DAFTAR OBAT FORMULARIUM

RENCANA ANGGARAN BELANJA BAHAN MEDIS PAKAI HABIS TAHUN 2015

NAMA PUSKESMAS UPTD PUSKESMAS CILEDUGALAMAT RADEN PATAHTELEPON

NO. NAMA OBAT KEMASAN

e-KATALOG PENERIMAAN OBAT

HARGA OBAT (Rp) PABRIK JAN FEB MAR APR MEI

1 2 4 5 6 7 8 9 10 11

OBAT

PERBEKALAN KESEHATAN

1 Alat Suntik sekali pakai 0,05 ml Pcs


3 Alat Suntik sekali pakai 1 ml Box 65,000.00 Jayamas 100

4 Alat Suntik sekali pakai 3 ml Box 65,000.00 Jayamas 200 500 900

5 Alat Suntik sekali pakai 5 ml Pcs

6 Blood set Set

7 Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum bedah Sach

8 Benang Bedah Silk No. 2/0 - 3/0 dengan jarum bedah Sach 110,000.00 Jayamas

9 Benang Bedah Catgut Chromic 2/0 -100 m Cassete

10 Benang Bedah Catgut Plain 3/0 -100 m Cassete

11 Benang Bedah Silk Black 3/0 -100 m Cassete

12 Dental Film Hanshin Pcs

13 Etanol 70 % - 1 L Botol 21,500.00 Jayamas 1

14 Gel USG / EKG Botol

15 Infusion Set Anak Pcs

16 Infusion Set Dewasa Pcs 3,200.00 Jayamas

17 IV. Catheter No.18 G Set



20 Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT Sach

21 Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR Sach

22 Kapas Pembalut / absorben 250 gram Bungkus 12,500.00 Jayamas 1 3 2

23 Kassa Hidrofil Steril uk. 16 x 16 Kotak 5,800.00 Jayamas 7

24 Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm Roll 105,000.00 Jayamas

25 Kassa pembalut hidrofil 4m x 10 cm Roll 1,500.00 Jayamas 5 15

26 Kertas EKG Roll

27 Kertas USG Sony 110 HG Roll

28 Larutan Clorin 5,25% - 1 L (Desinfektan Alat) Botol

29 Larutan Desinfectan - 1 L (Desinfektan Ruangan) Botol

30 Larutan Antiseptik / Desinfektan hanrub mengandung chlorhexidine gluconate 0.5 % Botol 500 ml 30,000.00

31 Lysol 1 L Botol 1 L 41,000.00 Jayamas

32 Lembar

33 Masker Kotak 16,500.00 Jayamas 8 6 11

34 Masker O2 Pcs

35 Masker nebulizer set dewasa Pcs

36 Masker nebulizer set anak Pcs

37 Plester 5 yard X 2 inch Roll

Kassa steril mengandung obat (Framycetin) / Lomatulle

38 Roll

39 Pot Urin Pcs

40 Sarung Tangan Kotak 32,500.00 Jayamas

41 Wing needle Pcs 3,200.00 Jayamas

42 Safety Box Pcs

43 Surgical blade no.11 (Pisau Bedah) Pcs

PEMERIKSAAN TB PARU

1 Emersi Botol 100 ml

2 Eter Alkohol Botol 100 ml

3 Kaca Slide / Object Glass Kotak

4 Pot dahak Pcs

5 Reagen Zielnelsen Set

6 Spiritus Bakar Botol

7 Tissu Lensa Kotak

8 Wadah Kaca Slide / Box Slide Pcs

9 Xylol Botol 100 ml

EMBALAGE

1 Kantong Kresek obat + cetakan, ukuran 15 x 30 Lembar

2 Plastik Obat dg klip + cetakan, ukuran 7 x 10 cm Pak /100lbr


4 Kertas Perkamen ( ukuran 8 x 11 ) Pak /1000lbr

5 Sendok obat Pcs

AKUPUNTUR

1 Jarum Akupuntur 13 mm Kotak

Plester non alergi 0,5 inch / Micropore



4 Jarum telinga (press needle) Kotak

5 Moxa Roll Kotak

OBAT PONED

1 Apron plastik Pcs

2 Ampul

3 Ampul

4 Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml Ampul

5 Ikat Tali Pusat ( Umbilical Cord klem ) Pcs

6 Metilergometrin maleat injeksi 0,200 mg - 1 ml Ampul

7 MgSO4 40 % injeksi Vial

8 Tablet

9 Natrium Bicarbonat injeksi Ampul

10 Nasal dewasa / Maxyflow Pcs

11 Nasal infant/ Oxyflow Pcs

12 Ampul

13 Penghisap Lendir Bayi Baru Lahir Pcs

14 Sarung Tangan panjang obgyn No. 6,5 Pasang

15 Sarung Tangan panjang obgyn No. 7 Pasang


17 Sarung tangan steril/Surgical gloves steril No. 6,5 Pasang

Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik

Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal

Misoprostol tablet 0,2 mg / Noprostol

Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin

18 Sarung tangan steril/Surgical gloves steril No. 7 Pasang

19 Sarung tangan steril/Surgical gloves steril No.7,5 Pasang

20 Sungkup bayi Set

21 Tanda Pengenal (ID Band) Bayi Psc

22 Tanda Pengenal (ID Band) Ibu Psc

23 Under Pad 60 x 90 cm Psc

24 Ampul

TAMBAHAN

1 Botol

2 Ambroksol tablet 30mg Tablet

3 Botol

4 Asering infus Botol

5 Asiklovir tablet 200 mg Tablet

6 Tablet

7 Buskopan injeksi Ampul

8 Bur Fissure standart Pcs

9 Bur Fissure panjang Pcs

10 Deksametason injeksi 5 mg/ml-1ml Ampul 1,580.00 Indofarma

11 Etanol 96 % - 1 L Botol

12 Gentian Violet larutan 1 % Botol

13 Glucose Larutan Infus 10% Steril Botol

Valethamate Br 8 mg /ml injeksi / Epidosin

Antiseptik & kortikosteroid Tetes mata (Neomycin 3,5 mg, Polymixin B Sulfat 10.000 IU, Dexamethason 1,0 mg) - 5 ml / Cendo Xitrol

Asam Mefenamat Sirup - 60 ml / Pondex

Bisacodyl 5 mg / Bicolax

14 Jarum Suntik No. 27 G Pcs

15 Klindamisin kapsul 150 mg Kapsul

16 Kasa Pembalut Hidrofil 4 m x 6 cm Roll

17 Kasa 2x80 Roll

18 Kapas 500 gram Bungkus

19 Larutan H2O2 Botol

20 Vial

21 Tablet

22 Metronidazol tablet 250 mg Tablet

23 Meylon injeksi Botol

24 Tablet

25 Tube

26 Botol

27 Obat analgetik (Antalgin 250 mg, Amidopyrin 50 mg, Lidocain HCl 10 mg)/Etamidon injeksi Vial

28 Polymigel tablet 400 mg/Strocain P Tablet

29 Propanolol tablet 40 mg (HCl) Tablet

30 Ranitidin injeksi 25 mg/ml Ampul

31 Saccaharine tablet Tablet

Metoklopramid injeksi / Primperan

Metoklopramid tablet 10 mg / Metolon

Obat Batuk Pilek kaplet ( Dextromethorphan HBr 10 mg, Gliseril guayakolat 50 mg, Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine Maleat 1 mg ) / Dextral

Obat Preparat Flebitis dan Varises ( Heparin 20.000 IU ) - 20 gr / Thrombophob

Obat tetes telinga kombinasi (( Polikmisin B sulfat 10.000 IU, NeomIsin sulfat 5 mg, Fludrokortison asetat 1 mg, Lidokain Hcl 40 mg ) / Otopain / Otopraf

32 Tube

33 Tablet

34 Tablet

35 Tissue lensa Buku

36 Xylene Botol 500 ml

37 ………………………. -

38 ………………………. -

39 ………………………. -

40 ………………………. -

TOTAL HARGA OBAT HABIS PAKAI

Mengetahui/MenyetujuiKepala UPTD Puskesmas Ciledug

drg. Iradani Yupitaningrum, M.Kes

NIP. 19650104 199403 2 002

Salep Kulti Anti Jamur ( Klotrimazole 1 % ) / Erphamazole

Teofilin tablet / Bronsolvan

Terbutalin tablet 2,5 mg / Astherin

PENERIMAAN OBAT

TOTAL HARGA KETJUN JUL AGS SEP OKT Total penerimaan Rata2 penerimaan Kebutuhan

12 13 14 15 16 17 18 19 20 22

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100 200.00 100.00 12 780,000 12 bln

1,600.00 533.33 64 4,160,000 12 bln

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- 2.00 24 2,640,000 12 bln

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3 1 5.00 1.67 20 430,000 12 bln

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- 3.00 36 115,200 12 bln

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6.00 2.00 24 300,000 12 bln

2 9.00 4.50 54 313,200 12 bln

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20.00 10.00 120 180,000 12 bln

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- 1.00 6 246,000 6 bln

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11 36.00 9.00 108 1,782,000 12 bln

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- 5.00 60 1,950,000 12 bln

50.00 50 160,000 1 bln

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13,056,400

Yang mengajukan,Petugas Pengelola Obat

SUPRIHARTIWI, AMF

NIP. 197601172009022004

RENCANA ANGGARAN BELANJA BAHAN OBAT- OBATANTAHUN 2015





1 2 4 5 6 7 8 9 10 11

OBAT

1 Tablet 86.00 Pertiwi Agung 500 1100 800 300

2 Amlodipin tablet 5 mg Tablet 187.00 Pertiwi Agung 30 450 570 180

3 Amlodipin tablet 10 mg Tablet 330.00 Pertiwi Agung

4 Aminofillin tablet 200 mg Tablet 80.00 Erela 1200

5 Amoksilin kaplet 500 mg Kaplet 261.00 Mersifarma 10000 12600 16900 14500

6 Amoksilin sirup kering 125 mg/ 5 ml - 60 ml Botol 2,445.00 Novapharin

7 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg + Magnesium Hidroksida 200 mg Tablet 72.00 Erela 5000 6200

8 Botol 2,140.00 Lucas 50 100

9 Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g + Polimiksin 10.000 IU/g Tube

10 Antibiotik Topikal Jelly ( Neomycin Sulfate 0,5% + Placenta Ekstrak 10 %) - 15 gr / Bioplacenton Tube

11 Antidiare tablet (Kaolin 550 mg + Pectin 20 mg ) / Neo Diaform Tablet

12 Antidiare suspensi (Kaolin 700 mg + Pectin 66 mg) - 60 ml / Kaolimec Botol

13 Antifungi DOEN kombinasi As. Benzoat 6% + As. Salisilat 3% - 30 gr / Whitefield Pot

Alopurinol tablet 100 mg / Merzaluric

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg /5 ml + Magnesium Hidroksida 200 mg /5 ml - 60 ml

14 Anti Hemmoroid DOEN kombinasi : Bismut subgalat 150 mg + Heksaklorofen 2,5 mg Supp

15 Anti Hemmoroid Kapsul : Ekstrak Graptophylli Folium 80% + Citrus Bioflavonoid 20% / Haemorogard Kapsul

16 Tube

17 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 135.00 KF

18 Aqua pro injeksi steril, bebas pirogen 20 ml Vial

19 Asam Asetilsalisilat tablet 80 mg / Aspimec Tablet

20 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 95.00 KF 5000 10000

21 Asam Mefenamat kaplet 500 mg Kaplet 112.00 Bernofarm 6300 3500 1600 400

22 Asiklovir tablet 400 mg Tube 336.00 Sampharindo 800

23 Atapulgit tablet 600mg Tablet 190.00 Zenith 2000 1500

24 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) - 1 ml Ampul 1,300.00 Ethica

25 Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet tambah darah kombinasi) Tablet 42.00 Erela

26 Betahistin Mesilat tablet 6 mg / Noverty Tablet

27 Betametason Krim 0.1 % (sebagai valerat) - 5 gr Tube 1,520.00 KF 50 20 50 50

28 Bisoprolol tablet 5 mg Tablet 645.00 Pratapala

29 Borax Glyserin ( GOM ) 10 % - 8 ml Botol

30 Bromheksin tablet 8 mg / Bromifar Tablet

31 Botol

32 Tablet 62.00 Promed 3600 4400 4800 3700 5200

33 Dektrometorfan sirup 10mg/5 ml (HBr) - 60 ml Botol

34 Dekstrometorfan tablet 15 mg (HBr) Tablet

35 Ampul

Antiinfeksi Topikal dengan Kortikosteroid krim (Kloramfenikol base 20 mg + Prednisolon 2,5 mg) - 10 gr / Klorfeson

Bromheksin larutan 2mg/ml (untuk Nebulizer) - 50 ml / Bisolvon

Deksametason tablet 0,5 mg / Molacort

Difenhidramin injeksi 10 mg/ml / Etadryl

36 Digoksin tablet 0,25 mg Tablet

37 Domperidon tablet 10 mg Tablet 167.00 Novapharin 300 500

38 Kapsul

39 Efedrin tablet 25 mg (HCl) Tablet

40 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) - 1 ml Ampul 8,100.00 Phapros

41 Eritromisin kapsul 500 mg Kapsul 930.00 Indofarma

42 Eritromisin sirup 200 mg 5 /ml - 60 ml Botol 7,700.00 Phyto kemo

43 Etakridin (Rivanol) Larutan 0,1 % - 300 ml Botol 2,550.00 Jayamas 96

44 Fenol Gliserol tetes telinga 10 % - 5 ml Botol

45 Fenitoin Kapsul 100 mg Kapsul 133.00 Ikapharmindo

46 Fitomenadion(Vit. K1) tablet salut gula 10 mg Tablet 634.00 Marin 600 900

47 Furosemid tablet 40 mg Tablet 75.00 Sampharindo

48 Sach 288.00 Phapros 1400 400 500

49 Gemfibrozil 300 mg kapsul Kapsul

50 Tube

51 Glibenklamid tablet 5 mg Tablet 56.00 Indofarma

52 Glimepiride 2 mg Tablet 436.00 KF

53 Gliseril Guaiakolat tablet 100 mg Tablet

54 Glucose Larutan Infus 5% steril - 500 ml Botol

55 Griseofulvin tablet 125 mg / Gricin Tablet 219.00 Indofarma

56 Glucose Larutan Infus 5% steril - 500 ml Botol 5,200.00 Widatra

57 Hidroklortiazid (HCT) tablet 25 mg Tablet

58 Tube

Doksisiklin kapsul 100 mg / Doxihat

Garam Oralit I serbuk, kombinasi : Natrium 0,52 g, Kalium klorida 0,30 g , Trinatrium sitrat dihidrat 0,58 g, Glukosa anhidrat 2,7 g

Gentamycin salep kulit 0,1% - 5 gr / Gentalex

Hidrokortison krim 2,5 % - 5 gr / Lexacorton

59 Tablet

60 Ibuprofen tablet 400 mg Tablet 149.00 Holi 700

61 Ichtyol salep kulit - 15 gr Pot

62 Isosorbid dinitrat (ISDN) tablet sublingual 5 mg Tablet 88.00 Indofarma

63 Kalium permanganat (PK) serbuk - 5 gr Pot

64 Kalsium laktat (Kalk) tablet 500 mg Tablet 70.00 3000 1000

65 Kaptopril tablet 25 mg Tablet 84.00 Errita 2600 1100

66 Ketokonazol tablet 200 mg Tablet


68 Kloramfenikol kapsul 250 mg Kapsul

69 Kloramfenikol salep mata 1% - 5 gr Tube 1,600.00

70 Kloramfenikol suspensi 125 mg/5ml - 60 ml Botol

71 Botol

72 Kloramfenikol tetes telinga 3 % - 5 ml Botol

73 Klorfeniramin maleat (CTM) tablet 4 mg Tablet

74 Kotimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mg Tablet 138.00 Promed 700

75 Kotimoksazol DOEN II (pedriatik) kombinasi : Sulfametoksazol 100 mg + Trimetoprim 20 mg Tablet

76 Kotimoksazol Suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprim 40 mg/ 5 ml - 60 ml Botol 2,145.00 Holi 250 400

77 Levertraan salep - 15 gr Pot

78 Lidokain injeksi 2% - 2 ml Ampul

79 Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 : 80.000) - 2 ml Ampul 1,363.00 Indofarma

80 Linkomisin kapsul 500 mg Kapsul

81 Loperamid tablet 2 mg Tablet 89.00 Ifars

Hyoscine - N - Butilbromide tablet 10 mg / Scopma

Kloramfenikol tetes mata 0,5 % - 5 ml / Erlamycetin

82 Loratadin tablet 10 mg Tablet 154.00 Promed 300

83 Mebendazol tablet 100 mg Tablet

84 Metampiron (Antalgin) tablet 500 mg Tablet

85 Metformin HCl tablet 500 mg Tablet 112.50

86 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Tablet 154.00 KF 300

87 Metronidazol tablet 500 mg Tablet 160.00 pyto Kemo 3900 1800 400 1300

88 Tube 3,000.00 KF

89 Botol

90 Tablet

91 Natrium Bikarbonat tablet 500 mg Tablet

92 Tablet 176.00 Phapros 800 1050 1400 950 900

93 Natrium Klorida larutan infus 0,9% - 500 ml Botol 4,700.00 Widatra

94 Natrium Klorida larutan 0,9% - 25 ml (untuk Nebulizer) Botol

95 Nifedipin tablet 10 mg Tablet 110.00 Dexa

96 Nistatin tablet salut 500.000 IU/g Tablet 640.00 Phapros

97 Nistatin vaginal tablet 100.000 IU/g Tablet 480.00 Phapros

98 Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol Botol

99 Tablet

100 Oksitetrasiklin HCl salep kulit 3 % - 5 gr Tube

101 Oksitetrasiklin HCl salep mata 1 % - 5 gr Tube

102 Omeprazol kapsul 20 mg Kapsul 211.00 Novapharin

103 Papaverin tablet 40 mg Tablet

104 Parasetamol drops Btl / 15 ml 5,200.00

Indofarma 168 336

Mikonazol krim/ salep 2 % (Nitrat) - 10 gr / Moladerm

Multivit Sirup - 60 ml / Lybex

Multivit Tablet / Pehavral

Natrium Diklofenak tablet 50 mg / Kemoren

Obat Pencernaan tablet (Diastase 200 mg, Pankreatin 100 mg) / Librozym

105 Parasetamol sirup 120 mg / 5ml - 60 ml Botol 1,438.00 Afifarma 336 588 756 168

106 Parasetamol tablet 100 mg Tablet

107 Parasetamol tablet 500 mg Tablet 79.00 Promed 11100 23700 21500 10400 24500

108 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet

109 Piroksikam tablet 10 mg Tablet

110 Botol 17,393.00 Pratapa Nirmala

111 Povidon Iodida larutan 10 % - 300 ml Botol 14,203.00 Afifarma 1

112 Prednison tablet 5 mg Tablet


114 Propiltiourasil tablet 100 mg Tablet

115 Ranitidin tablet 150 mg Tablet 120.00 Dexa 1600 2200

116 Ringer Laktat larutan infus - 500 ml Botol 5,200.00 Widatra

117 Salbutamol tablet 2 mg (sebagai sulfat) Tablet 59.00 yarindo

118 Botol

119 Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang endap 4 % - 30 gr Pot 2,000.00 Marin

120 Salisil Bedak 2 % - 50 gr Kotak 1,250.00 Rama 200 200 500

121 Sefadroksil Kapsul 500 mg Kapsul 509.00 Holi

122 Sianokobalamin (vitamin B12) tablet 50 mcg Tablet

123 Simvastatin tablet 10 mg Tablet 169.00 Natura Labora 60 330 420 570 660

124 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 255.00 Bernofarm 1100 2700

125 Sulfasetamida Natrium tetes mata 15 % - 5 ml Botol

126 Tetrasiklin kapsul 500 mg Kapsul 148.00 Holi

127 Thiamfenikol kapsul 500 mg Kapsul

128 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Tablet

Polikresulen (kondensasi) - 10 ml / Albothyl

Salbutamol 2.5 mg/ ml (untuk Nebulizer) / Ventolin

129 Vitamin B Kompleks tablet Tablet 107.00 KF 6000 9000

130 Zinc tablet 20 mg Tablet 474.00 Indofarma 600 2100

OBAT PROGRAM TB PARU

127 Obat FDC Kategori 1 Paket 359,990.00 Indofarma

128 Obat FDC Kategori 2 Paket 1,199,900.00 Indofarma

129 Obat FDC Anak Paket 214,990.00 Indofarma

130 Obat FDC Sisipan Paket

OBAT PROGRAM IMS

131 Kanamisin injeksi 1 gr Vial

132 Levofloksasin tablet 500 mg Tablet

133 Sefiksim kapsul 100 mg Kapsul 859.00 Benofarm

OBAT PROGRAM FILARIASIS

134 Dietilkarbamazin Sitrat tablet 100 mg Tablet

OBAT PROGRAM KECACINGAN

135 Albendazole tablet 400 mg Tablet 338.00 Holi Farma

136 Pirantel tablet score (base) 125 mg Tablet

OBAT PROGRAM GIZI

137 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 260.00 KF

138 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 459.00

1 Alprazolam tablet 1 mg Tablet 233.00 KF

2 Amitriptilin tablet salut 25 mg (HCl) Tablet 112.00 Indofarma

3 Clobazam tablet 10 mg Tablet 900.00 Dexa

4 Diazepam tablet 2 mg Tablet


6 Diazepan injeksi 5 mg /ml - 2 ml Ampul

7 Tube rectal 11,525.00

8 Fenobarbital tablet 30 mg Tablet

9 Tablet 419.00 Gracia

10 Haloperidol tablet 1,5 mg Tablet 69.00 Indofarma

11 Haloperidol tablet 5 mg Tablet 96.00 Indofarma

12 Tablet

13 Karbamazepin tablet 200 mg Tablet 245.00 Indofarma

14 Klorpromazin tablet salut 100 mg (HCl) Tablet 149.00 KF

15 Kodein tablet 10 mg Tablet

16 Risperidon tablet 2 mg Tablet 1,008.00 Mersifarma

17 Tablet

18 Triheksifenidil tablet 2 mg Tablet

OBAT GIGI

1 Artikulating Paper Buku

2 Bur High Speed Kotak

3 Bur Low Speed Kotak

4 Cavit / Dentorit Pot

5 Celluloid strip Set

6 Cresopen - 13 ml Botol

7 Dentin Conditioner Botol

8 Devitalisasi Pasta (Non Arsen) Btl / ktk

9 Disclosing Agent Tube

Diazepam tube Rectal 5 mg/2.5 ml / Stesolid

Fluoxetin tablet 10 mg / Antiprestin

Imipramin tablet 25 mg / Tofranil

Sertralin tablet / Nudep

10 Disposible saliva ejektor Bungkus @ 100 pcs

11 Etil Chlorida spray - 100 ml Botol

12 Eugenol cairan Botol 16,667.00 KF 1 1 1

13 Set

14 Set

15 Set

16 Macro gold + propylen + EDTA Set

17 Oil Spray Botol

18 Ampul

19 Pulperyl Botol

20 Spon Gelatin Cubicels / Spongostan/ Haemospon Pcs

21 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Set

22 Tetric N Ceram Paket

23 Tetric N Ceram Refill (A2, A3, A3,5) - 3,5 gr Tube

24 Tetric Bonding - 6 gr Botol

25 Tetric Etch Refill - 2 gr Tube

26 Trikresol Formalin (TKF) Botol

27 Ampul

28 Xylestesin Non Adrenalin injeksi Ampul

29 CHKM Botol

30 Iodoform/Mumifying pasta Botol

JUMLAH HARGA OBAT

Glass Ionomer Radiopak / Fuji VII

Glass Ionomer Cement ART / Fuji IX / Ketac Molar

Kalsium Hidroksida pasta / Calcidor / Dycal

Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 ml + Adrenalin 12.5 mcg ) / Pehacain

Xylestesin Adrenalin injeksi / Scandonest



NIP. 19650104 199403 2 002

PENERIMAAN OBAT


12 13 14 15 16 17 18 19 20 22

2400 200 5,300.00 883.33 5,300 455,800 6 bln

1080 660 2,970.00 495.00 2,969 555,203 6 bln

990.00 5,940 1,960,200 6 bln

1600 2,800.00 1,400.00 8,400 672,000 6 bln

37000 91,000.00 18,200.00 109,248 28,513,728 6 bln

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9000 4000 24,200.00 6,050.00 36,300 2,613,600 6 bln

450 600.00 200.00 1,200 2,568,000 6 bln

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22000 37,000.00 12,333.33 74,000 7,030,000 6 bln

7300 6300 1800 27,200.00 3,885.71 23,314 2,611,200 6 bln

700 500 2,000.00 666.67 4,000 1,344,000 6 bln

500 200 4,200.00 1,050.00 6,300 1,197,000 6 bln

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3000 3,000.00 3,000.00 18,000 756,000 6 bln

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150 48 24 96 488.00 61.00 366 556,320 6 bln

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9000 1000 2600 3700 38,000.00 4,222.22 25,333 1,570,667 6 bln

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1500 2,300.00 766.67 4,600 768,200 6 bln

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96 192.00 96.00 288 734,400 3 bln

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400 400 2,300.00 575.00 3,450 2,187,300 6 bln

- 100.00 99 7,425 1 bln

3000 500 5,800.00 1,160.00 6,960 2,004,480 6 bln

- - -

- - -

3200 3,200.00 3,200.00 19,200 1,075,200 6 bln

3,200.00 19,200 8,371,200 6 bln

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- 100.00 300 65,700 3 bln

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700.00 700.00 4,200 625,800 6 bln

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9000 3000 16,000.00 5,333.33 32,000 2,240,000 6 bln

8000 1700 13,400.00 3,350.00 20,100 1,688,400 6 bln

- - -

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- 50.00 300 480,000 6 bln

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700.00 700.00 4,200 579,600 6 bln

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650.00 325.00 1,950 4,182,750 6 bln

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- 90.00 540 736,020 6 bln

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300.00 300.00 1,200 184,800 4 bln

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8,000.00 48,000 5,400,000 6 bln

300.00 300.00 1,200 184,800 4 bln

3500 10,900.00 2,180.00 13,080 2,092,800 6 bln

- 50.00 300 900,000 6 bln

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3000 1350 9,450.00 1,575.00 9,450 1,663,200 6 bln

- 3.00 18 84,600 6 bln

- - -

- - -

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- 100.00 600 288,000 6 bln

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- 1,500.00 9,000 1,899,000 6 bln

- - -

1260 336 2,100.00 525.00 3,152 16,390,400 6 bln

252 88 420 2,608.00 372.57 2,235 3,214,546 6 bln

- - -

52000 10000 12000 165,200.00 20,650.00 123,900 9,788,100 6 bln

- - -

- - -

- - - -

1 2.00 1.00 6 85,218 6 bln

- - -

- - -

- - -

2500 6,300.00 2,100.00 12,600 1,512,000 6 bln

- - -

- 100.00 600 35,400 6 bln

- - -

- 30.00 180 360,000 6 bln

400 100 200 1,600.00 266.67 1,600 2,000,000 6 bln

- - - -

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1920 3,960.00 660.00 3,960 669,240 6 bln

3800 7,600.00 2,533.33 15,200 3,876,000 6 bln

- - -

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- - -

- - -

18000 15000 48,000.00 12,000.00 72,000 7,704,000 6 bln

3500 200 6,400.00 1,600.00 9,600 4,550,400 6 bln

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3 6.00 1.50 9 150,003 6 bln

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141,182,700


SUPRIHARTIWI, AMF

NIP. 197601172009022004

RENCANA ANGGARAN BELANJA BAHAN MEDIS PAKAI HABISTAHUN 2016





1 2 4 5 6 7 8 9 10 11

OBAT

PERBEKALAN KESEHATAN



3 Alat Suntik sekali pakai 1 ml Box 65,000.00 Jayamas 100

4 Alat Suntik sekali pakai 3 ml Box 65,000.00 Jayamas 200 500 900

5 Alat Suntik sekali pakai 5 ml Pcs

6 Blood set Set

7 Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum bedah Sach

8 Benang Bedah Silk No. 2/0 - 3/0 dengan jarum bedah Sach 110,000.00 Jayamas

9 Benang Bedah Catgut Chromic 2/0 -100 m Cassete

10 Benang Bedah Catgut Plain 3/0 -100 m Cassete

11 Benang Bedah Silk Black 3/0 -100 m Cassete

12 Dental Film Hanshin Pcs

13 Etanol 70 % - 1 L Botol 21,500.00 Jayamas 1

14 Gel USG / EKG Botol

15 Infusion Set Anak Pcs

16 Infusion Set Dewasa Pcs 3,200.00 Jayamas




20 Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT Sach

21 Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR Sach

22 Kapas Pembalut / absorben 250 gram Bungkus 12,500.00 Jayamas 1 3 2

23 Kassa Hidrofil Steril uk. 16 x 16 Kotak 5,800.00 Jayamas 7

24 Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm Roll 105,000.00 Jayamas

25 Kassa pembalut hidrofil 4m x 10 cm Roll 1,500.00 Jayamas 5 15

26 Kertas EKG Roll

27 Kertas USG Sony 110 HG Roll

28 Larutan Clorin 5,25% - 1 L (Desinfektan Alat) Botol

29 Larutan Desinfectan - 1 L (Desinfektan Ruangan) Botol

30 Larutan Antiseptik / Desinfektan hanrub mengandung chlorhexidine gluconate 0.5 % Botol 500 ml 30,000.00

31 Lysol 1 L Botol 1 L 41,000.00 Jayamas

32 Lembar

33 Masker Kotak 16,500.00 Jayamas 8 6 11

34 Masker O2 Pcs

35 Masker nebulizer set dewasa Pcs

36 Masker nebulizer set anak Pcs

37 Plester 5 yard X 2 inch Roll

38 Roll

39 Pot Urin Pcs

40 Sarung Tangan Kotak 32,500.00 Jayamas

Kassa steril mengandung obat (Framycetin) / Lomatulle

Plester non alergi 0,5 inch / Micropore

41 Wing needle Pcs 1,400.00 Jayamas

42 Safety Box Pcs

43 Surgical blade no.11 (Pisau Bedah) Pcs

PEMERIKSAAN TB PARU

1 Emersi Botol 100 ml

2 Eter Alkohol Botol 100 ml

3 Kaca Slide / Object Glass Kotak

4 Pot dahak Pcs

5 Reagen Zielnelsen Set

6 Spiritus Bakar Botol

7 Tissu Lensa Kotak

8 Wadah Kaca Slide / Box Slide Pcs

9 Xylol Botol 100 ml

EMBALAGE

1 Kantong Kresek obat + cetakan, ukuran 15 x 30 Lembar



4 Kertas Perkamen ( ukuran 8 x 11 ) Pak /1000lbr

5 Sendok obat Pcs

AKUPUNTUR




4 Jarum telinga (press needle) Kotak

5 Moxa Roll Kotak

OBAT PONED

1 Apron plastik Pcs

2 Ampul

3 Ampul

4 Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml Ampul

5 Ikat Tali Pusat ( Umbilical Cord klem ) Pcs

6 Metilergometrin maleat injeksi 0,200 mg - 1 ml Ampul

7 MgSO4 40 % injeksi Vial

8 Tablet

9 Natrium Bicarbonat injeksi Ampul

10 Nasal dewasa / Maxyflow Pcs

11 Nasal infant/ Oxyflow Pcs

12 Ampul

13 Penghisap Lendir Bayi Baru Lahir Pcs


15 Sarung Tangan panjang obgyn No. 7 Pasang


17 Sarung tangan steril/Surgical gloves steril No. 6,5 Pasang

18 Sarung tangan steril/Surgical gloves steril No. 7 Pasang

19 Sarung tangan steril/Surgical gloves steril No.7,5 Pasang

20 Sungkup bayi Set

21 Tanda Pengenal (ID Band) Bayi Psc

22 Tanda Pengenal (ID Band) Ibu Psc

23 Under Pad 60 x 90 cm Psc

Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik

Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal

Misoprostol tablet 0,2 mg / Noprostol

Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin

24 Ampul

TAMBAHAN

1 Botol

2 Ambroksol tablet 30mg Tablet

3 Botol

4 Asering infus Botol

5 Asiklovir tablet 200 mg Tablet

6 Tablet

7 Buskopan injeksi Ampul

8 Bur Fissure standart Pcs

9 Bur Fissure panjang Pcs

10 Deksametason injeksi 5 mg/ml-1ml Ampul 1,580.00 Indofarma

11 Etanol 96 % - 1 L Botol

12 Gentian Violet larutan 1 % Botol

13 Glucose Larutan Infus 10% Steril Botol

14 Jarum Suntik No. 27 G Pcs


16 Kasa Pembalut Hidrofil 4 m x 6 cm Roll

17 Kasa 2x80 Roll

18 Kapas 500 gram Bungkus

19 Larutan H2O2 Botol

20 Vial

Valethamate Br 8 mg /ml injeksi / Epidosin

Antiseptik & kortikosteroid Tetes mata (Neomycin 3,5 mg, Polymixin B Sulfat 10.000 IU, Dexamethason 1,0 mg) - 5 ml / Cendo Xitrol

Asam Mefenamat Sirup - 60 ml / Pondex

Bisacodyl 5 mg / Bicolax

Metoklopramid injeksi / Primperan

21 Tablet

22 Metronidazol tablet 250 mg Tablet

23 Meylon injeksi Botol

24 Tablet

25 Tube

26 Botol

27 Obat analgetik (Antalgin 250 mg, Amidopyrin 50 mg, Lidocain HCl 10 mg)/Etamidon injeksi Vial

28 Polymigel tablet 400 mg/Strocain P Tablet


30 Ranitidin injeksi 25 mg/ml Ampul

31 Saccaharine tablet Tablet

32 Tube

33 Tablet

34 Tablet

35 Tissue lensa Buku

36 Xylene Botol 500 ml

37 ………………………. -

38 ………………………. -

39 ………………………. -

40 ………………………. -

JUMLAH HARGA OBAT HABIS PAKAI

Metoklopramid tablet 10 mg / Metolon

Obat Batuk Pilek kaplet ( Dextromethorphan HBr 10 mg, Gliseril guayakolat 50 mg, Phenylpropanolamine HCL 12,5 mg, Chlorpeniramine Maleat 1 mg ) / Dextral

Obat Preparat Flebitis dan Varises ( Heparin 20.000 IU ) - 20 gr / Thrombophob

Obat tetes telinga kombinasi (( Polikmisin B sulfat 10.000 IU, NeomIsin sulfat 5 mg, Fludrokortison asetat 1 mg, Lidokain Hcl 40 mg ) / Otopain / Otopraf

Salep Kulti Anti Jamur ( Klotrimazole 1 % ) / Erphamazole

Teofilin tablet / Bronsolvan

Terbutalin tablet 2,5 mg / Astherin

Mengetahui/Menyetujui

Kepala UPTD Puskesmas Ciledug


NIP. 19650104 199403 2 002

PENERIMAAN OBAT


12 13 14 15 16 17 18 19 20 22

- - -

- - -

- - -

100 200.00 100.00 12 780,000 12 bln

1,600.00 533.33 64 4,160,000 12 bln

- - -

- - -

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- 2.00 24 2,640,000 12 bln

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3 1 5.00 1.67 20 430,000 12 bln

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- 3.00 36 115,200 12 bln

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6.00 2.00 24 300,000 12 bln

2 9.00 4.50 54 313,200 12 bln

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20.00 10.00 120 180,000 12 bln

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- 1.00 6 246,000 6 bln

- - -

11 36.00 9.00 108 1,782,000 12 bln

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- 5.00 60 1,950,000 12 bln

50.00 50 70,000 1 bln

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12,966,400

Yang mengajukan,

Petugas Pengelola Obat

SUPRIHARTIWI, AMF

NIP. 197601172009022004

RENCANA ANGGARAN BELANJA BAHAN OBAT- OBATANTAHUN 2016





1 2 4 5 6 7 8 9 10 11

OBAT

1 Tablet 86.00 Pertiwi Agung 500 1100 800 300

2 Amlodipin tablet 5 mg Tablet 187.00 Pertiwi Agung 30 450 570 180

3 Amlodipin tablet 10 mg Tablet 330.00 Pertiwi Agung

4 Aminofillin tablet 200 mg Tablet 80.00 Erela 1200

5 Amoksilin kaplet 500 mg Kaplet 261.00 Mersifarma 10000 12600 16900 14500

6 Amoksilin sirup kering 125 mg/ 5 ml - 60 ml Botol 2,445.00 Novapharin

7 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg + Magnesium Hidroksida 200 mg Tablet 72.00 Erela 5000 6200

8 Botol 2,140.00 Lucas 50 100

9 Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g + Polimiksin 10.000 IU/g Tube

10 Antibiotik Topikal Jelly ( Neomycin Sulfate 0,5% + Placenta Ekstrak 10 %) - 15 gr / Bioplacenton Tube

11 Antidiare tablet (Kaolin 550 mg + Pectin 20 mg ) / Neo Diaform Tablet

12 Antidiare suspensi (Kaolin 700 mg + Pectin 66 mg) - 60 ml / Kaolimec Botol

13 Antifungi DOEN kombinasi As. Benzoat 6% + As. Salisilat 3% - 30 gr / Whitefield Pot



14 Anti Hemmoroid DOEN kombinasi : Bismut subgalat 150 mg + Heksaklorofen 2,5 mg Supp

15 Anti Hemmoroid Kapsul : Ekstrak Graptophylli Folium 80% + Citrus Bioflavonoid 20% / Haemorogard Kapsul

16 Tube

17 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 135.00 KF

18 Aqua pro injeksi steril, bebas pirogen 20 ml Vial

19 Asam Asetilsalisilat tablet 80 mg / Aspimec Tablet

20 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 95.00 KF 5000 10000

21 Asam Mefenamat kaplet 500 mg Kaplet 112.00 Bernofarm 6300 3500 1600 400

22 Asiklovir tablet 400 mg Tube 336.00 Sampharindo 800

23 Atapulgit tablet 600mg Tablet 190.00 Zenith 2000 1500

24 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) - 1 ml Ampul 1,300.00 Ethica

25 Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet tambah darah kombinasi) Tablet 42.00 Erela

26 Betahistin Mesilat tablet 6 mg / Noverty Tablet

27 Betametason Krim 0.1 % (sebagai valerat) - 5 gr Tube 1,520.00 KF 50 20 50 50

28 Bisoprolol tablet 5 mg Tablet 645.00 Pratapala

29 Borax Glyserin ( GOM ) 10 % - 8 ml Botol

30 Bromheksin tablet 8 mg / Bromifar Tablet

31 Botol

32 Tablet 62.00 Promed 3600 4400 4800 3700 5200

33 Dektrometorfan sirup 10mg/5 ml (HBr) - 60 ml Botol

34 Dekstrometorfan tablet 15 mg (HBr) Tablet

35 Ampul

Antiinfeksi Topikal dengan Kortikosteroid krim (Kloramfenikol base 20 mg + Prednisolon 2,5 mg) - 10 gr / Klorfeson

Bromheksin larutan 2mg/ml (untuk Nebulizer) - 50 ml / Bisolvon


Difenhidramin injeksi 10 mg/ml / Etadryl

36 Digoksin tablet 0,25 mg Tablet

37 Domperidon tablet 10 mg Tablet 167.00 Novapharin 300 500

38 Kapsul

39 Efedrin tablet 25 mg (HCl) Tablet

40 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) - 1 ml Ampul 8,100.00 Phapros

41 Eritromisin kapsul 500 mg Kapsul 930.00 Indofarma

42 Eritromisin sirup 200 mg 5 /ml - 60 ml Botol 7,700.00 Phyto kemo

43 Etakridin (Rivanol) Larutan 0,1 % - 300 ml Botol 2,550.00 Jayamas 96

44 Fenol Gliserol tetes telinga 10 % - 5 ml Botol

45 Fenitoin Kapsul 100 mg Kapsul 133.00 Ikapharmindo

46 Fitomenadion(Vit. K1) tablet salut gula 10 mg Tablet 634.00 Marin 600 900

47 Furosemid tablet 40 mg Tablet 75.00 Sampharindo

48 Sach 288.00 Phapros 1400 400 500

49 Gemfibrozil 300 mg kapsul Kapsul

50 Tube

51 Glibenklamid tablet 5 mg Tablet 56.00 Indofarma

52 Glimepiride 2 mg Tablet 436.00 KF

53 Gliseril Guaiakolat tablet 100 mg Tablet

54 Glucose Larutan Infus 5% steril - 500 ml Botol

55 Griseofulvin tablet 125 mg / Gricin Tablet 219.00 Indofarma

56 Glucose Larutan Infus 5% steril - 500 ml Botol 5,200.00 Widatra

57 Hidroklortiazid (HCT) tablet 25 mg Tablet

58 Tube

Doksisiklin kapsul 100 mg / Doxihat


Gentamycin salep kulit 0,1% - 5 gr / Gentalex

Hidrokortison krim 2,5 % - 5 gr / Lexacorton

59 Tablet

60 Ibuprofen tablet 400 mg Tablet 149.00 Holi 700

61 Ichtyol salep kulit - 15 gr Pot

62 Isosorbid dinitrat (ISDN) tablet sublingual 5 mg Tablet 88.00 Indofarma

63 Kalium permanganat (PK) serbuk - 5 gr Pot

64 Kalsium laktat (Kalk) tablet 500 mg Tablet 70.00 3000 1000

65 Kaptopril tablet 25 mg Tablet 84.00 Errita 2600 1100

66 Ketokonazol tablet 200 mg Tablet


68 Kloramfenikol kapsul 250 mg Kapsul

69 Kloramfenikol salep mata 1% - 5 gr Tube 1,600.00

70 Kloramfenikol suspensi 125 mg/5ml - 60 ml Botol

71 Botol

72 Kloramfenikol tetes telinga 3 % - 5 ml Botol

73 Klorfeniramin maleat (CTM) tablet 4 mg Tablet 51.00 Rama 22100 11600 14900

74 Kotimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mg Tablet 138.00 Promed 700

75 Kotimoksazol DOEN II (pedriatik) kombinasi : Sulfametoksazol 100 mg + Trimetoprim 20 mg Tablet

76 Kotimoksazol Suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprim 40 mg/ 5 ml - 60 ml Botol 2,145.00 Holi 250 400

77 Levertraan salep - 15 gr Pot

78 Lidokain injeksi 2% - 2 ml Ampul

79 Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 : 80.000) - 2 ml Ampul 1,363.00 Indofarma

80 Linkomisin kapsul 500 mg Kapsul

81 Loperamid tablet 2 mg Tablet 89.00 Ifars

Hyoscine - N - Butilbromide tablet 10 mg / Scopma

Kloramfenikol tetes mata 0,5 % - 5 ml / Erlamycetin

82 Loratadin tablet 10 mg Tablet 154.00 Promed 300

83 Mebendazol tablet 100 mg Tablet

84 Metampiron (Antalgin) tablet 500 mg Tablet

85 Metformin HCl tablet 500 mg Tablet 112.50

86 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Tablet 154.00 KF 300

87 Metronidazol tablet 500 mg Tablet 160.00 pyto Kemo 3900 1800 400 1300

88 Tube 3,000.00 KF

89 Botol

90 Tablet

91 Natrium Bikarbonat tablet 500 mg Tablet

92 Tablet 176.00 Phapros 800 1050 1400 950 900

93 Natrium Klorida larutan infus 0,9% - 500 ml Botol 4,700.00 Widatra

94 Natrium Klorida larutan 0,9% - 25 ml (untuk Nebulizer) Botol

95 Nifedipin tablet 10 mg Tablet 110.00 Dexa

96 Nistatin tablet salut 500.000 IU/g Tablet 640.00 Phapros

97 Nistatin vaginal tablet 100.000 IU/g Tablet 480.00 Phapros

98 Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol Botol

99 Tablet

100 Oksitetrasiklin HCl salep kulit 3 % - 5 gr Tube

101 Oksitetrasiklin HCl salep mata 1 % - 5 gr Tube

102 Omeprazol kapsul 20 mg Kapsul 211.00 Novapharin

103 Papaverin tablet 40 mg Tablet

104 Parasetamol drops Btl / 15 ml 5,200.00

Indofarma 168 336

Mikonazol krim/ salep 2 % (Nitrat) - 10 gr / Moladerm

Multivit Sirup - 60 ml / Lybex

Multivit Tablet / Pehavral


Obat Pencernaan tablet (Diastase 200 mg, Pankreatin 100 mg) / Librozym

105 Parasetamol sirup 120 mg / 5ml - 60 ml Botol 1,438.00 Afifarma 336 588 756 168

106 Parasetamol tablet 100 mg Tablet

107 Parasetamol tablet 500 mg Tablet 79.00 Promed 11100 23700 21500 10400 24500

108 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet

109 Piroksikam tablet 10 mg Tablet

110 Botol 17,393.00 Pratapa Nirmala

111 Povidon Iodida larutan 10 % - 300 ml Botol 14,203.00 Afifarma 1

112 Prednison tablet 5 mg Tablet


114 Propiltiourasil tablet 100 mg Tablet

115 Ranitidin tablet 150 mg Tablet 120.00 Dexa 1600 2200

116 Ringer Laktat larutan infus - 500 ml Botol 5,200.00 Widatra

117 Salbutamol tablet 2 mg (sebagai sulfat) Tablet 59.00 yarindo

118 Botol

119 Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang endap 4 % - 30 gr Pot 2,000.00 Marin

120 Salisil Bedak 2 % - 50 gr Kotak 1,250.00 Rama 200 200 500

121 Sefadroksil Kapsul 500 mg Kapsul 509.00 Holi

122 Sianokobalamin (vitamin B12) tablet 50 mcg Tablet

123 Simvastatin tablet 10 mg Tablet 169.00 Natura Labora 60 330 420 570 660

124 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 255.00 Bernofarm 1100 2700

125 Sulfasetamida Natrium tetes mata 15 % - 5 ml Botol

126 Tetrasiklin kapsul 500 mg Kapsul 148.00 Holi

127 Thiamfenikol kapsul 500 mg Kapsul

128 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Tablet

Polikresulen (kondensasi) - 10 ml / Albothyl

Salbutamol 2.5 mg/ ml (untuk Nebulizer) / Ventolin

129 Vitamin B Kompleks tablet Tablet 107.00 KF 6000 9000

130 Zinc tablet 20 mg Tablet 474.00 Indofarma 600 2100

OBAT PROGRAM TB PARU

127 Obat FDC Kategori 1 Paket 359,990.00 Indofarma

128 Obat FDC Kategori 2 Paket 1,199,900.00 Indofarma

129 Obat FDC Anak Paket 214,990.00 Indofarma

130 Obat FDC Sisipan Paket

OBAT PROGRAM IMS

131 Kanamisin injeksi 1 gr Vial

132 Levofloksasin tablet 500 mg Tablet

133 Sefiksim kapsul 100 mg Kapsul 859.00 Benofarm

OBAT PROGRAM FILARIASIS

134 Dietilkarbamazin Sitrat tablet 100 mg Tablet

OBAT PROGRAM KECACINGAN

135 Albendazole tablet 400 mg Tablet 338.00 Holi Farma

136 Pirantel tablet score (base) 125 mg Tablet

OBAT PROGRAM GIZI

137 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 260.00 KF

138 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 459.00

1 Alprazolam tablet 1 mg Tablet 233.00 KF

2 Amitriptilin tablet salut 25 mg (HCl) Tablet 112.00 Indofarma

3 Clobazam tablet 10 mg Tablet 900.00 Dexa



6 Diazepan injeksi 5 mg /ml - 2 ml Ampul

7 Tube rectal 11,525.00

8 Fenobarbital tablet 30 mg Tablet

9 Tablet 419.00 Gracia

10 Haloperidol tablet 1,5 mg Tablet 69.00 Indofarma

11 Haloperidol tablet 5 mg Tablet 96.00 Indofarma

12 Tablet

13 Karbamazepin tablet 200 mg Tablet 245.00 Indofarma

14 Klorpromazin tablet salut 100 mg (HCl) Tablet 149.00 KF

15 Kodein tablet 10 mg Tablet

16 Risperidon tablet 2 mg Tablet 1,008.00 Mersifarma

17 Tablet

18 Triheksifenidil tablet 2 mg Tablet

OBAT GIGI

1 Artikulating Paper Buku

2 Bur High Speed Kotak

3 Bur Low Speed Kotak

4 Cavit / Dentorit Pot

5 Celluloid strip Set

6 Cresopen - 13 ml Botol

7 Dentin Conditioner Botol

8 Devitalisasi Pasta (Non Arsen) Btl / ktk

9 Disclosing Agent Tube

Diazepam tube Rectal 5 mg/2.5 ml / Stesolid

Fluoxetin tablet 10 mg / Antiprestin

Imipramin tablet 25 mg / Tofranil

Sertralin tablet / Nudep

10 Disposible saliva ejektor Bungkus @ 100 pcs

11 Etil Chlorida spray - 100 ml Botol

12 Eugenol cairan Botol 16,667.00 KF 1 1 1

13 Set

14 Set

15 Set

16 Macro gold + propylen + EDTA Set

17 Oil Spray Botol

18 Ampul

19 Pulperyl Botol

20 Spon Gelatin Cubicels / Spongostan/ Haemospon Pcs

21 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan Set

22 Tetric N Ceram Paket

23 Tetric N Ceram Refill (A2, A3, A3,5) - 3,5 gr Tube

24 Tetric Bonding - 6 gr Botol

25 Tetric Etch Refill - 2 gr Tube

26 Trikresol Formalin (TKF) Botol

27 Ampul

28 Xylestesin Non Adrenalin injeksi Ampul

29 CHKM Botol

30 Iodoform/Mumifying pasta Botol

JUMLAH HARGA OBAT

Glass Ionomer Radiopak / Fuji VII

Glass Ionomer Cement ART / Fuji IX / Ketac Molar

Kalsium Hidroksida pasta / Calcidor / Dycal

Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 ml + Adrenalin 12.5 mcg ) / Pehacain

Xylestesin Adrenalin injeksi / Scandonest



NIP. 19650104 199403 2 002

PENERIMAAN OBAT


12 13 14 15 16 17 18 19 20 22

2400 200 5,300.00 883.33 5,300 455,800 6 bln

1080 660 2,970.00 495.00 2,969 555,203 6 bln

990.00 5,940 1,960,200 6 bln

1600 2,800.00 1,400.00 8,400 672,000 6 bln

37000 91,000.00 18,200.00 109,248 28,513,728 6 bln

- - - -

9000 4000 24,200.00 6,050.00 36,300 2,613,600 6 bln

450 600.00 200.00 1,200 2,568,000 6 bln

- - -

- - -

- - -

- - -

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- - -

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- - -

22000 37,000.00 12,333.33 74,000 7,030,000 6 bln

7300 6300 1800 27,200.00 3,885.71 23,314 2,611,200 6 bln

700 500 2,000.00 666.67 4,000 1,344,000 6 bln

500 200 4,200.00 1,050.00 6,300 1,197,000 6 bln

- - -

3000 3,000.00 3,000.00 18,000 756,000 6 bln

- - -

150 48 24 96 488.00 61.00 366 556,320 6 bln

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- - -

9000 1000 2600 3700 38,000.00 4,222.22 25,333 1,570,667 6 bln

- - -

- - -

- - -

- - -

1500 2,300.00 766.67 4,600 768,200 6 bln

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- - - -

- - -

96 192.00 96.00 288 734,400 3 bln

- - -

- -

400 400 2,300.00 575.00 3,450 2,187,300 6 bln

- 100.00 99 7,425 1 bln

3000 500 5,800.00 1,160.00 6,960 2,004,480 6 bln

- - -

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3200 3,200.00 3,200.00 19,200 1,075,200 6 bln

3,200.00 19,200 8,371,200 6 bln

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- - -

- 100.00 300 65,700 3 bln

- -

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700.00 700.00 4,200 625,800 6 bln

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- - -

9000 3000 16,000.00 5,333.33 32,000 2,240,000 6 bln

8000 1700 13,400.00 3,350.00 20,100 1,688,400 6 bln

- - -

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- 50.00 300 480,000 6 bln

- - -

- - -

- - -

42000 14100 104,700.00 20,940.00 125,640 6,407,640 6 bln

700.00 700.00 4,200 579,600 6 bln

- - -

650.00 325.00 1,950 4,182,750 6 bln

- - -

- - -

- 90.00 540 736,020 6 bln

- - -

- - -

300.00 300.00 1,200 184,800 4 bln

- - -

- - -

8,000.00 48,000 5,400,000 6 bln

300.00 300.00 1,200 184,800 4 bln

3500 10,900.00 2,180.00 13,080 2,092,800 6 bln

- 50.00 300 900,000 6 bln

- - -

- - -

- - -

3000 1350 9,450.00 1,575.00 9,450 1,663,200 6 bln

- 3.00 18 84,600 6 bln

- - -

- - -

- - -

- 100.00 600 288,000 6 bln

- - -

- - -

- - -

- - -

- 1,500.00 9,000 1,899,000 6 bln

- - -

1260 336 2,100.00 525.00 3,152 16,390,400 6 bln

252 88 420 2,608.00 372.57 2,235 3,214,546 6 bln

- - -

52000 10000 12000 165,200.00 20,650.00 123,900 9,788,100 6 bln

- - -

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1 2.00 1.00 6 85,218 6 bln

- - -

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- - -

2500 6,300.00 2,100.00 12,600 1,512,000 6 bln

- - -

- 100.00 600 35,400 6 bln

- - -

- 30.00 180 360,000 6 bln

400 100 200 1,600.00 266.67 1,600 2,000,000 6 bln

- - - -

- - -

1920 3,960.00 660.00 3,960 669,240 6 bln

3800 7,600.00 2,533.33 15,200 3,876,000 6 bln

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- - -

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18000 15000 48,000.00 12,000.00 72,000 7,704,000 6 bln

3500 200 6,400.00 1,600.00 9,600 4,550,400 6 bln

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3 6.00 1.50 9 150,003 6 bln

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147,590,340


SUPRIHARTIWI, AMF

NIP. 197601172009022004

DAFTAR OBAT DAN MEDIS PAKAI PUSKESMAS CILEDUG1

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1011

DAFTAR OBAT DAN MEDIS PAKAI PUSKESMAS CILEDUGOBAT

Amlodipin tablet 5 mg

Amlodipin tablet 10 mg

Aminofillin tablet 200 mg

Amoksilin kaplet 500 mg

Amoksilin sirup kering 125 mg/ 5 ml - 60 mlAntasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg + Magnesium Hidroksida 200 mg

Asam Askorbat (Vitamin C) tablet 50 mg

Asam Mefenamat kaplet 500 mg

Asiklovir tablet 400 mg

Atapulgit tablet 600mg

Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) - 1 ml

Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet tambah darah kombinasi)

Betametason Krim 0.1 % (sebagai valerat) - 5 gr

Domperidon tablet 10 mg

Etakridin (Rivanol) Larutan 0,1 % - 300 ml

Fitomenadion(Vit. K1) tablet salut gula 10 mg

Glibenklamid tablet 5 mg

Griseofulvin tablet 125 mg / Gricin

Ibuprofen tablet 400 mg

Kalsium laktat (Kalk) tablet 500 mg

Kaptopril tablet 25 mg

Klorfeniramin maleat (CTM) tablet 4 mg

Kotimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mgKotimoksazol Suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprim 40 mg/ 5 ml - 60 mlLidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 : 80.000) - 2 mlLoratadin tablet 10 mg

Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg

Metronidazol tablet 500 mg

Nistatin vaginal tablet 100.000 IU/g

Omeprazol kapsul 20 mg

Parasetamol drops

Parasetamol sirup 120 mg / 5ml - 60 ml

Parasetamol tablet 500 mg

Povidon Iodida larutan 10 % - 300 ml

Ranitidin tablet 150 mg

Salbutamol tablet 2 mg (sebagai sulfat)

Salisil Bedak 2 % - 50 gr

Simvastatin tablet 10 mg

Siprofloksasin tablet 500 mg (sebagai HCl)

Vitamin B Kompleks tablet






Zinc tablet 20 mg

Eugenol cairan

BAHAN MEDIS HABIS PAKAIAlat Suntik sekali pakai 1 mlAlat Suntik sekali pakai 3 mlBenang Bedah Silk No. 2/0 - 3/0 dengan jarum bedahEtanol 70 % - 1 LInfusion Set DewasaKapas Pembalut / absorben 250 gram Kassa Hidrofil Steril uk. 16 x 16 Kassa pembalut hidrofil 4m x 10 cmMasker Sarung TanganWing needle

DAFTAR OBAT FORMULARIUM

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