Laporan Pemakaian Dan Lembar Permintaan Obat Tahun 2019

LAPORAN P
PUSKESMAS : ....................................................
KECAMATAN : .....................................................
No Nama Obat Satuan
1 2 3
Alat Kesehatan
Tahun 2011
1 Kasa Pembalut Hidrofil 4 m x 10 cm DAK 2011 rol
Tahun 2012
3
Infusion set anak DAK 2012 Set
4
Kasa Hidrofil 36 m x 80 cm DAK 2012 Rol
5
Kasa Hidrofil steril 16 x 16 (isi 16 lembar) DAK 2012 Kotak
6
Plester 5 yard x 2 inchi DAK 2012 Rol
7
Plester rol kain 1.25cm x 5m APBD II 2012 Rol
Tahun 2013
8 Plester 5cm x 4.5m APBD II 2013 Rol
9 Wing Needle no 27 G APBD II 2013 Set
Tahun 2014
10 Wing Needle No. 23 G APBD II PERUB. 2014 pcs
Tahun 2015
11 IV Catheter (STERA) No. 20 G x 1 1/4 " DAK 2015 Set
12 IV Catheter (STERA) No. 22 G x 1 " DAK 2015 Set
13 IV Catheter (STERA) No. 24 G x 3/4 " DAK 2015 Set
14 IV Catheter no 20 G DAK 2015 Set

18 Pharmafix 10 x 5cm DAK 2015 Rol
19 Wing Needle no 21 G APBD II 2015 Pcs
Tahun 2016
20 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2016 Pcs
23 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2016 Pcs
25 Folley Catheter 2 way No. 18 DAK 2016 Pcs
28 Handscoen Safeglove PP Steril no 7,5 DAK 2016 Pasang
29 Handscoen Safeglove PP Steril no 8 DAK 2016 Pasang
30 Infusion Set Anak (60 drops/ml) DAK 2016 Pcs
31 Infusion Set Dewasa (20 drops/ml) DAK 2016 Pcs
34 Masker Onemed Surgical Mask Earloop DAK 2016 Pcs
35 Silk 2/0 + jarum 1/2 GT 35 mm DAK 2016 Pcs
36 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2016 Pcs
Tahun 2017
38 AXIMED Nonwoven Fixation/ 5 cm x 10 m DAK 2017 Roll

44 Handscoen Safeglove PP no 7 (Sterile / Pre Powder) DAK 2017 pcs
45 Handscoen Safeglove PP no 7,5 (Sterile / Pre Powder) DAK 2017 pcs
46 Handscoen Safeglove PP no 8 (Sterile / Pre Powder) DAK 2017 pcs
47 Infusion Set Anak 60 Drops/Ml With Y Type, Airvent DAK 2017 Pcs
48 Infusion Set Dewasa 20 Drops/Ml With Y Type, Airvent, DAK 2017 Pcs
49 IV Catheter (TERUMO) SR+OX1832C3 (IV Cateter No 18) DAK 2017 Pcs
53 Masker Earloop DAK 2017 Pcs
56 Wing Needle 21 G DAK 2017 Pcs
Tahun 2018
69 Handscoen Safeglove PP Steril no 8 DAK 2018 Pasang

70 Infusion Set Anak (60 drops/ml) DAK 2018 Pcs
71 Infusion Set Dewasa (20 drops/ml) DAK 2018 Pcs

74 Povidone Iodine 30 ml DAK 2018 Botol
76 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 18) DAK 2018 pcs
80 Kapas Adsorben 250g DAK 2018 pcs
81 Kasa Hidrofil 36m/ 40 yard x 80 cm DAK 2018 Roll
82 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak
83 Masker Earloop DAK 2018 Pcs
84 Pembalut Elastis 7,5 cm x 4,55 m DAK 2018 Roll
85 Pharmafix 5cm x 500cm DAK 2018 Roll
86 Plester 5 cm x 5 m DAK 2018 Roll
87 Rivanol 300 ml DAK 2018 Botol
90 Verban 4 Yard x 10 cm DAK 2018 Roll
91 Verban 4 Yard x 5 cm DAK 2018 Roll
92 Wing needle No.23 DAK 2018 Botol
95
96
Tahun 2019
95 Abocath / IV Catheter no 18 G DAK 2019 Set
99 Alat Suntik sekali pakai 1 ml (syringe pump) DAK 2019 set

100 Alat Suntik sekali pakai 3 ml (syringe pump) DAK 2019 Set
101 Alat Suntik sekali pakai 5 ml (syringe pump) DAK 2019 set
102 Catgut/Benang Bedah No. 2/0 dengan jarum DAK 2019 set
103 Catgut/Benang Bedah No. 3/0 dengan jarum DAK 2019 set
104 Elastis bandage 7,4cm x 4,5m DAK 2019 Pcs
105 Foley Catheter no 18 DAK 2019 pcs

108 Handschoon (Sarung tangan) no. 7 DAK 2019 pasang
109 Handschoon (Sarung tangan) no. 7,5 DAK 2019 pasang
110 Handschoon (Sarung tangan) no. 8 DAK 2019 Pasang
111 Hypafix 10cm x 5 m DAK 2019 Rol
112 Infusion set anak DAK 2019 set

113 Infusion set dewasa DAK 2019 Set
114 Jarum Kulit DAK 2019 Set/12

115 Jarum Otot DAK 2019 Set/12
116 Kapas Pembalut Adsorben 250 gram DAK 2019 bungkus
117 Kasa Hidrofil 36 m x 80 cm DAK 2019 rol
118 Kasa Hidrofil steril 16 x 16 (isi 16 lembar) DAK 2019 Kotak
119 Kasa Pembalut Hidrofil 4 m x 10 cm DAK 2019 Rol
120 Kasa Pembalut Hidrofil 4 m x 5 cm DAK 2019 Rol
121 Masker Bedah DAK 2019 Pcs
122 Plester 5 yard x 2 inchi DAK 2019 Rol
123 Silk (benang bedah) 2/0 + jarum 1/2 GT 35 mm DAK 2019 Pcs
124 Urine Bag Standard Steril DAK 2019 Set

125 Wing Needle no 21 G DAK 2019 Set
129
130
131
132
133
Obat Emergency
Tahun 2012
134 Kasa steril 16/16 APBD II 2012 Kotak

Tahun 2015
135 Asam Traneksamat tablet 500mg APBD II 2015 tablet

136 Diklofenak Dietilammon (Voltaren cream) APBD II 2015 tube
Tahun 2016
137 Counterpain crm 15 g APBD II 2016 Tube
138 Diklofenak dietilammon Crm (Voltaren crm) APBD II 2016 Tube
139 Heparin komb. Gel (Thrombopob gel 20 g) APBD II 2016 Tube
140 Jarum Kulit APBD II 2016 Set/12
141 Jarum Otot APBD II 2016 Set/12
142 Komb B complek + vit c 500mg (selcom) APBD II 2016 Tablet
143 Minyak kayu putih 60 ml APBD II 2016 Botol
144 Minyak Telon 60 ml APBD II 2016 Botol
145 Obat Flu kombinasi (Demacolin) APBD II 2016 Tablet
146 Oksigen tabung (Oxycan) APBD II 2016 Tabung
147 Pisau Operasi APBD II 2016 Pcs
148 Serum anti bisa ular injeksi 5ml APBD II 2016 Vial
149 Serum anti tetanus 1.500 iu/amp APBD II 2016 Ampul

Tahun 2017
150 Alkohol 70% 300 ml APBD II 2017 Pcs
151 Asam Traneksamat injeksi 250 mg APBD II 2017 Ampul
152 Asam Traneksamat tablet 500 mg APBD II 2017 Tablet
153 Combivent nebules APBD II 2017 Ampul
155 Dulcolax strip @4 tablet APBD II 2017 Strip
156 Elastis bandage 7,4cm x 4,5m APBD II 2017 Roll
157 Hand sanitizer 50 ml APBD II 2017 botol
158 Hansaplast sachet @100 sachet APBD II 2017 Kotak
160 Komb B complek + vit c 500mg (Selcom C) APBD II 2017 Tablet

165 Scabimite cream 10g APBD II 2017 Tube

Tahun 2018
168 Alkohol 70% 300 ml APBD II 2018 Botol
169 Asam Traneksamat tablet 500 mg APBD II 2018 tablet
171 Diklofenak dietilammon Crm (Voltaren crm) APBD II 2018 Tube
173 Jarum Kulit APBD II 2018 Set/12
174 Jarum Otot APBD II 2018 Set/12
175 Komb B complek + vit c 500mg (selcom) APBD II 2018 Tablet

180 Pisau Operasi APBD II 2018 Pcs
183
184
Tahun 2019
185 Alkohol 70% 300 ml APBD II 2019 Botol

186 Asam Tranexamat inj 250 mg APBD II 2019 Ampul
187 Asam Tranexamat tablet 500 mg APBD II 2019 Tablet

189 Dulcolax strip @4 tablet APBD II 2019 Strip
190 Dumin 125 mg rectal APBD II 2019 Tube
191 Elastis bandage 7,4cm x 4,5m APBD II 2019 Rol

192 Etil Klorida Spray APBD II 2019 Botol
193 H2O2 3% 100ml APBD II 2019 Botol
194 Hand sanitizer 100 ml APBD II 2019 Botol
195 Hand sanitizer 50 ml APBD II 2019 Botol

196 Hansaplast sachet @100 sachet APBD II 2019 Kotak
198 Komb B complek + vit c 500mg (Selcom C) APBD II 2019 Tablet
201 Multivitamin (Prenatin-plus) APBD II 2019 Tablet
204 Parasetamol Rectal (Dumin 125 mg rectal) APBD II 2019 Tube

205 Plester rol kain 1.25cm x 5m APBD II 2019 Rol
206 Scabimite cream 10g APBD II 2019 Tube
207 Serum Anti Bisa Ular inj 5 ml APBD II 2019 Vial
208 Serum Anti Tetanus 1.500 iu/ampul APBD II 2019 Ampul
209 Voltaren gel 10 g APBD II 2019 Tube
210
211
212
213
214
Obat Generik
Tahun 2012
215 Antalgin (Metampiron) injeksi 250 mg/ml DAK 2012 Ampul

216 Antalgin (Metampiron) tablet 500 mg DAK 2012 Tablet
217 Antifungi DOEN DAK 2012 Pot
218 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2012 Ampul
219 Dekstran 70 laurat infus 6% steril DAK 2012 Botol
220 Dekstrometorfan tablet 15 mg (HBr) DAK 2012 Tablet
221 Diltiazem HCl tablet 30 mg DAK 2012 Tablet
222 Efedrin tablet 25 mg DAK 2012 Tablet
223 Etakridin (Rivanol) larutan 0,1% DAK 2012 botol
224 Fenilbutason tablet 200 mg DAK 2012 Tablet
225 Glukosa larutan infus 10% steril DAK 2012 Botol
226 Magnesium Sulfat inj (IV) 20% DAK 2012 vial
228 Magnesium sulfat serbuk 30 gram DAK 2012 Bungkus
229 Metilergometrin Maleat tablet 0,125 mg DAK 2012 Tablet
230 Parasetamol tablet 100 mg DAK 2012 Tablet
231 Pirantel tablet score (base) 125 mg DAK 2012 Tablet
Tahun 2013
232 Ambroksol sirup 15 mg/ml DAK 3013 Botol

233 Ambroksol sirup 15 mg/ml SILVA 2013 botol
234 Ambroksol tablet 30 mg DAK 2013 Tablet
235 Ambroksol tablet 30 mg SILVA 2013 tablet
236 Anti Bakteri DOEN salep kombinasi DAK 3013 Tube
237 Asiklovir krim 5 % SILVA 2013 tube
238 Asiklovir tablet 200 mg SILVA 2013 tablet
239 Betametason krim 0,1 % (sebagai valerat) DAK 3013 Tube
240 Dekstrometorfan sirup 10 mg/5ml (HBr) DAK 3013 Botol
241 Dekstrometorfan tablet 15 mg (HBr) SILVA 2013 tablet
242 Eritromisin kapsul / kaplet 500 mg DAK 3013 Kaplet
243 Eritromisin sirup 200 mg/5 ml DAK 3013 Botol
244 Furosemid injeksi i.v / im 10 mg/ml DAK 3013 Ampul
245 Furosemid injeksi i.v / im 10 mg/ml SILVA 2013 ampul
246 Gentian Violet larutan 1 % DAK 3013 Botol
247 Gliseril Guayakolat ablet 100mg APBD II 2013 Tablet
248 Isoniazid tablet 100 mg SILVA 2013 tablet
249 Isosorbid Dinitrat tablet sublingual 5 mg DAK 3013 Tablet
250 Isosorbid Dinitrat tablet sublingual 5 mg SILVA 2013 tablet
251 Metoklopramide tablet 10 mg DAK 3013 Tablet
252 Mikonazol krim/salep 2 % (Nitrat ) SILVA 2013 tube
253 Nistatin vaginal tablet 100.000IU/g DAK 3013 Tablet
254 Papaverin injeksi 40 mg/ml DAK 3013 Ampul

255 Papaverin tablet 40 mg DAK 3013 Tablet
256 Propanolol tablet 40 mg (HCI) DAK 3013 Tablet
257 Propiltiourasil tablet 100 mg DAK 3013 Tablet
258 Propiltiourasil tablet 100 mg SILVA 2013 tablet
Tahun 2014
259 Aminofilin injeksi 24 mg/ml DAK 2014 Ampul
260 Asam Askorbat (Vitamin C) tablet 50 mg DAK 2014 Tablet
261 Asam Mefenamat 500 mg DAK 2014 Kaplet
262 Asiklovir 200 mg DAK 2014 Tablet
263 Glibenklamid tablet 5 mg DAK 2014 Tablet
264 Glimepiride tablet 1 mg DAK 2014 Tablet
265 Kaptopril tablet 12,5 mg DAK 2014 Tablet
266 Ketokonazol tablet 200 mg DAK 2014 Tablet
267 Kotrimoksazol Suspensi SILVA 2014 botol
268 Loratadin tablet 10 mg DAK 2014 Tablet
269 Metronidazol kaptab 500 mg DAK 2014 Tablet
270 Obat Antituberkulosis Sisipan Prov. 2014 Paket
271 Parasetamol sirup 120 mg / 5 ml DAK 2014 Botol
272 Parasetamol sirup 120 mg / 5 ml SILVA 2014 botol
273 Salisil Bedak 2% DAK 2014 botol
274 Sefiksim kapsul 100 mg DAK 2014 Kapsul
Tahun 2015
275 Alopurinol tablet/kapsul/kaplet 100 mg DAK 2015 Tablet
276 Amoksisilin sirup kering 125 mg/ 5 ml DAK 2015 Botol
277 Asam Asetilsalisilat (asetosal) tablet 100 mg DAK 2015 Tablet
278 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2015 Ampul
279 Difenhidramin inj. 10 mg/ml - 1 ml DAK 2015 Ampul
280 Furosemid tablet 40 mg DAK 2015 Tablet
282 Kalsium Laktat (Kalk) tablet 500 mg DAK 2015 Tablet
283 Kaptopril tablet scored 25 mg DAK 2015 Tablet

284 Kotrimoksazol DOEN I komb 480 mg DAK 2015 Tablet
285 Metformin HCl tablet 500 mg DAK 2015 Tablet
286 Obat Kusta Dewasa MB PROV 2015 Blister

287 Obat TB FDC Katagori II PROV 2015 paket
288 Obat TB FDC Kategori Anak PROV 2015 paket
290 Ringer Laktat larutan infus steril DAK 2015 Botol
291 Salbutamol tablet 2 mg DAK 2015 Tablet
292 Sefadroksil sirup 125 mg/5 ml DAK 2015 Botol
Tahun 2016
293 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2016 vial
294 Albendazol tablet 400 mg PROV 2016 tablet
295 Ambroksol sirup 15 mg/5 ml APBD II 2016 Botol
296 Ambroksol tablet 30 mg APBD II 2016 Tablet
297 Amoksisilin kapsul/kaplet/tablet scored 500 mg DAK 2016 Kaplet

Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg
298 Magnesium Hidroksida 200 mg DAK 2016 Tablet
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 Botol
299 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2016
Antihemoroid, kombinasi: bismut subgalat 150 mg heksaklorofen 2,5 mg
300 lidokain 10 mg seng oksida 120 mg DAK 2016 Supp
301 Asam Asetilsalisilat (Asetosal) tab 100 mg DAK 2016 Tablet
302 Asam Askorbat (Vitamin C) tablet/kapsul/kaplet 250 mg DAK 2016 Tablet
303 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2016 Tablet
304 Asiklovir tablet 200 mg DAK 2016 Tablet
305 Attapulgit tablet 600 mg DAK 2016 Tablet
307 Deksametason tablet 0,5 mg DAK 2016 Tablet
308 Digoksin 0,25 mg DAK 2016 Tablet
309 Dimenhidrinat tablet/kapsul/kaplet 50 mg DAK 2016 Tablet
310 Doksisiklin 100 mg DAK 2016 Tablet
311 Domperidon suspensi/sirup 5 mg/5 ml DAK 2016 Botol
312 Domperidon tablet/kapsul/kaplet 10 mg DAK 2016 Tablet
313 Fenitoin kapsul 100 mg JIWA APBD II 2016 Kapsul
314 Garam Oralit I PROV 2016 Sachet

315 Gentamisin tetes mata 0,3% DAK 2016 Botol
316 Gliquidon tablet 30 mg DAK 2016 Tablet
318 Hidroklortiazid tablet 25 mg DAK 2016 Tablet
319 Hidrokortison krim 2,5 % DAK 2016 Tube
320 Ibuprofen 400 mg Tablet DAK 2016 Tablet
321 Isoniazid tablet 100 mg PROV 2016 kapsul

322 Kalsium Hidroksida pasta APBD II 2016 Tube
323 Kaptopril tablet 25 mg DAK 2016 Tablet
324 Ketorolak inj 30 mg/ml DAK 2016 Ampul
325 Kloramfenikol salep mata 1% DAK 2016 Tube
326 Kloramfenikol suspensi 125 mg/ 5 ml DAK 2016 Botol

327 Kloramfenikol tetes telinga 3% APBD II 2016 Botol
328 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2016 Tablet
329 Lidokain injeksi 2% (HCl) + Epinefrin 1: 80.000 - 2 ml DAK 2016 Ampul
330 Loperamid tablet 2 mg DAK 2016 Tablet
331 Magnesium Sulfat inj (IV) 20% PROV 2016 vial

332 Magnesium Sulfat inj (IV) 40% PROV 2016 vial
333 Metilprednisolon tablet 4 mg DAK 2016 Tablet
334 Metoklopramide sirup 5 mg/ 5 ml DAK 2016 Botol
336 Natrium diklofenak tablet 25 mg DAK 2016 Tablet
337 Natrium diklofenak tablet/kapsul/kaplet 50 mg DAK 2016 Tablet
338 Natrium Klorida larutan infus 0,9% APBD II 2016 Botol
339 Nifedipin tablet 10 mg DAK 2016 Tablet

341 Obat TB FDC Katagori I PROV 2016 paket
342 Omeprazol kapsul/kaplet 20 mg DAK 2016 Kapsul
343 Parasetamol tablet 500 mg PROV 2016 tablet

344 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2016 Tablet
346 Povidone Iodine larutan 10% 300 ml DAK 2016 Botol
347 Propanolol tablet 10 mg (HCL) DAK 2016 Tablet
348 Ranitidin injeksi 25 mg/2 ml DAK 2016 Ampul
349 Ranitidin tablet 150 mg DAK 2016 Tablet
350 Retinol (Vitamin A) 100.000 iu Prov. 2016 kapsul

352 Ringer Laktat DAK 2016 Botol
353 Salbutamol cairan ih 0,1% (Ventolin) DAK 2016 Ampul
354 Salbutamol tablet 4 mg (sebagai Sulfat) DAK 2016 Tablet
355 Sefadroksil kapsul 500 mg DAK 2016 Kapsul
356 Sefotaksim serb inj 1.000 mg DAK 2016 Vial
357 Setirizin sirup 5 mg/5 ml DAK 2016 Botol
358 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2016 Ampul
359 Simvastatin scored tablet 10 mg DAK 2016 Tablet
360 Siprofloksasin tab scored 500 mg DAK 2016 Tablet
361 Spironolakton tablet 25 mg DAK 2016 Tablet
362 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2016 tablet

363 Tetrasiklin tablet/kapsul/kaplet 500 mg DAK 2016 Kapsul
364 Vitamin B kompleks tablet DAK 2016 Tablet
365 Zink tablet 20 mg tablet PROV 2016 tablet

Tahun 2017
366 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2017 Vial

368 Alopurinol 100 mg DAK 2017 tablet
370 Amoksisilin sirup kering 125 mg/5 ml DAK 2017 Botol

376 Asam Folat tablet/kapsul/kaplet 0,4 mg DAK 2017 Tablet
377 Asam Mefenamat tablet/kapsul/kaplet 500 mg DAK 2017 Kaplet
381 Bedak Salisil serbuk 2% DAK 2017 botol
384 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) DAK 2017 Ampul
389 Ephinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) DAK 2017 Ampul
390 Eritromisin sirup kering 200 mg/ 5 ml DAK 2017 Botol
391 Fitomenadion (Vit K) inj 10 mg/ml PROV 2017 Ampul

392 Fitomenadion (Vit.K1) tablet/kaplet salut gula 10 mg DAK 2017 Tablet

396 Glukosa larutan infus 10% DAK 2017 Botol
400 Isoniazid tablet 100 mg PROV 2017 Tablet

402 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg DAK 2017 Tablet
404 Karbamazepin tablet 200 mg JIWA APBD II 2017 Tablet
405 Karbamazepin tablet/kapsul/kaplet 200 mg DAK 2017 Tablet

406 Kloramfenikol kapsul 500 mg DAK 2017 Tablet

409 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol
200 mg + Trimetoprim 40 mg DAK 2017
410 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet
80 mg DAK 2017
Kotrimoksazol forte kombinasi: sulfametoksazol 800 mg trimetoprim 160
411 mg DAK 2017 Kaplet
412 Lidokain injeksi 2% (HCl) + Epinefrin 1: 80.000 - 2 mL DAK 2017 Ampul
413 Lidokain Injeksi 2% (HCL) DAK 2017 Ampul
414 Magnesium sulfat injeksi 40% DAK 2017 vial

416 Metilergometrin Maleat injeksi 0,2 mg/ml DAK 2017 Ampul
419 Metoklopramide tablet DAK 2017 Tablet
424 Nistatin vaginal tablet 100.000 IU/ g DAK 2017 tablet

428 Oksitosin inj 10 IU/ml DAK 2017 ampul

Povidone Iodine 300 ml DAK 2017 Botol
431 Prokain Benzyl Penisilin inj PROV 2017 vial


437 Salbutamol cairan ih 0,1% DAK 2017 ampul
440 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2017 Pot
441 Sefadroksil kapsul 500 mg DAK 2017 Kapsul

442 Sefadroksil Sirup Kering 125 mg/5ml DAK 2017 Botol

450 Tiamin (Vitamin B1) tablet/kapsul/kaplet 50 mg (HCl/ Nitrat) DAK 2017 Tablet

Tahun 2018
453 Albendazol syr 200 mg / 5ml DAK 2018

455 Alopurinol tablet 100 mg DAK 2018 Tablet
456 Alopurinol tablet 300 mg DAK 2018 Tablet
457 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol
458 Ambroksol tablet 30 mg DAK 2018 Tablet
460 Amoksisilin sirup kering 125 mg/5 ml DAK 2018 Botol

463 lidokain 10 mg seng oksida 120 mg DAK 2018 Supp
464 Anti Bakteri DOEN salep kombinasi DAK 2018 Tube
465 Antifungi DOEN DAK 2018 Pot
466 Antimigren: kombinasi ergotamin 1 mg + kofein 50 mg DAK 2018 Tablet
467 Asam Asetilsalisilat (Asetosal) tab 80 mg DAK 2018

472 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet
474 Asiklovir tkrim 5% DAK 2018 Tube
476 Asiklovir tablet 400 mg DAK 2018 tablet
477 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul
478 Atropin (Sulfat) tetes mata 0,5% DAK 2018 Botol
480 Betahistin tablet 6mg DAK 2018 Tablet
481 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube
482 Bisoprolol Fumarate tablet 5 mg DAK 2018 tablet
483 Combivent nebules DAK II 2018 Ampul

486 Difenhidramin Injeksi i.v./i.m. 10 mg/ml (HCl) DAK 2018 Ampul
488 Dimenhidrinat tablet/kapsul/kaplet 50 mg DAK 2018 Tablet
492 Ephinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) DAK 2018 Ampul
493 Eritromisin sirup kering 200 mg/ 5 ml DAK 2018 Botol
494 Fenitoin kapsul 100 mg JIWA APBD II 2018 Kapsul
495 Fenol Glycerol Tetes Telinga 10% Botol
496 Fitomenadion (Vit K) inj 10 mg/ml PROV 2018 Ampul

497 Fitomenadion (Vit K1) tablet 10 mg DAK 2018 Tablet
498 Furosemid Injeksi 10 mg / ml DAK 2018 Ampul
501 Gentamisin salep kulit 0,1% DAK 2018 Tube
502 Gentamisin salep mata 0,3% DAK 2018 Tube
504 Gentian Violet larutan 1 % DAK 2018 Botol
505 Glibenclamide tablet DAK 2018 Tablet
506 Glimepiride tablet 1 mg DAK 2018 Tablet
508 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet
510 Griseofulvin tablet 125 ml DAK 2018 Tablet
513 Hiosin butilbromida Injeksi DAK 2018 ampul
514 Ibuprofen Syrup 100 mg / 5 ml DAK 2018 Botol

516 Ibuprofen 200 mg Tablet DAK 2018 tablet
517 Isoniazid tablet 100 mg PROV 2018 Tablet

519 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg DAK 2018 Tablet
521 Karbamazepin tablet 200 mg JIWA APBD II 2018 Tablet
522 Ketokonazol tablet 200 mg DAK 2018 Tablet
523 Ketoprofen Supp 100 mg DAK 2018 Suppo
524 Ketorolak inj 30 mg/ml DAK 2018 Ampul
526 Kloramfenikol suspensi 125 mg/ 5 ml DAK 2018 Botol
527 Kloramfenikol tablet 500 mg/ 5 ml DAK 2018 Tablet
528 Kloramfenikol tablet 250 mg/ 5 ml DAK 2018 Tablet
529 Kloramfenikol tetes telinga 3% DAK 2018 Botol

532 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul
533 Lidokain Injeksi 2% (HCL) DAK 2018

535 Loratadin tablet 10 mg DAK 2018 Tablet
536 Magnesium Sulfat Injeksi 40% DAK 2018 vial
538 Metilergometrin Maleat Injeksi 0,2 mg/ml DAK 2018 ampul
539 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet
543 Metronidazol syrup 125 mg / 5ml DAK 2018 Botol

544 Mikonazol krim/salep 2 % (Nitrat ) DAK 2018
N-asetil tablet 200 mg DAK 2018
545 tablet
550 Nistati vaginal tablet 100.000 UI DAK 2018 Ovula

553 Obat TB FDC Katagori II PROV 2018 paket
555 Oksitetrasiklin 1% salep mata DAK 2018 Tube
556 Oksitosin inj 10 IU/ml DAK 2018 ampul
557 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet
558 Parasetamol syrup 120 mg / 5ml DAK 2018 Botol
560 Parasetamol drop 100 mg / ml DAK 2018 Botol
561 Pirantel Palmoat Syrup 125 mg/ 5 ml DAK 2018
562 Pirantel tablet score (base) 125 mg DAK 2018 Tablet
564 Piroksikam tablet 20 mg DAK 2018 Tablet
566 Prednison tablet 5 mg DAK 2018 Tablet
567 Prokain Benzyl Penisilin inj PROV 2018 vial

570 Propiltiourasil tablet 100 mg DAK 2018 Tablet

576 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2018 Ampul
578 Salbutamol MDI/Aerosol 100 mcg/dosis DAK 2018 Pcs
579 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot
580 Salisil Bedak 2% DAK 2018 Pcs
581 Sefadroksil tablet 500 mg DAK 2018 Tablet
582 Sefadroksil syrup 125 mg/ 5ml DAK 2018 Botol
583 Sefiksim Syrup 100 mg / 5ml DAK 2018 Botol
584 Sefiksim tablet 100 mg DAK 2018 Tablet
586 Seftriakson Injeksi 1000 mg DAK 2018 Vial
588 Setirizine tablet 10 mg DAK 2018 Tablet
589 Simetidin tablet 200 mg DAK 2018 Tablet
593 Spironolakton tablet 100 mg DAK 2018

596 Tiamfenikol tablet 500 mg DAK 2018 Tablet
597 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet

601
602
Tahun 2019
603 Albendazol Syr 200 mg / 5ml DAK 2019 botol

604 Albendazol tablet 400 mg DAK 2019 Tablet
605 Allopurinol tablet 100 mg DAK 2019 tablet
606 Allopurinol tablet 300 mg DAK 2019 tablet
607 Ambroxol sirup 15 mg/5 ml DAK 2019 botol
608 Ambroxol tablet 30 mg DAK 2019 tablet
609 Amoksisilin kaplet 500 mg DAK 2019 kaplet
610 Amoksisilin sirup kering 125 mg/ 5 ml DAK 2019 Botol
611 Ampisislin injeksi 1000 mg DAK 2019 vial

612 Antalgin (Metampiron) injeksi 250 mg/ml DAK 2019 ampul
613 Antalgin (Metampiron) tablet 500 mg DAK 2019 tablet
614 Antasida DOEN I tablet kunyah kombinasi DAK 2019 tablet
615 Antasida DOEN II suspensi kombinasi DAK 2019 botol
616 Anti Bakteri DOEN salep kulit kombinasi DAK 2019 tube
617 Antifungi DOEN salep kulit DAK 2019 pot
618 Antihemoroid DOEN Kombinasi (supositoria) DAK 2019 supp
619 Antimigren: Ergotamin Tartrat + Kofein DAK 2019 Tablet
620 Asam Asetilsalisilat (Asetosal) tablet 100 mg DAK 2019 Tablet
623 Asam Askorbat (Vitamin C) tablet 50 mg DAK 2019 tablet

624 Asam Folat tablet 1 mg DAK 2019 tablet
627 Asiklovir krim 5 % DAK 2019 tube

630 Atapulgit tablet 600 mg DAK 2019 Tablet
631 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2019 Ampul

632 Atropin sulfat tetes mata 0,5% DAK 2019 Botol
633 Betahistin Mesilat tablet 6 mg DAK 2019 tablet
634 Betametason krim 0,1 % (sebagai valerat) DAK 2019 tube
635 Bisoprolol tablet 5 mg DAK 2019 Tablet
637 Deksametason tablet 0,5 mg DAK 2019 tablet

638 Dietilkarbamazin Sitrat 100 mg DAK 2019 tablet
639 Difenhidramin inj. 10 mg/ml - 1 ml DAK 2019 Ampul
640 Digoksin tablet 0,25 mg DAK 2019 Tablet
641 Diltiazem HCl tablet 30 mg DAK 2019 tablet

642 Dimenhidrinat tablet 50 mg DAK 2019 Tablet
643 Doksisiklin tablet 100 mg DAK 2019 Tablet
646 Efedrin tablet 25 mg DAK 2019 tablet

647 Epinefrin (adrenalin) injeksi 0,1% (sebagai HCl) DAK 2019 ampul
648 Eritromisin kapsul / kaplet 500 mg DAK 2019 kaplet
649 Eritromisin sirup 200 mg/5 ml DAK 2019 botol
650 Etakridin (Rivanol) larutan 0,1% DAK 2019 Botol
651 Fenilbutason tablet 200 mg DAK 2019 tablet
652 Fenol Gliserol tetes telinga 10% DAK 2019 botol
653 Fitomenadion (Vit K) inj 10 mg/ml DAK 2019 vial
654 Fitomenadion (Vit. K1) tablet 10 mg DAK 2019 tablet
655 Furosemid injeksi i.v / im 10 mg/ml DAK 2019 ampul
657 Garam Oralit I serbuk DAK 2019 sachet

658 Gentamisin injeksi 40 mg/ ml DAK 2019 ampul
659 Gentamisin Salep Kulit 0,1 % DAK 2019 tube
660 Gentamisin Sulfat Salep Mata 0,3 % DAK 2019 tube
661 Gentamisin Sulfat Tetes Mata 0,3 % DAK 2019 botol
662 Gentian Violet larutan 1 % DAK 2019 botol
663 Glibenklamid tablet 5 mg DAK 2019 Tablet
664 Glimepiride tablet 1 mg DAK 2019 tablet

666 Gliseril Guayakolat tablet 100 mg DAK 2019 tablet

669 Glukosa larutan infus 40% steril DAK 2019 ampul

670 Griseofulvin tablet 125 mg DAK 2019 tablet
673 Hiosina butilbromida Injeksi DAK 2019 Ampul
674 Ibuprofen Syrup 100 mg DAK 2019 Botol
675 Ibuprofen tablet 200 mg DAK 2019 Tablet
676 Ibuprofen tablet 400 mg DAK 2019 Tablet
677 Isoniasid tablet 100 mg DAK 2019 tablet
678 Isosorbid Dinitrat tablet sublingual 5 mg DAK 2019 tablet

679 Kalsium Glukonat Injeksi 200 mg DAK 2019 Ampul
680 Kalsium Laktat (Kalk) tablet 500 mg DAK 2019 Tablet
681 Kaptopril tablet 12,5 mg DAK 2019 tablet

682 Kaptopril tablet 25 mg DAK 2019 tablet
683 Ketokonazol tablet 200 mg DAK 2019 tablet
684 Ketoprofen injeksi 100 mg DAK 2019 ampul
685 Ketoprofen Supp 100 mg DAK 2019 Suppo
686 Ketoprofen tablet 100 mg DAK 2019 tablet
687 Ketorolak injeksi 30 mg/ml DAK 2019 Ampul
688 Kloramfenikol Injeksi 1000 mg / vial DAK 2019 vial

689 Kloramfenikol kapsul 250 mg DAK 2019 Kapsul
690 Kloramfenikol kapsul 500 mg DAK 2019 Kapsul
692 Kloramfenikol suspensi 125 mg / 5 ml DAK 2019 botol

693 Kloramfenikol tetes telinga 3 % DAK 2019 botol
Kombinasi : Ipratropium bromida inhalasi 0,5 mg Salbutamol 2,5 mg
695 (Combivent Nebulle) DAK 2019 Ampul
696 Kotrimoksazol DOEN I komb 480 mg Tablet
697 Kotrimoksazol DOEN II (pediatrik) komb 120 mg DAK 2019 tablet

699 Kotrimoksazol Suspensi kombinasi 240 mg/5 ml botol

700 Lidokain Injeksi 2% (HCL) DAK 2019 Ampul
701 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml DAK 2019 Ampul
703 Loratadin tablet 10 mg DAK 2019 tablet

706 Magnesium sulfat serbuk 30 gram DAK 2019 bungkus
707 Mebendazol Syr 100 mg / 5ml DAK 2019 botol
708 Mebendazol tablet 500 mg DAK 2019 tablet
709 Meloksikam suppositoria DAK 2019 supp
710 Meloksikam tablet 15 mg DAK 2019 tablet
711 Menadion (Vit. K3) injeksi 10 mg/ml DAK 2019 ampul
712 Metformin HCI tablet 500 mg DAK 2019 tablet
713 Metilergometrin Maleat injeksi 0,200 mg DAK 2019 ampul
714 Metilergometrin Maleat tablet 0,125 mg DAK 2019 tablet
715 Metilprednisolon Injeksi 500 mg DAK 2019 vial
718 Metoklopramide tablet 10 mg DAK 2019 tablet

719 Metronidazol Infus 500 mg/100ml DAK 2019 botol
721 Metronidazol Syr 125 mg / 5ml DAK 2019 Botol
722 Mikonazol krim/salep 2 % (Nitrat ) DAK 2019 tube

723 Na. Thiroxin tablet 100 mcg DAK 2019 tablet
724 n-asetil sistein tablet 200 mg DAK 2019 Tablet
725 Natrium Bikarbonat tablet 500 mg DAK 2019 tablet
726 Natrium Diklofenak tablet 25 mg DAK 2019 tablet
727 Natrium Diklofenak tablet 50 mg DAK 2019 tablet
728 Natrium Klorida larutan infuse 0.9 % DAK 2019 botol
729 Nifedipin tablet 10 mg DAK 2019 tablet
730 Nistatin vaginal tablet 100.000IU/g DAK 2019 ovula
731 Obat Batuk Hitam (OBH) cairan DAK 2019 botol
732 Oksitetrasiklin HCL salep mata 1 % DAK 2019 tube
733 Oksitetrasiklin salep kulit 3% DAK 2019 tube
734 Oksitetrasiklin salep mata 1% DAK 2019 tube
735 Oksitosin injeksi 10 iu / ml - 1 ml DAK 2019 ampul
736 Omeprazol kapsul/kaplet 20 mg DAK 2019 Kapsul
737 Papaverin injeksi 40 mg/ml DAK 2019 ampul

738 Papaverin tablet 40 mg DAK 2019 tablet
739 Parasetamol drops DAK 2019 Botol
740 Parasetamol sirup 120 mg/5ml DAK 2019 botol
741 Parasetamol tablet 100 mg DAK 2019 tablet
743 Pirantel suspensi 125 mg/5 ml DAK 2019 Botol

744 Pirantel tablet score (base) 125 mg DAK 2019 tablet
745 Pirantel tablet score (base) 250 mg DAK 2019 tablet
747 Piroksikam kapsul/kaplet/tablet 20 mg DAK 2019 tablet

748 Piroksikam tablet 10 mg DAK 2019 tablet
749 Povidon Iodin larutan 10% 15ml DAK 2019 Botol
750 Povidon Iodin larutan 10% 30ml DAK 2019 Botol
751 Povidon Iodin larutan 10% 60 DAK 2019 Botol
752 Povidon lodida larutan 10 % 300 ml DAK 2019 botol
753 Prednison tablet 5 mg DAK 2019 tablet
755 Propanolol tablet 40 mg (HCI) DAK 2019 tablet

756 Propiltiourasil tablet 100 mg DAK 2019 tablet
758 Ranitidin tablet 150 mg DAK 2019 tablet

759 Retinol (Vitamin A ) kapsul lunak 100.000 IU DAK 2019 kapsul
760 Retinol (Vitamin A) kapsul lunak 200.000 iu DAK 2019 kapsul
761 Ringer Laktat larutan infus steril DAK 2019 Botol
762 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2019 Ampul
763 Salbutamol MDI (Ventolin inhaler) DAK 2019 PCS
764 Salbutamol tablet 2 mg (sebagai sulfat) DAK 2019 Tablet
766 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap DAK 2019 Pot
767 Salisil Bedak 2% DAK 2019 Kotak

768 Sefadroksil kapsul/kaplet 500 mg DAK 2019 Kapsul
769 Sefadroksil sirup kering 125 mg/5ml DAK 2019 botol

770 Sefixime capsul 100 mg DAK 2019 kapsul
771 Sefixime sirup 100 mg/5 ml DAK 2019 botol
772 Sefotaksim injeksi 1 g DAK 2019 vial
773 Seftriakson injeksi 1 g DAK 2019 vial
775 Setirizin tablet DAK 2019 tablet
777 Simetidin tablet 200 mg DAK 2019 tablet

779 Siprofloksasin 500 mg DAK 2019 kaplet

782 Tablet Tambah Darah/Sulfas Ferrosus DAK 2019 tablet

783 Tetrakain HCl tetes mata 0,5% DAK 2019 Botol
785 Tiamfenikol kapsul /kaplet 500mg DAK 2019 tablet

786 Tiamin (Vitamin B1) Injeksi 100 mg/ml DAK 2019 ampul
787 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2019 Tablet
788 Tramadol capsul 50 mg DAK 2019 kapsul

790 Zink tablet 20 mg DAK 2019 tablet

791
792
793
794
795
Obat HIV
796 5(ZDV)+Lamivudine (3TC) 300/150 mg Hiv. 2015 kapsul

797 5Efavirenz (EFV) 600 mg Hiv. 2015 btl@30tab
798 5Lamivudine (3TC) 150 mg Hiv. 2015 btl@60tab
799 5Lopinavir/ritonavir (LPV/r) 200/50 mg Hiv. 2015 btl@120tab
800 5Nevirapine (NVP) 200 mg Zidovudine Hiv. 2015 btl@60tab
801 5Tenofovir (TDF) 300 mg Hiv. 2015 btl@30tab
802 5Tenofovir+Lamivudine+Efavirenz(300/300/600 mg) Hiv. 2015 btl@30tab
Obat Gigi
Tahun 2012
803 Temporary Stoping Fletcher DAK 2012 Botol

Tahun 2016
804 Cavitron APBD II 2016 Botol
805 Etil Klorida semprot APBD II 2016 Botol
806 Eugenol spray DAK 2016 Botol
807 GIC Serbuk dan Cairan (Fuji IX ART) APBD II 2016 Set
808 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol
809 Mummifying pasta APBD II 2016 Botol
810 Semen Zeng Fosfat serbuk & cairan APBD II 2016 Set
811 Spongostan APBD II 2016 Botol
812 TKF (Tricresol Formaldehid) APBD II 2016 Botol
Tahun 2017
814 Devitalisasi pasta APBD II 2017 Botol
818 Mumifying pasta APBD II 2017 Botol
821 Temporary Stopping Fletcher serbuk dan cairan Gigi APBD II 2017 Set
Tahun 2018
824 Devitalisasi pasta APBD II 2018 Botol

828 Kalsium Hidroksida Pasta APBD II 2018 Tube
830 Mumifying pasta APBD II 2018 Botol

834
835
Tahun 2019
837 Devitalisasi pasta (non arsen) APBD II 2019 Botol
839 Eugenol cairan DAK 2019 Botol
840 Glass Ionomer Cement Serbuk dan Cairan APBD II 2019 Set
843 Mummifying Pasta APBD II 2019 Botol
846 Temporary Stopping Fletcher serbuk dan cairan APBD II 2019 Set
848
849
850
851
852
Obat Jiwa
Tahun 2012
853 Diazepam injeksi 5 mg/ml DAK 2012 Ampul
Tahun 2014
854 Amitriptilin tablet salut 25 mg (HCl) DAK 2014 Tablet
Tahun 2015
855 Alprazolam tablet/kapsul/kaplet 1 mg DAK 2015 Tablet
856 Diazepam tablet 5 mg PROV 2015 Tablet
857 Fenobarbital tablet 30 mg PROV 2015 tablet
858 Flufenazin injeksi i.m. 25 mg/ml DAK 2015 Ampul
859 Klobazam tab 10 mg DAK 2015 Tablet
860 Klozapin Tablet 25 mg DAK 2015 Tablet
861 Kodein tablet 10 mg DAK 2015 Tablet
862 Risperidon tablet 2 mg DAK 2015 Tablet
863 Sertralin tab 50 mg DAK 2015 Tablet
864 Trifluoperazin tablet 2 mg (STELOSI) APBD II 2015 Tablet
865 Trifluoperazin tablet 5 mg DAK 2015 Tablet
866 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet
Tahun 2016
867 Amitriptilin tablet salut 25 mg (HCl) JIWA APBD II 2016 Tablet
868 Clobazam tablet 10 mg JIWA APBD II 2016 Tablet
868 Diazepam injeksi 5 mg/ml - 2 ml PROV 2016 Ampul
868 Diazepam larutan rektal 5 mg/2,5 mL JIWA APBD II 2016 Tube
868 Diazepam tablet 5 mg PROV 2016 Tablet
868 Fenobarbital inj PROV 2016 Ampul
868 Fenobarbital injeksi JIWA APBD II 2016 Ampul
868 Haloperidol tablet 0,5 mg JIWA APBD II 2016 Tablet
868 Haloperidol tablet 1,5 mg PROV 2016 tablet
868 Haloperidol tablet 5 mg PROV 2016 tablet
868 Klorpromazin tablet 25 mg JIWA APBD II 2016 Tablet
868 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet
868 Triheksilfenidil tablet 2 mg JIWA APBD II 2016 Tablet
Tahun 2017
870 Fenobarbital tablet 50 mg Jiwa APBD II 2017 Tablet
871 Flufenazin injeksi i.m. 25 mg/ml Jiwa APBD II 2017 Ampul
872 Haloperidol Tablet 0,5 mg DAK 2017 tablet
873 Haloperidol tablet 5 mg Jiwa APBD II 2017 tablet

874 Haloperidol tablet/kapsul/kaplet 5 mg DAK 2017 Tablet

876 Klozapin Tablet 25 mg Jiwa APBD II 2017 Tablet
877 Trifluoperazin tablet 5 mg Jiwa APBD II 2017 Tablet
Tahun 2018
878 Alprazolam tablet 0,5 mg JIWA APBD II 2018 Tablet
879 Amitriptilin tablet salut 25 mg (HCl) JIWA APBD II 2018 Tablet
880 Anti bakteri Salep Kulit DAK 2018 Tube
883 Diazepam tablet 5 mg JIWA APBD II 2018 Tablet
884 Fenitoin Injeksi 50 mg/ ml JIWA APBD II 2018 Ampul
885 Fenobarbital inj PROV 2018 Ampul
886 Fenobarbital injeksi JIWA APBD II 2018 Ampul
887 Fenobarbital tablet 30 mg JIWA APBD II 2018 Tablet
888 Flufenazin Injeksi 25mg / ml JIWA APBD II 2018 Ampul
889 Haloperidol Injeksi 50mg / ml JIWA APBD II 2018 Ampul
892 Haloperidol tablet 5 mg JIWA APBD II 2018 Tablet
893 Karbamazepin tablet 200 mg Tablet
894 Klobazam tablet 10 mg JIWA APBD II 2018 Tablet
895 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet
896 Klorpromazine Injeksi 25mg / ml Ampul
899 Kodein tablet 10 mg JIWA APBD II 2018 Tablet
900 Lorazepam tablet 2 mg JIWA APBD II 2018 Tablet
901 Risperidon tablet 2 mg JIWA APBD II 2018 Tablet
902 Trifluoperazin tablet 5 mg JIWA APBD II 2018 Tablet
903 Triheksilfenidil tablet 2 mg JIWA APBD II 2018 Tablet
904 Valproat tablet 250 mg JIWA APBD II 2018 Tablet
905 Valproat syrup 250 mg/5 ml JIWA APBD II 2018 Botol
906
907
Tahun 2019
908 Alprazolam tablet/kapsul/kaplet 0,5 mg APBD II 2019 Tablet
909 Alprazolam tablet/kapsul/kaplet 1 mg APBD II 2019 Tablet
910 Amitriptilin tablet salut 25 mg (HCl) APBD II 2019 Tablet
911 Diazepam injeksi 5 mg/ml - 2 ml APBD II 2019 Ampul
912 Diazepam larutan rektal 10 mg/2,5 ml APBD II 2019 Tube
913 Diazepam larutan rektal 5 mg/2,5 ml APBD II 2019 Tube
914 Diazepam tablet 2 mg APBD II 2019 Tablet
915 Diazepam Tablet 5 mg APBD II 2019 Tablet
916 Fenitoin injeksi 50 mg/ml APBD II 2019 Ampul
917 Fenitoin kapsul/kaplet 100 mg APBD II 2019 Kapsul
918 Fenitoin kapsul/kaplet 30 mg APBD II 2019 Kapsul
919 Fenobarbital 30 mg Tablet APBD II 2019 botol
920 Fenobarbital injeksi APBD II 2019 Ampul
921 Fenobarbital tablet 100 mg APBD II 2019 Tablet
922 Flufenazin injeksi i.m. 25 mg/ml APBD II 2019 Ampul
923 Haloperidol Injeksi APBD II 2019 Ampul
924 Haloperidol tablet 0,5 mg APBD II 2019 Tablet
925 Haloperidol tablet 1,5 mg APBD II 2019 Tablet
926 Haloperidol tablet 5 mg APBD II 2019 Tablet
927 Karbamazepin Syr 100 mg/ 5ml APBD II 2019 Botol
928 Karbamazepin tablet 200 mg APBD II 2019 Tablet
929 Klobazam tab 10 mg APBD II 2019 Tablet
930 Klorpromazin injeksi i.m. 25 mg/ml (HCl) APBD II 2019 Ampul
931 Klorpromazin tablet 25 mg APBD II 2019 Tablet
932 Klorpromazin tablet salut 100 mg (HCl) APBD II 2019 Tablet
933 Klozapin Tablet 25 mg APBD II 2019 Tablet
934 Kodein 10 mg APBD II 2019 Tablet
935 Lorazepam tablet 2 mg APBD II 2019 Tablet
936 Olanzapin tab 10 mg APBD II 2019 Tablet
937 Risperidon tablet 2 mg APBD II 2019 Tablet
938 Sertralin tab 50 mg APBD II 2019 Tablet
939 Trifluoperazin tablet 2 mg APBD II 2019 Botol
940 Trifluoperazin tablet 5 mg APBD II 2019 Tablet
941 Trihexpenidil Tablet 2 mg APBD II 2019 Botol
942 Valproat Syr 250 mg / 5ml APBD II 2019 Botol
943 Valproat tablet selaput enterik 250 mg APBD II 2019 Tablet
944
945
946
947
948
Laboratorium
Tahun 2016
949 Cell Pack LAB APBD II 2016 Botol
950 Cleaner (Cell Clean) LAB APBD II 2016 Botol
951 Kontrol LAB APBD II 2016 Botol
952 Reagen Gol Darah LAB APBD II 2016 Set
953 Stromatolyser LAB APBD II 2016 Botol
954 Widal Test LAB APBD II 2016 Set
Tahun 2017
Tahun 2018
966 Pot faeces LAB APBD II 2108 Pcs
967 Pot Urine LAB APBD II 2108 Pcs
968
969
Tahun 2019
976 Pot faeces LAB APBD II 2109 Pcs
977 Pot Urine LAB APBD II 2109 Pcs
978
979
980
981
982
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT TAHUN 2019
PELAPORAN BULAN / PERIODE :……………………………..

PERMINTAAN BULAN / PERIODE :……………………………..
Hilang/
Penerima- Persedia- Pemakai-
Harga Satuan Stok Awal Retur Rusak/
an an an
Bulan Expired
4 5 6 7 8 9 10
606.98
303.49
4,000.00
55,200.00
8,500.00
23,108.40 4
3,702.60
18,600.00
4,650.00
5,770.00
3,800.00
3,800.00
3,800.00
8,355.00
8,355.00
8,355.00
8,355.00
51,305.00
4,025.00
647.00
653.00
776.33
134,000.00
80,000.00
8,000.00
8,000.00
8,000.00
4,180.00
4,180.00
3,500.00
3,200.00
8,355.00
8,355.00
330.00
110,000.00
3,000.00
646.94
652.51
776.33
48,235.00
140,700.00 129
140,700.00 154
10,212.00
10,212.00
10,212.00
4,389.00
4,389.00
4,389.00
6,765.00
95
6,380.00
8,355.00
8,355.00
8,355.00
8,335.00
330.00
3,209.00
3,150.00
5,643.00
5,643.00
5,643.00
679.29 264
685.14 1442
815.15 764
5,862.50
5,862.50
9,660.00 18
9,660.00 5
9,660.00 39
6,595.00 206
6,595.00
6,595.00
6,457.50
6,090.00 134
1,482.00 209
746.00 318
3,190.00
19,800.00
6,405.00 274
6,405.00 107
6,405.00 210
6,405.00 16
12,559.00
105,000.00 6
8,400.00 23
493.96 4010
27,830.00 2
27,000.00 25
24,948.00
3,300.00 22
3,208.33
4,982.00 40
1,482.00
746.00
1,470.00 40
1,470.00 10
1,470.00
6,600.00
1,625.00
8,821.00
24,000.00
17,000.00
59,000.00
27,500.00
27,500.00
562.00
17,000.00
15,000.00 2
429.00
48,050.00
1,553.00
702,400.00
201,700.00
6,000.00
8,804.00
2,456.00
21,750.00
24,000.00
8,095.00
83,858.00
19,000.00 6
42,050.00 2
59,000.00 6
562.00
17,000.00 2
15,000.00 8
429.00
48,050.00
58,218.00
1,046,576.00 2
207,751.00
14,800.00 39
2,900.00 353
41,421.00
65,700.00
91,400.00
-
800.00
27,300.00 4
24,200.00
500.00 300
64,900.00
-
479,996.00
130,999.00
1,333.33
149.00
1,718.75
1,265.00
35,526.00
110.00
151.63
51.26
1,800.00
81.00
5,727.00
1,539.80
1,947.90
1,026.60
121.00
41.90
320.00
2,475.00
2,475.00
85.93
85.93
2,491.00
2,152.00
239.00
1,525.00
1,378.85
92.00
864.25
7,220.00
1,751.00
1,751.00
900.00
50.00
44.00
92.00
92.00
89.00
3,000.00
407.00
1,150.00
119.00
108.00
264.00
264.00
3,818.00
95.00
112.00
237.00
56.00
265.00
62.00
300.00
2,167.00
154.00
154.00
159,898.00
1,438.00
1,438.00
1,250.00
859.00
86.00
2,445.00
116.00
1,400.00
116.00
75.00
5,700.00
70.00
84.00
138.00
112.50
20,906.00
1,200,000.00
214,990.00
79.00
5,200.00
59.00
4,896.00
459.00
149.00
4,187.00
163.00
261.00
62.00
2,025.00
3,045.00 19
116.00
159.00
48.00
237.00
190.00
1,518.00
44.00
97.00
104.00
270.00
3,000.00
118.00
133.00
288.00
4,000.00
1,000.00
6,900.00 106
149.00
2,798.00
127.00
44.00
432,000.00 2
68.00
1,290.00
1,600.00
3,955.00
9,295.00
51.00
1,845.00
89.00
5,500.00 120
3,104.00
205.00
2,580.00
133.00
145.00
159.00
8,862.00 47
110.00
20,906.00
360,000.50
160.00
79.00
118.00
3,700.00 1
3,700.00 7
70.00 860
1,140.00
120.00
255.00 1,000
459.00 8,650
7,150.00
6,600.00
89.00
516.00
4,500.00
7,999.00
1,098.00
169.00
281.00
315.00
27.30
310.00
115.00
473.00
2,000.00
380.00 3,000
90.00
261.00
2,090.00
62.00
2,025.00
116.00 500
59.00
159.00
84.00
106.00 40
237.00 100
349.00
600
145.00
1,025.00
1,518.00 105
44.00
1,176.00 317
97.00 1225
270.00 100
3,000.00
118.00
2,204.00
35
6,700.00
1,566.00
691.00
520
288.00
4,000.00 100
6,900.00
7,500.00
50
149.00 500
2,650.00
127.00
44.00
432,000.00
63.00
68.00
3,158.00 980
270.00
1,007.00 2818
1,798.00
42.00
2,140.00
199
151.00
2828
308.00 50
149.00
860.00
3,650.00
100.00
2,684.00 19
205.00 70
2,580.00
90.00 994
133.00 471
159.00
8,862.00
110.00
523.00
7
20,906.00
360,000.50
214,990.00
1,900.00
55
56.00 18850
4,070.00
1,800.00 48
8,880.00
1,390.00
105.00
255.00
459.00
7,150.00
4,000.00
238
66.00
1625
83.00
2,429.00
516.00
4,485.00
4,500.00
1,098.00 186
131.00 80
281.00 361
294.00
27.30 2,236
310.00
86.00
115.00
473.00
2,860.00 114
120
-
99.00
210.00
9,700.00 363
404.00 12,580
233.00 23530
-
54.00
1,995.00 5
3,167.00
3,035.00
4,496.00 48
173.00
99.00
-
105.00 110
-
52.00
70.00 1580
103.00
9,100.00
236.00 1000
380.00 500
1,595.00 6
16,500.00
136.00 5000
110.00
1,340.00 170
236.00
4,550.00
1,097.00 240
32.00 4356
1,095.00
104.00
105.00 171
264.00
2,700.00 290
85.00 105
1,408.00
6,090.00 120
-
2,590.00 23
-
710.00
1,333.00 24
77.00 4,000
260.00 1,000
5,500.00 28
2,675.00 120
4,232.00 120
4,200.00 46
119.00 15000
174.00
1,075.00
140.00 6000
-
210.00 490
-
2,475.00 141
39,500.00
4,200.00
- 250
105.00
145.00 384
507,500.00
59.00
75.00 140
-
270.00
2,380.00 50
1,045.00 97
1,881.00
4,700.00
1,090.00
310.00
8,000.00 72
22.00 17488
- 1000
1,210.00 660
-
114.00 2000
123.00 499
3,796.00 15
96.00 22184
2,959.00
210.00 700
-
2,530.00 200
124.00 39
3,950.00
3,414.00 287
350.00
128.00 6155
115.00
6,410.00
172.00 610
560.00 100
28,424.00
2,500.00
1,199.00
130.00 1,524
2,000.00
53.00
6,649.00
9,700.00
286.00
123.00 80
385.00 4980
-
68.00
-
76.00
432.00 640
1,155.00
705.00 3820
260.00
459.00
7,150.00
10,875.00 120
70.00 1695
29,400.00
2,621.00 24
3,520.00 94
478.00 1534
3,926.00 18
5,530.00
803.00 250
4,200.00 143
4,483.00 370
2,850.00 100
90.00
447.00 500
110.00
265.00 300
195.00
539.00
350.00 11,200
-
1,471.00 1453
85.00 3837
118.00 10637
513.00 8,038
1,035.00
459.00
191,250.00
76,020.00
736,203.00
156,780.00
31,950.00
354,530.00
34,000.00 1
135,000.00
153,000.00
18,100.00 3
1,009,125.00
126,000.00 2
882,000.00
225,000.00 1
702,000.00
115,200.00
135,000.00
750,420.00
153,000.00
18,100.00
1,009,125.00 2
882,000.00 3
658,125.00
702,000.00
658,125.00
135,000.00
226,600.00 2
-
244,700.00 5
126,900.00
1,717,400.00
507,500.00
154,100.00
882,000.00
658,125.00
725,000.00 2
139,600.00 2
2,368.10
112.00
233.00 482
540.00
56.00
55,000.00
900.00 284
1,550.00
500.00 100
1,008.00
3,300.00
993.00 160
405.00
510.00 1,885
112.00
900.00
2,344.00
11,525.00
540.00 1,456
1,800.00 30
1,800.00
59.00
69.00 1,150
69.00
96.00
68.00
1,341.00 1,075
510.00
11,525.00
2,509.00
115,797.00
59.00 680
2,990.00
75.00
789.00
7,018.00
877.00
88.00
-
3,035.00 8
12,573.00 37
18,279.00
109.00 300
3,738.00
-
-
171.00 4,819
59,800.00
101,300.00 12
-
-
56.00
230.00
739.00
1,121.00 809
1,243.00 59
-
147.00
571.00
-
273.00
269.00
-
1,200.00
15,789.00
3,051,180.00
2,066,378.00
1,635,645.00
700,000.00
2,020,838.00
750,000.00
3,051,180.00
2,066,378.00
1,635,645.00
2,092,173.00
750,000.00
2,300,000.00
2,139,320.00
1,693,380.00
2,092,173.00
750,000.00
660,000.00
6,500.00
6,000.00 70
OBAT TAHUN 2019
DOKUMEN NOMOR TANGGAL

………….. IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
………….. PUSKESMAS
P e m b e r i a n
Sisa Stok Stok Perminta-
Akhir Optimum an APBD APBD
APBN Lain-lain Jumlah
Provinsi Kabupaten
11 12 13 14 15 16 17 18
TANGGAL
……../…….../………
Keterang-
an
19

PUSKESMAS : PUSKESMAS II NEGARA PELAPORAN BULAN / PERIODE : JANUARI 2019 IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
KECAMATAN : NEGARA PERMINTAAN BULAN / PERIODE : FEBRUARI 2019 PUSKESMAS
Hilang/ P e m b e r i a n
Penerima- Persedia- Pemakai- Sisa Stok Stok Perminta- Keterang-
No Nama Obat Satuan Harga Satuan Stok Awal Retur Rusak/ APBD APBD
an an an Akhir Optimum an APBN Lain-lain Jumlah an
Bulan Expired Provinsi Kabupaten
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Alat Kesehatan
Tahun 2012 - -
3 4 - 4
Plester 5 yard x 2 inchi DAK 2012 Rol 23,108.40 4
Tahun 2017 - -
12 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2017 Pcs 129 4 125
140,700.00 129
140,700.00 154 154 - 154
19 Infusion Set Anak 60 Drops/Ml With Y Type, Airvent DAK 2017 Pcs 6,765.00
95 95 - 95
Tahun 2018 - -
30 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2018 Pcs 264 136 128 500
679.29 264
31 Alat Suntik Sekali Pakai (TP) 3 cc DAK 2018 Pcs 1,442 242 1,200
685.14 1442
32 Alat Suntik Sekali Pakai (TP) 5 cc DAK 2018 Pcs 764 72 692 500
815.15 764
35 Folley Catheter 2 way No. 18 DAK 2018 Pcs 18 13 5
9,660.00 18
9,660.00 5
9,660.00 39
38 Handscoen Safeglove PP Steril no 7,0 DAK 2018 Pasang 206 106 100
6,595.00 206
42 Infusion Set Dewasa (20 drops/ml) DAK 2018 Pcs 134 48 86
6,090.00 134
45 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 18) DAK 2018 pcs 50 324 54 270
6,405.00 274
46 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 20) DAK 2018 Pcs 50 157 59 98
6,405.00 107
47 IV Catheter (TERUMO) SR+OX2225C3 (IV Cateter No 22) DAK 2018 Pcs 210 17 193
6,405.00 210
6,405.00 16
50 Kasa Hidrofil 36m/ 40 yard x 80 cm DAK 2018 Roll 6 5 1
105,000.00 6
51 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak 23 4 19
8,400.00 23
52 Masker Earloop DAK 2018 Pcs 2,000 6,010 510 5,500
493.96 4010
53 Pembalut Elastis 7,5 cm x 4,55 m DAK 2018 Roll 2 - 2
27,830.00 2
54 Pharmafix 5cm x 500cm DAK 2018 Roll 25 7 18
27,000.00 25
56 Rivanol 300 ml DAK 2018 Botol 22 - 22
3,300.00 22
58 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2018 Pcs 40 13 27
4,982.00 40
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
59 Verban 4 Yard x 10 cm DAK 2018 Roll 209 14 195
1,482.00 209
746.00 318
61 Wing needle No.23 DAK 2018 Botol 40 - 40
1,470.00 40
1,470.00 10
Obat Emergency - -
Tahun 2016 - -
108 Minyak Telon 60 ml APBD II 2016 Botol 15,000.00 2 2 2 -
Tahun 2017 - -
117 Hand sanitizer 50 ml APBD II 2017 botol 19,000.00 6 6 6 5
118 Hansaplast sachet @100 sachet APBD II 2017 Kotak 42,050.00 2 2 - 2
119 Heparin komb. Gel (Thrombopob gel 20 g) APBD II 2017 Tube 59,000.00 6 6 - 6
120 Perihidrol (Larutan H2O2 3%) APBD II 2017 botol 10,100.00 2 2 - 2
121 Minyak kayu putih 60 ml APBD II 2017 Botol 17,000.00 2 2 2 - 5
122 Minyak Telon 60 ml APBD II 2017 Botol 15,000.00 8 8 5 3
125 Serum anti bisa ular injeksi 5ml APBD II 2017 Vial 1,046,576.00 2 2 - 2 4
Tahun 2018 - -
127 Alkohol 70% 300 ml APBD II 2018 Botol 14,800.00 39 48 87 13 74 48
128 Asam Traneksamat tablet 500 mg APBD II 2018 tablet 2,900.00 353 353 120 233
130 Diklofenak dietilammon Crm (Voltaren crm) APBD II 2018 Tube 65,700.00 20 20 - 20
134 Komb B complek + vit c 500mg (selcom) APBD II 2018 Tablet 800.00 - - 300
135 Minyak kayu putih 60 ml APBD II 2018 Botol 27,300.00 4 4 4 -
137 Obat Flu kombinasi (Demacolin) APBD II 2018 Tablet 500.00 300 300 600 30 570 500
141 Scabimite cream 10 gr APBD 2018 Tube 20 20 - 20
142 Serum anti bisa ular injeksi 5ml APBD II 2018 Vial 479,996.00 - -
143 Serum anti tetanus 1.500 iu/amp APBD II 2018 Ampul 130,999.00 - - 20
Obat Generik - -
Tahun 2016 - -
182 lidokain 10 mg seng oksida 120 mg DAK 2016 Supp 3,045.00 19 19 - 19
192 Glukosa larutan infus 5% steril DAK 2016 Botol 6,900.00 106 106 - 106
194 Kalsium Hidroksida pasta APBD II 2016 Tube 432,000.00 2 2 1 1
198 Magnesium Sulfat inj (IV) 20% PROV 2016 vial 5,500.00 120 120 - 120
201 Natrium Klorida larutan infus 0,9% APBD II 2016 Botol 8,862.00 47 47 4 43
204 Povidone Iodine 60 ml DAK 2016 Botol 1 1 -

3,700.00 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
205 Povidone Iodine larutan 10% 300 ml DAK 2016 Botol 7 3 4
3,700.00 7
206 Propanolol tablet 10 mg (HCL) DAK 2016 Tablet 70.00 860 860 30 830
208 Retinol (Vitamin A) 100.000 iu Prov. 2016 kapsul 255.00 1,000 500 1,500 500 1,000
209 Retinol (Vitamin A) 200.000 iu Prov. 2016 kapsul 459.00 8,650 4,000 12,650 - 8,650 4,000
Tahun 2017 - -
216 Albendazol tablet 400 mg PROV 2017 tablet 380.00 3,000 8,720 11,720 2,390 9,330
221 Asam Asetilsalisilat (Asetosal) tab 100 mg DAK 2017 Tablet 500 - 500 -
116.00 500
224 Asam Mefenamat tablet/kapsul/kaplet 500 mg DAK 2017 Kaplet 40 40 -
106.00 40
225 Asiklovir tablet 200 mg DAK 2017 Tablet 237.00 100 100 - 100
226 Asiklovir tablet 400 mg DAK 2017 Tablet 349.00

600 600 - 600
229 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2017 Ampul 105 100 5
1,518.00 105
1,176.00 317 317 29 288
232 Digoksin 0,25 mg DAK 2017 Tablet 97.00 1225 1,225 - 1,225
233 Doksisiklin 100 mg DAK 2017 Tablet 100 - 100

270.00 100
236 Ephinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) DAK 2017 Ampul 2,204.00
35 35 4 31
237 Fitomenadion (Vit.K1) tablet/kaplet salut gula 10 mg DAK 2017 Tablet 691.00
520 520 - 520
239 Gentamisin tetes mata 0,3% DAK 2017 Botol 4,000.00 100 100 - 100
240 Glukosa larutan infus 10% DAK 2017 Botol 7,500.00

50 50 - 50
241 Hidroklortiazid tablet 25 mg DAK 2017 Tablet 149.00 500 500 - 500
248 Karbamazepin tablet 200 mg JIWA APBD II 2017 Tablet 3,158.00 980 980 155 825
250 Kloramfenikol kapsul 500 mg DAK 2017 Tablet 1,007.00 2818 2,818 90 2,728
252 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol 2,140.00

199 199 86 113
253 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet 151.00
2828 2,828 425 2,403 2,000
80 mg DAK 2017
254 mg DAK 2017 Kaplet 308.00 50 50 10 40
255 Lidokain injeksi 2% (HCl) + Epinefrin 1: 80.000 - 2 mL DAK 2017 Ampul 149.00 - -
256 Lidokain Injeksi 2% (HCL) DAK 2017 Ampul 860.00

224 224 - 224
257 Magnesium sulfat injeksi 40% DAK 2017 vial

3,650.00 - -
258 Metformin HCl tablet 500 mg DAK 2017 Tablet - -

100.00
259 Metilergometrin Maleat injeksi 0,2 mg/ml DAK 2017 Ampul 2,684.00 19 19 - 19
260 Metilprednisolon tablet 4 mg DAK 2017 Tablet 70 10 60
205.00 70
261 Metoklopramide sirup 5 mg/ 5 ml DAK 2017 Botol 120 320 71 249
2,580.00 200
262 Metoklopramide tablet DAK 2017 Tablet 994 485 509
90.00 994
263 Metronidazol kaptab 500 mg DAK 2017 Tablet 133.00 471 471 10 461
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
267 Nistatin vaginal tablet 100.000 IU/ g DAK 2017 tablet 523.00
7 7 3 4
270 Oksitosin inj 10 IU/ml DAK 2017 ampul 1,900.00

55 55 11 44
271 Parasetamol tablet 500 mg DAK 2017 Tablet 18,850 9,378 9,472
56.00 18850
272 Povidone Iodine 300 ml DAK 2017 Botol 48 - 48
1,800.00 48
277 Ringer Laktat DAK 2017 Botol 308 308 - 100
7,150.00 308
278 Salbutamol tablet 2 mg (sebagai Sulfat) DAK 2017 Tablet 66.00
1625 7,000 8,625 929 7,696
284 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2017 Ampul 186 16 170
1,098.00 186
285 Simvastatin scored tablet 10 mg DAK 2017 Tablet 131.00 80 80 - 80
286 Siprofloksasin tab scored 500 mg DAK 2017 Tablet 281.00 361 361 361 -
287 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2017 tablet 27.30 2,236 2,236 1,555 681
Tahun 2018 - -
291 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2018 Vial 120 234 44 190
2,860.00 114
292 Albendazol syr 200 mg / 5ml DAK 2018 120 710 830 474 356
296 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol 9,700.00 363 300 663 241 422 288
297 Ambroksol tablet 30 mg DAK 2018 Tablet 404.00 12,580 12,580 4,968 7,612
298 Amoksisilin kapsul/kaplet/tablet scored 500 mg DAK 2018 Kaplet 233.00 23530 10,000 33,530 6,053 27,477
301 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2018 1,995.00 5 5 - 5
304 Antifungi DOEN DAK 2018 Pot 4,496.00 48 48 - 48

308 Asam Askorbat (Vitamin C) tablet/kapsul/kaplet 50 mg DAK 2018 Tablet 105.00 110 110 70 40
311 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet 70.00 1580 1,580 190 1,390
314 Asiklovir tablet 200 mg DAK 2018 Tablet 236.00 1000 1,000 - 1,000
315 Asiklovir tablet 400 mg DAK 2018 tablet 380.00 500 500 - 500
316 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul 1,595.00 6 6 - 6
318 Attapulgit tablet 600 mg DAK 2018 Tablet 136.00 5000 5,000 - 5,000
320 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube 1,340.00 170 170 51 119
323 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2018 Ampul 240 - 240
1,097.00 240
324 Deksametason tablet 0,5 mg DAK 2018 Tablet 4,356 3,789 567
32.00 4356
327 Dimenhidrinat tablet/kapsul/kaplet 50 mg DAK 2018 Tablet 171 111 60
105.00 171
329 Domperidon suspensi/sirup 5 mg/5 ml DAK 2018 Botol 2,700.00 290 290 58 232
330 Domperidon tablet/kapsul/kaplet 10 mg DAK 2018 Tablet 105 10 95

85.00 105
331 Ephinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) DAK 2018 Ampul 30 30 - 30
1,408.00
332 Eritromisin sirup kering 200 mg/ 5 ml DAK 2018 Botol 120 - 120
6,090.00 120
334 Fenol Glycerol Tetes Telinga 10% Botol 2,590.00 23 48 71 9 62
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
337 Furosemid Injeksi 10 mg / ml DAK 2018 Ampul 1,333.00 24 24 7 17
338 Furosemid tablet 40 mg DAK 2018 Tablet 77.00 4,000 4,000 298 3,702
339 Garam Oralit I PROV 2018 Sachet 260.00 1,000 1,000 - 1,000
340 Gentamisin salep kulit 0,1% DAK 2018 Tube 5,500.00 28 28 24 4
341 Gentamisin salep mata 0,3% DAK 2018 Tube 2,675.00 120 120 - 120
342 Gentamisin tetes mata 0,3% DAK 2018 Botol 4,232.00 120 120 41 79
343 Gentian Violet larutan 1 % DAK 2018 Botol 4,200.00 46 72 118 8 110
344 Glibenclamide tablet DAK 2018 Tablet 119.00 15000 15,000 - 15,000
347 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet 6,000 - 6,000
140.00 6000
349 Griseofulvin tablet 125 ml DAK 2018 Tablet 210.00 490 490 50 440
351 Hidrokortison krim 2,5 % DAK 2018 Tube 2,475.00 141 120 261 79 182 120
354 Ibuprofen 400 mg Tablet DAK 2018 Tablet - 250 250 60 190
356 Isoniazid tablet 100 mg PROV 2018 Tablet 145.00 384 300 684 72 612
359 Kaptopril tablet 25 mg DAK 2018 Tablet 75.00 140 140 - 140
362 Ketoprofen Supp 100 mg DAK 2018 Suppo 2,380.00 50 50 - 50
363 Ketorolak inj 30 mg/ml DAK 2018 Ampul 97 10 87

1,045.00 97
368 Kloramfenikol tetes telinga 3% DAK 2018 Botol 8,000.00 72 72 - 72
369 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2018 Tablet 22.00 17488 5,000 22,488 5,817 16,671
370 mg DAK 2018 Kaplet - 1000 1,000 - 1,000
371 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul 1,210.00 660 660 78 582
373 Loperamid tablet 2 mg DAK 2018 Tablet 2,000 - 2,000
114.00 2000
374 Loratadin tablet 10 mg DAK 2018 Tablet 499 320 179
123.00 499
375 Magnesium Sulfat Injeksi 40% DAK 2018 vial 15 2 13
3,796.00 15
376 Metformin HCl tablet 500 mg DAK 2018 Tablet 5,000 27,184 2,380 24,804
96.00 22184
377 Metilergometrin Maleat Injeksi 0,2 mg/ml DAK 2018 ampul 50 50 - 50
2,959.00
378 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet 500 1,200 90 1,110
210.00 700
382 Metronidazol syrup 125 mg / 5ml DAK 2018 Botol 3,950.00 39 39 - 39
383 Mikonazol krim/salep 2 % (Nitrat ) DAK 2018 3,414.00 287 48 335 44 291
386 Natrium diklofenak tablet 50 mg DAK 2018 Tablet 6,155 1,396 4,759
115.00 6155
387 Natrium Klorida larutan infus 0,9% APBD II 2018 Botol 6,410.00 100 100 - 100 100
388 Nifedipin tablet 10 mg DAK 2018 Tablet 172.00 610 610 520 90
389 Nistati vaginal tablet 100.000 UI DAK 2018 Ovula 560.00 100 100 200 - 200
391 Obat TB FDC Katagori I PROV 2018 paket 6 6 6 - 5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
392 Obat TB FDC Katagori II PROV 2018 paket 1 1 1 -
393 Obat TB FDC Kategori Anak PROV 2018 paket - - 2
396 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet 130.00 1,524 1,524 455 1,069
402 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2018 Tablet 80 20 60

123.00 80
403 Piroksikam tablet 20 mg DAK 2018 Tablet 4,980 15 4,965
385.00 4980
409 Propiltiourasil tablet 100 mg DAK 2018 Tablet 432.00 640 1,000 1,640 90 1,550
411 Ranitidin tablet 150 mg DAK 2018 Tablet 3,820 621 3,199
705.00 3820
414 Ringer Laktat DAK 2018 Botol 100 200 35 165
7,150.00 100
415 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2018 Ampul 160 280 84 196 100
10,875.00 120
416 Salbutamol tablet 4 mg (sebagai Sulfat) DAK 2018 Tablet 1,695 1,275 420 5,000
70.00 1695
418 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot 2,621.00 24 200 224 200 24
419 Salisil Bedak 2% DAK 2018 Pcs 96 190 39 151

3,520.00 94
420 Sefadroksil tablet 500 mg DAK 2018 Tablet 1,534 470 1,064
478.00 1534
421 Sefadroksil syrup 125 mg/ 5ml DAK 2018 Botol 18 1 17
3,926.00 18
423 Sefiksim tablet 100 mg DAK 2018 Tablet 250 250 - 1,000
803.00 250
424 Sefotaksim serb inj 1.000 mg DAK 2018 Vial 200 343 144 199 200
4,200.00 143
425 Seftriakson Injeksi 1000 mg DAK 2018 Vial 370 - 370
4,483.00 370
426 Setirizin sirup 5 mg/5 ml DAK 2018 Botol 100 - 100
2,850.00 100
428 Simetidin tablet 200 mg DAK 2018 Tablet 500 - 500
447.00 500
430 Siprofloksasin tab scored 500 mg DAK 2018 Tablet 265.00 3000 3,000 6,000 479 5,521 3,000
433 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2018 tablet 350.00 11,200 5,600 16,800 - 16,800
435 Tiamfenikol tablet 500 mg DAK 2018 Tablet 500 1,953 280 1,673
1,471.00 1453
436 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet 2,000 5,837 405 5,432
85.00 3837
437 Vitamin B kompleks tablet DAK 2018 Tablet 10,637 6,087 4,550
118.00 10637
438 Zink tablet 20 mg tablet PROV 2018 tablet 513.00 8,038 5,000 13,038 1,004 12,034
439 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2018 Ampul 100 100 - 100
1,035.00
Obat Gigi - -
Tahun 2012 - -
642 Temporary Stoping Fletcher DAK 2012 Botol 34,000.00 1 1 - 1
Tahun 2016 - -
643 Eugenol spray DAK 2016 Botol 3 - 3

18,100.00 3
644 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol 126,000.00 2 2 - 2
646 Semen Zeng Fosfat serbuk & cairan APBD II 2016 Set 225,000.00 1 1 - 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2017 - -
652 GIC Serbuk dan Cairan (Fuji IX ART) APBD II 2017 Set 1,009,125.00 2 2 1 1
653 Mumifying pasta APBD II 2017 Botol 882,000.00 3 3 1 2
Tahun 2018 - -
658 Cavitron APBD II 2018 Botol 226,600.00 2 4 6 - 6
660 Etil Klorida semprot APBD II 2018 Botol 244,700.00 5 5 1 4 5

667 Spongostan APBD II 2018 Botol 725,000.00 2 2 2
668 TKF (Tricresol Formaldehid) APBD II 2018 Botol 139,600.00 2 2 - 2
Obat Jiwa - -
Tahun 2015 - -
688 Alprazolam tablet/kapsul/kaplet 1 mg DAK 2015 Tablet 233.00 482 482 - 482
690 Diazepam injeksi 10 mg/2ml APBD II 2015 Ampul 38,245.00 25 25 - 25
691 Klobazam tab 10 mg DAK 2015 Tablet 900.00 284 288 572 44 528
692 Kodein tablet 10 mg DAK 2015 Tablet 500.00 100 100 - 100
694 Trifluoperazin tablet 5 mg DAK 2015 Tablet 405.00 160 160 10 150
695 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet 510.00 1,885 1,000 2,885 240 2,645 1,000
Tahun 2016 - -
700 Diazepam tablet 2 mg APBD II 2016 Tablet 1,331.00 501 501 28 473
701 Diazepam tablet 5 mg PROV 2016 Tablet 540.00 1,456 1,456 18 1,438
702 Fenobarbital inj PROV 2016 Ampul 1,800.00 30 30 - 30
705 Haloperidol tablet 1,5 mg JIWA APBD II 2016 Tablet 69.00 2,150 2,150 165 1,985
708 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet 1,341.00 1,075 1,075 30 1,045
Tahun 2017 - -
711 Haloperidol Tablet 0,5 mg DAK 2017 tablet 59.00 680 680 30 650
Tahun 2018 - -
719 Anti bakteri Salep Kulit DAK 2018 Tube 3,035.00 8 8 - 8
720 Diazepam larutan rektal 5 mg/2,5 mL JIWA APBD II 2018 Tube 12,573.00 37 37 - 37
726 Fenobarbital tablet 30 mg JIWA APBD II 2018 Tablet 171.00 4,819 4,819 30 4,789
728 Haloperidol Injeksi 50mg / ml JIWA APBD II 2018 Ampul 101,300.00 12 12 - 12
731 Haloperidol tablet 5 mg JIWA APBD II 2018 Tablet 56.00 300 300 300 -
734 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet 1,121.00 809 900 1,709 407 1,302 900
735 Klorpromazine Injeksi 25mg / ml Ampul 1,243.00 59 59 - 59
Laboratorium - -
Tahun 2018 - -
788 Kontrol LAB APBD II 2018 Botol 1,693,380.00 1 1 1
789 Reagen Gol Darah LAB APBD II 2018 Set 660,000.00 1 1 1
790 Pot Urine LAB APBD II 2108 Pcs 6,000.00 70 70 70
791 Widal H APBD 2018 Pcs 1 1 1
792 Widal AO APBD 2018 Pcs 1 1 1
793 Widal BO APBD 2018 Pcs 1 1 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
794 Widal O APBD 2018 Pcs 1 1 1
Mengetahui, Yang menyerahkan, Yang melaporkan/meminta Yang menerima

Kepala Dinas Kesehatan Kepala Seksi Farmasi Kepala Puskesmas Petugas Puskesmas
Kabupaten Jembrana Dinas Kesehatan Kab. Jembrana
( Dr. Putu Suasta, M. Kes. ) ( Widiyatno, S. Si., Apt ) ( dr. Ni Made Anggaraeni ) ( Ni Putu Eka Yesi Arisanti)
NIP. 19600429 198703 1 010 NIP. 19720206 200604 1 004 NIP. 19810217 200902 2 005 NIP. 198506122006042003

PUSKESMAS : PUSKESMAS II NEGARA PELAPORAN BULAN / PERIODE : FEBRUARI 2019 IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
KECAMATAN : NEGARA PERMINTAAN BULAN / PERIODE : MARET 2019 PUSKESMAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Alat Kesehatan -
Tahun 2012 - - -
3 4 - 4
Tahun 2017 - - -
12 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2017 Pcs 125 - 125
140,700.00 125
140,700.00 154 154 10 144
95 95 - 95
Tahun 2018 - - -
30 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2018 Pcs 128 113 15
679.29 128
31 Alat Suntik Sekali Pakai (TP) 3 cc DAK 2018 Pcs 1,200 - 1,200
685.14 1200
815.15 692
35 Folley Catheter 2 way No. 18 DAK 2018 Pcs 5 5 -
9,660.00 5
36 Folley Catheter 2 way No. 20 DAK 2018 Pcs 3 3 -
9,660.00 3
9,660.00 38
38 Handscoen Safeglove PP Steril no 7,0 DAK 2018 Pasang 100 - 100
6,595.00 100
6,090.00 86
45 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 18) DAK 2018 pcs 270 13 257
6,405.00 270
6,405.00 98
6,405.00 193
48 IV Catheter (TERUMO) SR+OX2419C3 (IV Cateter No 24) DAK 2018 Pcs 3 3 -
6,405.00 3
50 Kasa Hidrofil 36m/ 40 yard x 80 cm DAK 2018 Roll 1 1 -
105,000.00 1
51 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak 19 1 18
8,400.00 19
52 Masker Earloop DAK 2018 Pcs 5,500 930 4,570
493.96 5500
27,830.00 2
54 Pharmafix 5cm x 500cm DAK 2018 Roll 18 11 7 10
27,000.00 18
3,300.00 22
4,982.00 27
1,482.00 195
746.00 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
1,470.00 40
1,470.00 10
63 Wing needle No.27 DAK 2018 Botol - -
1,470.00 -
Tahun 2019 - - -
64 Abocath / IV Catheter no 18 G DAK 2019 Set - - -
68 Alat Suntik sekali pakai 1 ml (syringe pump) DAK 2019 set - - -
69 Alat Suntik sekali pakai 3 ml (syringe pump) DAK 2019 Set - - -
71 Catgut/Benang Bedah No. 2/0 dengan jarum DAK 2019 set - - -
73 Elastis bandage 7,4cm x 4,5m DAK 2019 Pcs - - -
74 Foley Catheter no 18 DAK 2019 pcs - - -
77 Handschoon (Sarung tangan) no. 7 DAK 2019 pasang - - -
78 Handschoon (Sarung tangan) no. 7,5 DAK 2019 pasang - - -
79 Handschoon (Sarung tangan) no. 8 DAK 2019 Pasang - - -
80 Hypafix 10cm x 5 m DAK 2019 Rol - - -
81 Infusion set anak DAK 2019 set - - -
82 Infusion set dewasa DAK 2019 Set - - -
83 Jarum Kulit DAK 2019 Set/12 - - -
84 Jarum Otot DAK 2019 Set/12 - - -
85 Kapas Pembalut Adsorben 250 gram DAK 2019 bungkus - - -
86 Kasa Hidrofil 36 m x 80 cm DAK 2019 rol - - -
87 Kasa Hidrofil steril 16 x 16 (isi 16 lembar) DAK 2019 Kotak - - -
88 Kasa Pembalut Hidrofil 4 m x 10 cm DAK 2019 Rol - - -
90 Masker Bedah DAK 2019 Pcs - - -
91 Plester 5 yard x 2 inchi DAK 2019 Rol - - -
92 Silk (benang bedah) 2/0 + jarum 1/2 GT 35 mm DAK 2019 Pcs - -

-
93 Urine Bag Standard Steril DAK 2019 Set - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
94 Wing Needle no 21 G DAK 2019 Set - - -
98 - - -
99 - - -
100 - - -
101 - - -
102 -
Obat Emergency - - -
Tahun 2016 - - -
108 Minyak Telon 60 ml APBD II 2016 Botol 15,000.00 - - -
Tahun 2017 - - -
112 Alkohol 70% 300 ml APBD II 2017 Pcs 6,000.00 - - -
113 Asam Traneksamat injeksi 250 mg APBD II 2017 Ampul 8,804.00 - - -
114 Asam Traneksamat tablet 500 mg APBD II 2017 Tablet 2,456.00 - - -
115 Dulcolax strip @4 tablet APBD II 2017 Strip 8,095.00 - - -
116 Elastis bandage 7,4cm x 4,5m APBD II 2017 Roll 83,858.00 - - -
117 Hand sanitizer 50 ml APBD II 2017 botol 19,000.00 - - -
120 Perihidrol (Larutan H2O2 3%) APBD II 2017 botol 10,100.00 2 2 1 1
121 Minyak kayu putih 60 ml APBD II 2017 Botol 17,000.00 - - -
122 Minyak Telon 60 ml APBD II 2017 Botol 15,000.00 3 3 - 3

125 Serum anti bisa ular injeksi 5ml APBD II 2017 Vial 1,046,576.00 2 2 - 2
126 Serum anti tetanus 1.500 iu/amp APBD II 2017 Ampul 207,751.00 - - -
Tahun 2018 - - -
127 Alkohol 70% 300 ml APBD II 2018 Botol 14,800.00 74 48 122 12 110
129 Counterpain crm 15 g APBD II 2018 Tube 41,421.00 - - -
131 Heparin komb. Gel (Thrombopob gel 20 g) APBD II 2018 Tube 91,400.00 - - -
132 Jarum Kulit APBD II 2018 Set/12 - - - -
133 Jarum Otot APBD II 2018 Set/12 - - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
134 Komb B complek + vit c 500mg (selcom) APBD II 2018 Tablet 800.00 - - - 300
135 Minyak kayu putih 60 ml APBD II 2018 Botol 27,300.00 - 5 5 2 3
137 Obat Flu kombinasi (Demacolin) APBD II 2018 Tablet 500.00 570 570 155 415
141 Scabimite cream 10 gr APBD 2018 Tube 20 20 7 13 10
142 Serum anti bisa ular injeksi 5ml APBD II 2018 Vial 479,996.00 - 2 2 - 2
143 Serum anti tetanus 1.500 iu/amp APBD II 2018 Ampul 130,999.00 - 20 20 1 19 20
144 Handsanitizer 50 ml APBD II 2018 Botol 5 5 - 5
Botol - -
Obat Generik - - -
Tahun 2016 - - -
182 lidokain 10 mg seng oksida 120 mg DAK 2016 Supp 3,045.00 19 19 9 10
192 Glukosa larutan infus 5% steril DAK 2016 Botol 6,900.00 106 106 46 60
194 Kalsium Hidroksida pasta APBD II 2016 Tube 432,000.00 1 1 - 1
204 Povidone Iodine 60 ml DAK 2016 Botol - -

3,700.00 -
205 Povidone Iodine larutan 10% 300 ml DAK 2016 Botol 4 4 -
3,700.00 4
208 Retinol (Vitamin A) 100.000 iu Prov. 2016 kapsul 255.00 1000 1,000 100 900
209 Retinol (Vitamin A) 200.000 iu Prov. 2016 kapsul 459.00 4000 4,000 4,000 -
Tahun 2017 - - -
216 Albendazol tablet 400 mg PROV 2017 tablet 380.00 9330 9,330 - 9,330
221 Asam Asetilsalisilat (Asetosal) tab 100 mg DAK 2017 Tablet - -

116.00 -
224 Asam Mefenamat tablet/kapsul/kaplet 500 mg DAK 2017 Kaplet - -
106.00 -

600 600 - 600
229 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2017 Ampul 5 5 -

1,518.00 5
1,176.00 288 288 25 263
232 Digoksin 0,25 mg DAK 2017 Tablet 97.00 1225 1,225 15 1,210

270.00 100
31 31 21 10
520 520 - 520

50 50 - 50
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
252 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol 2,140.00 113 91 22
200 mg + Trimetoprim 40 mg DAK 2017 113
253 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet 151.00 2,000 4,403 925 3,478
80 mg DAK 2017 2403
254 mg DAK 2017 Kaplet 308.00 40 40 40 -

224 224 - 224
259 Metilergometrin Maleat injeksi 0,2 mg/ml DAK 2017 Ampul 2,684.00 19 19 2 17
260 Metilprednisolon tablet 4 mg DAK 2017 Tablet 60 60 -
205.00 60
261 Metoklopramide sirup 5 mg/ 5 ml DAK 2017 Botol 249 66 183
2,580.00 249
90.00 509
263 Metronidazol kaptab 500 mg DAK 2017 Tablet 133.00 461 461 220 241
4 4 4 -

44 44 6 38
271 Parasetamol tablet 500 mg DAK 2017 Tablet 9,472 9,319 153
56.00 9472
272 Povidone Iodine 300 ml DAK 2017 Botol 48 1 47
1,800.00 48
277 Ringer Laktat DAK 2017 Botol - -
7,150.00 -
7696 7,696 1,740 5,956
1,098.00 170
285 Simvastatin scored tablet 10 mg DAK 2017 Tablet 131.00 80 80 - 80 2,000
286 Siprofloksasin tab scored 500 mg DAK 2017 Tablet 281.00 - - -
287 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2017 tablet 27.30 681 681 681 -
Tahun 2018 - - -
291 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2018 Vial 190 41 149
2,860.00 190
292 Albendazol syr 200 mg / 5ml DAK 2018 356 356 - 356
296 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol 9,700.00 422 422 326 96
297 Ambroksol tablet 30 mg DAK 2018 Tablet 404.00 7612 7,612 4,626 2,986
301 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2018 1,995.00 5 5 - 5
304 Antifungi DOEN DAK 2018 Pot 4,496.00 48 48 - 48

308 Asam Askorbat (Vitamin C) tablet/kapsul/kaplet 50 mg DAK 2018 Tablet 105.00 40 40 40 -
311 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet 70.00 1390 1,390 180 1,210

103.00 -
313 Asiklovir tkrim 5% DAK 2018 Tube - - 50
9,100.00 -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
316 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul 1,595.00 6 6 2 4
318 Attapulgit tablet 600 mg DAK 2018 Tablet 136.00 5000 5,000 200 4,800
320 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube 1,340.00 119 119 33 86
1,097.00 240
324 Deksametason tablet 0,5 mg DAK 2018 Tablet 567 296 271
32.00 567
327 Dimenhidrinat tablet/kapsul/kaplet 50 mg DAK 2018 Tablet 60 - 60
105.00 60
330 Domperidon tablet/kapsul/kaplet 10 mg DAK 2018 Tablet 95 60 35

85.00 95
331 Ephinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml (0,1%) DAK 2018 Ampul 30 - 30
1,408.00 30
332 Eritromisin sirup kering 200 mg/ 5 ml DAK 2018 Botol 120 - 120
6,090.00 120
334 Fenol Glycerol Tetes Telinga 10% Botol 2,590.00 62 62 8 54
337 Furosemid Injeksi 10 mg / ml DAK 2018 Ampul 1,333.00 17 17 - 17
338 Furosemid tablet 40 mg DAK 2018 Tablet 77.00 3702 3,702 1,445 2,257
339 Garam Oralit I PROV 2018 Sachet 260.00 1000 1,000 - 1,000
340 Gentamisin salep kulit 0,1% DAK 2018 Tube 5,500.00 4 4 - 4
343 Gentian Violet larutan 1 % DAK 2018 Botol 4,200.00 110 110 21 89
344 Glibenclamide tablet DAK 2018 Tablet 119.00 15000 15,000 - 15,000 5,000
347 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet 6,000 - 6,000
140.00 6000
349 Griseofulvin tablet 125 ml DAK 2018 Tablet 210.00 440 440 - 440
351 Hidrokortison krim 2,5 % DAK 2018 Tube 2,475.00 182 182 108 74 100
354 Ibuprofen 400 mg Tablet DAK 2018 Tablet - 190 190 - 190
356 Isoniazid tablet 100 mg PROV 2018 Tablet 145.00 612 612 63 549
359 Kaptopril tablet 25 mg DAK 2018 Tablet 75.00 140 140 110 30
363 Ketorolak inj 30 mg/ml DAK 2018 Ampul 87 14 73 100

1,045.00 87
368 Kloramfenikol tetes telinga 3% DAK 2018 Botol 8,000.00 72 72 - 72
369 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2018 Tablet 22.00 16671 16,671 7,920 8,751
370 mg DAK 2018 Kaplet - 1000 1,000 460 540
371 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul 582 327 255
1,210.00 582
114.00 2000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
374 Loratadin tablet 10 mg DAK 2018 Tablet 179 159 20
123.00 179
3,796.00 13
376 Metformin HCl tablet 500 mg DAK 2018 Tablet 24,804 2,225 22,579
96.00 24804
377 Metilergometrin Maleat Injeksi 0,2 mg/ml DAK 2018 ampul 50 - 50
2,959.00 50
378 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet 1,110 10 1,100
210.00 1110
382 Metronidazol syrup 125 mg / 5ml DAK 2018 Botol 3,950.00 39 39 - 39
383 Mikonazol krim/salep 2 % (Nitrat ) DAK 2018 3,414.00 291 291 36 255
386 Natrium diklofenak tablet 50 mg DAK 2018 Tablet 4,759 1,874 2,885 5,000
115.00 4759
387 Natrium Klorida larutan infus 0,9% APBD II 2018 Botol 6,410.00 100 100 200 - 200
388 Nifedipin tablet 10 mg DAK 2018 Tablet 172.00 90 90 - 90

389 Nistati vaginal tablet 100.000 UI DAK 2018 Ovula 560.00 200 200 11 189
391 Obat TB FDC Katagori I PROV 2018 paket - 5 5 5 - 5
392 Obat TB FDC Katagori II PROV 2018 paket - - -
393 Obat TB FDC Kategori Anak PROV 2018 paket - 2 2 - 2
396 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet 130.00 1069 1,069 370 699
402 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2018 Tablet 60 - 60

123.00 60
385.00 4965
409 Propiltiourasil tablet 100 mg DAK 2018 Tablet 432.00 1550 1,550 60 1,490
411 Ranitidin tablet 150 mg DAK 2018 Tablet 3,199 1,277 1,922 200
705.00 3199
414 Ringer Laktat DAK 2018 Botol 165 119 46
7,150.00 165
415 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2018 Ampul 100 296 100 196 100
10,875.00 196
70.00 420
418 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot 24 3 21
2,621.00 24
419 Salisil Bedak 2% DAK 2018 Pcs 151 54 97
3,520.00 151
420 Sefadroksil tablet 500 mg DAK 2018 Tablet 1,064 764 300
478.00 1064
421 Sefadroksil syrup 125 mg/ 5ml DAK 2018 Botol 17 - 17
3,926.00 17
423 Sefiksim tablet 100 mg DAK 2018 Tablet - -
803.00 -
4,200.00 199
4,483.00 370
426 Setirizin sirup 5 mg/5 ml DAK 2018 Botol 100 12 88
2,850.00 100
428 Simetidin tablet 200 mg DAK 2018 Tablet 500 10 490
447.00 500
430 Siprofloksasin tab scored 500 mg DAK 2018 Tablet 265.00 5521 3,000 8,521 875 7,646 2,000
433 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2018 tablet 350.00 16800 16,800 5,379 11,421 5,000
435 Tiamfenikol tablet 500 mg DAK 2018 Tablet 1,673 405 1,268
1,471.00 1673
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
436 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet 5,432 1,740 3,692
85.00 5432
437 Vitamin B kompleks tablet DAK 2018 Tablet 4,550 3,592 958
118.00 4550
438 Zink tablet 20 mg tablet PROV 2018 tablet 513.00 12034 12,034 981 11,053 3,000
439 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2018 Ampul 100 - 100
1,035.00 100
Tahun 2019 - - -
600 Ringer Laktat larutan infus steril DAK 2019 Botol - 508 508 - 508 200
Obat Gigi - - -
Tahun 2012 - - -
Tahun 2016 - - -

18,100.00 3
644 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol 126,000.00 2 2 1 1
Tahun 2017 - - -
652 GIC Serbuk dan Cairan (Fuji IX ART) APBD II 2017 Set 1,009,125.00 1 1 1 -
653 Mumifying pasta APBD II 2017 Botol 882,000.00 2 2 - 2
Tahun 2018 - - -
658 Cavitron APBD II 2018 Botol 226,600.00 6 6 2 4
660 Etil Klorida semprot APBD II 2018 Botol 244,700.00 4 4 4 - 5

667 Spongostan APBD II 2018 Botol 725,000.00 - - -
Obat Jiwa - - -
Tahun 2015 - - -
691 Klobazam tab 10 mg DAK 2015 Tablet 900.00 528 528 - 528
692 Kodein tablet 10 mg DAK 2015 Tablet 500.00 100 100 10 90
694 Trifluoperazin tablet 5 mg DAK 2015 Tablet 405.00 150 150 120 30
695 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet 510.00 2645 1,000 3,645 550 3,095
Tahun 2016 - - -
700 Diazepam tablet 2 mg APBD II 2016 Tablet 1,331.00 473 473 43 430
701 Diazepam tablet 5 mg PROV 2016 Tablet 540.00 1438 1,438 361 1,077
705 Haloperidol tablet 1,5 mg JIWA APBD II 2016 Tablet 69.00 1985 1,985 470 1,515
708 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet 1,341.00 1045 1,045 - 1,045
Tahun 2017 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2018 - - -
720 Diazepam larutan rektal 5 mg/2,5 mL JIWA APBD II 2018 Tube 12,573.00 37 37 1 36
726 Fenobarbital tablet 30 mg JIWA APBD II 2018 Tablet 171.00 4789 4,789 180 4,609
728 Haloperidol Injeksi 50mg / ml JIWA APBD II 2018 Ampul 101,300.00 12 12 2 10
731 Haloperidol tablet 5 mg JIWA APBD II 2018 Tablet 56.00 - - -
734 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet 1,121.00 1302 900 2,202 252 1,950
Laboratorium - - -
Tahun 2018 - - -
962 Kontrol LAB APBD II 2018 Botol 1,693,380.00 - - -
965 Reagen Gol Darah LAB APBD II 2018 Set 660,000.00 - - -
967 Pot Urine LAB APBD II 2108 Pcs 6,000.00 - - -
968 Widal H APBD 2018 Pcs - - -
969 Widal AO APBD 2018 Pcs - - -
970 Widal BO APBD 2018 Pcs - - -
971 Widal O APBD 2018 Pcs - - -

NIP. 19600429 198703 1 010 NIP. 19720206 200604 1 004 NIP. 19810217 200902 2 005 NIP. 198506122006042003

PUSKESMAS : PUSKESMAS II NEGARA PELAPORAN BULAN / PERIODE : MARET 2019 IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
KECAMATAN : NEGARA PERMINTAAN BULAN / PERIODE : APRIL 2019 PUSKESMAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Alat Kesehatan -
Tahun 2012 - - -
3 4 1 3
Tahun 2017 - - -
140,700.00 125
140,700.00 144 144 - 144
95 95 3 92 50
Tahun 2018 - - -
30 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2018 Pcs 15 - 15

679.29 15
685.14 1200
815.15 521
35 Folley Catheter 2 way No. 18 DAK 2018 Pcs - -
9,660.00 -
9,660.00 -
9,660.00 31
6,595.00 100
6,090.00 48
6,405.00 257
6,405.00 73
6,405.00 181
48 IV Catheter (TERUMO) SR+OX2419C3 (IV Cateter No 24) DAK 2018 Pcs - -
6,405.00 -
50 Kasa Hidrofil 36m/ 40 yard x 80 cm DAK 2018 Roll - -
105,000.00 -
51 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak 18 - 18
8,400.00 18
52 Masker Earloop DAK 2018 Pcs 4,570 1,120 3,450
493.96 4570
27,830.00 2
54 Pharmafix 5cm x 500cm DAK 2018 Roll 7 7 -
27,000.00 7
55 Plester 5 cm x 5 m DAK 2018 Roll 10 10 - 10 10
24,948.00 -
3,300.00 22
4,982.00 18
1,482.00 100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
60 Verban 4 Yard x 5 cm DAK 2018 Roll 1,000 1,258 25 1,233
746.00 258
1,470.00 40
1,470.00 10
1,470.00 -
Tahun 2019 - - -

-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
98 - - -
99 - - -
100 - - -
101 - - -
102 -
Tahun 2016 - - -
108 Minyak Telon 60 ml APBD II 2016 Botol 15,000.00 - - - 5
Tahun 2017 - - -
120 Perihidrol (Larutan H2O2 3%) APBD II 2017 botol 10,100.00 1 1 - 1
121 Minyak kayu putih 60 ml APBD II 2017 Botol 17,000.00 - - - 5
122 Minyak Telon 60 ml APBD II 2017 Botol 15,000.00 3 3 2 1

125 Serum anti bisa ular injeksi 5ml APBD II 2017 Vial 1,046,576.00 2 2 2 -
Tahun 2018 - - -
127 Alkohol 70% 300 ml APBD II 2018 Botol 14,800.00 110 110 11 99
134 Komb B complek + vit c 500mg (selcom) APBD II 2018 Tablet 800.00 - - - 500
135 Minyak kayu putih 60 ml APBD II 2018 Botol 27,300.00 3 3 1 2
137 Obat Flu kombinasi (Demacolin) APBD II 2018 Tablet 500.00 415 415 415 - 300
141 Scabimite cream 10 gr APBD 2018 Tube 13 10 23 17 6

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
142 Serum anti bisa ular injeksi 5ml APBD II 2018 Vial 479,996.00 2 2 - 2
143 Serum anti tetanus 1.500 iu/amp APBD II 2018 Ampul 130,999.00 19 19 18 1
Tahun 2019 - - -
169 Serum Anti Tetanus 1.500 iu/ampul APBD II 2019 Ampul - 20 20 - 20
Obat Generik - - -
Tahun 2016 - - -
182 lidokain 10 mg seng oksida 120 mg DAK 2016 Supp 3,045.00 10 10 3 7
192 Glukosa larutan infus 5% steril DAK 2016 Botol 6,900.00 60 60 - 60
201 Natrium Klorida larutan infus 0,9% APBD II 2016 Botol 8,862.00 18 18 18 -

3,700.00 -
205 Povidone Iodine larutan 10% 300 ml DAK 2016 Botol - -
3,700.00 -
208 Retinol (Vitamin A) 100.000 iu Prov. 2016 kapsul 255.00 900 900 - 900
209 Retinol (Vitamin A) 200.000 iu Prov. 2016 kapsul 459.00 - - -
Tahun 2017 - - -
216 Albendazol tablet 400 mg PROV 2017 tablet 380.00 9330 9,330 1,770 7,560

116.00 -
106.00 -

600 600 - 600
229 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2017 Ampul - -

1,518.00 -
1,176.00 263 263 2 261

270.00 100
10 10 10 -
520 520 - 520

50 50 - 50
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
250 Kloramfenikol kapsul 500 mg DAK 2017 Tablet 1,007.00 2653 2,653 - 2,653
252 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol 2,140.00 22 15 7

200 mg + Trimetoprim 40 mg DAK 2017 22
253 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet 151.00 3,478 1,032 2,446 5,000
80 mg DAK 2017 3478
254 mg DAK 2017 Kaplet 308.00 - - -

224 224 75 149 100
260 Metilprednisolon tablet 4 mg DAK 2017 Tablet - -
205.00 -
2,580.00 183
262 Metoklopramide tablet DAK 2017 Tablet 200 - 200
90.00 200
263 Metronidazol kaptab 500 mg DAK 2017 Tablet 133.00 241 241 241 -
- - -

38 38 14 24
271 Parasetamol tablet 500 mg DAK 2017 Tablet 153 85 68

56.00 153
1,800.00 47
7,150.00 -
5956 5,956 1,556 4,400
1,098.00 158
285 Simvastatin scored tablet 10 mg DAK 2017 Tablet 131.00 80 80 80 -
287 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2017 tablet 27.30 - - -
Tahun 2018 - - -
2,860.00 149
296 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol 9,700.00 96 96 95 1
297 Ambroksol tablet 30 mg DAK 2018 Tablet 404.00 2986 2,986 2,486 500
301 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2018 1,995.00 5 5 1 4
304 Antifungi DOEN DAK 2018 Pot 4,496.00 48 48 1 47

308 Asam Askorbat (Vitamin C) tablet/kapsul/kaplet 50 mg DAK 2018 Tablet 105.00 - - - 5,000
311 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet 70.00 1210 1,210 - 1,210 5,000

103.00 -
313 Asiklovir tkrim 5% DAK 2018 Tube 50 50 - 50
9,100.00 -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
316 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul 1,595.00 4 4 2 2 10
320 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube 1,340.00 86 86 33 53 200
323 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2018 Ampul 234 76 158 50
1,097.00 234
324 Deksametason tablet 0,5 mg DAK 2018 Tablet 271 113 158
32.00 271
105.00 60
330 Domperidon tablet/kapsul/kaplet 10 mg DAK 2018 Tablet 35 - 35

85.00 35
1,408.00 30
332 Eritromisin sirup kering 200 mg/ 5 ml DAK 2018 Botol 120 120 -
6,090.00 120
338 Furosemid tablet 40 mg DAK 2018 Tablet 77.00 2257 2,257 1,728 529 2,000
340 Gentamisin salep kulit 0,1% DAK 2018 Tube 5,500.00 4 4 - 4
344 Glibenclamide tablet DAK 2018 Tablet 119.00 15000 5,000 20,000 - 20,000
347 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet 6,000 3,734 2,266
140.00 6000
349 Griseofulvin tablet 125 ml DAK 2018 Tablet 210.00 440 440 - 440
351 Hidrokortison krim 2,5 % DAK 2018 Tube 2,475.00 74 74 21 53 200
356 Isoniazid tablet 100 mg PROV 2018 Tablet 145.00 549 549 51 498
362 Ketoprofen Supp 100 mg DAK 2018 Suppo 2,380.00 50 50 1 49

1,045.00 73
368 Kloramfenikol tetes telinga 3% DAK 2018 Botol 8,000.00 72 72 7 65 72
369 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2018 Tablet 22.00 8751 8,751 7,961 790
370 mg DAK 2018 Kaplet - 540 540 - 540
371 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul 255 - 255 200
1,210.00 255
114.00 2000
374 Loratadin tablet 10 mg DAK 2018 Tablet 20 20 -
123.00 20
375 Magnesium Sulfat Injeksi 40% DAK 2018 vial 12 - 12 10
3,796.00 12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
96.00 22579
2,959.00 50
378 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet 1,100 90 1,010
210.00 1100
382 Metronidazol syrup 125 mg / 5ml DAK 2018 Botol 3,950.00 39 39 6 33
386 Natrium diklofenak tablet 50 mg DAK 2018 Tablet 2,885 2,105 780 5,600
115.00 2885
388 Nifedipin tablet 10 mg DAK 2018 Tablet 172.00 90 90 70 20

391 Obat TB FDC Katagori I PROV 2018 paket - 5 5 5 -
393 Obat TB FDC Kategori Anak PROV 2018 paket 2 2 - 2
396 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet 130.00 699 699 345 354
402 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2018 Tablet 60 40 20 5,000
123.00 60
385.00 4835
411 Ranitidin tablet 150 mg DAK 2018 Tablet 1,922 1,627 295
705.00 1922
414 Ringer Laktat DAK 2018 Botol 46 34 12
7,150.00 46
415 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2018 Ampul 196 140 56
10,875.00 196
416 Salbutamol tablet 4 mg (sebagai Sulfat) DAK 2018 Tablet 5,410 335 5,075 2,000
70.00 5410
418 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot 21 6 15
2,621.00 21
419 Salisil Bedak 2% DAK 2018 Pcs 97 60 37
3,520.00 97
420 Sefadroksil tablet 500 mg DAK 2018 Tablet 300 160 140
478.00 300
3,926.00 17
423 Sefiksim tablet 100 mg DAK 2018 Tablet 300 300 300 -
803.00 -
424 Sefotaksim serb inj 1.000 mg DAK 2018 Vial 300 659 196 463
4,200.00 359
4,483.00 370
2,850.00 88
428 Simetidin tablet 200 mg DAK 2018 Tablet 490 255 235
447.00 490
430 Siprofloksasin tab scored 500 mg DAK 2018 Tablet 265.00 7646 3,000 10,646 845 9,801
433 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2018 tablet 350.00 11421 5,600 17,021 6,366 10,655 5,000
435 Tiamfenikol tablet 500 mg DAK 2018 Tablet 1,268 480 788
1,471.00 1268
436 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet 3,692 3,057 635
85.00 3692
437 Vitamin B kompleks tablet DAK 2018 Tablet 958 748 210 10,000
118.00 958
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
438 Zink tablet 20 mg tablet PROV 2018 tablet 513.00 11053 7,200 18,253 941 17,312
1,035.00 100
Tahun 2019 - - -
441 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2019 Vial - -
-
442 Albendazol Syr 200 mg / 5ml DAK 2019 botol - - -
443 Albendazol tablet 400 mg DAK 2019 Tablet - - -
444 Allopurinol tablet 100 mg DAK 2019 tablet - - - 10,000
445 Allopurinol tablet 300 mg DAK 2019 tablet - - -
446 Ambroxol sirup 15 mg/5 ml DAK 2019 botol - - -
447 Ambroxol tablet 30 mg DAK 2019 tablet - - -
448 Amoksisilin kaplet 500 mg DAK 2019 kaplet - - -
449 Amoksisilin sirup kering 125 mg/ 5 ml DAK 2019 Botol - - -
450 Ampisislin injeksi 1000 mg DAK 2019 vial - - -
451 Antalgin (Metampiron) injeksi 250 mg/ml DAK 2019 ampul - - -
452 Antalgin (Metampiron) tablet 500 mg DAK 2019 tablet - - -
453 Antasida DOEN I tablet kunyah kombinasi DAK 2019 tablet - - - 10,000
454 Antasida DOEN II suspensi kombinasi DAK 2019 botol - 500 500 7 493
455 Anti Bakteri DOEN salep kulit kombinasi DAK 2019 tube - - -
456 Antifungi DOEN salep kulit DAK 2019 pot - - -
457 Antihemoroid DOEN Kombinasi (supositoria) DAK 2019 supp - - - 100
458 Antimigren: Ergotamin Tartrat + Kofein DAK 2019 Tablet - - -
459 Asam Asetilsalisilat (Asetosal) tablet 100 mg DAK 2019 Tablet - -

-
460 Asam Askorbat (Vitamin C) tablet 100 mg DAK 2019 Tablet - - -
462 Asam Askorbat (Vitamin C) tablet 50 mg DAK 2019 tablet - - -
463 Asam Folat tablet 1 mg DAK 2019 tablet - - -
464 Asam Folat tablet/kapsul/kaplet 0,4 mg DAK 2019 Tablet - -

-
-
466 Asiklovir krim 5 % DAK 2019 tube - - -
467 Asiklovir tablet 400 mg DAK 2019 tablet - - -
469 Atapulgit tablet 600 mg DAK 2019 Tablet - - -
470 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2019 Ampul - - -
471 Atropin sulfat tetes mata 0,5% DAK 2019 Botol - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
472 Betahistin Mesilat tablet 6 mg DAK 2019 tablet - - -
473 Betametason krim 0,1 % (sebagai valerat) DAK 2019 tube - - -
474 Bisoprolol tablet 5 mg DAK 2019 Tablet - - -

-
476 Deksametason tablet 0,5 mg DAK 2019 tablet - - -
477 Dietilkarbamazin Sitrat 100 mg DAK 2019 tablet - - -
478 Difenhidramin inj. 10 mg/ml - 1 ml DAK 2019 Ampul - - -
479 Digoksin tablet 0,25 mg DAK 2019 Tablet - - -
480 Diltiazem HCl tablet 30 mg DAK 2019 tablet - - -
481 Dimenhidrinat tablet 50 mg DAK 2019 Tablet - - - 10,000
482 Doksisiklin tablet 100 mg DAK 2019 Tablet - -

-
483 Domperidon suspensi/sirup 5 mg/5 ml DAK 2019 Botol - - -
484 Domperidon tablet/kapsul/kaplet 10 mg DAK 2019 Tablet - -

-
485 Efedrin tablet 25 mg DAK 2019 tablet - - -
486 Epinefrin (adrenalin) injeksi 0,1% (sebagai HCl) DAK 2019 ampul - 15 15 - 15
487 Eritromisin kapsul / kaplet 500 mg DAK 2019 kaplet - - -
488 Eritromisin sirup 200 mg/5 ml DAK 2019 botol - - -
489 Etakridin (Rivanol) larutan 0,1% DAK 2019 Botol - - -
490 Fenilbutason tablet 200 mg DAK 2019 tablet - - -
491 Fenol Gliserol tetes telinga 10% DAK 2019 botol - - -
492 Fitomenadion (Vit K) inj 10 mg/ml DAK 2019 vial - - -
493 Fitomenadion (Vit. K1) tablet 10 mg DAK 2019 tablet - - -
494 Furosemid injeksi i.v / im 10 mg/ml DAK 2019 ampul - - -
495 Furosemid tablet 40 mg DAK 2019 Tablet - - -
496 Garam Oralit I serbuk DAK 2019 sachet - - -
497 Gentamisin injeksi 40 mg/ ml DAK 2019 ampul - - -
498 Gentamisin Salep Kulit 0,1 % DAK 2019 tube - - -
499 Gentamisin Sulfat Salep Mata 0,3 % DAK 2019 tube - - - 100
500 Gentamisin Sulfat Tetes Mata 0,3 % DAK 2019 botol - - -
501 Gentian Violet larutan 1 % DAK 2019 botol - - -
502 Glibenklamid tablet 5 mg DAK 2019 Tablet - - -
503 Glimepiride tablet 1 mg DAK 2019 tablet - - -
504 Gliquidon tablet 30 mg DAK 2019 Tablet - -

-
505 Gliseril Guayakolat tablet 100 mg DAK 2019 tablet - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
506 Glukosa larutan infus 5% steril DAK 2019 Botol - - -
508 Glukosa larutan infus 40% steril DAK 2019 ampul - - -
509 Griseofulvin tablet 125 mg DAK 2019 tablet - - -
510 Hidroklortiazid tablet 25 mg DAK 2019 Tablet - - -
511 Hidrokortison krim 2,5 % DAK 2019 Tube - - -
512 Hiosina butilbromida Injeksi DAK 2019 Ampul - - -
513 Ibuprofen Syrup 100 mg DAK 2019 Botol - - -
514 Ibuprofen tablet 200 mg DAK 2019 Tablet - - -
516 Isoniasid tablet 100 mg DAK 2019 tablet - - -
517 Isosorbid Dinitrat tablet sublingual 5 mg DAK 2019 tablet - - -
518 Kalsium Glukonat Injeksi 200 mg DAK 2019 Ampul - - -
519 Kalsium Laktat (Kalk) tablet 500 mg DAK 2019 Tablet - - - 5,000
520 Kaptopril tablet 12,5 mg DAK 2019 tablet - - -
521 Kaptopril tablet 25 mg DAK 2019 tablet - - -
522 Ketokonazol tablet 200 mg DAK 2019 tablet - - -
523 Ketoprofen injeksi 100 mg DAK 2019 ampul - - -
524 Ketoprofen Supp 100 mg DAK 2019 Suppo - - -
525 Ketoprofen tablet 100 mg DAK 2019 tablet - - -
526 Ketorolak injeksi 30 mg/ml DAK 2019 Ampul 100 100 - 100
-
527 Kloramfenikol Injeksi 1000 mg / vial DAK 2019 vial - - -
528 Kloramfenikol kapsul 250 mg DAK 2019 Kapsul - - -
530 Kloramfenikol salep mata 1% DAK 2019 Tube - - -
531 Kloramfenikol suspensi 125 mg / 5 ml DAK 2019 botol - - -
532 Kloramfenikol tetes telinga 3 % DAK 2019 botol - - -
533 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2019 Tablet - - -

534 (Combivent Nebulle) DAK 2019 Ampul - 100 100 - 100 100
535 Kotrimoksazol DOEN I komb 480 mg Tablet - - -
536 Kotrimoksazol DOEN II (pediatrik) komb 120 mg DAK 2019 tablet - - -

537 mg DAK 2019 Kaplet - - -
538 Kotrimoksazol Suspensi kombinasi 240 mg/5 ml botol - - -
539 Lidokain Injeksi 2% (HCL) DAK 2019 Ampul - -

-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
540 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml DAK 2019 Ampul - - -
541 Loperamid tablet 2 mg DAK 2019 Tablet - -

-
542 Loratadin tablet 10 mg DAK 2019 tablet - - -
543 Magnesium Sulfat inj (IV) 20% DAK 2019 vial - - -
545 Magnesium sulfat serbuk 30 gram DAK 2019 bungkus - - -
546 Mebendazol Syr 100 mg / 5ml DAK 2019 botol - - -
547 Mebendazol tablet 500 mg DAK 2019 tablet - - -
548 Meloksikam suppositoria DAK 2019 supp - - -
549 Meloksikam tablet 15 mg DAK 2019 tablet - - -
550 Menadion (Vit. K3) injeksi 10 mg/ml DAK 2019 ampul - - -
551 Metformin HCI tablet 500 mg DAK 2019 tablet - - -
552 Metilergometrin Maleat injeksi 0,200 mg DAK 2019 ampul - - -
553 Metilergometrin Maleat tablet 0,125 mg DAK 2019 tablet - - -
554 Metilprednisolon Injeksi 500 mg DAK 2019 vial - - -

-
556 Metoklopramide sirup 5 mg/ 5 ml DAK 2019 Botol - -
-
557 Metoklopramide tablet 10 mg DAK 2019 tablet - - -
558 Metronidazol Infus 500 mg/100ml DAK 2019 botol - - -
559 Metronidazol kaptab 500 mg DAK 2019 Tablet - - -
560 Metronidazol Syr 125 mg / 5ml DAK 2019 Botol - - -
561 Mikonazol krim/salep 2 % (Nitrat ) DAK 2019 tube - - -
562 Na. Thiroxin tablet 100 mcg DAK 2019 tablet - - -
563 n-asetil sistein tablet 200 mg DAK 2019 Tablet - - -
564 Natrium Bikarbonat tablet 500 mg DAK 2019 tablet - - -
565 Natrium Diklofenak tablet 25 mg DAK 2019 tablet - - -
566 Natrium Diklofenak tablet 50 mg DAK 2019 tablet - 5,600 5,600 - 5,600
567 Natrium Klorida larutan infuse 0.9 % DAK 2019 botol - - -
568 Nifedipin tablet 10 mg DAK 2019 tablet - - -
569 Nistatin vaginal tablet 100.000IU/g DAK 2019 ovula - - -
570 Obat Batuk Hitam (OBH) cairan DAK 2019 botol - - -
571 Oksitetrasiklin HCL salep mata 1 % DAK 2019 tube - - -
572 Oksitetrasiklin salep kulit 3% DAK 2019 tube - - -
573 Oksitetrasiklin salep mata 1% DAK 2019 tube - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
574 Oksitosin injeksi 10 iu / ml - 1 ml DAK 2019 ampul - - -
575 Omeprazol kapsul/kaplet 20 mg DAK 2019 Kapsul - - -
576 Papaverin injeksi 40 mg/ml DAK 2019 ampul - - -
577 Papaverin tablet 40 mg DAK 2019 tablet - - -
578 Parasetamol drops DAK 2019 Botol - - - 500
579 Parasetamol sirup 120 mg/5ml DAK 2019 botol - 1,000 1,000 85 915
580 Parasetamol tablet 100 mg DAK 2019 tablet - - -
581 Parasetamol tablet 500 mg DAK 2019 Tablet - - -
582 Pirantel suspensi 125 mg/5 ml DAK 2019 Botol - - -
583 Pirantel tablet score (base) 125 mg DAK 2019 tablet - - -
585 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2019 Tablet - -

-
586 Piroksikam kapsul/kaplet/tablet 20 mg DAK 2019 tablet - - -
587 Piroksikam tablet 10 mg DAK 2019 tablet - - -
588 Povidon Iodin larutan 10% 15ml DAK 2019 Botol - - -
590 Povidon Iodin larutan 10% 60 DAK 2019 Botol - - -
591 Povidon lodida larutan 10 % 300 ml DAK 2019 botol - - -
592 Prednison tablet 5 mg DAK 2019 tablet - - -
593 Propanolol tablet 10 mg (HCL) DAK 2019 Tablet - - -
594 Propanolol tablet 40 mg (HCI) DAK 2019 tablet - - -
595 Propiltiourasil tablet 100 mg DAK 2019 tablet - - -
596 Ranitidin injeksi 25 mg/2 ml DAK 2019 Ampul - 400 400 123 277
597 Ranitidin tablet 150 mg DAK 2019 tablet - - -
598 Retinol (Vitamin A ) kapsul lunak 100.000 IU DAK 2019 kapsul - - -
599 Retinol (Vitamin A) kapsul lunak 200.000 iu DAK 2019 kapsul - - -
600 Ringer Laktat larutan infus steril DAK 2019 Botol 508 500 1,008 130 878
601 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2019 Ampul - -

-
602 Salbutamol MDI (Ventolin inhaler) DAK 2019 PCS - -
-
603 Salbutamol tablet 2 mg (sebagai sulfat) DAK 2019 Tablet - - -
604 Salbutamol tablet 4 mg (sebagai Sulfat) DAK 2019 Tablet - -

-
605 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap DAK 2019 Pot - -
-
606 Salisil Bedak 2% DAK 2019 Kotak - - -
607 Sefadroksil kapsul/kaplet 500 mg DAK 2019 Kapsul - -

-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
608 Sefadroksil sirup kering 125 mg/5ml DAK 2019 botol - - -
609 Sefixime capsul 100 mg DAK 2019 kapsul - - -
610 Sefixime sirup 100 mg/5 ml DAK 2019 botol - - -
611 Sefotaksim injeksi 1 g DAK 2019 vial - - -
612 Seftriakson injeksi 1 g DAK 2019 vial - - -
613 Setirizin sirup 5 mg/5 ml DAK 2019 Botol - -

-
614 Setirizin tablet DAK 2019 tablet - -
-
615 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2019 Ampul - -
-
616 Simetidin tablet 200 mg DAK 2019 tablet - - -
617 Simvastatin scored tablet 10 mg DAK 2019 Tablet - 3,360 3,360 - 3,360
618 Siprofloksasin 500 mg DAK 2019 kaplet - - -
619 Spironolakton tablet 100 mg DAK 2019 Tablet - - -
621 Tablet Tambah Darah/Sulfas Ferrosus DAK 2019 tablet - - -
622 Tetrakain HCl tetes mata 0,5% DAK 2019 Botol - - -
623 Tetrasiklin tablet/kapsul/kaplet 500 mg DAK 2019 Kapsul - -

-
624 Tiamfenikol kapsul /kaplet 500mg DAK 2019 tablet - - -
625 Tiamin (Vitamin B1) Injeksi 100 mg/ml DAK 2019 ampul - - -
626 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2019 Tablet - -
-
627 Tramadol capsul 50 mg DAK 2019 kapsul - - -
628 Vitamin B kompleks tablet DAK 2019 Tablet - -

-
629 Zink tablet 20 mg DAK 2019 tablet - - -
630 - - -
631 - - -
632 - - -
633 - - -
634 - - -
Obat Gigi - - -
Tahun 2012 - - -
Tahun 2016 - - -

18,100.00 3
644 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol 126,000.00 1 1 - 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2017 - - -
652 GIC Serbuk dan Cairan (Fuji IX ART) APBD II 2017 Set 1,009,125.00 - - -
Tahun 2018 - - -
658 Cavitron APBD II 2018 Botol 226,600.00 4 4 - 4
663 Kalsium Hidroksida Pasta APBD II 2018 Tube 507,500.00 - - -

Tahun 2019 - - -
671 Cavitron APBD II 2019 Botol - - -
672 Devitalisasi pasta (non arsen) APBD II 2019 Botol - - -
673 Etil Klorida semprot APBD II 2019 Botol - - - 5
674 Eugenol cairan DAK 2019 Botol - - -
675 Glass Ionomer Cement Serbuk dan Cairan APBD II 2019 Set - - -
676 Kalsium Hidroksida pasta APBD II 2019 Tube - - -
677 Monoklorkamfer Mentol cairan (CHKM) APBD II 2019 Botol - - -
678 Mummifying Pasta APBD II 2019 Botol - - -
679 Semen Zeng Fosfat serbuk & cairan APBD II 2019 Set - - -
680 Spongostan APBD II 2019 Botol - - -
681 Temporary Stopping Fletcher serbuk dan cairan APBD II 2019 Set - - -
682 TKF (Tricresol Formaldehid) APBD II 2019 Botol - - -
683 - - -
684 - - -
685 - - -
686 - - -
687 - - -
Obat Jiwa - - -
Tahun 2015 - - -
688 Alprazolam tablet/kapsul/kaplet 1 mg DAK 2015 Tablet 233.00 482 482 4 478
690 Diazepam injeksi 10 mg/2ml APBD II 2015 Ampul 38,245.00 25 25 8 17
691 Klobazam tab 10 mg DAK 2015 Tablet 900.00 528 528 153 375
692 Kodein tablet 10 mg DAK 2015 Tablet 500.00 90 90 20 70
694 Trifluoperazin tablet 5 mg DAK 2015 Tablet 405.00 30 30 - 30
695 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet 510.00 3095 3,095 480 2,615
Tahun 2016 - - -
700 Diazepam tablet 2 mg APBD II 2016 Tablet 1,331.00 430 430 157 273 1,000
701 Diazepam tablet 5 mg PROV 2016 Tablet 540.00 1077 1,077 225 852
705 Haloperidol tablet 1,5 mg JIWA APBD II 2016 Tablet 69.00 1515 1,515 1,155 360 1,000
708 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet 1,341.00 1045 1,045 90 955
Tahun 2017 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2018 - - -
734 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet 1,121.00 1950 1,950 430 1,520
735 Klorpromazine Injeksi 25mg / ml Ampul 1,243.00 59 59 2 57
Tahun 2019 - - -
747 Alprazolam tablet/kapsul/kaplet 0,5 mg APBD II 2019 Tablet - - -
748 Alprazolam tablet/kapsul/kaplet 1 mg APBD II 2019 Tablet - - -
749 Amitriptilin tablet salut 25 mg (HCl) APBD II 2019 Tablet - - -
750 Diazepam injeksi 5 mg/ml - 2 ml APBD II 2019 Ampul - - -
751 Diazepam larutan rektal 10 mg/2,5 ml APBD II 2019 Tube - - -
753 Diazepam tablet 2 mg APBD II 2019 Tablet - - -
754 Diazepam Tablet 5 mg APBD II 2019 Tablet - - -
755 Fenitoin injeksi 50 mg/ml APBD II 2019 Ampul - - -
756 Fenitoin kapsul/kaplet 100 mg APBD II 2019 Kapsul - - -
758 Fenobarbital 30 mg Tablet APBD II 2019 botol - - -
759 Fenobarbital injeksi APBD II 2019 Ampul - - -
760 Fenobarbital tablet 100 mg APBD II 2019 Tablet - - -
761 Flufenazin injeksi i.m. 25 mg/ml APBD II 2019 Ampul - - -
762 Haloperidol Injeksi APBD II 2019 Ampul - - -
763 Haloperidol tablet 0,5 mg APBD II 2019 Tablet - - -
765 Haloperidol tablet 5 mg APBD II 2019 Tablet - - -
766 Karbamazepin Syr 100 mg/ 5ml APBD II 2019 Botol - - -
767 Karbamazepin tablet 200 mg APBD II 2019 Tablet - - -
768 Klobazam tab 10 mg APBD II 2019 Tablet - - -
769 Klorpromazin injeksi i.m. 25 mg/ml (HCl) APBD II 2019 Ampul - - -
770 Klorpromazin tablet 25 mg APBD II 2019 Tablet - - - 1,500
771 Klorpromazin tablet salut 100 mg (HCl) APBD II 2019 Tablet - - -
772 Klozapin Tablet 25 mg APBD II 2019 Tablet - - -
773 Kodein 10 mg APBD II 2019 Tablet - - - 100
774 Lorazepam tablet 2 mg APBD II 2019 Tablet - - -
775 Olanzapin tab 10 mg APBD II 2019 Tablet - - -
776 Risperidon tablet 2 mg APBD II 2019 Tablet - - -
777 Sertralin tab 50 mg APBD II 2019 Tablet - - -
778 Trifluoperazin tablet 2 mg APBD II 2019 Botol - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
779 Trifluoperazin tablet 5 mg APBD II 2019 Tablet - - -
780 Trihexpenidil Tablet 2 mg APBD II 2019 Botol - - -
781 Valproat Syr 250 mg / 5ml APBD II 2019 Botol - - -
782 Valproat tablet selaput enterik 250 mg APBD II 2019 Tablet - - -
783 - - -
784 - - -
785 - - -
786 - - -
787 - - -
Laboratorium - - -
Tahun 2018 - - -

NIP. 19600429 198703 1 010 NIP. 19720206 200604 1 004 NIP. 19810217 200902 2 005 NIP. 198506122006042003

PUSKESMAS : PUSKESMAS II NEGARA PELAPORAN BULAN / PERIODE : APRIL 2019 IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
KECAMATAN : NEGARA PERMINTAAN BULAN / PERIODE : MEI 2019 PUSKESMAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Alat Kesehatan -
Tahun 2012 - - -
3 3 3
Tahun 2017 - - -

140,700.00 105
140,700.00 144 144 - 144
92 92 12 80 100
Tahun 2018 - - -
30 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2018 Pcs 15 15 -

679.29 15
685.14 1200
815.15 412
9,660.00 -
9,660.00 -
9,660.00 16
6,595.00 70
42 Infusion Set Dewasa (20 drops/ml) DAK 2018 Pcs 9 9 -
6,090.00 9
6,405.00 226
6,405.00 51
6,405.00 156
6,405.00 -
105,000.00 -
51 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak 18 18 -
8,400.00 18
52 Masker Earloop DAK 2018 Pcs 3,450 1,500 1,950
493.96 3450
27,830.00 2
54 Pharmafix 5cm x 500cm DAK 2018 Roll - -
27,000.00 -
55 Plester 5 cm x 5 m DAK 2018 Roll 10 7 3
24,948.00 10
3,300.00 22
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
58 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2018 Pcs 4 4 -
4,982.00 4
59 Verban 4 Yard x 10 cm DAK 2018 Roll 75 75 -
1,482.00 75
60 Verban 4 Yard x 5 cm DAK 2018 Roll 1,233 263 970
746.00 1233
1,470.00 40
1,470.00 10
1,470.00 -
Tahun 2019 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

-
98 - - -
99 - - -
100 - - -
101 - - -
102 -
Tahun 2016 - - -
Tahun 2017 - - -
120 Perihidrol (Larutan H2O2 3%) APBD II 2017 botol 10,100.00 1 1 1

125 Serum anti bisa ular injeksi 5ml APBD II 2017 Vial 1,046,576.00 - - - -
Tahun 2018 - - -
127 Alkohol 70% 300 ml APBD II 2018 Botol 14,800.00 99 24 123 13 110
128 Asam Traneksamat tablet 500 mg APBD II 2018 tablet 2,900.00 53 53 53

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
134 Komb B complek + vit c 500mg (selcom) APBD II 2018 Tablet 800.00 - - -
135 Minyak kayu putih 60 ml APBD II 2018 Botol 27,300.00 2 5 7 - 7
136 Minyak Telon 60 ml APBD II 2018 Botol 24,200.00 - 2 2 - 2
137 Obat Flu kombinasi (Demacolin) APBD II 2018 Tablet 500.00 - - -
141 Scabimite cream 10 gr APBD 2018 Tube 6 6 5 1
142 Serum anti bisa ular injeksi 5ml APBD II 2018 Vial 479,996.00 2 3 5 3 2
143 Serum anti tetanus 1.500 iu/amp APBD II 2018 Ampul 130,999.00 1 1 1 -
145 Plesterin APBD II 2018 Pcs 24,948.00 - 20 14
Tahun 2019 - - -
169 Serum Anti Tetanus 1.500 iu/ampul APBD II 2019 Ampul 20 20 40 16 24 20
Obat Generik - - -
Tahun 2016 - - -
201 Natrium Klorida larutan infus 0,9% APBD II 2016 Botol 8,862.00 - - -

3,700.00 -
3,700.00 -
Tahun 2017 - - -
216 Albendazol tablet 400 mg PROV 2017 tablet 380.00 7560 7,560 3,210 4,350

116.00 -
106.00 -

600 600 - 600

1,518.00 -
1,176.00 261 261 3 258
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

270.00 100
- - -
520 520 104 416 -
239 Gentamisin tetes mata 0,3% DAK 2017 Botol 4,000.00 14 14 14 -

50 50 - 50
248 Karbamazepin tablet 200 mg JIWA APBD II 2017 Tablet 3,158.00 240 240 240 -
252 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol 2,140.00

7 7 7 -
253 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet 151.00
2446 5,000 7,446 802 6,644
80 mg DAK 2017
254 mg DAK 2017 Kaplet 308.00 - - -

149 100 249 159 90
205.00 -
2,580.00 124
90.00 200
263 Metronidazol kaptab 500 mg DAK 2017 Tablet 133.00 - - -
- - -

24 24 14 10 100
271 Parasetamol tablet 500 mg DAK 2017 Tablet 68 10 58

56.00 68
272 Povidone Iodine 300 ml DAK 2017 Botol 45 - 45
1,800.00 45
7,150.00 -
4400 4,400 773 3,627
1,098.00 119
285 Simvastatin scored tablet 10 mg DAK 2017 Tablet 131.00 - - -
Tahun 2018 - - -
291 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2018 Vial 101 75 26
2,860.00 101
296 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol 9,700.00 1 1 - 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
297 Ambroksol tablet 30 mg DAK 2018 Tablet 404.00 500 500 480 20
298 Amoksisilin kapsul/kaplet/tablet scored 500 mg DAK 2018 Kaplet 233.00 15727 15,727 5,226 10,501
301 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2018 1,995.00 4 4 3 1

308 Asam Askorbat (Vitamin C) tablet/kapsul/kaplet 50 mg DAK 2018 Tablet 105.00 - - -
311 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet 70.00 1210 1,210 290 920

103.00 -
313 Asiklovir tkrim 5% DAK 2018 Tube 50 - 50
9,100.00 50
316 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul 1,595.00 2 2 2 -
320 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube 1,340.00 53 53 53 -
323 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2018 Ampul 240 398 51 347
1,097.00 158
324 Deksametason tablet 0,5 mg DAK 2018 Tablet 158 158
32.00 158
105.00 60

85.00 35
1,408.00 30
332 Eritromisin sirup kering 200 mg/ 5 ml DAK 2018 Botol - -
6,090.00 -
338 Furosemid tablet 40 mg DAK 2018 Tablet 77.00 529 2,000 2,529 275 2,254
339 Garam Oralit I PROV 2018 Sachet 260.00 1000 1,000 2,000 - 2,000
340 Gentamisin salep kulit 0,1% DAK 2018 Tube 5,500.00 4 4 4 -
341 Gentamisin salep mata 0,3% DAK 2018 Tube 2,675.00 120 120 240 - 240
343 Gentian Violet larutan 1 % DAK 2018 Botol 4,200.00 80 80 10 70 24.00
347 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet 2,266 2,266 -
140.00 2266
351 Hidrokortison krim 2,5 % DAK 2018 Tube 2,475.00 53 53 53 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
356 Isoniazid tablet 100 mg PROV 2018 Tablet 145.00 498 498 38 460 1,000

1,045.00 55
368 Kloramfenikol tetes telinga 3% DAK 2018 Botol 8,000.00 65 65 15 50
369 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2018 Tablet 22.00 790 790 504 286
370 mg DAK 2018 Kaplet - 540 540 - 540
371 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul 255 300 555 - 555 100
1,210.00
114.00 2000
374 Loratadin tablet 10 mg DAK 2018 Tablet - -
123.00 -
375 Magnesium Sulfat Injeksi 40% DAK 2018 vial 12 - 12
3,796.00 12
96.00 19514
2,959.00 50
378 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet 1,010 130 880
210.00 1010
379 Metilprednisolon tablet 4 mg DAK 2018 Tablet - - -
-
380 Metoklopramide sirup 5 mg/ 5 ml DAK 2018 Botol 120 120 - 120
2,530.00 -
386 Natrium diklofenak tablet 50 mg DAK 2018 Tablet 780 780 -

115.00 780
388 Nifedipin tablet 10 mg DAK 2018 Tablet 172.00 20 20 20

389 Nistati vaginal tablet 100.000 UI DAK 2018 Ovula 560.00 178 178 11 167 67.00
391 Obat TB FDC Katagori I PROV 2018 paket - - -
393 Obat TB FDC Kategori Anak PROV 2018 paket 2 2 2 -
396 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet 130.00 354 354 286 68
402 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2018 Tablet 20 - 20

123.00 20
385.00 4623
411 Ranitidin tablet 150 mg DAK 2018 Tablet 295 165 130
705.00 295
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
414 Ringer Laktat DAK 2018 Botol 12 12 -
7,150.00 12
415 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2018 Ampul 56 - 56
10,875.00 56
70.00 5075
418 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot 2,621.00 15 15 9 6
419 Salisil Bedak 2% DAK 2018 Pcs 96 133 48 85 100

3,520.00 37
420 Sefadroksil tablet 500 mg DAK 2018 Tablet 140 - 140
478.00 140
3,926.00 8
803.00 -
4,200.00 463
4,483.00 370
2,850.00 55
428 Simetidin tablet 200 mg DAK 2018 Tablet 235 235 -
447.00 235
430 Siprofloksasin tab scored 500 mg DAK 2018 Tablet 265.00 9801 9,801 630 9,171
435 Tiamfenikol tablet 500 mg DAK 2018 Tablet 788 265 523
1,471.00 788
436 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet 635 585 50
85.00 635
437 Vitamin B kompleks tablet DAK 2018 Tablet 210 210 -
118.00 210
438 Zink tablet 20 mg tablet PROV 2018 tablet 513.00 17312 17,312 715 16,597
439 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2018 Ampul 100 - 100 100
1,035.00 100
Tahun 2019 - - -
441 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2019 Vial 120 120 - 120 120
-
444 Allopurinol tablet 100 mg DAK 2019 tablet - 1,000 1,000 - 1,000 5,000
448 Amoksisilin kaplet 500 mg DAK 2019 kaplet - 6,000 6,000 - 6,000
449 Amoksisilin sirup kering 125 mg/ 5 ml DAK 2019 Botol - 300 300 31 269 300

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
453 Antasida DOEN I tablet kunyah kombinasi DAK 2019 tablet - 5,000 5,000 - 5,000 10,000
454 Antasida DOEN II suspensi kombinasi DAK 2019 botol 493 300 793 85 708 200
457 Antihemoroid DOEN Kombinasi (supositoria) DAK 2019 supp - 100 100 - 100 100
459 Asam Asetilsalisilat (Asetosal) tablet 100 mg DAK 2019 Tablet 1,000 1,000 - 1,000
-
462 Asam Askorbat (Vitamin C) tablet 50 mg DAK 2019 tablet - 6,000 6,000 1,442 4,558 10,000
463 Asam Folat tablet 1 mg DAK 2019 tablet - 2,000 2,000 - 2,000 100

-
-
470 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2019 Ampul - 5 5 - 5
473 Betametason krim 0,1 % (sebagai valerat) DAK 2019 tube - 200 200 35 165 200

-
481 Dimenhidrinat tablet 50 mg DAK 2019 Tablet - 1,000 1,000 - 1,000

-

-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
486 Epinefrin (adrenalin) injeksi 0,1% (sebagai HCl) DAK 2019 ampul 15 15 - 15
492 Fitomenadion (Vit K) inj 10 mg/ml DAK 2019 vial - - -
499 Gentamisin Sulfat Salep Mata 0,3 % DAK 2019 tube - - -
500 Gentamisin Sulfat Tetes Mata 0,3 % DAK 2019 botol - 120 120 - 120 48

-
511 Hidrokortison krim 2,5 % DAK 2019 Tube - 120 120 3 117 200

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
519 Kalsium Laktat (Kalk) tablet 500 mg DAK 2019 Tablet - 2,000 2,000 - 2,000 2,000
526 Ketorolak injeksi 30 mg/ml DAK 2019 Ampul 100 200 - 200 100
100
531 Kloramfenikol suspensi 125 mg / 5 ml DAK 2019 botol - - - 100
532 Kloramfenikol tetes telinga 3 % DAK 2019 botol - 15 15 - 15
533 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2019 Tablet - - - 5,000

534 (Combivent Nebulle) DAK 2019 Ampul 100 100 200 32 168 100

537 mg DAK 2019 Kaplet - - -
538 Kotrimoksazol Suspensi kombinasi 240 mg/5 ml botol - 500 500 4 496

-

-
544 Magnesium Sulfat inj (IV) 40% DAK 2019 vial - 10 10 - 10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
555 Metilprednisolon tablet 4 mg DAK 2019 Tablet 4,000 4,000 - 4,000

-
-
557 Metoklopramide tablet 10 mg DAK 2019 tablet - - - 5,000
563 n-asetil sistein tablet 200 mg DAK 2019 Tablet - 2,600 2,600 20 2,580
566 Natrium Diklofenak tablet 50 mg DAK 2019 tablet 5600 5,600 11,200 1,030 10,170 2,800
578 Parasetamol drops DAK 2019 Botol - 112 112 - 112 100
579 Parasetamol sirup 120 mg/5ml DAK 2019 botol 915 500 1,415 398 1,017 500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
581 Parasetamol tablet 500 mg DAK 2019 Tablet - 16,500 16,500 - 16,500 10,000
585 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2019 Tablet 3,000 3,000 - 3,000 5,000
-
596 Ranitidin injeksi 25 mg/2 ml DAK 2019 Ampul 277 100 377 306 71 500
600 Ringer Laktat larutan infus steril DAK 2019 Botol 878 878 209 669

-
-

-
-

-

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
-
-
-
617 Simvastatin scored tablet 10 mg DAK 2019 Tablet 3360 3,360 70 3,290

-
-
628 Vitamin B kompleks tablet DAK 2019 Tablet 9,400 9,400 3,721 5,679 10,000
-
630 Obat TB FDC Katagori I PROV 2019 Ampul - 5 5 5 5
631 - - -
632 - - -
633 - - -
634 - - -
Obat HIV - - -
635 5(ZDV)+Lamivudine (3TC) 300/150 mg Hiv. 2015 kapsul 459.00 - - -
636 5Efavirenz (EFV) 600 mg Hiv. 2015 btl@30tab 191,250.00 - - -
637 5Lamivudine (3TC) 150 mg Hiv. 2015 btl@60tab 76,020.00 - - -
638 5Lopinavir/ritonavir (LPV/r) 200/50 mg Hiv. 2015 btl@120tab 736,203.00 - - -
639 5Nevirapine (NVP) 200 mg Zidovudine Hiv. 2015 btl@60tab 156,780.00 - - -
640 5Tenofovir (TDF) 300 mg Hiv. 2015 btl@30tab 31,950.00 - - -
641 5Tenofovir+Lamivudine+Efavirenz(300/300/600 mg) Hiv. 2015 btl@30tab 354,530.00 - - -
Obat Gigi - - -
Tahun 2012 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2016 - - -
643 Eugenol spray DAK 2016 Botol 3 - 3 -

18,100.00 3
644 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol 126,000.00 1 1 1 -
645 Mummifying pasta APBD II 2016 Botol 882,000.00 - - -
Tahun 2017 - - -
Tahun 2018 - - -
658 Cavitron APBD II 2018 Botol 226,600.00 4 4 - 4 5

668 TKF (Tricresol Formaldehid) APBD II 2018 Botol 139,600.00 2 2 1 1
Tahun 2019 - - -
673 Etil Klorida semprot APBD II 2019 Botol - - -
683 - - -
684 - - -
685 - - -
686 - - -
687 - - -
Obat Jiwa - - -
Tahun 2015 - - -
690 Diazepam injeksi 10 mg/2ml APBD II 2015 Ampul 38,245.00 17 17 - 17 10
692 Kodein tablet 10 mg DAK 2015 Tablet 500.00 70 70 20 50 -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
695 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet 510.00 2615 2,615 270 2,345
Tahun 2016 - - -
700 Diazepam tablet 2 mg APBD II 2016 Tablet 1,331.00 273 1,000 1,273 50 1,223 500
701 Diazepam tablet 5 mg PROV 2016 Tablet 540.00 852 852 87 765
705 Haloperidol tablet 1,5 mg JIWA APBD II 2016 Tablet 69.00 360 1,000 1,360 330 1,030 5,000
708 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet 1,341.00 955 100 1,055 15 1,040
Tahun 2017 - - -
Tahun 2018 - - -
720 Diazepam larutan rektal 5 mg/2,5 mL JIWA APBD II 2018 Tube 12,573.00 23 23 - 23 10
734 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet 1,121.00 1520 1,520 160 1,360 900
Tahun 2019 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
767 Karbamazepin tablet 200 mg APBD II 2019 Tablet - - - 2,000
770 Klorpromazin tablet 25 mg APBD II 2019 Tablet - - -
773 Kodein 10 mg APBD II 2019 Tablet - - -
783 - - -
784 - - -
785 - - -
786 - - -
787 - - -
Laboratorium - - -
Tahun 2018 - - -
965 Reagen Gol Darah LAB APBD II 2018 Set 660,000.00 - - - 1
Tahun 2019 - - -
970 Cell Pack LAB APBD II 2019 Botol - - -
971 Cleaner (Cell Clean) LAB APBD II 2019 Botol - - -
972 Kontrol LAB APBD II 2019 Botol - - -
973 Stromatolyser LAB APBD II 2019 Botol - - -
974 Widal Test LAB APBD II 2019 Set - - -
975 Reagen Gol Darah LAB APBD II 2019 Set - - -
976 Pot faeces LAB APBD II 2109 Pcs - - -
977 Pot Urine LAB APBD II 2109 Pcs - - -
978 Reagen TBC/ZN Paket - 8 8 8
979 Reagen Sifilis Paket - 300 300 300
980 - - -
981 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
982 - - -

NIP. 19600429 198703 1 010 NIP. 19720206 200604 1 004 NIP. 19810217 200902 2 005 NIP. 198506122006042003

PUSKESMAS : PUSKESMAS II NEGARA PELAPORAN BULAN / PERIODE : MEI 2019 IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
KECAMATAN : NEGARA PERMINTAAN BULAN / PERIODE : JUNI 2019 PUSKESMAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Alat Kesehatan -
Tahun 2012 - - -
3 - -
Plester 5 yard x 2 inchi DAK 2012 Rol 23,108.40 -
Tahun 2017 - - -
12 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2017 Pcs 85 - 85

140,700.00 85
140,700.00 144 144 5 139
80 100 180 2 178
Tahun 2018 - - -
30 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2018 Pcs - -

679.29 -
685.14 1200
32 Alat Suntik Sekali Pakai (TP) 5 cc DAK 2018 Pcs 297 - 297
815.15 297
9,660.00 -
9,660.00 -
37 Folley Catheter 2 way No. 22 DAK 2018 Pcs 7 - 7
9,660.00 7
38 Handscoen Safeglove PP Steril no 7,0 DAK 2018 Pasang 30 30 -
6,595.00 30
42 Infusion Set Dewasa (20 drops/ml) DAK 2018 Pcs - -
6,090.00 -
6,405.00 203
6,405.00 15
6,405.00 127
6,405.00 -
105,000.00 -
51 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak - -
8,400.00 -
52 Masker Earloop DAK 2018 Pcs 1,950 1,250 700
493.96 1950
27,830.00 2
27,000.00 -
55 Plester 5 cm x 5 m DAK 2018 Roll 3 3 -
24,948.00 3
3,300.00 22
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
58 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2018 Pcs - -
4,982.00 -
59 Verban 4 Yard x 10 cm DAK 2018 Roll - -
1,482.00 -
746.00 970
1,470.00 40
1,470.00 10
1,470.00 -
Tahun 2019 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

-
98 - - -
99 - - -
100 - - -
101 - - -
102 -
Tahun 2016 - - -
Tahun 2017 - - -
119 Heparin komb. Gel (Thrombopob gel 20 g) APBD II 2017 Tube 59,000.00 6 6 2 4
120 Perihidrol (Larutan H2O2 3%) APBD II 2017 botol 10,100.00 - - -
122 Minyak Telon 60 ml APBD II 2017 Botol 15,000.00 1 1 1 -

125 Serum anti bisa ular injeksi 5ml APBD II 2017 Vial 1,046,576.00 - - -
Tahun 2018 - - -
128 Asam Traneksamat tablet 500 mg APBD II 2018 tablet 2,900.00 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
135 Minyak kayu putih 60 ml APBD II 2018 Botol 27,300.00 7 7 3 4
136 Minyak Telon 60 ml APBD II 2018 Botol 24,200.00 2 2 - 2 4
141 Scabimite cream 10 gr APBD 2018 Tube 1 1 1 -
142 Serum anti bisa ular injeksi 5ml APBD II 2018 Vial 479,996.00 2 4 6 4 2 2
145 Plesterin APBD II 2018 Pcs 24,948.00 14 9 10
Tahun 2019 - - -
169 Serum Anti Tetanus 1.500 iu/ampul APBD II 2019 Ampul 24 20 44 21 23 20
Obat Generik - - -
Tahun 2016 - - -

3,700.00 -
3,700.00 -
Tahun 2017 - - -
216 Albendazol tablet 400 mg PROV 2017 tablet 380.00 4350 4,350 - 4,350

116.00 -
106.00 -
225 Asiklovir tablet 200 mg DAK 2017 Tablet 237.00 100 100 100 -

600 600 - 600

1,518.00 -
1,176.00 258 258 8 250
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
232 Digoksin 0,25 mg DAK 2017 Tablet 97.00 1210 1,210 100 1,110

270.00 100
- - -
- - -
239 Gentamisin tetes mata 0,3% DAK 2017 Botol 4,000.00 - - -

50 50 - 50
248 Karbamazepin tablet 200 mg JIWA APBD II 2017 Tablet 3,158.00 - - -
252 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol 2,140.00 - -

200 mg + Trimetoprim 40 mg DAK 2017 -
253 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet 151.00 6,644 503 6,141
80 mg DAK 2017 6644
254 mg DAK 2017
Kaplet 308.00 - - -
256 Lidokain Injeksi 2% (HCL) DAK 2017 Ampul 860.00 90 15 75

90
259 Metilergometrin Maleat injeksi 0,2 mg/ml DAK 2017 Ampul 2,684.00 6 6 6 -
205.00 -
2,580.00 104
262 Metoklopramide tablet DAK 2017 Tablet 180 180 -
90.00 180
- - -
268 Obat Kusta Dewasa MB PROV 2017 Blister 20,906.00 - 3 3 3 -
269 Obat TB FDC Katagori I PROV 2017 paket 360,000.50 - - -

10 10 10 -
271 Parasetamol tablet 500 mg DAK 2017 Tablet 58 58 -

56.00 58
1,800.00 45
7,150.00 -
3627 3,627 396 3,231
1,098.00 85
Tahun 2018 - - -
291 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2018 Vial 26 26 -
2,860.00 26
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
296 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol 9,700.00 1 1 - 1
297 Ambroksol tablet 30 mg DAK 2018 Tablet 404.00 20 20 20 -
301 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2018 1,995.00 1 1 1 -

311 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet 70.00 920 920 335 585

103.00 -
9,100.00 50
316 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul 1,595.00 - - -
320 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube 1,340.00 - - -
323 Deksametason injeksi i.v./i.m. 5 mg/ml DAK 2018 Ampul 347 - 347
1,097.00 347
324 Deksametason tablet 0,5 mg DAK 2018 Tablet - -
32.00 -
105.00 60
329 Domperidon suspensi/sirup 5 mg/5 ml DAK 2018 Botol 2,700.00 38 38 30 8 100
330 Domperidon tablet/kapsul/kaplet 10 mg DAK 2018 Tablet 35 - 35 1,000

85.00 35
1,408.00 30
6,090.00 -
338 Furosemid tablet 40 mg DAK 2018 Tablet 77.00 2254 2,254 145 2,109
340 Gentamisin salep kulit 0,1% DAK 2018 Tube 5,500.00 - - -
344 Glibenclamide tablet DAK 2018 Tablet 119.00 20000 20,000 100 19,900
347 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet - -

140.00 -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
351 Hidrokortison krim 2,5 % DAK 2018 Tube 2,475.00 - - -
354 Ibuprofen 400 mg Tablet DAK 2018 Tablet - 190 190 10 180
363 Ketorolak inj 30 mg/ml DAK 2018 Ampul 30 30 - 50

1,045.00 30
369 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2018 Tablet 22.00 286 286 286 -
370 mg DAK 2018 Kaplet - 540 540 - 540
371 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul 1,210.00 555 90 645 135 510
114.00 2000
123.00 -
3,796.00 12
96.00 15829
377 Metilergometrin Maleat Injeksi 0,2 mg/ml DAK 2018 ampul 50 2 48 100
2,959.00 50
378 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet 880 120 760
210.00 880
379 Metilprednisolon tablet 4 mg DAK 2018 Tablet - - -
-
380 Metoklopramide sirup 5 mg/ 5 ml DAK 2018 Botol 120 - 120
2,530.00 120
386 Natrium diklofenak tablet 50 mg DAK 2018 Tablet - -

115.00 -
387 Natrium Klorida larutan infus 0,9% APBD II 2018 Botol 6,410.00 100 100 - 100
388 Nifedipin tablet 10 mg DAK 2018 Tablet 172.00 - - -

391 Obat TB FDC Katagori I PROV 2018 paket - 5 5 - 5
393 Obat TB FDC Kategori Anak PROV 2018 paket - - -
394 Oksitetrasiklin 1% salep mata DAK 2018 Tube 2,500.00 - - -
395 Oksitosin inj 10 IU/ml DAK 2018 ampul 1,199.00 - 100 100 10 90
396 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet 130.00 68 68 68 -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
402 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2018 Tablet 20 20 -
123.00 20
385.00 4463
409 Propiltiourasil tablet 100 mg DAK 2018 Tablet 432.00 1200 1,200 330 870

705.00 130
7,150.00 -
415 Salbutamol cairan ih 0,1% (Ventolin nebulle) DAK 2018 Ampul 56 56 -
10,875.00 56
416 Salbutamol tablet 4 mg (sebagai Sulfat) DAK 2018 Tablet 6,315 916 5,399
70.00 6315
418 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot 2,621.00 6 6 5 1 24
419 Salisil Bedak 2% DAK 2018 Pcs 96 181 34 147 96

3,520.00 85
420 Sefadroksil tablet 500 mg DAK 2018 Tablet 140 140 -
478.00 140
3,926.00 8
803.00 -
4,200.00 304
4,483.00 370
426 Setirizin sirup 5 mg/5 ml DAK 2018 Botol 28 28 -
2,850.00 28
428 Simetidin tablet 200 mg DAK 2018 Tablet - -
447.00 -
433 Tablet Tambah Darah/Sulfas Ferrosus Prov. 2018 tablet 350.00 9840 9,840 1,950 7,890
435 Tiamfenikol tablet 500 mg DAK 2018 Tablet 523 23 500 1,000
1,471.00 523
436 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet 50 - 50 5,000
85.00 50
437 Vitamin B kompleks tablet DAK 2018 Tablet - -
118.00 -
439 Sianokobalamin (vitamin B12) injeksi 500 mcg DAK 2018 Ampul 100 200 - 200
1,035.00 100
Tahun 2019 - - -
441 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2019 Vial 120 240 43 197 120
120
444 Allopurinol tablet 100 mg DAK 2019 tablet 1000 3,000 4,000 - 4,000
448 Amoksisilin kaplet 500 mg DAK 2019 kaplet 6000 6,000 - 6,000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
449 Amoksisilin sirup kering 125 mg/ 5 ml DAK 2019 Botol 269 200 469 147 322 200
453 Antasida DOEN I tablet kunyah kombinasi DAK 2019 tablet 5000 5,000 10,000 250 9,750
454 Antasida DOEN II suspensi kombinasi DAK 2019 botol 708 200 908 75 833
457 Antihemoroid DOEN Kombinasi (supositoria) DAK 2019 supp 100 50 150 47 103 50
459 Asam Asetilsalisilat (Asetosal) tablet 100 mg DAK 2019 Tablet 1,000 100 900
1000
462 Asam Askorbat (Vitamin C) tablet 50 mg DAK 2019 tablet 4558 3,000 7,558 4,004 3,554 5,000
463 Asam Folat tablet 1 mg DAK 2019 tablet 2000 100 2,100 100 2,000

-
-
470 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2019 Ampul 5 5 - 5
473 Betametason krim 0,1 % (sebagai valerat) DAK 2019 tube 165 100 265 49 216 100

-

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
481 Dimenhidrinat tablet 50 mg DAK 2019 Tablet 1000 1,000 2,000 220 1,780

-

-
486 Epinefrin (adrenalin) injeksi 0,1% (sebagai HCl) DAK 2019 ampul 15 15 - 15
492 Fitomenadion (Vit K) inj 10 mg/ml DAK 2019 vial - 30 30 9 21 30
499 Gentamisin Sulfat Salep Mata 0,3 % DAK 2019 tube - - -
500 Gentamisin Sulfat Tetes Mata 0,3 % DAK 2019 botol 120 48 168 - 168

-
511 Hidrokortison krim 2,5 % DAK 2019 Tube 117 240 357 41 316

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
519 Kalsium Laktat (Kalk) tablet 500 mg DAK 2019 Tablet 2000 2,000 4,000 70 3,930
526 Ketorolak injeksi 30 mg/ml DAK 2019 Ampul 100 300 6 294
200
531 Kloramfenikol suspensi 125 mg / 5 ml DAK 2019 botol - 100 100 - 100
532 Kloramfenikol tetes telinga 3 % DAK 2019 botol 15 15 - 15
533 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2019 Tablet - 3,000 3,000 1,724 1,276 3,000
534 (Combivent Nebulle) DAK 2019 Ampul 168 168 92 76 100

537 mg DAK 2019 Kaplet - - -
538 Kotrimoksazol Suspensi kombinasi 240 mg/5 ml botol 496 200 696 29 667

-

-
544 Magnesium Sulfat inj (IV) 40% DAK 2019 vial 10 10 - 10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
555 Metilprednisolon tablet 4 mg DAK 2019 Tablet 4,000 120 3,880

4000
-
557 Metoklopramide tablet 10 mg DAK 2019 tablet - 5,000 5,000 - 5,000
563 n-asetil sistein tablet 200 mg DAK 2019 Tablet 2580 2,580 630 1,950 5,000
566 Natrium Diklofenak tablet 50 mg DAK 2019 tablet 10170 2,800 12,970 1,235 11,735

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
578 Parasetamol drops DAK 2019 Botol 112 112 224 10 214 112
579 Parasetamol sirup 120 mg/5ml DAK 2019 botol 1017 300 1,317 360 957 200
581 Parasetamol tablet 500 mg DAK 2019 Tablet 16500 16,500 332 16,168
585 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2019 Tablet 3,000 6,000 433 5,567 2,000
3000
596 Ranitidin injeksi 25 mg/2 ml DAK 2019 Ampul 71 800 871 48 823
600 Ringer Laktat larutan infus steril DAK 2019 Botol 669 669 89 580

-
-

-
-

-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

-
-
-
617 Simvastatin scored tablet 10 mg DAK 2019 Tablet 3290 3,290 10 3,280

-
-
5679
630 Obat TB FDC Katagori I PROV 2019 Ampul - - -
631 - - -
632 - - -
633 - - -
634 - - -
Obat HIV - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Obat Gigi - - -
Tahun 2012 - - -
Tahun 2016 - - -
643 Eugenol spray DAK 2016 Botol - -

18,100.00 -
644 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol 126,000.00 - - -
Tahun 2017 - - -
Tahun 2018 - - -
658 Cavitron APBD II 2018 Botol 226,600.00 4 9 13 - 13

Tahun 2019 - - -
683 - - -
684 - - -
685 - - -
686 - - -
687 - - -
Obat Jiwa - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2015 - - -
690 Diazepam injeksi 10 mg/2ml APBD II 2015 Ampul 38,245.00 17 10 27 - 27
692 Kodein tablet 10 mg DAK 2015 Tablet 500.00 - - -
695 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet 510.00 2345 1,000 3,345 420 2,000 925
Tahun 2016 - - -
700 Diazepam tablet 2 mg APBD II 2016 Tablet 1,331.00 1223 500 1,723 32 1,691
705 Haloperidol tablet 1,5 mg JIWA APBD II 2016 Tablet 69.00 1030 1,000 2,030 590 1,440
708 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet 1,341.00 1040 1,040 110 930
Tahun 2017 - - -
711 Haloperidol Tablet 0,5 mg DAK 2017 tablet 59.00 291 291 - 291
Tahun 2018 - - -
719 Anti bakteri Salep Kulit DAK 2018 Tube 3,035.00 8 8 8 -
734 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet 1,121.00 1360 900 2,260 490 1,770 900
Tahun 2019 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
767 Karbamazepin tablet 200 mg APBD II 2019 Tablet - 2,500 2,500 180 2,320
783 - - -
784 - - -
785 - - -
786 - - -
787 - - -
Laboratorium - - -
Tahun 2018 - - -
Tahun 2019 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
978 Reagen TBC/ZN Paket - - -
979 Reagen Sifilis Paket - - -
980 - - -
981 - - -
982 - - -

NIP. 19600429 198703 1 010 NIP. 19720206 200604 1 004 NIP. 19810217 200902 2 005 NIP. 198506122006042003

PUSKESMAS : PUSKESMAS II NEGARA PELAPORAN BULAN / PERIODE : JUNI 2019 IFK / DINAS KES ……./ IFK / 2019 ……../…….../………
KECAMATAN : NEGARA PERMINTAAN BULAN / PERIODE : JULI 2019 PUSKESMAS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Alat Kesehatan -
Tahun 2012 - - -
3 - -
Plester 5 yard x 2 inchi DAK 2012 Rol 23,108.40 -
Tahun 2017 - - -

3,908.33 85
3,908.33 139 139 24 115
178 178 28 150
Tahun 2018 - - -
30 Alat Suntik Sekali Pakai (TP) 1 cc DAK 2018 Pcs - -

679.29 -
685.14 1200
815.15 297
9,660.00 -
9,660.00 -
37 Folley Catheter 2 way No. 22 DAK 2018 Pcs 7 - 7
9,660.00 7
38 Handscoen Safeglove PP Steril no 7,0 DAK 2018 Pasang - -
6,595.00 -
42 Infusion Set Dewasa (20 drops/ml) DAK 2018 Pcs - -
6,090.00 -
6,405.00 179
46 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 20) DAK 2018 Pcs 5 5 -
6,405.00 5
6,405.00 68
6,405.00 -
105,000.00 -
51 Kasa hydrophil Steril 16 x 16 DAK 2018 Kotak - -
8,400.00 -
52 Masker Earloop DAK 2018 Pcs 700 700 -
493.96 700
27,830.00 2
27,000.00 -
55 Plester 5 cm x 5 m DAK 2018 Roll - -
24,948.00 -
3,300.00 22
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
58 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2018 Pcs - -
4,982.00 -
59 Verban 4 Yard x 10 cm DAK 2018 Roll - -
1,482.00 -
746.00 928
61 Wing needle No.23 DAK 2018 Botol 40 10 30
1,470.00 40
1,470.00 10
1,470.00 -
Tahun 2019 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

-
98 - - -
99 - - -
100 - - -
101 - - -
102 -
Tahun 2016 - - -
Tahun 2017 - - -
120 Perihidrol (Larutan H2O2 3%) APBD II 2017 botol 10,100.00 - - -

125 Serum anti bisa ular injeksi 5ml APBD II 2017 Vial 1,046,576.00 - - -
Tahun 2018 - - -
128 Asam Traneksamat tablet 500 mg APBD II 2018 tablet 2,900.00 - - -
132 Jarum Kulit APBD II 2018 Set/12 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
133 Jarum Otot APBD II 2018 Set/12 - - -
135 Minyak kayu putih 60 ml APBD II 2018 Botol 27,300.00 4 4 1 3 5
141 Scabimite cream 10 gr APBD 2018 Tube 58,218.00 - - -
142 Serum anti bisa ular injeksi 5ml APBD II 2018 Vial 479,996.00 2 2 2 -
144 Handsanitizer 50 ml APBD II 2018 Botol 19,000.00 5 5 - 5
145 Plesterin APBD II 2018 Pcs 24,948.00 9 9 5 4
Tahun 2019 - - -
169 Serum Anti Tetanus 1.500 iu/ampul APBD II 2019 Ampul 130,999.00 23 23 8 15 20
Obat Generik - - -
Tahun 2016 - - -
198 Magnesium Sulfat inj (IV) 20% PROV 2016 vial 5,500.00 120 120 1 119

3,700.00 -
3,700.00 -
209 Retinol (Vitamin A) 200.000 iu Prov. 2016 kapsul 459.00 - - - 4,500
Tahun 2017 - - -
216 Albendazol tablet 400 mg PROV 2017 tablet 380.00 - - -

116.00 -
106.00 -
225 Asiklovir tablet 200 mg DAK 2017 Tablet 237.00 - - -

600 600 - 600

1,518.00 -
1,176.00 250 250 17 233
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

270.00 100
- - -
- - -
239 Gentamisin tetes mata 0,3% DAK 2017 Botol 4,000.00 - - -

50 50 - 50
248 Karbamazepin tablet 200 mg JIWA APBD II 2017 Tablet 3,158.00 - - -
252 Kotrimoksazol (Dewasa ) kombinasi tiap 5 ml Suspensi :Sulfametoksazol Botol 2,140.00 - -

200 mg + Trimetoprim 40 mg DAK 2017 -
253 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ trimetoprim Tablet 151.00 6,141 260 5,881
80 mg DAK 2017 6141
254 mg DAK 2017
Kaplet 308.00 - - -
256 Lidokain Injeksi 2% (HCL) DAK 2017 Ampul 860.00 75 45 30 100

75
259 Metilergometrin Maleat injeksi 0,2 mg/ml DAK 2017 Ampul 2,684.00 - - -
205.00 -
261 Metoklopramide sirup 5 mg/ 5 ml DAK 2017 Botol 32 32 -
2,580.00 32
262 Metoklopramide tablet DAK 2017 Tablet - -
90.00 -
- - -
268 Obat Kusta Dewasa MB PROV 2017 Blister 20,906.00 - - -
269 Obat TB FDC Katagori I PROV 2017 paket 360,000.50 - - -

- - -
271 Parasetamol tablet 500 mg DAK 2017 Tablet - -

56.00 -
1,800.00 40
7,150.00 -
3231 3,231 342 2,889
1,098.00 42
Tahun 2018 - - -
291 Air Untuk Injeksi (Aqua pro Injeks) 20 ml DAK 2018 Vial - -
2,860.00 -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
296 Ambroksol sirup 15 mg/5 ml DAK 2018 Botol 9,700.00 1 1 1 -
297 Ambroksol tablet 30 mg DAK 2018 Tablet 404.00 - - -
301 ml, Magnesium Hidroksida 200 mg/ 5 ml. DAK 2018 1,995.00 - - -

311 Asam Folat tablet/kapsul/kaplet 1 mg DAK 2018 Tablet 70.00 585 585 310 275

103.00 -
9,100.00 50
316 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2018 ampul 1,595.00 - - -
320 Betametason krim 0,1 % (sebagai valerat) DAK 2018 Tube 1,340.00 - - -
1,097.00 347
324 Deksametason tablet 0,5 mg DAK 2018 Tablet - -
32.00 -
105.00 60

85.00 35
1,408.00 30
6,090.00 -
337 Furosemid Injeksi 10 mg / ml DAK 2018 Ampul 1,333.00 - - -
338 Furosemid tablet 40 mg DAK 2018 Tablet 77.00 2109 2,109 115 1,994
339 Garam Oralit I PROV 2018 Sachet 260.00 2000 2,000 179 1,821
340 Gentamisin salep kulit 0,1% DAK 2018 Tube 5,500.00 - - -
342 Gentamisin tetes mata 0,3% DAK 2018 Botol 4,232.00 3 3 3 - 240
343 Gentian Violet larutan 1 % DAK 2018 Botol 4,200.00 52 52 22 30 72
347 Gliseril Guayakolat tablet 100mg DAK 2018 Tablet - -

140.00 -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
351 Hidrokortison krim 2,5 % DAK 2018 Tube 2,475.00 - - -
354 Ibuprofen 400 mg Tablet DAK 2018 Tablet 127.00 180 180 - 180
363 Ketorolak inj 30 mg/ml DAK 2018 Ampul - -

1,045.00 -
369 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2018 Tablet 22.00 - - -

370 mg DAK 2018 Kaplet 308.00 540 540 10 530
371 Lidokain Injeksi 2% + Epineprin 1:80.000 (HCL) DAK 2018 Ampul 1,210.00 510 510 - 510
114.00 2000
123.00 -
375 Magnesium Sulfat Injeksi 40% DAK 2018 vial 10 - 10
3,796.00 10
376 Metformin HCl tablet 500 mg DAK 2018 Tablet 13,381 4,840 8,541 10,000
96.00 13381
377 Metilergometrin Maleat Injeksi 0,2 mg/ml DAK 2018 ampul 100 148 6 142
2,959.00 48
378 Metilergometrin Maleat tablet 0,125 mg DAK 2018 Tablet 760 100 660 1,000
210.00 760
-
2,530.00 120
383 Mikonazol krim/salep 2 % (Nitrat ) DAK 2018 3,414.00 141 141 28 113 100
386 Natrium diklofenak tablet 50 mg DAK 2018 Tablet - -

115.00 -
387 Natrium Klorida larutan infus 0,9% APBD II 2018 Botol 6,410.00 100 100 52 48 60
388 Nifedipin tablet 10 mg DAK 2018 Tablet 172.00 - - -

391 Obat TB FDC Katagori I PROV 2018 paket 5 5 5 -
393 Obat TB FDC Kategori Anak PROV 2018 paket - - -
394 Oksitetrasiklin 1% salep mata DAK 2018 Tube 2,500.00 - - -
395 Oksitosin inj 10 IU/ml DAK 2018 ampul 1,199.00 90 90 24 66
396 Omeprazol kapsul/kaplet 20 mg DAK 2018 Tablet 130.00 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
402 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2018 Tablet - - 3,000
123.00 -
385.00 4433
409 Propiltiourasil tablet 100 mg DAK 2018 Tablet 432.00 870 870 300 570

705.00 120
7,150.00 -
10,875.00 -
416 Salbutamol tablet 4 mg (sebagai Sulfat) DAK 2018 Tablet 5,399 1,042 4,357
70.00 5399
418 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% DAK 2018 Pot 2,621.00 1 1 1 -
419 Salisil Bedak 2% DAK 2018 Pcs 96 243 27 216

3,520.00 147
420 Sefadroksil tablet 500 mg DAK 2018 Tablet - -
478.00 -
3,926.00 8
803.00 -
4,200.00 311
4,483.00 370
2,850.00 -
428 Simetidin tablet 200 mg DAK 2018 Tablet - -
447.00 -
435 Tiamfenikol tablet 500 mg DAK 2018 Tablet 500 - 500

1,471.00 500
436 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) DAK 2018 Tablet 50 - 50
85.00 50
118.00 -
1,035.00 200
Tahun 2019 - - -
2,860.00 197
444 Allopurinol tablet 100 mg DAK 2019 tablet 99.00 4000 4,000 - 4,000
446 Ambroxol sirup 15 mg/5 ml DAK 2019 botol - - - 50
448 Amoksisilin kaplet 500 mg DAK 2019 kaplet 233.00 6000 6,000 12,000 - 12,000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
449 Amoksisilin sirup kering 125 mg/ 5 ml DAK 2019 Botol 3,324.00 322 322 73 249 500
450 Ampisislin injeksi 1000 mg DAK 2019 vial 8,237.00 - - -
453 Antasida DOEN I tablet kunyah kombinasi DAK 2019 tablet 54.00 9750 9,750 2,540 7,210 10,000
454 Antasida DOEN II suspensi kombinasi DAK 2019 botol 1,995.00 833 833 26 807 200
456 Antifungi DOEN salep kulit DAK 2019 pot 4,496.00 - - -
457 Antihemoroid DOEN Kombinasi (supositoria) DAK 2019 supp 3,167.00 103 50 153 - 153
458 Antimigren: Ergotamin Tartrat + Kofein DAK 2019 Tablet 173.00 - - -
459 Asam Asetilsalisilat (Asetosal) tablet 100 mg DAK 2019 Tablet 900 40 860
99.00 900
462 Asam Askorbat (Vitamin C) tablet 50 mg DAK 2019 tablet 105.00 3554 5,000 8,554 2,503 6,051 5,000
463 Asam Folat tablet 1 mg DAK 2019 tablet 2000 2,000 - 2,000

52.00 -
465 Asam Mefenamat tablet/kapsul/kaplet 500 mg DAK 2019 Kaplet - - 10,000
103.00 -
466 Asiklovir krim 5 % DAK 2019 tube - - - 30
467 Asiklovir tablet 400 mg DAK 2019 tablet 380.00 - - -
469 Atapulgit tablet 600 mg DAK 2019 Tablet 136.00 - - -
470 Atropin (Sulfat) injeksi 0,25 mg/ml DAK 2019 Ampul 5 5 2 3
472 Betahistin Mesilat tablet 6 mg DAK 2019 tablet 110.00 - 3,000 3,000 - 3,000 3,000
473 Betametason krim 0,1 % (sebagai valerat) DAK 2019 tube 1,340.00 216 50 266 34 232 100

1,097.00 -
476 Deksametason tablet 0,5 mg DAK 2019 tablet 32.00 - - -
478 Difenhidramin inj. 10 mg/ml - 1 ml DAK 2019 Ampul 1,095.00 - - -
479 Digoksin tablet 0,25 mg DAK 2019 Tablet 104.00 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
481 Dimenhidrinat tablet 50 mg DAK 2019 Tablet 105.00 1780 1,780 - 1,780

264.00 -

-
486 Epinefrin (adrenalin) injeksi 0,1% (sebagai HCl) DAK 2019 ampul 1,408.00 15 15 - 15
491 Fenol Gliserol tetes telinga 10% DAK 2019 botol 2,590.00 - - -
492 Fitomenadion (Vit K) inj 10 mg/ml DAK 2019 vial 3,682.00 21 30 51 10 41
493 Fitomenadion (Vit. K1) tablet 10 mg DAK 2019 tablet 710.00 - - -
494 Furosemid injeksi i.v / im 10 mg/ml DAK 2019 ampul 1,333.00 - - -
495 Furosemid tablet 40 mg DAK 2019 Tablet 77.00 - - -
499 Gentamisin Sulfat Salep Mata 0,3 % DAK 2019 tube 2,675.00 - - -
500 Gentamisin Sulfat Tetes Mata 0,3 % DAK 2019 botol 4,232.00 168 168 51 117
502 Glibenklamid tablet 5 mg DAK 2019 Tablet 180.00 - - -

-
506 Glukosa larutan infus 5% steril DAK 2019 Botol 6,900.00 - - -
507 Glukosa larutan infus 10% steril DAK 2019 Botol 7,500.00 - - -
510 Hidroklortiazid tablet 25 mg DAK 2019 Tablet 155.00 - - -
511 Hidrokortison krim 2,5 % DAK 2019 Tube 2,475.00 316 316 40 276

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
518 Kalsium Glukonat Injeksi 200 mg DAK 2019 Ampul 10,351.00 - 5 5 1 4
519 Kalsium Laktat (Kalk) tablet 500 mg DAK 2019 Tablet 59.00 3930 3,930 530 3,400
521 Kaptopril tablet 25 mg DAK 2019 tablet - - - 500
524 Ketoprofen Supp 100 mg DAK 2019 Suppo 2,380.00 - - -
526 Ketorolak injeksi 30 mg/ml DAK 2019 Ampul 100 394 91 303
1,045.00 294
529 Kloramfenikol kapsul 500 mg DAK 2019 Kapsul 1,090.00 - - - 3,000
530 Kloramfenikol salep mata 1% DAK 2019 Tube 1,881.00 - - -
531 Kloramfenikol suspensi 125 mg / 5 ml DAK 2019 botol 100 100 - 100 100
532 Kloramfenikol tetes telinga 3 % DAK 2019 botol 15 15 15
533 Klorfeniramin Maleat (CTM) tablet 4 mg DAK 2019 Tablet 1276 1,276 1,010 266
534 (Combivent Nebulle) DAK 2019 Ampul 4,550.00 76 200 276 83 193 100

537 mg DAK 2019 Kaplet - - -
538 Kotrimoksazol Suspensi kombinasi 240 mg/5 ml botol 2,052.00 667 667 21 646

-
540 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml DAK 2019 Ampul 1,210.00 - - -

-
544 Magnesium Sulfat inj (IV) 40% DAK 2019 vial 3,796.00 10 5 15 15
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
551 Metformin HCI tablet 500 mg DAK 2019 tablet 96.00 - - -
552 Metilergometrin Maleat injeksi 0,200 mg DAK 2019 ampul 2,959.00 - - -
553 Metilergometrin Maleat tablet 0,125 mg DAK 2019 tablet 210.00 - - -
555 Metilprednisolon tablet 4 mg DAK 2019 Tablet 3,880 185 3,695

134.00 3880
2,530.00 -
557 Metoklopramide tablet 10 mg DAK 2019 tablet 80.00 5000 5,000 - 5,000
560 Metronidazol Syr 125 mg / 5ml DAK 2019 Botol 3,950.00 - - -
561 Mikonazol krim/salep 2 % (Nitrat ) DAK 2019 tube 3,414.00 - - -
563 n-asetil sistein tablet 200 mg DAK 2019 Tablet 350.00 1950 1,950 860 1,090
566 Natrium Diklofenak tablet 50 mg DAK 2019 tablet 115.00 11735 11,735 1,340 10,395 5,600
567 Natrium Klorida larutan infuse 0.9 % DAK 2019 botol 6,410.00 - - -
569 Nistatin vaginal tablet 100.000IU/g DAK 2019 ovula 560.00 - - -
573 Oksitetrasiklin salep mata 1% DAK 2019 tube 2,500.00 - - -
574 Oksitosin injeksi 10 iu / ml - 1 ml DAK 2019 ampul 1,199.00 - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
578 Parasetamol drops DAK 2019 Botol 6,649.00 214 112 326 2 324
579 Parasetamol sirup 120 mg/5ml DAK 2019 botol 1,107.00 957 200 1,157 337 820 500
581 Parasetamol tablet 500 mg DAK 2019 Tablet 53.00 16168 16,168 278 15,890 16,800
585 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) DAK 2019 Tablet 5,567 343 5,224
123.00 5567
596 Ranitidin injeksi 25 mg/2 ml DAK 2019 Ampul 1,155.00 823 823 143 680
600 Ringer Laktat larutan infus steril DAK 2019 Botol 7,150.00 580 580 202 378

-
-
603 Salbutamol tablet 2 mg (sebagai sulfat) DAK 2019 Tablet 63.00 - - -

70.00 -
605 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap DAK 2019 Pot 24 24 - 24
2,621.00 -

-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

-
-
-
617 Simvastatin scored tablet 10 mg DAK 2019 Tablet 110.00 3280 3,280 270 3,010
619 Spironolakton tablet 100 mg DAK 2019 Tablet 539.00 - - -
620 Spironolakton tablet 25 mg DAK 2019 Tablet 195.00 - - -

303.00 -
-
628 Vitamin B kompleks tablet DAK 2019 Tablet 12,444 - 12,444

118.00 12444
630 Obat TB FDC Katagori I PROV 2019 Ampul - - -
631 Kloramfenikol sk Tube - - - 100
632 Amlodipine 5 mg tablet 78.00 - - - 5,000
633 Amlodipine 10 mg Prov 2019 tablet 94.00 - 100 100 - 100
634 - - -
Obat HIV - - -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Obat Gigi - - -
Tahun 2012 - - -
Tahun 2016 - - -
643 Eugenol spray DAK 2016 Botol - -

18,100.00 -
644 Monoklorkamfer Mentol cairan (CHKM) APBD II 2016 Botol 126,000.00 - - -
Tahun 2017 - - -
Tahun 2018 - - -
658 Cavitron APBD II 2018 Botol 226,600.00 13 13 - 13

Tahun 2019 - - -
683 - - -
684 - - -
685 - - -
686 - - -
687 - - -
Obat Jiwa - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tahun 2015 - - -
688 Alprazolam tablet/kapsul/kaplet 1 mg DAK 2015 Tablet 233.00 478 478 - 478 200
692 Kodein tablet 10 mg DAK 2015 Tablet 500.00 - - -
694 Trifluoperazin tablet 5 mg DAK 2015 Tablet 405.00 30 30 30 -
695 Trihexpenidil tablet 2 mg (HEXIMER 2 mg) APBD II 2015 Tablet 510.00 925 925 146 779 1,000
Tahun 2016 - - -
700 Diazepam tablet 2 mg APBD II 2016 Tablet 1,331.00 1691 1,691 63 1,628
705 Haloperidol tablet 1,5 mg JIWA APBD II 2016 Tablet 69.00 1440 1,440 510 930 500
708 Lorazepam tablet 2 mg JIWA APBD II 2016 Tablet 1,341.00 930 930 60 870
Tahun 2017 - - -
711 Haloperidol Tablet 0,5 mg DAK 2017 tablet 59.00 291 291 65 226 300
Tahun 2018 - - -
719 Anti bakteri Salep Kulit DAK 2018 Tube 3,035.00 - - -
720 Diazepam larutan rektal 5 mg/2,5 mL JIWA APBD II 2018 Tube 12,573.00 20 20 - 20
731 Haloperidol tablet 5 mg JIWA APBD II 2018 Tablet 56.00 - - - 3,000
734 Klozapin tablet 25 mg JIWA APBD II 2018 Tablet 1,121.00 1770 900 2,670 240 2,430
Tahun 2019 - - -
749 Amitriptilin tablet salut 25 mg (HCl) APBD II 2019 Tablet - - - 200
756 Fenitoin kapsul/kaplet 100 mg APBD II 2019 Kapsul - - - 500
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
767 Karbamazepin tablet 200 mg APBD II 2019 Tablet 230.00 2320 2,320 90 2,230
783 - - -
784 - - -
785 - - -
786 - - -
787 - - -
Laboratorium - - -
Tahun 2018 - - -
Tahun 2019 - - -
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
978 Reagen TBC/ZN Paket - - -
979 Reagen Sifilis Paket - - -
980 - - -
981 - - -
982 - - -

NIP. 19600429 198703 1 010 NIP. 19720206 200604 1 004 NIP. 19810217 200902 2 005 NIP. 198506122006042003

Laporan Pemakaian Dan Lembar Permintaan Obat Tahun 2019

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Laporan Pemakaian Dan Lembar Permintaan Obat Tahun 2019

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LAPORAN P

No Nama Obat Satuan

12 IV Catheter (STERA) No. 22 G x 1 " DAK 2015 Set

13 IV Catheter (STERA) No. 24 G x 3/4 " DAK 2015 Set

14 IV Catheter no 20 G DAK 2015 Set

15 IV Catheter no 22 G DAK 2015 Set

16 IV Catheter no 24 G DAK 2015 Set

18 Pharmafix 10 x 5cm DAK 2015 Rol

19 Wing Needle no 21 G APBD II 2015 Pcs

21 Alat Suntik Sekali Pakai (TP) 3 cc DAK 2016 Pcs

22 Alat Suntik Sekali Pakai (TP) 5 cc DAK 2016 Pcs

23 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2016 Pcs

24 Catgut Chromic 3/0 + jarum 1/2 GT 35 mm DAK 2016 Pcs

25 Folley Catheter 2 way No. 18 DAK 2016 Pcs

26 Folley Catheter 2 way No. 20 DAK 2016 Pcs

27 Folley Catheter 2 way No. 22 DAK 2016 Pcs

28 Handscoen Safeglove PP Steril no 7,5 DAK 2016 Pasang

29 Handscoen Safeglove PP Steril no 8 DAK 2016 Pasang

30 Infusion Set Anak (60 drops/ml) DAK 2016 Pcs

31 Infusion Set Dewasa (20 drops/ml) DAK 2016 Pcs

32 IV Catheter no 18 G DAK 2016 Set

33 IV Catheter no 22 G DAK 2016 Set

34 Masker Onemed Surgical Mask Earloop DAK 2016 Pcs

35 Silk 2/0 + jarum 1/2 GT 35 mm DAK 2016 Pcs

36 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2016 Pcs

36 Alat Suntik Sekali Pakai (TP) 3 cc DAK 2017 Pcs

37 Alat Suntik Sekali Pakai (TP) 5 cc DAK 2017 Pcs

38 AXIMED Nonwoven Fixation/ 5 cm x 10 m DAK 2017 Roll

39 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2017 Pcs

40 Catgut Chromic 3/0 + jarum 1/2 GT 35 mm DAK 2017 Pcs

41 Folley Catheter 2 way No. 18 DAK 2017 Pcs

43 Folley Catheter 2 way No. 22 DAK 2017 Pcs

44 Handscoen Safeglove PP no 7 (Sterile / Pre Powder) DAK 2017 pcs

45 Handscoen Safeglove PP no 7,5 (Sterile / Pre Powder) DAK 2017 pcs

46 Handscoen Safeglove PP no 8 (Sterile / Pre Powder) DAK 2017 pcs

49 IV Catheter (TERUMO) SR+OX1832C3 (IV Cateter No 18) DAK 2017 Pcs

50 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 20) DAK 2017 Pcs

51 IV Catheter (TERUMO) SR+OX2225C3 (IV Cateter No 22) DAK 2017 Pcs

52 IV Catheter (TERUMO) SR+OX2419C3 (IV Cateter No 24) DAK 2017 Pcs

53 Masker Earloop DAK 2017 Pcs

54 Silk 2/0 + jarum 1/2 GT 35 mm DAK 2017 Pcs

55 Urine Bag Standard Steril 2 Lt (T Valve) DAK 2017 Pcs

56 Wing Needle 21 G DAK 2017 Pcs

57 Wing Needle 23 G DAK 2017 Pcs

58 Wing Needle 25 G DAK 2017 Pcs

60 Alat Suntik Sekali Pakai (TP) 3 cc DAK 2018 Pcs

61 Alat Suntik Sekali Pakai (TP) 5 cc DAK 2018 Pcs

62 Catgut Chromic 2/0 + jarum 1/2 GT 35 mm DAK 2018 Pcs

63 Catgut Chromic 3/0 + jarum 1/2 GT 35 mm DAK 2018 Pcs

64 Folley Catheter 2 way No. 18 DAK 2018 Pcs

65 Folley Catheter 2 way No. 20 DAK 2018 Pcs

66 Folley Catheter 2 way No. 22 DAK 2018 Pcs

67 Handscoen Safeglove PP Steril no 7,0 DAK 2018 Pasang

68 Handscoen Safeglove PP Steril no 7,5 DAK 2018 Pasang

69 Handscoen Safeglove PP Steril no 8 DAK 2018 Pasang

71 Infusion Set Dewasa (20 drops/ml) DAK 2018 Pcs

72 Kasa Pembalut Hidrofil 4 m x 10 cm DAK 2018 rol

75 Povidone Iodine 300 ml DAK 2018 Botol

76 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 18) DAK 2018 pcs

77 IV Catheter (TERUMO) SR+OX2032C3 (IV Cateter No 20) DAK 2018 Pcs

78 IV Catheter (TERUMO) SR+OX2225C3 (IV Cateter No 22) DAK 2018 Pcs

79 IV Catheter (TERUMO) SR+OX2419C3 (IV Cateter No 24) DAK 2018 Pcs

80 Kapas Adsorben 250g DAK 2018 pcs