LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT (LPLPO)

PUSKESMAS : DOLONG PELAPORAN BLN/PERIODE : DESEMB

KECAMATAN : WALEA KEPULAUAN PERMINTAAN BLN/PERIODE : JANUAR
KABUPATEN : TOJO UNA UNA
PROPINSI : SULAWESI TENGAH

Stok Peneri- Perse- Pema- Stok Permin- Pemberian

NO Nama Obat/Alkes/BMHP Satuan Awal maan diaan kaian Akhir taan APBD I APBD II Program

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No 26 Buah 632 0 632 0 632
2 Abbocath No 28 Buah 324 0 324 0 324
3 Abbocath No 30 Buah 346 0 346 0 346
4 Abbocath No 32 Buah 372 0 372 0 372
5 ACT Strip 4,500 0 4,500 0 4,500
6 Acyclovir 200 mg Tablet 100 0 100 0 100
7 Acyclovir 400 mg Tablet 7,283 0 7,283 82 7,201
8 Acyclovir Krim 5% Tube 21 0 21 3 18
9 Adidryl Injeksi Vial 0 0 0 0 0
10 Adimidon Injeksi Vial 200 0 200 0 200
11 Ailin Botol 63 0 63 0 63
12 Alat Suntik Sekali Pakai 1 ml Buah 386 0 386 0 386
13 Alat Suntik Sekali Pakai 10 ml Buah 0 0 0 0 0
14 Alat Suntik Sekali Pakai 20 ml Buah 2,600 0 2,600 0 2,600
15 Alat Suntik Sekali Pakai 3 ml Buah 1,800 0 1,800 0 1,800
16 Alat Suntik Sekali Pakai 5 ml Buah 802 0 802 0 802
17 Alat Tes HB Familu Dr Buah 1,200 0 1,200 0 1,200
18 Albendazol Tablet 400 mg Tablet 17 0 17 0 17
19 Allopurinol Tab 100 mg Tablet 1,200 0 1,200 10 1,190
20 Allopurinol Tab 300 mg Tablet 990 0 990 0 990
21 Alprazolam 0,5 mg Tablet 0 0 0 0 0
22 Alprazolam 1 mg Tablet 50 0 50 0 50
23 Alterol Tetes Mata Botol 2,300 0 2,300 0 2,300
24 Ambroxol Syrup 15 mg/5 ml Botol 58 0 58 0 58
25 Ambroxol Tab 30 mg Tablet 1,016 0 1,016 155 861
26 Aminophillin HCL Tab 2,5 mg Tablet 0 0 0 0 0
27 Aminophillin Injeksi 24 mg/ml Ampul 1,900 0 1,900 0 1,900
28 Aminophillin Tablet Tablet 500 0 500 0 500
29 Amitriptilin Tablet Salut 25 mg Tablet 4,000 0 4,000 0 4,000
30 Amlodipine 10 mg Tablet 1,480 0 1,480 0 1,480
31 Amlodipine 5 mg Tablet 245 0 245 0 245
32 Amoxycillin Kap 250 mg Tablet 0 0 0 0 0
33 Amoxycillin Kap 500 mg Tablet 843 0 843 195 648
34 Amoxycillin Syrup 125 mg/5 mg Botol 116 0 116 6 110
35 Amoxycillin Syrup 250 mg/5 mg Botol 120 0 120 0 120
36 Ampicillin Injeksi Ampul 51 0 51 0 51
37 Ampicillin Kap 500 mg Tablet 410 0 410 0 410
38 Ampicillin Syrup Kering 125 mg Botol 0 0 0 0 0
39 Antalgin Injeksi 250 mg/ml Ampul 1,000 0 1,000 0 1,000
40 Antalgin Tablet 500 mg Tablet 110 0 110 10 100
41 Antasida DOEN Syrup Botol 587 0 587 2 585
42 Antasida DOEN Tablet 500 mg Tablet 7,979 0 7,979 40 7,939
43 Anti Hemoroid Suppo 0 0 0 0 0
44 Antifungi doen Kombinasi Suppensi 0 0 0 0 0
45 Antiseptic Hand Rub Botol 80 0 80 0 80
46 Antraian METAMIZOLE Ampul 10 0 10 0 10
47 Aqua Pro Injeksi Botol 26,000 0 26,000 0 26,000
48 Artem Ampul 4,800 0 4,800 0 4,800
49 Asam Askorbat Tablet 50 mg Tablet 0 0 0 0 0
50 Asam Folat Tablet 2,200 0 2,200 0 2,200
51 Asam Mefenamat 500 mg Tablet 2,200 0 2,200 546 1,654
52 Asam Traneksamat Ampul 0 0 0 0 0
53 Asam Valproat Botol 0 0 0 0 0
54 Asetosal 80 mg / Miniaspi Tablet 0 0 0 0 0
55 Asetosal Tablet 100 mg Tablet 0 0 0 0 0
56 Asetosal Tablet 500 mg Tablet 0 0 0 0 0
57 Atropin Injeksi 0,25 mg Ampul 20 0 20 0 20
58 Bacitracin Polimixyn B Salep Tube 1,008 0 1,008 0 1,008
59 Betahistine Mesilate Tablet 142 0 142 18 124
60 Betametason Krim 0,1 % Tube 93 0 93 0 93
61 Bicolax Tablet 430 0 430 0 430
62 Bio ATP Tablet 350 0 350 0 350
63 Biocombine Ampul 18 0 18 1 17
64 Bionemi Tablet 357 0 357 83 274
65 Bisoprolol Tablet 50 0 50 0 50
66 Blood Lancet Buah 100 0 100 0 100
67 Buscopan Injeksi Ampul 0 0 0 0 0
68 Captopril 12,5 mg Tablet 2,630 0 2,630 0 2,630
69 Captopril 25 mg Tablet 4,960 0 4,960 30 4,930
70 Catapres Injeksi Ampul 20 0 20 0 20
71 Catgut No. 2/1 Buah 0 0 0 0 0
72 Catgut No. 3/1 Buah 24 0 24 0 24
73 Cathejell Botol 192 0 192 0 192
74 Cefadroxil 500 mg Tablet 2,596 0 2,596 168 2,428
75 Cefadroxil Syrup Botol 114 0 114 1 113
76 Ceftriaxone Vial 0 0 0 0 0
77 Cetirizine 10 mg Tablet 4,950 0 4,950 0 4,950
78 Cetirizine Sirup Botol 0 0 0 0 0
79 Cimetidin 200 mg Tab Tablet 1,860 0 1,860 168 1,692
80 Citicoline Tablet 0 0 0 0 0
81 Clobazam 10 mg Tablet 0 0 0 0 0
82 Clonidine 0,15 mg Tablet 84 0 84 0 84
83 Clopidogrel Tablet 200 0 200 0 200
84 Clozapine Tablet 250 0 250 0 250
85 Codein Tablet 100 0 100 0 100
86 Combivent Vial 3,300 0 3,300 0 3,300
87 Curcuma 20 mg Tablet 200 0 200 0 200
88 Cyprofloksasin Tab 500 mg Tablet 760 0 760 20 740
89 D-Artep Tablet 0 0 0 0 0
90 Decanoas Ampul 199 0 199 0 199
91 Delamidon Ampul 5,500 0 5,500 0 5,500
92 Dexamethason Injeksi 5 mg/ml Ampul 111 0 111 7 104
93 Dexamethason Tablet 0,5 mg Tablet 11,860 0 11,860 328 11,532
94 Dextamec Tablet 0 0 0 0 0
95 Dextrometorphan Sir 10 mg/ml Botol 0 0 0 0 0
96 Dextrometorphan Tab 15 mg Tablet 0 0 0 0 0
97 Diafac Tablet 900 0 900 0 900
98 Diazepam Injeksi Ampul 0 0 0 0 0
99 Diazepam Tablet 2 mg Tablet 1,480 0 1,480 13 1,467
100 Diazepam Tablet 5 mg Tablet 0 0 0 0 0
101 Difenhidramin Injeksi Ampul 736 0 736 7 729
102 Digoxin Tab 0,25 mg Tablet 700 0 700 0 700
103 Diltiazem Tablet 30 mg Tablet 30 0 30 0 30
104 Dimenhidrinat Tablet 200 0 200 0 200
105 Diuvar Ampul 4,000 0 4,000 0 4,000
106 Domperidon Suspens 5 mg/5 ml Botol 115 0 115 1 114
107 Domperidon Tablet Tablet 1,775 0 1,775 75 1,700
108 Doxyciclin 100 mg Kapsul 0 0 0 0 0
109 Dulcolax 5 mg Tablet 0 0 0 0 0
110 Dumin Rectal 125 mg Suppo 0 0 0 0 0
111 Dumin Rectal 250 mg Suppo 0 0 0 0 0
112 E-care / Alkohol Swab Kotak 0 0 0 0 0
113 EDTA Botol 1,300 0 1,300 0 1,300
114 Efedrin Tablet 25 mg Tablet 0 0 0 0 0
115 Efline Tablet 3,965 0 3,965 0 3,965
116 Ekstrak Belladon Tab 10 mg Tablet 0 0 0 0 0
117 Elastis Verban Set 0 0 0 0 0
118 Emersin Oil Botol 300 2 302 0 302
119 Emineton Tablet 0 0 0 0 0
120 Enbatic Tube 0 0 0 0 0
121 Enzimfort Tablet 0 0 0 0 0
122 Epinefrin/Adrenalina Injeksi Ampul 10 0 10 0 10
123 Erlamicetin Tetes Telinga Botol 39 0 39 2 37
124 Ergotamin Coffein Tab Tablet 184 0 184 0 184
125 Eritromicin 250 mg Kap Kapsul 0 0 0 0 0
126 Eritromicin 500 mg Kap Kapsul 665 0 665 80 585
127 Eritromicin Sirup Botol 203 0 203 0 203
128 Erphatrim Kapsul 8 0 8 0 8
129 Etakridin (rivanol Lar 0,1 %) Botol 428 0 428 0 428
130 Etanol 70% 1 L Botol 40 0 40 0 40
131 Etanol 70% 100 ml Botol 0 0 0 0 0
132 Etanol 70% 300 ml Botol 10 0 10 0 10
133 Ethambutol 500 mg Tablet 0 0 0 0 0
134 Ethilclorida Spray Botol 0 0 0 0 0
135 Eukinin Tablet 500 0 500 0 500
136 Farsix (Furosemide injeksi) Ampul 0 0 0 0 0
137 Fenilbutason Tab 200 mg Tablet 490 0 490 0 490
138 Fenitoin Tablet 0 0 0 0 0
139 Fenitoin Injeksi Ampul 0 0 0 0 0
140 Fenoksimetil Penisilin 250 mg Tablet 0 0 0 0 0
141 Fenoksimetil Penisilin 500 mg Tablet 0 0 0 0 0
142 Fenorbarbital Injeksi 50 mg/ 1 ml Ampul 60 0 60 0 60
143 Fenorbarbital Tab 30 mg Tablet 0 0 0 0 0
144 Fepiram (Piracetam injeks) Ampul 390 0 390 0 390
145 Ferro Sulpat Tab 30 mg Tablet 7,500 0 7,500 0 7,500
146 Fitomenadion Injeksi 2 mg/ml Ampul 0 0 0 0 0
147 Fitomenadion Tab 10 mg Tablet 0 0 0 0 0
148 Folley Catheter No. 10 Set 0 0 0 0 0
149 Folley Catheter No. 16 Set 0 0 0 0 0
150 Folley Catheter No. 18 Set 0 0 0 0 0
151 Folley Catheter No. 22 Set 0 0 0 0 0
152 Furosemit Tab 40 mg Tablet 0 0 0 0 0
153 Gabapentine Kapsul 0 0 0 0 0
154 Gameksan Krim 1 % Tube 1,920 0 1,920 0 1,920
155 Garam Oralit 200 ml Air Sachet 58 0 58 0 58
156 Gemfibrosil Kapsul 300 mg Kapsul 0 0 0 0 0
157 Gentamicin 40 mg (vial) Ampul 50 0 50 0 50
158 Gentamicin Salep Tube 44 0 44 1 43
159 Gentian violet Lar 1 % Pot 31 0 31 0 31
160 Glass Lonomer Cement Pot 1,100 0 1,100 0 1,100
161 Glibenklamit Tab 5 mg Tablet 1,040 0 1,040 0 1,040
162 Glimepiride 2 mg Tablet 0 0 0 0 0
163 Gliseril Guaiacolate 100 mg Tablet 9,802 0 9,802 67 9,735
164 Gliserin Pot 0 0 0 0 0
165 Glukosa Set 80 0 80 0 80
166 Glukosa Lar Infus 10% Steril Botol 100 0 100 0 100
167 Glukosa Lar Infus 5% Steril Botol 11,400 0 11,400 0 11,400
168 Gol Darah Tulip Pot 300 0 300 0 300
169 Griseofulvin Tab 125 mg Tablet 2,170 0 2,170 0 2,170
170 Halloperidol Tab 0,5 mg Tablet 170 0 170 0 170
171 Halloperidol Tab 1,5 mg Tablet 80 0 80 0 80
172 Halloperidol Tab 5 mg Tablet 0 0 0 0 0
173 Handscoen Geneklog Set 40 0 40 0 40
174 Handscoen Program Paket 0 0 0 0 0
175 Handscond 50 cm Set 0 0 0 0 0
176 Handscond No. 7 Steril Set 230 0 230 0 230
177 Handscond No. 7,5 Biasa Set 0 0 0 0 0
178 Handscond No. 7,5 Steril Set 396 0 396 0 396
179 Handscond No. 8 Steril Set 50 0 50 0 50
180 Handscond Non Steril Set 100 0 100 0 100
181 Hbs Ag Card Set 0 0 0 0 0
182 Hemafort Tablet 8,420 0 8,420 50 8,370
183 Hemoglobin Set 700 0 700 0 700
184 Hustab Tablet 1,008 0 1,008 0 1,008
185 Hydroclortiazid Tab 25 mg Tablet 0 0 0 0 0
186 Hydrocortizon Krim 2,5 % Tube 949 0 949 3 946
187 Hyscopan Tab Tablet 200 0 200 0 200
188 Ibuprofen Tab 200 mg Tablet 371 0 371 0 371
189 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
190 Ibuproifen Sirup Botol 90 0 90 0 90
191 Infusion Set Anak Set 550 0 550 0 550
192 Infusion Set Dewasa Set 550 0 550 0 550
193 Isoniazit Tab 100 mg Tablet 800 0 800 0 800
194 Isoniazit Tab 300 mg Tablet 0 0 0 0 0
195 Isosorbid Dinitrat Tab 5 mg Tablet 0 0 0 0 0
196 Itracycline Kap 250 mg Tablet 0 0 0 0 0
197 Jarum Hacting Kulit Sach 50 0 50 0 50
198 Jarum Hacting Otot Sach 0 0 0 0 0
199 Jarum Kulit No. 11 Set 0 0 0 0 0
200 Jarum Otot No. 11 Set 24 0 24 0 24
201 Kaca Slide TB Set 0 0 0 0 0
202 Kalsium Glukonas Botol 0 0 0 0 0
203 Kalsium Hydroksida pasta Botol 8 0 8 0 8
204 Kalsium Laktat (KALK) 500 mg Tablet 32,570 0 32,570 70 32,500
205 Kanamicyn Injeksi Ampul 20 0 20 0 20
206 Kanarco Injeksi Ampul 0 0 0 0 0
207 Kaolimec Suspensi Botol 0 0 0 0 0
208 Kaotin Botol 46 0 46 0 46
209 Kapas Berlemak 500 mg Set 0 0 0 0 0
210 Kapas Pembalut 250 mg Set 5 0 5 0 5
211 Kapas Putih Tablet 0 0 0 0 0
212 Karbamazepin 200 mg Tablet 0 0 0 0 0
213 Kasa Hidrofil 4 m x 15 m Set 0 0 0 0 0
214 Kasa Hidrofil 4 m x 8 m Set 0 0 0 0 0
215 Kasa Kompres 40/40 Steril Set 0 0 0 0 0
216 Kasa Pembalut 2 x 80 m Rol 0 0 0 0 0
217 Kasa Steril 18 x 22 cm (16 x 16) Kotak 0 0 0 0 0
218 Kertas EKG Rol 0 0 0 0 0
219 Kertas USG Rol 90 0 90 0 90
220 Ketamin Injeksi 10 mg/ml Ampul 5,400 0 5,400 0 5,400
221 Ketokonazol Krim Tube 21 0 21 0 21
222 Ketokonazol Tab 200 mg Tablet 14,840 0 14,840 0 14,840
223 Ketorolak Injeksi Ampul 0 0 0 0 0
224 Kloramphenikol Kap 250 mg Kapsul 124 0 124 0 124
225 Kloramphenikol Kap 500 mg Kapsul 280 0 280 10 270
226 Kloramphenikol Salep Mata 1 % Tube 259 0 259 3 256
227 Kloramphenikol Suspensi Botol 4 0 4 1 3
228 Kloramphenikol Tetes Mata 0,5 % Botol 69,300 0 69,300 0 69,300
229 Kloramphenikol Tetes Telinga 3 % Botol 0 0 0 0 0
230 Klorfeniramin Maleat 4 mg Tablet 4,895 0 4,895 285 4,610
231 Klorfenol kamfer Menthol Tablet 30 0 30 0 30
232 Kloroquin Tab 150 mg Tablet 1,800 0 1,800 0 1,800
233 Klorpromazin Injeksi 5 mg/ml Ampul 0 0 0 0 0
234 Klorpromazin Tab 100 mg Tablet 61 0 61 36 25
235 Klorpromazin Tab 25 mg Tablet 0 0 0 0 0
236 Kolicgon Tablet 0 0 0 0 0
237 Komb. Sulfadoxin + Pirimethamin Tablet 1,956 0 1,956 0 1,956
238 Kotrimoxazol Pediatrik Tablet 3,800 0 3,800 0 3,800
239 Kotrimoxazol Suspensi 60 ml Botol 299 0 299 0 299
240 Kotrimoxazol Tab 480 mg Tablet 1,048 0 1,048 8 1,040
241 Kuinin (Kina) Tab 200 mg Tablet 0 0 0 0 0
242 Kuinin Injeksi25 % - 2 ml Ampul 0 0 0 0 0
243 Lansprazole 30 mg Kapsul 0 0 0 0 0
244 Larutan Benedic Botol 0 0 0 0 0
245 Larutan Eosin 2 % Botol 0 0 0 0 0
246 Larutan Ethanol Asam Botol 5 0 5 0 5
247 Larutan Giemsa Stain Botol 0 0 0 0 0
248 Larutan H2O3 Botol 0 0 0 0 0
249 Larutan HCL 0,1 % Botol 0 0 0 0 0
250 Larutan Karbonfuksin Botol 0 0 0 0 0
251 Larutan Metanol Botol 0 0 0 0 0
252 Larutan Metilen Blue Botol 0 0 0 0 0
253 Larutan PK Pot 0 0 0 0 0
254 Larutan Turk Botol 0 0 0 0 0
255 Leucoplast Roll 30 0 30 0 30
256 Lexaford 5 mg Tablet 0 0 0 0 0
257 Lidokain Kompositum Injeksi Ampul 900 0 900 0 900
258 Lismin Sirup Botol 24 0 24 0 24
259 Lisol Botol 39 0 39 0 39
260 Lodomer Ampul 0 0 0 0 0
261 Loperamid Tablet 155 0 155 0 155
262 Loratadine Tablet 89 0 89 92 3
263 Lytamin Sirup Botol 0 0 0 0 0
264 M.Y my Jelly Tube 0 0 0 0 0
265 Maag Slang No. 8 Buah 1,100 0 1,100 0 1,100
266 Maag Slang No. 21 Buah 28 0 28 0 28
267 Masker Karet Box 10 0 10 0 10
268 Masker N96 Box 6 0 6 0 6
269 Masker Tali Box 10 0 10 0 10
270 MDT Comby Anak Paket 0 0 0 0 0
271 MDT Comby Dewasa Paket 0 0 0 0 0
272 Mebendazol Tab 100 mg Tablet 0 0 0 0 0
273 Medigibs 18 x 28 Set 0 0 0 0 0
274 Meloxicam 15 mg Tablet 9,100 0 9,100 0 9,100
275 Metergine Ampul 5,500 0 5,500 0 5,500
276 Metformin Tablet 13,280 0 13,280 0 13,280
277 Methilprednisolone 8 mg Tablet 120 0 120 0 120
278 Metilergometrin Injeksi 0,2 mg Ampul 10 0 10 0 10
279 Metilergometrin Tab Tablet 0 0 0 0 0
280 Metoclopramid 10 mg Tablet 2,720 0 2,720 0 2,720
281 Metoclopramid sirup Botol 24 0 24 0 24
282 Metoclorpramide Inj Ampul 0 0 0 0 0
283 Metolon Ampul 0 0 0 0 0
284 Metronidazol Tab 250 mg Tablet 0 0 0 0 0
285 Metronidazol Tab 500 mg Tablet 13,459 0 13,459 146 13,313
286 MgSO4 Inj 20 % - 25 ml Vial 16 0 16 0 16
287 MgSO4 Inj 40 % - 25 ml Vial 4 0 4 0 4
288 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
289 Miconazol 10 mg Salep Tube 139 0 139 0 139
290 Microskopis Slide Set 0 0 0 0 0
291 Mineral Mix Sachet 0 0 0 0 0
292 Mucotussan Tablet 0 0 0 0 0
293 Na Bikarbonat Tab 500 mg Tablet 220 0 220 0 220
294 Na Tiosulfat Inj 25 % - 10 ml Ampul 10,000 0 10,000 0 10,000
295 NaCL Lar Infus 0,9 % Botol 40 0 40 0 40
296 Natrium Diklofenak Tab 25 mg Tablet 1,740 0 1,740 30 1,710
297 Needle No. 24 Buah 0 0 0 0 0
298 Needle No. 25 Buah 305 0 305 0 305
299 Neurotropic Kaplet Kaplet 280 0 280 0 280
300 Neurotropic Plus Kaplet 1,000 0 1,000 0 1,000
301 Neurovit E Tablet 3,152 0 3,152 14 3,138
302 Nifedipin Tab 10 mg Tablet 84 0 84 84 0
303 Nistatin Tab 500.000 IU Tablet 0 0 0 0 0
304 Nistatin Tab Vaginal 100.000 IU Tablet 0 0 0 0 0
305 Nitrium Floresein Tetes mata 2 % Botol 13,000 0 13,000 0 13,000
306 Norages Ampul 0 0 0 0 0
307 Novachlor Kapsul 0 0 0 0 0
308 Novadex 0,5 mg Tablet 0 0 0 0 0
309 Novadium 2 mg Tablet 500 0 500 0 500
310 Novadril Injeksi Flakon 0 0 0 0 0
311 Novagesic Syrup Botol 300 0 300 0 300
312 Novamox Tablet 0 0 0 0 0
313 Novapyron Tablet 0 0 0 0 0
314 Novastan Tablet 0 0 0 0 0
315 Novaxifen Syrup Botol 0 0 0 0 0
316 Novazone 200 mg Tablet 100 0 100 0 100
317 Novorapide Set 4 0 4 0 4
318 Noza Tablet 0 0 0 0 0
319 OAT FDC Kategori Anak Paket 0 0 0 0 0
320 OAT FDC Kategori I Dewasa Paket 3 0 3 0 3
321 OAT FDC Kategori II Dewasa Paket 1 0 1 0 1
322 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
323 OAT Kombipak Paket 0 0 0 0 0
324 Obat Batuk Hitam (OBH) Botol 25 0 25 17 8
325 Oksitetraciclin Inj 50 ml - 10 ml Ampul 50 0 50 0 50
326 Oksitetraciclin Salep Kulit 3 % Tube 126 0 126 1 125
327 Oksitetraciclin Salep Mata 1 % Tube 62 0 62 0 62
328 Oksitosin Inj 50 ml - 10 ml Ampul 100 0 100 0 100
329 Omeprazole 20 mg Kapsul 350 0 350 0 350
330 Oxybiotic Vial 0 0 0 0 0
331 Papaverin Inj Ampul 1,087 0 1,087 0 1,087
332 Papaverin Tab 40 mg Tablet 5,866 0 5,866 68 5,798
333 Paracetamol Sirup 60 mg / 5 ml Botol 251 0 251 22 229
334 Paracetamol Tab 100 mg Tablet 0 0 0 0 0
335 Paracetamol Tab 500 mg Tablet 1,045 0 1,045 155 890
336 Pehakain Injeksi Ampul 0 0 0 0 0
337 Pehamoxil Forte (amoxycillin) Tablet 7 0 7 0 7
338 Pehavral Tablet 0 0 0 0 0
339 Pembalut Gips Buah 0 0 0 0 0
340 Permanganas kalikus Botol 0 0 0 0 0
341 Pethidin Injeksi Flakon 72 0 72 0 72
342 Pewarna Ziehls Nels Set 0 0 0 0 0
343 Phenol Glycerol Botol 10 0 10 0 10
344 Pilokarpin Tetes Mata 2 % Botol 4 0 4 0 4
345 Piracetam 400 mg Tablet 0 0 0 0 0
346 Piracetam Inj Ampul 0 0 0 0 0
347 Pirantel Tab 125 mg Tablet 48 0 48 2 46
348 Pirazinamide 500 mg Tablet 8,600 0 8,600 0 8,600
349 Piridoxyn (vit B6) Tab 10 mg Tablet 484 0 484 44 440
350 Piroxicam 20 mg Kap Tablet 202 0 202 150 52
351 Pisau Bedah Buah 0 0 0 0 0
352 Pitogin Injeksi Ampul 1,800 0 1,800 0 1,800
353 Plano Test Box 35 0 35 0 35
354 Plesterin Box 40 0 40 0 40
355 Plester 5 Yard x Inci Rol 5 0 5 0 5
356 Plester 7 Yard x 2 Inci Rol 0 0 0 0 0
357 Poligyp Buah 5 0 5 0 5
358 Pot Sputum Pot 0 0 0 0 0
359 Povidon Iodida 10% - 30 ml Botol 150 0 150 0 150
360 Povidon Iodida 10% - 300 ml Botol 0 0 0 0 0
361 Povidon Iodida 60 ml Botol 80 0 80 0 80
362 Povidone 1 Liter Botol 1,200 0 1,200 0 1,200
363 Prednison Tablet 5 mg Tablet 880 0 880 118 762
364 Primakuin 15 mg Tablet Tablet 0 0 0 0 0
365 Promavit Kapsul 307 0 307 5 302
366 Propanolol HCL Tab 10 mg Tablet 250 0 250 0 250
367 Propanolol HCL Tab 40 mg Tablet 0 0 0 0 0
368 Propiltiuracil Tab 100 mg Tablet 540 0 540 20 520
369 Ramipril Tablet 160 0 160 0 160
370 Ranitidin Injeksi 25 mg - 2 ml Ampul 184 0 184 2 182
371 Ranitidin Tablet 150 mg Tablet 5,000 0 5,000 10 4,990
372 RDT DBD / Rigt SIgn Sachet 0 0 0 0 0
373 RDT Malaria Set 0 0 0 0 0
374 Reco Drops Botol 0 0 0 0 0
375 Recodryl Injeksi Vial 0 0 0 0 0
376 Recovit Sirup Botol 0 0 0 0 0
377 Rees Eker Buah 0 0 0 0 0
378 Renovit Tablet 0 0 0 0 0
379 Reserpin Tab 0,10 mg Tablet 0 0 0 0 0
380 Reserpin Tab 0,25 mg Tablet 0 0 0 0 0
381 Resperidone Tablet 0 0 0 0 0
382 Rifampisin Tab 450 mg Tablet 280 0 280 0 280
383 Rifampisin Tab 600 mg Tablet 6,800 0 6,800 0 6,800
384 Ringer Laktat Lar Infus Steril Botol 100 0 100 0 100
385 Salbutamol 2 mg Tablet Tablet 0 0 0 0 0
386 Salbutamol 4 mg Tablet Tablet 2,063 0 2,063 46 2,017
387 Salep 2 - 4 Pot 88 0 88 0 88
388 Salicyl Talk Dos 146 0 146 0 146
389 Saltrim Tablet Tablet 0 0 0 0 0
390 Selediar Tablet 0 0 0 0 0
391 Seles B13 Tablet 0 0 0 0 0
392 Seles B6 10 mg Tablet 2,000 0 2,000 0 2,000
393 Seles C 50 mg Tablet 0 0 0 0 0
394 Selesbion Kaplet Kapsul 0 0 0 0 0
395 Selesbion Plus Cal Tablet 0 0 0 0 0
396 Selesgin 500 mg Tablet 900 0 900 0 900
397 Selesnizol 500 mg Tablet 1,300 0 1,300 0 1,300
398 Selkom C kaplet 2,000 0 2,000 0 2,000
399 Selviplex Kaplet 0 0 0 0 0
400 Seven Seas Botol 144 0 144 1 143
401 SGOT Kit 90 0 90 0 90
402 SGPT Kit 1,230 0 1,230 0 1,230
403 Siadidril Ampul 0 0 0 0 0
404 Sianokobalamin Inj 500 mg Ampul 91 0 91 0 91
405 Sianokobalamin Tab 50 mg Tablet 2,000 0 2,000 0 2,000
406 Silk Black 4/0 100 m Buah 0 0 0 0 0
407 Silk Black No 2/0 Buah 0 0 0 0 0
408 Silk Black No 3/0 Buah 3 0 3 0 3
409 Simvastatin Tablet 10 mg Tablet 1,780 0 1,780 20 1,760
410 Simvastatin Tablet 20 mg Tablet 0 0 0 0 0
411 Skizone Tube 0 0 0 0 0
412 Slide TB Paru Box 6,000 0 6,000 0 6,000
413 Sohobion Injeksi Ampul 0 0 0 0 0
414 Soldextam Tablet 0 0 0 0 0
415 Sotatic Injeksi Ampul 900 0 900 0 900
416 Sotatic Tablet Tablet 320 0 320 0 320
417 Spasmolite Tablet 0 0 0 0 0
418 Spironolakton Tablet 50 0 50 10 40
419 Spritus Botol 2 0 2 0 2
420 Stelosi Tablet 5 0 5 0 5
421 Stesolid Suppo Supp 0 0 0 0 0
422 Stesolid (Diazepam injeksi) Ampul 0 0 0 0 0
423 Stik Asam Urat Stik 100 0 100 0 100
424 Stik Gula Darah Stik 100 0 100 0 100
425 Stik Hb Family Dr Stik 250 0 250 0 250
426 Stik Kolesterol Stik 170 0 170 0 170
427 Sulfadoxine Pyrimetamine Tablet 0 0 0 0 0
428 Tablet Tambah Darah Tablet 1,400 0 1,400 60 1,340
429 Teramycin Injeksi Ampul 0 0 0 0 0
430 Termorex Drop Botol 0 0 0 0 0
431 Tetracyclin HCL Kap 250 mg Tablet 0 0 0 0 0
432 Tetracyclin HCL Kap 500 mg Tablet 3,250 0 3,250 0 3,250
433 Tetrakain HCL Tetes Mata 0,5 % Botol 1,000 0 1,000 0 1,000
434 Thiamin HCL Injeksi Ampul 909 0 909 0 909
435 Thiamin HCL Tab 50 mg Tablet 3,786 0 3,786 46 3,740
436 Tiopental Injeksi 100 mg Tablet 10 0 10 0 10
437 Tramadol Tab 50 mg Tablet 0 0 0 0 0
438 Traneksid Ampul 0 0 0 0 0
439 Transamin 250 mg/ml Ampul 14,000 0 14,000 0 14,000
440 Transamin 500 mg Injeksi Tablet 0 0 0 0 0
441 Trifacort 5 mg Tablet 0 0 0 0 0
442 Trifaneuron Tablet 0 0 0 0 0
443 Triheksiphenidil HCL Tab 2 mg Tablet 0 0 0 0 0
444 Trisulfa 500 mg Tablet 0 0 0 0 0
445 Truvit Botol 77 0 77 1 76
446 Ulsikur Injeksi Ampul 10 0 10 0 10
447 Uric Acid Buah 40 0 40 0 40
448 Urine Bag Buah 0 0 0 0 0
449 Vaksin Verorab Paket 0 0 0 0 0
450 Vastigo 6 mg Tablet 0 0 0 0 0
451 Ventolin Nebules 2,5 mg Ampul 0 0 0 0 0
452 Verban 5 ml Rol 15 0 15 0 15
453 Vicillin Injeksi Ampul 20 0 20 0 20
454 Vitamin A Kapsul Biru Botol 0 0 0 0 0
455 Vitamin A Kapsul Merah Botol 13,600 0 13,600 0 13,600
456 Vitamin B Kompleks Injeksi Vial 80 0 80 0 80
457 Vitamin B Kompleks Tab Tablet 4,970 0 4,970 65 4,905
458 Vitamin C 50 Mg Tablet 6,926 0 6,926 124 6,802
459 Vitomerga Tablet 0 0 0 0 0
460 Widal Kit 0 0 0 0 0
461 Wing Needle No. 29 Pcs 0 0 0 0 0
462 Wing Needle No. 31 Pcs 106 0 106 0 106
463 Wing Needle No. 33 Pcs 0 0 0 0 0
464 Wing Needle No. 35 Pcs 2,600 0 2,600 0 2,600
465 Xlestesin Buah 150 0 150 0 150
466 Zink 20 mg Tablet 970 0 970 0 970
467 Zink Sirup Botol 91 0 91 1 90

JAMKESDA UMUM BPJS

JUMLAH KUNJUNGAN RESEP

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang Men

Kepala Seksi Kefarmasian Penanggung Jawab
Gudang Farmasi

Sahrul, SKM Jesry Massorah. S.Farm., Apt Nurafni M.Towanda,SKM Fitriani Damarull
Nip. 19820714 200502 1 003 Nip. 19820403 200804 2 003 Nip. 19810820 200502 2 007 Nip. 19901204 2
PO)

: DESEMBER 2018
: JANUARI 2019

emberian
Lain- Jumlah KET
lain
13 14 15
BPJS

Yang Menerima

ani Damarullah, A.Md.Keb

. 19901204 201704 2 007
 LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT (LPLPO)

PUSKESMAS : DOLONG PELAPORAN BLN/PERIODE : JANUAR

KECAMATAN : WALEA KEPULAUAN PERMINTAAN BLN/PERIODE : FEBRUA
KABUPATEN : TOJO UNA UNA
PROPINSI : SULAWESI TENGAH

Stok Peneri- Perse- Pema- Stok Permin- Pemberian

NO Nama Obat/Alkes/BMHP Satuan Awal maan diaan kaian Akhir taan APBD I APBD II Program

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No 26 Buah 632 0 632 0 632
2 Abbocath No 28 Buah 324 0 324 0 324
3 Abbocath No 30 Buah 346 0 346 0 346
4 Abbocath No 32 Buah 372 0 372 0 372
5 ACT Strip 4,500 0 4,500 0 4,500
6 Acyclovir 200 mg Tablet 100 0 100 0 100
7 Acyclovir 400 mg Tablet 7,201 0 7,201 52 7,149
8 Acyclovir Krim 5% Tube 18 0 18 2 16
9 Adidryl Injeksi Vial 0 0 0 0 0
10 Adimidon Injeksi Vial 200 0 200 0 200
11 Ailin Botol 63 0 63 0 63
12 Alat Suntik Sekali Pakai 1 ml Buah 386 0 386 0 386
13 Alat Suntik Sekali Pakai 10 ml Buah 0 0 0 0 0
14 Alat Suntik Sekali Pakai 20 ml Buah 2,600 0 2,600 0 2,600
15 Alat Suntik Sekali Pakai 3 ml Buah 1,800 0 1,800 0 1,800
16 Alat Suntik Sekali Pakai 5 ml Buah 802 0 802 0 802
17 Alat Tes HB Familu Dr Buah 1,200 0 1,200 0 1,200
18 Albendazol Tablet 400 mg Tablet 17 0 17 0 17
19 Allopurinol Tab 100 mg Tablet 1,190 0 1,190 10 1,180
20 Allopurinol Tab 300 mg Tablet 990 0 990 0 990
21 Alprazolam 0,5 mg Tablet 0 0 0 0 0
22 Alprazolam 1 mg Tablet 50 0 50 0 50
23 Alterol Tetes Mata Botol 2,300 0 2,300 0 2,300
24 Ambroxol Syrup 15 mg/5 ml Botol 58 0 58 0 58
25 Ambroxol Tab 30 mg Tablet 861 0 861 40 821
26 Aminophillin HCL Tab 2,5 mg Tablet 0 0 0 0 0
27 Aminophillin Injeksi 24 mg/ml Ampul 1,900 0 1,900 0 1,900
28 Aminophillin Tablet Tablet 500 0 500 0 500
29 Amitriptilin Tablet Salut 25 mg Tablet 4,000 0 4,000 0 4,000
30 Amlodipine 10 mg Tablet 1,480 0 1,480 50 1,430
31 Amlodipine 5 mg Tablet 245 0 245 0 245
32 Amoxycillin Kap 250 mg Tablet 0 0 0 0 0
33 Amoxycillin Kap 500 mg Tablet 648 0 648 10 638
34 Amoxycillin Syrup 125 mg/5 mg Botol 110 0 110 7 103
35 Amoxycillin Syrup 250 mg/5 mg Botol 120 0 120 0 120
36 Ampicillin Injeksi Ampul 51 0 51 0 51
37 Ampicillin Kap 500 mg Tablet 410 0 410 0 410
38 Ampicillin Syrup Kering 125 mg Botol 0 0 0 0 0
39 Antalgin Injeksi 250 mg/ml Ampul 0 0 0 0 0
40 Antalgin Tablet 500 mg Tablet 100 0 100 30 70
41 Antasida DOEN Syrup Botol 585 0 585 6 579
42 Antasida DOEN Tablet 500 mg Tablet 7,939 0 7,939 20 7,919
43 Anti Hemoroid Suppo 0 0 0 0 0
44 Antifungi doen Kombinasi Suppensi 0 0 0 0 0
45 Antiseptic Hand Rub Botol 80 0 80 0 80
46 Antraian METAMIZOLE Ampul 10 0 10 0 10
47 Aqua Pro Injeksi Botol 26,000 0 26,000 0 26,000
48 Artem Ampul 4,800 0 4,800 0 4,800
49 Asam Askorbat Tablet 50 mg Tablet 0 0 0 0 0
50 Asam Folat Tablet 2,200 0 2,200 0 2,200
51 Asam Mefenamat 500 mg Tablet 1,654 0 1,654 288 1,366
52 Asam Traneksamat Ampul 0 0 0 0 0
53 Asam Valproat Botol 0 0 0 0 0
54 Asetosal 80 mg / Miniaspi Tablet 0 0 0 0 0
55 Asetosal Tablet 100 mg Tablet 0 0 0 0 0
56 Asetosal Tablet 500 mg Tablet 0 0 0 0 0
57 Atropin Injeksi 0,25 mg Ampul 20 0 20 0 20
58 Bacitracin Polimixyn B Salep Tube 1,008 0 1,008 0 1,008
59 Betahistine Mesilate Tablet 124 0 124 50 74
60 Betametason Krim 0,1 % Tube 93 0 93 0 93
61 Bicolax Tablet 430 0 430 0 430
62 Bio ATP Tablet 350 0 350 0 350
63 Biocombine Ampul 17 0 17 0 17
64 Bionemi Tablet 274 0 274 40 234
65 Bisoprolol Tablet 50 0 50 0 50
66 Blood Lancet Buah 100 0 100 0 100
67 Buscopan Injeksi Ampul 0 0 0 0 0
68 Captopril 12,5 mg Tablet 2,630 0 2,630 0 2,630
69 Captopril 25 mg Tablet 4,930 0 4,930 20 4,910
70 Catapres Injeksi Ampul 20 0 20 0 20
71 Catgut No. 2/1 Buah 0 0 0 0 0
72 Catgut No. 3/1 Buah 24 0 24 0 24
73 Cathejell Botol 192 0 192 0 192
74 Cefadroxil 500 mg Tablet 2,428 0 2,428 10 2,418
75 Cefadroxil Syrup Botol 113 0 113 1 112
76 Ceftriaxone Vial 0 0 0 0 0
77 Cetirizine 10 mg Tablet 4,950 0 4,950 107 4,843
78 Cetirizine Sirup Botol 0 0 0 0 0
79 Cimetidin 200 mg Tab Tablet 1,692 0 1,692 0 1,692
80 Citicoline Tablet 0 0 0 0 0
81 Clobazam 10 mg Tablet 0 0 0 0 0
82 Clonidine 0,15 mg Tablet 84 0 84 50 34
83 Clopidogrel Tablet 200 0 200 0 200
84 Clozapine Tablet 250 0 250 0 250
85 Codein Tablet 100 0 100 10 90
86 Combivent Vial 3,300 0 3,300 0 3,300
87 Curcuma 20 mg Tablet 200 0 200 0 200
88 Cyprofloksasin Tab 500 mg Tablet 740 0 740 130 610
89 D-Artep Tablet 0 0 0 0 0
90 Decanoas Ampul 199 0 199 0 199
91 Delamidon Ampul 5,500 0 5,500 0 5,500
92 Dexamethason Injeksi 5 mg/ml Ampul 104 0 104 0 104
93 Dexamethason Tablet 0,5 mg Tablet 11,532 0 11,532 414 11,118
94 Dextamec Tablet 0 0 0 0 0
95 Dextrometorphan Sir 10 mg/ml Botol 0 0 0 0 0
96 Dextrometorphan Tab 15 mg Tablet 0 0 0 0 0
97 Diafac Tablet 900 0 900 0 900
98 Diazepam Injeksi Ampul 0 0 0 0 0
99 Diazepam Tablet 2 mg Tablet 1,467 0 1,467 0 1,467
100 Diazepam Tablet 5 mg Tablet 0 0 0 0 0
101 Difenhidramin Injeksi Ampul 729 0 729 16 713
102 Digoxin Tab 0,25 mg Tablet 700 0 700 0 700
103 Diltiazem Tablet 30 mg Tablet 30 0 30 0 30
104 Dimenhidrinat Tablet 200 0 200 0 200
105 Diuvar Ampul 4,000 0 4,000 0 4,000
106 Domperidon Suspens 5 mg/5 ml Botol 114 0 114 0 114
107 Domperidon Tablet Tablet 1,700 0 1,700 30 1,670
108 Doxyciclin 100 mg Kapsul 0 0 0 0 0
109 Dulcolax 5 mg Tablet 0 0 0 0 0
110 Dumin Rectal 125 mg Suppo 0 0 0 0 0
111 Dumin Rectal 250 mg Suppo 0 0 0 0 0
112 E-care / Alkohol Swab Kotak 0 0 0 0 0
113 EDTA Botol 1,300 0 1,300 0 1,300
114 Efedrin Tablet 25 mg Tablet 0 0 0 0 0
115 Efline Tablet 3,965 0 3,965 44 3,921
116 Ekstrak Belladon Tab 10 mg Tablet 0 0 0 0 0
117 Elastis Verban Set 0 0 0 0 0
118 Emersin Oil Botol 300 2 302 0 302
119 Emineton Tablet 0 0 0 0 0
120 Enbatic Tube 0 0 0 0 0
121 Enzimfort Tablet 0 0 0 0 0
122 Epinefrin/Adrenalina Injeksi Ampul 10 0 10 0 10
123 Erlamicetin Tetes Telinga Botol 37 0 37 0 37
124 Ergotamin Coffein Tab Tablet 184 0 184 0 184
125 Eritromicin 250 mg Kap Kapsul 0 0 0 0 0
126 Eritromicin 500 mg Kap Kapsul 585 0 585 0 585
127 Eritromicin Sirup Botol 203 0 203 0 203
128 Erphatrim Kapsul 8 0 8 0 8
129 Etakridin (rivanol Lar 0,1 %) Botol 428 0 428 0 428
130 Etanol 70% 1 L Botol 40 0 40 0 40
131 Etanol 70% 100 ml Botol 0 0 0 0 0
132 Etanol 70% 300 ml Botol 10 0 10 0 10
133 Ethambutol 500 mg Tablet 0 0 0 0 0
134 Ethilclorida Spray Botol 0 0 0 0 0
135 Eukinin Tablet 500 0 500 0 500
136 Farsix (Furosemide injeksi) Ampul 0 0 0 0 0
137 Fenilbutason Tab 200 mg Tablet 490 0 490 0 490
138 Fenitoin Tablet 0 0 0 0 0
139 Fenitoin Injeksi Ampul 0 0 0 0 0
140 Fenoksimetil Penisilin 250 mg Tablet 0 0 0 0 0
141 Fenoksimetil Penisilin 500 mg Tablet 0 0 0 0 0
142 Fenorbarbital Injeksi 50 mg/ 1 ml Ampul 60 0 60 0 60
143 Fenorbarbital Tab 30 mg Tablet 0 0 0 0 0
144 Fepiram (Piracetam injeks) Ampul 390 0 390 0 390
145 Ferro Sulpat Tab 30 mg Tablet 7,500 0 7,500 0 7,500
146 Fitomenadion Injeksi 2 mg/ml Ampul 0 0 0 0 0
147 Fitomenadion Tab 10 mg Tablet 0 0 0 0 0
148 Folley Catheter No. 10 Set 0 0 0 0 0
149 Folley Catheter No. 16 Set 0 0 0 0 0
150 Folley Catheter No. 18 Set 0 0 0 0 0
151 Folley Catheter No. 22 Set 0 0 0 0 0
152 Furosemit Tab 40 mg Tablet 0 0 0 0 0
153 Gabapentine Kapsul 0 0 0 0 0
154 Gameksan Krim 1 % Tube 1,920 0 1,920 0 1,920
155 Garam Oralit 200 ml Air Sachet 58 0 58 0 58
156 Gemfibrosil Kapsul 300 mg Kapsul 0 0 0 0 0
157 Gentamicin 40 mg (vial) Ampul 50 0 50 0 50
158 Gentamicin Salep Tube 43 0 43 0 43
159 Gentian violet Lar 1 % Pot 31 0 31 0 31
160 Glass Lonomer Cement Pot 1,100 0 1,100 0 1,100
161 Glibenklamit Tab 5 mg Tablet 1,040 0 1,040 0 1,040
162 Glimepiride 2 mg Tablet 100 0 100 10 90
163 Gliseril Guaiacolate 100 mg Tablet 9,735 0 9,735 156 9,579
164 Gliserin Pot 0 0 0 0 0
165 Glukosa Set 80 0 80 0 80
166 Glukosa Lar Infus 10% Steril Botol 100 0 100 0 100
167 Glukosa Lar Infus 5% Steril Botol 11,400 0 11,400 0 11,400
168 Gol Darah Tulip Pot 300 0 300 0 300
169 Griseofulvin Tab 125 mg Tablet 2,170 0 2,170 0 2,170
170 Halloperidol Tab 0,5 mg Tablet 170 0 170 10 160
171 Halloperidol Tab 1,5 mg Tablet 80 0 80 0 80
172 Halloperidol Tab 5 mg Tablet 0 0 0 0 0
173 Handscoen Geneklog Set 40 0 40 0 40
174 Handscoen Program Paket 0 0 0 0 0
175 Handscond 50 cm Set 0 0 0 0 0
176 Handscond No. 7 Steril Set 230 0 230 0 230
177 Handscond No. 7,5 Biasa Set 0 0 0 0 0
178 Handscond No. 7,5 Steril Set 396 0 396 0 396
179 Handscond No. 8 Steril Set 50 0 50 0 50
180 Handscond Non Steril Set 100 0 100 0 100
181 Hbs Ag Card Set 0 0 0 0 0
182 Hemafort Tablet 8,370 0 8,370 20 8,350
183 Hemoglobin Set 700 0 700 0 700
184 Hustab Tablet 1,008 0 1,008 0 1,008
185 Hydroclortiazid Tab 25 mg Tablet 0 0 0 0 0
186 Hydrocortizon Krim 2,5 % Tube 946 0 946 4 942
187 Hyscopan Tab Tablet 200 0 200 0 200
188 Ibuprofen Tab 200 mg Tablet 371 0 371 0 371
189 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
190 Ibuproifen Sirup Botol 90 0 90 0 90
191 Infusion Set Anak Set 550 0 550 0 550
192 Infusion Set Dewasa Set 550 0 550 0 550
193 Isoniazit Tab 100 mg Tablet 800 0 800 0 800
194 Isoniazit Tab 300 mg Tablet 0 0 0 0 0
195 Isosorbid Dinitrat Tab 5 mg Tablet 0 0 0 0 0
196 Itracycline Kap 250 mg Tablet 0 0 0 0 0
197 Jarum Hacting Kulit Sach 50 0 50 0 50
198 Jarum Hacting Otot Sach 0 0 0 0 0
199 Jarum Kulit No. 11 Set 0 0 0 0 0
200 Jarum Otot No. 11 Set 24 0 24 0 24
201 Kaca Slide TB Set 0 0 0 0 0
202 Kalsium Glukonas Botol 0 0 0 0 0
203 Kalsium Hydroksida pasta Botol 8 0 8 0 8
204 Kalsium Laktat (KALK) 500 mg Tablet 32,500 0 32,500 20 32,480
205 Kanamicyn Injeksi Ampul 20 0 20 0 20
206 Kanarco Injeksi Ampul 0 0 0 0 0
207 Kaolimec Suspensi Botol 0 0 0 0 0
208 Kaotin Botol 46 0 46 0 46
209 Kapas Berlemak 500 mg Set 0 0 0 0 0
210 Kapas Pembalut 250 mg Set 5 0 5 0 5
211 Kapas Putih Tablet 0 0 0 0 0
212 Karbamazepin 200 mg Tablet 0 0 0 0 0
213 Kasa Hidrofil 4 m x 15 m Set 0 0 0 0 0
214 Kasa Hidrofil 4 m x 8 m Set 0 0 0 0 0
215 Kasa Kompres 40/40 Steril Set 0 0 0 0 0
216 Kasa Pembalut 2 x 80 m Rol 0 0 0 0 0
217 Kasa Steril 18 x 22 cm (16 x 16) Kotak 0 0 0 0 0
218 Kertas EKG Rol 0 0 0 0 0
219 Kertas USG Rol 90 0 90 0 90
220 Ketamin Injeksi 10 mg/ml Ampul 5,400 0 5,400 0 5,400
221 Ketokonazol Krim Tube 21 0 21 0 21
222 Ketokonazol Tab 200 mg Tablet 14,840 0 14,840 0 14,840
223 Ketorolak Injeksi Ampul 0 0 0 0 0
224 Kloramphenikol Kap 250 mg Kapsul 124 0 124 0 124
225 Kloramphenikol Kap 500 mg Kapsul 270 0 270 0 270
226 Kloramphenikol Salep Mata 1 % Tube 256 0 256 0 256
227 Kloramphenikol Suspensi Botol 3 0 3 1 2
228 Kloramphenikol Tetes Mata 0,5 % Botol 69,300 0 69,300 0 69,300
229 Kloramphenikol Tetes Telinga 3 % Botol 0 0 0 0 0
230 Klorfeniramin Maleat 4 mg Tablet 4,610 0 4,610 70 4,540
231 Klorfenol kamfer Menthol Tablet 30 0 30 0 30
232 Kloroquin Tab 150 mg Tablet 1,800 0 1,800 0 1,800
233 Klorpromazin Injeksi 5 mg/ml Ampul 0 0 0 0 0
234 Klorpromazin Tab 100 mg Tablet 25 0 25 10 15
235 Klorpromazin Tab 25 mg Tablet 0 0 0 0 0
236 Kolicgon Tablet 0 0 0 0 0
237 Komb. Sulfadoxin + Pirimethamin Tablet 1,956 0 1,956 0 1,956
238 Kotrimoxazol Pediatrik Tablet 3,800 0 3,800 0 3,800
239 Kotrimoxazol Suspensi 60 ml Botol 299 0 299 3 296
240 Kotrimoxazol Tab 480 mg Tablet 1,040 0 1,040 40 1,000
241 Kuinin (Kina) Tab 200 mg Tablet 0 0 0 0 0
242 Kuinin Injeksi25 % - 2 ml Ampul 0 0 0 0 0
243 Lansprazole 30 mg Kapsul 0 0 0 0 0
244 Larutan Benedic Botol 0 0 0 0 0
245 Larutan Eosin 2 % Botol 0 0 0 0 0
246 Larutan Ethanol Asam Botol 5 0 5 0 5
247 Larutan Giemsa Stain Botol 0 0 0 0 0
248 Larutan H2O3 Botol 0 0 0 0 0
249 Larutan HCL 0,1 % Botol 0 0 0 0 0
250 Larutan Karbonfuksin Botol 0 0 0 0 0
251 Larutan Metanol Botol 0 0 0 0 0
252 Larutan Metilen Blue Botol 0 0 0 0 0
253 Larutan PK Pot 0 0 0 0 0
254 Larutan Turk Botol 0 0 0 0 0
255 Leucoplast Roll 30 0 30 0 30
256 Lexaford 5 mg Tablet 0 0 0 0 0
257 Lidokain Kompositum Injeksi Ampul 900 0 900 0 900
258 Lismin Sirup Botol 24 0 24 0 24
259 Lisol Botol 39 0 39 0 39
260 Lodomer Ampul 0 0 0 0 0
261 Loperamid Tablet 155 0 155 28 127
262 Loratadine Tablet 0 0 0 0 0
263 Lytamin Sirup Botol 0 0 0 0 0
264 M.Y my Jelly Tube 0 0 0 0 0
265 Maag Slang No. 8 Buah 1,100 0 1,100 0 1,100
266 Maag Slang No. 21 Buah 28 0 28 0 28
267 Masker Karet Box 10 0 10 0 10
268 Masker N96 Box 6 0 6 0 6
269 Masker Tali Box 10 0 10 0 10
270 MDT Comby Anak Paket 0 0 0 0 0
271 MDT Comby Dewasa Paket 0 0 0 0 0
272 Mebendazol Tab 100 mg Tablet 0 0 0 0 0
273 Medigibs 18 x 28 Set 0 0 0 0 0
274 Meloxicam 15 mg Tablet 9,100 0 9,100 0 9,100
275 Metergine Ampul 5,500 0 5,500 0 5,500
276 Metformin Tablet 13,280 0 13,280 20 13,260
277 Methilprednisolone 8 mg Tablet 120 0 120 0 120
278 Metilergometrin Injeksi 0,2 mg Ampul 10 0 10 0 10
279 Metilergometrin Tab Tablet 0 0 0 0 0
280 Metoclopramid 10 mg Tablet 2,720 0 2,720 0 2,720
281 Metoclopramid sirup Botol 24 0 24 0 24
282 Metoclorpramide Inj Ampul 0 0 0 0 0
283 Metolon Ampul 0 0 0 0 0
284 Metronidazol Tab 250 mg Tablet 0 0 0 0 0
285 Metronidazol Tab 500 mg Tablet 13,313 0 13,313 18 13,295
286 MgSO4 Inj 20 % - 25 ml Vial 16 0 16 0 16
287 MgSO4 Inj 40 % - 25 ml Vial 4 0 4 0 4
288 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
289 Miconazol 10 mg Salep Tube 139 0 139 0 139
290 Microskopis Slide Set 0 0 0 0 0
291 Mineral Mix Sachet 0 0 0 0 0
292 Mucotussan Tablet 0 0 0 0 0
293 Na Bikarbonat Tab 500 mg Tablet 220 0 220 0 220
294 Na Tiosulfat Inj 25 % - 10 ml Ampul 10,000 0 10,000 0 10,000
295 NaCL Lar Infus 0,9 % Botol 40 0 40 0 40
296 Natrium Diklofenak Tab 25 mg Tablet 1,710 0 1,710 20 1,690
297 Needle No. 24 Buah 0 0 0 0 0
298 Needle No. 25 Buah 305 0 305 0 305
299 Neurotropic Kaplet Kaplet 280 0 280 0 280
300 Neurotropic Plus Kaplet 1,000 0 1,000 0 1,000
301 Neurovit E Tablet 3,138 0 3,138 40 3,098
302 Nifedipin Tab 10 mg Tablet 10 0 10 10 0 100
303 Nistatin Tab 500.000 IU Tablet 0 0 0 0 0
304 Nistatin Tab Vaginal 100.000 IU Tablet 0 0 0 0 0
305 Nitrium Floresein Tetes mata 2 % Botol 13,000 0 13,000 0 13,000
306 Norages Ampul 0 0 0 0 0
307 Novachlor Kapsul 0 0 0 0 0
308 Novadex 0,5 mg Tablet 0 0 0 0 0
309 Novadium 2 mg Tablet 500 0 500 0 500
310 Novadril Injeksi Flakon 0 0 0 0 0
311 Novagesic Syrup Botol 300 0 300 0 300
312 Novamox Tablet 0 0 0 0 0
313 Novapyron Tablet 0 0 0 0 0
314 Novastan Tablet 0 0 0 0 0
315 Novaxifen Syrup Botol 0 0 0 0 0
316 Novazone 200 mg Tablet 100 0 100 0 100
317 Novorapide Set 4 0 4 0 4
318 Noza Tablet 0 0 0 0 0
319 OAT FDC Kategori Anak Paket 0 0 0 0 0
320 OAT FDC Kategori I Dewasa Paket 3 0 3 0 3
321 OAT FDC Kategori II Dewasa Paket 1 0 1 0 1
322 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
323 OAT Kombipak Paket 0 0 0 0 0
324 Obat Batuk Hitam (OBH) Botol 8 0 8 1 7
325 Oksitetraciclin Inj 50 ml - 10 ml Ampul 50 0 50 0 50
326 Oksitetraciclin Salep Kulit 3 % Tube 125 0 125 1 124
327 Oksitetraciclin Salep Mata 1 % Tube 62 0 62 0 62
328 Oksitosin Inj 50 ml - 10 ml Ampul 100 0 100 0 100
329 Omeprazole 20 mg Kapsul 350 0 350 20 330
330 Oxybiotic Vial 0 0 0 0 0
331 Papaverin Inj Ampul 1,087 0 1,087 0 1,087
332 Papaverin Tab 40 mg Tablet 5,798 0 5,798 12 5,786
333 Paracetamol Sirup 60 mg / 5 ml Botol 229 0 229 16 213
334 Paracetamol Tab 100 mg Tablet 0 0 0 0 0
335 Paracetamol Tab 500 mg Tablet 890 0 890 146 744
336 Pehakain Injeksi Ampul 0 0 0 0 0
337 Pehamoxil Forte (amoxycillin) Tablet 7 0 7 0 7
338 Pehavral Tablet 0 0 0 0 0
339 Pembalut Gips Buah 0 0 0 0 0
340 Permanganas kalikus Botol 0 0 0 0 0
341 Pethidin Injeksi Flakon 72 0 72 0 72
342 Pewarna Ziehls Nels Set 0 0 0 0 0
343 Phenol Glycerol Botol 10 0 10 0 10
344 Pilokarpin Tetes Mata 2 % Botol 4 0 4 0 4
345 Piracetam 400 mg Tablet 0 0 0 0 0
346 Piracetam Inj Ampul 0 0 0 0 0
347 Pirantel Tab 125 mg Tablet 46 0 46 0 46
348 Pirazinamide 500 mg Tablet 8,600 0 8,600 0 8,600
349 Piridoxyn (vit B6) Tab 10 mg Tablet 440 0 440 10 430
350 Piroxicam 20 mg Kap Tablet 200 0 200 150 50
351 Pisau Bedah Buah 0 0 0 0 0
352 Pitogin Injeksi Ampul 1,800 0 1,800 0 1,800
353 Plano Test Box 35 0 35 0 35
354 Plesterin Box 40 0 40 0 40
355 Plester 5 Yard x Inci Rol 5 0 5 0 5
356 Plester 7 Yard x 2 Inci Rol 0 0 0 0 0
357 Poligyp Buah 5 0 5 0 5
358 Pot Sputum Pot 0 0 0 0 0
359 Povidon Iodida 10% - 30 ml Botol 150 0 150 0 150
360 Povidon Iodida 10% - 300 ml Botol 0 0 0 0 0
361 Povidon Iodida 60 ml Botol 80 0 80 0 80
362 Povidone 1 Liter Botol 1,200 0 1,200 0 1,200
363 Prednison Tablet 5 mg Tablet 762 0 762 22 740
364 Primakuin 15 mg Tablet Tablet 0 0 0 0 0
365 Promavit Kapsul 302 0 302 10 292
366 Propanolol HCL Tab 10 mg Tablet 250 0 250 0 250
367 Propanolol HCL Tab 40 mg Tablet 0 0 0 0 0
368 Propiltiuracil Tab 100 mg Tablet 520 0 520 20 500
369 Ramipril Tablet 160 0 160 0 160
370 Ranitidin Injeksi 25 mg - 2 ml Ampul 182 0 182 1 181
371 Ranitidin Tablet 150 mg Tablet 4,990 0 4,990 88 4,902
372 RDT DBD / Rigt SIgn Sachet 0 0 0 0 0
373 RDT Malaria Set 0 0 0 0 0
374 Reco Drops Botol 0 0 0 0 0
375 Recodryl Injeksi Vial 0 0 0 0 0
376 Recovit Sirup Botol 0 0 0 0 0
377 Rees Eker Buah 0 0 0 0 0
378 Renovit Tablet 0 0 0 0 0
379 Reserpin Tab 0,10 mg Tablet 0 0 0 0 0
380 Reserpin Tab 0,25 mg Tablet 0 0 0 0 0
381 Resperidone Tablet 0 0 0 0 0
382 Rifampisin Tab 450 mg Tablet 280 0 280 0 280
383 Rifampisin Tab 600 mg Tablet 6,800 0 6,800 0 6,800
384 Ringer Laktat Lar Infus Steril Botol 100 0 100 0 100
385 Salbutamol 2 mg Tablet Tablet 0 0 0 0 0
386 Salbutamol 4 mg Tablet Tablet 2,017 0 2,017 52 1,965
387 Salep 2 - 4 Pot 88 0 88 0 88
388 Salicyl Talk Dos 146 0 146 0 146
389 Saltrim Tablet Tablet 0 0 0 0 0
390 Selediar Tablet 0 0 0 0 0
391 Seles B13 Tablet 0 0 0 0 0
392 Seles B6 10 mg Tablet 2,000 0 2,000 0 2,000
393 Seles C 50 mg Tablet 0 0 0 0 0
394 Selesbion Kaplet Kapsul 0 0 0 0 0
395 Selesbion Plus Cal Tablet 0 0 0 0 0
396 Selesgin 500 mg Tablet 900 0 900 0 900
397 Selesnizol 500 mg Tablet 1,300 0 1,300 0 1,300
398 Selkom C kaplet 2,000 0 2,000 0 2,000
399 Selviplex Kaplet 0 0 0 0 0
400 Seven Seas Botol 143 0 143 1 142
401 SGOT Kit 90 0 90 0 90
402 SGPT Kit 1,230 0 1,230 0 1,230
403 Siadidril Ampul 0 0 0 0 0
404 Sianokobalamin Inj 500 mg Ampul 91 0 91 0 91
405 Sianokobalamin Tab 50 mg Tablet 2,000 0 2,000 0 2,000
406 Silk Black 4/0 100 m Buah 0 0 0 0 0
407 Silk Black No 2/0 Buah 0 0 0 0 0
408 Silk Black No 3/0 Buah 3 0 3 0 3
409 Simvastatin Tablet 10 mg Tablet 1,760 0 1,760 0 1,760
410 Simvastatin Tablet 20 mg Tablet 10 0 10 10 0
411 Skizone Tube 0 0 0 0 0
412 Slide TB Paru Box 6,000 0 6,000 0 6,000
413 Sohobion Injeksi Ampul 0 0 0 0 0
414 Soldextam Tablet 0 0 0 0 0
415 Sotatic Injeksi Ampul 900 0 900 0 900
416 Sotatic Tablet Tablet 320 0 320 0 320
417 Spasmolite Tablet 0 0 0 0 0
418 Spironolakton Tablet 40 0 40 0 40
419 Spritus Botol 2 0 2 0 2
420 Stelosi Tablet 5 0 5 0 5
421 Stesolid Suppo Supp 0 0 0 0 0
422 Stesolid (Diazepam injeksi) Ampul 0 0 0 0 0
423 Stik Asam Urat Stik 100 0 100 0 100
424 Stik Gula Darah Stik 100 0 100 0 100
425 Stik Hb Family Dr Stik 250 0 250 0 250
426 Stik Kolesterol Stik 170 0 170 0 170
427 Sulfadoxine Pyrimetamine Tablet 0 0 0 0 0
428 Tablet Tambah Darah Tablet 1,340 0 1,340 0 1,340
429 Teramycin Injeksi Ampul 0 0 0 0 0
430 Termorex Drop Botol 0 0 0 0 0
431 Tetracyclin HCL Kap 250 mg Tablet 0 0 0 0 0
432 Tetracyclin HCL Kap 500 mg Tablet 3,250 0 3,250 0 3,250
433 Tetrakain HCL Tetes Mata 0,5 % Botol 1,000 0 1,000 0 1,000
434 Thiamin HCL Injeksi Ampul 909 0 909 2 907
435 Thiamin HCL Tab 50 mg Tablet 3,740 0 3,740 0 3,740
436 Tiopental Injeksi 100 mg Tablet 10 0 10 0 10
437 Tramadol Tab 50 mg Tablet 0 0 0 0 0
438 Traneksid Ampul 0 0 0 0 0
439 Transamin 250 mg/ml Ampul 14,000 0 14,000 0 14,000
440 Transamin 500 mg Injeksi Tablet 0 0 0 0 0
441 Trifacort 5 mg Tablet 0 0 0 0 0
442 Trifaneuron Tablet 0 0 0 0 0
443 Triheksiphenidil HCL Tab 2 mg Tablet 0 0 0 0 0
444 Trisulfa 500 mg Tablet 0 0 0 0 0
445 Truvit Botol 76 0 76 3 73
446 Ulsikur Injeksi Ampul 10 0 10 0 10
447 Uric Acid Buah 40 0 40 0 40
448 Urine Bag Buah 0 0 0 0 0
449 Vaksin Verorab Paket 0 0 0 0 0
450 Vastigo 6 mg Tablet 0 0 0 0 0
451 Ventolin Nebules 2,5 mg Ampul 0 0 0 0 0
452 Verban 5 ml Rol 15 0 15 0 15
453 Vicillin Injeksi Ampul 20 0 20 0 20
454 Vitamin A Kapsul Biru Botol 0 0 0 0 0
455 Vitamin A Kapsul Merah Botol 13,600 0 13,600 0 13,600
456 Vitamin B Kompleks Injeksi Vial 80 0 80 0 80
457 Vitamin B Kompleks Tab Tablet 4,905 0 4,905 0 4,905
458 Vitamin C 50 Mg Tablet 6,802 0 6,802 67 6,735
459 Vitomerga Tablet 0 0 0 0 0
460 Widal Kit 0 0 0 0 0
461 Wing Needle No. 29 Pcs 0 0 0 0 0
462 Wing Needle No. 31 Pcs 106 0 106 0 106
463 Wing Needle No. 33 Pcs 0 0 0 0 0
464 Wing Needle No. 35 Pcs 2,600 0 2,600 0 2,600
465 Xlestesin Buah 150 0 150 0 150
466 Zink 20 mg Tablet 970 0 970 0 970
467 Zink Sirup Botol 90 0 90 0 90

JAMKESDA UMUM BPJS

JUMLAH KUNJUNGAN RESEP

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang Men

Kepala Seksi Kefarmasian Penanggung Jawab
Gudang Farmasi

Sahrul, SKM Jesry Massorah. S.Farm., Apt Nurafni M.Towanda,SKM Fitriani Damarull
Nip. 19820714 200502 1 003 Nip. 19820403 200804 2 003 Nip. 19810820 200502 2 007 Nip. 19901204 2
PO)

: JANUARI 2019
: FEBRUARI 2019

emberian
Lain- Jumlah KET
lain
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ani Damarullah, A.Md.Keb

. 19901204 201704 2 007