Lap - Pantau Obat

LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKESMAS DAN JARINGANNYA
PUSKESMAS : LUBUK SIKAPING

KABUPATEN : PASAMAN
PERIODE : Desember 2018
NO NAMA OBAT SATUAN PUSKESMAS PUSKESMAS BIDAN PUSTU TOTAL HARGA / SATUAN TOTAL PERSEDIAAN
GUDANG APOTIK DESA Rp Rp
1 2 3 4 5 6 7 8 9 10
1 Acetylcysteine Ktk/60 1200
2 Acyclovir cream Tube - 2,260.00 -
3 Acyclovir Tab 200 mg Ktk / 100 - 239.00 -
4 Adineuron Tablet Ktk / 100 - 250.00 -
5 Alat Suntik 1 ml Ktk / 100 - 1,147.12 -
6 Alat Suntik 2,5 ml Ktk / 100 249 27 10 286 1,089.90 311,711.40
Alat Suntik 5 ml Ktk / 100 99 99 1,089.90 107,900.10
Albendazol Tab 400 mg Ktk / 30 - 350.00 -
7 Alluporinol tab 100 mg Ktk / 100 2100 370 2,470 88.00 217,360.00
8 Alprazolam 0,5 mg Ktk/100
9 Aludona - D Syrup Fls - 34,875.00
10 Ambroxol syr Btl/60 ml - 2,598.00 -
11 Ambroxol Tab Ktk / 100 - 87.43 -
12 Aminophyllin Injeksi Ktk / 30 - 4,014.00 -
13 Aminophyllin tab 200 mg Btl / 1000 1500 1050 575 3,125 93.00 290,625.00
14 Amitriptilin tab 25 mg Ktk / 100 900 900 117.00 105,300.00
15 amlodipin ktk/30 5670 90 5,760 341.00 1,964,160.00
16 Amoksilin Kaplet 500 mg Ktk / 100 14900 3329 230 18,459 270.00 4,983,930.00
17 Amoksisilin Syrup Btl 350 96 14 460 2,500.00 1,150,000.00
18 Antalgin Injeksi Ktk / 30 - 1,272.70 -
19 Antalgin Tablet 500 mg Ktk/100 - 142.22 -
20 Antasida DOEN Tab Ktk/100 11700 3494 437 15,631 74.00 1,156,694.00
21 Antasida DOEN Tab Btl / 1000 - 29.14 -
22 Antasida sirup btl 155 13 168 2,200.00 369,600.00
23 Anti Fungi DOEN Salep Pot 118 26 144 1,640.00 236,160.00
24 Anti Migren DOEN tab Btl / 100 - 142.00 -
25 Antihemoroid supp Ktk/10 100 40 140 1,909.10 267,274.00
26 Aqua Dest Steril Btl - 2,000.00 -
27 Aqua Pro Injeksi Ktk / 10 120 120 5,500.00 660,000.00
28 Artemeter Injeksi Ktk / 6 - 300.00 -
29 Artesunate +Amodiaquin Ktk / 3 - 10,992.67 -
30 Artesunate Injeksi Ktk / 8 - 18,992.88 -
31 Asam Mefenamat 250 mg -
Asam Mefenamat 500 mg Ktk / 100 12600 2120 380 15,100 116.00 1,751,600.00
32 Asetosal tablet 100 mg Ktk / 100 - 122.00 -
34 Atropin Sulfat Inj Ktk/30 93 93 1,291.00 120,063.00
35 Atropin Sulfat tab 0.5 mg Btl/500 - 25.01 -
36 ATS Injeksi 1.500 IU Ampul - 99,850.00 -
37 ATS Injeksi 20.000 IU Vial - 624,360.00 -
38 Bacitracin tube 56 1 57 2,641.00 150,537.00
39 Betametason cream Tube 186 39 7 232 1,520.00 352,640.00
40 Blood Lancet Ktk / 100 - 180.00 -
41 Catarlent T.M Btl 5 ml - 25,850.00 -
42 Catgut 2/0 + 3/0 Biji 81 23 104 28,000.00 2,912,000.00
Catopril tab 12,5 mg Ktk / 60 - 112.80 -
43 Catopril tab 12,5 mg Ktk / 100 1200 211 1,411 62.00 87,482.00
44 Catopril tab 25 mg Ktk / 100 600 1723 80 2,403 89.00 213,867.00
45 Cefadroxil kap 500 mg Kek/100 4800 4,800 521.00 2,500,800.00
46 Cefadroxil syr BTL 25 25 7,827.00 195,675.00
47 Cefotaxim Injeksi Ktk / 2 - 6,615.00 -
48 Cepezet tab 100 mg Btl/ 250 - 79.44 -
49 Cetirizine ktk/100 - 186.00 -
50 Cetirizine Sirup Btl 50
51 Cimetidine Tab 200 mg Ktk / 100 - 112.80 -
Clobazam tab Ktk / 100 800 800
52 Cover Glass Ktk 100 - 264.00 -
53 CTM Tablet 4 mg Btl/ 1000 1400 3063 1006 5,469 27.00 147,663.00
54 Cyprofloxacin 500 mg Ktk / 100 4100 740 210 5,050 271.09 1,369,004.50
55 Cyprofloxacin 500 mg Ktk / 50 - 170.00 -
56 Dexametason Injeksi Ktk / 100 100 100 1,550.00 155,000.00
57 Dexametason tab 0,5 mg Btl / 1000 - 85.00 -
58 Dextran 70 % - 35,526.00 -
59 Dextrometorfan Sirup Botol - 2,734.00 -
60 Dextrometorfan tab 15 mg Btl / 1000 - 34.02 -
61 Diasec Tab Ktk / 10 - 1,540.00 -
62 Diazepam Inj 5 mg / ml ktk / 30 - 2,461.00 -
63 Diazepam Tablet 2 mg Btl / 1000 - 30.45 -
65 Difenhidramin HCl Injeksi Ktk / 30 - 1,008.00 -
66 Digoksin Tablet 0,5 mg Ktk/100 - 62.81 -
Domperidon syr Btl/60 ml 110 11 13 134 3,410.00 456,940.00
67 Domperidon tab 10 mg Ktk/100 2100 850 180 3,130 185.00 579,050.00
68 Dulcolax Supp adult Ktk / 5 50 50 10,000.00 500,000.00
Efedrin HCl tablet 25 mg Btl / 250 - 53.82 -
70 Epinefrin Injeksi 0,1 % Ktk / 30 - 345.70 -
71 Epinefrin Injeksi 0,1 % Ktk / 100 100 100 300.00 30,000.00
72 Erytromisin Kaps 250 mg Ktk / 100 1600 1,600 497.00 795,200.00
73 Erytromisin Syrup Fls - 7,731.00 -
74 Etakridin ( Rivanol ) Botol - 1,718.00 -
75 Etanol 70 % Botol 22 6 28 33,000.00 924,000.00
76 Etanol 70 %ol 100 Ml botol 12 12
77 Etil Klorida Semprot Botol - 105,000.00 -
78 Eugenol Cairan Botol 36 36 3,257.00 117,252.00
79 Extrac Belladone tab Btl / 1000 - 17.89 -
80 Face Mask Pcs - 7,000.00 -
81 Fenil Butazon tab Btl/1000 - 72.38 -
82 Fenobarbital tab 30 mg Btl / 100 2200 2,200 69.00 151,800.00
Fenobarbital inj Ampul 120 120
83 Fenoks Penisilin Tab 500 mg Ktk / 100 - 370.63 -
84 Fenol Gliserol TT 10 % Botol 127 4 131 1,058.00 138,598.00
85 Fitomenadion (Vit.K) Inj Ktk / 30 75 4 79 1,660.90 131,211.10
86 Fitomenadion (Vit.K)Tab Btl / 100 3800 440 200 4,440 660.00 2,930,400.00
87 Folley Catheter 2 Ways Biji - 7,800.00 -
88 Furosemida Tab 40 mg Btl / 250 - 55.96 -
89 Furosemida Tab 40 mg Ktk / 200 800 800 80.00 64,000.00
90 Gameksan Emulsi 1 % Botol - 7,315.00 -
91 Garam Oralit 200 ml Ktk/100 62 2 64 303.00 19,392.00
92 Gentamici SK Tube - 1,469.00 -
93 Gentamisin Injeksi Vial - 12,500.00 -
Gentamisin TM tube 75 9 84 3,353.00 281,652.00
Gentian Violet 1 % Botol - 945.00 -
94 Glass Ionomer Semen Set - 363,636.00 -
95 Glibenklamid tablet 5 mg Btl / 100 2400 2,400 58.00 139,200.00
96 Gliseril Guaiacolat tablet Btl / 1000 12200 2320 778 15,298 29.30 448,231.40
97 Glukosa Infus 10 % Fls - 4,100.00 -
99 Glukosa Infus 5 % Fls 38 2 1 41 4,830.00 198,030.00
100 Griseofulvin Tab 125 mg Btl / 100 2700 280 400 3,380 219.00 740,220.00
101 Haloperidol Inj Ampul 156 156
102 Haloperidol Tab 1,5 mg Kotak / 100 2200 2,200 72.00 158,400.00
103 Haloperidol tab 5 mg Ktk/100 - 116.73 -
104 Haloperidol Tablet 0,5 mg Ktk / 100 - 57.50 -
105 Hanscoon 6,5 ktk/50 38 38 4,462.50 169,575.00
106 Hanscoon 7,5 20 20 412.50 8,250.00
107 Hidroklortiazid (HCT)Tab Btl / 1000 1000 1,000 17.00 17,000.00
108 Hidrokortison Krim 2,5 % Tube 185 26 211 2,668.00 562,948.00
109 Ibuprofen Tablet 200 mg Btl / 100 500 1306 130 1,936 94.19 182,351.84
110 Ibuprofen Tablet 400 mg Ktk/100 - 149.00 -
111 Infusion Set Anak Set - 3,636.00 -
112 Infusion Set Dewasa Set 110 13 123 3,500.00 430,500.00
113 Iodiol Btl/100 - 930.00 -
114 Isoniazida Tab 100 mg Btl / 1000 - 27.00 -
116 Isosorbit Dinitrat Tab 5 mg Ktk / 100 - 65.24 -
117 IV Catheter No. 18 Biji - 3,000.00 -
118 IV Catheter No. 20 Biji 147 147 7,787.00 1,144,689.00
119 IV Catheter No. 22 Biji 115 115 7,787.00 895,505.00
121 Kalium Diclofenat 50 mg Ktk / 50 - 425.00 -
122 Kalium Permanganat (PK) Pot - 4,090.00 -
123 Kalsium Laktat Tab 500 mg Btl /1000 2000 2330 649 4,979 54.50 271,355.50
124 Kapas Berlemak 500 gr Bungkus - 14,007.00 -
125 Kapas Pembalut 250 gram Rol 19 1 20 7,500.00 150,000.00
126 Karbamazepin Tab 200 mg Ktk / 100 2300 2,300 257.00 591,100.00
127 Kasa 16 x 16 Steril Rol 50 3 53 1,393.00 73,829.00
128 Kasa 2x80 Rol - 7,858.00 -
129 Kasa 36 x 80 cm Rol 22 22
130 Kasa 4x10 Rol 70 32 102 552.00 56,304.00
131 Kasa 4x5 Rol 100 14 114 276.00 31,464.00
132 Kasa Elastis 4 Inc Rol - 10,000.00 -
133 Kassa 4 x 15 cm Rol - 3,066.00 -
134 Kassa 4 x 3 cm Rol - 666.00 -
135 ketokonazole ktk/50 1950 150 2,100 310.00 651,000.00
136 Kloramfenikol Syr Fls 90 90 11,558.00 1,040,220.00
137 Kloramfenikol 250 mg Btl / 250 2300 455 2,755 213.00 586,815.00
Kloramfenikol SK Botol 134 134 1,679.00 224,986.00
138 Kloramfrnikol S.M 1 % Tube 92 15 3 110 1,600.00 176,000.00
139 Kloramixin D Eye Drop Fls - 11,558.00 -
140 Klorpromazin 25 mg Inj ktk / 30 29 29 1,072.00 31,088.00
141 Klorpromazin Tab 100 mg Btl/ 1000 - 29.11 -
142 Klorpromazin tab 25 mg Btl/1000 - 24.45 -
143 Kodein Tablet 10 mg Btl / 250 2400 2,400 525.00 1,260,000.00
144 Korimoksazol Tab 120 mg Btl / 100 - 72.45 -
145 Korimoksazol Tab 480 mg Btl / 100 3800 1492 320 5,612 145.00 813,740.00
146 Kotrimoksazol Suspensi Botol 268 48 29 345 2,222.00 766,590.00
147 Kuinin ( Kina ) Tab 200 mg Ktk / 60 - 249.52 -
148 Kuinin Injeksi 25 % Ktk / 30 - 1,171.17 -
149 Lart. Etanol Asam Botol - 79.44 -
150 Lartan Karbol Fuksin Fls - 46,700.00 -
151 Larutan Benedict Fls - 40,000.00 -
152 Larutan Fauchet Fls - 110,000.00 -
153 Larutan Giemsa Fls - 150,000.00 -
Larutan HCl 0,1 N Botol - 28,000.00 -
154 Larutan Kinyoun Fls - 95,000.00 -
155 Larutan Metilen Biru Fls - 66,700.00 -
156 Larutan Turk Fls - 33,000.00 -
157 Levertran salep pot - 1,395.00 -
158 Lidokain Injeksi Ktk / 30 240 21 10 271 1,360.00 368,560.00
159 Loperamide Ktk/100 -
160 Lunex Injeksi 100 mg/ ml Ktk / 10 - 9,800.00 -
162 Lysmin Syrup Botol - 18,150.00 -
163 Lysol Fls - 27,500.00 -
164 Magnesium Sulfat Injeksi Ktk / 10 - 1,947.90 -
165 Masker 150 150 1,181.00 177,150.00
166 Mess Blade 11, 15, 23 Ktk / 100 - 1,650.00 -
Metformin tab 500 mg Ktk/100 2500 2,500 142.23 355,575.00
167 Methyl Prednisolon 4 mg Ktk/100 4000 140 4,140 210.00 869,400.00
168 Metil Ergometrin Injeksi Ktk / 30 8 8 1,564.50 12,516.00
169 Metil Ergometrin Tab Ktk / 100 900 900 154.00 138,600.00
170 Metoklorfofamid ktk/100 1900 350 2,250 105.00 236,250.00
171 Metronidazol Tab 250 mg Ktk / 100 600 1450 684 2,734 113.00 308,942.00
172 Metronidazol Tab 500 mg Ktk / 100 2000 2,000 164.00 328,000.00
173 Miconazol Salaf 48 4 52 -
174 Modicate Ampul Ampul - 88,250.00 -
175 Nalhecting Kulit / Otot Lusin - 10,984.83 -
176 Natrium Bikarbonat Tab Btl/ 1000 - 15.02 -
177 Natrium Diklofenat Ktk/50 - 293,86
178 Natrium Klorida Infus 0,9 % Botol 48 5 53 5,145.00 272,685.00
179 Nifedipin Tab 10 mg Ktk / 100 500 370 870 112.00 97,440.00
180 Nistatin Tablet 100.000 IU Fls - 35,600.00 -
181 Nistatin Tablet 500.000 IU Ktk / 100 - 461.08 -
182 Obat Batuk Hitam ( OBH ) Botol - 1,299.00 -
183 Obat T.B Kategori Anak Paket - 127,200.00 -
184 Obat T.B Kategori I Paket - 236,000.00 -
185 Obat T.B Kategori II Paket - 376,500.00 -
186 OBH Indo Plus Fls - 6,536.00 -
187 Objek Glass Pcs - 10,000.00 -
188 Oksitetrasiklin S.K 3% Tube - 1,572.00 -
189 Oksitetrasiklin S.M 1% Tube 50 50 1,600.00 80,000.00
190 Oksitosin Injeksi Ktk / 30 110 23 4 137 1,820.00 249,340.00
191 Omeprazol kapsul Ktk/30 3240 255 57 3,552 216.00 767,232.00
192 Papaverin Tablet 40 mg Btl/ 100 - 122.00 -
193 Paraformaldehid Tab 1 gr Btl / 100 - 60.75 -
194 Parasetamol Sirup 120 mg Botol 302 88 19 409 1,496.00 611,864.00
195 Parasetamol Tablet 100 mg / drops Btl / 100 - 32.96 -
196 Parasetamol Tablet 500 mg Btl/ 100 23400 3714 841 27,955 82.80 2,314,674.00
197 Pehacain Injeksi Ktk / 20 - 1,650.00 -
Pehamoxil 500 mg Ktk/50 - 283.70 -
Pembalut Gips Rol - 6,162.00 -
198 Petidin Injeksi Ktk / 10 - 1,520.00 -
199 Pirantel tabl 125 mg ktk/28 - 274.00 -
200 Piridoksin Tab 10 mg Btl/ 1000 3100 1433 804 5,337 18.27 97,506.99
201 Piroksikam Kapsul 10 mg Ktk/100 - 66.00 -
202 Plester Rol 25 3 28 23,625.00 661,500.00
203 Povidon Iodida 10 % Btl/300ml 31 31 14,000.00 434,000.00
205 Prednison Tablet 5 mg Btl / 1000 1700 1110 300 3,110 59.66 185,542.60
206 Primaquin tablet 15 mg Btl / 1000 - 30.00 -
207 Propanolol HCl Tab 40 mg Btl / 100 500 500 114.00 57,000.00
208 Propiltiourasil Tablet Btl / 100 - 277.00 -
209 Pyrazinamid Tab 500 mg Ktk / 100 - 462.00 -
210 Ranitidin tablet 150 mg Ktk / 30 8800 1480 270 10,550 126.00 1,329,300.00
211 Ranitidine INJ Ampul 90
212 Reserpin Tablet 0,25 mg Botol / 1000 - 55.00 -
213 Retinol (Vit.A) 100.000 IU Btl / 50 - 255.00 -
215 Rifampisin Kapsul 300 mg Ktk / 100 - 350.00 -
Ringer Laktat Larutan Infus Botol 44 14 58 5,460.00 316,680.00
216 Risperidone Ktk/100 3500
217 Salbutamol Tablet 2 mg Ktk / 100 2400 180 2,580 62.00 159,960.00
218 Salbutamol Tablet 4 mg Ktk / 100 - 97.49 -
219 Salep 2 - 4 Pot 118 33 7 158 2,400.00 379,200.00
220 Salisil Bedak 2 % Bungkus - 1,250.00 -
Sarung Tangan S 300 300
Sarung Tangan L 200 200
221 Salisil Spiritus 10 % Botol - 1,375.00 -
Semen Seng Fosfat Set - 80,659.00 -
222 Serum ABU 5 ml Ktk / 10 - 410,190.00 -
223 Sianokobalamin (vit.B12)Inj Ktk / 100 - 989.86 -
224 Silk ( Benang Bedah ) Bungkus 116 27 4 147 6,983.00 1,026,501.00
225 Simvastatin tab Ktk/30 - 174.00 -
226 Spirolakton Tab 100 mg Ktk / 100 - 1,054.96 -
227 Stesolide Tube 10
228 Stomach Tube Pcs - 7,800.00 -
229 Sulfadimidin Tablet 500 mg Btl/ 1000 - 82.69 -
Sulfasetamid TM tube - 3,387.00 -
230 Tablet Tambah darah Bks / 30 1210 550 1,760 43.00 75,680.00
231 Tetagam inj 9 9
232 Tetrasiklin HCl 250 mg BTL/ 1000 - 53.70 -
233 Tetrasiklin HCl 500 mg Ktk / 100 - 245.31 -
234 Tiamin HCl ( Vit. B1 ) Inj. Ktk / 30 - 731.80 -
235 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 10300 2690 538 13,528 21.00 284,088.00
236 Tramadol Inj Ktk/5 - 6,707.40 -
Tramadol tab Ktk/50 - 339.62 -
237 Tranexamid Acid 500 mg Ktk/100 - 570.00 -
238 Trifluoperazine 5 mg Ktk/100 600 600 425.00 255,000.00
239 Trihexifenidil (THP)Tab 2 mg Ktk / 100 700 700 42.00 29,400.00
240 Urine bag T. Type Steril Pcs - 6,500.00 -
241 Urineg tab ( As. Nalidiksat ) Ktk / 100 - 2,365.00 -
242 Urispas Tab Ktk / 30 - 3,162.50 -
243 Valisanbe Tab 2 mg Ktk / 100 - 132.00 -
Ventolin 60 60
244 Vit. B 12 INJ
245 Vit. B Complek tab Btl / 1000 18700 3156 656 22,512 110.00 2,476,320.00
246 Vit. B12 Tab Btl / 1000 1700 1,700 14.00 23,800.00
247 Vit. C tablet 50 mg Btl / 1000 12400 2989 1800 17,189 100.00 1,718,900.00
248 Wing Nedle no 23 G Ktk/100 - 2,145.00 -
Wing Nedle no 25 G Ktk/100 - 2,145.00 -
249 Zink Tablet Ktk / 100 360 70 430 497.00 213,710.00
JUMLAH Rp 57,424,539
Lubuk Sikaping, 30 Juni 2018
Kepala Puskesmas Lb.Sikaping Pengelola gudang obat
dr. Lusi Hastuty Ns. Indri Wardani, S. Kep
NIP.19760305 200501 2 008 NIP.19780314 200501 2 007
LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKES

KABUPATEN : PASAMAN
PERIODE : Februari 2018
NO NAMA OBAT SATUAN PUSKESMAS PUSKESMAS BIDAN PUSTU
GUDANG APOTIK DESA
1 2 3 4 5 6 7
1 Acetylcysteine Ktk/60
2 Acyclovir cream Tube
3 Acyclovir Tab 200 mg Ktk / 100 700 537 170
4 Adineuron Tablet Ktk / 100
5 Alat Suntik 1 ml Ktk / 100
6 Alat Suntik 2,5 ml Ktk / 100 198 83 115
Alat Suntik 5 ml Ktk / 100 200
Albendazol Tab 400 mg Ktk / 30
7 Alluporinol tab 100 mg Ktk / 100 4700 234 110
8 Alprazolam 0,5 mg Ktk/100
9 Aludona - D Syrup Fls
10 Ambroxol syr Btl/60 ml
11 Ambroxol Tab Ktk / 100
12 Aminophyllin Injeksi Ktk / 30
13 Aminophyllin tab 200 mg Btl / 1000 1800 570 960 30
14 Amitriptilin tab 25 mg Ktk / 100 800 445
15 amlodipin ktk/30
16 Amoksilin Kaplet 500 mg Ktk / 100 12700 945 3152 613
17 Amoksisilin Syrup Btl 324 13 83 8
18 Antalgin Injeksi Ktk / 30
19 Antalgin Tablet 500 mg Ktk/100
20 Antasida DOEN Tab Ktk/100 10000 2476 447
21 Antasida DOEN Tab Btl / 1000
22 Antasida sirup btl 290 6 12
23 Anti Fungi DOEN Salep Pot 148 14 13 2
24 Anti Migren DOEN tab Btl / 100
25 Antihemoroid supp Ktk/10 170 9 36 6
26 Aqua Dest Steril Btl
27 Aqua Pro Injeksi Ktk / 10
28 Artemeter Injeksi Ktk / 6
29 Artesunate +Amodiaquin Ktk / 3
30 Artesunate Injeksi Ktk / 8
31 Asam Mefenamat 250 mg
Asam Mefenamat 500 mg Ktk / 100 8700 253 2030 275
32 Asetosal tablet 100 mg Ktk / 100
34 Atropin Sulfat Inj Ktk/30 54
35 Atropin Sulfat tab 0.5 mg Btl/500
36 ATS Injeksi 1.500 IU Ampul
37 ATS Injeksi 20.000 IU Vial
38 Bacitracin tube 4
39 Betametason cream Tube 1
40 Blood Lancet Ktk / 100
41 Catarlent T.M Btl 5 ml
42 Catgut 2/0 + 3/0 Biji 100 32 5
Catopril tab 12,5 mg Ktk / 60
43 Catopril tab 12,5 mg Ktk / 100 3800 18
44 Catopril tab 25 mg Ktk / 100 5000 226 161 140
45 Cefadroxil kap 500 mg Kek/100 4900 163 1409 13
46 Cefadroxil syr BTL 190 5 60 6
47 Cefotaxim Injeksi Ktk / 2
48 Cepezet tab 100 mg Btl/ 250
49 Cetirizine ktk/100
51 Cimetidine Tab 200 mg Ktk / 100
52 Cover Glass Ktk 100
53 CTM Tablet 4 mg Btl/ 1000 24900 1305 2799 1163
54 Cyprofloxacin 500 mg Ktk / 100 4200 378 400
55 Cyprofloxacin 500 mg Ktk / 50
56 Dexametason Injeksi Ktk / 100
57 Dexametason tab 0,5 mg Btl / 1000 4000 371 1726 380
58 Dextran 70 %
59 Dextrometorfan Sirup Botol
60 Dextrometorfan tab 15 mg Btl / 1000
61 Diasec Tab Ktk / 10
62 Diazepam Inj 5 mg / ml ktk / 30
63 Diazepam Tablet 2 mg Btl / 1000
65 Difenhidramin HCl Injeksi Ktk / 30
66 Digoksin Tablet 0,5 mg Ktk/100
Domperidon syr Btl/60 ml 172 7 5 8
67 Domperidon tab 10 mg Ktk/100 2500 389 390
68 Dulcolax Supp adult Ktk / 5
Efedrin HCl tablet 25 mg Btl / 250 5000 601 615 60
70 Epinefrin Injeksi 0,1 % Ktk / 30
72 Erytromisin Kaps 250 mg Ktk / 100 1000 160 350
73 Erytromisin Syrup Fls
74 Etakridin ( Rivanol ) Botol
75 Etanol 70 % Botol 95 8 3
76 Etanol 70 %ol 100 Ml botol
77 Etil Klorida Semprot Botol
78 Eugenol Cairan Botol 12
79 Extrac Belladone tab Btl / 1000
80 Face Mask Pcs
81 Fenil Butazon tab Btl/1000
82 Fenobarbital tab 30 mg Btl / 100 2900 70
83 Fenoks Penisilin Tab 500 mg Ktk / 100
84 Fenol Gliserol TT 10 % Botol
85 Fitomenadion (Vit.K) Inj Ktk / 30 85 7 3
86 Fitomenadion (Vit.K)Tab Btl / 100 130
87 Folley Catheter 2 Ways Biji
88 Furosemida Tab 40 mg Btl / 250
89 Furosemida Tab 40 mg Ktk / 200 800 219 60
90 Gameksan Emulsi 1 % Botol
91 Garam Oralit 200 ml Ktk/100 1100 67 311 94
92 Gentamici SK Tube
93 Gentamisin Injeksi Vial
Gentamisin TM tube 72
Gentian Violet 1 % Botol
94 Glass Ionomer Semen Set
95 Glibenklamid tablet 5 mg Btl / 100
96 Gliseril Guaiacolat tablet Btl / 1000
97 Glukosa Infus 10 % Fls
99 Glukosa Infus 5 % Fls 41
100 Griseofulvin Tab 125 mg Btl / 100 5
101 Haloperidol Inj Ampul 49
102 Haloperidol Tab 1,5 mg Kotak / 100 3400 60
103 Haloperidol tab 5 mg Ktk/100
104 Haloperidol Tablet 0,5 mg Ktk / 100
105 Hanscoon 6,5 ktk/50 450 5
106 Hanscoon 7,5 564
107 Hidroklortiazid (HCT)Tab Btl / 1000
108 Hidrokortison Krim 2,5 % Tube 120 13 2
109 Ibuprofen Tablet 200 mg Btl / 100 400 1358
110 Ibuprofen Tablet 400 mg Ktk/100 9800 285 175
111 Infusion Set Anak Set
112 Infusion Set Dewasa Set 102 17 2
113 Iodiol Btl/100
114 Isoniazida Tab 100 mg Btl / 1000
116 Isosorbit Dinitrat Tab 5 mg Ktk / 100
117 IV Catheter No. 18 Biji
119 IV Catheter No. 22 Biji 125
121 Kalium Diclofenat 50 mg Ktk / 50
122 Kalium Permanganat (PK) Pot
123 Kalsium Laktat Tab 500 mg Btl /1000 5200 2940 734
124 Kapas Berlemak 500 gr Bungkus
125 Kapas Pembalut 250 gram Rol 16 1
126 Karbamazepin Tab 200 mg Ktk / 100 1700 220
127 Kasa 16 x 16 Steril Rol 26
128 Kasa 2x80 Rol
129 Kasa 36 x 80 cm Rol 4
130 Kasa 4x10 Rol 130 29
131 Kasa 4x5 Rol 150 7
132 Kasa Elastis 4 Inc Rol
133 Kassa 4 x 15 cm Rol
135 ketokonazole ktk/50 2700 204 454
136 Kloramfenikol Syr Fls 90 8
137 Kloramfenikol 250 mg Btl / 250 2600 180 695 60
Kloramfenikol T.T 3 % Botol
138 Kloramfrnikol S.M 1 % Tube 52 17 11
139 Kloramixin D Eye Drop Fls
140 Klorpromazin 25 mg Inj ktk / 30
141 Klorpromazin Tab 100 mg Btl/ 1000
142 Klorpromazin tab 25 mg Btl/1000
143 Kodein Tablet 10 mg Btl / 250 2700 200
144 Korimoksazol Tab 120 mg Btl / 100
145 Korimoksazol Tab 480 mg Btl / 100 2700 5 1793 18
146 Kotrimoksazol Suspensi Botol 354 22 68 16
147 Kuinin ( Kina ) Tab 200 mg Ktk / 60
148 Kuinin Injeksi 25 % Ktk / 30
149 Lart. Etanol Asam Botol
150 Lartan Karbol Fuksin Fls
151 Larutan Benedict Fls
152 Larutan Fauchet Fls
153 Larutan Giemsa Fls
Larutan HCl 0,1 N Botol
154 Larutan Kinyoun Fls
155 Larutan Metilen Biru Fls
156 Larutan Turk Fls
157 Levertran salep pot
158 Lidokain Injeksi Ktk / 30 327 18 2
159 Loperamide Ktk/100 121 180
160 Lunex Injeksi 100 mg/ ml Ktk / 10
162 Lysmin Syrup Botol
163 Lysol Fls
164 Magnesium Sulfat Injeksi Ktk / 10
165 Masker 25
166 Mess Blade 11, 15, 23 Ktk / 100
Metformin tab 500 mg Ktk/100 1600
167 Methyl Prednisolon 4 mg Ktk/100 4700 267 87
168 Metil Ergometrin Injeksi Ktk / 30 86 11 2
169 Metil Ergometrin Tab Ktk / 100 100 100 80
170 Metoklorfofamid ktk/100 2300 410 200
171 Metronidazol Tab 250 mg Ktk / 100 1800 616 1375 149
172 Metronidazol Tab 500 mg Ktk / 100 1100 115
173 Miconazol Salaf
174 Modicate Ampul Ampul
175 Nalhecting Kulit / Otot Lusin
176 Natrium Bikarbonat Tab Btl/ 1000
177 Natrium Diklofenat Ktk/50 2150 133 310
178 Natrium Klorida Infus 0,9 % Botol 39 8 2
179 Nifedipin Tab 10 mg Ktk / 100 200 534 345
180 Nistatin Tablet 100.000 IU Fls
181 Nistatin Tablet 500.000 IU Ktk / 100
182 Obat Batuk Hitam ( OBH ) Botol
183 Obat T.B Kategori Anak Paket
184 Obat T.B Kategori I Paket
185 Obat T.B Kategori II Paket
186 OBH Indo Plus Fls
187 Objek Glass Pcs
188 Oksitetrasiklin S.K 3% Tube
189 Oksitetrasiklin S.M 1% Tube
190 Oksitosin Injeksi Ktk / 30 222 35 3
191 Omeprazol kapsul Ktk/30 5880 30 252
192 Papaverin Tablet 40 mg Btl/ 100 1000 160 905 258
193 Paraformaldehid Tab 1 gr Btl / 100
194 Parasetamol Sirup 120 mg Botol 290 6
195 Parasetamol Tablet 100 mg / drops Btl / 100
196 Parasetamol Tablet 500 mg Btl/ 100 16700 528 3683 990
197 Pehacain Injeksi Ktk / 20
Pehamoxil 500 mg Ktk/50
Pembalut Gips Rol
198 Petidin Injeksi Ktk / 10
199 Pirantel tabl 125 mg ktk/28 180 64 187 30
200 Piridoksin Tab 10 mg Btl/ 1000 6800 211 1268 521
201 Piroksikam Kapsul 10 mg Ktk/100
202 Plester Rol 36 4 1
203 Povidon Iodida 10 % Btl/300ml 23
205 Prednison Tablet 5 mg Btl / 1000 8900 415 1074 639
206 Primaquin tablet 15 mg Btl / 1000
207 Propanolol HCl Tab 40 mg Btl / 100 1000 488
208 Propiltiourasil Tablet Btl / 100
209 Pyrazinamid Tab 500 mg Ktk / 100
210 Ranitidin tablet 150 mg Ktk / 30 4000 183 2270 470
212 Reserpin Tablet 0,25 mg Botol / 1000
213 Retinol (Vit.A) 100.000 IU Btl / 50
215 Rifampisin Kapsul 300 mg Ktk / 100
Ringer Laktat Larutan Infus Botol 43 11
216 Risperidone Ktk/100 2300 150
217 Salbutamol Tablet 2 mg Ktk / 100 3300 137 225
218 Salbutamol Tablet 4 mg Ktk / 100
219 Salep 2 - 4 Pot 99 8 28 3
220 Salisil Bedak 2 % Bungkus 18 10 22
221 Salisil Spiritus 10 % Botol
Semen Seng Fosfat Set
222 Serum ABU 5 ml Ktk / 10
223 Sianokobalamin (vit.B12)Inj Ktk / 100
224 Silk ( Benang Bedah ) Bungkus 116 30 5
225 Simvastatin tab Ktk/30 3180 124
226 Spirolakton Tab 100 mg Ktk / 100
228 Stomach Tube Pcs
229 Sulfadimidin Tablet 500 mg Btl/ 1000
Sulfasetamid TM tube
230 Tablet Tambah darah Bks / 30 11520 1839 2410 1370
231 Tetagam inj
232 Tetrasiklin HCl 250 mg BTL/ 1000
233 Tetrasiklin HCl 500 mg Ktk / 100
234 Tiamin HCl ( Vit. B1 ) Inj. Ktk / 30
235 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 6400 490 3170 842
236 Tramadol Inj Ktk/5
Tramadol tab Ktk/50
237 Tranexamid Acid 500 mg Ktk/100
238 Trifluoperazine 5 mg Ktk/100 600 390
239 Trihexifenidil (THP)Tab 2 mg Ktk / 100 1700 160
240 Urine bag T. Type Steril Pcs
241 Urineg tab ( As. Nalidiksat ) Ktk / 100
242 Urispas Tab Ktk / 30
243 Valisanbe Tab 2 mg Ktk / 100
244 Vit. B 12 INJ 100
245 Vit. B Complek tab Btl / 1000 10200 2272 1098
246 Vit. B12 Tab Btl / 1000 600
247 Vit. C tablet 50 mg Btl / 1000 11600 1100 2523 1026
248 Wing Nedle no 23 G Ktk/100
Wing Nedle no 25 G Ktk/100
249 Zink Tablet Ktk / 100 3500 319 1708 450
JUMLAH
Pimpinan Puskesmas Lb.Sikaping
dr. LUSI HASTUTY

NIP.197603052005012008
NERIK DI PUSKESMAS DAN JARINGANNYA
TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

Rp Rp
8 9 10
- 2,260.00 -
1,407 239.00 336,273.00
- 250.00 -
- 1,147.12 -
396 1,089.90 431,600.40
200 1,089.90 217,980.00
- 350.00 -
5,044 88.00 443,872.00
- 34,875.00
- 2,598.00 -
- 87.43 -
- 4,014.00 -
3,360 93.00 312,480.00
1,245 117.00 145,665.00
- 341.00 -
17,410 270.00 4,700,700.00
428 2,500.00 1,070,000.00
- 1,272.70 -
- 142.22 -
12,923 74.00 956,302.00
- 29.14 -
308 2,200.00 677,600.00
177 1,640.00 290,280.00
- 142.00 -
221 1,909.10 421,911.10
- 2,000.00 -
- 5,500.00 -
- 300.00 -
- 10,992.67 -
- 18,992.88 -
-
11,258 116.00 1,305,928.00
- 122.00 -
- 148.71 -
54 1,291.00 69,714.00
- 25.01 -
- 99,850.00 -
- 624,360.00 -
4 2,641.00 10,564.00
1 1,520.00 1,520.00
- 180.00 -
- 25,850.00 -
137 28,000.00 3,836,000.00
- 112.80 -
3,818 62.00 236,716.00
5,527 89.00 491,903.00
6,485 521.00 3,378,685.00
261 7,827.00 2,042,847.00
- 6,615.00 -
- 79.44 -
- 186.00 -
- 112.80 -
- 264.00 -
30,167 27.00 814,509.00
4,978 271.09 1,349,486.02
- 170.00 -
- 1,550.00 -
6,477 85.00 550,545.00
- 35,526.00 -
- 2,734.00 -
- 34.02 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
192 3,410.00 654,720.00
3,279 185.00 606,615.00
- 10,000.00 -
6,276 53.82 337,774.32
- 345.70 -
- 300.00 -
1,510 497.00 750,470.00
- 7,731.00 -
- 1,718.00 -
106 33,000.00 3,498,000.00
-
- 105,000.00 -
12 3,257.00 39,084.00
- 17.89 -
- 7,000.00 -
- 72.38 -
2,970 69.00 204,930.00
- 370.63 -
- 1,058.00 -
95 1,660.90 157,785.50
130 660.00 85,800.00
- 7,800.00 -
- 55.96 -
1,079 80.00 86,320.00
- 7,315.00 -
1,572 303.00 476,316.00
- 1,469.00 -
- 12,500.00 -
72 3,353.00 241,416.00
- 945.00 -
- 363,636.00 -
- 58.00 -
- 29.30 -
- 4,100.00 -
- 1,040.00 -
41 4,830.00 198,030.00
5 219.00 1,095.00
49
3,460 72.00 249,120.00
- 116.73 -
- 57.50 -
455 4,462.50 2,030,437.50
564 412.50 232,650.00
- 17.00 -
135 2,668.00 360,180.00
1,758 94.19 165,586.02
10,260 149.00 1,528,740.00
- 3,636.00 -
121 3,500.00 423,500.00
- 930.00 -
- 27.00 -
- 66.14 -
- 65.24 -
- 3,000.00 -
- 7,787.00 -
125 7,787.00 973,375.00
- 7,061.00 -
- 425.00 -
- 4,090.00 -
8,874 54.50 483,633.00
- 14,007.00 -
17 7,500.00 127,500.00
1,920 257.00 493,440.00
26 1,393.00 36,218.00
- 7,858.00 -
4
159 552.00 87,768.00
157 276.00 43,332.00
- 10,000.00 -
- 3,066.00 -
- 666.00 -
3,358 310.00 1,040,980.00
98 11,558.00 1,132,684.00
3,535 213.00 752,955.00
- 1,679.00 -
80 1,600.00 128,000.00
- 11,558.00 -
- 1,072.00 -
- 29.11 -
- 24.45 -
2,900 525.00 1,522,500.00
- 72.45 -
4,516 145.00 654,820.00
460 2,222.00 1,022,120.00
- 249.52 -
- 1,171.17 -
- 79.44 -
- 46,700.00 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 28,000.00 -
- 95,000.00 -
- 66,700.00 -
- 33,000.00 -
- 1,395.00 -
347 1,360.00 471,920.00
301
- 9,800.00 -
- 6,900.00 -
- 18,150.00 -
- 27,500.00 -
- 1,947.90 -
25 1,181.00 29,525.00
- 1,650.00 -
1,600 142.23 227,568.00
5,054 210.00 1,061,340.00
99 1,564.50 154,885.50
280 154.00 43,120.00
2,910 105.00 305,550.00
3,940 113.00 445,220.00
1,215 164.00 199,260.00
- -
- 88,250.00 -
- 10,984.83 -
- 15.02 -
2,593 293,86
49 5,145.00 252,105.00
1,079 112.00 120,848.00
- 35,600.00 -
- 461.08 -
- 1,299.00 -
- 127,200.00 -
- 236,000.00 -
- 376,500.00 -
- 6,536.00 -
- 10,000.00 -
- 1,572.00 -
- 1,600.00 -
260 1,820.00 473,200.00
6,162 216.00 1,330,992.00
2,323 122.00 283,406.00
- 60.75 -
296 1,496.00 442,816.00
- 32.96 -
21,901 82.80 1,813,402.80
- 1,650.00 -
- 283.70 -
- 6,162.00 -
- 1,520.00 -
461 274.00 126,314.00
8,800 18.27 160,776.00
- 66.00 -
41 23,625.00 968,625.00
23 14,000.00 322,000.00
9 2,000.00 18,000.00
11,028 59.66 657,930.48
- 30.00 -
1,488 114.00 169,632.00
- 277.00 -
- 462.00 -
6,923 126.00 872,298.00
- 55.00 -
- 255.00 -
- 335.40 -
- 350.00 -
54 5,460.00 294,840.00
3,662 62.00 227,044.00

- 97.49 -
138 2,400.00 331,200.00
50 1,250.00 62,500.00
- 1,375.00 -
- 80,659.00 -
- 410,190.00 -
- 989.86 -
151 6,983.00 1,054,433.00
3,304 174.00 574,896.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
- 3,387.00 -
17,139 43.00 736,977.00
-
- 53.70 -
- 245.31 -
- 731.80 -
10,902 21.00 228,942.00
- 6,707.40 -
- 339.62 -
- 570.00 -
990 425.00 420,750.00
1,860 42.00 78,120.00
- 6,500.00 -
- 2,365.00 -
- 3,162.50 -
- 132.00 -
13,570 110.00 1,492,700.00

600 14.00 8,400.00
16,249 100.00 1,624,900.00
- 2,145.00 -
- 2,145.00 -
5,977 497.00 2,970,569.00
Rp 63,007,411
Lubuk Sikaping, 28 Februari 2018
Pengelola gudang obat
Ns. Indri Wardani, S. Kep

NIP.19780314 200501 2 007

KABUPATEN : PASAMAN
PERIODE : MARET 2017
1 2 3 4 5 6 7 8 9 10
Alprazolam Ktk / 100 2200 612 2,812
Acetylcysteine Ktk / 60 1500 960 2,460
6 Albendazol Tab 400 mg Ktk / 30 1764 1,764 350.00 617,400.00
7 Ambroxol Tab Ktk / 100 70 15 85 87.43 7,431.55
8 Ambroxol syr Btl/60 ml 15 15 2,598.00 38,970.00
10 Acyclovir Tab 200 mg Ktk / 100 2700 325 100 3,125 239.00 746,875.00
11 Alluporinol tab 100 mg Ktk / 100 - 88.00 -
12 Aminophyllin Injeksi Ktk / 30 10 10 4,014.00 40,140.00
13 Aminophyllin tab 200 mg Btl / 1000 2900 194 1,420 235 4,749 93.00 441,657.00
14 Amitriptilin tab 25 mg Ktk / 100 800 745 1,545 117.00 180,765.00
15 Amoksisilin Syrup Btl 381 12 112 14 519 2,500.00 1,297,500.00
16 Amoksilin Kaplet 500 mg Ktk / 100 17000 1892 3,465 318 22,675 270.00 6,122,250.00
17 Amlodipin ktk/30 1470 95 15 1,580 341.00 538,780.00
20 Antasida DOEN Tab Ktk/100 7600 1009 2,876 790 12,275 74.00 908,350.00
22 Anti Fungi DOEN Salep Pot 76 23 4 9 112 1,640.00 183,680.00
24 Antihemoroid supp Ktk/10 70 16 8 94 1,909.10 179,455.40
25 Aqua Pro Injeksi Ktk / 10 - 5,500.00 -
27 Vit. C tablet 50 mg Btl / 1000 16000 1631 3,200 824 21,655 100.00 2,165,500.00
Asam Mefenamat 250 mg -
32 Asam Mefenamat 500 mg Ktk / 100 6600 1114 1,130 280 9,124 116.00 1,058,384.00
35 Betametason cream Tube 188 16 12 216 1,520.00 328,320.00
36 Blood Lancet Ktk / 100 - 180.00 -
38 Catgut 2/0 + 3/0 Biji 61 29 3 93 28,000.00 2,604,000.00
39 Catopril tab 12,5 mg Ktk / 60 3400 3,400 112.80 383,520.00
40 Catopril tab 12,5 mg Ktk / 100 240 240 62.00 14,880.00
41 Catopril tab 25 mg Ktk / 100 6500 392 1,166 273 8,331 89.00 741,459.00
42 Cetirizine ktk/100 54 54 186.00 10,044.00
45 Cover Glass Ktk 100 - 264.00 -
46 Cyprofloxacin 500 mg Ktk / 100 8800 250 350 89 9,489 271.09 2,572,373.01
48 Dexametason tab 0,5 mg Btl / 1000 8500 177 1,170 374 10,221 85.00 868,785.00
52 Dextran 70 % Fls - 35,526.00 -
53 Diasec Tab Ktk / 10 - 1,540.00 -
59 Dulcolax Supp adult Ktk / 5 17 17 10,000.00 170,000.00
60 Efedrin HCl tablet 25 mg Btl / 250 2600 228 876 30 3,734 53.82 200,963.88
64 Erytromisin Kaps 250 mg Ktk / 100 1500 286 140 1,926 497.00 957,222.00
66 Etakridin ( Rivanol ) Botol 1 1 1,718.00 1,718.00
Etanol 70 %ol 100 Ml botol -
67 Etanol 70 % Botol 88 5 1 94 33,000.00 3,102,000.00
68 Etil Klorida Semprot Botol 0 - 105,000.00 -
70 Face Mask Pcs - 7,000.00 -
72 Fenobarbital tab 30 mg Btl / 100 - 69.00 -
74 Fenol Gliserol TT 10 % Botol 12 27 18 2 59 1,058.00 62,422.00
75 Fitomenadion (Vit.K) Inj Ktk / 30 90 10 1 101 1,660.90 167,750.90
76 Fitomenadion (Vit.K)Tab Btl / 100 1700 344 775 26 2,845 660.00 1,877,700.00
77 Furosemida Tab 40 mg Btl / 250 195 195 55.96 10,912.20
78 Furosemida Tab 40 mg Ktk / 200 - 80.00 -
81 Garam Oralit 200 ml Ktk/100 722 131 383 50 1,286 303.00 389,658.00
82 Gentian Violet 1 % Botol - 945.00 -
83 Gentamisin TM tube 48 12 4 64 3,353.00 214,592.00
87 Glibenklamid tablet 5 mg Btl / 100 363 590 953 58.00 55,274.00
88 Gliseril Guaiacolat tablet Btl / 1000 4500 1534 3,097 731 9,862 29.30 288,956.60
89 Glukosa Infus 5 % Fls 8 8 4,830.00 38,640.00
92 Griseofulvin Tab 125 mg Btl / 100 2300 436 350 425 3,511 219.00 768,909.00
Hanscoon 7,5 100 100 412.50 41,250.00
Hanscoon 6,5 ktk/50 223 10 233 4,462.50 1,039,762.50
94 Haloperidol Tab 1,5 mg Kotak / 100 2500 180 2,680 72.00 192,960.00
95 Hidroklortiazid (HCT)Tab Btl / 1000 - 17.00 -
96 Hidrokortison Krim 2,5 % Tube 63 17 8 10 98 2,668.00 261,464.00
97 Ibuprofen Tablet 200 mg Btl / 100 400 673 1,195 2,268 94.19 213,622.92
98 Ibuprofen Tablet 400 mg Ktk/100 11900 612 555 260 13,327 149.00 1,985,723.00
99 Infusion Set Anak Set 5 5 3,636.00 18,180.00
100 Infusion Set Dewasa Set 182 12 2 196 3,500.00 686,000.00
102 IV Catheter No. 20 Biji 164 4 168 7,787.00 1,308,216.00
107 Iodiol Btl/100 - 930.00 -
110 Kalsium Laktat Tab 500 mg Btl /1000 10000 840 2,780 814 14,434 54.50 786,653.00
113 Karbamazepin Tab 200 mg Ktk / 100 2300 367 2,667 257.00 685,419.00
114 Kasa 2x80 Rol 1 1 7,858.00 7,858.00
115 Kasa 40 x 40 cm Rol - 1,393.00 -
116 Kassa 4 x 3 cm Rol 9 9 666.00 5,994.00
117 Kassa 4 x 15 cm Rol 19 19 3,066.00 58,254.00
118 ketokonazole ktk/50 3400 809 4,209 310.00 1,304,790.00
121 Kloramfenikol Syr Fls - 11,558.00 -
122 Kloramfenikol 250 mg Btl / 250 3200 415 515 40 4,170 213.00 888,210.00
123 Kloramfrnikol S.M 1 % Tube 71 21 8 3 103 1,600.00 164,800.00
124 Kloramfenikol T.T 3 % Botol - 1,679.00 -
125 CTM Tablet 4 mg Btl/ 1000 7700 1221 2,187 1334 12,442 27.00 335,934.00
127 Klorpromazin 25 mg Inj ktk / 30 - 1,072.00 -
128 Klorpromazin Tab 100 mg Btl/ 1000 3000 550 3,550 29.11 103,340.50
130 Kodein Tablet 10 mg Btl / 250 900 600 1,500 525.00 787,500.00
131 Korimoksazol Tab 480 mg Btl / 100 2400 355 1,749 223 4,727 145.00 685,415.00
132 Kotrimoksazol Suspensi Botol 381 25 96 17 519 2,222.00 1,153,218.00
136 Lidokain Injeksi Ktk / 30 322 13 335 1,360.00 455,600.00
138 Lysol Fls - 27,500.00 -
142 Larutan HCl 0,1 N Botol - 28,000.00 -
151 Loperamide tab Ktk/100 1500 480 1,980 174.00 344,520.00
152 Sulfasetamid TM tube - 3,387.00 -
Masker 200 200 1,181.00 236,200.00
155 Metformin tab 500 mg Ktk/100 1400 239 1,639 142.23 233,114.97
156 Mess Blade 11, 15, 23 Ktk / 100 - 1,650.00 -
157 Metil Ergometrin Injeksi Ktk / 30 71 9 2 82 1,564.50 128,289.00
158 Metil Ergometrin Tab Ktk / 100 200 200 400 30 830 154.00 127,820.00
159 Metronidazol Tab 250 mg Ktk / 100 3200 200 1,124 274 4,798 113.00 542,174.00
160 Metronidazol Tab 500 mg Ktk / 100 600 483 1,083 164.00 177,612.00
161 Methyl Prednisolon 4 mg Ktk/100 3300 186 180 3,666 210.00 769,860.00
164 Natrium Klorida Infus 0,9 % Botol 28 5 2 35 5,145.00 180,075.00
165 Nifedipin Tab 10 mg Ktk / 100 1100 355 540 1,995 112.00 223,440.00
Natrium Diklofenat Ktk/50 2000 460 2,460 293,86
174 Oksitetrasiklin S.M 1% Tube 7 7 1,600.00 11,200.00
175 Objek Glass Pcs - 10,000.00 -
176 Oksitosin Injeksi Ktk / 30 501 19 520 1,820.00 946,400.00
177 Omeprazol kapsul Ktk/30 1800 575 30 167 2,572 216.00 555,552.00
179 Parasetamol Sirup 120 mg Botol 430 3 102 24 559 1,496.00 836,264.00
180 Parasetamol Tablet 500 mg Btl/ 100 17100 401 3,269 962 21,732 82.80 1,799,409.60
181 Parasetamol Drops 100 mg Btl 270 4 274 32.96 9,031.04
182 Pembalut Gips Rol - 6,162.00 -
183 Papaverin Tablet 40 mg Btl/ 100 1700 358 695 372 3,125 122.00 381,250.00
186 Pehamoxil 500 mg Ktk/50 - 283.70 -
187 Pirantel tabl 125 mg ktk/28 532 29 237 71 869 274.00 238,106.00
188 Piridoksin Tab 10 mg Btl/ 1000 6800 598 1,174 1000 9,572 18.27 174,880.44
189 Plester Rol 59 4 63 23,625.00 1,488,375.00
190 Piroksikam Kapsul 10 mg Ktk/100 30 30 66.00 1,980.00
191 Povidon Iodida 10 % Btl/300ml 2 5 7 14,000.00 98,000.00
193 Prednison Tablet 5 mg Btl / 1000 9200 209 1,575 935 11,919 59.66 711,087.54
195 Propiltiourasil Tablet Btl / 100 2 2 277.00 554.00
196 Propanolol HCl Tab 40 mg Btl / 100 1000 518 1,518 114.00 173,052.00
Ranitidin Injeksi Ampul 90
198 Ranitidin tablet 150 mg Ktk / 30 3900 1402 1,279 430 7,011 126.00 883,386.00
203 Ringer Laktat Larutan Infus Botol 22 9 2 33 5,460.00 180,180.00
204 Salbutamol Tablet 2 mg Ktk / 100 2600 259 204 3,063 62.00 189,906.00
206 Salep 2 - 4 Pot 93 19 13 9 134 2,400.00 321,600.00
207 Salisil Bedak 2 % Bungkus 41 3 27 71 1,250.00 88,750.00
209 Semen Seng Fosfat Set - 80,659.00 -
Simvastatin tab tab 2250 410 2,660
212 Serum ABU 5 ml Ktk / 10 - 410,190.00 -
214 Silk ( Benang Bedah ) Bungkus 80 26 106 6,983.00 740,198.00
Stesolid Supositoria Tube 24
218 Tablet Tambah darah Bks / 30 51150 275 1,900 3010 56,335 43.00 2,422,405.00
Tetagam inj 4 4
223 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 14400 1520 2,310 915 19,145 21.00 402,045.00
224 Trihexifenidil (THP)Tab 2 mg Ktk / 100 4000 290 4,290 42.00 180,180.00
227 Urispas Tab Ktk / 30 - 3,162.50 -
230 Vit. B12 Tab Btl / 1000 10 10 14.00 140.00
231 Vit. B Complek tab Btl / 1000 21500 1190 1,050 23,740 110.00 2,611,400.00
232 Cefadroxil kap 500 mg Kek/100 2200 200 38 2,438 521.00 1,270,198.00
233 Cefadroxil syr BTL 140 17 8 165 7,827.00 1,291,455.00
235 Zink Tablet Ktk / 100 4600 992 1,333 29 6,954 497.00 3,456,138.00
236 Tramadol tab Ktk/50 - 339.62 -
Haloperidol Inj Ampul 11 11
238 Antasida sirup btl 55 0 8 30 93 2,200.00 204,600.00
242 Domperidon syr Btl/60 ml 135 19 5 159 3,410.00 542,190.00
243 Metoklorfofamid ktk/100 700 460 300 70 1,530 105.00 160,650.00
244 Kasa 4x5 Rol 74 74 276.00 20,424.00
245 Kasa 4x10 Rol 135 10 145 552.00 80,040.00
246 Bacitracin tube 95 29 5 4 133 2,641.00 351,253.00
248 Trifluoperazine 5 mg Ktk/100 600 390 990 425.00 420,750.00
Risperidone Tab 2500 290 2,790
249 Miconazol Salaf Tube 148 18 10 176 -
Lubuk Sikaping, 31 Maret 2017
HARI SANTOSO, SKM Indri Wardani

NIP.197512122000121003 NIP.19780314 200501 2 007
LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKESM

KABUPATEN : PASAMAN
PERIODE : April 2017
GUDANG APOTIK DESA
1 2 3 4 5 6 7
6 Albendazol Tab 400 mg Ktk / 30 1764
Acetylcysteine Ktk/60 4500 680
Alprazolam 0,5 mg Ktk/100 2200 487
7 Ambroxol Tab Ktk / 100 30 15
8 Ambroxol syr Btl/60 ml 20
11 Alluporinol tab 100 mg Ktk / 100 5000 80
17 amlodipin ktk/30 690 45 35
18 Antalgin Tablet 500 mg Ktk/100 360
20 Antasida DOEN Tab Ktk/100 16000 100 2461 610
31 Asetosal tablet 500 mg Ktk / 100 15200
Asam Mefenamat 250 mg
32 Asam Mefenamat 500 mg Ktk / 100 599 1540 120
35 Betametason cream Tube 182 10 18
38 Catgut 2/0 + 3/0 Biji 48 31 10
39 Catopril tab 12,5 mg Ktk / 60
42 Cetirizine ktk/100 54
Cetirizine Sirup Btl 100
44 Cimetidine Tab 200 mg Ktk / 100 480
46 Cyprofloxacin 500 mg Ktk / 100 8300 220 530 349
49 Dexametason Injeksi Ktk / 100 151
52 Dextran 70 % Fls
59 Dulcolax Supp adult Ktk / 5 8
60 Efedrin HCl tablet 25 mg Btl / 250 2400 98 749
66 Etakridin ( Rivanol ) Botol 1
Etanol 70 %ol 100 Ml botol
70 Face Mask Pcs
72 Fenobarbital tab 30 mg Btl / 100
74 Fenol Gliserol TT 10 % Botol 12 23 23
75 Fitomenadion (Vit.K) Inj Ktk / 30 60 16
76 Fitomenadion (Vit.K)Tab Btl / 100 1500 284 745 96
78 Furosemida Tab 40 mg Ktk / 200 195
82 Gentian Violet 1 % Botol 5
83 Gentamisin TM tube 43 6 9
87 Glibenklamid tablet 5 mg Btl / 100 223 360
88 Gliseril Guaiacolat tablet Btl / 1000 2900 300 2588 404
89 Glukosa Infus 5 % Fls 28 1
92 Griseofulvin Tab 125 mg Btl / 100 2300 346 280 280
Hanscoon 7,5 150
Hanscoon 6,5 ktk/50 200
96 Hidrokortison Krim 2,5 % Tube 178 13 7 8
97 Ibuprofen Tablet 200 mg Btl / 100 4000 612 1340
98 Ibuprofen Tablet 400 mg Ktk/100 10300 81 1240 150
99 Infusion Set Anak Set 5
102 IV Catheter No. 20 Biji 148 4
107 Iodiol Btl/100
110 Kalsium Laktat Tab 500 mg Btl /1000 13700 265 2100 374
112 Kapas Pembalut 250 gram Rol 23 1 1
114 Kasa 2x80 Rol
115 Kasa 40 x 40 Steril Rol
116 Kassa 4 x 3 cm Rol 6
118 ketokonazole ktk/50 3300 739
121 Kloramfenikol Syr Fls 100
124 Kloramfenikol T.T 3 % Botol
125 CTM Tablet 4 mg Btl/ 1000 24200 520 1934 499
128 Klorpromazin Tab 100 mg Btl/ 1000 3000 100
Loperamide Ktk/100 1500 435
138 Lysol Fls
142 Larutan HCl 0,1 N Botol
152 Sulfasetamid TM tube
Masker 200
155 Metformin tab 500 mg Ktk/100 1400 139
156 Mess Blade 11, 15, 23 Ktk / 100
158 Metil Ergometrin Tab Ktk / 100 200 200 270 30
164 Natrium Klorida Infus 0,9 % Botol 46 3
Natrium Diklofenat Ktk/50 2000 340
174 Oksitetrasiklin S.M 1% Tube 4
175 Objek Glass Pcs
176 Oksitosin Injeksi Ktk / 30 488 25
177 Omeprazol kapsul Ktk/30 1800 415 30 147
179 Parasetamol Sirup 120 mg Botol 229 32 99 28
181 Parasetamol Tablet 100 mg Btl / 100 260 8
182 Pembalut Gips Rol
186 Pehamoxil 500 mg Ktk/50
189 Plester Rol 53 3
192 Povidon Iodida 10 % Btl/30ml 96 9
195 Propiltiourasil Tablet Btl / 100 2
Risperidone Ktk/100 2500 220
Ranitidine INJ Ampul 90
203 Ringer Laktat Larutan Infus Botol 39 13 1
206 Salep 2 - 4 Pot 88 16 13 7
209 Semen Seng Fosfat Set
214 Silk ( Benang Bedah ) Bungkus 80 25
Stesolide Tube 24
Tetagam inj
Vit. B 12 INJ 100
230 Vit. B12 Tab Btl / 1000
231 Vit. B Complek tab Btl / 1000 28700 200 1000 775
232 Cefadroxil kap 500 mg Kek/100 2000 160 4
233 Cefadroxil syr BTL 140 10 3
235 Zink Tablet Ktk / 100 4300 864 1163
236 Tramadol tab Ktk/50
Haloperidol Inj Ampul 11
238 Antasida sirup btl 225 16 18 25
242 Domperidon syr Btl/60 ml 135 18
243 Metoklorfofamid ktk/100 700 460 220 60
244 Kasa 4x5 Rol 145
245 Kasa 4x10 Rol 395 32
Kasa 36 x 80 cm 5
246 Bacitracin tube 95 29 4
249 Miconazol Salaf 138 7 6 8
JUMLAH
Kepala Puskesmas Lb.Sikaping
HARI SANTOSO, SKM

NIP.197512122000121003

Rp Rp
8 9 10
- 34,875.00
- 250.00 -
685 1,089.90 746,581.50
- 1,147.12 -
- 1,089.90 -
1,764 350.00 617,400.00
45 87.43 3,934.35
20 2,598.00 51,960.00
- 2,260.00 -
3,907 239.00 933,773.00
5,080 88.00 447,040.00
- 4,014.00 -
4,065 93.00 378,045.00
1,545 117.00 180,765.00
697 2,500.00 1,742,500.00
28,358 270.00 7,656,660.00
770 341.00 262,570.00
360 142.22 51,199.20
- 1,272.70 -
19,171 74.00 1,418,654.00
- 29.14 -
159 1,640.00 260,760.00
- 142.00 -
191 1,909.10 364,638.10
- 5,500.00 -
- 2,000.00 -
26,328 100.00 2,632,800.00
- 10,992.67 -
- 18,992.88 -
- 122.00 -
15,200 148.71 2,260,392.00
-
2,259 116.00 262,044.00
- 25.01 -
55 1,291.00 71,005.00
210 1,520.00 319,200.00
- 180.00 -
- 25,850.00 -
89 28,000.00 2,492,000.00
- 112.80 -
3,570 62.00 221,340.00
7,348 89.00 653,972.00
54 186.00 10,044.00
- 6,615.00 -
480 112.80 54,144.00
- 264.00 -
9,399 271.09 2,547,974.91
- 170.00 -
8,993 85.00 764,405.00
151 1,550.00 234,050.00
- 2,734.00 -
- 34.02 -
- 35,526.00 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
8 10,000.00 80,000.00
3,247 53.82 174,753.54
- 17.89 -
- 345.70 -
- 300.00 -
1,996 497.00 992,012.00
- 7,731.00 -
1 1,718.00 1,718.00
-
86 33,000.00 2,838,000.00
- 105,000.00 -
24 3,257.00 78,168.00
- 7,000.00 -
- 72.38 -
- 69.00 -
- 370.63 -
58 1,058.00 61,364.00
76 1,660.90 126,228.40
2,625 660.00 1,732,500.00
- 55.96 -
195 80.00 15,600.00
- 7,800.00 -
- 7,315.00 -
2,287 303.00 692,961.00
5 945.00 4,725.00
58 3,353.00 194,474.00
- 1,469.00 -
- 12,500.00 -
- 363,636.00 -
583 58.00 33,814.00
6,192 29.30 181,425.60
29 4,830.00 140,070.00
- 4,100.00 -
- 1,040.00 -
3,206 219.00 702,114.00
- 57.50 -
150 412.50 61,875.00
200 4,462.50 892,500.00
2,260 72.00 162,720.00
- 17.00 -
206 2,668.00 549,608.00
5,952 94.19 560,618.88
11,771 149.00 1,753,879.00
5 3,636.00 18,180.00
183 3,500.00 640,500.00
- 3,000.00 -
152 7,787.00 1,183,624.00
50 7,787.00 389,350.00
- 7,061.00 -
- 27.00 -
- 66.14 -
- 930.00 -
- 65.24 -
- 4,090.00 -
16,439 54.50 895,925.50
- 14,007.00 -
25 7,500.00 187,500.00
2,517 257.00 646,869.00
- 7,858.00 -
- 1,393.00 -
6 666.00 3,996.00
- 3,066.00 -
4,039 310.00 1,252,090.00
- 425.00 -
- 11,558.00 -
100 11,558.00 1,155,800.00
4,160 213.00 886,080.00
28 1,600.00 44,800.00
- 1,679.00 -
27,153 27.00 733,131.00
- 24.45 -
- 1,072.00 -
3,100 29.11 90,241.00
- 79.44 -
1,500 525.00 787,500.00
4,382 145.00 635,390.00
484 2,222.00 1,075,448.00
- 72.45 -
- 249.52 -
- 1,171.17 -
485 1,360.00 659,600.00
- 1,395.00 -
- 27,500.00 -
- 18,150.00 -
- 6,900.00 -
- 9,800.00 -
- 28,000.00 -
- 79.44 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 95,000.00 -
- 33,000.00 -
- 66,700.00 -
- 46,700.00 -
2,575 174.00 448,050.00
- 3,387.00 -
- 35,600.00 -
200 1,181.00 236,200.00
- 1,947.90 -
1,539 142.23 218,891.97
- 1,650.00 -
80 1,564.50 125,160.00
700 154.00 107,800.00
4,758 113.00 537,654.00
3,802 164.00 623,528.00
3,380 210.00 709,800.00
- 88,250.00 -
- 15.02 -
49 5,145.00 252,105.00
1,710 112.00 191,520.00
- 10,984.83 -
2,340 293,86
- 461.08 -
- 376,500.00 -
- 236,000.00 -
- 127,200.00 -
- 1,299.00 -
- 6,536.00 -
- 1,572.00 -
4 1,600.00 6,400.00
- 10,000.00 -
513 1,820.00 933,660.00
2,392 216.00 516,672.00
- 60.75 -
388 1,496.00 580,448.00
32,964 82.80 2,729,419.20
268 32.96 8,833.28
- 6,162.00 -
3,070 122.00 374,540.00
- 1,650.00 -
- 1,520.00 -
- 283.70 -
820 274.00 224,680.00
8,740 18.27 159,679.80
56 23,625.00 1,323,000.00
- 66.00 -
2 14,000.00 28,000.00
105 2,000.00 210,000.00
10,407 59.66 620,881.62
- 30.00 -
2 277.00 554.00
1,518 114.00 173,052.00
- 462.00 -
16,268 126.00 2,049,768.00

- 55.00 -
- 335.40 -
- 255.00 -
- 350.00 -
53 5,460.00 289,380.00
2,785 62.00 172,670.00
- 97.49 -
124 2,400.00 297,600.00
69 1,250.00 86,250.00
- 1,375.00 -
- 80,659.00 -
- 99,850.00 -
- 624,360.00 -
- 410,190.00 -
- 989.86 -
105 6,983.00 733,215.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
52,260 43.00 2,247,180.00
- 53.70 -
- 245.31 -
- 731.80 -
-
- 6,707.40 -
31,470 21.00 660,870.00
4,040 42.00 169,680.00
- 570.00 -
- 2,365.00 -
- 3,162.50 -
- 6,500.00 -
- 132.00 -
- 14.00 -
30,675 110.00 3,374,250.00
2,164 521.00 1,127,444.00
153 7,827.00 1,197,531.00
- 300.00 -
6,327 497.00 3,144,519.00
- 339.62 -
11
- 116.73 -
284 2,200.00 624,800.00
- 2,145.00 -
- 2,145.00 -
4,074 185.00 753,690.00
153 3,410.00 521,730.00
1,440 105.00 151,200.00
145 276.00 40,020.00
427 552.00 235,704.00
128 2,641.00 338,048.00

- 10,000.00 -
990 425.00 420,750.00
159 -
Rp 80,513,082
Lubuk Sikaping, 30 April 2017
Indri Wardani
NIP.19780314 200501 2 007

KABUPATEN : PASAMAN
PERIODE : Mei 2017
GUDANG APOTIK DESA
1 2 3 4 5 6 7
6 Albendazol Tab 400 mg Ktk / 30
13 Aminophyllin tab 200 mg Btl / 1000 2100 300 1495
17 amlodipin ktk/30 0 0
32 Asam Mefenamat 500 mg Ktk / 100 12600 2120 1625 520
35 Betametason cream Tube 140 29 25 8
38 Catgut 2/0 + 3/0 Biji 40 29 7
40 Catopril tab 12,5 mg Ktk / 100 2600 305 320
52 Dextran 70 % Fls
60 Efedrin HCl tablet 25 mg Btl / 250 2200 93 591 30
70 Face Mask Pcs
74 Fenol Gliserol TT 10 % Botol 4 17 25 7
82 Gentian Violet 1 % Botol
88 Gliseril Guaiacolat tablet Btl / 1000 0 800 2172 1059
Hanscoon 7,5 135
107 Iodiol Btl/100
114 Kasa 2x80 Rol
115 Kasa 40 x 40 Steril Rol
116 Kassa 4 x 3 cm Rol 7
123 Kloramfrnikol S.M 1 % Tube 56 16 5 10
125 CTM Tablet 4 mg Btl/ 1000 18400 1160 2590 931
138 Lysol Fls
Masker 150
156 Mess Blade 11, 15, 23 Ktk / 100
161 Methyl Prednisolon 4 mg Ktk/100 2000 840 80 180
174 Oksitetrasiklin S.M 1% Tube 4
175 Objek Glass Pcs
179 Parasetamol Sirup 120 mg Botol 100 30 120 42
181 Parasetamol Tablet 100 mg / drops Btl / 100 204 1
191 Povidon Iodida 10 % Btl/300ml
196 Propanolol HCl Tab 40 mg Btl / 100
203 Ringer Laktat Larutan Infus Botol 28 9 1
206 Salep 2 - 4 Pot 85 11 10 5
Stesolide Tube 24
Tetagam inj
Vit. B 12 INJ
230 Vit. B12 Tab Btl / 1000
235 Zink Tablet Ktk / 100 4000 794 1508 80
Haloperidol Inj Ampul
242 Domperidon syr Btl/60 ml 135 17
244 Kasa 4x5 Rol 145
245 Kasa 4x10 Rol 291 36
Kasa 36 x 80 cm 0
246 Bacitracin tube 90 29 3 2
Vit. B12 INJ 100
JUMLAH
HARI SANTOSO, SKM

NIP.197512122000121003

Rp Rp
8 9 10
- 34,875.00
- 250.00 -
615 1,089.90 670,288.50
- 1,147.12 -
- 1,089.90 -
- 350.00 -
- 87.43 -
- 2,598.00 -
- 2,260.00 -
3,767 239.00 900,313.00
4,505 88.00 396,440.00
- 4,014.00 -
3,895 93.00 362,235.00
1,490 117.00 174,330.00
628 2,500.00 1,570,000.00
25,170 270.00 6,795,900.00
- 341.00 -
- 142.22 -
- 1,272.70 -
17,903 74.00 1,324,822.00
- 29.14 -
147 1,640.00 241,080.00
- 142.00 -
163 1,909.10 311,183.30
- 5,500.00 -
- 2,000.00 -
24,674 100.00 2,467,400.00
- 10,992.67 -
- 18,992.88 -
- 122.00 -
- 148.71 -
-
16,865 116.00 1,956,340.00
- 25.01 -
55 1,291.00 71,005.00
202 1,520.00 307,040.00
- 180.00 -
- 25,850.00 -
76 28,000.00 2,128,000.00
- 112.80 -
3,225 62.00 199,950.00
6,804 89.00 605,556.00
- 186.00 -
- 6,615.00 -
- 112.80 -
- 264.00 -
9,072 271.09 2,459,328.48
- 170.00 -
7,384 85.00 627,640.00
151 1,550.00 234,050.00
- 2,734.00 -
- 34.02 -
- 35,526.00 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
- 10,000.00 -
2,914 53.82 156,831.48
- 17.89 -
- 345.70 -
- 300.00 -
1,926 497.00 957,222.00
- 7,731.00 -
- 1,718.00 -
-
88 33,000.00 2,904,000.00
- 105,000.00 -
24 3,257.00 78,168.00
- 7,000.00 -
- 72.38 -
- 69.00 -
- 370.63 -
53 1,058.00 56,074.00
58 1,660.90 96,332.20
1,360 660.00 897,600.00
- 55.96 -
1,175 80.00 94,000.00
- 7,800.00 -
- 7,315.00 -
1,989 303.00 602,667.00
- 945.00 -
51 3,353.00 171,003.00
- 1,469.00 -
- 12,500.00 -
- 363,636.00 -
521 58.00 30,218.00
4,031 29.30 118,108.30
27 4,830.00 130,410.00
- 4,100.00 -
- 1,040.00 -
2,836 219.00 621,084.00
- 57.50 -
135 412.50 55,687.50
170 4,462.50 758,625.00
1,715 72.00 123,480.00
- 17.00 -
186 2,668.00 496,248.00
4,970 94.19 468,124.30
10,064 149.00 1,499,536.00
5 3,636.00 18,180.00
181 3,500.00 633,500.00
- 3,000.00 -
152 7,787.00 1,183,624.00
50 7,787.00 389,350.00
- 7,061.00 -
- 27.00 -
- 66.14 -
- 930.00 -
- 65.24 -
- 4,090.00 -
15,249 54.50 831,070.50
- 14,007.00 -
21 7,500.00 157,500.00
2,257 257.00 580,049.00
- 7,858.00 -
- 1,393.00 -
7 666.00 4,662.00
- 3,066.00 -
3,989 310.00 1,236,590.00
- 425.00 -
- 11,558.00 -
100 11,558.00 1,155,800.00
4,150 213.00 883,950.00
87 1,600.00 139,200.00
- 1,679.00 -
23,081 27.00 623,187.00
- 24.45 -
- 1,072.00 -
2,435 29.11 70,882.85
- 79.44 -
1,500 525.00 787,500.00
3,972 145.00 575,940.00
451 2,222.00 1,002,122.00
- 72.45 -
- 249.52 -
- 1,171.17 -
326 1,360.00 443,360.00
- 1,395.00 -
- 27,500.00 -
- 18,150.00 -
- 6,900.00 -
- 9,800.00 -
- 28,000.00 -
- 79.44 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 95,000.00 -
- 33,000.00 -
- 66,700.00 -
- 46,700.00 -
2,565 174.00 446,310.00
- 3,387.00 -
- 35,600.00 -
150 1,181.00 177,150.00
- 1,947.90 -
1,400 142.23 199,122.00
- 1,650.00 -
69 1,564.50 107,950.50
900 154.00 138,600.00
4,508 113.00 509,404.00
3,600 164.00 590,400.00
3,100 210.00 651,000.00
- 88,250.00 -
- 15.02 -
44 5,145.00 226,380.00
1,570 112.00 175,840.00
- 10,984.83 -
1,885 293,86
- 461.08 -
- 376,500.00 -
- 236,000.00 -
- 127,200.00 -
- 1,299.00 -
- 6,536.00 -
- 1,572.00 -
4 1,600.00 6,400.00
- 10,000.00 -
520 1,820.00 946,400.00
1,901 216.00 410,616.00
- 60.75 -
292 1,496.00 436,832.00
26,124 82.80 2,163,067.20
205 32.96 6,756.80
- 6,162.00 -
3,127 122.00 381,494.00
- 1,650.00 -
- 1,520.00 -
- 283.70 -
769 274.00 210,706.00
8,525 18.27 155,751.75
55 23,625.00 1,299,375.00
- 66.00 -
- 14,000.00 -
104 2,000.00 208,000.00
9,910 59.66 591,230.60
- 30.00 -
- 277.00 -
- 114.00 -
- 462.00 -
14,909 126.00 1,878,534.00

- 55.00 -
- 335.40 -
- 255.00 -
- 350.00 -
38 5,460.00 207,480.00
2,615 62.00 162,130.00
- 97.49 -
111 2,400.00 266,400.00
55 1,250.00 68,750.00
- 1,375.00 -
- 80,659.00 -
- 99,850.00 -
- 624,360.00 -
- 410,190.00 -
- 989.86 -
105 6,983.00 733,215.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
46,583 43.00 2,003,069.00
- 53.70 -
- 245.31 -
- 731.80 -
-
- 6,707.40 -
16,047 21.00 336,987.00
3,650 42.00 153,300.00
- 570.00 -
- 2,365.00 -
- 3,162.50 -
- 6,500.00 -
- 132.00 -
- 14.00 -
27,569 110.00 3,032,590.00
778 521.00 405,338.00
150 7,827.00 1,174,050.00
- 300.00 -
6,382 497.00 3,171,854.00
- 339.62 -
-
- 116.73 -
255 2,200.00 561,000.00
- 2,145.00 -
- 2,145.00 -
3,624 185.00 670,440.00
152 3,410.00 518,320.00
1,360 105.00 142,800.00
145 276.00 40,020.00
327 552.00 180,504.00
-
124 2,641.00 327,484.00
- 10,000.00 -
900 425.00 382,500.00
100
141 -
Rp 70,907,838
Lubuk Sikaping, 31 Mei 2017
Indri Wardani
NIP.19780314 200501 2 007

KABUPATEN : PASAMAN
PERIODE : Juni 2017
GUDANG APOTIK DESA
1 2 3 4 5 6 7
10 Acyclovir Tab 200 mg Ktk / 100 3100 130
17 amlodipin ktk/30
38 Catgut 2/0 + 3/0 Biji 80 27 4
Cetirizine Sirup Btl
52 Dextran 70 % Fls
59 Dulcolax Supp adult Ktk / 5 2
66 Etakridin ( Rivanol ) Botol 1 1
67 Etanol 70 % Botol 71 7
70 Face Mask Pcs
74 Fenol Gliserol TT 10 % Botol 4 11 24 5
88 Gliseril Guaiacolat tablet Btl / 1000 905 829
Hanscoon 7,5 130
107 Iodiol Btl/100
114 Kasa 2x80 Rol
116 Kassa 4 x 3 cm Rol 130 7
125 CTM Tablet 4 mg Btl/ 1000 32800 1913 1650 1401
138 Lysol Fls
Masker 150
156 Mess Blade 11, 15, 23 Ktk / 100
175 Objek Glass Pcs
179 Parasetamol Sirup 120 mg Botol 59 63 34
181 Parasetamol Tablet 100 mg / drops Btl / 100 194 7
Risperidone Ktk/100 400
Ranitidine INJ Ampul
203 Ringer Laktat Larutan Infus Botol 39 11
206 Salep 2 - 4 Pot 119 8 14 5
Stesolide Tube
Tetagam inj
Vit. B 12 INJ
230 Vit. B12 Tab Btl / 1000
235 Zink Tablet Ktk / 100 3300 1548 70
242 Domperidon syr Btl/60 ml 130 15 5
244 Kasa 4x5 Rol
245 Kasa 4x10 Rol 266 36
Kasa 36 x 80 cm
Vit. B12 INJ
JUMLAH
HARI SANTOSO, SKM

NIP.197512122000121003

Rp Rp
8 9 10
- 34,875.00
- 250.00 -
421 1,089.90 458,847.90
- 1,147.12 -
- 1,089.90 -
1,763 350.00 617,050.00
- 87.43 -
- 2,598.00 -
- 2,260.00 -
3,230 239.00 771,970.00
4,405 88.00 387,640.00
- 4,014.00 -
2,899 93.00 269,607.00
1,480 117.00 173,160.00
567 2,500.00 1,417,500.00
21,895 270.00 5,911,650.00
- 341.00 -
- 142.22 -
- 1,272.70 -
13,409 74.00 992,266.00
- 29.14 -
139 1,640.00 227,960.00
- 142.00 -
177 1,909.10 337,910.70
- 5,500.00 -
- 2,000.00 -
21,253 100.00 2,125,300.00
- 10,992.67 -
- 18,992.88 -
- 122.00 -
- 148.71 -
-
15,380 116.00 1,784,080.00
- 25.01 -
55 1,291.00 71,005.00
182 1,520.00 276,640.00
- 180.00 -
- 25,850.00 -
111 28,000.00 3,108,000.00
- 112.80 -
2,890 62.00 179,180.00
5,553 89.00 494,217.00
- 186.00 -
- 6,615.00 -
- 112.80 -
- 264.00 -
8,522 271.09 2,310,228.98
- 170.00 -
11,113 85.00 944,605.00
151 1,550.00 234,050.00
- 2,734.00 -
- 34.02 -
- 35,526.00 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
2 10,000.00 20,000.00
2,654 53.82 142,838.28
- 17.89 -
- 345.70 -
- 300.00 -
1,926 497.00 957,222.00
- 7,731.00 -
2 1,718.00 3,436.00
-
78 33,000.00 2,574,000.00
- 105,000.00 -
24 3,257.00 78,168.00
- 7,000.00 -
- 72.38 -
- 69.00 -
- 370.63 -
44 1,058.00 46,552.00
78 1,660.90 129,550.20
1,310 660.00 864,600.00
- 55.96 -
1,135 80.00 90,800.00
- 7,800.00 -
- 7,315.00 -
1,583 303.00 479,649.00
- 945.00 -
50 3,353.00 167,650.00
- 1,469.00 -
- 12,500.00 -
- 363,636.00 -
461 58.00 26,738.00
1,734 29.30 50,806.20
- 4,830.00 -
- 4,100.00 -
- 1,040.00 -
2,716 219.00 594,804.00
- 57.50 -
130 412.50 53,625.00
160 4,462.50 714,000.00
2,215 72.00 159,480.00
- 17.00 -
173 2,668.00 461,564.00
4,020 94.19 378,643.80
8,489 149.00 1,264,861.00
1 3,636.00 3,636.00
175 3,500.00 612,500.00
- 3,000.00 -
147 7,787.00 1,144,689.00
50 7,787.00 389,350.00
- 7,061.00 -
- 27.00 -
- 66.14 -
- 930.00 -
- 65.24 -
- 4,090.00 -
12,554 54.50 684,193.00
- 14,007.00 -
16 7,500.00 120,000.00
2,847 257.00 731,679.00
- 7,858.00 -
27 1,393.00 37,611.00
137 666.00 91,242.00
- 3,066.00 -
3,909 310.00 1,211,790.00
- 425.00 -
- 11,558.00 -
100 11,558.00 1,155,800.00
3,850 213.00 820,050.00
79 1,600.00 126,400.00
- 1,679.00 -
37,764 27.00 1,019,628.00
- 24.45 -
- 1,072.00 -
3,895 29.11 113,383.45
- 79.44 -
1,500 525.00 787,500.00
4,182 145.00 606,390.00
418 2,222.00 928,796.00
- 72.45 -
- 249.52 -
- 1,171.17 -
315 1,360.00 428,400.00
- 1,395.00 -
- 27,500.00 -
- 18,150.00 -
- 6,900.00 -
- 9,800.00 -
- 28,000.00 -
- 79.44 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 95,000.00 -
- 33,000.00 -
- 66,700.00 -
- 46,700.00 -
2,495 174.00 434,130.00
- 3,387.00 -
- 35,600.00 -
150 1,181.00 177,150.00
- 1,947.90 -
1,365 142.23 194,143.95
- 1,650.00 -
58 1,564.50 90,741.00
770 154.00 118,580.00
3,923 113.00 443,299.00
3,424 164.00 561,536.00
2,960 210.00 621,600.00
- 88,250.00 -
- 15.02 -
41 5,145.00 210,945.00
2,040 112.00 228,480.00
- 10,984.83 -
4,780 293,86
- 461.08 -
- 376,500.00 -
- 236,000.00 -
- 127,200.00 -
- 1,299.00 -
- 6,536.00 -
- 1,572.00 -
- 1,600.00 -
- 10,000.00 -
120 1,820.00 218,400.00
1,697 216.00 366,552.00
- 60.75 -
156 1,496.00 233,376.00
38,326 82.80 3,173,392.80
201 32.96 6,624.96
- 6,162.00 -
2,907 122.00 354,654.00
- 1,650.00 -
- 1,520.00 -
- 283.70 -
736 274.00 201,664.00
10,121 18.27 184,910.67
48 23,625.00 1,134,000.00
- 66.00 -
- 14,000.00 -
57 2,000.00 114,000.00
9,092 59.66 542,428.72
- 30.00 -
- 277.00 -
1,518 114.00 173,052.00
- 462.00 -
13,014 126.00 1,639,764.00

- 55.00 -
- 335.40 -
- 255.00 -
- 350.00 -
50 5,460.00 273,000.00
2,545 62.00 157,790.00
- 97.49 -
146 2,400.00 350,400.00
138 1,250.00 172,500.00
- 1,375.00 -
- 80,659.00 -
- 99,850.00 -
- 624,360.00 -
- 410,190.00 -
- 989.86 -
97 6,983.00 677,351.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
42,004 43.00 1,806,172.00
- 53.70 -
- 245.31 -
- 731.80 -
-
- 6,707.40 -
26,807 21.00 562,947.00
3,620 42.00 152,040.00
- 570.00 -
- 2,365.00 -
- 3,162.50 -
- 6,500.00 -
- 132.00 -
- 14.00 -
24,167 110.00 2,658,370.00
2,283 521.00 1,189,443.00
139 7,827.00 1,087,953.00
- 300.00 -
4,918 497.00 2,444,246.00
- 339.62 -
-
- 116.73 -
211 2,200.00 464,200.00
- 2,145.00 -
- 2,145.00 -
3,494 185.00 646,390.00
150 3,410.00 511,500.00
960 105.00 100,800.00
- 276.00 -
302 552.00 166,704.00
-
120 2,641.00 316,920.00
- 10,000.00 -
990 425.00 420,750.00
-
125 -
Rp 68,527,043
Lubuk Sikaping, 23 Juni 2017

NIP.19780314 200501 2 007

KABUPATEN : PASAMAN
PERIODE : Juli 2017
1 2 3 4 5 6 7 8 9 10
6 Albendazol Tab 400 mg Ktk / 30 - 350.00 -
Acetylcysteine Ktk/60 1370
11 Alluporinol tab 100 mg Ktk / 100 3400 625 170 4,195 88.00 369,160.00
12 Aminophyllin Injeksi Ktk / 30 - 4,014.00 -
13 Aminophyllin tab 200 mg Btl / 1000 300 118 1030 325 1,773 93.00 164,889.00
14 Amitriptilin tab 25 mg Ktk / 100 800 550 1,350 117.00 157,950.00
15 Amoksisilin Syrup Btl 314 107 17 438 2,500.00 1,095,000.00
16 Amoksilin Kaplet 500 mg Ktk / 100 13000 471 3308 813 17,592 270.00 4,749,840.00
17 amlodipin ktk/30 - 341.00 -
20 Antasida DOEN Tab Ktk/100 6700 1257 2860 30 10,847 74.00 802,678.00
22 Anti Fungi DOEN Salep Pot 107 19 7 2 135 1,640.00 221,400.00
24 Antihemoroid supp Ktk/10 100 10 43 7 160 1,909.10 305,456.00
27 Vit. C tablet 50 mg Btl / 1000 13700 296 2368 956 17,320 100.00 1,732,000.00
32 Asam Mefenamat 500 mg Ktk / 100 10700 1290 1560 420 13,970 116.00 1,620,520.00
35 Betametason cream Tube 126 16 18 2 162 1,520.00 246,240.00
36 Blood Lancet Ktk / 100 - 180.00 -
38 Catgut 2/0 + 3/0 Biji 62 27 4 93 28,000.00 2,604,000.00
39 Catopril tab 12,5 mg Ktk / 60 - 112.80 -
40 Catopril tab 12,5 mg Ktk / 100 2100 105 90 2,295 62.00 142,290.00
41 Catopril tab 25 mg Ktk / 100 1300 203 1870 320 3,693 89.00 328,677.00
45 Cover Glass Ktk 100 - 264.00 -
48 Dexametason tab 0,5 mg Btl / 1000 7500 400 1795 399 10,094 85.00 857,990.00
52 Dextran 70 % Fls - 35,526.00 -
53 Diasec Tab Ktk / 10 - 1,540.00 -
59 Dulcolax Supp adult Ktk / 5 - 10,000.00 -
67 Etanol 70 % Botol 62 5 2 69 33,000.00 2,277,000.00
70 Face Mask Pcs - 7,000.00 -
74 Fenol Gliserol TT 10 % Botol 7 19 4 30 1,058.00 31,740.00
76 Fitomenadion (Vit.K)Tab Btl / 100 200 129 635 116 1,080 660.00 712,800.00
78 Furosemida Tab 40 mg Ktk / 200 800 230 80 1,110 80.00 88,800.00
81 Garam Oralit 200 ml Ktk/100 550 36 324 117 1,027 303.00 311,181.00
83 Gentamisin TM tube 12 4 3 19 3,353.00 63,707.00
87 Glibenklamid tablet 5 mg Btl / 100 46 320 366 58.00 21,228.00
88 Gliseril Guaiacolat tablet Btl / 1000 545 404 949 29.30 27,805.70
89 Glukosa Infus 5 % Fls 25 1 26 4,830.00 125,580.00
Hanscoon 7,5 111 111 412.50 45,787.50
Hanscoon 6,5 ktk/50 70 70 4,462.50 312,375.00
94 Haloperidol Tab 1,5 mg Kotak / 100 500 175 675 72.00 48,600.00
98 Ibuprofen Tablet 400 mg Ktk/100 5100 453 1445 6,998 149.00 1,042,702.00
99 Infusion Set Anak Set 1 1 3,636.00 3,636.00
100 Infusion Set Dewasa Set 131 17 1 149 3,500.00 521,500.00
107 Iodiol Btl/100 - 930.00 -
110 Kalsium Laktat Tab 500 mg Btl /1000 6300 550 2540 699 10,089 54.50 549,850.50
112 Kapas Pembalut 250 gram Rol 12 2 1 15 7,500.00 112,500.00
114 Kasa 2x80 Rol - 7,858.00 -
115 Kasa 16 x 16 Steril Rol 27 27 1,393.00 37,611.00
116 Kassa 4 x 3 cm Rol - 666.00 -
117 Kassa 4 x 15 cm Rol - 3,066.00 -
121 Kloramfenikol Syr Fls 90 10 100 11,558.00 1,155,800.00
123 Kloramfrnikol S.M 1 % Tube 44 11 8 63 1,600.00 100,800.00
125 CTM Tablet 4 mg Btl/ 1000 29100 841 2015 746 32,702 27.00 882,954.00
128 Klorpromazin Tab 100 mg Btl/ 1000 - 29.11 -
131 Korimoksazol Tab 480 mg Btl / 100 1600 190 1194 83 3,067 145.00 444,715.00
132 Kotrimoksazol Suspensi Botol 258 89 5 352 2,222.00 782,144.00
138 Lysol Fls - 27,500.00 -
151 Simvastatin tab Ktk/30 2100 305 2,405 174.00 418,470.00
Masker 150 150 1,181.00 177,150.00
156 Mess Blade 11, 15, 23 Ktk / 100 - 1,650.00 -
158 Metil Ergometrin Tab Ktk / 100 200 200 370 770 154.00 118,580.00
159 Metronidazol Tab 250 mg Ktk / 100 1900 170 1094 329 3,493 113.00 394,709.00
161 Methyl Prednisolon 4 mg Ktk/100 1900 480 370 180 2,930 210.00 615,300.00
164 Natrium Klorida Infus 0,9 % Botol 23 5 1 29 5,145.00 149,205.00
Natrium Diklofenat Ktk/50 4200 440 4,640 293,86
174 Oksitetrasiklin S.M 1% Tube - 1,600.00 -
175 Objek Glass Pcs - 10,000.00 -
177 Omeprazol kapsul Ktk/30 870 180 210 57 1,317 216.00 284,472.00
179 Parasetamol Sirup 120 mg Botol 23 23 1,496.00 34,408.00
180 Parasetamol Tablet 500 mg Btl/ 100 24500 493 2390 1402 28,785 82.80 2,383,398.00
181 Parasetamol Tablet 100 mg / dro Btl / 100 108 3 5 116 32.96 3,823.36
186 Pehamoxil 500 mg Ktk/50 - 283.70 -
188 Piridoksin Tab 10 mg Btl/ 1000 5900 883 1837 605 9,225 18.27 168,540.75
189 Plester Rol 40 4 44 23,625.00 1,039,500.00
191 Povidon Iodida 10 % Btl/300ml - 14,000.00 -
193 Prednison Tablet 5 mg Btl / 1000 5300 436 1325 670 7,731 59.66 461,231.46
198 Ranitidin tablet 150 mg Ktk / 30 8900 1794 215 10,909 126.00 1,374,534.00
203 Ringer Laktat Larutan Infus Botol 23 15 38 5,460.00 207,480.00
206 Salep 2 - 4 Pot 93 25 10 4 132 2,400.00 316,800.00
207 Salisil Bedak 2 % Bungkus 95 26 121 1,250.00 151,250.00
212 Serum ABU 5 ml Ktk / 10 - 410,190.00 -
Stesolide Tube 24
218 Tablet Tambah darah Bks / 30 29940 1560 1280 1410 34,190 43.00 1,470,170.00
Tetagam inj -
223 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 20300 970 2810 287 24,367 21.00 511,707.00
227 Urispas Tab Ktk / 30 - 3,162.50 -
Vit. B 12 INJ
230 Vit. B12 Tab Btl / 1000 - 14.00 -
231 Vit. B Complek tab Btl / 1000 14900 1825 1139 17,864 110.00 1,965,040.00
232 Cefadroxil kap 500 mg Kek/100 1500 180 200 13 1,893 521.00 986,253.00
235 Zink Tablet Ktk / 100 2800 504 1283 40 4,627 497.00 2,299,619.00
Haloperidol Inj Ampul -
238 Antasida sirup btl 140 20 12 172 2,200.00 378,400.00
242 Domperidon syr Btl/60 ml 130 5 135 3,410.00 460,350.00
243 Metoklorfofamid ktk/100 300 430 300 100 1,130 105.00 118,650.00
244 Kasa 4x5 Rol 110 13 123 276.00 33,948.00
245 Kasa 4x10 Rol 230 30 7 267 552.00 147,384.00
Kasa 36 x 80 cm 9 9
246 Bacitracin tube 80 28 2 110 2,641.00 290,510.00
Vit. B12 INJ 100 100
249 Miconazol Salaf 85 17 6 1 109 -
Lubuk Sikaping, 31 Juli 2017
HARI SANTOSO, SKM Ns. Indri Wardani, S. Kep

NIP.197512122000121003 NIP.19780314 200501 2 007
LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKE

KABUPATEN : PASAMAN
PERIODE : Agustus 2017
GUDANG APOTIK DESA
1 2 3 4 5 6 7
Acetylcysteine Ktk/60
17 amlodipin ktk/30
38 Catgut 2/0 + 3/0 Biji 110 26 7
49 Dexametason Injeksi Ktk / 100 142 2
52 Dextran 70 % Fls
67 Etanol 70 % Botol 150 8 1
70 Face Mask Pcs
78 Furosemida Tab 40 mg Ktk / 200 230 60
83 Gentamisin TM tube 5 7
87 Glibenklamid tablet 5 mg Btl / 100 190
Hanscoon 7,5 394
107 Iodiol Btl/100
114 Kasa 2x80 Rol
125 CTM Tablet 4 mg Btl/ 1000 42200 1000 2443 1060
Loperamide Ktk/100 400 664 100
138 Lysol Fls
Masker 140
156 Mess Blade 11, 15, 23 Ktk / 100
158 Metil Ergometrin Tab Ktk / 100 200 270
Natrium Diklofenat Ktk/50 4550 750 90
175 Objek Glass Pcs
179 Parasetamol Sirup 120 mg Botol
181 Parasetamol Tablet 100 mg / drops Btl / 100 51
187 Pirantel tabl 125 mg ktk/28 500 187 49
203 Ringer Laktat Larutan Infus Botol 41 14
206 Salep 2 - 4 Pot 145 17 21 4
207 Salisil Bedak 2 % Bungkus 70 32
Stesolide Tube 24
Tetagam inj
Vit. B 12 INJ
230 Vit. B12 Tab Btl / 1000
235 Zink Tablet Ktk / 100 4400 684 1653 300
241 Domperidon tab 10 mg Ktk/100 4300 170 524 11
242 Domperidon syr Btl/60 ml 177 41 5
244 Kasa 4x5 Rol 135 13 2
245 Kasa 4x10 Rol 280 36
Kasa 36 x 80 cm 9
Vit. B12 INJ 100
249 Miconazol Salaf 80 3 1
JUMLAH
HARI SANTOSO, SKM

NIP.197512122000121003

Rp Rp
8 9 10
- 34,875.00
- 250.00 -
567 1,089.90 617,973.30
- 1,147.12 -
- 1,089.90 -
870 350.00 304,500.00
- 87.43 -
- 2,598.00 -
- 2,260.00 -
2,937 239.00 701,943.00
5,995 88.00 527,560.00
- 4,014.00 -
5,943 93.00 552,699.00
1,320 117.00 154,440.00
645 2,500.00 1,612,500.00
23,010 270.00 6,212,700.00
- 341.00 -
- 142.22 -
- 1,272.70 -
18,210 74.00 1,347,540.00
- 29.14 -
203 1,640.00 332,920.00
- 142.00 -
239 1,909.10 456,274.90
- 5,500.00 -
- 2,000.00 -
28,417 100.00 2,841,700.00
- 10,992.67 -
- 18,992.88 -
- 122.00 -
- 148.71 -
-
22,543 116.00 2,614,988.00
- 25.01 -
55 1,291.00 71,005.00
137 1,520.00 208,240.00
- 180.00 -
- 25,850.00 -
143 28,000.00 4,004,000.00
- 112.80 -
7,756 62.00 480,872.00
7,716 89.00 686,724.00
- 186.00 -
- 6,615.00 -
- 112.80 -
- 264.00 -
7,092 271.09 1,922,570.28
- 170.00 -
13,624 85.00 1,158,040.00
144 1,550.00 223,200.00
- 2,734.00 -
- 34.02 -
- 35,526.00 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
- 10,000.00 -
7,594 53.82 408,709.08
- 17.89 -
- 345.70 -
- 300.00 -
1,660 497.00 825,020.00
- 7,731.00 -
- 1,718.00 -
-
159 33,000.00 5,247,000.00
- 105,000.00 -
24 3,257.00 78,168.00
- 7,000.00 -
- 72.38 -
- 69.00 -
- 370.63 -
- 1,058.00 -
132 1,660.90 219,238.80
800 660.00 528,000.00
- 55.96 -
290 80.00 23,200.00
- 7,800.00 -
- 7,315.00 -
897 303.00 271,791.00
- 945.00 -
12 3,353.00 40,236.00
- 1,469.00 -
- 12,500.00 -
- 363,636.00 -
190 58.00 11,020.00
- 29.30 -
46 4,830.00 222,180.00
- 4,100.00 -
- 1,040.00 -
1,340 219.00 293,460.00
- 57.50 -
394 412.50 162,525.00
570 4,462.50 2,543,625.00
5,035 72.00 362,520.00
- 17.00 -
125 2,668.00 333,500.00
6,625 94.19 624,008.75
5,188 149.00 773,012.00
- 3,636.00 -
147 3,500.00 514,500.00
- 3,000.00 -
126 7,787.00 981,162.00
44 7,787.00 342,628.00
- 7,061.00 -
- 27.00 -
- 66.14 -
- 930.00 -
- 65.24 -
- 4,090.00 -
12,334 54.50 672,203.00
- 14,007.00 -
34 7,500.00 255,000.00
2,670 257.00 686,190.00
- 7,858.00 -
27 1,393.00 37,611.00
- 666.00 -
- 3,066.00 -
3,949 310.00 1,224,190.00
- 425.00 -
- 11,558.00 -
100 11,558.00 1,155,800.00
3,835 213.00 816,855.00
131 1,600.00 209,600.00
- 1,679.00 -
46,703 27.00 1,260,981.00
- 24.45 -
- 1,072.00 -
4,740 29.11 137,981.40
- 79.44 -
1,255 525.00 658,875.00
8,733 145.00 1,266,285.00
595 2,222.00 1,322,090.00
- 72.45 -
- 249.52 -
- 1,171.17 -
300 1,360.00 408,000.00
- 1,395.00 -
- 27,500.00 -
- 18,150.00 -
- 6,900.00 -
- 9,800.00 -
- 28,000.00 -
- 79.44 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 95,000.00 -
- 33,000.00 -
- 66,700.00 -
- 46,700.00 -
3,845 174.00 669,030.00
- 3,387.00 -
- 35,600.00 -
140 1,181.00 165,340.00
- 1,947.90 -
2,020 142.23 287,304.60
- 1,650.00 -
141 1,564.50 220,594.50
470 154.00 72,380.00
3,913 113.00 442,169.00
3,792 164.00 621,888.00
2,510 210.00 527,100.00
- 88,250.00 -
- 15.02 -
48 5,145.00 246,960.00
1,710 112.00 191,520.00
- 10,984.83 -
5,390 293,86
- 461.08 -
- 376,500.00 -
- 236,000.00 -
- 127,200.00 -
- 1,299.00 -
- 6,536.00 -
- 1,572.00 -
- 1,600.00 -
- 10,000.00 -
197 1,820.00 358,540.00
1,197 216.00 258,552.00
- 60.75 -
- 1,496.00 -
19,232 82.80 1,592,409.60
51 32.96 1,680.96
- 6,162.00 -
2,085 122.00 254,370.00
- 1,650.00 -
- 1,520.00 -
- 283.70 -
736 274.00 201,664.00
12,567 18.27 229,599.09
41 23,625.00 968,625.00
- 66.00 -
- 14,000.00 -
46 2,000.00 92,000.00
16,300 59.66 972,458.00
- 30.00 -
- 277.00 -
1,488 114.00 169,632.00
- 462.00 -
18,998 126.00 2,393,748.00

- 55.00 -
- 335.40 -
- 255.00 -
- 350.00 -
55 5,460.00 300,300.00
4,290 62.00 265,980.00
- 97.49 -
187 2,400.00 448,800.00
102 1,250.00 127,500.00
- 1,375.00 -
- 80,659.00 -
- 99,850.00 -
- 624,360.00 -
- 410,190.00 -
- 989.86 -
132 6,983.00 921,756.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
40,800 43.00 1,754,400.00
- 53.70 -
- 245.31 -
- 731.80 -
-
- 6,707.40 -
21,777 21.00 457,317.00
2,310 42.00 97,020.00
- 570.00 -
- 2,365.00 -
- 3,162.50 -
- 6,500.00 -
- 132.00 -
- 14.00 -
23,158 110.00 2,547,380.00
6,283 521.00 3,273,443.00
357 7,827.00 2,794,239.00
- 300.00 -
7,037 497.00 3,497,389.00
- 339.62 -
-
- 116.73 -
125 2,200.00 275,000.00
- 2,145.00 -
- 2,145.00 -
5,005 185.00 925,925.00
223 3,410.00 760,430.00
3,032 105.00 318,360.00
150 276.00 41,400.00
316 552.00 174,432.00
9
104 2,641.00 274,664.00
- 10,000.00 -
990 425.00 420,750.00
100
84 -
Rp 82,142,854
Lubuk Sikaping, 31 Agustus 2017

NIP.19780314 200501 2 007

KABUPATEN : PASAMAN
PERIODE : September 2017
1 2 3 4 5 6 7 8 9 10
6 Albendazol Tab 400 mg Ktk / 30 - 350.00 -
Acetylcysteine Ktk/60
11 Alluporinol tab 100 mg Ktk / 100 5400 435 160 5,995 88.00 527,560.00
12 Aminophyllin Injeksi Ktk / 30 400 400 4,014.00 1,605,600.00
13 Aminophyllin tab 200 mg Btl / 1000 4100 68 1030 5,198 93.00 483,414.00
14 Amitriptilin tab 25 mg Ktk / 100 800 800 117.00 93,600.00
15 Amoksisilin Syrup Btl 432 10 70 24 536 2,500.00 1,340,000.00
16 Amoksilin Kaplet 500 mg Ktk / 100 15800 640 3300 408 20,148 270.00 5,439,960.00
17 amlodipin ktk/30 - 341.00 -
20 Antasida DOEN Tab Ktk/100 11000 600 3400 1180 16,180 74.00 1,197,320.00
22 Anti Fungi DOEN Salep Pot 168 18 16 202 1,640.00 331,280.00
24 Antihemoroid supp Ktk/10 190 17 30 7 244 1,909.10 465,820.40
27 Vit. C tablet 50 mg Btl / 1000 22000 976 2588 576 26,140 100.00 2,614,000.00
32 Asam Mefenamat 500 mg Ktk / 100 18200 900 1808 80 20,988 116.00 2,434,608.00
35 Betametason cream Tube 62 12 31 7 112 1,520.00 170,240.00
36 Blood Lancet Ktk / 100 - 180.00 -
38 Catgut 2/0 + 3/0 Biji 83 31 5 119 28,000.00 3,332,000.00
39 Catopril tab 12,5 mg Ktk / 60 - 112.80 -
40 Catopril tab 12,5 mg Ktk / 100 7000 170 86 7,256 62.00 449,872.00
41 Catopril tab 25 mg Ktk / 100 4900 282 1930 210 7,322 89.00 651,658.00
45 Cover Glass Ktk 100 - 264.00 -
48 Dexametason tab 0,5 mg Btl / 1000 10400 100 1828 364 12,692 85.00 1,078,820.00
49 Dexametason Injeksi Ktk / 100 144 2 146 1,550.00 226,300.00
52 Dextran 70 % Fls - 35,526.00 -
53 Diasec Tab Ktk / 10 - 1,540.00 -
59 Dulcolax Supp adult Ktk / 5 - 10,000.00 -
67 Etanol 70 % Botol 141 10 151 33,000.00 4,983,000.00
70 Face Mask Pcs - 7,000.00 -
74 Fenol Gliserol TT 10 % Botol - 1,058.00 -
76 Fitomenadion (Vit.K)Tab Btl / 100 159 525 46 730 660.00 481,800.00
78 Furosemida Tab 40 mg Ktk / 200 800 228 60 1,088 80.00 87,040.00
81 Garam Oralit 200 ml Ktk/100 145 331 123 599 303.00 181,497.00
83 Gentamisin TM tube - 3,353.00 -
87 Glibenklamid tablet 5 mg Btl / 100 - 58.00 -
88 Gliseril Guaiacolat tablet Btl / 1000 - 29.30 -
89 Glukosa Infus 5 % Fls 45 45 4,830.00 217,350.00
Hanscoon 7,5 302 302 412.50 124,575.00
Hanscoon 6,5 ktk/50 495 495 4,462.50 2,208,937.50
94 Haloperidol Tab 1,5 mg Kotak / 100 4000 565 4,565 72.00 328,680.00
98 Ibuprofen Tablet 400 mg Ktk/100 2700 452 1691 380 5,223 149.00 778,227.00
99 Infusion Set Anak Set - 3,636.00 -
100 Infusion Set Dewasa Set 128 19 147 3,500.00 514,500.00
107 Iodiol Btl/100 - 930.00 -
110 Kalsium Laktat Tab 500 mg Btl /1000 5700 484 3065 1219 10,468 54.50 570,506.00
114 Kasa 2x80 Rol - 7,858.00 -
115 Kasa 16 x 16 Steril Rol 26 26 1,393.00 36,218.00
116 Kassa 4 x 3 cm Rol - 666.00 -
117 Kassa 4 x 15 cm Rol - 3,066.00 -
121 Kloramfenikol Syr Fls 90 9 99 11,558.00 1,144,242.00
123 Kloramfrnikol S.M 1 % Tube 106 1 8 2 117 1,600.00 187,200.00
125 CTM Tablet 4 mg Btl/ 1000 25300 711 2568 1424 30,003 27.00 810,081.00
128 Klorpromazin Tab 100 mg Btl/ 1000 4000 200 4,200 29.11 122,262.00
131 Korimoksazol Tab 480 mg Btl / 100 4600 210 2080 243 7,133 145.00 1,034,285.00
132 Kotrimoksazol Suspensi Botol 423 18 91 31 563 2,222.00 1,250,986.00
Loperamide Ktk/100 200 419 300 919
138 Lysol Fls - 27,500.00 -
151 Simvastatin tab Ktk/30 3600 164 3,764 174.00 654,936.00
Masker 140 140 1,181.00 165,340.00
156 Mess Blade 11, 15, 23 Ktk / 100 - 1,650.00 -
158 Metil Ergometrin Tab Ktk / 100 100 100 270 470 154.00 72,380.00
159 Metronidazol Tab 250 mg Ktk / 100 1800 515 1250 249 3,814 113.00 430,982.00
161 Methyl Prednisolon 4 mg Ktk/100 1200 320 240 160 1,920 210.00 403,200.00
164 Natrium Klorida Infus 0,9 % Botol 9 7 16 5,145.00 82,320.00
Natrium Diklofenat Ktk/50 4550 430 90 5,070 293,86
174 Oksitetrasiklin S.M 1% Tube - 1,600.00 -
175 Objek Glass Pcs - 10,000.00 -
177 Omeprazol kapsul Ktk/30 540 110 150 27 827 216.00 178,632.00
179 Parasetamol Sirup 120 mg Botol - 1,496.00 -
180 Parasetamol Tablet 500 mg Btl/ 100 5900 306 3606 1194 11,006 82.80 911,296.80
181 Parasetamol Tablet 100 mg / Btl / 100 - 32.96 -
186 Pehamoxil 500 mg Ktk/50 - 283.70 -
188 Piridoksin Tab 10 mg Btl/ 1000 9000 690 1992 419 12,101 18.27 221,085.27
189 Plester Rol 75 5 1 81 23,625.00 1,913,625.00
191 Povidon Iodida 10 % Btl/300ml - 14,000.00 -
193 Prednison Tablet 5 mg Btl / 1000 13500 245 1294 554 15,593 59.66 930,278.38
198 Ranitidin tablet 150 mg Ktk / 30 14200 1045 2040 95 17,380 126.00 2,189,880.00
203 Ringer Laktat Larutan Infus Botol 61 13 74 5,460.00 404,040.00
206 Salep 2 - 4 Pot 115 12 46 4 177 2,400.00 424,800.00
207 Salisil Bedak 2 % Bungkus 50 3 44 97 1,250.00 121,250.00
212 Serum ABU 5 ml Ktk / 10 - 410,190.00 -
Stesolide Tube 24
218 Tablet Tambah darah Bks / 30 29130 1200 2620 660 33,610 43.00 1,445,230.00
Tetagam inj -
223 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 13900 1500 3475 442 19,317 21.00 405,657.00
227 Urispas Tab Ktk / 30 - 3,162.50 -
Vit. B 12 INJ
230 Vit. B12 Tab Btl / 1000 - 14.00 -
231 Vit. B Complek tab Btl / 1000 16400 700 2585 1099 20,784 110.00 2,286,240.00
232 Cefadroxil kap 500 mg Kek/100 5400 17 140 13 5,570 521.00 2,901,970.00
235 Zink Tablet Ktk / 100 3800 614 1958 250 6,622 497.00 3,291,134.00
Haloperidol Inj Ampul -
238 Antasida sirup btl 53 38 18 16 125 2,200.00 275,000.00
242 Domperidon syr Btl/60 ml 177 36 5 9 227 3,410.00 774,070.00
243 Metoklorfofamid ktk/100 2300 430 400 3,130 105.00 328,650.00
244 Kasa 4x5 Rol 100 13 113 276.00 31,188.00
245 Kasa 4x10 Rol 245 33 1 279 552.00 154,008.00
Kasa 36 x 80 cm 8 8
246 Bacitracin tube 75 27 5 107 2,641.00 282,587.00
Vit. B12 INJ 100 100
249 Miconazol Salaf 45 7 13 65 -
Lubuk Sikaping, 30 September 2017
HARI SANTOSO, SKM Ns. Indri Wardani, S. Kep

NIP.197512122000121003 NIP.19780314 200501 2 007
LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSK

KABUPATEN : PASAMAN
PERIODE : Oktober 2017
NO NAMA OBAT SATUAN PUSKESMAS PUSKESMAS BIDAN
GUDANG APOTIK DESA
1 2 3 4 5 6
6 Alat Suntik 2,5 ml Ktk / 100 500 55
Alat Suntik 5 ml Ktk / 100
Albendazol Tab 400 mg Ktk / 30
8 Alprazolam 0,5 mg Ktk/100 1100 45
15 amlodipin ktk/30
16 Amoksilin Kaplet 500 mg Ktk / 100 11700 1253 3417
17 Amoksisilin Syrup Btl 300 33 101
20 Antasida DOEN Tab Ktk/100 8400 1037 3490
22 Antasida sirup btl 103 18
23 Anti Fungi DOEN Salep Pot 153 18 15
25 Antihemoroid supp Ktk/10 170 17 46
Asam Mefenamat 500 mg Ktk / 100 16000 330 2368
42 Catgut 2/0 + 3/0 Biji 94 30
44 Catopril tab 25 mg Ktk / 100 3900 69 1855
46 Cefadroxil syr BTL 230 28
53 CTM Tablet 4 mg Btl/ 1000 20700 2579
54 Cyprofloxacin 500 mg Ktk / 100 5400 420 530
57 Dexametason tab 0,5 mg Btl / 1000 8500 153 1978
58 Dextran 70 % Fls
Domperidon syr Btl/60 ml 172 30 5
69 Efedrin HCl tablet 25 mg Btl / 250 5000 972 902
75 Etanol 70 % Botol 133 9
80 Face Mask Pcs
86 Fitomenadion (Vit.K)Tab Btl / 100 104 425
89 Furosemida Tab 40 mg Ktk / 200 800 228
91 Garam Oralit 200 ml Ktk/100 1200 28 195
Gentamisin TM tube
95 Glibenklamid tablet 5 mg Btl / 100
99 Glukosa Infus 5 % Fls 45
100 Griseofulvin Tab 125 mg Btl / 100 274 350
101 Haloperidol Inj Ampul
105 Hanscoon 6,5 ktk/50 450
110 Ibuprofen Tablet 400 mg Ktk/100 1300 480 1677
112 Infusion Set Dewasa Set 116 23
113 Iodiol Btl/100
123 Kalsium Laktat Tab 500 mg Btl /1000 3000 513 3395
126 Karbamazepin Tab 200 mg Ktk / 100 1700 180 100
128 Kasa 2x80 Rol
129 Kasa 36 x 80 cm 8
130 Kasa 4x10 Rol 195 41
131 Kasa 4x5 Rol 80 12
137 Kloramfenikol 250 mg Btl / 250 2700 275 515
145 Korimoksazol Tab 480 mg Btl / 100 4300 210 1910
146 Kotrimoksazol Suspensi Botol 398 11 81
158 Lidokain Injeksi Ktk / 30 211 16
159 Loperamide Ktk/100 200 303 290
163 Lysol Fls
165 Masker 130
166 Mess Blade 11, 15, 23 Ktk / 100
Metformin tab 500 mg Ktk/100 1500 210
168 Metil Ergometrin Injeksi Ktk / 30 109 14
169 Metil Ergometrin Tab Ktk / 100 100 370
171 Metronidazol Tab 250 mg Ktk / 100 1800 405 1130
177 Natrium Diklofenat Ktk/50 4450 60 150
187 Objek Glass Pcs
190 Oksitosin Injeksi Ktk / 30 193 30
191 Omeprazol kapsul Ktk/30 90 200
192 Papaverin Tablet 40 mg Btl/ 100 1200 190 1275
196 Parasetamol Tablet 500 mg Btl/ 100 26600 2816
Pembalut Gips Rol
199 Pirantel tabl 125 mg ktk/28 368 96 186
200 Piridoksin Tab 10 mg Btl/ 1000 8900 348 1996
205 Prednison Tablet 5 mg Btl / 1000 12700 232 1439
210 Ranitidin tablet 150 mg Ktk / 30 12100 1330 2303
Ringer Laktat Larutan Infus Botol 50 13
219 Salep 2 - 4 Pot 100 6 47
220 Salisil Bedak 2 % Bungkus 90 4
227 Stesolide Tube
230 Tablet Tambah darah Bks / 30 22890 2820
231 Tetagam inj
235 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 11500 1018 3695
Tramadol tab Ktk/50
244 Vit. B 12 INJ 100
245 Vit. B Complek tab Btl / 1000 20300 120 2974
246 Vit. B12 Tab Btl / 1000
247 Vit. C tablet 50 mg Btl / 1000 18200 673 2294
249 Zink Tablet Ktk / 100 3500 504 1888
JUMLAH
HARI SANTOSO, SKM

NIP.197512122000121003
BAT GENERIK DI PUSKESMAS DAN JARINGANNYA
PUSTU TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

Rp Rp
7 8 9 10
- 2,260.00 -
2,677 239.00 639,803.00
- 250.00 -
- 1,147.12 -
30 585 1,089.90 637,591.50
- 1,089.90 -
- 350.00 -
5,885 88.00 517,880.00
- 34,875.00
- 2,598.00 -
- 87.43 -
- 4,014.00 -
340 4,898 93.00 455,514.00
1,305 117.00 152,685.00
- 341.00 -
133 16,503 270.00 4,455,810.00
22 456 2,500.00 1,140,000.00
- 1,272.70 -
- 142.22 -
915 13,842 74.00 1,024,308.00
- 29.14 -
6 127 2,200.00 279,400.00
10 196 1,640.00 321,440.00
- 142.00 -
6 239 1,909.10 456,274.90
- 2,000.00 -
- 5,500.00 -
- 300.00 -
- 10,992.67 -
- 18,992.88 -
-
520 19,218 116.00 2,229,288.00
- 122.00 -
- 148.71 -
55 1,291.00 71,005.00
- 25.01 -
- 99,850.00 -
- 624,360.00 -
8 119 2,641.00 314,279.00
14 96 1,520.00 145,920.00
- 180.00 -
- 25,850.00 -
3 127 28,000.00 3,556,000.00
- 112.80 -
6,761 62.00 419,182.00
190 6,014 89.00 535,246.00
13 4,620 521.00 2,407,020.00
6 264 7,827.00 2,066,328.00
- 6,615.00 -
- 79.44 -
- 186.00 -
- 112.80 -
- 264.00 -
727 24,006 27.00 648,162.00
122 6,472 271.09 1,754,494.48
- 170.00 -
2 1,550.00 3,100.00
759 11,390 85.00 968,150.00
- 35,526.00 -
- 2,734.00 -
- 34.02 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
9 216 3,410.00 736,560.00
4,569 185.00 845,265.00
- 10,000.00 -
60 6,934 53.82 373,187.88
- 345.70 -
- 300.00 -
1,740 497.00 864,780.00
- 7,731.00 -
- 1,718.00 -
1 143 33,000.00 4,719,000.00
-
- 105,000.00 -
24 3,257.00 78,168.00
- 17.89 -
- 7,000.00 -
- 72.38 -
- 69.00 -
- 370.63 -
- 1,058.00 -
3 109 1,660.90 181,038.10
46 575 660.00 379,500.00
- 7,800.00 -
- 55.96 -
60 1,088 80.00 87,040.00
- 7,315.00 -
105 1,528 303.00 462,984.00
- 1,469.00 -
- 12,500.00 -
- 3,353.00 -
- 945.00 -
- 363,636.00 -
- 58.00 -
- 29.30 -
- 4,100.00 -
- 1,040.00 -
45 4,830.00 217,350.00
470 1,094 219.00 239,586.00
-
3,860 72.00 277,920.00
- 116.73 -
- 57.50 -
450 4,462.50 2,008,125.00
179 412.50 73,837.50
- 17.00 -
6 84 2,668.00 224,112.00
4,657 94.19 438,642.83
330 3,787 149.00 564,263.00
- 3,636.00 -
7 146 3,500.00 511,000.00
- 930.00 -
- 27.00 -
- 66.14 -
- 65.24 -
- 3,000.00 -
114 7,787.00 887,718.00
44 7,787.00 342,628.00
- 7,061.00 -
- 425.00 -
- 4,090.00 -
929 7,837 54.50 427,116.50
- 14,007.00 -
26 7,500.00 195,000.00
1,980 257.00 508,860.00
26 1,393.00 36,218.00
- 7,858.00 -
8
236 552.00 130,272.00
92 276.00 25,392.00
- 10,000.00 -
- 3,066.00 -
- 666.00 -
3,659 310.00 1,134,290.00
99 11,558.00 1,144,242.00
80 3,570 213.00 760,410.00
- 1,679.00 -
1 93 1,600.00 148,800.00
- 11,558.00 -
- 1,072.00 -
3,530 29.11 102,758.30
- 24.45 -
620 525.00 325,500.00
- 72.45 -
213 6,633 145.00 961,785.00
29 519 2,222.00 1,153,218.00
- 249.52 -
- 1,171.17 -
- 79.44 -
- 46,700.00 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 28,000.00 -
- 95,000.00 -
- 66,700.00 -
- 33,000.00 -
- 1,395.00 -
8 235 1,360.00 319,600.00
793
- 9,800.00 -
- 6,900.00 -
- 18,150.00 -
- 27,500.00 -
- 1,947.90 -
130 1,181.00 153,530.00
- 1,650.00 -
1,710 142.23 243,213.30
160 1,000 210.00 210,000.00
2 125 1,564.50 195,562.50
100 570 154.00 87,780.00
3,030 105.00 318,150.00
219 3,554 113.00 401,602.00
2,202 164.00 361,128.00
38 -
- 88,250.00 -
- 10,984.83 -
- 15.02 -
4,660 293,86
51 5,145.00 262,395.00
1,735 112.00 194,320.00
- 35,600.00 -
- 461.08 -
- 1,299.00 -
- 127,200.00 -
- 236,000.00 -
- 376,500.00 -
- 6,536.00 -
- 10,000.00 -
- 1,572.00 -
- 1,600.00 -
15 238 1,820.00 433,160.00
307 597 216.00 128,952.00
52 2,717 122.00 331,474.00
- 60.75 -
- 1,496.00 -
- 32.96 -
239 29,655 82.80 2,455,434.00
- 1,650.00 -
- 283.70 -
- 6,162.00 -
- 1,520.00 -
41 691 274.00 189,334.00
338 11,582 18.27 211,603.14
- 66.00 -
2 65 23,625.00 1,535,625.00
- 14,000.00 -
34 2,000.00 68,000.00
424 14,795 59.66 882,669.70
- 30.00 -
1,488 114.00 169,632.00
- 277.00 -
- 462.00 -
565 16,298 126.00 2,053,548.00
- 55.00 -
- 255.00 -
- 335.40 -
- 350.00 -
2 65 5,460.00 354,900.00
3,901 62.00 241,862.00

- 97.49 -
3 156 2,400.00 374,400.00
94 1,250.00 117,500.00
- 1,375.00 -
- 80,659.00 -
- 410,190.00 -
- 989.86 -
163 6,983.00 1,138,229.00
3,620 174.00 629,880.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
- 3,387.00 -
3210 28,920 43.00 1,243,560.00
-
- 53.70 -
- 245.31 -
- 731.80 -
1312 17,525 21.00 368,025.00
- 6,707.40 -
- 339.62 -
- 570.00 -
1,290 425.00 548,250.00
2,910 42.00 122,220.00
- 6,500.00 -
- 2,365.00 -
- 3,162.50 -
- 132.00 -
1818 25,212 110.00 2,773,320.00

- 14.00 -
1439 22,606 100.00 2,260,600.00
- 2,145.00 -
- 2,145.00 -
220 6,112 497.00 3,037,664.00
Rp 68,144,907
Lubuk Sikaping, 31 Oktober 2017

NIP.19780314 200501 2 007
LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKESMAS DA

KABUPATEN : PASAMAN
PERIODE : November 2017
NO NAMA OBAT SATUAN PUSKESMAS PUSKESMAS BIDAN PUSTU TOTAL
GUDANG APOTIK DESA
1 2 3 4 5 6 7 8
2 Acyclovir cream Tube -
3 Acyclovir Tab 200 mg Ktk / 100 1700 267 270 2,237
4 Adineuron Tablet Ktk / 100 -
5 Alat Suntik 1 ml Ktk / 100 -
6 Alat Suntik 2,5 ml Ktk / 100 400 32 12 444
Alat Suntik 5 ml Ktk / 100 -
Albendazol Tab 400 mg Ktk / 30 858 858
7 Alluporinol tab 100 mg Ktk / 100 5300 255 160 5,715
9 Aludona - D Syrup Fls -
10 Ambroxol syr Btl/60 ml -
11 Ambroxol Tab Ktk / 100 -
12 Aminophyllin Injeksi Ktk / 30 -
13 Aminophyllin tab 200 mg Btl / 1000 2700 40 1190 270 4,200
15 amlodipin ktk/30 -
16 Amoksilin Kaplet 500 mg Ktk / 100 8300 1055 3537 383 13,275
18 Antalgin Injeksi Ktk / 30 -
19 Antalgin Tablet 500 mg Ktk/100 -
20 Antasida DOEN Tab Ktk/100 6800 500 2800 665 10,765
21 Antasida DOEN Tab Btl / 1000 -
23 Anti Fungi DOEN Salep Pot 153 18 12 8 191
24 Anti Migren DOEN tab Btl / 100 -
25 Antihemoroid supp Ktk/10 170 17 36 6 229
26 Aqua Dest Steril Btl -
27 Aqua Pro Injeksi Ktk / 10 -
28 Artemeter Injeksi Ktk / 6 -
29 Artesunate +Amodiaquin Ktk / 3 -
30 Artesunate Injeksi Ktk / 8 -
31 Asam Mefenamat 250 mg -
Asam Mefenamat 500 mg Ktk / 100 14200 630 2056 420 17,306
32 Asetosal tablet 100 mg Ktk / 100 -
33 Asetosal tablet 500 mg Ktk / 100 -
34 Atropin Sulfat Inj Ktk/30 55 55
35 Atropin Sulfat tab 0.5 mg Btl/500 -
36 ATS Injeksi 1.500 IU Ampul -
37 ATS Injeksi 20.000 IU Vial -
39 Betametason cream Tube 22 15 17 4 58
40 Blood Lancet Ktk / 100 -
41 Catarlent T.M Btl 5 ml -
42 Catgut 2/0 + 3/0 Biji 79 29 2 110
Catopril tab 12,5 mg Ktk / 60 -
43 Catopril tab 12,5 mg Ktk / 100 6200 145 116 6,461
44 Catopril tab 25 mg Ktk / 100 2800 324 1576 180 4,880
45 Cefadroxil kap 500 mg Kek/100 3400 600 60 13 4,073
46 Cefadroxil syr BTL 220 3 6 229
47 Cefotaxim Injeksi Ktk / 2 -
48 Cepezet tab 100 mg Btl/ 250 -
49 Cetirizine ktk/100 -
51 Cimetidine Tab 200 mg Ktk / 100 -
52 Cover Glass Ktk 100 -
53 CTM Tablet 4 mg Btl/ 1000 12300 600 2963 847 16,710
54 Cyprofloxacin 500 mg Ktk / 100 5400 69 520 122 6,111
55 Cyprofloxacin 500 mg Ktk / 50 -
56 Dexametason Injeksi Ktk / 100 144 2 146
57 Dexametason tab 0,5 mg Btl / 1000 7600 130 1967 305 10,002
58 Dextran 70 % -
59 Dextrometorfan Sirup Botol -
60 Dextrometorfan tab 15 mg Btl / 1000 -
61 Diasec Tab Ktk / 10 -
62 Diazepam Inj 5 mg / ml ktk / 30 -
63 Diazepam Tablet 2 mg Btl / 1000 -
64 Diazepam Tablet 5 mg Btl / 250 -
65 Difenhidramin HCl Injeksi Ktk / 30 -
66 Digoksin Tablet 0,5 mg Ktk/100 -
Domperidon syr Btl/60 ml 172 24 5 8 209
67 Domperidon tab 10 mg Ktk/100 3400 169 355 3,924
68 Dulcolax Supp adult Ktk / 5 -
Efedrin HCl tablet 25 mg Btl / 250 5000 949 771 60 6,780
70 Epinefrin Injeksi 0,1 % Ktk / 30 -
71 Epinefrin Injeksi 0,1 % Ktk / 100 -
72 Erytromisin Kaps 250 mg Ktk / 100 1300 160 250 1,710
73 Erytromisin Syrup Fls -
74 Etakridin ( Rivanol ) Botol -
75 Etanol 70 % Botol 127 8 135
76 Etanol 70 %ol 100 Ml botol -
77 Etil Klorida Semprot Botol -
78 Eugenol Cairan Botol 24 24
79 Extrac Belladone tab Btl / 1000 -
80 Face Mask Pcs -
81 Fenil Butazon tab Btl/1000 -
82 Fenobarbital tab 30 mg Btl / 100 -
83 Fenoks Penisilin Tab 500 m Ktk / 100 -
84 Fenol Gliserol TT 10 % Botol -
85 Fitomenadion (Vit.K) Inj Ktk / 30 101 3 3 107
87 Folley Catheter 2 Ways Biji -
88 Furosemida Tab 40 mg Btl / 250 -
89 Furosemida Tab 40 mg Ktk / 200 800 225 60 1,085
90 Gameksan Emulsi 1 % Botol -
91 Garam Oralit 200 ml Ktk/100 825 51 338 80 1,294
92 Gentamici SK Tube -
93 Gentamisin Injeksi Vial -
Gentamisin TM tube -
Gentian Violet 1 % Botol -
94 Glass Ionomer Semen Set -
95 Glibenklamid tablet 5 mg Btl / 100 -
96 Gliseril Guaiacolat tablet Btl / 1000 -
97 Glukosa Infus 10 % Fls -
98 Glukosa Infus 40 % Fls -
99 Glukosa Infus 5 % Fls 41 2 43
101 Haloperidol Inj Ampul -
102 Haloperidol Tab 1,5 mg Kotak / 100 3000 3,000
103 Haloperidol tab 5 mg Ktk/100 -
104 Haloperidol Tablet 0,5 mg Ktk / 100 -
105 Hanscoon 6,5 ktk/50 450 450
106 Hanscoon 7,5 161 161
107 Hidroklortiazid (HCT)Tab Btl / 1000 -
108 Hidrokortison Krim 2,5 % Tube 42 5 16 4 67
109 Ibuprofen Tablet 200 mg Btl / 100 2300 333 1284 3,917
110 Ibuprofen Tablet 400 mg Ktk/100 500 372 1637 300 2,809
111 Infusion Set Anak Set -
112 Infusion Set Dewasa Set 104 15 4 123
113 Iodiol Btl/100 -
114 Isoniazida Tab 100 mg Btl / 1000 -
115 Isoniazida Tab 300 mg Btl / 1000 -
116 Isosorbit Dinitrat Tab 5 mg Ktk / 100 -
117 IV Catheter No. 18 Biji -
120 IV Catheter No. 24 Biji -
121 Kalium Diclofenat 50 mg Ktk / 50 -
122 Kalium Permanganat (PK) Pot -
123 Kalsium Laktat Tab 500 mg Btl /1000 1500 551 3015 704 5,770
124 Kapas Berlemak 500 gr Bungkus -
126 Karbamazepin Tab 200 mg Ktk / 100 1200 1,200
127 Kasa 16 x 16 Steril Rol 26 26
128 Kasa 2x80 Rol -
129 Kasa 36 x 80 cm 8 8
130 Kasa 4x10 Rol 140 45 185
131 Kasa 4x5 Rol 80 11 91
132 Kasa Elastis 4 Inc Rol -
133 Kassa 4 x 15 cm Rol -
134 Kassa 4 x 3 cm Rol -
135 ketokonazole ktk/50 2700 435 480 3,615
137 Kloramfenikol 250 mg Btl / 250 2700 250 515 60 3,525
Kloramfenikol T.T 3 % Botol -
138 Kloramfrnikol S.M 1 % Tube 39 20 11 1 71
139 Kloramixin D Eye Drop Fls -
140 Klorpromazin 25 mg Inj ktk / 30 -
141 Klorpromazin Tab 100 mg Btl/ 1000 2500 2,500
142 Klorpromazin tab 25 mg Btl/1000 -
144 Korimoksazol Tab 120 mg Btl / 100 -
145 Korimoksazol Tab 480 mg Btl / 100 3800 155 1995 148 6,098
146 Kotrimoksazol Suspensi Botol 388 11 97 25 521
147 Kuinin ( Kina ) Tab 200 mg Ktk / 60 -
148 Kuinin Injeksi 25 % Ktk / 30 -
149 Lart. Etanol Asam Botol -
150 Lartan Karbol Fuksin Fls -
151 Larutan Benedict Fls -
152 Larutan Fauchet Fls -
153 Larutan Giemsa Fls -
Larutan HCl 0,1 N Botol -
154 Larutan Kinyoun Fls -
155 Larutan Metilen Biru Fls -
156 Larutan Turk Fls -
157 Levertran salep pot -
158 Lidokain Injeksi Ktk / 30 160 17 2 179
159 Loperamide Ktk/100 200 262 190 652
160 Lunex Injeksi 100 mg/ ml Ktk / 10 -
161 Lunex Injeksi 50 mg/ ml Ktk / 10 -
162 Lysmin Syrup Botol -
163 Lysol Fls -
164 Magnesium Sulfat Injeksi Ktk / 10 -
165 Masker 105 105
166 Mess Blade 11, 15, 23 Ktk / 100 -
Metformin tab 500 mg Ktk/100 1500 1,500
169 Metil Ergometrin Tab Ktk / 100 100 270 100 470
170 Metoklorfofamid ktk/100 2300 410 300 3,010
171 Metronidazol Tab 250 mg Ktk / 100 1500 203 1215 189 3,107
172 Metronidazol Tab 500 mg Ktk / 100 1600 402 2,002
174 Modicate Ampul Ampul -
175 Nalhecting Kulit / Otot Lusin -
176 Natrium Bikarbonat Tab Btl/ 1000 -
177 Natrium Diklofenat Ktk/50 3450 320 210 3,980
178 Natrium Klorida Infus 0,9 % Botol 36 4 2 42
179 Nifedipin Tab 10 mg Ktk / 100 500 530 570 1,600
180 Nistatin Tablet 100.000 IU Fls -
181 Nistatin Tablet 500.000 IU Ktk / 100 -
182 Obat Batuk Hitam ( OBH ) Botol -
183 Obat T.B Kategori Anak Paket -
184 Obat T.B Kategori I Paket -
185 Obat T.B Kategori II Paket -
186 OBH Indo Plus Fls -
187 Objek Glass Pcs -
188 Oksitetrasiklin S.K 3% Tube -
189 Oksitetrasiklin S.M 1% Tube -
190 Oksitosin Injeksi Ktk / 30 170 23 9 202
191 Omeprazol kapsul Ktk/30 70 277 347
192 Papaverin Tablet 40 mg Btl/ 100 1100 160 1255 8 2,523
193 Paraformaldehid Tab 1 gr Btl / 100 -
194 Parasetamol Sirup 120 mg Botol -
195 Parasetamol Tablet 100 mg Btl / 100 -
196 Parasetamol Tablet 500 mg Btl/ 100 14800 1062 2938 684 19,484
197 Pehacain Injeksi Ktk / 20 -
Pehamoxil 500 mg Ktk/50 -
Pembalut Gips Rol -
198 Petidin Injeksi Ktk / 10 -
199 Pirantel tabl 125 mg ktk/28 368 96 125 41 630
200 Piridoksin Tab 10 mg Btl/ 1000 8200 700 1906 243 11,049
201 Piroksikam Kapsul 10 mg Ktk/100 -
202 Plester Rol 53 4 1 58
203 Povidon Iodida 10 % Btl/300ml -
204 Povidon Iodida 10 % Btl/30ml 15 9 24
205 Prednison Tablet 5 mg Btl / 1000 12100 165 1219 394 13,878
206 Primaquin tablet 15 mg Btl / 1000 -
207 Propanolol HCl Tab 40 mg Btl / 100 -
208 Propiltiourasil Tablet Btl / 100 -
209 Pyrazinamid Tab 500 mg Ktk / 100 -
210 Ranitidin tablet 150 mg Ktk / 30 11500 300 2433 540 14,773
211 Ranitidine INJ Ampul
212 Reserpin Tablet 0,25 mg Botol / 1000 -
213 Retinol (Vit.A) 100.000 IU Btl / 50 -
214 Retinol (Vit.A) 200.000 IU Btl / 50 -
215 Rifampisin Kapsul 300 mg Ktk / 100 -
Ringer Laktat Larutan Infus Botol 35 11 3 49
217 Salbutamol Tablet 2 mg Ktk / 100 3300 296 255 3,851
218 Salbutamol Tablet 4 mg Ktk / 100 -
219 Salep 2 - 4 Pot 71 23 39 3 136
220 Salisil Bedak 2 % Bungkus 64 5 43 112
221 Salisil Spiritus 10 % Botol -
Semen Seng Fosfat Set -
222 Serum ABU 5 ml Ktk / 10 -
223 Sianokobalamin (vit.B12)Inj Ktk / 100 -
225 Simvastatin tab Ktk/30 3300 3,300
226 Spirolakton Tab 100 mg Ktk / 100 -
228 Stomach Tube Pcs -
229 Sulfadimidin Tablet 500 mg Btl/ 1000 -
Sulfasetamid TM tube -
230 Tablet Tambah darah Bks / 30 14790 1040 3000 2810 21,640
231 Tetagam inj -
232 Tetrasiklin HCl 250 mg BTL/ 1000 -
233 Tetrasiklin HCl 500 mg Ktk / 100 -
234 Tiamin HCl ( Vit. B1 ) Inj. Ktk / 30 -
235 Tiamin HCl ( Vit. B1 ) Tab Btl/ 1000 10300 640 3005 1177 15,122
236 Tramadol Inj Ktk/5 -
Tramadol tab Ktk/50 -
237 Tranexamid Acid 500 mg Ktk/100 -
239 Trihexifenidil (THP)Tab 2 m Ktk / 100 2200 350 2,550
240 Urine bag T. Type Steril Pcs -
241 Urineg tab ( As. Nalidiksat ) Ktk / 100 -
242 Urispas Tab Ktk / 30 -
243 Valisanbe Tab 2 mg Ktk / 100 -
244 Vit. B 12 INJ 100
245 Vit. B Complek tab Btl / 1000 6100 436 2418 1378 10,332
246 Vit. B12 Tab Btl / 1000 -
247 Vit. C tablet 50 mg Btl / 1000 15700 501 2541 1109 19,851
248 Wing Nedle no 23 G Ktk/100 -
Wing Nedle no 25 G Ktk/100 -
249 Zink Tablet Ktk / 100 3300 424 1188 210 5,122
JUMLAH
Lubuk Sikaping, 30 No
Kepala Puskesmas Lb.Sikaping Pengelola guda
HARI SANTOSO, SKM Ns. Indri Wardan

NIP.197512122000121003 NIP.19780314 200
DI PUSKESMAS DAN JARINGANNYA
HARGA / SATUAN TOTAL PERSEDIAAN

Rp Rp
9 10
2,260.00 -
239.00 534,643.00
250.00 -
1,147.12 -
1,089.90 483,915.60
1,089.90 -
350.00 300,300.00
88.00 502,920.00
34,875.00
2,598.00 -
87.43 -
4,014.00 -
93.00 390,600.00
117.00 93,600.00
341.00 -
270.00 3,584,250.00
2,500.00 912,500.00
1,272.70 -
142.22 -
74.00 796,610.00
29.14 -
2,200.00 114,400.00
1,640.00 313,240.00
142.00 -
1,909.10 437,183.90
2,000.00 -
5,500.00 -
300.00 -
10,992.67 -
18,992.88 -
116.00 2,007,496.00
122.00 -
148.71 -
1,291.00 71,005.00
25.01 -
99,850.00 -
624,360.00 -
2,641.00 110,922.00
1,520.00 88,160.00
180.00 -
25,850.00 -
28,000.00 3,080,000.00
112.80 -
62.00 400,582.00
89.00 434,320.00
521.00 2,122,033.00
7,827.00 1,792,383.00
6,615.00 -
79.44 -
186.00 -
112.80 -
264.00 -
27.00 451,170.00
271.09 1,656,630.99
170.00 -
1,550.00 226,300.00
85.00 850,170.00
35,526.00 -
2,734.00 -
34.02 -
1,540.00 -
2,461.00 -
30.45 -
28.75 -
1,008.00 -
62.81 -
3,410.00 712,690.00
185.00 725,940.00
10,000.00 -
53.82 364,899.60
345.70 -
300.00 -
497.00 849,870.00
7,731.00 -
1,718.00 -
33,000.00 4,455,000.00
105,000.00 -
3,257.00 78,168.00
17.89 -
7,000.00 -
72.38 -
69.00 -
370.63 -
1,058.00 -
1,660.90 177,716.30
660.00 319,440.00
7,800.00 -
55.96 -
80.00 86,800.00
7,315.00 -
303.00 392,082.00
1,469.00 -
12,500.00 -
3,353.00 -
945.00 -
363,636.00 -
58.00 -
29.30 -
4,100.00 -
1,040.00 -
4,830.00 207,690.00
219.00 152,424.00
72.00 216,000.00
116.73 -
57.50 -
4,462.50 2,008,125.00
412.50 66,412.50
17.00 -
2,668.00 178,756.00
94.19 368,942.23
149.00 418,541.00
3,636.00 -
3,500.00 430,500.00
930.00 -
27.00 -
66.14 -
65.24 -
3,000.00 -
7,787.00 872,144.00
7,787.00 303,693.00
7,061.00 -
425.00 -
4,090.00 -
54.50 314,465.00
14,007.00 -
7,500.00 195,000.00
257.00 308,400.00
1,393.00 36,218.00
7,858.00 -
552.00 102,120.00
276.00 25,116.00
10,000.00 -
3,066.00 -
666.00 -
310.00 1,120,650.00
11,558.00 1,040,220.00
213.00 750,825.00
1,679.00 -
1,600.00 113,600.00
11,558.00 -
1,072.00 -
29.11 72,775.00
24.45 -
525.00 157,500.00
72.45 -
145.00 884,210.00
2,222.00 1,157,662.00
249.52 -
1,171.17 -
79.44 -
46,700.00 -
40,000.00 -
110,000.00 -
150,000.00 -
28,000.00 -
95,000.00 -
66,700.00 -
33,000.00 -
1,395.00 -
1,360.00 243,440.00
9,800.00 -
6,900.00 -
18,150.00 -
27,500.00 -
1,947.90 -
1,181.00 124,005.00
1,650.00 -
142.23 213,345.00
210.00 134,400.00
1,564.50 187,740.00
154.00 72,380.00
105.00 316,050.00
113.00 351,091.00
164.00 328,328.00
-
88,250.00 -
10,984.83 -
15.02 -
293,86
5,145.00 216,090.00
112.00 179,200.00
35,600.00 -
461.08 -
1,299.00 -
127,200.00 -
236,000.00 -
376,500.00 -
6,536.00 -
10,000.00 -
1,572.00 -
1,600.00 -
1,820.00 367,640.00
216.00 74,952.00
122.00 307,806.00
60.75 -
1,496.00 -
32.96 -
82.80 1,613,275.20
1,650.00 -
283.70 -
6,162.00 -
1,520.00 -
274.00 172,620.00
18.27 201,865.23
66.00 -
23,625.00 1,370,250.00
14,000.00 -
2,000.00 48,000.00
59.66 827,961.48
30.00 -
114.00 -
277.00 -
462.00 -
126.00 1,861,398.00
55.00 -
255.00 -
335.40 -
350.00 -
5,460.00 267,540.00
62.00 238,762.00
97.49 -
2,400.00 326,400.00
1,250.00 140,000.00
1,375.00 -
80,659.00 -
410,190.00 -
989.86 -
6,983.00 1,033,484.00
174.00 574,200.00
1,054.96 -
7,800.00 -
82.69 -
3,387.00 -
43.00 930,520.00
53.70 -
245.31 -
731.80 -
21.00 317,562.00
6,707.40 -
339.62 -
570.00 -
425.00 165,750.00
42.00 107,100.00
6,500.00 -
2,365.00 -
3,162.50 -
132.00 -
110.00 1,136,520.00
14.00 -
100.00 1,985,100.00
2,145.00 -
2,145.00 -
497.00 2,545,634.00
Rp 57,854,704
Lubuk Sikaping, 30 November 2017

NIP.19780314 200501 2 007

KABUPATEN : PASAMAN
PERIODE : Desember 2017
GUDANG APOTIK DESA
1 2 3 4 5 6 7
Alat Suntik 5 ml Ktk / 100 200
Albendazol Tab 400 mg Ktk / 30 826
15 amlodipin ktk/30
Asam Mefenamat 500 mg Ktk / 100 12800 610 1715 260
38 Bacitracin tube 18 6
42 Catgut 2/0 + 3/0 Biji 121 29 11
53 CTM Tablet 4 mg Btl/ 1000 36000 1047 2606 1165
56 Dexametason Injeksi Ktk / 100
58 Dextran 70 %
Domperidon syr Btl/60 ml 182 21 5 6
Efedrin HCl tablet 25 mg Btl / 250 5000 640 617 60
75 Etanol 70 % Botol 119 8 3
80 Face Mask Pcs
86 Fitomenadion (Vit.K)Tab Btl / 100 1 250 6
Gentamisin TM tube
95 Glibenklamid tablet 5 mg Btl / 100 100
100 Griseofulvin Tab 125 mg Btl / 100 5 140 10
101 Haloperidol Inj Ampul
102 Haloperidol Tab 1,5 mg Kotak / 100 2500
105 Hanscoon 6,5 ktk/50 660
110 Ibuprofen Tablet 400 mg Ktk/100 675 220
113 Iodiol Btl/100
125 Kapas Pembalut 250 gram Rol 22
128 Kasa 2x80 Rol
129 Kasa 36 x 80 cm Rol 6
130 Kasa 4x10 Rol 150 35
131 Kasa 4x5 Rol 120 9
132 Kasa Elastis 4 Inc Rol 11
135 ketokonazole ktk/50 2700 429 480
159 Loperamide Ktk/100 200 223 180
163 Lysol Fls
165 Masker
166 Mess Blade 11, 15, 23 Ktk / 100
Metformin tab 500 mg Ktk/100 1000 225
167 Methyl Prednisolon 4 mg Ktk/100 274 140
173 Miconazol Salaf 8
177 Natrium Diklofenat Ktk/50 3150 290
178 Natrium Klorida Infus 0,9 % Botol 50 210 5 2
187 Objek Glass Pcs
191 Omeprazol kapsul Ktk/30
Pembalut Gips Rol
Ringer Laktat Larutan Infus Botol 32 11 2
219 Salep 2 - 4 Pot 69 11 34 3
231 Tetagam inj
Tramadol tab Ktk/50
244 Vit. B 12 INJ 100
246 Vit. B12 Tab Btl / 1000 700
249 Zink Tablet Ktk / 100 4200 344 1538 490
JUMLAH
HARI SANTOSO, SKM

NIP.197512122000121003

Rp Rp
8 9 10
- 2,260.00 -
1,847 239.00 441,433.00
- 250.00 -
- 1,147.12 -
624 1,089.90 680,097.60
200 1,089.90 217,980.00
826 350.00 289,100.00
5,575 88.00 490,600.00
- 34,875.00
- 2,598.00 -
- 87.43 -
- 4,014.00 -
3,388 93.00 315,084.00
1,275 117.00 149,175.00
- 341.00 -
20,069 270.00 5,418,630.00
288 2,500.00 720,000.00
- 1,272.70 -
- 142.22 -
7,075 74.00 523,550.00
- 29.14 -
45 2,200.00 99,000.00
188 1,640.00 308,320.00
- 142.00 -
214 1,909.10 408,547.40
- 2,000.00 -
- 5,500.00 -
- 300.00 -
- 10,992.67 -
- 18,992.88 -
-
15,385 116.00 1,784,660.00
- 122.00 -
- 148.71 -
55 1,291.00 71,005.00
- 25.01 -
- 99,850.00 -
- 624,360.00 -
24 2,641.00 63,384.00
46 1,520.00 69,920.00
- 180.00 -
- 25,850.00 -
161 28,000.00 4,508,000.00
- 112.80 -
5,766 62.00 357,492.00
4,000 89.00 356,000.00
6,756 521.00 3,519,876.00
219 7,827.00 1,714,113.00
- 6,615.00 -
- 79.44 -
- 186.00 -
- 112.80 -
- 264.00 -
40,818 27.00 1,102,086.00
5,846 271.09 1,584,792.14
- 170.00 -
- 1,550.00 -
8,356 85.00 710,260.00
- 35,526.00 -
- 2,734.00 -
- 34.02 -
- 1,540.00 -
- 2,461.00 -
- 30.45 -
- 28.75 -
- 1,008.00 -
- 62.81 -
214 3,410.00 729,740.00
3,778 185.00 698,930.00
- 10,000.00 -
6,317 53.82 339,980.94
- 345.70 -
- 300.00 -
1,530 497.00 760,410.00
- 7,731.00 -
- 1,718.00 -
130 33,000.00 4,290,000.00
-
- 105,000.00 -
12 3,257.00 39,084.00
- 17.89 -
- 7,000.00 -
- 72.38 -
- 69.00 -
- 370.63 -
- 1,058.00 -
104 1,660.90 172,733.60
257 660.00 169,620.00
- 7,800.00 -
- 55.96 -
1,079 80.00 86,320.00
- 7,315.00 -
1,026 303.00 310,878.00
- 1,469.00 -
- 12,500.00 -
- 3,353.00 -
- 945.00 -
- 363,636.00 -
100 58.00 5,800.00
- 29.30 -
- 4,100.00 -
- 1,040.00 -
43 4,830.00 207,690.00
155 219.00 33,945.00
-
2,500 72.00 180,000.00
- 116.73 -
- 57.50 -
660 4,462.50 2,945,250.00
585 412.50 241,312.50
- 17.00 -
43 2,668.00 114,724.00
5,890 94.19 554,779.10
895 149.00 133,355.00
- 3,636.00 -
121 3,500.00 423,500.00
- 930.00 -
- 27.00 -
- 66.14 -
- 65.24 -
- 3,000.00 -
- 7,787.00 -
129 7,787.00 1,004,523.00
- 7,061.00 -
- 425.00 -
- 4,090.00 -
8,449 54.50 460,470.50
- 14,007.00 -
22 7,500.00 165,000.00
1,340 257.00 344,380.00
26 1,393.00 36,218.00
- 7,858.00 -
6
185 552.00 102,120.00
129 276.00 35,604.00
11 10,000.00 110,000.00
- 3,066.00 -
- 666.00 -
3,609 310.00 1,118,790.00
99 11,558.00 1,144,242.00
3,385 213.00 721,005.00
- 1,679.00 -
62 1,600.00 99,200.00
- 11,558.00 -
- 1,072.00 -
5,235 29.11 152,390.85
- 24.45 -
3,288 525.00 1,726,200.00
- 72.45 -
5,898 145.00 855,210.00
524 2,222.00 1,164,328.00
- 249.52 -
- 1,171.17 -
- 79.44 -
- 46,700.00 -
- 40,000.00 -
- 110,000.00 -
- 150,000.00 -
- 28,000.00 -
- 95,000.00 -
- 66,700.00 -
- 33,000.00 -
- 1,395.00 -
410 1,360.00 557,600.00
603
- 9,800.00 -
- 6,900.00 -
- 18,150.00 -
- 27,500.00 -
- 1,947.90 -
- 1,181.00 -
- 1,650.00 -
1,225 142.23 174,231.75
414 210.00 86,940.00
118 1,564.50 184,611.00
400 154.00 61,600.00
2,790 105.00 292,950.00
2,813 113.00 317,869.00
1,752 164.00 287,328.00
8 -
- 88,250.00 -
- 10,984.83 -
- 15.02 -
3,440 293,86
267 5,145.00 1,373,715.00
1,294 112.00 144,928.00
- 35,600.00 -
- 461.08 -
- 1,299.00 -
- 127,200.00 -
- 236,000.00 -
- 376,500.00 -
- 6,536.00 -
- 10,000.00 -
- 1,572.00 -
- 1,600.00 -
293 1,820.00 533,260.00
- 216.00 -
3,093 122.00 377,346.00
- 60.75 -
- 1,496.00 -
- 32.96 -
29,588 82.80 2,449,886.40
- 1,650.00 -
- 283.70 -
- 6,162.00 -
- 1,520.00 -
602 274.00 164,948.00
10,433 18.27 190,610.91
- 66.00 -
52 23,625.00 1,228,500.00
- 14,000.00 -
18 2,000.00 36,000.00
12,778 59.66 762,335.48
- 30.00 -
1,488 114.00 169,632.00
- 277.00 -
- 462.00 -
11,962 126.00 1,507,212.00
- 55.00 -
- 255.00 -
- 335.40 -
- 350.00 -
45 5,460.00 245,700.00
3,771 62.00 233,802.00

- 97.49 -
117 2,400.00 280,800.00
88 1,250.00 110,000.00
- 1,375.00 -
- 80,659.00 -
- 410,190.00 -
- 989.86 -
167 6,983.00 1,166,161.00
3,494 174.00 607,956.00
- 1,054.96 -
- 7,800.00 -
- 82.69 -
- 3,387.00 -
28,690 43.00 1,233,670.00
-
- 53.70 -
- 245.31 -
- 731.80 -
15,637 21.00 328,377.00
- 6,707.40 -
- 339.62 -
- 570.00 -
990 425.00 420,750.00
2,940 42.00 123,480.00
- 6,500.00 -
- 2,365.00 -
- 3,162.50 -
- 132.00 -
14,498 110.00 1,594,780.00

700 14.00 9,800.00
15,999 100.00 1,599,900.00
- 2,145.00 -
- 2,145.00 -
6,572 497.00 3,266,284.00
Rp 66,437,518
Lubuk Sikaping, 31 Desember 2017

NIP.19780314 200501 2 007

Lap - Pantau Obat

Uploaded by

Copyright:

Available Formats

Lap - Pantau Obat

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Lap - Pantau Obat

Uploaded by

Copyright:

Available Formats

LAPORAN PEMANTAUAN PENYEDIAAN OBAT GENERIK DI PUSKESMAS DAN JARINGANNYA

PUSKESMAS : LUBUK SIKAPING

PUSKESMAS : LUBUK SIKAPING

Pimpinan Puskesmas Lb.Sikaping

dr. LUSI HASTUTY

TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

3,662 62.00 227,044.00

13,570 110.00 1,492,700.00

Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

HARI SANTOSO, SKM Indri Wardani

PUSKESMAS : LUBUK SIKAPING

Kepala Puskesmas Lb.Sikaping

HARI SANTOSO, SKM

TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

16,268 126.00 2,049,768.00

128 2,641.00 338,048.00

PUSKESMAS : LUBUK SIKAPING

Kepala Puskesmas Lb.Sikaping

HARI SANTOSO, SKM

TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

14,909 126.00 1,878,534.00

PUSKESMAS : LUBUK SIKAPING

Kepala Puskesmas Lb.Sikaping

HARI SANTOSO, SKM

TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

13,014 126.00 1,639,764.00

Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

HARI SANTOSO, SKM Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

Kepala Puskesmas Lb.Sikaping

HARI SANTOSO, SKM

TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

18,998 126.00 2,393,748.00

Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

HARI SANTOSO, SKM Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

Kepala Puskesmas Lb.Sikaping

HARI SANTOSO, SKM

PUSTU TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

3,901 62.00 241,862.00

1818 25,212 110.00 2,773,320.00

Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

HARI SANTOSO, SKM Ns. Indri Wardan

HARGA / SATUAN TOTAL PERSEDIAAN

Ns. Indri Wardani, S. Kep

PUSKESMAS : LUBUK SIKAPING

Kepala Puskesmas Lb.Sikaping

HARI SANTOSO, SKM

TOTAL HARGA / SATUAN TOTAL PERSEDIAAN

3,771 62.00 233,802.00

14,498 110.00 1,594,780.00

Ns. Indri Wardani, S. Kep

You might also like