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PUSKESMAS MUARA TIGA

Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

1 Air Raksa dental use 100 gram

2 Abocath No. 20 pcs 10 120

3 Abocath No. 22 pcs 50 600

4 Abocath No. 24 pcs 5 60

5 Acyclovir 200 mg ktk 10x10 tablet 245 200 1200 294000

6 Acyclovir 400 mg ktk 10x10 tablet 354 200 1200 424800

7 Asiklovir krim 5% Tube 5 gr 50 300 15000

8 Alat suntik sekali pakai 1 ml 100 pcs

9 Alat suntik sekali pakai 2.5 ml 100 pcs 100 1200

10 Alat suntik sekali pakai 5 ml 100 pcs

Box,10 Strip @ Dus 30


11 Alopurinol tablet 100 mg 90 500 6000 540000
Ampul

12 Aminofilin injeksi 24 mg / ml - 10 ml 30 ampul 4.204

13 Aminofilin tablet 200 mg Botol @ 100 Tablet 86 20 240 20640

14 Amitriptilin HCL tablet salut 25 mg Dus,10 Strip @ 10 tts 123 20 240 29520

15 Amoksisilin kaplet 500 mg kotak @ 10x10 Tab 279 7000 8400 2343600

16 Amoksisilin sirup kering 125 mg/5 ml Botol @ 60 ml 2.56 400 4800 12288

17 Amoksisilin sirup kering Forte 250 mg/5 m Dus,Botol 60 ml 4.73 100 1200 5676

18 Amlodipin 5 mg. ktk 30 tab.

19 Antalgin (Metampiron) tablet 500 mg 1000 tablet 2000 24000

20 Antasida DOEN tablet Dus,10 Strip @ 10 Tabler 78 3000 36000 2808000

21 Antasida DOEN sirup Botol 60 ml 2.3 100 1200 2760

22 Anti bakteri DOEN salap Basitrasin Dus 25 tube @ 5 g 2.767 50 600 1660.2

23 Anti hemoroid DOEN kombinasi Kotak 10 x10 Tablet 570 5 60 34200

24 Antifungi DOEN kombinasi : 3 - 6 24 pot @ 30 g 5 60

25 Antimigren DOEN kombinasi (Ergotamin) Botol 100 tablet 149 20 240 35760

26 Asam askorbat (vit.C) tablet 50 mg Dus 10 Strip x 10 Tab 105 5000 60000 6300000

27 Asam Mefenamat tablet 500 mg Strip 127 3000 36000 4572000


Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

28 Attapulgit tablet ( Puralex ) 50 tab/ktk

29 Betametson krim 0,1% tube @5 g 1.558 75 900 1402.2

30 Bisakodil Supp. ( Stolax ) 6 supp

31 Captopril 12.5 mg. Dus,10 Strip @ 10 Tablet 69 1000 12000 828000

32 Captopril 25 mg Dus@ 10x10's 97 1000 12000 1164000

33 Cat gut/benang bedah No. 2/0 - 3/0 24 x 70 cm

34 Cetrizin tab 50 tab/ktk

35 Deksametason injeksi 5 mg/ml - 1 ml Dus,100 Ampul @ 1 ml 1.738 30 360 625.68

36 Deksametason tablet 0,5 mg Strip 68 5000 60000 4080000

37 Diazepam injeksi 5 mg/ml - 2 ml 30 ampul 5 60

38 Diazepam tablet 2 mg 1000 tablet 100 1200

39 Diazepam tablet 5 mg 250 tablet

40 Difenhidramin HCL injeksi 10 mg/ml - 1 ml ampul @1 ml 1.160 60 720 835.2

41 Digoksin tablet 0,25 mg. Box 10x10 Tab 103 20 240 24720

42 Domperidon tablet 10 mg. Strip 174 1000 12000 2088000

43 Ekstrak Belladona tab 10 mg 1000/btl 300 3600

44 Eritromisin kapsul 500mg Dus,10 blister @ 10 kss 1.023 2000 24000 24552

45 Eritromisin sirup 200mg/5ml Botol @ 60 ml 8.09 30 360 2912.4

46 Etakridin (Rivanol) larutan 0,1% 300 ml

47 Etanol 70% 1000 ml

48 Etanol 70% Botol 100 ml 2625 3 36 94500

49 Etil klorida semprot 100 ml 1 12

50 Eugenol cairan Botol 10 ml 18333 1 12 219996

51 Fenol gliserol tts telinga 10% ktk 24 btl @ 5 ml.

52 Fenitoin natrium kapsul 100 mg Botol @ 100 146 30 360 52560

53 Fenobarbital tablet 30 mg 1000 tablet

54 Fitomenadion (vit.K1) tab. salut gula 10 mBotol @ 100 Tablet Salut gula 698 30 360 251280

55 Fitomenadion (vit.K1) Injeksi Ampul

56 Furosemid tablet 40 mg Dus,10 strip @ 10 Tablet 84 20 240 20160


Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

57 Furosemide Inj. 10 mg/ml. Dus,25 Ampul @ 2 ml 2012

58 Gameksan emulsi 1% btl 30 ml.

59 Garam oralit untuk 200 ml air Dus @ 100 Sachet 317 50 600 190200

60 Gentamisin Sulfat salep kulit 0,1 % tube

61 Gentamisin Sulfat tetes mata 0,3% Dus, botol plastik 5 ml 3513 25 300 1053900

62 Gentian Violet larutan 1% 10 ml 50 600

63 Glass lonomer cement (GC IX) Set

64 Glimepirid 100 tab/ktk

65 Glibenklamid tablet 5 mg Dus, 10 Blister 10 kaptab 61 150 1800 109800

66 Gliseril Guayakolat 100 mg 4 bks @250 tab

67 Glukosa larutan infus 5% steril 500 ml 5720 15 180 1029600

68 Glukosa 10% btl 500 ml. 6270

69 Glukosa larutan infus 40% steril amp 25 ml.

70 Griseofulvin tablet 125 mg, Micronized Dus 10 blister @ 10 Tablet 241 500 6000 1446000

71 Haloperidol tablet 0,5 mg Dus 10 blister @ 10 Tablet 62 400 4800 297600

72 Haloperidol tablet 1,5 mg Dus 10 blister @ 10 Tablet 76 500 6000 456000

73 Handscoon 50 pcs/ktk 10 144

74 Haloperidol tablet 5 mg Dus 10 blister @ 10 Tablet 105 200 2400 252000

75 Hidrokortoson krim 2,5 % 24 tube @5 g 2868 72 864 2477952

76 Hodroklorotiazid (HCT) tablet 25 mg 1000 tablet 100 1200

77 Ibuprofen tablet 200 mg 100 tablet 121 1000 12000 1452000

78 Ibuprofen tablet 400 mg Strip 100 tablet 157 500 6000 942000

79 Ibuprofen susp. 60 ml. btl 60 ml. 3849 100 1200 4618800

80 Infusion set anak Set 5 60

81 Infusion set dewasa Set 30 360

82 Isosorbit Dinitrat tablet Sublingual 5 ml Dus 10 blister @ 10 Tablet 98 100 1200 117600

83 Kalsium Hidroksida pasta 2 tube

84 Kalsium laktat (Kalk) tablet 500 mg 1000 tablet 1000 12000

85 Karbamazepin tablet 200 mg Dus 10 blister @ 10 Tablet 269 100 1200 322800
Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

86 Kapas pembalut/Absorben 250 gram Bungkus 3 36

87 Kasa kompres 16/16 steril Bungkus 50 600

88 Kasa pembalut Hidrofil 4 m x 10 cm Rol 50 600

89 Ketokonazol krim 2% Tube 10 gr 2633 15 180 473940

90 Ketokonazol tablet 200 mg. strip 320 100 1200 384000

91 Ketorolac Inj 10mg/ml ktk 5 amp

92 Kloramfinekol kapsul 250 mg 120 Kaplet 1000 12000

93 Kloramfinekol salap mata 1% tube 5 gr. 24 288

94 Kloramfinekol tetes telinga 3% btl 5 ml. 24 288

95 Kloramfenikol susp. 125 mg/ml btl 60 ml.

96 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 tablet 10000 120000

97 Klorfenol Kanfer Mentol (CHKM) 10 ml

98 Klorokuin tablet 150 mg 1000 tablet 20 240

99 Klorpromazin HCL tablet salut 100 mg 250 tablet 1000 12000

100 Klorpromazin HCL tablet salut 25 mg 1000 tablet

101 Kodein 10 mg 100 tablet

102 Kotrimaksazol suspensi 60 ml 100 1200

103 Kotrimaksazol tablet 480 mg dus 10 strip @ 10 tablet 152 1000 1200 182400

104 Kotrimaksazol tablet pediatrik 120 mg 100 tablet

105 Kuinin (Kina) tablet 200 mg 60 tablet

106 Lansoprazol 30 mg. kaps. Dus 2 strip @ 10 Capsul 521 500 6000 3126000

107 Lidokain HCL inj. 2% Dus 100 Amp@ 2 ml 929 30 360 334440

108 Loperamide ktk 100 tab

109 Loratadin tablet 10 mg. Strip 170

110 Masker 20 pcs/ktk 10 120

111 Mebendazol tablet 100 mg ktk 5 x 6 tab. 7854 10 120 942480

112 Meloksikam 7,5 mg Dus 25 Catch @ 1 tab 2000 2400

113 Metformin 500 mg Dus 10 blister @ 10 Tablet 125 100 1200 150000

114 Metilergometrin maleat tab. salut 0,125 ktk 10 x 10 tab.


Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

115 Metilergometrin maleat inj. 0,200 mg - 1 30 ampul.

116 Metoklopramid tablet 10 mg. 100 tab.

117 Metronidazol tablet 250 mg 10 Strip@10 tab 116 200 2400 278400

118 Mikonazol krim / salap 2% nitrat tube 10 gram 3075 50 600 1845000

119 Mummifying pasta botol

120 Natrium bikarbonat tablet 500 mg 1000 tablet

121 Natrium Diklofenac 50 mg kotak 5x10 tablet 216 300 3600 777600

122 Natrium klorida larutan infus 0,9% steril 500 ml

dus,10 strip@10 tab salut


123 Nifedipin 110 30 360 39600
selaput

124 Nistatin tablet salut 500.000 IU Dus @ 10x10s 704

125 Nistatin tablet salut 100.000 IU ktk 10x10 tablet

126 Obat Batuk Hitam (O.B.H) cairan 100 ml 30 360

127 Oksitetrasiklin HCL inj. I.m 50 mg/ml - 10 10 vial 2 24

128 Oksitetrasiklin HCL salap mata 1% tube 3,5 gr.

129 Oksitetrasiklin HCL salap 3% tube 5 g 100 1200

130 Omeprazol 20 mg. kaps. Dus 10 x3,5 221 300 3600 795600

131 Parasetamol sirup 120 mg/5 ml Botol @ 60 ml 1535 200 2400 3684000

132 Parasetamol tablet 100 mg. 100 tab 2000 24000

133 Parasetamol tablet 500 mg strip 88 10000 120000 10560000

134 Pirantel tablet 125 mg dus,25 blister @ 4 tablet 318 50 600 190800

135 Piridoksin HCL(Vit.B6) tablet 10 mg 1000 tablet 1000 12000

136 Pirocicam 20 mg 120 kaplet 1000 12000

137 Plester 5 yards x 2 inch rol 3 36

138 Povidon lodida 10% botol @ 30 ml 2344 5 60 140640

139 Prednison tablet 5 mg 1000 tablet 5000 60000

140 Primakuin tablet 15 mg 1000 tablet

141 Propiltiorasil (PTU) tab 1000 tablet 100 1200

142 Propranolol HCL tablet 40 mg dus 10 strip @ 10 tablet 114 100 1200 136800

143 Ranitidin tab 150 mg Dus, 10 ampul @2 ml 132 2000 24000 3168000
Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

144 Ranitidin Inj. 25 mg/ml. 10 tablet salut selaput 1340 5 60 80400

145 Ringer laktat larutan infus steril botol 500 ml 5720 80 960 5491200

146 Salap 2 - 4, kombinasi : 24 pot @30 g 2200 5 60 132000

147 Salbutamol tablet 2 mg ktk 10x10 tablet 91 1000 12000 1092000

148 Salisil bedak 2% dus @ 50 gr 1350 30 360 486000

149 Sefadroksil kapsul 500 mg. dus,10 strip @ 10 kapsul 548 200 2400 1315200

150 Serum Anti Bisa Ular (ABU I) Inj. ktk 10 vial

151 Serum Anti tetanus Inj.1.500 IU (ATS) ktk 10 amp.

152 Serum Anti tetanus Inj. 20.000 IU (ATS) vial

153 Sianokobalamin (Vit.B12) inj. 500 mcg/ml- 100 Ampul 30 360

154 Silk (Benang bedang Sutera) No. 3/0 100 ampul 5 60

155 Simetidin tablet 200 mg. 100 tab. 1000 12000

156 Simvastatin tablet 10 mg. dus, 3 strip @ 10 kaplet salut selaput 177 60 720 127440

157 Siprofloksasin tablet 500 mg dus,10 blister 10 tab ss 290 200 2400 696000

158 Sulfasetamida Natrium tetes mata 15% ktk 24 btl @ 5 ml. 24 288

159 Tablet Tambah Darah besi II sulfat 1000 tablet 1000 12000

160 Temporary Stopping Fletcher (Fletcher) set/ 100 g

161 Tetrasiklin HCL kapsul 250 mg dus, 10 strip @ 10 kapsul 162 1000 12000 1944000

162 Tetrasiklin HCL kapsul 500 mg 100 tablet 1500 18000

163 Tiamfenikol kapsul 500 mg. 100 kaps. 2000 24000

164 Tiamin HCL (vit.B1) injeksi 100 mg/ml - 1 30 ampul 60 720

165 Tiamin HCL/Mononitrat (vit.B1) tablet 50 1000 tablet 5000 60000

166 Tramadol kapsul 50 mg. 50 kaps. 1000 12000

167 Triheksifenidil Hidroklorida tablet 2 mg ktk 10 x 10 tab. 1000 12000

168 Urine bag pcs

169 Vitamin B Komplek tablet 100 tablet/ktk 5000 60000

170 Vitamin Sirup 60 ml 50 600

171 Zink tablet 20 mg. 100 tab. 30 360

172 Zink Sirup ( Zircum Kid) 60 ml 2 24


Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

JUMLAH TOTAL HARGA 80,490,672

Yang Melaporkan, Mengetahui,


Pengelola Obat Ka Puskesmas Muara Tiga

Kartini dr.H.T.Yusrizal
Nip.19671228 199703 2 001 Nip.19701030 200112 1 001
LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT (LPLPO) PUSTU
T A H U N …………
PUSKESMAS PEMBANTU :
KECAMATAN/PUSKESMAS : PELAPORAN PERIODE :
KABUPATEN : PIDIE PERMINTAAN PERIODE :
PROVINSI : ACEH

Presediaan Jumlah
NO Nama Obat Kemasan Awal
Penerimaan
Persediaan
Pemakaian Sisa Stock Permintaan Pemberian KET

1 2 3 4 5 6 7 8 9 10 11
1 Aminofilin tablet 200 mg ktk 10x10 tablet

2 Amoksisilin kaplet 500 mg 100 kaplet

3 Amoksisilin sirup kering 125 mg/5 ml 60 ml

4 Antalgin (Metampiron) tablet 500 mg 1000 tablet

5 Antasida DOEN tablet 1000 tablet

6 Anti bakteri DOEN salap Basitrasin 25 tube @ 5 g

7 Antifungi DOEN kombinasi : 3 - 6 24 pot @ 30 g

8 Asam askorbat (vit.C) tablet 50 mg 1000 tablet

9 Captopril 12,5 mg 100 tab

10 Deksametason tablet 0,5 mg 1000 tablet

11 Diaform 1000 tablet

12 Efedrin HCL tablet 25 mg 1000 tablet

13 Exkstrak Belladona tablet ktk 10 x 10 tab.

14 Etakridin (Rivanol) larutan 0,1% 300 ml

15 Etanol 70% 1000 ml

16 Fenol Gliserol tetes telinga 100 ml

17 Fitomenadion (vit.K1) tab. salut gula 10 m 100 tablet

18 Furosemid tablet 40 mg 250 tablet

19 Garam oralit untuk 200 ml air 100 kantong

20 Gentian Violet larutan 1% 10 ml

21 Glibenklamid tablet 5 mg 100 tablet

22 Gliseril Guayakolat 100 mg 4 bks @250 tab

23 Griseofulvin tablet 125 mg, Micronized 100 tablet

24 Hidrokortoson krim 2,5 % 24 tube @5 g

25 Hodroklorotiazid (HCT) tablet 25 mg 1000 tablet

26 Ibuprofen tablet 200 mg 100 tablet

27 Kalsium laktat (Kalk) tablet 500 mg 1000 tablet

28 Kapas pembalut/Absorben 250 gram Bungkus

29 Kasa kompres 16/16 steril Bungkus

30 Kasa pembalut Hidrofil 4 m x 15 cm Rol

31 Kloramfinekol kapsul 250 mg 120 Kaplet

32 Kloramfinekol tetes telinga 3% btl 5 ml.

33 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 tablet

34 Klorokuin 1000 tablet

35 Kotrimaksazol suspensi 60 ml

36 Kotrimaksazol tablet 480 mg 100 tablet

37 Kotrimaksazol tablet pediatrik 120 mg 100 tablet

38 Lidokain HCL inj. 2% ktk 100 amp.

39 Metilergometrin maleat tab. salut 0,125 m ktk 10 x 10 tab.

40 Metronidazol tablet 250 mg Box 100 tab

41 Natrium bikarbonat tablet 500 mg 1000 tablet

42 Obat Batuk Hitam (O.B.H) cairan 100 ml

43 OBP ( Obat Batuk Putih ) 100 ml

44 Oksitetrasiklin HCL salap 3% tube 5 g

45 Omeprazol 20 mg. kaps. 3 x 10 kps

46 Parasetamol tablet 100 mg 100 tablet

47 Parasetamol sirup 120 mg/5 ml btl 60 ml.

48 Parasetamol tablet 500 mg 100 tablet


Presediaan Jumlah
NO Nama Obat Kemasan Awal
Penerimaan
Persediaan
Pemakaian Sisa Stock Permintaan Pemberian KET

1 2 3 4 5 6 7 8 9 10 11
49 Pirantel tablet 125 mg 60 tablet

50 Piridoksin HCL(Vit.B6) tablet 10 mg 1000 tablet

51 Plester 5 yards x 2 inch rol

52 Povidon lodida 10% 30 ml

53 Prednison tablet 5 mg 1000 tablet

54 Propanolol tablet 100 tablet

55 Primakuin 1000 tablet

56 Ringer laktat larutan infus steril 500 ml

57 Salap 2 - 4, kombinasi : 24 pot @30 g

58 Salisil bedak 2% 50 gr

59 Sulfasetamida Natrium tetes mata 15% ktk 24 btl @ 5 ml.

60 Tetrasiklin HCL kapsul 500 mg 100 tablet

61 Tiamin HCL/Mononitrat (vit.B1) tablet 50 1000 tablet

62 Vitamin B Komplek tablet btl 1000 tab.

MENGETAHUI Yang menyerahkan ……………………., ………………….2013

KEPALA PUSKESMAS …………………. Pengelola Obat puskesmas…………. Kepala Pustu …………………………

……………………………………………….. ………………………………………… ……………………………………………….

NIP. NIP. NIP


PUSKESMAS MUARA TIGA
Pemakaian
NO Nama Obat Kemasan Harga Satuan
Perbulan
Total Kebutuhan Jumlah Harga

1 2 3 4 5 6 7

1 Air Raksa dental use 100 gram

2 Abocath No. 20 pcs 10 60

3 Abocath No. 22 pcs 50 300

4 Abocath No. 24 pcs 5 30

5 Acyclovir 200 mg ktk 10x10 tablet 245 200 1200 294000

6 Acyclovir 400 mg ktk 10x10 tablet 354 200 1200 424800

7 Asiklovir krim 5% Tube 5 gr 50 300 15000

8 Alat suntik sekali pakai 1 ml 100 pcs 360

9 Alat suntik sekali pakai 2.5 ml 100 pcs 100 600

10 Alat suntik sekali pakai 5 ml 100 pcs

Box,10 Strip @ Dus 30


11 Alopurinol tablet 100 mg 90 500 3000 270000
Ampul

12 Aminofilin injeksi 24 mg / ml - 10 ml 30 ampul 4.204

13 Aminofilin tablet 200 mg Botol @ 100 Tablet 86 20 120 10320

14 Amitriptilin HCL tablet salut 25 mg Dus,10 Strip @ 10 tts 123 20 120 14760

15 Amoksisilin kaplet 500 mg kotak @ 10x10 Tab 279 7000 42000 11718000

16 Amoksisilin sirup kering 125 mg/5 ml Botol @ 60 ml 2.56 400 2400 6144

17 Amoksisilin sirup kering Forte 250 mg/5 m Dus,Botol 60 ml 4.73 bn 600 2838

18 Amlodipin 5 mg. ktk 30 tab.

19 Antalgin (Metampiron) tablet 500 mg 1000 tablet 2000 12000

20 Antasida DOEN tablet Dus,10 Strip @ 10 Tabler 78 3000 18000 1404000

21 Antasida DOEN sirup Botol 60 ml 2.3 100 600 1380

22 Anti bakteri DOEN salap Basitrasin Dus 25 tube @ 5 g 2.767 50 300 830.1

23 Anti hemoroid DOEN kombinasi Kotak 10 x10 Tablet 570 5 30 17100

24 Antifungi DOEN kombinasi : 3 - 6 24 pot @ 30 g 5 30

25 Antimigren DOEN kombinasi (Ergotamin) Botol 100 tablet 149 20 120 17880

26 Asam askorbat (vit.C) tablet 50 mg Dus 10 Strip x 10 Tab 105 5000 30000 3150000

27 Asam Mefenamat tablet 500 mg Strip 127 3000 18000 2286000

28 Attapulgit tablet ( Puralex ) 50 tab/ktk

29 Betametson krim 0,1% tube @5 g 1.558 75 450 701.1

30 Bisakodil Supp. ( Stolax ) 6 supp

31 Captopril 12.5 mg. Dus,10 Strip @ 10 Tablet 69 1000 6000 414000

32 Captopril 25 mg Dus@ 10x10's 97 1000 6000 582000


33 Cat gut/benang bedah No. 2/0 - 3/0 24 x 70 cm

34 Cetrizin tab 50 tab/ktk

35 Deksametason injeksi 5 mg/ml - 1 ml Dus,100 Ampul @ 1 ml 1.738 30 180 312.84

36 Deksametason tablet 0,5 mg Strip 68 5000 30000 2040000

37 Diazepam injeksi 5 mg/ml - 2 ml 30 ampul 5 30

38 Diazepam tablet 2 mg 1000 tablet 100 600

39 Diazepam tablet 5 mg 250 tablet

40 Difenhidramin HCL injeksi 10 mg/ml - 1 ml ampul @1 ml 1.160 60 360 417.6

41 Digoksin tablet 0,25 mg. Box 10x10 Tab 103 20 120 12360

42 Domperidon tablet 10 mg. Strip 174 1000 6000 1044000

43 Ekstrak Belladona tab 10 mg 1000/btl 300 1800

44 Eritromisin kapsul 500mg Dus,10 blister @ 10 kss 1.023 2000 12000 12276

45 Eritromisin sirup 200mg/5ml Botol @ 60 ml 8.09 30 180 1456.2

46 Etakridin (Rivanol) larutan 0,1% 300 ml

47 Etanol 70% 1000 ml

48 Etanol 70% Botol 100 ml 2625 3 18 47250

49 Etil klorida semprot 100 ml 1 6

50 Eugenol cairan Botol 10 ml 18333 1 6 109998

51 Fenol gliserol tts telinga 10% ktk 24 btl @ 5 ml.

52 Fenitoin natrium kapsul 100 mg Botol @ 100 146 30 180 26280

53 Fenobarbital tablet 30 mg 1000 tablet

54 Fitomenadion (vit.K1) tab. salut gula 10 mBotol @ 100 Tablet Salut gula 698 30 180 125640

55 Fitomenadion (vit.K1) Injeksi Ampul

56 Furosemid tablet 40 mg Dus,10 strip @ 10 Tablet 84 20 120 10080

57 Furosemide Inj. 10 mg/ml. Dus,25 Ampul @ 2 ml 2012

58 Gameksan emulsi 1% btl 30 ml.

59 Garam oralit untuk 200 ml air Dus @ 100 Sachet 317 50 300 95100

60 Gentamisin Sulfat salep kulit 0,1 % tube

61 Gentamisin Sulfat tetes mata 0,3% Dus, botol plastik 5 ml 3513 25 150 526950

62 Gentian Violet larutan 1% 10 ml 50 300

63 Glass lonomer cement (GC IX) Set

64 Glimepirid 100 tab/ktk

65 Glibenklamid tablet 5 mg Dus, 10 Blister 10 kaptab 61 150 900 54900

66 Gliseril Guayakolat 100 mg 4 bks @250 tab

67 Glukosa larutan infus 5% steril 500 ml 5720 15 90 514800


68 Glukosa 10% btl 500 ml. 6270

69 Glukosa larutan infus 40% steril amp 25 ml.

70 Griseofulvin tablet 125 mg, Micronized Dus 10 blister @ 10 Tablet 241 500 3000 723000

71 Haloperidol tablet 0,5 mg Dus 10 blister @ 10 Tablet 62 400 2400 148800

72 Haloperidol tablet 1,5 mg Dus 10 blister @ 10 Tablet 76 500 3000 228000

73 Handscoon 50 pcs/ktk 10 60

74 Haloperidol tablet 5 mg Dus 10 blister @ 10 Tablet 105 200 1200 126000

75 Hidrokortoson krim 2,5 % 24 tube @5 g 2868 72 432 1238976

76 Hodroklorotiazid (HCT) tablet 25 mg 1000 tablet 100 600

77 Ibuprofen tablet 200 mg 100 tablet 121 1000 6000 726000

78 Ibuprofen tablet 400 mg Strip 100 tablet 157 500 3000 471000

79 Ibuprofen susp. 60 ml. btl 60 ml. 3849 100 600 2309400

80 Infusion set anak Set 5 30

81 Infusion set dewasa Set 30 180

82 Isosorbit Dinitrat tablet Sublingual 5 ml Dus 10 blister @ 10 Tablet 98 100 600 58800

83 Kalsium Hidroksida pasta 2 tube

84 Kalsium laktat (Kalk) tablet 500 mg 1000 tablet 1000 6000

85 Karbamazepin tablet 200 mg Dus 10 blister @ 10 Tablet 269 100 600 161400

86 Kapas pembalut/Absorben 250 gram Bungkus 3 18

87 Kasa kompres 16/16 steril Bungkus 50 300

88 Kasa pembalut Hidrofil 4 m x 10 cm Rol 50 300

89 Ketokonazol krim 2% Tube 10 gr 2633 15 90 236970

90 Ketokonazol tablet 200 mg. strip 320 100 600 192000

91 Ketorolac Inj 10mg/ml ktk 5 amp

92 Kloramfinekol kapsul 250 mg 120 Kaplet 1000 6000

93 Kloramfinekol salap mata 1% tube 5 gr. 24 144

94 Kloramfinekol tetes telinga 3% btl 5 ml. 24 144

95 Kloramfenikol susp. 125 mg/ml btl 60 ml.

96 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 tablet 10000 60000

97 Klorfenol Kanfer Mentol (CHKM) 10 ml

98 Klorokuin tablet 150 mg 1000 tablet 20 120

99 Klorpromazin HCL tablet salut 100 mg 250 tablet 1000 6000

100 Klorpromazin HCL tablet salut 25 mg 1000 tablet

101 Kodein 10 mg 100 tablet

102 Kotrimaksazol suspensi 60 ml 100 600


103 Kotrimaksazol tablet 480 mg dus 10 strip @ 10 tablet 152 1000 6000 912000

104 Kotrimaksazol tablet pediatrik 120 mg 100 tablet

105 Kuinin (Kina) tablet 200 mg 60 tablet

106 Lansoprazol 30 mg. kaps. Dus 2 strip @ 10 Capsul 521 500 3000 1563000

107 Lidokain HCL inj. 2% Dus 100 Amp@ 2 ml 929 30 180 167220

108 Loperamide ktk 100 tab

109 Loratadin tablet 10 mg. Strip 170

110 Masker 20 pcs/ktk 10 60

111 Mebendazol tablet 100 mg ktk 5 x 6 tab. 7854 10 60 471240

112 Meloksikam 7,5 mg Dus 25 Catch @ 1 tab 2000 12000

113 Metformin 500 mg Dus 10 blister @ 10 Tablet 125 100 600 75000

114 Metilergometrin maleat tab. salut 0,125 ktk 10 x 10 tab.

115 Metilergometrin maleat inj. 0,200 mg - 1 30 ampul.

116 Metoklopramid tablet 10 mg. 100 tab.

117 Metronidazol tablet 250 mg 10 Strip@10 tab 116 200 1200 139200

118 Mikonazol krim / salap 2% nitrat tube 10 gram 3075 50 300 922500

119 Mummifying pasta botol

120 Natrium bikarbonat tablet 500 mg 1000 tablet

121 Natrium Diklofenac 50 mg kotak 5x10 tablet 216 300 1800 388800

122 Natrium klorida larutan infus 0,9% steril 500 ml

dus,10 strip@10 tab salut


123 Nifedipin 110 30 180 19800
selaput

124 Nistatin tablet salut 500.000 IU Dus @ 10x10s 704

125 Nistatin tablet salut 100.000 IU ktk 10x10 tablet

126 Obat Batuk Hitam (O.B.H) cairan 100 ml 30 180

127 Oksitetrasiklin HCL inj. I.m 50 mg/ml - 10 10 vial 2 12

128 Oksitetrasiklin HCL salap mata 1% tube 3,5 gr.

129 Oksitetrasiklin HCL salap 3% tube 5 g 100 600

130 Omeprazol 20 mg. kaps. Dus 10 x3,5 221 300 1800 397800

131 Parasetamol sirup 120 mg/5 ml Botol @ 60 ml 1535 200 1200 1842000

132 Parasetamol tablet 100 mg. 100 tab 2000 12000

133 Parasetamol tablet 500 mg strip 88 10000 60000 5280000

134 Pirantel tablet 125 mg dus,25 blister @ 4 tablet 318 50 300 95400

135 Piridoksin HCL(Vit.B6) tablet 10 mg 1000 tablet 1000 6000

136 Pirocicam 20 mg 120 kaplet 1000 6000

137 Plester 5 yards x 2 inch rol 3 18

138 Povidon lodida 10% botol @ 30 ml 2344 5 30 70320


139 Prednison tablet 5 mg 1000 tablet 5000 30000

140 Primakuin tablet 15 mg 1000 tablet

141 Propiltiorasil (PTU) tab 1000 tablet 100 600

142 Propranolol HCL tablet 40 mg dus 10 strip @ 10 tablet 114 100 600 68400

143 Ranitidin tab 150 mg Dus, 10 ampul @2 ml 132 2000 12000 1584000

144 Ranitidin Inj. 25 mg/ml. 10 tablet salut selaput 1340 5 30 40200

145 Ringer laktat larutan infus steril botol 500 ml 5720 80 480 2745600

146 Salap 2 - 4, kombinasi : 24 pot @30 g 2200 5 30 66000

147 Salbutamol tablet 2 mg ktk 10x10 tablet 91 1000 6000 546000

148 Salisil bedak 2% dus @ 50 gr 1350 30 180 243000

149 Sefadroksil kapsul 500 mg. dus,10 strip @ 10 kapsul 548 200 1200 657600

150 Serum Anti Bisa Ular (ABU I) Inj. ktk 10 vial

151 Serum Anti tetanus Inj.1.500 IU (ATS) ktk 10 amp.

152 Serum Anti tetanus Inj. 20.000 IU (ATS) vial

153 Sianokobalamin (Vit.B12) inj. 500 mcg/ml- 100 Ampul 30 180

154 Silk (Benang bedang Sutera) No. 3/0 100 ampul 5 30

155 Simetidin tablet 200 mg. 100 tab. 1000 6000

156 Simvastatin tablet 10 mg. dus, 3 strip @ 10 kaplet salut selaput 177 60 360 63720

157 Siprofloksasin tablet 500 mg dus,10 blister 10 tab ss 290 200 1200 348000

158 Sulfasetamida Natrium tetes mata 15% ktk 24 btl @ 5 ml. 24 144

159 Tablet Tambah Darah besi II sulfat 1000 tablet 1000 6000

160 Temporary Stopping Fletcher (Fletcher) set/ 100 g

161 Tetrasiklin HCL kapsul 250 mg dus, 10 strip @ 10 kapsul 162 1000 6000 972000

162 Tetrasiklin HCL kapsul 500 mg 100 tablet 1500 9000

163 Tiamfenikol kapsul 500 mg. 100 kaps. 2000 12000

164 Tiamin HCL (vit.B1) injeksi 100 mg/ml - 1 30 ampul 60 360

165 Tiamin HCL/Mononitrat (vit.B1) tablet 50 1000 tablet 5000 30000

166 Tramadol kapsul 50 mg. 50 kaps. 1000 6000

167 Triheksifenidil Hidroklorida tablet 2 mg ktk 10 x 10 tab. 1000 6000

168 Urine bag pcs

169 Vitamin B Komplek tablet 100 tablet/ktk 5000 30000

170 Vitamin Sirup 60 ml 50 300

171 Zink tablet 20 mg. 100 tab. 30 180

172 Zink Sirup ( Zircum Kid) 60 ml 2 12

JUMLAH TOTAL HARGA 51,581,691


Yang Melaporkan, Mengetahui,
Pengelola Obat Ka Puskesmas Muara Tiga

Kartini dr.H.T.Yusrizal
Nip.19671228 199703 2 001 Nip.19701030 200112 1 001
294000

424800

15000

270000

10320

14760

11718000

6144
2838

1404000

1380

830.1

17100

17880

3150000

2286000

701.1

414000

582000

31284

2040000

417.6

12360

1044000

12276

1456.2

47250

109998

26280

125640

10080

95100

526950

54900

514800

723000

148800

228000

126000

1238976

726000

471000

2309400
58800

161400

236970

192000

912000

1563000

167220

471240

75000

139200

922500

388800

19800

397800

1842000

5280000

95400

70320

68400

1584000

40200

2745600

66000

546000

243000

657600

63720

348000

972000

51581691
Rencana Kebutuhan Obat
Puskesmas Muara Tiga

Pemakaian Total Kebutuhan 6


NO Nama Obat Kemasan Harga Satuan
Perbulan Bulan
Jumlah Harga

1 2 3 4 5 6 7

1 Acyclovir 200 mg ktk 10x10 tablet 245 200 1200 294000

2 Anti hemoroid DOEN kombinasi Kotak 10 x10 Tablet 570 5 30 17100

3 Asam Mefenamat tablet 500 mg Strip 127 3000 18000 2286000

4 Deksametason injeksi 5 mg/ml - 1 ml Dus,100 Ampul @ 1 ml 1.738 30 180 312.84

5 Gentamisin Sulfat tetes mata 0,3% Dus, botol plastik 5 ml 3513 25 150 526950

6 Hidrokortoson krim 2,5 % 24 tube @5 g 2868 72 432 1238976

7 Kotrimaksazol tablet 480 mg dus 10 strip @ 10 tablet 152 1500 9000 1368000

8 Lansoprazol 30 mg. kaps. Dus 2 strip @ 10 Capsul 521 500 3000 1563000

9 Parasetamol sirup 120 mg/5 ml Botol @ 60 ml 1535 200 1200 1842000

10 Parasetamol tablet 500 mg strip 88 10000 60000 5280000

11 Ranitidin tab 150 mg Dus, 10 ampul @2 ml 132 2000 12000 1584000

12 Simvastatin tablet 10 mg. dus, 3 strip @ 10 kaplet salut selaput 177 200 1200 348000

JUMLAH TOTAL HARGA 16,379,310

Yang Melaporkan, Mengetahui,


Pengelola Obat Ka Puskesmas Muara Tiga

Kartini dr.H.T.Yusrizal
Nip.19671228 199703 2 001 Nip.19701030 200112 1 001
15000

1380

148800

471240
PUSKESMAS MUARA TIGA

Harga
Satuan/ Pemakaian Total
NO Nama Obat Kemasan Jumlah Harga
Harga Perbulan Kebutuhan
Pasaran
1 2 3 4 5 6 7

1 Asiklovir krim 5% Tube 5 gr 25 150

2 Oksitetrasiklin HCL salap 3% tube 5 g 300 1800

JUMLAH TOTAL HARGA

Yang Melaporkan, Mengetahui,


Pengelola Obat Ka Puskesmas Muara Tiga

Kartini dr.H.T.Yusrizal
Nip.19671228 199703 2 001 Nip.19701030 200112 1 001

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