,000
18 tiger1 18 30-12-2014 900,000
19 kursi tiger2 19 30-12-2014 675,000
20 kursi tiger2 20 30-12-2014 675,000
21 kursi bar 21 30-12-2014 600,000
22 - tpt limbah non medis hijau 22 21-04-2016 blu 210,815
23 - tpt limbah non medis hijau 23 21-04-2016 blu 210,815
24 - tpt limbah non medis hijau 24 21-04-2016 blu 210,815
25 - tpt limbah non medis hijau 25 21-04-2016 blu 210,815
26 - tpt limbah non medis hijau 26 21-04-2016 blu 210,815
27 - tpt limbah non medis hijau 27 21-04-2016 blu 210,815
28 - tpt limbah non medis hijau 28 21-04-2016 blu 210,815
29 - tpt limbah non medis hijau 29 21-04-2016 blu 210,815

Tgl Cetak : 27-04-2017 Halaman : 18


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
30 - tpt limbah non medis hijau 30 21-04-2016 blu 210,815
31 - tpt limbah non medis hijau 31 21-04-2016 blu 210,815
32 - medical waste container 36 32 21-04-2016 blu 210,815
lt
33 - medical waste container 36 33 21-04-2016 blu 210,815
lt
34 - medical waste container 36 34 21-04-2016 blu 210,815
lt
35 - medical waste container 36 35 21-04-2016 blu 210,815
lt
36 - medical waste container 36 36 21-04-2016 blu 210,815
lt
37 - medical waste container 36 37 21-04-2016 blu 210,815
lt
38 - medical waste container 36 38 21-04-2016 blu 210,815
lt
39 - medical waste container 36 39 21-04-2016 blu 210,815
lt
40 - medical waste container 36 40 21-04-2016 blu 210,815
lt
41 - medical waste container 36 41 21-04-2016 blu 210,815
lt
3060101048 (Uninterruptible Power Supply (UPS))
1 Kenika kz 600 Ups 1 17-02-2015 BLU 500,000
3060102053 (DC Converter)
1 power DVR converter gama elektro 1 19-08-2016 blu 600,000
3060102128 (Camera Digital)
1 canon 1 31-12-2014 4,000,000
3060102135 (LCD Monitor)
1 1 18-07-2013 860,000
3060201001 (Telephone (PABX))
1 1 07-01-2014 Pembelian 100,000
2 2 07-01-2014 Pembelian 100,000
3 3 07-01-2014 Pembelian 100,000
4 4 07-01-2014 Pembelian 100,000
3060201003 (Pesawat Telephone)
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3 3 03-07-2013 150,000
4 4 17-07-2013 75,000
5 5 25-11-2013 75,000
6 panasonic 6 25-06-2014 130,000
3060201007 (Telex)
1 1 31-12-2006 SWADAYA 439,000
3060299999 (Alat Komunikasi Lainnya)

Tgl Cetak : 27-04-2017 Halaman : 19


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 nursecall 4 central pos/nursecall 1 12-10-2016 blu 8,396,625
2 nursecall 4 central pos/nursecall 2 12-10-2016 blu 8,396,625
3 nursecall 4 central pos/nursecall 3 12-10-2016 blu 8,396,625
4 nursecall 4 central pos/nursecall 4 12-10-2016 blu 8,396,625
3070101001 (Sterilisator)
1 1 31-12-2006 DROPPING 2,400,000
2 2 31-12-2006 DROPPING 2,400,000
3 3 31-12-2006 SWADAYA 1,200,000
4 - RB 4 31-12-2006 42,000,000
3070101002 (Minor Surgical Set (Alat Kedokteran Umum))
1 1 31-12-2006 DROPPING 10,000,000
3070101003 (Diagnostik Set)
1 1 31-12-2006 DROPPING 8,890,000
3070101004 (Stetoscope (Alat Kedokteran Umum))
1 1 31-12-2006 SWADAYA 25,000
2 2 31-12-2006 SWADAYA 25,000
3 3 31-12-2006 SWADAYA 25,000
4 4 31-12-2006 SWADAYA 25,000
5 287.0001/RK, GERMANY 5 17-12-2012 DROPPING PUSDOKKES 407,000
6 287.0001/RK, GERMANY 6 17-12-2012 DROPPING PUSDOKKES 407,000
7 287.0001/RK, GERMANY 7 17-12-2012 DROPPING PUSDOKKES 407,000
8 superbult 8 27-06-2013 1,630,000
9 RK Germany sa 9 31-12-2011 Pusdokkes 407,000
10 RK Germany sa 10 31-12-2011 Pusdokkes 407,000
11 RK Germany sa 11 31-12-2011 Pusdokkes 407,000
12 RK Germany sa 12 31-12-2011 Pusdokkes 407,000
13 RK Germany sa 13 31-12-2011 Pusdokkes 407,000
14 RK Germany sa 14 31-12-2011 Pusdokkes 407,000
3070101005 (Tensimeter)
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3 3 31-12-2006 SWADAYA 100,000
4 4 31-12-2006 SWADAYA 100,000
5 5 31-12-2006 SWADAYA 100,000
6 6 31-12-2006 SWADAYA 100,000
7 286.8501/RK, GERMANY 7 17-12-2012 DROPPING PUSDOKKES 1,584,000
8 286.8501/RK, GERMANY 8 17-12-2012 DROPPING PUSDOKKES 1,584,000
9 286.8801/RK, GERMANY TENSI LAPANGAN 9 17-12-2012 DROPPING PUSDOKKES 693,000
10 RK Germany (tensi sa 10 31-12-2011 Pusdokkes 693,000
lapangan)
11 RK Germany (tensi sa 11 31-12-2011 Pusdokkes 693,000
lapangan)
12 286.8501 RK Germany sa 12 31-12-2011 Pusdokkes 1,584,000

Tgl Cetak : 27-04-2017 Halaman : 20


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
13 286.8501 RK Germany sa 13 31-12-2011 Pusdokkes 1,584,000
14 286.8501 RK Germany sa 14 31-12-2011 Pusdokkes 1,584,000
15 286.8501 RK Germany sa 15 31-12-2011 Pusdokkes 1,584,000
16 Reister 16 28-02-2014 dpk pusdokkes 1,980,000
3070101007 (Head Lamp (Alat Kedokteran Umum))
1 1 31-12-2006 SWADAYA 25,000
2 LED/SURGIMED, RRC 2 17-12-2012 DROPPING PUSDOKKES 825,000
3 Ryne INA sa 3 31-12-2011 Pusdokkes 825,000
4 Ryne INA sa 4 31-12-2011 Pusdokkes 825,000
3070101008 (Waskom)
1 1 31-12-2006 SWADAYA 50,000
2 2 31-12-2006 SWADAYA 50,000
3 3 31-12-2006 SWADAYA 50,000
4 4 10-03-2011 15,500
5 5 10-03-2011 15,500
6 6 10-03-2011 15,500
7 7 10-03-2011 15,500
3070101009 (Timbangan Badan (Alat Kedokteran Umum))
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3 ZT-120/ SMIC, RRC 3 17-12-2012 DROPPING PUSDOKKES 1,078,000
4 ZT-120 SMIC RRC sa 4 31-12-2011 Pusdokkes 1,078,000
5 ZT-120 SMIC RRC sa 5 31-12-2011 Pusdokkes 1,078,000
3070101010 (Timbangan Bayi)
1 1 31-12-2006 SWADAYA 80,000
2 BF 2051/ LAICA, ITALY 2 17-12-2012 DROPPING PUSDOKKES 1,320,000
3 BF 2051 Laica italy sa 3 21-12-2011 Pusdokkes 1,320,000
4 BF 2051 Laica italy sa 4 21-12-2011 Pusdokkes 1,320,000
3070101015 (Chirurgical Pinset)
1 1 31-12-2006 SWADAYA 15,000
3070101016 (Naalvoeder)
1 1 31-12-2006 SWADAYA 35,000
2 2 31-12-2006 SWADAYA 35,000
3 3 31-12-2006 SWADAYA 35,000
3070101026 (Tabung 02)
1 1 30-05-2014 2,145,000
2 2 30-05-2014 2,145,000
3070101028 (Autoclave Table)
1 ELITECH 1 23-09-2011 PEMBELIAN 1,800,000
2 - - 2 28-02-2013 - 27,321,000
3070101032 (Bak Instrument (Stainles,Kaca,Email))
1 1 31-12-2006 SWADAYA 200,000
2 2 31-12-2006 SWADAYA 200,000
Tgl Cetak : 27-04-2017 Halaman : 21
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3 0156/ MAGNATE, 3 17-12-2012 DROPPING PUSDOKKES 313,500
THAILAND
4 0156/ MAGNATE, 4 17-12-2012 DROPPING PUSDOKKES 313,500
THAILAND
5 0156/ MAGNATE, 5 17-12-2012 DROPPING PUSDOKKES 313,500
THAILAND
6 0156/ MAGNATE, 6 17-12-2012 DROPPING PUSDOKKES 313,500
THAILAND
7 0156/ MAGNATE, 7 17-12-2012 DROPPING PUSDOKKES 313,500
THAILAND
8 0156 magnate Thailand sa 8 31-12-2011 Pusdokkes 313,500
9 0156 magnate Thailand sa 9 31-12-2011 Pusdokkes 313,500
10 0156 magnate Thailand sa 10 31-12-2011 Pusdokkes 313,500
11 0156 magnate Thailand sa 11 31-12-2011 Pusdokkes 313,500
3070101042 (Brancard)
1 1 31-12-2006 SWADAYA 9,000,000
2 2 31-12-2006 SWADAYA 9,000,000
3 3 31-12-2006 SWADAYA 9,000,000
4 4 31-12-2006 SWADAYA 9,000,000
5 5 31-12-2006 SWADAYA 9,000,000
6 6 31-12-2006 SWADAYA 9,000,000
7 PARAMOUNT, ALAT IGD 7 31-10-2014 tranfer masuk 13,887,382
INDONESIA
8 S/S PLUS INDOMED (BH) HD 8 31-10-2015 blu 8,140,000
9 S/S PLUS INDOMED (BH) HD 9 31-10-2015 blu 8,140,000
10 des19 beroda 10 19-11-2015 blu 16,280,000
3070101061 (Elektro Counter)
1 1 31-12-2006 DROPPING 27,000,000
3070101080 (Infusion Pump)
1 1 31-12-2006 DROPPING 20,000,000
2 Top 3300 Top Japan sa 2 31-12-2011 Pusdokkes 55,879,026
3 Top 3300 Top Japan sa 3 31-12-2011 Pusdokkes 55,879,026
3070101088 (Korentang)
1 1 31-12-2006 SWADAYA 200,000
3070101094 (Mangkok/Kom Betadin (Stainless,Keramik/China))
1 1 31-12-2006 SWADAYA 11,500
2 2 31-12-2006 SWADAYA 11,500
3 3 31-12-2006 SWADAYA 11,500
3070101096 (Meja Suntik Beroda)
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3 3 31-12-2006 SWADAYA 100,000
4 4 31-12-2006 SWADAYA 100,000
3070101097 (Lemari Obat (Kaca))

Tgl Cetak : 27-04-2017 Halaman : 22


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 1 31-12-2006 SWADAYA 678,500
2 2 31-12-2006 SWADAYA 678,500
3 3 31-12-2006 SWADAYA 678,500
4 4 31-12-2006 SWADAYA 678,500
5 5 31-12-2006 SWADAYA 678,500
6 6 31-12-2006 SWADAYA 678,500
7 7 31-12-2006 SWADAYA 678,500
3070101105 (Nierbekhen)
1 1 31-12-2006 SWADAYA 40,600
2 2 31-12-2006 SWADAYA 40,600
3 3 31-12-2006 SWADAYA 40,600
4 4 31-12-2006 SWADAYA 40,600
5 5 31-12-2006 SWADAYA 40,600
6 6 31-12-2006 SWADAYA 40,600
7 7 31-12-2006 SWADAYA 40,600
8 8 31-12-2006 SWADAYA 40,600
9 9 31-12-2006 SWADAYA 40,600
10 10 31-12-2006 SWADAYA 40,600
11 11 31-12-2006 SWADAYA 40,600
12 12 31-12-2006 SWADAYA 40,600
13 13 31-12-2006 SWADAYA 40,600
14 14 31-12-2006 SWADAYA 40,600
15 15 31-12-2006 SWADAYA 40,600
3070101108 (Operating Lamp)
1 1 31-12-2006 DROPPING 43,000,000
2 2 31-12-2006 DROPPING 43,000,000
3070101127 (Kursi Dorong)
1 1 31-12-2006 SWADAYA 1,500,000
2 2 31-12-2006 SWADAYA 1,500,000
3 3 31-12-2006 SWADAYA 1,500,000
4 - - 4 30-04-2013 - 1,000,000
5 SERENITY, CHINA ALAT IGD 5 31-10-2014 pusdokkes 2,713,245
3070101134 (Suction Pump)
1 1 31-12-2006 DROPPING 11,000,000
2 2 31-12-2006 DROPPING 11,000,000
3 3 31-12-2006 DROPPING 11,000,000
4 ORDISI, SPAIN ALAT IGD 4 31-10-2014 pusdokkes 53,600,424
5 bh mobile pos1 5 13-10-2015 blu 3,685,000
6 1242 2TB D SU192 6 25-07-2016 blu 38,500,000
3070101139 (Standar Infus)
1 1 31-12-2006 SWADAYA 53,000
2 2 31-12-2006 SWADAYA 53,000

Tgl Cetak : 27-04-2017 Halaman : 23


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3 3 31-12-2006 SWADAYA 53,000
4 4 31-12-2006 SWADAYA 53,000
5 5 31-12-2006 SWADAYA 53,000
6 6 31-12-2006 SWADAYA 53,000
7 7 31-12-2006 SWADAYA 53,000
8 8 31-12-2006 SWADAYA 53,000
9 9 31-12-2006 SWADAYA 53,000
10 10 31-12-2006 SWADAYA 53,000
11 11 31-12-2006 SWADAYA 53,000
12 12 31-12-2006 SWADAYA 53,000
13 13 31-12-2006 SWADAYA 53,000
14 14 31-12-2006 SWADAYA 53,000
15 15 31-12-2006 SWADAYA 53,000
16 16 31-12-2006 SWADAYA 53,000
17 17 31-12-2006 SWADAYA 53,000
18 18 31-12-2006 SWADAYA 53,000
19 19 31-12-2006 SWADAYA 53,000
20 20 31-12-2006 SWADAYA 53,000
21 21 31-12-2006 SWADAYA 53,000
22 22 31-12-2006 SWADAYA 53,000
23 23 31-12-2006 SWADAYA 53,000
24 24 31-12-2006 SWADAYA 53,000
25 25 31-12-2006 SWADAYA 53,000
26 26 31-12-2006 SWADAYA 53,000
27 27 31-12-2006 SWADAYA 53,000
28 28 31-12-2006 SWADAYA 53,000
29 29 31-12-2006 SWADAYA 53,000
30 30 31-12-2006 SWADAYA 53,000
31 31 31-12-2006 SWADAYA 53,000
32 32 31-12-2006 SWADAYA 53,000
33 33 31-12-2006 SWADAYA 53,000
34 34 31-12-2006 SWADAYA 53,000
35 35 31-12-2006 SWADAYA 53,000
36 36 31-12-2006 SWADAYA 53,000
37 37 31-12-2006 SWADAYA 53,000
38 38 31-12-2006 SWADAYA 53,000
39 39 31-12-2006 SWADAYA 53,000
40 40 31-12-2006 SWADAYA 53,000
41 41 22-08-2013 220,000
42 42 22-08-2013 220,000
43 43 22-08-2013 220,000
44 44 22-08-2013 220,000

Tgl Cetak : 27-04-2017 Halaman : 24


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
45 45 22-08-2013 220,000
3070101140 (Standar Waskom)
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3 3 31-12-2006 SWADAYA 100,000
4 M.8905 SS/ HSP 4 17-12-2012 DROPPING PUSDOKKES 1,925,000
INDONESIA
3070101144 (Syringe Pump (Alat Kedokteran Umum))
1 1 31-12-2006 DROPPING 23,000,000
2 2 27-06-2013 22,499,999
3070101146 (Termometer Mercury Untuk Suhu Badan)
1 1 31-12-2006 SWADAYA 9,200
2 2 31-12-2006 SWADAYA 9,200
3 3 31-12-2006 SWADAYA 9,200
3070101151 (Tromol Has)
1 1 31-12-2006 SWADAYA 120,000
2 2 31-12-2006 SWADAYA 120,000
3 3 31-12-2006 SWADAYA 120,000
4 4 31-12-2006 SWADAYA 120,000
5 plat INA sa 5 31-12-2011 Pusdokkes 352,000
6 plat INA sa 6 31-12-2011 Pusdokkes 352,000
7 plat INA sa 7 31-12-2011 Pusdokkes 352,000
8 plat INA sa 8 31-12-2011 Pusdokkes 352,000
3070101152 (Urinal)
1 0108/ MAGNATE 1 17-12-2012 DROPPING 440,000
THAILAND
2 0108/ MAGNATE 2 17-12-2012 DROPPING 440,000
THAILAND
3 0108/ MAGNATE 3 17-12-2012 DROPPING 440,000
THAILAND
4 0108/ MAGNATE 4 17-12-2012 DROPPING 440,000
THAILAND
5 0108/ MAGNATE 5 17-12-2012 DROPPING 440,000
THAILAND
6 0108 magnate Thailand sa 6 31-12-2011 Pusdokkes 440,000
7 0108 magnate Thailand sa 7 31-12-2011 Pusdokkes 440,000
8 0108 magnate Thailand sa 8 31-12-2011 Pusdokkes 440,000
9 0108 magnate Thailand sa 9 31-12-2011 Pusdokkes 440,000
3070101155 (UV Sterilizer)
1 1 31-12-2006 DROPPING 13,000,000
2 2 31-12-2006 DROPPING 13,000,000
3 4lampubh pos3+ok 3 22-10-2015 blu 5,720,000
4 4lampubh pos3+ok 4 22-10-2015 blu 5,720,000
3070101999 (Alat Kedokteran Umum Lainnya)

Tgl Cetak : 27-04-2017 Halaman : 25


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 Bed side ABS 6 26-05-2014 1,500,000
2 Bed side ABS 7 26-05-2014 1,500,000
3 Bed side ABS 8 26-05-2014 1,500,000
4 Bed side ABS 9 26-05-2014 1,500,000
5 Bed side ABS 10 26-05-2014 1,500,000
6 bed + mtrs px ABS 2 CR BED+MATRAS px HD 11 30-09-2015 blu 7,150,000
OM
7 bed + mtrs px ABS 2 CR BED+MATRAS px HD 12 30-09-2015 blu 7,150,000
OM
8 bed + mtrs px ABS 2 CR BED+MATRAS px HD 13 30-09-2015 blu 7,150,000
OM
9 bed + mtrs px ABS 2 CR BED+MATRAS px HD 14 30-09-2015 blu 7,150,000
OM
10 bed + mtrs px ABS 2 CR BED+MATRAS px HD 15 30-09-2015 blu 7,150,000
OM
3070102002 (Dental Unit)
1 1 31-12-2006 HIBAH 15,945,000
2 gnatus pop star lsf me p gigi 2 13-08-2015 blu 58,025,000
3070102003 (Dental X-Ray Unit)
1 1 31-12-2006 DROPPING 75,000,000
3070102005 (Dental Hand Instruments Set)
1 dental set instr p gigi 1 13-08-2015 blu 28,298,600
3070102014 (Minor Surgical Set (Alat Kedokteran Gigi))
1 - pgigi 1 13-08-2015 blu 15,707,230
3070102020 (Dental Ultra Sonic)
1 1 31-12-2006 DROPPING 10,000,000
3070102027 (Bend Pusher)
1 1 31-12-2006 SWADAYA 75,000
3070102033 (Burnisher)
1 1 31-12-2006 SWADAYA 30,000
2 2 31-12-2006 SWADAYA 30,000
3070102039 (Cryer)
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3070102040 (Curret Gigi)
1 1 31-12-2006 SWADAYA 10,000
2 2 31-12-2006 SWADAYA 10,000
3070102048 (Exkavator)
1 1 31-12-2006 SWADAYA 25,000
2 2 31-12-2006 SWADAYA 25,000
3070102059 (Kaca Mulut/Spigel)
1 1 31-12-2006 SWADAYA 25,000
2 2 31-12-2006 SWADAYA 25,000
3 3 31-12-2006 SWADAYA 25,000

Tgl Cetak : 27-04-2017 Halaman : 26


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3070102067 (Light Curing Unit)
1 1 31-12-2006 DROPPING 957,000
3070102079 (Pinset Dental)
1 1 31-12-2006 SWADAYA 20,000
2 2 31-12-2006 SWADAYA 20,000
3 3 31-12-2006 SWADAYA 20,000
3070102080 (Pisau Lilin/Wasmess/Wax Knife)
1 1 31-12-2006 SWADAYA 10,000
3070102081 (Plastik Instrument)
1 1 31-12-2006 SWADAYA 15,000
2 2 31-12-2006 SWADAYA 15,000
3070102089 (Spatel Gips)
1 1 31-12-2006 SWADAYA 10,000
2 2 31-12-2006 SWADAYA 10,000
3 3 31-12-2006 SWADAYA 10,000
4 4 31-12-2006 SWADAYA 10,000
5 5 31-12-2006 SWADAYA 10,000
3070102093 (Tang Ektrasi (Dewasa,Anak))
1 1 31-12-2006 DROPPING 293,000
2 2 31-12-2006 DROPPING 293,000
3 3 31-12-2006 DROPPING 293,000
4 4 31-12-2006 DROPPING 293,000
5 5 31-12-2006 DROPPING 293,000
6 6 31-12-2006 DROPPING 293,000
7 7 31-12-2006 DROPPING 293,000
8 8 31-12-2006 DROPPING 293,000
9 9 31-12-2006 DROPPING 293,000
10 10 31-12-2006 DROPPING 293,000
11 11 31-12-2006 DROPPING 293,000
12 12 31-12-2006 DROPPING 293,000
13 13 31-12-2006 DROPPING 293,000
14 14 31-12-2006 DROPPING 293,000
15 15 31-12-2006 DROPPING 293,000
16 16 31-12-2006 DROPPING 293,000
17 17 31-12-2006 DROPPING 293,000
18 18 31-12-2006 DROPPING 293,000
3070103003 (Service Model Kit)
1 Bidan Kit sa 1 31-12-2011 Pusdokkes 4,390,100
2 Bidan Kit sa 2 31-12-2011 Pusdokkes 4,390,100
3070103006 (Speculum)
1 1 31-12-2006 SWADAYA 62,500
2 2 31-12-2006 SWADAYA 62,500
3 3 31-12-2006 SWADAYA 62,500
Tgl Cetak : 27-04-2017 Halaman : 27
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
4 4 31-12-2006 SWADAYA 62,500
5 5 31-12-2006 SWADAYA 62,500
6 6 31-12-2006 SWADAYA 62,500
7 7 31-12-2006 SWADAYA 62,500
8 8 31-12-2006 SWADAYA 62,500
9 9 31-12-2006 SWADAYA 62,500
10 10 31-12-2006 SWADAYA 62,500
11 11 31-12-2006 SWADAYA 62,500
12 12 31-12-2006 SWADAYA 62,500
3070104001 (Minor Surgeri Set)
1 1 31-12-2006 DROPPING 2,500,000
2 2 17-12-2012 DROPPING PUSDOKKES 682,000
3 3 17-12-2012 DROPPING PUSDOKKES 682,000
3070104011 (Anaesthesi App)
1 1 31-12-2006 DROPPING 125,000,000
3070104012 (Operating Table Bedah)
1 1 31-12-2006 DROPPING 40,000,000
2 2 31-12-2006 DROPPING 40,000,000
3 3 25-10-2013 84,348,000
3070104022 (Mobile Operating Lamp)
1 3 21-12-2006 saldo awal 1,500,000
3070104038 (Basic Surgical Instrument)
1 1 30-06-2014 3,670,150
3070104071 (Electric Suction Pump)
1 1632GL Thomas portable 2 26-05-2014 5,000,000
3070104074 (Emergency Trolley)
1 Onemed W/ lock Emgcy trolly ok-icu-igd 1 21-04-2016 blu 19,800,000
2 Onemed W/ lock Emgcy trolly ok-icu-igd 2 21-04-2016 blu 19,800,000
3 Onemed W/ lock Emgcy trolly ok-icu-igd 3 21-04-2016 blu 19,800,000
3070104086 (Heacting Set)
1 1 17-12-2012 DROPPING PUSDOKKES 1,595,000
2 sa 2 31-12-2011 Pusdokkes 1,471,800
3 sa 3 31-12-2011 Pusdokkes 1,471,800
3070104111 (Laparatomi Set)
1 1 31-12-2006 DROPPING 83,450,000
3070104121 (Mayo Table Stand Mobile, Stainles Steel)
1 1 31-12-2006 SWADAYA 1,500,000
3070104999 (Alat Kedokteran Bedah Lainnya)
1 operasi set 1 25-10-2013 4,534,750
2 ok instrument 2 16-03-2014 Pembelian 4,602,840
3 OK 3 21-01-2014 pembelian 975,000
4 set doek ok set 4 13-08-2015 blu 16,354,800
5 sealing 80 Alat press steril ok 5 21-04-2016 blu 2,860,000
Tgl Cetak : 27-04-2017 Halaman : 28
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3070105002 (Hysterectomy Set)
1 1 01-06-2011 1,914,000
3070105008 (Curetage And Dilation Set)
1 1 31-12-2006 DROPPING 1,500,000
3070105010 (Basic Obstetric Set)
1 1 31-12-2006 SWADAYA 200,000
3070105011 (Gynecological Examining Table)
1 1 31-12-2006 SWADAYA 678,000
3070105027 (Oxygen Regulator)
1 YR.88/ INNOVA, RRC 1 17-12-2012 DROPPING PUSDOKKES 962,500
2 YR.88/ INNOVA, RRC 2 17-12-2012 DROPPING PUSDOKKES 962,500
3 YR.88/ INNOVA, RRC 3 17-12-2012 DROPPING PUSDOKKES 962,500
3070105054 (Vacuum Extractor (Alat Kesehatan Kebidanan Dan Penyakit Kandungan)
1 1 31-12-2006 SWADAYA 200,000
3070105060 (Baby Incubator (Alat Kesehatan Kebidanan Dan Penyakit Kandungan))
1 1 31-12-2006 SWADATA 100,000
2 2 31-12-2006 SWADATA 100,000
3 3 31-12-2006 SWADATA 100,000
4 4 31-12-2006 SWADATA 100,000
5 5 31-12-2006 SWADATA 100,000
3070105063 (Alat Partus Set)
1 1 31-12-2006 DROPPING 1,000,000
2 2 17-12-2012 DROPPING PUSDOKKES 1,452,000
3 sa 3 31-12-2011 Pusdokkes 1,342,000
4 sa 4 31-12-2011 Pusdokkes 1,342,000
3070105083 (Dopler (Fetal Heart Sound Detector))
1 1 14-05-2011 2,090,000
2 BF 600 + 2 23-09-2011 PEMBELIAN 1,900,000
3070105087 (Forcep Fulture)
1 1 31-12-2006 SWADAYA 25,000
2 2 31-12-2006 SWADAYA 25,000
3 3 31-12-2006 SWADAYA 25,000
4 4 31-12-2006 SWADAYA 25,000
5 5 31-12-2006 SWADAYA 25,000
6 6 31-12-2006 SWADAYA 25,000
3070105097 (Lampu Gynaecologi)
1 1 31-12-2006 SWADAYA 125,000
2 2 31-12-2006 SWADAYA 125,000
3 led pos2 3 13-10-2015 blu 1,210,000
3070105107 (Partus Instrument Set)
1 0m pos2 1 13-10-2015 blu 880,000
2 om +heactsetpos1258,5 2 13-10-2015 blu 1,138,500
3070105119 (Tampon Tang)
Tgl Cetak : 27-04-2017 Halaman : 29
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 1 31-12-2006 SWADAYA 50,000
3070105999 (Alat Kesehatan Kebidanan Dan Penyakit Kandungan Lainnya)
1 1 22-08-2013 2,850,000
3070106096 (Otoscope Halogen Lamp)
1 - ok 1 28-02-2013 - 16,250,000
3070106150 (X-Ray Viewer)
1 M-8940/HSP, 1 17-12-2012 DROPPING PUSDOKKES 935,000
INDONESIA
2 M-8940/HSP, 2 17-12-2012 DROPPING PUSDOKKES 935,000
INDONESIA
3 M 8940 Lokal INA sa 3 31-12-2011 Pusdokkes 935,000
4 M 8940 Lokal INA sa 4 31-12-2011 Pusdokkes 935,000
5 M 8940 Lokal INA sa 5 31-12-2011 Pusdokkes 935,000
6 M 8940 Lokal INA sa 6 31-12-2011 Pusdokkes 935,000
3070108030 (Ultra Sono Graphy (USG) Internal Medicine)
1 Mindray DP-20 USG poli KIA 1 26-09-2016 blu 76,640,000
3070109003 (Autopsi Set)
1 Varieus Hebu Medical sa 1 31-12-2011 Pusdokkes 97,587,946
GmbH
3070109999 (Alat Kedokteran Kamar Jenasah Lainnya)
1 HB 8891 Hebu Medical sa 1 31-12-2011 Pusdokkes 41,020,996
GmbH (Electric Saw
Machine)
3070110011 (Neirbekken Stainless Steel)
1 1 10-03-2011 104,333
2 2 10-03-2011 104,333
3 3 10-03-2011 104,333
4 1201/ MAGNATE, 4 17-12-2012 DROPPING PUSDOKKES 71,500
THAILAND
5 1201/ MAGNATE, 5 17-12-2012 DROPPING PUSDOKKES 71,500
THAILAND
6 1201/ MAGNATE, 6 17-12-2012 DROPPING PUSDOKKES 71,500
THAILAND
7 1201/ MAGNATE, 7 17-12-2012 DROPPING PUSDOKKES 71,500
THAILAND
8 1201/ MAGNATE, 8 17-12-2012 DROPPING PUSDOKKES 71,500
THAILAND
9 1201 Magnate Thailand sa 9 31-12-2011 Pusdokkes 71,500
10 1201 Magnate Thailand sa 10 31-12-2011 Pusdokkes 71,500
3070110044 (Doek Klem-Towel Forceps)
1 1 31-12-2006 SWADAYA 40,000
2 2 31-12-2006 SWADAYA 40,000
3 3 31-12-2006 SWADAYA 40,000
4 4 31-12-2006 SWADAYA 40,000
5 5 31-12-2006 SWADAYA 40,000

Tgl Cetak : 27-04-2017 Halaman : 30


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
6 6 31-12-2006 SWADAYA 40,000
7 7 31-12-2006 SWADAYA 40,000
8 8 31-12-2006 SWADAYA 40,000
9 9 31-12-2006 SWADAYA 40,000
10 10 31-12-2006 SWADAYA 40,000
11 11 31-12-2006 SWADAYA 40,000
12 12 31-12-2006 SWADAYA 40,000
13 13 31-12-2006 SWADAYA 40,000
14 14 31-12-2006 SWADAYA 40,000
15 15 31-12-2006 SWADAYA 40,000
16 16 31-12-2006 SWADAYA 40,000
17 17 31-12-2006 SWADAYA 40,000
18 18 31-12-2006 SWADAYA 40,000
19 19 31-12-2006 SWADAYA 40,000
20 20 10-03-2011 16,500
21 21 10-03-2011 16,500
22 22 10-03-2011 16,500
23 23 10-03-2011 16,500
24 24 10-03-2011 16,500
25 25 10-03-2011 16,500
26 26 10-03-2011 16,500
27 27 10-03-2011 16,500
3070110065 (Baby Incubator (Alat Kedokteran Anak))
1 1 31-12-2006 SWADAYA 100,000
2 2 31-12-2006 SWADAYA 100,000
3070110999 (Alat Kedokteran Anak Lainnya)
1 bed for children 1 31-10-2014 5,352,000
2 bed for children 2 31-10-2014 5,352,000
3 bed for children 3 31-10-2014 5,352,000
4 bed for children 4 31-10-2014 5,352,000
5 alat phototerapy 5 25-08-2014 1,180,000
3070111003 (Bed Pan For Adult 310 mm Complete)
1 0101/ MAGNATE, 1 17-12-2012 DROPPING PUSDOKKES 660,000
THAILAND
2 0101/ MAGNATE, 2 17-12-2012 DROPPING PUSDOKKES 660,000
THAILAND
3 0101/ MAGNATE, 3 17-12-2012 DROPPING PUSDOKKES 660,000
THAILAND
4 0101/ MAGNATE, 4 17-12-2012 DROPPING PUSDOKKES 660,000
THAILAND
5 0101/ MAGNATE, 5 17-12-2012 DROPPING PUSDOKKES 660,000
THAILAND
6 0101 Magnate Thailand sa 6 31-12-2011 Pusdokkes 644,600
7 0101 Magnate Thailand sa 7 31-12-2011 Pusdokkes 644,600
Tgl Cetak : 27-04-2017 Halaman : 31
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
8 0101 Magnate Thailand sa 8 31-12-2011 Pusdokkes 644,600
9 0101 Magnate Thailand sa 9 31-12-2011 Pusdokkes 644,600
3070111021 (Dressing Forceps)
1 PLATA INDONESIA 24 CM 1 17-12-2012 DROPPING PUSDOKKES 352,000
2 PLATA INDONESIA 24 CM 2 17-12-2012 DROPPING PUSDOKKES 352,000
3 PLATA INDONESIA 24 CM 3 17-12-2012 DROPPING PUSDOKKES 352,000
4 PLATA INDONESIA 24 CM 4 17-12-2012 DROPPING PUSDOKKES 352,000
5 PLATA INDONESIA 24 CM 5 17-12-2012 DROPPING PUSDOKKES 352,000
6 PLATA, INDONESIA 21 CM 6 17-12-2012 DROPPING PUSDOKKES 352,000
7 PLATA, INDONESIA 21 CM 7 17-12-2012 DROPPING PUSDOKKES 352,000
8 PLATA, INDONESIA 21 CM 8 17-12-2012 DROPPING PUSDOKKES 352,000
9 PLATA, INDONESIA 21 CM 9 17-12-2012 DROPPING PUSDOKKES 352,000
10 PLATA, INDONESIA 21 CM 10 17-12-2012 DROPPING PUSDOKKES 352,000
3070111032 (Knife Handle)
1 1 10-03-2011 27,000
2 2 10-03-2011 27,000
3 3 10-03-2011 27,000
3070112002 (Wheel Chair (Alat Kesehatan Rehabilitasi Medis))
1 1 31-12-2006 SWADAYA 750,000
2 2 21-04-2011 1,500,000
3 3 21-04-2011 1,500,000
3070113005 (Patient Monitor)
1 1 10-02-2011 16,000,435
2 mec 1000 2 21-06-2013 17,000,000
3 mec 1000 3 21-06-2013 17,000,000
4 mec 1000 4 01-10-2013 19,000,000
5 mec 1000 5 01-10-2013 19,000,000
6 6 21-01-2016 blu 20,350,000
3070114001 (Electrocardiograph)
1 - - 1 31-03-2013 - 11,499,999
2 - - 2 31-03-2013 - 11,499,999
3 NIHON KOHDEN, JAPAN ALAT IGD 3 31-10-2014 pusdokkes 44,574,732
4 cardio7bh igd 4 22-10-2015 blu 24,000,000
3070114004 (Central Gas)
1 o2 ctrl central 1 08-12-2015 blu 14,825,580
3070114006 (Heart Rate Monitor)
1 AM 1200 ADVANCE SC OK 1 30-10-2015 blu 18,700,000
2 Am 1500 ADV VERSI II px monitor icu 2 14-04-2016 blu 20,350,000
3 AM 1500 ADV VERSI II + px monitor O K 3 19-05-2016 blu 20,350,000
PRINTER
3070114021 (Defibrilator Phisiocontrol)
1 type beneheart minray defibrillator OK 1 01-08-2015 sisa DPK 2013 78,497,312
3070114022 (ECG 3 Channel)
Tgl Cetak : 27-04-2017 Halaman : 32
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 1 31-12-2006 DROPPING 27,500,000
2 2 31-12-2006 DROPPING 27,500,000
3 ECG 1150 nihon kohden 3 28-02-2014 dpk pusdokkes 44,836,892
Japan
3070114027 (EKG Monitor)
1 1 31-12-2006 DROPPING 33,000,000
2 - - 2 28-02-2013 - 16,500,000
3 - - 3 28-02-2013 - 16,500,000
4 - - 4 28-02-2013 - 16,500,000
3070115003 (Automatic Film Processing Unit)
1 KONICA 1 28-02-2011 DROPPING PUSDOKKES 122,650,000
3070115006 (Cassete Film (Alat Kedokteran Radiodiagnostic))
1 film 24x30 ro 1 07-09-2015 blu 1,760,000
3070115008 (Film Processing Tank)
1 1 31-12-2006 SWADAYA 150,000
2 2 31-12-2006 SWADAYA 150,000
3070115009 (General Purpose X-Ray Unit)
1 1 31-12-2006 DROPPING 300,000,000
3070115011 (Grid)
1 lisholm ro 1 07-09-2015 blu 1,760,000
3070115017 (X-Ray Mobile Unit)
1 MEDNIF 1 28-02-2011 DROPPING PUSDOKKES 308,000,000
3070115999 (Alat Kedokteran Radiodiagnostic Lainnya)
1 film drier 1 07-09-2015 blu 433,840,000
2 COLENTA Kompt radiography(cassette 2 30-11-2016 blu 107,360,000
reader)
3070117999 (Alat Kedokteran Transfusi Darah Lainnya)
1 Blood warmer penghangat cairan OK 1 15-10-2016 blu 1,294,700
3070118014 (Film Hanger)
1 1 31-12-2006 SWADAYA 250,000
2 2 31-12-2006 SWADAYA 250,000
3 3 31-12-2006 SWADAYA 250,000
4 4 31-12-2006 SWADAYA 250,000
5 5 31-12-2006 SWADAYA 250,000
6 6 31-12-2006 SWADAYA 250,000
7 7 31-12-2006 SWADAYA 250,000
8 8 31-12-2006 SWADAYA 250,000
9 9 31-12-2006 SWADAYA 250,000
3070118016 (Film Pass Box)
1 1 31-12-2006 SWADAYA 150,000
3070120011 (Kasur Anti Decubitus)
1 1 24-03-2011 800,000
2 2500 F/ GRAND, 2 17-12-2012 DROPPING PUSDOKKES 1,650,000

Tgl Cetak : 27-04-2017 Halaman : 33


DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
TAIWAN
3 2500 F/ GRAND, 3 17-12-2012 DROPPING PUSDOKKES 1,650,000
TAIWAN
4 2500F Grand Taiwan sa 4 31-12-2011 Pusdokkes 1,650,000
5 2500F Grand Taiwan sa 5 31-12-2011 Pusdokkes 1,650,000
3070121022 (Emergency Kit)
1 1 31-12-2006 SWADAYA 25,110,000
2 2 17-12-2012 DROPPING PUSDOKKES 4,390,100
3 sa 3 31-12-2011 Pusdokkes 43,901,000
4 sa 4 31-12-2011 Pusdokkes 43,901,000
3070121028 (Infant Ventilator)
1 type synovent E3 minray ventilator OK 1 01-08-2015 sisa DPK 2013 197,609,999
3070124003 (Co2 Analyzer (Alat Kedokteran I C U))
1 sandana icu 1 22-01-2016 blu 34,593,020
3070124004 (Icu Bed Electric)
1 1 31-12-2006 DROPPING 4,562,500
2 2 31-12-2006 DROPPING 4,562,500
3 3 31-12-2006 DROPPING 4,562,500
4 4 31-12-2006 DROPPING 4,562,500
5 5 31-12-2006 DROPPING 4,562,500
6 6 31-12-2006 DROPPING 4,562,500
7 7 31-12-2006 DROPPING 4,562,500
8 8 31-12-2006 DROPPING 4,562,500
9 9 31-10-2014 25,087,500
10 10 31-10-2014 25,087,500
11 11 31-10-2014 25,087,500
12 12 31-10-2014 25,087,500
3070128001 (Anesthesi Apparatus)
1 - ok 2 30-06-2013 - 196,460,000
3070128999 (Alat Kedokteran Anaesthesi Lainnya)
1 1 22-08-2013 1,750,000
2 DK 50-DS/UNIT compressor ventilator ok 2 21-04-2016 blu 93,500,000
3070199999 (Alat Kedokteran Lainnya)
1 veldbert lipat 1 31-03-2014 500,000
2 veldbert lipat 2 31-03-2014 500,000
3070201016 (O 2 Masker)
1 GEA, RRC 1 17-12-2012 DROPPING PUSDOKKES 60,500
2 GEA, RRC 2 17-12-2012 DROPPING PUSDOKKES 60,500
3 GEA, RRC 3 17-12-2012 DROPPING PUSDOKKES 60,500
4 GEA, RRC 4 17-12-2012 DROPPING PUSDOKKES 60,500
5 GEA, RRC 5 17-12-2012 DROPPING PUSDOKKES 60,500
6 GEA, RRC 6 17-12-2012 DROPPING PUSDOKKES 60,500
7 GEA, RRC 7 17-12-2012 DROPPING PUSDOKKES 60,500
Tgl Cetak : 27-04-2017 Halaman : 34
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
3070203010 (Intubation Trainer)
1 1 31-12-2006 DROPPING 6,000,000
3080111001 (Centrifuge (Alat Laboratorium Umum))
1 1 31-12-2006 SWADAYA 147,000
3080111021 (Autoclave (Alat Laboratorium Umum))
1 1 31-12-2006 SWADAYA 150,000
3080111023 (Timbangan/Neraca)
1 Kondisi Rusak 1 31-12-2006 100,000
3080111030 (Stop Watch)
1 1 31-12-2006 SWADAYA 35,000
3080111041 (Corong)
1 1 31-12-2006 SWADAYA 50,000
3080111138 (Spectrophotometer)
1 1 31-12-2006 SWADAYA 40,000
3080112043 (Microscope Monocular)
1 1 31-12-2006 SWADAYA 2,500,000
3080149009 (Digital Thermometer)
1 GIZI+APOTEK 1 02-09-2016 BLU 338,902
2 GIZI+APOTEK 2 02-09-2016 BLU 338,902
3080201028 (Thermoluminiscence Dosimeter (TLD) Reader)
1 TLD radiologi 1 29-10-2014 2,000,000
3100101004 (Internet)
1 speedy wifi speedy-bpjs 1 13-03-2015 blu 5,608,000
3100102001 (P.C Unit)
1 1 31-12-2006 SWADAYA 831,000
2 2 31-12-2006 SWADAYA 831,000
3 3 31-12-2006 SWADAYA 831,000
4 4 31-12-2006 SWADAYA 831,000
5 5 31-12-2006 SWADAYA 831,000
6 6 31-12-2006 SWADAYA 831,000
7 7 31-12-2006 SWADAYA 831,000
8 8 31-12-2006 SWADAYA 831,000
9 9 31-12-2006 SWADAYA 831,000
10 LENOVO 10 14-10-2011 PT. ASKES 4,000,000
11 11 12-07-2013 2,410,000
12 12 12-07-2013 2,575,000
13 13 28-10-2013 4,360,000
14 hp subbagrenmin 14 17-07-2013 20,340,000
15 corei3 simbada r. dokpol 15 15-01-2014 Pembelian 4,850,000
16 server 16 01-04-2014 Pembelian 11,658,000
17 17 26-05-2014 Pembelian 4,400,000
18 18 26-05-2014 Pembelian 4,400,000
19 19 26-05-2014 Pembelian 4,400,000
Tgl Cetak : 27-04-2017 Halaman : 35
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
20 20 26-05-2014 Pembelian 4,400,000
21 - matkes 21 25-07-2014 pembl 1,880,000
22 22 31-10-2014 4,250,000
23 23 31-10-2014 4,250,000
24 24 31-10-2014 4,250,000
25 25 31-10-2014 4,250,000
26 26 31-10-2014 3,595,000
27 27 31-12-2014 4,200,000
28 28 27-02-2015 BLU 5,000,000
29 29 27-02-2015 BLU 5,000,000
30 - pc rm 30 15-04-2015 blu 6,230,000
31 paket bpjs 31 13-05-2015 blu 11,950,000
32 - aula 32 21-03-2016 blu 6,000,000
3100102002 (Lap Top)
1 toshiba keu 1 30-10-2014 6,999,000
3100102003 (Note Book)
1 DELL reklas dari pers kompt lainny 1 22-06-2016 sarpras polda 17,560,349
3100201010 (Line Printer)
1 prnt gl px prt gelang px 1 23-03-2016 blu 8,850,000
2 prnt gl px prt gelang px 2 23-03-2016 blu 8,850,000
3100202001 (Card Reader (Peralatan Mini Komputer))
1 toshiba 1 12-05-2014 15,000
3100203001 (CPU (Peralatan Personal Komputer))
1 cpu-keu 1 06-03-2015 blu 3,575,000
2 2 30-06-2015 blu 4,100,000
3 Acer Aspire TC 710 Black P C BPJS 3 30-08-2016 blu 9,680,000
4 Intel 1155 Core i-3 3220 Kasir 4 09-08-2016 blu 4,328,500
5 PC LGA 1150 core r staff jangmed 5 15-07-2016 blu 5,956,472
i3-4130
3100203002 (Monitor)
1 LG 16" 1 26-05-2014 Pembelian 800,000
3100203003 (Printer (Peralatan Personal Komputer))
1 1 31-12-2006 SWADAYA 250,000
2 2 31-12-2006 SWADAYA 250,000
3 3 31-12-2006 SWADAYA 250,000
4 4 31-12-2006 SWADAYA 250,000
5 5 31-12-2006 SWADAYA 250,000
6 6 31-12-2006 SWADAYA 250,000
7 7 31-12-2006 SWADAYA 250,000
8 8 31-12-2006 SWADAYA 250,000
9 EPSON LQ 2190 9 14-10-2011 PT. ASKES 6,000,000
10 10 02-10-2013 665,000
11 canon mpx 237 r dokpol 11 20-01-2014 Pembelian 1,075,000
Tgl Cetak : 27-04-2017 Halaman : 36
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
12 L210 bpjs 12 12-05-2014 Pembelian 2,450,000
13 epson L110 p umum 13 26-05-2014 Pembelian 1,575,000
14 epson L120 keu 14 26-05-2014 Pembelian 1,425,000
15 hp laser o 1102 fo 15 26-05-2014 Pembelian 975,000
16 epson L210 16 24-06-2014 Pembelian 2,050,000
17 L210 17 21-07-2014 pembl 2,100,000
18 L120 18 21-07-2014 pembl 1,650,000
19 L110 19 11-04-2014 1,750,000
20 lx310 20 31-10-2014 2,100,000
21 L210 21 30-11-2014 2,200,000
22 LQ2190 22 31-12-2014 7,100,000
23 hp laserjet m1132 +toner p1102 23 30-01-2015 blu 3,000,000
24 HP Laserjet P1102 24 27-02-2015 BLU 1,400,000
25 25 30-06-2015 blu 2,200,000
26 epson L120 laborat 26 15-03-2016 blu 2,200,000
27 fuji xerox dpm 355df aula 27 21-03-2016 blu 8,300,000
28 epson L220 staf dokpol 28 14-06-2016 blu 2,970,000
29 Epson workforce M200 F.O 29 30-08-2016 blu 3,918,000
pigmen
30 Epson L1300 Urmin 30 30-08-2016 blu 8,050,000
31 Epson L-220 urmin+gd matkes 31 15-07-2016 blu 2,763,365
32 Epson L-220 urmin+gd matkes 32 15-07-2016 blu 2,763,365
3100203009 (Keyboard (Peralatan Personal Komputer))
1 1 30-11-2014 225,000
3100203017 (External/ Portable Hardisk)
1 keu 1 17-09-2014 pembl 665,000
2 Seagate 1 TB 2 27-02-2015 BLU 1,050,000
3 Seagate 1 TB 3 27-02-2015 BLU 1,050,000
3100203999 (Peralatan Personal Komputer Lainnya)
1 epson lx cartridge 1 30-05-2014 85,000
2 epson lx cartridge 2 30-05-2014 85,000
3 epson lx cartridge 3 30-05-2014 85,000
4 epson lx cartridge 4 30-05-2014 85,000
5 epson lx cartridge 5 30-05-2014 85,000
6 hp laserjet cartridge 6 30-05-2014 265,000
3100299999 (Peralatan Komputer Lainnya)
1 cartridge hp laserjet 1 12-05-2014 pembelian 250,000
2 power suply jvc 2 03-06-2014 270,000
3 stavolt 3 16-10-2014 290,000
3130102003 (Sumur Pemboran Air)
1 sumur bor 1 27-02-2015 BLU 1,800,000
3150299999 (Alat Pelindung Lainnya)
1 PB/ timah hitam PB Radiologi 1 26-09-2016 blu 9,750,000
Tgl Cetak : 27-04-2017 Halaman : 37
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
2 PB/ timah hitam PB Radiologi 2 26-09-2016 blu 9,750,000
3 PB/ timah hitam PB Radiologi 3 26-09-2016 blu 9,750,000
4 PB/ timah hitam PB Radiologi 4 26-09-2016 blu 9,750,000
5 PB/ timah hitam PB Radiologi 5 26-09-2016 blu 9,750,000
6 PB/ timah hitam PB Radiologi 6 26-09-2016 blu 9,750,000
7 PB/ timah hitam PB Radiologi 7 26-09-2016 blu 9,750,000
8 PB/ timah hitam PB Radiologi 8 26-09-2016 blu 9,750,000
9 PB/ timah hitam PB Radiologi 9 26-09-2016 blu 9,750,000
10 PB/ timah hitam PB Radiologi 10 26-09-2016 blu 9,750,000
3150301021 (Tandu)
1 YDC-1A4 Rescue RRC sa 1 31-12-2011 Pusdokkes 1,474,000
2 YDC-1A4 Rescue RRC sa 2 31-12-2011 Pusdokkes 1,474,000
3180102009 (Rambu-rambu Petunjuk/Penuntun)
1 - neon box titik kumpul 1 14-04-2016 blu 9,625,000
2 petunjuk masuk keluar akses masuk keluar 2 09-09-2016 blu 1,100,000
3 petunjuk masuk keluar akses masuk keluar 3 09-09-2016 blu 1,100,000
4010102004 (Bangunan Gudang Terbuka Permanen)
1 gudang genset 1 28-03-2013 24,955,375
4010106001 (Bangunan Rumah Sakit Umum)
1 1 31-12-2006 SWADAYA 3,236,200,439
2 - matkes 2 30-06-2013 - 198,480,000
3 - ok cntral 3 01-01-2013 - 366,563,000
4 klas I+vip lt.2 4 25-06-2014 penyelsaian pemb 178,000,000
5 urmin+kasir+dokpol 5 28-02-2014 200,000,000
6 lanjutan vip lt II 6 31-12-2014 572,941,000
7 r otopsi/dokpol 7 31-12-2014 247,655,000
8 LT2 APT/ADM/AULA/PK/HD 8 07-11-2015 sukemi 1,885,955,000
9 R. KlasI+gizi Lt.1 CV. EKA JAYA 9 30-11-2016 blu 1,754,154,000
4040104999 (Pagar Lainnya)
1 - pagar pembatas Ipal +trlis 1 18-10-2016 blu 6,336,000
perin
4040199999 (Tugu/Tanda Batas Lainnya)
1 kanopi gizi/ro/kls 1 baru 1 18-10-2016 blu 98,522,001
5020704002 (Bangunan Pompa Air Buangan Domestik)
1 - - 1 30-04-2013 - 169,250,000
2 pagar penampungan 2 18-10-2013 3,000,000
5030201999 (Instalasi Air Buangan Domestik Lainnya)
1 - ipal 1 15-04-2013 - 196,297,970
5030602001 (Instalasi Gardu Listrik Distribusi Kapasitas Kecil)
1 meter listrik kantin 1 03-11-2014 1,500,000
5030802999 (Instalasi Jaringan Pipa Gas Lainnya)
1 instalasi gas medis/O2 1 30-05-2014 35,000,000
5031001001 (Instalasi Generating Set)
Tgl Cetak : 27-04-2017 Halaman : 38
DAFTAR BMN SAMPAI DENGAN TAHUN 2016
UAKPB : 060.01.0500.679635.000.KD RS BHAYANGKARA LUMAJANG
Kode Barang Nama Barang
No. No Aset Tgl. Perlh Asal Perolehan Rupiah Aset
Merk Barang Keterangan
1 - panel 1 31-03-2013 - 33,550,000
5040299999 (Jaringan Listrik Lainnya)
1 1 09-01-2013 9,689,000
2 2 19-11-2013 2,532,500
3 r otopsi 3 06-02-2014 Pembelian 1,730,000
4 R.dokpol inst eksh fan 4 28-02-2014 1,252,000
5040301001 (Jaringan Telepon Diatas Tanah Kapasitas Kecil)
1 inst pabx 1 07-01-2014 Pembelian 17,500,000
5040399999 (Jaringan Telepon Lainnya)
1 jaringan PABX 1 26-09-2014 pembl 15,000,000
8010101001 (Software Komputer)
1 1 17-05-2013 30,000,000
2 upgrade softwr 3 27-05-2015 blu 10,000,000

Tgl Cetak : 27-04-2017 Halaman : 39

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