Laporan Pemakaian Dan Lembar Permintaan Obat (Lplpo) Dinas Kesehatan Kabupaten Malang Propinsi Jawa Timur Unit: Puskesmas Lawang Desember
Uploaded by
tikaLaporan Pemakaian Dan Lembar Permintaan Obat (Lplpo) Dinas Kesehatan Kabupaten Malang Propinsi Jawa Timur Unit: Puskesmas Lawang Desember
Uploaded by
tikaLAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
DESEMBER
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00
2 Adalat Oros 20 mg TABLET Rp 3,255.00
3 Albendazol 400 mg TABLET Rp -
4 Alopurinol 100 mg TABLET Rp 90.00
5 Alopurinol 300 mg TABLET Rp 210.00
6 Ambroxol 30 mg TABLET Rp 100.00
7 Amlodipin 5 mg TABLET Rp 105.00
8 Amlodipin 10 mg TABLET Rp 104.00
9 Aminofilina 200 mg TABLET Rp 91.00
10 Amoksilin 250 mg KAPSUL Rp 195.00
11 Amoksilin 500 mg KAPLET Rp 232.00
12 Antalgin 500 mg TABLET Rp -
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00
18 Asam folat 1 mg TABLET Rp 67.00
19 Asam mefenamat 500mg TABLET Rp 106.00
20 Asetosal 100 mg TABLET Rp 130.00
21 Asiklovir 400mg TABLET Rp 349.00
22 Betahistin mesilat 5 mg TABLET Rp 149.00
23 Bisoprolol tablet 5 mg TABLET Rp 330.00
24 Bromhexin 8 mg TABLET
25 Cefadroxil 500 mg KAPSUL Rp 516.00
26 Cetirizin 10mg TABLET Rp 143.00
27 Deksametason 0,5 mg TABLET Rp 44.00
28 Dekstrometorfan 15 mg TABLET Rp -
29 Digoksin 0,25 mg TABLET Rp 105.00
30 Diltiazem 30 mg TABLET Rp 127.00
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00
32 Doksisiklin 100mg KAPSUL Rp 268.00
33 Domperidon tablet 10 mg TABLET Rp 118.00
34 Efedrin HCL 25 mg TABLET Rp 47.00
35 Eritromisin 500mg KAPLET Rp 730.00
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00
37 Furosemid 40 mg TABLET Rp 78.00
38 Glibenklamid 5 mg TABLET Rp 100.00
39 Glimepiride tablet 2 mg TABLET Rp 289.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Gliseril Guaiakolat 100 mg TABLET Rp -
41 Griseofulvin 125 mg TABLET Rp 245.00
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00
44 Ibuprofen 400 mg TABLET Rp 127.00
45 Ibuprofen 200 mg TABLET Rp 105.00
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00
47 Kalium Diklofenac 50mg TABLET Rp 200.00
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00
49 Kaptopril 25 mg TABLET Rp 80.00
50 Kaptopril 12,5 mg TABLET Rp 62.00
51 Ketokonazol 200mg tablet TABLET Rp 280.00
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00
53 Klopidogrel TABLET Rp 2,000.00
54 Kloramfenikol kapsul 250 mg KAPSUL Rp 249.00
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00
56 Klorokuin tablet 150 mg TABLET Rp -
57 Klorpropamid tablet 100 mg TABLET Rp -
Kotrimoksazol anak
58 (Sulfametoksazol100mg+Trimetoprim20mg) TABLET
Rp -
Kotrimoksazol dewasa kombinasi :
59 Sulfametoksazol400mg+Trimetoprim80mg TABLET
Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00
61 Lisinopril 5mg tablet TABLET Rp 269.00
62 Loratadin tablet 10 mg TABLET Rp 134.00
63 Mebendazol tablet 100 mg TABLET Rp -
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00
65 Metformin 500mg tablet TABLET Rp 100.00
66 Metil Prednisolon 4 mg TABLET Rp 194.00
67 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00
68 Metoklopramid 5mg TABLET Rp 123.00
69 Metronidazol 250 mg TABLET Rp 78.00
70 Metronidazol 500mg TABLET Rp 133.00
71 N-asetylsistein KAPSUL Rp 1,100.00
72 Natrium Diklofenac 25 mg TABLET Rp 132.00
73 Natrium Diklofenac 50 mg TABLET Rp 159.00
74 Nifedipin 10 mg tablet TABLET Rp 104.00
75 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00
76 Omeprazole 20mg TABLET Rp 160.00
77 Ondansetron tab TABLET Rp 160.00
78 Parasetamol 100 mg TABLET Rp 200.00
79 Parasetamol 500 mg TABLET Rp 56.00
80 Pirantel 125 mg TABLET Rp 269.00
81 Pirasetam 800 mg tablet TABLET Rp 62.00
82 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00
83 Prednison tablet 5 mg TABLET Rp 96.00
84 Primakuin tablet 15 mg TABLET Rp -
85 Propanolol HCL tablet 10 mg TABLET Rp 52.00
86 Propiltiourasil tablet 100 mg TABLET Rp 100.00
87 Ranitidin tablet 150 mg TABLET Rp 105.00
88 Salbutamol tablet 2 mg TABLET Rp 66.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
89 Salbutamol tablet 4 mg TABLET Rp 80.00
90 Simvastatin 10 mg TABLET Rp 131.00
91 Siprofloksazin tablet 500 mg TABLET Rp 281.00
92 Spironolactone 25 mg TABLET Rp 315.00
Tablet Tambah Darah Kombinasi : Besi sulfat
93 200mg+Asam folat 0,25mg TABLET
Rp 355.00
94 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00
95 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00
96 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00
97 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00
98 Vitamin B Kompleks TABLET Rp 115.00
99 Zinc 10 mg TABLET Rp 513.00
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00
2 Amoxillin 1000 mg VIAL Rp 10,500.00
3 Ampisillin im/iv 1000mg/ml VIAL Rp -
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp -
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00
8 Ceftriaxone 1 gr injeksi VIAL Rp -
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00
11 Epinefrin injeksi AMPUL Rp 2,204.00
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00
13 Fitomenadion (Vit K1)inj infant AMPUL Rp -
14 Furosemid injeksi AMPUL Rp 2,300.00
15 Gentamisin injeksi AMPUL Rp 3,386.00
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00
17 Kloramfenikol injeksi VIAL Rp -
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp -
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp -
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00
26 Omeprazole Injeksi AMPUL Rp 11,868.00
27 Ondansetron injeksi AMPUL Rp 1,650.00
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp -
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp -
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp -
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00
35 Vitamin B Kompleks injeksi AMPUL Rp -
c. Salep
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00
2 Asiklovir krim 5% TUBE Rp 4,000.00
3 Betametason krim 0,1 % TUBE Rp 1,349.00
4 Bufacetin Salep Kulit TUBE Rp 3,008.00
5 Gameksan emulsi 1 % 30ml TUBE Rp -
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00
9 Ketokonazol krim 2% TUBE Rp -
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00
11 Miconazol cream 2 % TUBE Rp 3,000.00
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00
2 Salisil Bedak 2 % POT Rp 1,025.00
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00
3 Cetirizin Syr BOTOL Rp -
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp -
5 Eritromisin sirup BOTOL Rp 6,150.00
6 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00
7 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00
Kotrimoksazol Suspensi komb: Sulfametoksazol
8 200mg+Trimetoprim40mg/5ml BOTOL
Rp 2,286.00
9
Mebendazol sirup 100 mg/5ml BOTOL Rp -
10
Metronidazole Sirup BOTOL Rp 9,950.00
11
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00
12
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00
13
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00
14
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00
15
Thiamfenikol syr BOTOL Rp -
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00
3 Gentian violet larutan 1 % BOTOL Rp -
4 Karbo Glycerin BOTOL Rp -
5 Kloramfenikol tetes mata BOTOL Rp -
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00
7 Polikresulen ( Albothyl ) BOTOL Rp -
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp -
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00
2 Alat suntik sekali pakai 3 ml SET Rp 792.00
3 Alat suntik sekali pakai 5 ml SET Rp 979.00
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00
5 Alkohol swab PAK Rp 11,000.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
6 Aqua pro injeksi, bebas pirogen BOTOL Rp -
7 Aquadest steril BOTOL Rp 14,960.00
8 Blood Lancet PCS Rp 14,566.00
9 Blood Tranfusion set PCS Rp 14,300.00
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00
12 Daryantulle LEMBAR Rp 8,990.00
13 Etanol 70 % BOTOL Rp -
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00
16 Foley Catheter no.16 PCS Rp 18,450.00
17 Female Catheter no.16 PCS Rp 18,450.00
18 Female Catheter no.18 PCS Rp 18,450.00
19 Folley cath no. 18 PCS Rp 18,450.00
20 Hanschoen "50 KOTAK Rp 46,200.00
21 Hanschoen steril no 6.5 PCS Rp 9,854.00
22 Hanschoen steril no 7 PCS Rp 9,854.00
23 Hansaplast 5 cm ROLL Rp 25,404.00
24 Hansaplast 7,5 cm ROLL Rp 31,265.00
25 I.V. Catheter No 18 PCS Rp 8,700.00
26 I.V. Catheter No 20 PCS Rp 8,700.00
27 I.V. Catheter No 22 PCS Rp 8,700.00
28 I.V. Catheter No 24 PCS Rp 8,700.00
29 I.V. Catheter No 26 PCS Rp 8,700.00
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00
31 Infusion set anak PCS Rp 7,000.00
32 Infusion set dewasa PCS Rp 7,000.00
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00
39 Kasa Steril PAK Rp 7,900.00
40 Kasa 4m x 5 cm PAK Rp 1,100.00
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00
42 Masker breathing (+ selang) PCS Rp 24,000.00
43 Masker non breathing PCS Rp 21,945.00
44 Masker N95 PCS Rp 390,000.00
45 My Jelly 82 gram TUBE Rp 29,550.00
46 Nasal kanul S PCS Rp 6,600.00
47 Nasal kanul L PCS Rp 6,600.00
48 NGT 7 x 75/80 PCS Rp -
49 Non woven fixation 5cm x 10 m BOX
50 One Med H2 O2 3 % BOTOL Rp -
51 One Med Surgical Blade PCS Rp -
52 Plester 5 yards x 2 inch ROL Rp 18,086.00
53 Plester infus (tegaderm) PCS Rp 224,200.00
54 Plester infus (e care + pot) PCS Rp 220,000.00
55 Plesterin PCS Rp 30,800.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
56 Policlean BOTOL Rp 608,000.00
57 Polyfix PAK Rp 43,850.00
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00
59 Spalk PCS Rp 61,600.00
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00
62 Urine Bag PCS Rp -
63 Umbilical Cord "50 PAK Rp 65,000.00
64 Underpeds BIJI Rp 1,000.00
65 Unolab supercare Nitril powder BOX Rp 77,493.00
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp -
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00
5 KAEN 3B BOTOL Rp 10,050.00
6 KAEN 4B BOTOL Rp 15,730.00
7 Metronidazol infus BOTOL Rp 9,950.00
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00
9 Parasetamol Infus BOTOL Rp 12,940.00
10 Ringer Lactate infus steril BOTOL Rp 7,150.00
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00
2 Bioplasenton Jelly TUBE Rp 14,175.00
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00
5 Bufacomb TUBE Rp 3,008.00
6 Calporosis TABLET Rp 430.00
7 Cendo Lyters tetes mata BOTOL Rp 430.00
8 Cendo Xitrol tetes mata BOTOL Rp -
9 Chloramex 500 mg KAPSUL Rp -
10 Combivent Nebule BOTOL Rp 4,995.00
11 Citicholin inj. 250 mg / 2ml AMPUL Rp -
12 Hiopar TABLET Rp 1,360.00
13 Laxadin sirup BOTOL Rp 12,450.00
14 Lactodiar SACHET Rp -
15 Lytamin syrup BOTOL Rp 5,000.00
16 Mecobion tablet TABLET Rp 1,000.00
17 Metamizole injeksi 500mg AMPUL Rp 8,635.00
18 Microlax BIJI Rp -
19 Neucompli TABLET Rp 5,500.00
20 Neurotropik plus TABLET Rp -
21 Neurotropik injeksi 5000mcg AMPUL Rp 362.00
22 Novalgin/Antrain injeksi AMPUL Rp 3,575.00
23 Noza TABLET Rp 11,500.00
24 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00
25 Pantocain Tetes Mata BOTOL Rp 11,500.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
26 Parasetamol supp BIJI Rp 1,500.00
27 Pehacain injeksi AMPUL Rp 12,155.00
28 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00
29 Salbutamol rotacaps KAPSUL Rp 450.00
30 Salbutamol rotahaler PCS Rp -
31 Sotatic Inj AMPUL Rp 1,650.00
32 Spasminal/Scopma TABLET Rp 1,360.00
33 Puralex TABLET Rp 140.00
34 Ulsidex TABLET Rp 424.00
35 Ventolin nebulizer BOTOL Rp 4,000.00
36 Zirkum syr BOTOL Rp 14,980.00
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00
3 Mineral Mix PAKET
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00
2 Clobazam 10mg tab TABLET Rp 967.00
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp -
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00
5 Fenitoin Natrium 30 mg KAPSUL Rp -
6 Haldol decanoat 50mg/ml inj AMPUL Rp -
7 Haloperidol 1,5 mg TABLET Rp 66.00
8 Haloperidol 5mg TABLET Rp 69.00
9 Karbamazepin 200 mg TABLET Rp 228.00
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp -
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp -
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp -
14 Lodomer 5mg/ml inj AMPUL Rp -
15 Risperidone 2mg TABLET Rp 347.00
16 Sikzonoat 25mg/ml inj AMPUL Rp -
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00
2 Diazepam 2 mg TABLET Rp 45.00
3 Diazepam 5 mg TABLET Rp 80.00
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp -
5 Fenobarbital 30 mg TABLET Rp -
6 Kodein tablet 10mg TABLET Rp 550.00
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00
9 Valdimex Inj AMPUL Rp 12,100.00
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp -
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00
n. TB Paru
1 Isoniazid (INH) 100mg TABLET
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2 Kombipack Kategori 1 PAKET Rp -
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00
7 Obat Antituberkulosis Sisipan PAKET Rp -
8 Slide PAK
9 Slide box BOX Rp -
10 Sputum pot BIJI Rp 2,728.00
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp -
12 Ziehl nelseen PAKET Rp 276,600.00
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
FEBRUARI
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 10 30 40 80
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 10 5 10 10 10 10 10 65
5 Alopurinol 300 mg TABLET Rp 210.00 10 17 5 32
6 Ambroxol 30 mg TABLET Rp 100.00 10 30 40 34 16 20 29 10 7 196
7 Amlodipin 5 mg TABLET Rp 105.00 10 90 20 20 14 60 52 70 30 245 20 82 20 80 30 31 29 98 1001
8 Amlodipin 10 mg TABLET Rp 104.00 60 20 18 90 30 77 20 20 64 77 49 70 71 78 50 98 892
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 86 111 75 171 42 19 64 133 75 35 90 60 116 75 40 30 40 46 30 156 266 140 161 2061
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 10 36 40 56 10 42 30 10 10 30 60 60 50 80 73 110 61 40 30 117 100 80 115 1250
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 3 6 5 3 3 20
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 18 17 2 40 30 37 55 51 25 19 20 19 6 9 27 23 2 4 19 10 33 466
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 5 23 20 48
18 Asam folat 1 mg TABLET Rp 67.00 0
19 Asam mefenamat 500mg TABLET Rp 106.00 20 50 50 80 30 20 58 60 10 30 75 10 45 85 50 60 35 20 50 50 70 88 75 1121
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Asiklovir 400mg TABLET Rp 349.00 12 50 20 30 26 138
22 Betahistin mesilat 5 mg TABLET Rp 149.00 12 10 10 10 36 20 32 12 10 10 10 10 10 6 20 6 224
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
24 Bromhexin 8 mg TABLET 36 25 75 70 30 60 66 70 50 60 20 50 178 115 150 138 30 1223
25 Cefadroxil 500 mg KAPSUL Rp 516.00 88 16 10 43 16 21 50 10 80 40 10 16 16 30 16 462
26 Cetirizin 10mg TABLET Rp 143.00 22 8 16 41 4 23 15 32 13 7 101 83 58 27 5 455
27 Deksametason 0,5 mg TABLET Rp 44.00 26 50 23 11 61 6 22 40 65 6 9 3 5 18 8 12 35 10 10 32 39 39 530
28 Dekstrometorfan 15 mg TABLET Rp - 0
29 Digoksin 0,25 mg TABLET Rp 105.00 0
30 Diltiazem 30 mg TABLET Rp 127.00 0
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00 4 21 10 25 10 10 45 35 37 197
32 Doksisiklin 100mg KAPSUL Rp 268.00 0
33 Domperidon tablet 10 mg TABLET Rp 118.00 6 25 6 25 10 12 10 20 10 12 11 2 149
34 Efedrin HCL 25 mg TABLET Rp 47.00 0
35 Eritromisin 500mg KAPLET Rp 730.00 30 30
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 20 10 5 6 5 10 56
37 Furosemid 40 mg TABLET Rp 78.00 10 5 5 5 7 5 3 40
38 Glibenklamid 5 mg TABLET Rp 100.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
39 Glimepiride tablet 2 mg TABLET Rp 289.00 10 10 30 30 15 5 26 40 20 30 20 24 16 30 19 21 12 15 30 403
40 Gliseril Guaiakolat 100 mg TABLET Rp - 34 33 9 17 7 15 30 109 39 44 23 65 62 23 23 19 53 108 4 717
41 Griseofulvin 125 mg TABLET Rp 245.00 0
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 10
44 Ibuprofen 400 mg TABLET Rp 127.00 16 30 46 30 10 132
45 Ibuprofen 200 mg TABLET Rp 105.00 26 40 52 20 56 10 8 6 218
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 0
47 Kalium Diklofenac 50mg TABLET Rp 200.00 0
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 10 43 20 350 25 5 25 45 30 15 14 30 170 30 812
49 Kaptopril 25 mg TABLET Rp 80.00 20 5 10 20 20 21 15 30 141
50 Kaptopril 12,5 mg TABLET Rp 62.00 25 20 10 10 25 40 5 135
51 Ketokonazol 200mg tablet TABLET Rp 280.00 20 10 15 20 65
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 10 24 46 20 40 30 170
53 Klopidogrel TABLET Rp 2,000.00 0
54 Kloramfenikol kapsul 500 mg KAPSUL Rp 249.00 0
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 136 144 159 130 46 56 115 38 55 50 15 87 28 23 52 11 38 13 133 162 83 163 1737
56 Klorokuin tablet 150 mg TABLET Rp - 0
57 Klorpropamid tablet 100 mg TABLET Rp - 0
58 Kotrimoksazol anak TABLET 12 12
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
59 Kotrimoksazol dewasa kombinasi : TABLET 12 6 18
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00 0
61 Lisinopril 5mg tablet TABLET Rp 269.00 0
62 Loratadin tablet 10 mg TABLET Rp 134.00 10 5 6 25 5 10 41 36 76 98 60 30 16 9 16 443
63 Mebendazol tablet 100 mg TABLET Rp - 0
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00 6 24 6 10 21 18 12 12 12 6 16 87 39 30 17 13 12 12 353
65 Metformin 500mg tablet TABLET Rp 100.00 25 15 20 10 45 25 10 50 75 30 20 25 10 42 92 45 42 42 14 120 30 120 907
66 Metil Prednisolon 4 mg TABLET Rp 194.00 12 24 30 41 19 15 12 40 15 22 42 42 45 30 30 10 18 2 449
67 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
68 Metoklopramid 5mg TABLET Rp 123.00 10 6 16
69 Metronidazol 250 mg TABLET Rp 78.00 20 10 30
70 Metronidazol 500mg TABLET Rp 133.00 10 35 10 5 10 70
71 N-asetylsistein KAPSUL Rp 1,100.00 46 26 6 70 30 40 79 5 10 16 40 10 14 172 90 222 876
72 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
73 Natrium Diklofenac 50 mg TABLET Rp 159.00 175 58 12 48 48 66 98 86 62 54 43 23 72 114 116 107 84 184 84 76 64 1674
74 Nifedipin 10 mg tablet TABLET Rp 104.00 0
75 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 11 11
76 Omeprazole 20mg TABLET Rp 160.00 54 54 6 42 31 69 144 28 22 72 18 11 12 30 10 16 29 11 6 6 671
77 Ondansetron tab TABLET Rp 160.00 24 10 34
78 Parasetamol 100 mg TABLET Rp 200.00 0
79 Parasetamol 500 mg TABLET Rp 56.00 186 110 60 237 215 116 113 290 170 185 217 115 228 310 83 148 155 118 84 46 273 226 363 4048
80 Pirantel 125 mg TABLET Rp 269.00 0
81 Pirasetam 800 mg tablet TABLET Rp 62.00 0
82 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 21 161 6 14 2 204
83 Prednison tablet 5 mg TABLET Rp 96.00 72 172 244
84 Primakuin tablet 15 mg TABLET Rp - 0
85 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
86 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
87 Ranitidin tablet 150 mg TABLET Rp 105.00 6 6 6 24 10 6 12 10 6 26 10 18 22 16 6 36 220
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
88 Salbutamol tablet 2 mg TABLET Rp 66.00 6 10 6 10 10 28 20 90
89 Salbutamol tablet 4 mg TABLET Rp 80.00 10 10 20
90 Simvastatin 10 mg TABLET Rp 131.00 20 5 10 10 10 16 30 50 30 15 5 46 6 7 17 30 35 10 30 382
91 Siprofloksazin tablet 500 mg TABLET Rp 281.00 20 20 10 30 20 30 7 25 30 6 198
92 Spironolactone 25 mg TABLET Rp 315.00 20 5 17 10 20 20 92
Tablet Tambah Darah Kombinasi : Besi sulfat
93 TABLET 60 110 15 45 10 1030 20 40 100 100 30 10 25 590 25 2210
200mg+Asam folat 0,25mg Rp 355.00
94 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
95 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
96 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 0
97 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 10 4 14
98 Vitamin B Kompleks TABLET Rp 115.00 289 99 62 88 146 136 196 281 158 117 145 156 101 73 111 43 75 157 44 107 219 93 222 3118
99 Zinc 10 mg TABLET Rp 513.00 5 5 13 2 25
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL 0
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 1 1
3 Betametason krim 0,1 % TUBE Rp 1,349.00 1 1 1 2 1 1 7
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 3 1 1 1 6
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 0
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 1 2
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 1 2 1 1 1 7
9 Ketokonazol krim 2% TUBE Rp - 1 1
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 1 3 1 1 6
11 Miconazol cream 2 % TUBE Rp 3,000.00 2 1 1 2 1 7
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 1 2 4
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 0
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 1 1 1 3
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 5 5
2 Salisil Bedak 2 % POT Rp 1,025.00 0
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 1 1 3 8 2 1 3 1 1 2 1 4 1 1 4 4 39
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 3 1 3 2 1 3 4 2 5 1 7 6 4 1 3 2 1 5 2 6 5 6 73
3 Cetirizin Syr BOTOL Rp - 1 1 1 3
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 0
5 Eritromisin sirup BOTOL Rp 6,150.00 0
6 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 1 1 7 1 1 1 2 14
7 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 1 1
Kotrimoksazol Suspensi komb: Sulfametoksazol
8 200mg+Trimetoprim40mg/5ml BOTOL 1 1 1 1 1 2 1 1 1 10
Rp 2,286.00
9
Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
10
Metronidazole Sirup BOTOL Rp 9,950.00 0
11
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 1 2 1 1 1 2 2 1 2 1 1 1 1 2 20
12
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 4 5 1 2 5 9 2 4 4 3 4 6 4 9 10 1 1 3 3 80
13
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 1 1
14
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1 2 1 1 5
15
Thiamfenikol syr BOTOL Rp - 0
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 1 1 2 5
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 3 1 1 1 1 1 1 10
3 Gentian violet larutan 1 % BOTOL Rp - 1 1
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 1 1
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1 1
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 3 3
5 Bufacomb TUBE Rp 3,008.00 1 1 2
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Herbakof Botol 1 2 7 10
13 Hiopar TABLET Rp 1,360.00 0
14 Laxadin sirup BOTOL Rp 12,450.00 1 1
15 Lactodiar SACHET Rp - 0
16 Lytamin syrup BOTOL Rp 5,000.00 0
17 Mecobion tablet TABLET Rp 1,000.00 0
18 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
19 Microlax BIJI Rp - 60 4 15 79
20 Neucompli TABLET Rp 5,500.00 5 10 13 20 36 6 22 11 12 4 30 32 30 231
21 Neurotropik plus TABLET Rp - 10 10
22 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
23 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 18 12 16 20 66
24 Noza TABLET Rp 11,500.00 40 10 34 55 10 30 101 64 24 75 84 38 115 100 20 90 890
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
25 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 2 1 3
26 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
27 Parasetamol supp BIJI Rp 1,500.00 0
28 Pehacain injeksi AMPUL Rp 12,155.00 4 1 5
29 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 1 3 3 1 2 1 11
30 Salbutamol rotacaps KAPSUL Rp 450.00 0
31 Salbutamol rotahaler PCS Rp - 0
32 Sotatic Inj AMPUL Rp 1,650.00 0
33 Spasminal/Scopma TABLET Rp 1,360.00 10 25 10 10 10 65
34 Puralex TABLET Rp 140.00 10 10 22 10 20 10 30 10 10 10 18 10 170
35 Ulsidex TABLET Rp 424.00 12 10 8 30
36 Ventolin nebulizer BOTOL Rp 4,000.00 1 1
37 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 0
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru
1 Isoniazid (INH) 100mg TABLET 11 32 44 87
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN
RAWAT RAWAT RAWAT
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
MARET
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 10 10 10 10 10 50
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 20 30 10 15 20 10 10 115
5 Alopurinol 300 mg TABLET Rp 210.00 8 10 18
6 Ambroxol 30 mg TABLET Rp 100.00 25 65 176 157 115 88 117 121 120 123 51 75 84 172 97 183 67 40 125 80 102 53 214 48 24 2522
7 Amlodipin 5 mg TABLET Rp 105.00 20 20 20 20 30 10 40 40 10 20 30 21 30 10 20 50 30 30 30 50 531
8 Amlodipin 10 mg TABLET Rp 104.00 40 43 80 105 50 40 50 110 50 70 30 30 63 110 40 30 70 20 70 30 70 50 120 10 30 1411
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 10 10 20
11 Amoksilin 500 mg KAPLET Rp 232.00 103 70 60 32 75 81 110 154 100 98 105 50 37 111 105 96 90 76 90 80 103 70 170 82 40 2188
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 80 52 50 50 80 24 30 60 40 21 20 25 20 70 30 20 20 40 30 50 40 70 78 20 1020
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 5 3 1 6 3 3 21
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 14 32 26 28 28 20 61 15 34 25 10 29 36 36 31 34 5 20 39 30 47 9 38 33 12 692
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 0
18 Asam folat 1 mg TABLET Rp 67.00 10 20 15 20 20 30 115
19 Asam mefenamat 500mg TABLET Rp 106.00 20 15 30 40 50 32 40 40 10 30 30 30 40 30 40 30 20 50 40 60 55 20 50 40 60 902
20 Asetosal 100 mg TABLET Rp 130.00 5 5
21 Asiklovir 400mg TABLET Rp 349.00 30 24 18 30 102
22 Betahistin mesilat 5 mg TABLET Rp 149.00 10 10 20 10 10 33 10 26 10 10 26 22 10 20 10 16 12 12 30 307
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
24 Bromhexin 8 mg TABLET 0
25 Cefadroxil 500 mg KAPSUL Rp 516.00 6 10 6 16 6 11 10 65
26 Cetirizin 10mg TABLET Rp 143.00 10 80 29 44 78 28 72 51 74 64 67 82 79 66 39 83 38 48 38 68 40 39 92 35 31 1375
27 Deksametason 0,5 mg TABLET Rp 44.00 31 44 110 107 79 39 50 126 15 52 15 11 13 52 100 111 15 75 37 18 38 86 179 20 20 1443
28 Dekstrometorfan 15 mg TABLET Rp - 0
29 Digoksin 0,25 mg TABLET Rp 105.00 0
30 Diltiazem 30 mg TABLET Rp 127.00 0
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00 10 15 6 20 20 10 10 30 22 6 12 15 176
32 Doksisiklin 100mg KAPSUL Rp 268.00 0
33 Domperidon tablet 10 mg TABLET Rp 118.00 20 10 10 10 30 20 30 10 3 10 6 20 25 10 16 10 240
34 Efedrin HCL 25 mg TABLET Rp 47.00 0
35 Eritromisin 500mg KAPLET Rp 730.00 10 10
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 10 10 10 5 22 10 10 77
37 Furosemid 40 mg TABLET Rp 78.00 5 5 8 5 10 15 10 5 10 5 5 5 88
38 Glibenklamid 5 mg TABLET Rp 100.00 10 10
39 Glimepiride tablet 2 mg TABLET Rp 289.00 30 10 22 10 30 20 20 50 20 10 30 10 55 40 60 10 5 32 10 30 40 544
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Gliseril Guaiakolat 100 mg TABLET Rp - 67 23 19 26 27 14 129 59 41 120 43 35 4 83 41 18 22 50 33 78 114 27 40 1113
41 Griseofulvin 125 mg TABLET Rp 245.00 0
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 10 10 10 30
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 6 6 10 32
44 Ibuprofen 400 mg TABLET Rp 127.00 6 30 62 130 30 10 10 40 20 60 10 20 30 50 30 10 30 10 40 30 658
45 Ibuprofen 200 mg TABLET Rp 105.00 20 10 10 30 10 10 15 20 20 10 23 20 10 52 260
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 10 10
47 Kalium Diklofenac 50mg TABLET Rp 200.00 10 10
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 5 20 10 5 11 10 5 65 5 20 20 15 5 196
49 Kaptopril 25 mg TABLET Rp 80.00 20 10 10 10 15 20 10 15 20 10 70 40 30 30 10 20 10 45 20 30 10 455
50 Kaptopril 12,5 mg TABLET Rp 62.00 5 10 30 35 10 90
51 Ketokonazol 200mg tablet TABLET Rp 280.00 10 5 15
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 0
53 Klopidogrel TABLET Rp 2,000.00 0
54 Kloramfenikol kapsul 500 mg KAPSUL Rp 249.00 0
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 110 60 40 12 10 15 45 126 104 73 101 36 29 83 79 45 51 24 36 51 98 79 18 38 42 1405
56 Klorokuin tablet 150 mg TABLET Rp - 0
57 Klorpropamid tablet 100 mg TABLET Rp - 0
Kotrimoksazol anak
58 (Sulfametoksazol100mg+Trimetoprim20mg) TABLET 0
Rp -
Kotrimoksazol dewasa kombinasi :
59 Sulfametoksazol400mg+Trimetoprim80mg TABLET 0
Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00 0
61 Lisinopril 5mg tablet TABLET Rp 269.00 0
62 Loratadin tablet 10 mg TABLET Rp 134.00 12 6 5 10 5 38
63 Mebendazol tablet 100 mg TABLET Rp - 0
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00 12 33 37 10 15 12 17 11 12 11 18 33 15 22 16 40 34 21 18 50 5 442
65 Metformin 500mg tablet TABLET Rp 100.00 15 10 50 40 50 25 30 40 30 45 65 15 45 50 92 102 35 25 31 72 40 67 30 70 1074
66 Metil Prednisolon 4 mg TABLET Rp 194.00 36 12 10 15 18 12 12 26 6 6 3 12 6 5 15 6 200
67 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
68 Metoklopramid 5mg TABLET Rp 123.00 6 10 20 10 46
69 Metronidazol 250 mg TABLET Rp 78.00 0
70 Metronidazol 500mg TABLET Rp 133.00 25 20 10 10 5 30 30 130
71 N-asetylsistein KAPSUL Rp 1,100.00 68 20 20 30 26 10 174
72 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
73 Natrium Diklofenac 50 mg TABLET Rp 159.00 6 42 56 57 53 46 18 88 58 62 28 6 30 76 36 29 76 26 6 60 30 82 154 42 34 1201
74 Nifedipin 10 mg tablet TABLET Rp 104.00 0
75 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 3 10 13
76 Omeprazole 20mg TABLET Rp 160.00 10 31 17 6 10 11 6 46 6 18 12 18 43 11 12 18 6 34 6 50 26 12 409
77 Ondansetron tab TABLET Rp 160.00 10 40 50
78 Parasetamol 100 mg TABLET Rp 200.00 0
79 Parasetamol 500 mg TABLET Rp 56.00 140 202 165 125 256 113 186 284 207 268 220 161 152 293 112 181 160 137 175 158 133 145 380 60 130 4543
80 Pirantel 125 mg TABLET Rp 269.00 0
81 Pirasetam 800 mg tablet TABLET Rp 62.00 0
82 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 84 103 6 124 5 25 102 21 10 31 16 5 44 33 19 102 29 129 7 5 83 5 988
83 Prednison tablet 5 mg TABLET Rp 96.00 30 90 30 120 270
84 Primakuin tablet 15 mg TABLET Rp - 0
85 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
86 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
87 Ranitidin tablet 150 mg TABLET Rp 105.00 6 18 10 12 38 6 6 18 18 24 18 6 18 12 8 12 30 6 40 34 45 6 36 427
88 Salbutamol tablet 2 mg TABLET Rp 66.00 40 8 16 10 10 5 10 99
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
89 Salbutamol tablet 4 mg TABLET Rp 80.00 10 13 10 10 10 10 10 10 10 93
90 Simvastatin 10 mg TABLET Rp 131.00 30 33 10 40 10 10 10 10 40 20 60 60 60 50 50 10 10 56 60 50 45 20 60 804
91 Siprofloksazin tablet 500 mg TABLET Rp 281.00 10 7 7 10 10 10 20 46 10 16 146
92 Spironolactone 25 mg TABLET Rp 315.00 3 10 10 10 10 8 51
Tablet Tambah Darah Kombinasi : Besi sulfat
93 200mg+Asam folat 0,25mg TABLET 45 20 10 15 40 20 20 30 5 40 20 20 10 6 301
Rp 355.00
94 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
95 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
96 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 0
97 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 12 16 5 10 43
98 Vitamin B Kompleks TABLET Rp 115.00 51 92 86 59 40 69 73 67 58 40 44 68 83 98 60 60 65 23 45 61 58 72 120 59 1551
99 Zinc 10 mg TABLET Rp 513.00 5 3 3 3 5 10 5 13 47
b. Injeksi 0
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL 0
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
c. Salep 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 0
3 Betametason krim 0,1 % TUBE Rp 1,349.00 1 1 1 2 1 1 7
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 0
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 1 1 1 1 1 1 1 1 9
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 1 2
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 1 2 1 1 1 2 1 1 1 12
9 Ketokonazol krim 2% TUBE Rp - 0
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
11 Miconazol cream 2 % TUBE Rp 3,000.00 1 1 3 1 1 1 8
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 1 1 3
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 1 1
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 2 1 3
d. Serbuk 0
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 5 10 2 17
2 Salisil Bedak 2 % POT Rp 1,025.00 1 1 1 2 2 7
e. Sirup 0
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 2 4 1 1 4 1 1 2 1 1 1 2 2 1 1 25
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 2 1 1 2 2 2 2 1 1 3 1 4 5 1 1 2 31
3 Cetirizin Syr BOTOL Rp - 1 1 1 3
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 1 1 1 3
5 Eritromisin sirup BOTOL Rp 6,150.00 0
6 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 1 1 2 1 1 1 1 1 9
7 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 0
Kotrimoksazol Suspensi komb: Sulfametoksazol
8 200mg+Trimetoprim40mg/5ml BOTOL 1 1 2 1 5
Rp 2,286.00
9
Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
10
Metronidazole Sirup BOTOL Rp 9,950.00 0
11
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 1 1 1 1 4 1 1 1 1 1 1 1 1 1 1 19
12
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 3 1 5 3 3 7 4 1 4 3 3 3 1 4 2 1 2 5 2 2 2 2 3 66
13
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
14
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 2 2
15
Thiamfenikol syr BOTOL Rp - 0
d. Tetes 0
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 1 1 1 4
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 2 1 1 1 1 1 8
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1 1
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
5 Alkohol swab PAK Rp 11,000.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
55 Plesterin PCS Rp 30,800.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 1 1 1 1 1 1 1 1 8
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Dextrofen syr BOTOL 2 1 3
13 Hiopar TABLET Rp 1,360.00 0
14 Laxadin sirup BOTOL Rp 12,450.00 1 1 1 1 4
15 Lactodiar SACHET Rp - 0
16 Lytamin syrup BOTOL Rp 5,000.00 0
17 Mecobion tablet TABLET Rp 1,000.00 0
18 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
19 Microlax BIJI Rp - 0
20 Neucompli TABLET Rp 5,500.00 20 10 10 20 10 10 30 10 30 30 55 24 259
21 Neurotropik plus TABLET Rp - 0
22 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
23 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
24 Noza TABLET Rp 11,500.00 30 70 83 35 18 10 246
25 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
26 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
27 Parasetamol supp BIJI Rp 1,500.00 0
28 Pehacain injeksi AMPUL Rp 12,155.00 0
29 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 1 2 2 2 1 2 2 12
30 Salbutamol rotacaps KAPSUL Rp 450.00 0
31 Salbutamol rotahaler PCS Rp - 0
32 Sotatic Inj AMPUL Rp 1,650.00 0
33 Spasminal/Scopma TABLET Rp 1,360.00 10 10
34 Puralex TABLET Rp 140.00 10 10 10 10 10 20 20 40 10 10 10 160
35 Ulsidex TABLET Rp 424.00 9 5 40 10 40 20 30 11 10 50 30 20 20 295
36 Ventolin nebulizer BOTOL Rp 4,000.00 0
37 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi 0
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa 0
1 Amitriptyllin 25 mg TABLET Rp 143.00 2 6 4 12
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik 0
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum 0
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Isoniazid (INH) 100mg TABLET 22 8 22 8 32 8 14 8 25 147
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
APRIL
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 20 10 6 10 10 56
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 20 10 10 40 10 20 10 20 10 10 160
5 Alopurinol 300 mg TABLET Rp 210.00 0
6 Ambroxol 30 mg TABLET Rp 100.00 180 61 94 132 50 125 6 41 47 2 48 10 796
7 Amlodipin 5 mg TABLET Rp 105.00 82 50 52 50 60 52 11 20 11 27 60 24 10 110 33 43 2 30 20 20 40 30 837
8 Amlodipin 10 mg TABLET Rp 104.00 60 80 110 20 100 62 59 30 40 47 100 50 33 60 82 41 36 23 146 50 20 20 1269
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 143 60 93 128 70 95 88 55 70 60 35 134 80 130 115 65 130 93 64 56 55 40 47 1906
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 50 56 30 40 20 25 30 60 83 60 10 40 30 126 20 59 40 10 40 61 80 50 1020
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 1 3 2 1 7
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 54 57 39 45 20 28 22 53 34 21 31 28 22 30 21 29 56 46 37 18 19 10 31 751
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 0
18 Asam folat 1 mg TABLET Rp 67.00 10 15 10 20 20 75
19 Asam mefenamat 500mg TABLET Rp 106.00 50 30 35 30 60 90 50 50 70 50 30 80 20 50 50 50 65 40 20 30 20 40 29 1039
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Asiklovir 400mg TABLET Rp 349.00 140 40 70 10 40 35 335
22 Betahistin mesilat 5 mg TABLET Rp 149.00 20 16 10 16 26 6 16 6 10 6 11 20 10 12 16 10 16 12 20 16 275
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
24 Bromhexin 8 mg TABLET 0
25 Cefadroxil 500 mg KAPSUL Rp 516.00 17 10 26 10 10 14 20 10 14 20 20 7 178
26 Cetirizin 10mg TABLET Rp 143.00 82 58 92 49 31 78 37 68 40 67 41 86 57 87 91 9 973
27 Deksametason 0,5 mg TABLET Rp 44.00 100 80 64 89 16 93 25 22 74 20 24 101 91 36 56 76 51 55 73 63 21 13 32 1275
28 Dekstrometorfan 15 mg TABLET Rp - 0
29 Digoksin 0,25 mg TABLET Rp 105.00 0
30 Diltiazem 30 mg TABLET Rp 127.00 0
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00 16 5 6 10 12 5 20 10 20 104
32 Doksisiklin 100mg KAPSUL Rp 268.00 0
33 Domperidon tablet 10 mg TABLET Rp 118.00 20 10 60 10 30 5 10 20 30 12 30 35 30 5 32 15 12 11 32 409
34 Efedrin HCL 25 mg TABLET Rp 47.00 0
35 Eritromisin 500mg KAPLET Rp 730.00 12 12
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 5 10 11 15 10 5 15 5 6 82
37 Furosemid 40 mg TABLET Rp 78.00 8 10 15 33
38 Glibenklamid 5 mg TABLET Rp 100.00 20 10 15 30 20 20 10 10 10 10 2 20 20 10 10 20 237
39 Glimepiride tablet 2 mg TABLET Rp 289.00 10 1 11
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Gliseril Guaiakolat 100 mg TABLET Rp - 19 73 30 36 37 74 38 50 89 85 98 163 131 93 143 126 82 65 102 43 64 52 103 1796
41 Griseofulvin 125 mg TABLET Rp 245.00 0
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 10 10 10 40
44 Ibuprofen 400 mg TABLET Rp 127.00 20 60 20 30 20 35 30 40 30 10 10 20 20 10 355
45 Ibuprofen 200 mg TABLET Rp 105.00 10 5 10 30 30 10 10 26 20 10 16 26 6 209
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 0
47 Kalium Diklofenac 50mg TABLET Rp 200.00 0
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 15 10 5 10 10 5 5 5 65
49 Kaptopril 25 mg TABLET Rp 80.00 10 20 25 20 10 21 10 20 22 16 30 10 30 244
50 Kaptopril 12,5 mg TABLET Rp 62.00 10 10 15 30 45 10 50 30 20 25 25 18 10 298
51 Ketokonazol 200mg tablet TABLET Rp 280.00 10 10 7 27
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 10 10 10 10 10 10 30 30 30 15 165
53 Klopidogrel TABLET Rp 2,000.00 0
54 Kloramfenikol kapsul 500 mg KAPSUL Rp 249.00 4 21 25
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 82 28 55 50 24 54 8 5 10 30 38 74 33 55 70 117 59 56 53 39 18 14 29 1001
56 Klorokuin tablet 150 mg TABLET Rp - 0
57 Klorpropamid tablet 100 mg TABLET Rp - 0
Kotrimoksazol anak
58 (Sulfametoksazol100mg+Trimetoprim20mg) TABLET 0
Rp -
Kotrimoksazol dewasa kombinasi :
59 Sulfametoksazol400mg+Trimetoprim80mg TABLET 10 10
Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00 0
61 Lisinopril 5mg tablet TABLET Rp 269.00 0
62 Loratadin tablet 10 mg TABLET Rp 134.00 10 6 5 12 5 34 6 25 38 16 63 50 45 20 38 373
63 Mebendazol tablet 100 mg TABLET Rp - 0
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00 18 12 11 31 6 39 28 23 11 11 12 29 27 23 6 10 12 18 36 18 30 411
65 Metformin 850mg TABLET 10 30 11 20 20 10 30 10 141
66 Metformin 500mg tablet TABLET Rp 100.00 40 55 50 75 55 50 23 45 10 10 55 20 45 10 36 579
67 Metil Prednisolon 4 mg TABLET Rp 194.00 32 5 6 18 12 6 6 6 10 6 10 117
68 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
69 Metoklopramid 5mg TABLET Rp 123.00 10 10
70 Metronidazol 250 mg TABLET Rp 78.00 0
71 Metronidazol 500mg TABLET Rp 133.00 45 10 30 20 10 30 20 20 20 10 10 225
72 N-asetylsistein KAPSUL Rp 1,100.00 10 16 10 10 36 10 40 30 60 46 60 40 40 5 15 6 40 10 20 10 514
73 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
74 Natrium Diklofenac 50 mg TABLET Rp 159.00 86 36 66 42 42 40 30 40 60 42 22 24 6 32 24 56 30 60 72 24 36 46 16 932
75 Nifedipin 10 mg tablet TABLET Rp 104.00 0
76 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 5 3 5 13
77 Omeprazole 20mg TABLET Rp 160.00 28 6 35 30 16 6 6 29 6 27 11 12 17 21 22 6 41 18 6 6 12 30 391
78 Ondansetron tab TABLET Rp 160.00 10 10
79 Parasetamol 100 mg TABLET Rp 200.00 0
80 Parasetamol 500 mg TABLET Rp 56.00 263 245 190 271 65 208 120 147 150 110 160 148 187 250 231 212 154 120 193 120 133 130 120 3927
81 Pirantel 125 mg TABLET Rp 269.00 0
82 Pirasetam 800 mg tablet TABLET Rp 62.00 0
83 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 19 117 21 233 171 14 5 118 124 8 31 101 19 7 19 1007
84 Prednison tablet 5 mg TABLET Rp 96.00 45 30 120 30 225
85 Primakuin tablet 15 mg TABLET Rp - 0
86 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
87 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
88 Ranitidin tablet 150 mg TABLET Rp 105.00 24 6 54 30 6 22 18 18 28 18 26 6 30 6 35 12 30 42 28 42 6 487
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
89 Salbutamol tablet 2 mg TABLET Rp 66.00 6 5 10 6 10 10 9 10 6 72
90 Salbutamol tablet 4 mg TABLET Rp 80.00 20 26 10 10 10 10 10 96
91 Simvastatin 10 mg TABLET Rp 131.00 49 90 60 30 20 90 40 30 50 20 30 30 30 14 20 10 30 10 20 30 10 713
92 Siprofloksazin tablet 500 mg TABLET Rp 281.00 44 10 10 6 6 4 10 10 100
93 Spironolactone 25 mg TABLET Rp 315.00 10 10 20
Tablet Tambah Darah Kombinasi : Besi sulfat
94 TABLET 30 26 30 45 5 20 10 30 20 10 5 231
200mg+Asam folat 0,25mg Rp 355.00
95 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
96 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
97 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 10 28 18 20 20 20 5 20 141
98 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 20 20
99 Vitamin B Kompleks TABLET Rp 115.00 91 73 111 116 55 96 34 60 49 58 124 74 74 60 80 87 83 47 58 178 80 70 162 1920
100 Zinc 10 mg TABLET Rp 513.00 5 20 5 10 20 3 20 5 5 10 12 5 27 5 152
b. Injeksi 0
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL 0
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
c. Salep 0
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 0
3 Betametason krim 0,1 % TUBE Rp 1,349.00 1 1 1 1 1 2 1 1 2 11
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 0
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 2 2 1 3 2 4 1 2 2 1 21
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 1
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 1 3 3 1 1 1 1 2 1 15
9 Ketokonazol krim 2% TUBE Rp - 1 1
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
11 Miconazol cream 2 % TUBE Rp 3,000.00 1 1 1 1 1 1 3 9
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 1
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 1 1
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 1 1
d. Serbuk 0
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 10 2 3 15 30
2 Salisil Bedak 2 % POT Rp 1,025.00 1 2 1 2 1 1 1 1 1 11
e. Sirup 0
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 3 1 2 1 2 1 1 2 1 2 3 2 1 1 1 25
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 4 1 2 2 1 2 2 2 2 2 2 2 3 1 1 1 3 33
3 Cetirizin Syr BOTOL Rp - 0
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 0
5 Domperidon syr BOTOL 0
6 Eritromisin sirup BOTOL Rp 6,150.00 0
7 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 1 1 2
8 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 1 1
Kotrimoksazol Suspensi komb: Sulfametoksazol
9 200mg+Trimetoprim40mg/5ml BOTOL 3 1 1 2 1 8
Rp 2,286.00
10
Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
11
Metronidazole Sirup BOTOL Rp 9,950.00 0
12
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 1 1 4 1 1 9
13
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 4 4 9 4 1 4 3 1 5 4 6 2 3 4 5 1 4 3 3 1 71
14
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
15
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1 1
16
Thiamfenikol syr BOTOL Rp - 0
d. Tetes 0
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 1 1 2 2 1 1 1 1 1 1 13
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 2 1 1 2 1 1 1 10
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1 1
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 1 1 1 1 4
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Dextrofen syr BOTOL 2 3 1 3 2 1 2 2 16
13 Demacolin TABLET 0
14 Herbakof botol 1 1 2 1 3 1 1 1 11
15 Hiopar TABLET Rp 1,360.00 0
16 Laxadin sirup BOTOL Rp 12,450.00 4 1 1 1 1 1 1 10
17 Lactodiar SACHET Rp - 0
18 Lytamin syrup BOTOL Rp 5,000.00 0
19 Mecobion tablet TABLET Rp 1,000.00 10 10
20 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
21 Microlax BIJI Rp - 0
22 Neucompli TABLET Rp 5,500.00 10 10 20 20 10 10 10 10 10 5 30 20 165
23 Neurotropik plus TABLET Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
24 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
25 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
26 Noza TABLET Rp 11,500.00 4 4
27 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 0
28 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
29 Parasetamol supp BIJI Rp 1,500.00 2 2
30 Pehacain injeksi AMPUL Rp 12,155.00 0
31 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 3 6 2 1 1 2 1 1 2 1 1 1 1 23
32 Salbutamol rotacaps KAPSUL Rp 450.00 0
33 Salbutamol rotahaler PCS Rp - 0
34 Sotatic Inj AMPUL Rp 1,650.00 0
35 Spasminal/Scopma TABLET Rp 1,360.00 0
36 Puralex TABLET Rp 140.00 20 14 40 20 10 10 10 30 10 20 10 40 10 244
37 Ulsidex TABLET Rp 424.00 10 20 10 10 20 6 20 40 11 12 40 10 10 15 3 10 247
38 Ventolin nebulizer BOTOL Rp 4,000.00 0
39 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi 0
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa 0
1 Amitriptyllin 25 mg TABLET Rp 143.00 3 2 1 6 1 2 2 2 2 4 25
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik 0
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru 0
1 Isoniazid (INH) 100mg TABLET 21 18 41 19 21 39 18 22 39 238
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
MEI
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 6 6
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 10 10 10 5 10 45
5 Alopurinol 300 mg TABLET Rp 210.00 0
6 Ambroxol 30 mg TABLET Rp 100.00 10 3 3 2 25 63 13 32 70 28 10 259
7 Amlodipin 5 mg TABLET Rp 105.00 35 42 83 40 12 10 20 120 22 10 50 20 20 103 25 20 20 30 5 58 15 25 41 10 836
8 Amlodipin 10 mg TABLET Rp 104.00 60 12 40 40 32 13 30 20 80 22 50 42 23 10 50 50 26 40 35 26 20 20 15 72 828
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 103 30 35 160 34 50 40 66 70 40 62 85 32 35 70 105 20 20 85 20 25 70 82 30 100 1469
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 30 30 20 20 20 52 40 50 40 36 40 40 40 20 10 50 35 10 50 30 6 20 20 20 10 739
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 3 1 3 7
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 29 18 28 16 23 12 20 15 21 16 48 12 14 10 16 31 5 10 24 10 14 3 27 17 439
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 0
18 Asam folat 1 mg TABLET Rp 67.00 20 10 30 10 120 7 197
19 Asam mefenamat 500mg TABLET Rp 106.00 74 42 30 110 20 20 30 36 55 48 50 30 20 20 56 30 10 20 50 20 10 40 35 20 60 936
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Asiklovir 400mg TABLET Rp 349.00 56 30 86
22 Betahistin mesilat 5 mg TABLET Rp 149.00 10 10 10 20 10 10 20 20 6 16 20 22 10 10 20 214
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
24 Bromhexin 8 mg TABLET 0
25 Cefadroxil 500 mg KAPSUL Rp 516.00 16 10 7 8 10 16 10 6 6 89
26 Cetirizin 10mg TABLET Rp 143.00 2 6 10 12 6 13 34 9 92
27 Deksametason 0,5 mg TABLET Rp 44.00 37 55 80 18 19 52 8 31 75 4 76 6 28 64 113 93 54 46 52 36 52 30 41 50 1120
28 Dekstrometorfan 15 mg TABLET Rp - 0
29 Digoksin 0,25 mg TABLET Rp 105.00 0
30 Diltiazem 30 mg TABLET Rp 127.00 0
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00 5 20 10 16 6 16 6 12 40 6 10 36 183
32 Doksisiklin 100mg KAPSUL Rp 268.00 0
33 Domperidon tablet 10 mg TABLET Rp 118.00 20 10 10 20 36 2 10 35 6 6 155
34 Efedrin HCL 25 mg TABLET Rp 47.00 0
35 Eritromisin 500mg KAPLET Rp 730.00 15 10 25
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 6 10 10 10 10 46
37 Furosemid 40 mg TABLET Rp 78.00 5 5 5 10 10 2 4 20 61
38 Glibenklamid 5 mg TABLET Rp 100.00 5 20 6 31
39 Glimepiride tablet 2 mg TABLET Rp 289.00 10 20 10 10 2 10 6 8 16 92
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Gliseril Guaiakolat 100 mg TABLET Rp - 155 71 102 100 99 60 19 37 58 26 11 38 776
41 Griseofulvin 125 mg TABLET Rp 245.00 0
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 10 6 26
44 Ibuprofen 400 mg TABLET Rp 127.00 10 30 30 10 10 90
45 Ibuprofen 200 mg TABLET Rp 105.00 6 20 10 16 10 20 10 36 20 10 50 6 27 21 10 32 304
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 0
47 Kalium Diklofenac 50mg TABLET Rp 200.00 0
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 20 10 5 10 280 15 37 30 407
49 Kaptopril 25 mg TABLET Rp 80.00 30 10 10 1 14 10 15 7 10 10 5 16 138
50 Kaptopril 12,5 mg TABLET Rp 62.00 1 25 1 10 10 10 10 6 12 10 6 60 161
51 Ketokonazol 200mg tablet TABLET Rp 280.00 10 14 10 10 10 54
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 10 10 20 10 30 30 10 10 10 10 10 15 40 20 25 260
53 Klopidogrel TABLET Rp 2,000.00 0
54 Kloramfenikol kapsul 500 mg KAPSUL Rp 249.00 20 15 15 5 55
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 74 8 10 73 57 20 23 22 55 27 13 16 5 26 66 27 12 56 11 35 30 22 72 760
56 Klorokuin tablet 150 mg TABLET Rp - 0
57 Klorpropamid tablet 100 mg TABLET Rp - 0
Kotrimoksazol anak
58 (Sulfametoksazol100mg+Trimetoprim20mg) TABLET 0
Rp -
Kotrimoksazol dewasa kombinasi :
59 Sulfametoksazol400mg+Trimetoprim80mg TABLET 15 15
Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00 0
61 Lisinopril 5mg tablet TABLET Rp 269.00 12 10 20 12 20 10 10 10 15 119
62 Loratadin tablet 10 mg TABLET Rp 134.00 66 23 43 77 102 54 34 23 52 61 76 24 56 23 33 42 30 40 54 26 62 13 24 26 46 1110
63 Mebendazol tablet 100 mg TABLET Rp - 0
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00 5 20 5 6 6 15 29 6 41 22 6 22 18 12 12 52 38 7 30 60 36 16 464
65 Metformin 850mg tablet TABLET 20 14 34
66 Metformin 500mg tablet TABLET Rp 100.00 10 70 15 45 10 10 20 10 10 20 20 2 10 15 15 20 302
67 Metil Prednisolon 4 mg TABLET Rp 194.00 6 20 6 10 6 6 6 6 12 6 6 6 12 16 124
68 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
69 Metoklopramid 5mg TABLET Rp 123.00 6 10 18 18 16 22 28 118
70 Metronidazol 250 mg TABLET Rp 78.00 0
71 Metronidazol 500mg TABLET Rp 133.00 10 10 10 10 10 10 10 70
72 N-asetylsistein KAPSUL Rp 1,100.00 30 3 30 20 20 55 101 78 96 54 70 45 110 106 80 86 31 58 42 48 10 62 1235
73 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
74 Natrium Diklofenac 50 mg TABLET Rp 159.00 30 10 10 50 18 18 10 18 54 18 18 70 12 6 24 16 18 8 30 42 36 26 18 46 42 648
75 Nifedipin 10 mg tablet TABLET Rp 104.00 10 10
76 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 5 5 5 15
77 Omeprazole 20mg TABLET Rp 160.00 18 6 40 20 30 6 18 17 6 6 6 18 15 12 12 30 41 14 18 46 379
78 Ondansetron tab TABLET Rp 160.00 0
78 Parasetamol 100 mg TABLET Rp 200.00 0
79 Parasetamol 500 mg TABLET Rp 56.00 217 87 95 145 40 164 120 156 163 217 160 100 82 110 138 132 166 88 145 91 82 111 90 117 129 3145
80 Pirantel 125 mg TABLET Rp 269.00 0
81 Pirasetam 800 mg tablet TABLET Rp 62.00 0
82 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 45 8 191 215 10 48 517
83 Prednison tablet 5 mg TABLET Rp 96.00 15 120 30 30 195
84 Primakuin tablet 15 mg TABLET Rp - 0
85 Propanolol HCL tablet 10 mg TABLET Rp 52.00 30 6 36
86 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
87 Ranitidin tablet 150 mg TABLET Rp 105.00 22 10 10 15 12 18 6 12 36 16 12 12 18 6 30 20 24 21 26 30 15 6 36 16 429
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
88 Salbutamol tablet 2 mg TABLET Rp 66.00 10 10 6 2 5 10 22 2 20 19 2 108
89 Salbutamol tablet 4 mg TABLET Rp 80.00 10 10 10 16 10 10 10 10 10 6 102
90 Simvastatin 10 mg TABLET Rp 131.00 70 20 5 14 10 10 40 10 20 12 23 90 10 11 5 16 8 20 10 30 434
91 Siprofloksazin tablet 500 mg TABLET Rp 281.00 7 20 3 10 10 17 10 20 6 10 6 3 122
92 Spironolactone 25 mg TABLET Rp 315.00 16 16
Tablet Tambah Darah Kombinasi : Besi sulfat
93 TABLET 30 30 20 5 30 30 10 60 15 34 5 15 35 600 10 35 964
200mg+Asam folat 0,25mg Rp 355.00
94 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
95 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
96 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 15 30 15 60
97 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 0
98 Vitamin B Kompleks TABLET Rp 115.00 88 72 56 125 196 49 115 153 130 120 208 57 23 148 118 54 189 51 101 44 52 61 90 52 63 2415
99 Zinc 10 mg TABLET Rp 513.00 5 10 13 5 15 15 10 3 25 5 10 6 10 132
b. Injeksi 0
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL 0
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
c. Salep 0
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 1 1 2
3 Betametason krim 0,1 % TUBE Rp 1,349.00 1 1 1 2 1 2 2 2 1 1 1 2 1 18
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 0
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 2 3 1 2 1 1 1 1 2 2 1 1 2 4 1 2 28
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 0
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 3 4
9 Ketokonazol krim 2% TUBE Rp - 1 1 1 3
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
11 Miconazol cream 2 % TUBE Rp 3,000.00 1 1 2
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 1
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 1 1 1 3
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 1 2 1 4
d. Serbuk 0
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 3 6 15 24
2 Salisil Bedak 2 % POT Rp 1,025.00 1 1 1 1 4
e. Sirup 0
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 1 1 1 1 1 1 7
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 1 1 1 1 1 2 1 1 1 2 2 2 3 19
3 Cetirizin Syr BOTOL Rp - 0
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 0
5 Eritromisin sirup BOTOL Rp 6,150.00 0
6 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 1 1 1 1 4
7 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 0
Kotrimoksazol Suspensi komb: Sulfametoksazol
8 200mg+Trimetoprim40mg/5ml BOTOL 1 1 2 1 5
Rp 2,286.00
9
Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
10
Metronidazole Sirup BOTOL Rp 9,950.00 0
11
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 2 1 2 2 2 1 2 1 1 2 17
12
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 5 2 3 2 1 5 5 2 1 2 1 1 1 2 1 34
13
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
14
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1 1
15
Thiamfenikol syr BOTOL Rp - 0
d. Tetes 0
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 1 2 1 1 6
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 2 1 1 1 2 1 2 1 1 13
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1 1 1 3
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 1 3 2 1 7
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Demacolin TABLET 0
13 Dextrofen sirup BOTOL 4 2 1 1 2 1 1 1 1 1 1 16
14 Herbakof sirup BOTOL 1 1 2 2 1 7
15 Hiopar TABLET Rp 1,360.00 0
16 Laxadin sirup BOTOL Rp 12,450.00 2 1 1 2 6
17 Lactodiar SACHET Rp - 0
18 Lytamin syrup BOTOL Rp 5,000.00 0
19 Mecobion tablet TABLET Rp 1,000.00 0
20 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
21 Microlax BIJI Rp - 0
22 Neucompli TABLET Rp 5,500.00 5 20 16 36 10 30 40 157
23 Neurotropik plus TABLET Rp - 0
24 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
25 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
26 Noza TABLET Rp 11,500.00 0
27 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 1 3 2 1 3 1 1 1 13
28 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
29 Parasetamol supp BIJI Rp 1,500.00 0
30 Pehacain injeksi AMPUL Rp 12,155.00 0
31 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 1 1 1 3 1 3 2 4 2 1 3 1 1 24
32 Salbutamol rotacaps KAPSUL Rp 450.00 0
33 Salbutamol rotahaler PCS Rp - 0
34 Sotatic Inj AMPUL Rp 1,650.00 0
35 Spasminal/Scopma TABLET Rp 1,360.00 0
36 Puralex TABLET Rp 140.00 5 10 20 30 30 10 10 10 40 20 20 20 30 6 10 10 16 297
37 Ulsidex TABLET Rp 424.00 30 30
38 Ventolin nebulizer BOTOL Rp 4,000.00 0
39 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi 0
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa 0
1 Amitriptyllin 25 mg TABLET Rp 143.00 1 10 2 4 6 1 24
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik 0
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru 0
1 Isoniazid (INH) 100mg TABLET 28 7 21 11 36 17 14 9 87 14 14 258
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
JUNI
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 0 10 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 17
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 10 6 10 0 0 0 0 10 0 0 0 10 0 0 0 0 0 0 46
5 Alopurinol 300 mg TABLET Rp 210.00 0
6 Ambroxol 30 mg TABLET Rp 100.00 70 50 50 101 30 37 46 49 20 22 20 20 32 33 32 20 4 25 661
7 Amlodipin 5 mg TABLET Rp 105.00 38 20 30 20 30 35 10 0 10 5 0 45 75 18 0 0 30 78 444
8 Amlodipin 10 mg TABLET Rp 104.00 66 22 5 20 5 20 6 40 41 10 5 0 7 20 36 25 20 20 368
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 70 53 20 60 70 65 44 90 55 0 30 50 95 27 70 30 15 93 937
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 60 20 10 70 10 20 20 30 40 10 0 10 30 0 20 0 20 0 370
14 Anti
Hemoroid (Bismut
TABLET 1 0 0 0 0 0 3 0 0 0 0 0 0 0 3 3 3 1 14
subgallat150mg+Heksaklorofen2,5mg) Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 5 27 19 31 14 22 3 12 15 2 1 0 7 23 33 5 15 25 259
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 0
18 Asam folat 1 mg TABLET Rp 67.00 0 0 85 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 105
19 Asam mefenamat 500mg TABLET Rp 106.00 0 20 20 60 40 40 48 56 60 0 20 70 30 20 60 40 15 10 609
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Asiklovir 400mg TABLET Rp 349.00 0 0 0 0 0 0 26 0 0 0 0 0 70 0 0 0 0 0 96
22 Betahistin mesilat 5 mg TABLET Rp 149.00 10 10 20 0 0 0 7 10 6 0 20 0 10 0 0 0 10 10 113
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
Bromhexin 8 mg TABLET 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 10
24 Candesartan 8 TABLET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 10
25 Cefadroxil 500 mg KAPSUL Rp 516.00 0 0 10 0 20 0 0 10 35 5 10 0 40 20 40 10 0 20 220
26 Cetirizin 10mg TABLET Rp 143.00 28 26 24 51 14 3 46 42 36 13 9 34 70 19 15 20 23 18 491
27 Deksametason 0,5 mg TABLET Rp 44.00 46 29 60 40 41 38 5 22 12 9 10 3 16 5 15 16 16 6 389
28 Dekstrometorfan 15 mg TABLET Rp - 0
29 Digoksin 0,25 mg TABLET Rp 105.00 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
30 Diltiazem 30 mg TABLET Rp 127.00 0
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00 26 30 0 10 0 0 4 6 0 10 10 0 10 0 20 0 10 6 142
32 Doksisiklin 100mg KAPSUL Rp 268.00 0
33 Domperidon tablet 10 mg TABLET Rp 118.00 0
34 Efedrin HCL 25 mg TABLET Rp 47.00 0
35 Eritromisin 500mg KAPLET Rp 730.00 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 8
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 10 0 0 10 10 0 10 0 0 0 0 0 20 0 0 0 0 0 60
37 Furosemid 40 mg TABLET Rp 78.00 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 10
38 Glibenklamid 5 mg TABLET Rp 100.00 0 0 12 0 0 0 10 0 0 0 0 0 10 0 0 0 0 0 32
39 Glimepiride tablet 2 mg TABLET Rp 289.00 0 0 17 10 0 0 0 0 0 0 0 10 10 0 0 0 5 20 72
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Gliseril Guaiakolat 100 mg TABLET Rp - 0 22 40 0 24 47 30 20 31 3 11 55 80 36 20 10 20 40 489
41 Griseofulvin 125 mg TABLET Rp 245.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 9
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 5 15
44 Ibuprofen 400 mg TABLET Rp 127.00 0 0 30 10 10 16 10 5 3 0 5 0 8 0 0 13 3 10 123
45 Ibuprofen 200 mg TABLET Rp 105.00 10 10 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 30
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2
47 Kalium Diklofenac 50mg TABLET Rp 200.00 0
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 0 5 50 5 0 0 0 10 0 0 0 0 35 0 10 0 0 0 115
49 Kaptopril 25 mg TABLET Rp 80.00 6 10 0 12 30 0 0 0 0 0 0 0 3 0 0 0 0 1 62
50 Kaptopril 12,5 mg TABLET Rp 62.00 16 0 0 0 0 0 10 1 25 0 0 6 25 0 0 0 0 20 103
51 Ketokonazol 200mg tablet TABLET Rp 280.00 7 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 27
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 20 25 0 45 15 10 25 25 15 10 10 10 15 10 10 10 30 25 310
53 Klopidogrel TABLET Rp 2,000.00 0
54 Kloramfenikol kapsul 250 mg KAPSUL Rp 249.00 0
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 50 49 35 21 72 39 57 74 14 22 10 105 106 57 111 30 12 42 906
56 Klorokuin tablet 150 mg TABLET Rp - 0
57 Klorpropamid tablet 100 mg TABLET Rp - 0
58 Kotrimoksazol anak TABLET 0
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
59 Kotrimoksazol dewasa kombinasi : TABLET 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 15 0 0 35
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00 0
61 Lisinopril 5mg tablet TABLET Rp 269.00 0
62 Loratadin tablet 10 mg TABLET Rp 134.00 16 0 12 28 17 37 0 0 5 0 0 5 0 0 0 0 0 0 120
63 Mebendazol tablet 100 mg TABLET Rp - 0
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00 52 29 6 35 16 0 32 17 12 6 10 5 12 12 16 5 0 12 277
65 Metformin 500mg tablet TABLET Rp 100.00 15 10 50 10 o0 15 0 2 2 0 0 10 0 15 2 10 15 10 166
66 Metil Prednisolon 4 mg TABLET Rp 194.00 6 0 0 34 16 10 6 0 0 0 0 0 0 7 6 6 0 3 94
67 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0 10 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 16
68 Metoklopramid 5mg TABLET Rp 123.00 0 5 10 0 10 0 0 0 0 0 0 5 0 0 10 5 45
69 Metronidazol 250 mg TABLET Rp 78.00 0
70 Metronidazol 500mg TABLET Rp 133.00 20 15 0 10 15 10 10 0 10 0 0 10 15 0 10 0 0 15 140
71 N-asetylsistein KAPSUL Rp 1,100.00 70 90 30 10 40 36 20 40 10 103 40 50 50 10 20 20 40 0 679
72 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
73 Natrium Diklofenac 50 mg TABLET Rp 159.00 54 70 22 34 12 18 30 30 44 6 12 49 30 28 22 6 18 66 551
74 Nifedipin 10 mg tablet TABLET Rp 104.00 0
75 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 0 3 0 0 0 0 0 0 0 0 0 3 5 0 0 0 0 0 11
76 Omeprazole 20mg TABLET Rp 160.00 16 33 0 41 12 6 15 12 6 6 0 24 12 0 0 10 6 24 223
77 Ondansetron tab TABLET Rp 160.00 0
78 Parasetamol 100 mg TABLET Rp 200.00 0
79 Parasetamol 500 mg TABLET Rp 56.00 198 150 150 148 149 115 45 138 126 53 65 93 170 90 122 70 40 133 2055
80 Pirantel 125 mg TABLET Rp 269.00 0
81 Pirasetam 800 mg tablet TABLET Rp 62.00 0
82 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 35 203 65 14 166 10 0 98 0 0 58 0 8 276 0 6 113 5 1057
83 Prednison tablet 5 mg TABLET Rp 96.00 0 0 0 0 56 0 0 30 0 0 0 10 0 0 0 0 0 45 141
84 Primakuin tablet 15 mg TABLET Rp - 0
85 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
86 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
87 Ranitidin tablet 150 mg TABLET Rp 105.00 18 24 38 24 0 24 28 12 6 3 0 18 6 0 6 0 0 0 207
88 Salbutamol tablet 2 mg TABLET Rp 66.00 10 10 0 10 0 10 0 2 0 0 11 0 0 1 20 0 3 0 77
89 Salbutamol tablet 4 mg TABLET Rp 80.00 10 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 20
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
90 Simvastatin 10 mg TABLET Rp 131.00 27 25 15 10 5 15 15 0 10 10 0 30 47 10 0 0 0 80 299
91 Siprofloksazin tablet 500 mg TABLET Rp 281.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 0 10 0 24
92 Spironolactone 25 mg TABLET Rp 315.00 0 0 0 0 10 0 0 0 37 0 0 0 0 0 0 0 0 0 47
93 Tablet Tambah Darah Kombinasi : Besi sulfat TABLET 20 7 415 0 10 0 30 10 20 0 0 10 70 0 20 0 0 0 612
200mg+Asam folat 0,25mg Rp 355.00
94 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
95 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
96 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 0 0 0 0 10 0 30 0 0 0 0 0 0 0 0 0 0 0 40
97 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 0
98 Vitamin B Kompleks TABLET Rp 115.00 76 52 40 73 71 46 26 26 58 17 30 70 86 39 38 46 23 66 883
99 Zinc 10 mg TABLET Rp 513.00 10 0 0 0 5 0 0 30 0 0 5 5 10 0 0 0 6 0 71
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
18 Lidokain
komp injeksi,Kombinasi:Lidokain HCl2%
AMPUL 0
+Epinefrin1:80000-2ml Rp 1,937.00
19
Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20
Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21
Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22
Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23
Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24
Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25
Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26
Omeprazole Injeksi AMPUL Rp 11,868.00 0
27
Ondansetron injeksi AMPUL Rp 1,650.00 0
28
Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29
Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30
Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31
Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32
Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33
Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
34
Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35
Vitamin B Kompleks injeksi AMPUL Rp - 0
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1
3 Betametason krim 0,1 % TUBE Rp 1,349.00 0 0 0 1 0 2 3 0 0 0 0 0 0 1 0 2 0 0 9
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 0
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 2 2 0 0 3 0 0 1 0 0 1 0 1 1 1 2 1 16
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 0 2 0 0 0 0 2 1 1 0 0 0 0 0 0 0 0 0 6
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 2 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 4
9 Ketokonazol krim 2% TUBE Rp - 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 3
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
11 Miconazol cream 2 % TUBE Rp 3,000.00 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 3
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 0
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 2
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 4 0 0 0 0 0 0 6 0 10 0 0 0 0 3 0 6 0 29
2 Salisil Bedak 2 % POT Rp 1,025.00 0
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 0 0 0 2 0 1 0 2 1 0 0 9 6 0 0 2 5 0 28
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 1 2 1 3 3 0 3 0 1 0 1 1 4 4 3 0 2 2 31
3 Cetirizin Syr BOTOL Rp - 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 0 4
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 0
5 Eritromisin sirup BOTOL Rp 6,150.00 0
6 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 0
7 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
8 Kotrimoksazol
Suspensi komb: Sulfametoksazol
200mg+Trimetoprim40mg/5ml BOTOL 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Rp 2,286.00
9
Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
10
Metronidazole Sirup BOTOL Rp 9,950.00 0
11
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 0 0 0 3 0 1 0 2 0 0 0 1 0 1 2 2 0 2 14
12
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 0 0 0 4 1 1 1 0 1 0 1 0 0 2 0 4 1 0 16
13
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
14
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 0
15
Thiamfenikol syr BOTOL Rp - 0
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 0 2 0 0 0 0 0 0 1 0 1 0 0 2 0 0 0 1 7
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 4
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 2
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 0 0 3 0 1 2 0 0 0 0 0 1 1 2 0 0 0 0 10
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Demacolin TABLET 0
13 Dextrofen syr BOTOL Rp 0 1 1 0 0 0 2 0 0 2 3 1 1 4 3 3 0 4 25
14 Herbakof syr BOTOL 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
15 Hiopar TABLET Rp 1,360.00 0
16 Laxadin sirup BOTOL Rp 12,450.00 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2
17 Lactodiar SACHET Rp - 0
18 Lytamin syrup BOTOL Rp 5,000.00 0
19 Mecobion tablet TABLET Rp 1,000.00 0
20 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
21 Microlax BIJI Rp - 0
22 Neucompli TABLET Rp 5,500.00 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 10 20 40
23 Neurotropik plus TABLET Rp - 0
24 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
25 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
26 Noza TABLET Rp 11,500.00 0
27 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 0 1 1 1 3 2 0 0 4 0 0 0 1 0 0 0 0 1 14
28 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
29 Parasetamol supp BIJI Rp 1,500.00 0
30 Pehacain injeksi AMPUL Rp 12,155.00 0
31 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 0 0 2 0 0 1 0 1 1 1 0 1 0 0 0 1 0 0 8
32 Salbutamol rotacaps KAPSUL Rp 450.00 0
33 Salbutamol rotahaler PCS Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
34 Sotatic Inj AMPUL Rp 1,650.00 0
35 Spasminal/Scopma TABLET Rp 1,360.00 0
36 Puralex TABLET Rp 140.00 20 0 0 20 0 0 0 0 0 10 0 0 20 20 10 0 0 20 120
37 Ulsidex TABLET Rp 424.00 0
38 Ventolin nebulizer BOTOL Rp 4,000.00 0
39 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 6
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 2 6
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru
1 Isoniazid (INH) 100mg TABLET 0 21 31 20 7 0 0 0 0 0 0 0 0 74 0 0 7 0 160
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
JULI
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 0
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 30 0 5 0 0 0 20 0 0 10 10 10 10 20 10 5 20 10 160
5 Alopurinol 300 mg TABLET Rp 210.00 10 10
6 Ambroxol 30 mg TABLET Rp 100.00 30 0 5 0 0 0 20 0 0 10 10 20 20 23 28 30 40 45 20 45 13 25 25 5 13 427
7 Amlodipin 5 mg TABLET Rp 105.00 15 20 16 0 20 5 13 5 10 6 0 22 10 13 17 10 35 10 17 5 35 20 3 30 337
8 Amlodipin 10 mg TABLET Rp 104.00 35 35 14 20 55 60 58 42 20 15 60 27 13 3 20 11 30 65 40 50 24 10 20 40 40 18 40 865
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 90 100 68 75 10 30 65 30 30 30 10 40 46 35 55 48 25 70 40 118 45 30 25 90 67 70 1342
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 50 26 48 30 0 70 30 21 20 10 10 9 30 10 30 10 50 20 10 20 65 10 36 20 635
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 1 0 0 0 6 0 0 0 0 3 0 3 5 3 3 24
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 26 55 16 32 15 2 13 24 8 16 50 5 29 27 10 20 20 13 15 12 50 22 36 15 531
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 25 8 33
18 Asam folat 1 mg TABLET Rp 67.00 60 0 0 0 0 0 70 0 90 0 0 15 15 10 30 15 40 345
19 Asam mefenamat 500mg TABLET Rp 106.00 80 40 40 42 20 10 35 26 10 16 10 10 36 30 50 20 5 20 40 26 46 23 40 46 75 65 52 913
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Aspilet / miniaspi 80mg TABLET 0 2 0 0 0 0 0 0 0 0 0 2
22 Asiklovir 400mg TABLET Rp 349.00 0 0 9 0 70 0 0 70 0 0 0 20 20 70 259
23 Betahistin mesilat 5 mg TABLET Rp 149.00 0 10 6 0 22 0 0 0 0 10 0 10 10 10 10 6 10 30 10 16 16 S 20 196
24 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
25 Bromhexin 8 mg TABLET 0
26 Candesartan 8mg TABLET 10 2 12
27 Cefadroxil 500 mg KAPSUL Rp 516.00 20 20 10 30 30 10 55 20 0 25 20 16 6 16 10 20 30 30 50 20 20 10 10 478
28 Cetirizin 10mg TABLET Rp 143.00 27 22 27 20 27 26 35 42 10 10 32 48 11 26 18 20 31 55 40 24 29 24 17 43 33 48 5 750
29 Deksametason 0,5 mg TABLET Rp 44.00 10 0 0 0 0 10 0 0 0 0 17 26 9 18 6 10 6 16 16 10 20 6 19 10 12 27 248
30 Dekstrometorfan 15 mg TABLET Rp - 30 16 23 16 10 22 22 6 13 16 7 1 182
31 Digoksin 0,25 mg TABLET Rp 105.00 0
32 Diltiazem 30 mg TABLET Rp 127.00 0
33 Dimenhidrinat tablet 50mg TABLET Rp 99.00 5 12 10 10 10 10 57
34 Doksisiklin 100mg KAPSUL Rp 268.00 0
35 Domperidon tablet 10 mg TABLET Rp 118.00 0 10 0 0 0 0 2 0 0 0 0 10 2 26 10 6 13 10 9 10 20 20 148
36 Efedrin HCL 25 mg TABLET Rp 47.00 0
37 Eritromisin 500mg KAPLET Rp 730.00 0 0 0 0 15 6 0 0 4 0 0 10 20 12 10 77
38 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 0 0 0 0 0 0 0 0 0 5 10 3 18
39 Furosemid 40 mg TABLET Rp 78.00 0 0 0 0 0 0 0 5 0 0 5 2 3 15
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Glibenklamid 5 mg TABLET Rp 100.00 5 10 15
41 Glimepiride tablet 2 mg TABLET Rp 289.00 10 0 0 0 0 10 0 0 3 0 0 20 1 10 10 10 10 2 5 91
42 Gliseril Guaiakolat 100 mg TABLET Rp - 71 37 45 30 27 9 13 19 5 37 39 46 10 13 21 9 31 5 38 25 9 11 14 29 24 12 629
43 Griseofulvin 125 mg TABLET Rp 245.00 0 0 0 0 0 0 20 0 0 0 0 20
44 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0 0 5 0 0 0 3 0 0 0 0 8
45 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 10
46 Ibuprofen 400 mg TABLET Rp 127.00 10 0 6 0 0 6 0 23 5 25 0 6 9 15 10 10 13 138
47 Ibuprofen 200 mg TABLET Rp 105.00 5 5
48 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 0
49 Kalium Diklofenac 50mg TABLET Rp 200.00 0
50 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 0 0 0 10 10 0 700 15 1020 0 0 15 20 10 5 5 30 10 10 5 10 30 50 1955
51 Kaptopril 25 mg TABLET Rp 80.00 0 15 0 0 1 0 0 4 15 0 0 7 15 10 10 15 92
52 Kaptopril 12,5 mg TABLET Rp 62.00 0 0 10 0 15 0 0 5 0 13 10 20 10 3 5 20 12 10 10 20 40 10 213
53 Ketokonazol 200mg tablet TABLET Rp 280.00 0
54 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 10 45 20 0 60 10 10 0 10 35 34 10 10 30 35 10 10 15 15 10 379
55 Klopidogrel TABLET Rp 2,000.00 0 2 0 0 0 0 0 0 0 0 0 2
56 Kloramfenikol kapsul 250 mg KAPSUL Rp 249.00 10 0 0 0 0 0 0 0 0 0 0 20 30
57 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 37 78 84 22 45 20 32 48 19 33 20 40 12 12 30 19 6 30 93 37 10 15 32 30 56 32 892
58 Klorokuin tablet 150 mg TABLET Rp - 0
59 Klorpropamid tablet 100 mg TABLET Rp - 0
60 Kotrimoksazol anak TABLET 15 15
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
61 Kotrimoksazol dewasa kombinasi : TABLET 0 0 12 10 0 0 15 0 0 0 0 12 6 55
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
62 Levofloksasin 500 mg TABLET Rp 495.00 7 7
63 Lisinopril 5mg tablet TABLET Rp 269.00 0
64 Loratadin tablet 10 mg TABLET Rp 134.00 0 0 0 0 0 0 10 0 7 0 17 5 5 7 11 62
65 Mebendazol tablet 100 mg TABLET Rp - 0
66 Meloksikam tablet 7,5 mg TABLET Rp 629.00 33 12 16 0 0 6 12 50 32 6 22 23 6 3 17 12 6 16 25 7 18 22 6 10 46 16 422
67 Metformin 500mg tablet TABLET Rp 100.00 40 10 15 0 15 15 18 10 10 0 30 25 10 15 10 35 25 32 18 15 25 4 21 398
68 Metil Prednisolon 4 mg TABLET Rp 194.00 6 0 0 0 6 6 0 5 7 20 0 12 46 6 6 5 6 6 6 15 158
69 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
70 Metoklopramid 5mg TABLET Rp 123.00 3 3 10 16
71 Metronidazol 250 mg TABLET Rp 78.00 0
71 Methisoprinol 500mg TABLET 0 0 0 0 0 0 7 0 13 0 0 20
72 Metronidazol 500mg TABLET Rp 133.00 10 0 0 15 0 0 0 0 0 0 10 20 10 65
73 N-asetylsistein KAPSUL Rp 1,100.00 10 40 30 0 6 20 10 10 0 20 30 16 10 12 16 20 20 36 6 6 36 16 22 20 30 20 462
74 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
75 Natrium Diklofenac 50 mg TABLET Rp 159.00 16 24 11 28 72 24 48 46 23 34 22 6 18 26 32 48 34 16 56 50 12 30 28 40 26 6 56 832
76 Nifedipin 10 mg tablet TABLET Rp 104.00 10 10
77 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 3 0 0 0 0 0 0 0 0 0 5 7 3 3 21
78 Omeprazole 20mg TABLET Rp 160.00 20 18 12 16 0 42 23 14 16 10 0 6 18 13 12 22 12 12 22 19 6 32 28 11 16 5 15 420
79 Ondansetron tab TABLET Rp 160.00 10 0 0 0 16 0 6 0 0 0 0 10 10 6 10 10 6 10 94
80 Parasetamol 100 mg TABLET Rp 200.00 5 5
81 Parasetamol 500 mg TABLET Rp 56.00 165 259 198 123 97 128 254 84 75 51 115 104 86 66 97 95 96 122 90 215 124 55 118 139 85 183 78 3302
82 Pirantel 125 mg TABLET Rp 269.00 0
83 Pirasetam 800 mg tablet TABLET Rp 62.00 0
84 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 26 65 19 0 42 0 0 289 0 0 113 20 35 6 58 4 268 6 54 43 8 57 24 1137
85 Prednison tablet 5 mg TABLET Rp 96.00 0 0 0 0 0 0 0 0 0 0 30 30
86 Primakuin tablet 15 mg TABLET Rp - 0
87 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
88 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
89 Ranitidin tablet 150 mg TABLET Rp 105.00 12 22 6 0 0 0 6 4 33 36 0 23 40 10 18 30 22 18 24 22 12 12 35 18 10 12 22 447
90 Salbutamol tablet 2 mg TABLET Rp 66.00 30 0 0 0 6 20 10 20 10 10 0 10 10 16 30 10 3 10 10 2 207
91 Salbutamol tablet 4 mg TABLET Rp 80.00 0 0 0 16 0 0 0 0 0 0 0 10 6 32
92 Simvastatin 10 mg TABLET Rp 131.00 30 5 30 30 37 0 10 12 20 30 0 32 15 5 15 10 10 20 20 20 5 10 40 20 42 20 488
93 Siprofloksazin tablet 500 mg TABLET Rp 281.00 0 10 0 0 0 30 10 10 10 10 0 10 34 20 10 10 7 171
94 Spironolactone 25 mg TABLET Rp 315.00 0
Tablet Tambah Darah Kombinasi : Besi sulfat
95 200mg+Asam folat 0,25mg TABLET 10 0 10 20 10 0 760 10 990 10 20 15 30 10 5 5 30 10 20 30 70 2065
Rp 355.00
96 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
97 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
98 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 0
99 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 0 0 0 0 0 0 20 0 9 0 0 29
100 Vitamin B Kompleks TABLET Rp 115.00 43 55 55 37 36 30 50 73 56 45 34 74 77 27 28 55 49 53 55 74 47 55 25 60 77 79 35 1384
101 Zinc 10 mg TABLET Rp 513.00 0 0 5 15 0 5 15 0 0 0 0 10 20 5 15 10 7 5 2 20 5 5 5 149
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL 0
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 2 2
3 Betametason krim 0,1 % TUBE Rp 1,349.00 1 0 0 0 2 0 0 0 1 1 1 1 2 3 1 1 14
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 0
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 0 0 0 0 1 2 0 0 0 0 2 2 1 1 3 1 1 2 1 2 20
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 1 0 0 0 0 0 0 0 0 0 1 1 4
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 0 0 1 0 2 0 0 1 1 0 1 2 1 1 1 1 2 14
9 Ketokonazol krim 2% TUBE Rp - 2 1 3
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
11 Miconazol cream 2 % TUBE Rp 3,000.00 0 1 1 1 0 1 1 3 1 0 0 1 1 1 1 13
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 3 1 5
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 1 1 2
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 0
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 0 0 5 10 0 5 0 6 0 0 6 15 5 7 5 10 12 5 5 6 5 107
2 Salisil Bedak 2 % POT Rp 1,025.00 0
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 1 1 1 2 4 9 2 5 0 3 1 1 1 2 1 1 1 2 1 2 42
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 1 4 3 0 0 2 3 0 5 0 1 1 2 2 3 5 2 3 2 2 41
3 Cetirizin Syr BOTOL Rp - 0 0 0 0 0 0 1 0 0 0 0 1
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 5 3 3 3 14
5 Domperidon BOTOL 0
6 Eritromisin sirup BOTOL Rp 6,150.00 0
7 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 0
8 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 0 0 0 0 0 0 1 0 0 0 0 1
Kotrimoksazol Suspensi komb: Sulfametoksazol
9 200mg+Trimetoprim40mg/5ml BOTOL 0 0 2 0 0 0 0 0 0 0 0 1 1 1 2 1 8
Rp 2,286.00
10 Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
11 Metronidazole Sirup BOTOL Rp 9,950.00 0
12 Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 1 0 0 0 1 0 0 0 1 0 1 1 5 6 1 1 1 1 1 2 24
13 Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 0 3 1 0 1 1 3 2 2 0 0 1 1 2 6 2 3 1 3 1 1 1 2 1 38
14 Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
15 Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 0 0 0 0 5 0 0 0 0 0 0 1 1 7
16 Thiamfenikol syr BOTOL Rp - 0
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 2 0 1 0 0 1 0 0 1 0 1 1 1 9
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 0 0 0 0 1 0 0 1 0 0 0 1 1 1 5
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 0 0 0 2 0 0 0 0 1 0 0 1 1 5
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 1 2 0 0 0 0 0 0 0 0 1 1 2 1 1 1 10
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Demacolin TABLET 0
13 Dextrofen sirup BOTOL 3 5 4 4 3 1 7 7 5 1 1 4 4 4 1 54
14 Herbacof sirup BOTOL 0 0 0 2 4 0 0 0 1 0 0 2 1 3 1 2 16
13 Hiopar TABLET Rp 1,360.00 0
14 Laxadin sirup BOTOL Rp 12,450.00 0
15 Lactodiar SACHET Rp - 0
16 Lytamin syrup BOTOL Rp 5,000.00 0
17 Mecobion tablet TABLET Rp 1,000.00 0
18 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
19 Microlax BIJI Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
20 Neucompli TABLET Rp 5,500.00 10 5 15
21 Neurotropik plus TABLET Rp - 0
22 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
23 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
24 Noza TABLET Rp 11,500.00 0
25 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 0 1 1 1 3 1 1 4 2 1 1 1 2 3 1 2 2 2 1 2 1 33
26 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
27 Parasetamol supp BIJI Rp 1,500.00 0
28 Pehacain injeksi AMPUL Rp 12,155.00 0
29 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 2 0 3 0 1 0 2 1 2 1 2 2 5 1 1 1 3 1 2 1 31
30 Salbutamol rotacaps KAPSUL Rp 450.00 0
31 Salbutamol rotahaler PCS Rp - 0
32 Sotatic Inj AMPUL Rp 1,650.00 0
33 Spasminal/Scopma TABLET Rp 1,360.00 0
34 Puralex TABLET Rp 140.00 0 0 0 15 0 20 30 0 20 0 0 10 14 20 30 10 10 20 10 10 10 10 10 20 269
35 Ulsidex TABLET Rp 424.00 0
36 Ventolin nebulizer BOTOL Rp 4,000.00 0
37 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 5 7 7 3 3 2 0 2 0 15 0 2 2 6 2 6 2 2 6 2 2 7 7 90
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru
1 Isoniazid (INH) 100mg TABLET 0 21 0 0 0 0 0 0 77 0 14 14 56 14 196
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT I JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
AGUSTUS
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 0
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 10 7 10 10 10 10 10 5 15 10 10 107
5 Alopurinol 300 mg TABLET Rp 210.00 0
6 Ambroxol 30 mg TABLET Rp 100.00 20 13 14 47 8 19 14 10 23 29 10 3 32 20 10 20 12 5 50 53 40 50 40 30 10 582
7 Amlodipin 5 mg TABLET Rp 105.00 65 36 10 10 10 5 30 10 2 10 45 40 15 10 10 50 30 10 20 20 50 488
8 Amlodipin 10 mg TABLET Rp 104.00 27 10 48 32 30 10 35 5 15 63 38 10 54 28 35 58 40 30 25 30 45 30 45 12 43 50 848
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 37 45 30 95 50 48 60 39 55 86 77 78 90 48 65 30 30 110 70 42 57 30 50 55 10 40 1427
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 10 10 10 20 20 30 30 20 16 10 10 50 30 50 30 10 46 40 442
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 3 3 7 2 3 3 21
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 12 57 21 38 36 44 29 4 20 26 6 20 8 34 19 12 10 10 47 12 14 45 25 35 29 613
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 0
18 Asam folat 1 mg TABLET Rp 67.00 30 20 10 15 10 20 105
19 Asam mefenamat 500mg TABLET Rp 106.00 25 52 81 60 50 80 20 20 70 38 20 35 26 61 10 26 40 40 30 40 10 40 60 10 30 974
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Asiklovir 400mg TABLET Rp 349.00 20 50 50 19 139
22 Betahistin mesilat 5 mg TABLET Rp 149.00 12 6 20 6 16 10 16 10 10 10 116
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
24 Bromhexin 8 mg TABLET 40 30 15 5 10 40 20 10 10 10 20 10 10 20 250
25 Candesartan 8mg TABLET 10 10 18 14 20 10 10 10 102
26 Cefadroxil 500 mg KAPSUL Rp 516.00 5 50 20 10 10 30 20 10 10 30 50 30 45 30 10 50 70 50 30 10 10 40 620
27 Cetirizin 10mg TABLET Rp 143.00 12 20 40 39 33 27 22 19 51 5 10 15 7 39 6 9 18 14 11 21 27 5 10 10 26 496
28 Deksametason 0,5 mg TABLET Rp 44.00 16 6 31 33 19 17 21 10 17 5 18 44 30 26 15 20 35 29 12 6 410
29 Dekstrometorfan 15 mg TABLET Rp - 0
30 Digoksin 0,25 mg TABLET Rp 105.00 0
31 Diltiazem 30 mg TABLET Rp 127.00 0
32 Dimenhidrinat tablet 50mg TABLET Rp 99.00 10 20 3 19 52
33 Doksisiklin 100mg KAPSUL Rp 268.00 0
34 Domperidon tablet 10 mg TABLET Rp 118.00 4 16 18 5 6 10 3 10 30 14 5 10 6 26 11 31 6 15 226
35 Efedrin HCL 25 mg TABLET Rp 47.00 0
36 Eritromisin 500mg KAPLET Rp 730.00 0
37 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 10 20 3 7 10 5 5 10 70
38 Furosemid 40 mg TABLET Rp 78.00 10 5 5 20
39 Glibenklamid 5 mg TABLET Rp 100.00 5 20 10 10 20 10 75
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Glimepiride tablet 2 mg TABLET Rp 289.00 16 15 10 5 10 15 10 5 20 106
41 Gliseril Guaiakolat 100 mg TABLET Rp - 17 12 16 75 18 21 4 9 22 2 20 3 22 43 12 9 18 14 11 30 9 13 400
42 Griseofulvin 125 mg TABLET Rp 245.00 0
43 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0
44 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 10 10 10 40
45 Ibuprofen 400 mg TABLET Rp 127.00 16 10 10 5 10 5 5 10 10 5 86
46 Ibuprofen 200 mg TABLET Rp 105.00 0
47 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 0
48 Kalium Diklofenac 50mg TABLET Rp 200.00 0
49 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 5 5 10 10 20 25 30 15 120
50 Kaptopril 25 mg TABLET Rp 80.00 25 20 2 47
51 Kaptopril 12,5 mg TABLET Rp 62.00 20 10 10 20 20 10 20 20 15 15 14 174
52 Ketokonazol 200mg tablet TABLET Rp 280.00 6 10 10 26
53 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 50 12 32 10 10 20 32 36 10 25 12 10 20 24 12 12 12 12 351
54 Klopidogrel TABLET Rp 2,000.00 0
55 Kloramfenikol kapsul 500 mg KAPSUL Rp 249.00 10 10
56 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 20 45 68 70 80 72 26 30 31 120 86 66 49 15 54 67 45 51 85 95 83 41 103 85 50 48 1585
57 Klorokuin tablet 150 mg TABLET Rp - 0
58 Klorpropamid tablet 100 mg TABLET Rp - 0
59 Kotrimoksazol anak TABLET 0
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
60 Kotrimoksazol dewasa kombinasi : TABLET 12 12 10 20 20 74
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
61 Levofloksasin 500 mg TABLET Rp 495.00 10 10 7 27
62 Lisinopril 5mg tablet TABLET Rp 269.00 0
63 Loratadin tablet 10 mg TABLET Rp 134.00 10 6 10 5 3 15 11 20 10 15 5 6 5 10 131
64 Mebendazol tablet 100 mg TABLET Rp - 0
65 Meloksikam tablet 7,5 mg TABLET Rp 629.00 11 21 18 6 6 6 12 4 11 6 5 5 5 33 30 18 10 5 212
66 Methisoprinol 500mg TABLET 15 20 20 10 10 75
67 Metformin 800mg TABLET 0
68 Metformin 500mg tablet TABLET Rp 100.00 7 6 35 25 30 10 10 7 10 25 15 10 10 30 10 10 10 20 280
69 Metil Prednisolon 4 mg TABLET Rp 194.00 5 5 62 6 6 6 7 12 6 28 16 159
70 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
71 Metoklopramid 5mg TABLET Rp 123.00 1 6 10 17
72 Metronidazol 250 mg TABLET Rp 78.00 0
73 Metronidazol 500mg TABLET Rp 133.00 10 15 20 30 75
74 N-asetylsistein KAPSUL Rp 1,100.00 10 13 46 66 46 30 20 30 10 60 20 6 20 32 16 10 10 50 20 10 36 6 26 30 623
75 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
76 Natrium Diklofenac 50 mg TABLET Rp 159.00 18 38 24 32 24 16 6 6 26 10 56 33 24 56 6 39 18 12 6 30 54 24 28 36 30 64 716
77 Nifedipin 10 mg tablet TABLET Rp 104.00 0
78 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 3 4 5 12
79 Omeprazole 20mg TABLET Rp 160.00 10 13 31 12 31 11 26 5 15 36 10 10 15 28 12 36 6 22 20 27 16 20 31 443
80 Ondansetron tab TABLET Rp 160.00 10 10 10 10 6 10 6 62
81 Parasetamol 100 mg TABLET Rp 200.00 0
82 Parasetamol 500 mg TABLET Rp 56.00 61 44 166 169 197 158 40 95 40 123 139 68 106 73 239 152 90 162 147 191 144 111 100 121 120 135 3191
83 Pirantel 125 mg TABLET Rp 269.00 0
84 Pirasetam 800 mg tablet TABLET Rp 62.00 0
85 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 113 20 10 252 15 88 14 90 24 5 72 24 210 89 3 17 77 15 56 14 1208
86 Prednison tablet 5 mg TABLET Rp 96.00 0
87 Primakuin tablet 15 mg TABLET Rp - 0
88 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
89 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
90 Ranitidin tablet 150 mg TABLET Rp 105.00 6 6 24 6 9 8 16 6 18 6 18 6 16 18 18 12 32 10 6 50 291
91 Salbutamol tablet 2 mg TABLET Rp 66.00 15 5 10 22 15 10 1 15 10 10 10 6 10 10 1 10 11 10 10 191
92 Salbutamol tablet 4 mg TABLET Rp 80.00 0
93 Simvastatin 10 mg TABLET Rp 131.00 20 5 40 16 10 20 10 10 20 20 30 20 30 10 20 60 50 40 10 50 491
94 Siprofloksazin tablet 500 mg TABLET Rp 281.00 20 10 10 10 30 10 10 10 10 30 20 170
95 Spironolactone 25 mg TABLET Rp 315.00 0
Tablet Tambah Darah Kombinasi : Besi sulfat
96 200mg+Asam folat 0,25mg TABLET 20 10 10 10 30 30 30 30 20 6 35 30 10 10 60 5 10 10 45 411
Rp 355.00
97 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
98 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
99 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 0
100 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 0
101 Vitamin B Kompleks TABLET Rp 115.00 84 33 64 59 25 56 39 34 20 56 31 13 45 44 46 60 32 67 18 55 72 27 35 30 45 98 1188
102 Zinc 10 mg TABLET Rp 513.00 5 20 10 20 15 20 5 10 18 13 10 10 156
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL 0
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 0
3 Betametason krim 0,1 % TUBE Rp 1,349.00 2 1 1 1 1 1 2 2 1 1 1 2 2 1 19
4 Bufacetin Salep Kulit TUBE Rp 3,008.00 3 3
5 Gameksan emulsi 1 % 30ml TUBE Rp - 0
6 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 1 4 2 2 1 1 2 3 3 1 2 1 4 1 1 30
7 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 1 1 1 1 1 6
8 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 2 2 1 1 3 3 3 1 1 2 20
9 Ketokonazol krim 2% TUBE Rp - 1 1 2
10 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
11 Miconazol cream 2 % TUBE Rp 3,000.00 5 1 1 1 2 1 1 12
12 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 0
13 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
14 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 1 1 2
15 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 0
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 11 17 10 20 10 5 27 16 36 17 10 6 6 5 22 6 5 10 239
2 Salisil Bedak 2 % POT Rp 1,025.00 0
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 1 1 2 2 3 2 2 2 1 1 1 19
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 1 3 3 1 1 3 1 3 5 2 1 1 1 4 1 1 1 2 3 2 4 2 1 47
3 Cetirizin Syr BOTOL Rp - 3 1 1 5
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 0
5 Domperidon tablet 10 mg BOTOL 0
6 Eritromisin sirup BOTOL Rp 6,150.00 0
7 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 0
8 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 0
Kotrimoksazol Suspensi komb: Sulfametoksazol
9 200mg+Trimetoprim40mg/5ml BOTOL 1 1 1 1 1 1 1 1 8
Rp 2,286.00
10 Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
11 Metronidazole Sirup BOTOL Rp 9,950.00 0
12 Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 3 3 6 2 5 4 4 2 4 2 1 1 1 4 3 8 2 3 3 1 62
13 Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 4 1 4 2 5 1 3 1 1 4 1 1 1 1 4 1 1 3 5 2 1 47
14 Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
15 Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1 1 1 3
16 Thiamfenikol syr BOTOL Rp - 0
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 1
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 2 1 1 1 1 2 8
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1 1
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 1 1 1 2 1 1 1 1 1 2 12
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Demacolin TABLET 0
13 Herbakof syr BOTOL 1 1
14 Hiopar TABLET Rp 1,360.00 0
15 Laxadin sirup BOTOL Rp 12,450.00 1 1 1 1 4
16 Lactodiar SACHET Rp - 0
17 Lytamin syrup BOTOL Rp 5,000.00 0
18 Mecobion tablet TABLET Rp 1,000.00 0
19 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
20 Microlax BIJI Rp - 0
21 Neucompli TABLET Rp 5,500.00 10 20 10 10 10 10 70
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
22 Neurotropik plus TABLET Rp - 6 20 26
23 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
24 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
25 Noza TABLET Rp 11,500.00 0
26 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 2 1 1 1 2 3 1 1 2 3 1 1 2 21
27 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
28 Parasetamol supp BIJI Rp 1,500.00 0
29 Pehacain injeksi AMPUL Rp 12,155.00 0
30 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 1 2 1 2 1 1 1 2 11
31 Salbutamol rotacaps KAPSUL Rp 450.00 0
32 Salbutamol rotahaler PCS Rp - 0
33 Sotatic Inj AMPUL Rp 1,650.00 0
34 Spasminal/Scopma TABLET Rp 1,360.00 0
35 Puralex TABLET Rp 140.00 10 10 10 10 20 10 20 30 10 30 30 40 40 30 10 20 10 30 30 20 10 20 450
36 Ulsidex TABLET Rp 424.00 0
37 Ventolin nebulizer BOTOL Rp 4,000.00 0
38 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 1 1
3 Mineral Mix PAKET 0
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 4 2 8 2 2 4 2 6 4 2 2 6 2 4 4 3 57
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru
1 Isoniazid (INH) 100mg TABLET 63 14 48 14 5 144
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 MB dewasa 0
9 Slide PAK 0
10 Slide box BOX Rp - 0
11 Sputum pot BIJI Rp 2,728.00 0
12 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
13 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
SEPTEMBER
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 10 10
2 Adalat Oros 20 mg TABLET Rp 3,255.00 0
3 Albendazol 400 mg TABLET Rp - 0
4 Alopurinol 100 mg TABLET Rp 90.00 10 5 10 10 20 20 30 10 10 10 10 10 155
5 Alopurinol 300 mg TABLET Rp 210.00 0
6 Ambroxol 30 mg TABLET Rp 100.00 47 28 23 20 33 40 50 10 20 34 36 45 41 10 10 22 22 33 7 25 35 591
7 Amlodipin 5 mg TABLET Rp 105.00 20 20 120 20 45 110 120 10 27 9 82 105 17 40 20 30 25 10 120 950
8 Amlodipin 10 mg TABLET Rp 104.00 55 45 130 25 70 10 21 20 40 35 13 71 20 20 60 10 20 60 13 738
9 Aminofilina 200 mg TABLET Rp 91.00 0
10 Amoksilin 250 mg KAPSUL Rp 195.00 0
11 Amoksilin 500 mg KAPLET Rp 232.00 88 38 25 55 43 20 42 35 10 79 25 30 95 16 51 35 22 15 30 48 50 41 25 35 40 993
12 Antalgin 500 mg TABLET Rp - 0
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 20 10 21 40 30 15 24 20 10 6 21 21 50 16 20 40 16 20 30 50 22 30 26 30 588
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 3 1 4 3 3 3 3 20
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00 0
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 40 35 48 22 25 20 15 16 58 12 55 19 47 32 17 17 5 19 10 19 24 28 18 24 38 663
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 0
18 Asam folat 1 mg TABLET Rp 67.00 15 10 20 15 20 50 60 20 20 25 50 40 10 10 365
19 Asam mefenamat 500mg TABLET Rp 106.00 50 36 20 86 10 62 25 20 40 40 30 40 20 30 40 6 40 60 83 25 32 20 56 871
20 Asetosal 100 mg TABLET Rp 130.00 0
21 Asiklovir 400mg TABLET Rp 349.00 50 55 20 30 56 211
22 Betahistin mesilat 5 mg TABLET Rp 149.00 10 10 30 10 6 10 20 10 20 10 20 10 10 20 196
23 Bisoprolol tablet 5 mg TABLET Rp 330.00 0
24 Bromhexin 8 mg TABLET 40 10 10 5 30 10 20 40 40 10 10 10 35 10 20 300
24 Candesartan 8 mg TABLET 30 10 10 50
25 Cefadroxil 500 mg KAPSUL Rp 516.00 50 38 22 10 20 40 20 10 20 30 20 70 60 30 30 26 10 20 30 20 30 25 20 40 691
26 Cetirizin 10mg TABLET Rp 143.00 27 5 5 31 32 11 12 18 19 27 17 23 12 7 2 248
27 Deksametason 0,5 mg TABLET Rp 44.00 28 12 18 12 18 16 32 16 15 15 6 52 25 22 6 4 6 30 29 6 6 374
28 Dekstrometorfan 15 mg TABLET Rp - 0
29 Digoksin 0,25 mg TABLET Rp 105.00 0
30 Diltiazem 30 mg TABLET Rp 127.00 0
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00 10 10 20
32 Doksisiklin 100mg KAPSUL Rp 268.00 0
33 Domperidon tablet 10 mg TABLET Rp 118.00 3 18 6 10 12 12 20 12 16 12 6 10 20 6 163
34 Efedrin HCL 25 mg TABLET Rp 47.00 0
35 Eritromisin 500mg KAPLET Rp 730.00 10 4 28 3 28 73
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 10 5 10 6 5 20 4 60
37 Furosemid 40 mg TABLET Rp 78.00 10 5 5 1 4 2 6 5 38
38 Glibenklamid 5 mg TABLET Rp 100.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
39 Glimepiride tablet 2 mg TABLET Rp 289.00 10 10 13 10 10 10 10 10 10 93
40 Gliseril Guaiakolat 100 mg TABLET Rp - 56 12 13 18 29 17 29 19 32 9 18 59 21 12 36 9 9 20 22 14 2 16 4 476
41 Griseofulvin 125 mg TABLET Rp 245.00 10 10 5 25
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00 0
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 10 16 6 42
44 Ibuprofen 400 mg TABLET Rp 127.00 11 10 6 5 6 5 30 10 5 15 10 20 133
45 Ibuprofen 200 mg TABLET Rp 105.00 0
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 1 2 3
47 Kalium Diklofenac 50mg TABLET Rp 200.00 0
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 10 104 10 50 6 5 20 10 60 20 10 30 335
49 Kaptopril 25 mg TABLET Rp 80.00 10 20 5 35
50 Kaptopril 12,5 mg TABLET Rp 62.00 10 10 10 16 15 20 10 15 26 14 5 10 25 10 10 30 10 246
51 Ketokonazol 200mg tablet TABLET Rp 280.00 4 14 14 10 7 49
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 12 10 15 24 12 22 24 20 10 10 12 32 12 12 12 10 10 259
53 Klopidogrel TABLET Rp 2,000.00 6 2 8
54 Kloramfenikol kapsul 500 mg KAPSUL Rp 249.00 10 10
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 91 100 78 66 88 90 59 52 130 96 70 75 74 40 81 60 51 60 58 86 107 82 82 59 30 1865
56 Klorokuin tablet 150 mg TABLET Rp - 0
57 Klorpropamid tablet 100 mg TABLET Rp - 0
58 Kotrimoksazol anak TABLET 0
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
59 Kotrimoksazol dewasa kombinasi : TABLET 20 10 30
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00 14 7 7 10 38
61 Lisinopril 5mg tablet TABLET Rp 269.00 2 2
62 Loratadin tablet 10 mg TABLET Rp 134.00 10 15 5 5 10 14 25 15 5 3 20 13 20 10 5 8 10 15 35 243
63 Mebendazol tablet 100 mg TABLET Rp - 0
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00 0
65 Metformin 500mg tablet TABLET Rp 100.00 15 15 10 30 15 15 25 48 10 15 20 15 55 288
66 Methisoprinol 500mg TABLET 6 8 14
67 Metil Prednisolon 4 mg TABLET Rp 194.00 11 26 18 6 6 6 6 8 26 5 118
68 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00 0
69 Metoklopramid 5mg TABLET Rp 123.00 20 10 6 6 42
70 Metronidazol 250 mg TABLET Rp 78.00 0
71 Metronidazol 500mg TABLET Rp 133.00 10 20 18 10 10 10 10 8 10 10 15 131
72 N-asetylsistein KAPSUL Rp 1,100.00 40 20 16 46 40 60 40 26 40 40 20 30 36 36 20 32 16 26 10 20 20 10 644
73 Natrium Diklofenac 25 mg TABLET Rp 132.00 0
74 Natrium Diklofenac 50 mg TABLET Rp 159.00 76 23 46 50 46 50 46 26 103 24 16 72 56 24 54 28 72 68 76 76 38 48 24 70 1212
75 Nifedipin 10 mg tablet TABLET Rp 104.00 0
76 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 3 5 8
77 Omeprazole 20mg TABLET Rp 160.00 22 17 29 21 6 12 23 44 6 10 4 22 17 21 15 11 20 6 28 21 21 10 5 7 12 410
78 Ondansetron tab TABLET Rp 160.00 10 12 10 20 10 6 6 10 10 20 12 126
79 Parasetamol 100 mg TABLET Rp 200.00 0
80 Parasetamol 500 mg TABLET Rp 56.00 163 124 141 115 142 132 104 99 209 81 81 80 162 129 125 96 93 76 115 105 181 149 160 128 175 3165
81 Pirantel 125 mg TABLET Rp 269.00 0
82 Pirasetam 800 mg tablet TABLET Rp 62.00 0
83 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 8 287 25 63 21 10 150 10 70 30 248 10 10 63 7 67 27 86 14 1206
84 Prednison tablet 5 mg TABLET Rp 96.00 5 84 89
85 Primakuin tablet 15 mg TABLET Rp - 0
86 Propanolol HCL tablet 10 mg TABLET Rp 52.00 0
87 Propiltiourasil tablet 100 mg TABLET Rp 100.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
88 Ranitidin tablet 150 mg TABLET Rp 105.00 24 12 12 22 6 6 6 17 12 6 12 6 10 6 10 6 10 16 6 4 6 12 227
89 Salbutamol tablet 2 mg TABLET Rp 66.00 30 20 15 10 10 10 10 6 10 10 131
90 Salbutamol tablet 4 mg TABLET Rp 80.00 0
91 Simvastatin 10 mg TABLET Rp 131.00 30 20 25 10 30 40 20 14 10 30 20 10 10 10 10 15 10 10 10 10 60 50 454
92 Siprofloksazin tablet 500 mg TABLET Rp 281.00 10 10 20 20 10 10 15 24 10 10 16 155
93 Spironolactone 25 mg TABLET Rp 315.00 0
94 Tablet Tambah Darah Kombinasi : Besi sulfat
200mg+Asam folat 0,25mg TABLET 10 10 56 10 45 30 30 30 60 10 20 30 11 50 402
Rp 355.00
95 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00 0
96 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00 0
97 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00 0
98 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 0
99 Vitamin B Kompleks TABLET Rp 115.00 42 60 74 65 33 63 63 37 50 55 37 79 98 60 68 47 62 74 70 72 76 38 83 59 68 1533
100 Zinc 10 mg TABLET Rp 513.00 5 15 8 10 12 5 5 5 10 5 80
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00 0
2 Amoxillin 1000 mg VIAL Rp 10,500.00 0
3 Ampisillin im/iv 1000mg/ml VIAL Rp - 0
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp - 0
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00 0
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00 0
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00 0
8 Ceftriaxone 1 gr injeksi VIAL Rp - 0
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00 0
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00 0
11 Epinefrin injeksi AMPUL Rp 2,204.00 0
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00 0
13 Fitomenadion (Vit K1)inj infant AMPUL Rp - 0
14 Furosemid injeksi AMPUL Rp 2,300.00 0
15 Gentamisin injeksi AMPUL Rp 3,386.00 0
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00 0
17 Kloramfenikol injeksi VIAL Rp - 0
18 Lidokain komp injeksi,Kombinasi:Lidokain HCl2% AMPUL 0
+Epinefrin1:80000-2ml Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00 0
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00 0
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00 0
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00 0
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp - 0
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp - 0
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00 0
26 Omeprazole Injeksi AMPUL Rp 11,868.00 0
27 Ondansetron injeksi AMPUL Rp 1,650.00 0
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp - 0
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp - 0
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00 0
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00 0
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00 0
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp - 0
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
35 Vitamin B Kompleks injeksi AMPUL Rp - 0
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00 0
2 Asiklovir krim 5% TUBE Rp 4,000.00 0
3 Bacitrasin salep TUBE 0
4 Betametason krim 0,1 % TUBE Rp 1,349.00 1 1 1 2 1 1 3 1 1 1 1 2 1 17
5 Bufacetin Salep Kulit TUBE Rp 3,008.00 2 1 1 4
6 Gameksan emulsi 1 % 30ml TUBE Rp - 0
7 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 1 2 3 7
8 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 2 3
9 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 1 1 1 1 1 1 2 1 1 2 2 1 1 17
10 Ketokonazol krim 2% TUBE Rp - 1 1 1 3
11 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 0
12 Miconazol cream 2 % TUBE Rp 3,000.00 1 1 1 1 1 1 1 1 1 1 2 12
13 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 1 1 3
14 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00 0
15 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 1 1
16 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00 1 1 2
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 11 12 16 10 12 10 21 6 6 12 116
2 Salisil Bedak 2 % POT Rp 1,025.00 0
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 2 1 1 1 1 1 1 1 1 1 1 1 14
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 2 2 1 3 1 3 2 2 2 1 1 1 1 1 2 25
3 Cetirizin Syr BOTOL Rp - 1 1 1 3
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp - 0
5 Domperidon sirup BOTOL 1 2 1 4
6 Eritromisin sirup BOTOL Rp 6,150.00 0
7 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 0
8 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00 1 1 2
Kotrimoksazol Suspensi komb: Sulfametoksazol
9 200mg+Trimetoprim40mg/5ml BOTOL 1 1 1 3
Rp 2,286.00
10
Mebendazol sirup 100 mg/5ml BOTOL Rp - 0
11
Metronidazole Sirup BOTOL Rp 9,950.00 0
12
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 2 2 1 1 7
13
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 3 4 1 2 1 3 2 2 5 5 2 2 6 4 2 3 47
14
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00 0
15
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1 1 2
16
Thiamfenikol syr BOTOL Rp - 0
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 1 2 1 1 1 2 9
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 1 1 3 1 1 1 1 2 1 13
3 Gentian violet larutan 1 % BOTOL Rp - 0
4 Karbo Glycerin BOTOL Rp - 0
5 Kloramfenikol tetes mata BOTOL Rp - 0
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1 1 1 1 2 1 1 8
7 Polikresulen ( Albothyl ) BOTOL Rp - 0
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp - 0
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2 Alat suntik sekali pakai 3 ml SET Rp 792.00 0
3 Alat suntik sekali pakai 5 ml SET Rp 979.00 0
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00 0
5 Alkohol swab PAK Rp 11,000.00 0
6 Aqua pro injeksi, bebas pirogen BOTOL Rp - 0
7 Aquadest steril BOTOL Rp 14,960.00 0
8 Blood Lancet PCS Rp 14,566.00 0
9 Blood Tranfusion set PCS Rp 14,300.00 0
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00 0
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00 0
12 Daryantulle LEMBAR Rp 8,990.00 0
13 Etanol 70 % BOTOL Rp - 0
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00 0
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00 0
16 Foley Catheter no.16 PCS Rp 18,450.00 0
17 Female Catheter no.16 PCS Rp 18,450.00 0
18 Female Catheter no.18 PCS Rp 18,450.00 0
19 Folley cath no. 18 PCS Rp 18,450.00 0
20 Hanschoen "50 KOTAK Rp 46,200.00 0
21 Hanschoen steril no 6.5 PCS Rp 9,854.00 0
22 Hanschoen steril no 7 PCS Rp 9,854.00 0
23 Hansaplast 5 cm ROLL Rp 25,404.00 0
24 Hansaplast 7,5 cm ROLL Rp 31,265.00 0
25 I.V. Catheter No 18 PCS Rp 8,700.00 0
26 I.V. Catheter No 20 PCS Rp 8,700.00 0
27 I.V. Catheter No 22 PCS Rp 8,700.00 0
28 I.V. Catheter No 24 PCS Rp 8,700.00 0
29 I.V. Catheter No 26 PCS Rp 8,700.00 0
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00 0
31 Infusion set anak PCS Rp 7,000.00 0
32 Infusion set dewasa PCS Rp 7,000.00 0
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00 0
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00 0
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00 0
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00 0
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00 0
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00 0
39 Kasa Steril PAK Rp 7,900.00 0
40 Kasa 4m x 5 cm PAK Rp 1,100.00 0
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00 0
42 Masker breathing (+ selang) PCS Rp 24,000.00 0
43 Masker non breathing PCS Rp 21,945.00 0
44 Masker N95 PCS Rp 390,000.00 0
45 My Jelly 82 gram TUBE Rp 29,550.00 0
46 Nasal kanul S PCS Rp 6,600.00 0
47 Nasal kanul L PCS Rp 6,600.00 0
48 NGT 7 x 75/80 PCS Rp - 0
49 Non woven fixation 5cm x 10 m BOX 0
50 One Med H2 O2 3 % BOTOL Rp - 0
51 One Med Surgical Blade PCS Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
52 Plester 5 yards x 2 inch ROL Rp 18,086.00 0
53 Plester infus (tegaderm) PCS Rp 224,200.00 0
54 Plester infus (e care + pot) PCS Rp 220,000.00 0
55 Plesterin PCS Rp 30,800.00 0
56 Policlean BOTOL Rp 608,000.00 0
57 Polyfix PAK Rp 43,850.00 0
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00 0
59 Spalk PCS Rp 61,600.00 0
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00 0
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00 0
62 Urine Bag PCS Rp - 0
63 Umbilical Cord "50 PAK Rp 65,000.00 0
64 Underpeds BIJI Rp 1,000.00 0
65 Unolab supercare Nitril powder BOX Rp 77,493.00 0
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00 0
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00 0
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp - 0
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00 0
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00 0
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00 0
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00 0
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00 0
5 KAEN 3B BOTOL Rp 10,050.00 0
6 KAEN 4B BOTOL Rp 15,730.00 0
7 Metronidazol infus BOTOL Rp 9,950.00 0
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00 0
9 Parasetamol Infus BOTOL Rp 12,940.00 0
10 Ringer Lactate infus steril BOTOL Rp 7,150.00 0
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00 0
2 Bioplasenton Jelly TUBE Rp 14,175.00 0
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00 0
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 0
5 Bufacomb TUBE Rp 3,008.00 1 1 1 2 1 1 1 1 2 1 1 1 3 2 19
6 Calporosis TABLET Rp 430.00 0
7 Cendo Lyters tetes mata BOTOL Rp 430.00 0
8 Cendo Xitrol tetes mata BOTOL Rp - 0
9 Chloramex 500 mg KAPSUL Rp - 0
10 Combivent Nebule BOTOL Rp 4,995.00 0
11 Citicholin inj. 250 mg / 2ml AMPUL Rp - 0
12 Demacolin TABLET 0
13 Hiopar TABLET Rp 1,360.00 0
14 Laxadin sirup BOTOL Rp 12,450.00 1 1
15 Lactodiar SACHET Rp - 0
16 Lytamin syrup BOTOL Rp 5,000.00 0
17 Mecobion tablet TABLET Rp 1,000.00 0
18 Metamizole injeksi 500mg AMPUL Rp 8,635.00 0
19 Microlax BIJI Rp - 0
20 Neucompli TABLET Rp 5,500.00 5 10 5 5 14 10 5 5 10 5 15 89
21 Neurotropik plus TABLET Rp - 0
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
22 Neurotropik injeksi 5000mcg AMPUL Rp 362.00 0
23 Novalgin/Antrain injeksi AMPUL Rp 3,575.00 0
24 Noza TABLET Rp 11,500.00 0
25 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 3 4 1 1 9
26 Pantocain Tetes Mata BOTOL Rp 11,500.00 0
27 Parasetamol supp BIJI Rp 1,500.00 0
28 Pehacain injeksi AMPUL Rp 12,155.00 0
29 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 2 2 1 1 1 2 3 1 1 2 1 1 1 2 21
30 Salbutamol rotacaps KAPSUL Rp 450.00 0
31 Salbutamol rotahaler PCS Rp - 0
32 Sotatic Inj AMPUL Rp 1,650.00 0
33 Spasminal/Scopma TABLET Rp 1,360.00 0
34 Puralex TABLET Rp 140.00 20 10 10 18 30 20 15 30 30 50 20 30 20 25 25 10 20 30 413
35 Ulsidex TABLET Rp 424.00 0
36 Ventolin nebulizer BOTOL Rp 4,000.00 0
37 Zirkum syr BOTOL Rp 14,980.00 0
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00 0
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 0
3 Mineral Mix PAKET 0
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 4 6 2 3 6 2 4 2 12 4 2 4 8 6 10 2 77
2 Clobazam 10mg tab TABLET Rp 967.00 0
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp - 0
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00 0
5 Fenitoin Natrium 30 mg KAPSUL Rp - 0
6 Haldol decanoat 50mg/ml inj AMPUL Rp - 0
7 Haloperidol 1,5 mg TABLET Rp 66.00 0
8 Haloperidol 5mg TABLET Rp 69.00 0
9 Karbamazepin 200 mg TABLET Rp 228.00 0
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp - 0
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp - 0
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00 0
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp - 0
14 Lodomer 5mg/ml inj AMPUL Rp - 0
15 Risperidone 2mg TABLET Rp 347.00 0
16 Sikzonoat 25mg/ml inj AMPUL Rp - 0
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00 0
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00 0
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00 0
2 Diazepam 2 mg TABLET Rp 45.00 0
3 Diazepam 5 mg TABLET Rp 80.00 0
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp - 0
5 Fenobarbital 30 mg TABLET Rp - 0
6 Kodein tablet 10mg TABLET Rp 550.00 0
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00 0
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00 0
9 Valdimex Inj AMPUL Rp 12,100.00 0
m. Serum
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00 0
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp - 0
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00 0
n. TB Paru
1 Isoniazid (INH) 100mg TABLET 21 14 14 11 60
2 Kombipack Kategori 1 PAKET Rp - 0
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00 0
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00 0
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00 0
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00 0
7 Obat Antituberkulosis Sisipan PAKET Rp - 0
8 Slide PAK 0
9 Slide box BOX Rp - 0
10 Sputum pot BIJI Rp 2,728.00 0
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp - 0
12 Ziehl nelseen PAKET Rp 276,600.00 0
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
OKTOBER
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00
2 Adalat Oros 20 mg TABLET Rp 3,255.00
3 Albendazol 400 mg TABLET Rp -
4 Alopurinol 100 mg TABLET Rp 90.00 10 10 20 10 20 5
5 Alopurinol 300 mg TABLET Rp 210.00
6 Ambroxol 30 mg TABLET Rp 100.00 47 36 20 58 22 44 25 30 21 10 34 45 38 15 2 2 63 55 28
7 Amlodipin 5 mg TABLET Rp 105.00 10 10 10 10 30 10 25 30 30 40 90 56 45 72 40 90 173 20
8 Amlodipin 10 mg TABLET Rp 104.00 50 30 30 60 20 40 42 30 10 65 20 10
9 Aminofilina 200 mg TABLET Rp 91.00
10 Amoksilin 250 mg KAPSUL Rp 195.00
11 Amoksilin 500 mg KAPLET Rp 232.00 55 89 22 30 30 60 55 40 50 20 44 40 40 20 55 20 70 56 35
12 Antalgin 500 mg TABLET Rp -
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 62 43 38 60 30 46 50 30 40 50 56 50 40 70 40 70 100
Anti Hemoroid (Bismut
14 subgallat150mg+Heksaklorofen2,5mg) TABLET 3 3 3 3 3 3 3 3 3
Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 14 10 24 25 12 17 10 27 11 43 18 30 17 10 22 22 6
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00
18 Asam folat 1 mg TABLET Rp 67.00 20 20 30 20 50 10
19 Asam mefenamat 500mg TABLET Rp 106.00 40 50 10 6 26
20 Asetosal 100 mg TABLET Rp 130.00
21 Asiklovir 400mg TABLET Rp 349.00 50 70 27
22 Betahistin mesilat 5 mg TABLET Rp 149.00 10 20 20 10 10 10 10 10 10 20 20
23 Bisoprolol tablet 5 mg TABLET Rp 330.00
24 Bromhexin 8 mg TABLET 10 15 30 10 30 10 30 20 10 10
25 Candesartan 8mg TABLET 10 10 20
26 Cefadroxil 500 mg KAPSUL Rp 516.00 35 10 50 20 20 40 10 10 10 40 20
27 Cetirizin 10mg TABLET Rp 143.00
28 Deksametason 0,5 mg TABLET Rp 44.00 16 24 24 12 12 14 6 12 10 25 3 12 21 24 18 16 9
29 Dekstrometorfan 15 mg TABLET Rp -
30 Digoksin 0,25 mg TABLET Rp 105.00
31 Diltiazem 30 mg TABLET Rp 127.00
32 Dimenhidrinat tablet 50mg TABLET Rp 99.00 10 6
33 Doksisiklin 100mg KAPSUL Rp 268.00
34 Domperidon tablet 10 mg TABLET Rp 118.00 30 52 20 10 22 2 12 26 16 8 5 20 34 20
35 Efedrin HCL 25 mg TABLET Rp 47.00
36 Eritromisin 500mg KAPLET Rp 730.00 55 28 10 9
37 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 5 10 10 5
38 Furosemid 40 mg TABLET Rp 78.00
39 Glibenklamid 5 mg TABLET Rp 100.00 5 10 20 20
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 Glimepiride tablet 2 mg TABLET Rp 289.00 10 10 10 10 30 20
41 Gliseril Guaiakolat 100 mg TABLET Rp - 9 24 4 18 20 18 2 5 27 9
42 Griseofulvin 125 mg TABLET Rp 245.00
43 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00
44 Hyosin N Butilbromida 10mg TABLET Rp 300.00 10 20 10 10 10 6 20 22
45 Ibuprofen 400 mg TABLET Rp 127.00 10 10 10 34 16 40 6 5 31 5 11 16 16
46 Ibuprofen 200 mg TABLET Rp 105.00
47 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00 10 1
48 Kalium Diklofenac 50mg TABLET Rp 200.00
49 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 35 10 10 10 25 2 49 30 5 10
50 Kaptopril 25 mg TABLET Rp 80.00
51 Kaptopril 12,5 mg TABLET Rp 62.00 10 10 10 24 10 20 10 10 20 66 40
52 Ketokonazol 200mg tablet TABLET Rp 280.00 20 7 10 10
53 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 12 10 10 12 22 12 10 10 10 22
54 Klopidogrel TABLET Rp 2,000.00 7 10
55 Kloramfenikol kapsul 250 mg KAPSUL Rp 249.00
56 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 102 75 74 67 52 59 33 30 76 45 71 110 97 66 32 18 35 44 3
57 Klorokuin tablet 150 mg TABLET Rp -
58 Klorpropamid tablet 100 mg TABLET Rp -
59 Kotrimoksazol anak TABLET
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
Kotrimoksazol dewasa kombinasi :
60 Sulfametoksazol400mg+Trimetoprim80mg TABLET 12 10 12
Rp 151.00
61 Levofloksasin 500 mg TABLET Rp 495.00 10
62 Lisinopril 5mg tablet TABLET Rp 269.00
63 Loratadin tablet 10 mg TABLET Rp 134.00 5 35 20 15 15 20 15 5 5 5 41 32 10 5 25 26 15
64 Mebendazol tablet 100 mg TABLET Rp -
65 Meloksikam tablet 7,5 mg TABLET Rp 629.00
66 Metformin 500mg tablet TABLET Rp 100.00 24 10 45 15 25 65 5 25 10 15 15 15 15
67 Metil Prednisolon 4 mg TABLET Rp 194.00 5 10 11 12 5 10 30 22
68 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00
69 Metoklopramid 5mg TABLET Rp 123.00 10
70 Metronidazol 250 mg TABLET Rp 78.00
71 Metronidazol 500mg TABLET Rp 133.00 20 20 15 15 65 30
72 N-asetylsistein KAPSUL Rp 1,100.00 20 26 42 22 20 10 12 30 40 10 10 10 9 10 20 10 10
73 Natrium Diklofenac 25 mg TABLET Rp 132.00
74 Natrium Diklofenac 50 mg TABLET Rp 159.00 55 52 46 29 46 81 42 45 66 48 85 70 51 54 48 47 53 42 12
75 Nifedipin 10 mg tablet TABLET Rp 104.00
76 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 3 3 2
77 Omeprazole 20mg TABLET Rp 160.00 18 25 11 5 16 10 12 5 21 15 34 30 43 5 5 40 6
78 Ondansetron tab TABLET Rp 160.00 20 20 10 5 2 8 5 6 10 10
79 Parasetamol 100 mg TABLET Rp 200.00
80 Parasetamol 500 mg TABLET Rp 56.00 175 117 194 59 100 80 115 115 105 110 165 175 205 170 98 97 90 317 75
81 Pirantel 125 mg TABLET Rp 269.00
82 Pirasetam 800 mg tablet TABLET Rp 62.00
83 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 185 10 20 116 10 73 6 98 103 20 7 71 38
84 Prednison tablet 5 mg TABLET Rp 96.00 10 60 60 90
85 Primakuin tablet 15 mg TABLET Rp -
86 Propanolol HCL tablet 10 mg TABLET Rp 52.00
87 Propiltiourasil tablet 100 mg TABLET Rp 100.00
88 Ranitidin tablet 150 mg TABLET Rp 105.00 10 10 6 6
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
89 Salbutamol tablet 2 mg TABLET Rp 66.00 20 20 10 10 10 10 2 10 2 3 5 10
90 Salbutamol tablet 4 mg TABLET Rp 80.00
91 Simvastatin 10 mg TABLET Rp 131.00 50 51 20 10 30 50 40 10 20 60 40 10 35 20 20 20 20
92 Siprofloksazin tablet 500 mg TABLET Rp 281.00 7 10 10 20 10 10 10 16 14 20 10
93 Spironolactone 25 mg TABLET Rp 315.00
Tablet Tambah Darah Kombinasi : Besi sulfat
94 TABLET 60 60 20 30 20 40 10 60 70 35
200mg+Asam folat 0,25mg Rp 355.00
95 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00
96 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00
97 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00
98 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00 10
99 Vitamin B Kompleks TABLET Rp 115.00 74 55 38 55 32 57 55 87 62 45 66 87 70 57 60 32 72 101 30
100 Zinc 10 mg TABLET Rp 513.00 10 14 10 5 10 5 5 20
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00
2 Amoxillin 1000 mg VIAL Rp 10,500.00
3 Ampisillin im/iv 1000mg/ml VIAL Rp -
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp -
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00
8 Ceftriaxone 1 gr injeksi VIAL Rp -
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00
11 Epinefrin injeksi AMPUL Rp 2,204.00
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00
13 Fitomenadion (Vit K1)inj infant AMPUL Rp -
14 Furosemid injeksi AMPUL Rp 2,300.00
15 Gentamisin injeksi AMPUL Rp 3,386.00
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00
17 Kloramfenikol injeksi VIAL Rp -
Lidokain komp injeksi,Kombinasi:Lidokain HCl2%
18 +Epinefrin1:80000-2ml AMPUL
Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp -
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp -
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00
26 Omeprazole Injeksi AMPUL Rp 11,868.00
27 Ondansetron injeksi AMPUL Rp 1,650.00
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp -
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp -
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp -
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00
35 Vitamin B Kompleks injeksi AMPUL Rp -
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00
2 Asiklovir krim 5% TUBE Rp 4,000.00 1
3 Basitrasin polimixin TUBE
4 Betametason krim 0,1 % TUBE Rp 1,349.00 2 1 1 2 2 2 1 1 1 1
5 Bufacetin Salep Kulit TUBE Rp 3,008.00 2 1 1 3 1 1 1
6 Gameksan emulsi 1 % 30ml TUBE Rp -
7 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1 1 1 1
8 Gentamisin salep mata 0,3% TUBE Rp 2,000.00 1 1
9 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 2 1 1 3 1 1
10 Ketokonazol krim 2% TUBE Rp - 1 1
11 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00
12 Miconazol cream 2 % TUBE Rp 3,000.00 2 1 2 1 1 1 2 1 2
13 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00 1 1
14 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00
15 Sulfadiazin Salep Kulit TUBE Rp 20,700.00
16 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 6 5 6 6 5 19
2 Salisil Bedak 2 % POT Rp 1,025.00
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 2 2 2 2 3 2 2 1 2 1
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 3 1 1 1 1 4 3 2 2 3 4 3
3 Cetirizin Syr BOTOL Rp - 2 1
4 Domperidon syr BOTOL 2 1 1 1 1
5 Dekstrometorfan 10 mg / 5 ml BOTOL Rp -
6 Eritromisin sirup BOTOL Rp 6,150.00
7 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00
8 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00
9 Kotrimoksazol Suspensi komb: Sulfametoksazol BOTOL 1 1 1 1
200mg+Trimetoprim40mg/5ml Rp 2,286.00
10
Mebendazol sirup 100 mg/5ml BOTOL Rp -
11
Metronidazole Sirup BOTOL Rp 9,950.00
12
Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1
13
Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 6 1 1 2 1 2 1 3 4 4 2 1 2 2 3 2 2 3 1
14
Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00
15
Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1
16
Thiamfenikol syr BOTOL Rp -
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 2 1 1 1 1
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 1 1 1
3 Gentian violet larutan 1 % BOTOL Rp -
4 Karbo Glycerin BOTOL Rp -
5 Kloramfenikol tetes mata BOTOL Rp -
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00 1
7 Polikresulen ( Albothyl ) BOTOL Rp -
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp -
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00
2 Alat suntik sekali pakai 3 ml SET Rp 792.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
3 Alat suntik sekali pakai 5 ml SET Rp 979.00
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00
5 Alkohol swab PAK Rp 11,000.00
6 Aqua pro injeksi, bebas pirogen BOTOL Rp -
7 Aquadest steril BOTOL Rp 14,960.00
8 Blood Lancet PCS Rp 14,566.00
9 Blood Tranfusion set PCS Rp 14,300.00
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00
12 Daryantulle LEMBAR Rp 8,990.00
13 Etanol 70 % BOTOL Rp -
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00
16 Foley Catheter no.16 PCS Rp 18,450.00
17 Female Catheter no.16 PCS Rp 18,450.00
18 Female Catheter no.18 PCS Rp 18,450.00
19 Folley cath no. 18 PCS Rp 18,450.00
20 Hanschoen "50 KOTAK Rp 46,200.00
21 Hanschoen steril no 6.5 PCS Rp 9,854.00
22 Hanschoen steril no 7 PCS Rp 9,854.00
23 Hansaplast 5 cm ROLL Rp 25,404.00
24 Hansaplast 7,5 cm ROLL Rp 31,265.00
25 I.V. Catheter No 18 PCS Rp 8,700.00
26 I.V. Catheter No 20 PCS Rp 8,700.00
27 I.V. Catheter No 22 PCS Rp 8,700.00
28 I.V. Catheter No 24 PCS Rp 8,700.00
29 I.V. Catheter No 26 PCS Rp 8,700.00
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00
31 Infusion set anak PCS Rp 7,000.00
32 Infusion set dewasa PCS Rp 7,000.00
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00
39 Kasa Steril PAK Rp 7,900.00
40 Kasa 4m x 5 cm PAK Rp 1,100.00
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00
42 Masker breathing (+ selang) PCS Rp 24,000.00
43 Masker non breathing PCS Rp 21,945.00
44 Masker N95 PCS Rp 390,000.00
45 My Jelly 82 gram TUBE Rp 29,550.00
46 Nasal kanul S PCS Rp 6,600.00
47 Nasal kanul L PCS Rp 6,600.00
48 NGT 7 x 75/80 PCS Rp -
49 Non woven fixation 5cm x 10 m BOX
50 One Med H2 O2 3 % BOTOL Rp -
51 One Med Surgical Blade PCS Rp -
52 Plester 5 yards x 2 inch ROL Rp 18,086.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
53 Plester infus (tegaderm) PCS Rp 224,200.00
54 Plester infus (e care + pot) PCS Rp 220,000.00
55 Plesterin PCS Rp 30,800.00
56 Policlean BOTOL Rp 608,000.00
57 Polyfix PAK Rp 43,850.00
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00
59 Spalk PCS Rp 61,600.00
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00
62 Urine Bag PCS Rp -
63 Umbilical Cord "50 PAK Rp 65,000.00
64 Underpeds BIJI Rp 1,000.00
65 Unolab supercare Nitril powder BOX Rp 77,493.00
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp -
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00
5 KAEN 3B BOTOL Rp 10,050.00
6 KAEN 4B BOTOL Rp 15,730.00
7 Metronidazol infus BOTOL Rp 9,950.00
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00
9 Parasetamol Infus BOTOL Rp 12,940.00
10 Ringer Lactate infus steril BOTOL Rp 7,150.00
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00
2 Bioplasenton Jelly TUBE Rp 14,175.00
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00
5 Bufacomb TUBE Rp 3,008.00 2 1 1 1
6 Calporosis TABLET Rp 430.00
7 Cendo Lyters tetes mata BOTOL Rp 430.00
8 Cendo Xitrol tetes mata BOTOL Rp -
9 Chloramex 500 mg KAPSUL Rp -
10 Combivent Nebule BOTOL Rp 4,995.00
11 Citicholin inj. 250 mg / 2ml AMPUL Rp -
12 Demacolin TABLET
13 Hiopar TABLET Rp 1,360.00
14 Laxadin sirup BOTOL Rp 12,450.00 1 1
15 Lactodiar SACHET Rp -
16 Lytamin syrup BOTOL Rp 5,000.00
17 Mecobion tablet TABLET Rp 1,000.00
18 Metamizole injeksi 500mg AMPUL Rp 8,635.00
19 Microlax BIJI Rp -
20 Neucompli TABLET Rp 5,500.00 15 5 5 5 15 10 10 10
21 Neurotropik plus TABLET Rp -
22 Neurotropik injeksi 5000mcg AMPUL Rp 362.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
23 Novalgin/Antrain injeksi AMPUL Rp 3,575.00
24 Noza TABLET Rp 11,500.00
25 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00
26 Pantocain Tetes Mata BOTOL Rp 11,500.00
27 Parasetamol supp BIJI Rp 1,500.00
28 Pehacain injeksi AMPUL Rp 12,155.00
29 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 2 2 1 2 2 1 1 2 1 2
30 Salbutamol rotacaps KAPSUL Rp 450.00
31 Salbutamol rotahaler PCS Rp -
32 Sotatic Inj AMPUL Rp 1,650.00
33 Spasminal/Scopma TABLET Rp 1,360.00
34 Puralex TABLET Rp 140.00 10 30 30 30 10 20 40 22 10 10 30 35 10 70
35 Ulsidex TABLET Rp 424.00
36 Ventolin nebulizer BOTOL Rp 4,000.00
37 Zirkum syr BOTOL Rp 14,980.00
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00 2
3 Mineral Mix PAKET
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 12 4 8 4 4 2 2 10 7 2 3 3 4
2 Clobazam 10mg tab TABLET Rp 967.00
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp -
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00
5 Fenitoin Natrium 30 mg KAPSUL Rp -
6 Haldol decanoat 50mg/ml inj AMPUL Rp -
7 Haloperidol 1,5 mg TABLET Rp 66.00
8 Haloperidol 5mg TABLET Rp 69.00
9 Karbamazepin 200 mg TABLET Rp 228.00
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp -
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp -
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp -
14 Lodomer 5mg/ml inj AMPUL Rp -
15 Risperidone 2mg TABLET Rp 347.00
16 Sikzonoat 25mg/ml inj AMPUL Rp -
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00
2 Diazepam 2 mg TABLET Rp 45.00
3 Diazepam 5 mg TABLET Rp 80.00
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp -
5 Fenobarbital 30 mg TABLET Rp -
6 Kodein tablet 10mg TABLET Rp 550.00
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00
9 Valdimex Inj AMPUL Rp 12,100.00
m. Serum
TANGGAL
NO NAMA OBAT SATUAN harga satuan TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp -
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00
n. TB Paru
1 Isoniazid (INH) 100mg TABLET 11 11
2 Kombipack Kategori 1 PAKET Rp -
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00
7 Obat Antituberkulosis Sisipan PAKET Rp -
8 Slide PAK
9 Slide box BOX Rp -
10 Sputum pot BIJI Rp 2,728.00
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp -
12 Ziehl nelseen PAKET Rp 276,600.00
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
NOVEMBER
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00
2 Adalat Oros 20 mg TABLET Rp 3,255.00
3 Albendazol 400 mg TABLET Rp -
4 Alopurinol 100 mg TABLET Rp 90.00
5 Alopurinol 300 mg TABLET Rp 210.00
6 Ambroxol 30 mg TABLET Rp 100.00
7 Amlodipin 5 mg TABLET Rp 105.00
8 Amlodipin 10 mg TABLET Rp 104.00
9 Aminofilina 200 mg TABLET Rp 91.00
10 Amoksilin 250 mg KAPSUL Rp 195.00
11 Amoksilin 500 mg KAPLET Rp 232.00
12 Antalgin 500 mg TABLET Rp -
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00
14 Anti Hemoroid (Bismut TABLET
subgallat150mg+Heksaklorofen2,5mg) Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00
18 Asam folat 1 mg TABLET Rp 67.00
19 Asam mefenamat 500mg TABLET Rp 106.00
20 Asetosal 100 mg TABLET Rp 130.00
21 Asiklovir 400mg TABLET Rp 349.00
22 Betahistin mesilat 5 mg TABLET Rp 149.00
23 Bisoprolol tablet 5 mg TABLET Rp 330.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
24 Bromhexin 8 mg TABLET
25 Cefadroxil 500 mg KAPSUL Rp 516.00
26 Cetirizin 10mg TABLET Rp 143.00
27 Deksametason 0,5 mg TABLET Rp 44.00
28 Dekstrometorfan 15 mg TABLET Rp -
29 Digoksin 0,25 mg TABLET Rp 105.00
30 Diltiazem 30 mg TABLET Rp 127.00
31 Dimenhidrinat tablet 50mg TABLET Rp 99.00
32 Doksisiklin 100mg KAPSUL Rp 268.00
33 Domperidon tablet 10 mg TABLET Rp 118.00
34 Efedrin HCL 25 mg TABLET Rp 47.00
35 Eritromisin 500mg KAPLET Rp 730.00
36 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00
37 Furosemid 40 mg TABLET Rp 78.00
38 Glibenklamid 5 mg TABLET Rp 100.00
39 Glimepiride tablet 2 mg TABLET Rp 289.00
40 Gliseril Guaiakolat 100 mg TABLET Rp -
41 Griseofulvin 125 mg TABLET Rp 245.00
42 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00
43 Hyosin N Butilbromida 10mg TABLET Rp 300.00
44 Ibuprofen 400 mg TABLET Rp 127.00
45 Ibuprofen 200 mg TABLET Rp 105.00
46 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00
47 Kalium Diklofenac 50mg TABLET Rp 200.00
48 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00
49 Kaptopril 25 mg TABLET Rp 80.00
50 Kaptopril 12,5 mg TABLET Rp 62.00
51 Ketokonazol 200mg tablet TABLET Rp 280.00
52 Klindamisin kapsul 300 mg KAPSUL Rp 361.00
53 Klopidogrel TABLET Rp 2,000.00
54 Kloramfenikol kapsul 250 mg KAPSUL Rp 249.00
55 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00
56 Klorokuin tablet 150 mg TABLET Rp -
57 Klorpropamid tablet 100 mg TABLET Rp -
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
58 Kotrimoksazol anak TABLET
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
59 Kotrimoksazol dewasa kombinasi : TABLET
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
60 Levofloksasin 500 mg TABLET Rp 495.00
61 Lisinopril 5mg tablet TABLET Rp 269.00
62 Loratadin tablet 10 mg TABLET Rp 134.00
63 Mebendazol tablet 100 mg TABLET Rp -
64 Meloksikam tablet 7,5 mg TABLET Rp 629.00
65 Metformin 500mg tablet TABLET Rp 100.00
66 Metil Prednisolon 4 mg TABLET Rp 194.00
67 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00
68 Metoklopramid 5mg TABLET Rp 123.00
69 Metronidazol 250 mg TABLET Rp 78.00
70 Metronidazol 500mg TABLET Rp 133.00
71 N-asetylsistein KAPSUL Rp 1,100.00
72 Natrium Diklofenac 25 mg TABLET Rp 132.00
73 Natrium Diklofenac 50 mg TABLET Rp 159.00
74 Nifedipin 10 mg tablet TABLET Rp 104.00
75 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00
76 Omeprazole 20mg TABLET Rp 160.00
77 Ondansetron tab TABLET Rp 160.00
78 Parasetamol 100 mg TABLET Rp 200.00
79 Parasetamol 500 mg TABLET Rp 56.00
80 Pirantel 125 mg TABLET Rp 269.00
81 Pirasetam 800 mg tablet TABLET Rp 62.00
82 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00
83 Prednison tablet 5 mg TABLET Rp 96.00
84 Primakuin tablet 15 mg TABLET Rp -
85 Propanolol HCL tablet 10 mg TABLET Rp 52.00
86 Propiltiourasil tablet 100 mg TABLET Rp 100.00
87 Ranitidin tablet 150 mg TABLET Rp 105.00
88 Salbutamol tablet 2 mg TABLET Rp 66.00
89 Salbutamol tablet 4 mg TABLET Rp 80.00
90 Simvastatin 10 mg TABLET Rp 131.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
91 Siprofloksazin tablet 500 mg TABLET Rp 281.00
92 Spironolactone 25 mg TABLET Rp 315.00
93 Tablet Tambah Darah Kombinasi : Besi sulfat TABLET
200mg+Asam folat 0,25mg Rp 355.00
94 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00
95 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00
96 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00
97 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00
98 Vitamin B Kompleks TABLET Rp 115.00
99 Zinc 10 mg TABLET Rp 513.00
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00
2 Amoxillin 1000 mg VIAL Rp 10,500.00
3 Ampisillin im/iv 1000mg/ml VIAL Rp -
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp -
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00
8 Ceftriaxone 1 gr injeksi VIAL Rp -
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00
11 Epinefrin injeksi AMPUL Rp 2,204.00
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00
13 Fitomenadion (Vit K1)inj infant AMPUL Rp -
14 Furosemid injeksi AMPUL Rp 2,300.00
15 Gentamisin injeksi AMPUL Rp 3,386.00
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00
17 Kloramfenikol injeksi VIAL Rp -
18 Lidokain komp injeksi,Kombinasi:Lidokain HCl2% AMPUL
+Epinefrin1:80000-2ml Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp -
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp -
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00
26 Omeprazole Injeksi AMPUL Rp 11,868.00
27 Ondansetron injeksi AMPUL Rp 1,650.00
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp -
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp -
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp -
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00
35 Vitamin B Kompleks injeksi AMPUL Rp -
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00
2 Asiklovir krim 5% TUBE Rp 4,000.00
3 Basitrasin polimyxin TUBE
4 Betametason krim 0,1 % TUBE Rp 1,349.00
5 Bufacetin Salep Kulit TUBE Rp 3,008.00
6 Gameksan emulsi 1 % 30ml TUBE Rp -
7 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00
8 Gentamisin salep mata 0,3% TUBE Rp 2,000.00
9 Hidrokortison krim 2,5 % TUBE Rp 2,650.00
10 Ketokonazol krim 2% TUBE Rp -
11 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00
12 Miconazol cream 2 % TUBE Rp 3,000.00
13 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00
14 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00
15 Sulfadiazin Salep Kulit TUBE Rp 20,700.00
16 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00
2 Salisil Bedak 2 % POT Rp 1,025.00
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 Cetirizin Syr BOTOL Rp -
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp -
5 Domperidon syr BOTOL
6 Eritromisin sirup BOTOL Rp 6,150.00
7 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00
8 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00
9 Kotrimoksazol Suspensi komb: Sulfametoksazol BOTOL
200mg+Trimetoprim40mg/5ml Rp 2,286.00
10 Mebendazol sirup 100 mg/5ml BOTOL Rp -
11 Metronidazole Sirup BOTOL Rp 9,950.00
12 Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00
13 Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00
14 Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00
15 Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00
16 Thiamfenikol syr BOTOL Rp -
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00
3 Gentian violet larutan 1 % BOTOL Rp -
4 Karbo Glycerin BOTOL Rp -
5 Kloramfenikol tetes mata BOTOL Rp -
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00
7 Polikresulen ( Albothyl ) BOTOL Rp -
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp -
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00
2 Alat suntik sekali pakai 3 ml SET Rp 792.00
3 Alat suntik sekali pakai 5 ml SET Rp 979.00
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00
5 Alkohol swab PAK Rp 11,000.00
6 Aqua pro injeksi, bebas pirogen BOTOL Rp -
7 Aquadest steril BOTOL Rp 14,960.00
8 Blood Lancet PCS Rp 14,566.00
9 Blood Tranfusion set PCS Rp 14,300.00
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00
12 Daryantulle LEMBAR Rp 8,990.00
13 Etanol 70 % BOTOL Rp -
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00
16 Foley Catheter no.16 PCS Rp 18,450.00
17 Female Catheter no.16 PCS Rp 18,450.00
18 Female Catheter no.18 PCS Rp 18,450.00
19 Folley cath no. 18 PCS Rp 18,450.00
20 Hanschoen "50 KOTAK Rp 46,200.00
21 Hanschoen steril no 6.5 PCS Rp 9,854.00
22 Hanschoen steril no 7 PCS Rp 9,854.00
23 Hansaplast 5 cm ROLL Rp 25,404.00
24 Hansaplast 7,5 cm ROLL Rp 31,265.00
25 I.V. Catheter No 18 PCS Rp 8,700.00
26 I.V. Catheter No 20 PCS Rp 8,700.00
27 I.V. Catheter No 22 PCS Rp 8,700.00
28 I.V. Catheter No 24 PCS Rp 8,700.00
29 I.V. Catheter No 26 PCS Rp 8,700.00
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00
31 Infusion set anak PCS Rp 7,000.00
32 Infusion set dewasa PCS Rp 7,000.00
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00
39 Kasa Steril PAK Rp 7,900.00
40 Kasa 4m x 5 cm PAK Rp 1,100.00
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00
42 Masker breathing (+ selang) PCS Rp 24,000.00
43 Masker non breathing PCS Rp 21,945.00
44 Masker N95 PCS Rp 390,000.00
45 My Jelly 82 gram TUBE Rp 29,550.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
46 Nasal kanul S PCS Rp 6,600.00
47 Nasal kanul L PCS Rp 6,600.00
48 NGT 7 x 75/80 PCS Rp -
49 Non woven fixation 5cm x 10 m BOX
50 One Med H2 O2 3 % BOTOL Rp -
51 One Med Surgical Blade PCS Rp -
52 Plester 5 yards x 2 inch ROL Rp 18,086.00
53 Plester infus (tegaderm) PCS Rp 224,200.00
54 Plester infus (e care + pot) PCS Rp 220,000.00
55 Plesterin PCS Rp 30,800.00
56 Policlean BOTOL Rp 608,000.00
57 Polyfix PAK Rp 43,850.00
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00
59 Spalk PCS Rp 61,600.00
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00
62 Urine Bag PCS Rp -
63 Umbilical Cord "50 PAK Rp 65,000.00
64 Underpeds BIJI Rp 1,000.00
65 Unolab supercare Nitril powder BOX Rp 77,493.00
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp -
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00
5 KAEN 3B BOTOL Rp 10,050.00
6 KAEN 4B BOTOL Rp 15,730.00
7 Metronidazol infus BOTOL Rp 9,950.00
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00
9 Parasetamol Infus BOTOL Rp 12,940.00
10 Ringer Lactate infus steril BOTOL Rp 7,150.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT PATEN
1 Aptil BOTOL Rp 23,100.00
2 Bioplasenton Jelly TUBE Rp 14,175.00
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00
5 Bufacomb TUBE Rp 3,008.00
6 Calporosis TABLET Rp 430.00
7 Cendo Lyters tetes mata BOTOL Rp 430.00
8 Cendo Xitrol tetes mata BOTOL Rp -
9 Chloramex 500 mg KAPSUL Rp -
10 Combivent Nebule BOTOL Rp 4,995.00
11 Citicholin inj. 250 mg / 2ml AMPUL Rp -
12 Hiopar TABLET Rp 1,360.00
13 Laxadin sirup BOTOL Rp 12,450.00
14 Lactodiar SACHET Rp -
15 Lytamin syrup BOTOL Rp 5,000.00
16 Mecobion tablet TABLET Rp 1,000.00
17 Metamizole injeksi 500mg AMPUL Rp 8,635.00
18 Microlax BIJI Rp -
19 Neucompli TABLET Rp 5,500.00
20 Neurotropik plus TABLET Rp -
21 Neurotropik injeksi 5000mcg AMPUL Rp 362.00
22 Novalgin/Antrain injeksi AMPUL Rp 3,575.00
23 Noza TABLET Rp 11,500.00
24 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00
25 Pantocain Tetes Mata BOTOL Rp 11,500.00
26 Parasetamol supp BIJI Rp 1,500.00
27 Pehacain injeksi AMPUL Rp 12,155.00
28 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00
29 Salbutamol rotacaps KAPSUL Rp 450.00
30 Salbutamol rotahaler PCS Rp -
31 Sotatic Inj AMPUL Rp 1,650.00
32 Spasminal/Scopma TABLET Rp 1,360.00
33 Puralex TABLET Rp 140.00
34 Ulsidex TABLET Rp 424.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
35 Ventolin nebulizer BOTOL Rp 4,000.00
36 Zirkum syr BOTOL Rp 14,980.00
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00
3 Mineral Mix PAKET
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00
2 Clobazam 10mg tab TABLET Rp 967.00
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp -
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00
5 Fenitoin Natrium 30 mg KAPSUL Rp -
6 Haldol decanoat 50mg/ml inj AMPUL Rp -
7 Haloperidol 1,5 mg TABLET Rp 66.00
8 Haloperidol 5mg TABLET Rp 69.00
9 Karbamazepin 200 mg TABLET Rp 228.00
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp -
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp -
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp -
14 Lodomer 5mg/ml inj AMPUL Rp -
15 Risperidone 2mg TABLET Rp 347.00
16 Sikzonoat 25mg/ml inj AMPUL Rp -
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00
2 Diazepam 2 mg TABLET Rp 45.00
3 Diazepam 5 mg TABLET Rp 80.00
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp -
5 Fenobarbital 30 mg TABLET Rp -
6 Kodein tablet 10mg TABLET Rp 550.00
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
9 Valdimex Inj AMPUL Rp 12,100.00
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp -
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00
n. TB Paru
1 Isoniazid (INH) 100mg TABLET
2 Kombipack Kategori 1 PAKET Rp -
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00
7 Obat Antituberkulosis Sisipan PAKET Rp -
8 Slide PAK
9 Slide box BOX Rp -
10 Sputum pot BIJI Rp 2,728.00
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp -
12 Ziehl nelseen PAKET Rp 276,600.00
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
dr.Nur Syamsu Dhuha
NIP.19771202 201001 1 002
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
Chart Title
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
DINAS KESEHATAN KABUPATEN MALANG
PROPINSI JAWA TIMUR
UNIT : PUSKESMAS LAWANG
JANUARI
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
OBAT GENERIK
a. Tablet/Kapsul
1 Acarbose 100 mg TABLET Rp 908.00 10 10
2 Adalat Oros 20 mg TABLET Rp 3,255.00
3 Albendazol 400 mg TABLET Rp -
4 Alopurinol 100 mg TABLET Rp 90.00 10 20 20 10 10 20 10
5 Alopurinol 300 mg TABLET Rp 210.00 10
6 Ambroxol 30 mg TABLET Rp 100.00 30 16 90 125 50 7 41 25 30 76 42 60 60 30
7 Amlodipin 5 mg TABLET Rp 105.00 10 10 30 30 20 53 10 40 50 30 60 30 80 35
8 Amlodipin 10 mg TABLET Rp 104.00 20 20 50 100 121 93 60 60 70 50 185 110 40 73 65
9 Aminofilina 200 mg TABLET Rp 91.00 3
10 Amoksilin 250 mg KAPSUL Rp 195.00
11 Amoksilin 500 mg KAPLET Rp 232.00 30 30 48 112 32 50 45 40 24 82 40 65 45 15
12 Antalgin 500 mg TABLET Rp -
13 Antasida (MgOH 200mg+AlOH 200mg) TABLET Rp 62.00 11 20 40 20 20 10 10 10 20 90
14 Anti Hemoroid (Bismut TABLET 3 3
subgallat150mg+Heksaklorofen2,5mg) Rp 3,045.00
15 Antimigran (Ergotamin Tartrat 1mg + Kofein 50mg) TABLET Rp 100.00
16 Asam Askorbat ( Vit C ) 50 mg TABLET Rp 104.00 3 3 9 5 5 20 18 5
17 Asam Askorbat (Vit C) 250 mg TABLET Rp 125.00 5 10 11
18 Asam folat 1 mg TABLET Rp 67.00
19 Asam mefenamat 500mg TABLET Rp 106.00 20 10 20 30 60 40 40 30 50 20 50 40 45 16
20 Asetosal 100 mg TABLET Rp 130.00 10
21 Asiklovir 400mg TABLET Rp 349.00 30 15 33 40 75 10
22 Betahistin mesilat 5 mg TABLET Rp 149.00 6 10 10 10 36 10 20 10 32 30
23 Bisoprolol tablet 5 mg TABLET Rp 330.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
24 Bromhexin 8 mg TABLET 10 10 40 10 20 20 26 40 20 10
25 candesartan TABLET 10 10 10 10 20 30 18 40 4
26 Cefadroxil 500 mg KAPSUL Rp 516.00 29 10 20 20 53 6 18 47 64 34 30 1
27 Cetirizin 10mg TABLET Rp 143.00 30 5 50 54 52 59 35 56 72 64 80 15 80 114 51
28 Deksametason 0,5 mg TABLET Rp 44.00 4 5 26 2 17 20 45 30 42 35 42
29 Dekstrometorfan 15 mg TABLET Rp -
30 Digoksin 0,25 mg TABLET Rp 105.00
31 Diltiazem 30 mg TABLET Rp 127.00
32 Dimenhidrinat tablet 50mg TABLET Rp 99.00 10 5 10 11 25
33 Doksisiklin 100mg KAPSUL Rp 268.00 6
34 Domperidon tablet 10 mg TABLET Rp 118.00 10 20 2 2 3
35 Efedrin HCL 25 mg TABLET Rp 47.00
36 Eritromisin 500mg KAPLET Rp 730.00 30
37 Fitomenadion (Vit K1) 10mg TABLET Rp 691.00 5
38 Furosemid 40 mg TABLET Rp 78.00 10 5 2 10 5
39 Glibenklamid 5 mg TABLET Rp 100.00 10
40 Glimepiride tablet 2 mg TABLET Rp 289.00 30 40 30 40 10 50 16 40 40 25 45 10
41 Gliseril Guaiakolat 100 mg TABLET Rp - 9 9 9 50 9 18 9 9 2 47 18 18 32 20
42 Griseofulvin 125 mg TABLET Rp 245.00
43 Hidroklorotiazid (HCT) 25 mg TABLET Rp 149.00
44 Hyosin N Butilbromida 10mg TABLET Rp 300.00 20 10 7
45 Ibuprofen 400 mg TABLET Rp 127.00 30 10
46 Ibuprofen 200 mg TABLET Rp 105.00 11 10 26 30 43 10 62 10 6 32 10 20 30
47 Isosorbid Dinitrat sublingual 5 mg TABLET Rp 88.00
48 Kalium Diklofenac 50mg TABLET Rp 200.00
49 Kalsium Laktat (Kalk) 500 mg TABLET Rp 63.00 10 10 100 5 25 10 10 20 20 25
50 Kaptopril 25 mg TABLET Rp 80.00 10 5 15 10 10 10 10 10
51 Kaptopril 12,5 mg TABLET Rp 62.00 40 15 15 20 60 10 10 25
52 Ketokonazol 200mg tablet TABLET Rp 280.00 6
53 Klindamisin kapsul 300 mg KAPSUL Rp 361.00 10 16 10 18 40 8 10 30
54 Klopidogrel TABLET Rp 2,000.00
55 Kloramfenikol kapsul 250 mg KAPSUL Rp 249.00
56 Klorfeniramin Maleat (CTM) 4 mg TABLET Rp 36.00 10 20 25 120 50 23 19 10 25 28 22 40 42 27
57 Klorokuin tablet 150 mg TABLET Rp -
58 Klorpropamid tablet 100 mg TABLET Rp -
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
59 Kotrimoksazol anak TABLET
(Sulfametoksazol100mg+Trimetoprim20mg) Rp -
60 Kotrimoksazol dewasa kombinasi : TABLET 6 8 6
Sulfametoksazol400mg+Trimetoprim80mg Rp 151.00
61 Levofloksasin 500 mg TABLET Rp 495.00
62 Lisinopril 5mg tablet TABLET Rp 269.00
63 Loratadin tablet 10 mg TABLET Rp 134.00 6 5 10 5
64 Mebendazol tablet 100 mg TABLET Rp -
65 Meloksikam tablet 7,5 mg TABLET Rp 629.00 6 6 5 10 18 16 28 12
66 Metformin 500mg tablet TABLET Rp 100.00 21 35 95 95 55 45 60 22 65 70 30 50 25
67 Metil Prednisolon 4 mg TABLET Rp 194.00 16 6 6 16 82 57 12 36 31 33 16 24 9
68 Metilergometrin Maleat 0,125 mg TABLET Rp 154.00
69 Metoklopramid 5mg TABLET Rp 123.00 2
70 Metronidazol 250 mg TABLET Rp 78.00
71 Metronidazol 500mg TABLET Rp 133.00 5 10 10
72 N-asetylsistein KAPSUL Rp 1,100.00 20 10 10 10 10 10 6 50 20
73 Natrium Diklofenac 25 mg TABLET Rp 132.00
74 Natrium Diklofenac 50 mg TABLET Rp 159.00 24 12 22 52 66 78 86 36 54 105 98 62 48 50 43
75 Nifedipin 10 mg tablet TABLET Rp 104.00 20 10 6 10 6
76 Nistatin tablet vaginal 100.000 IU/g TABLET Rp 545.00 3
77 Omeprazole 20mg TABLET Rp 160.00 12 6 36 54 82 53 48 54 42 54 82 41 47 48 18
78 Ondansetron tab TABLET Rp 160.00 16 12 18 10 22 20 6 6 30
79 Parasetamol 100 mg TABLET Rp 200.00
80 Parasetamol 500 mg TABLET Rp 56.00 65 20 110 116 234 142 80 126 153 129 202 115 135 121 81
81 Pirantel 125 mg TABLET Rp 269.00
82 Pirasetam 800 mg tablet TABLET Rp 62.00
83 Piridoksin HCL (Vit B6) tablet 10 mg TABLET Rp 118.00 17 19 28 103 3 90 66 12 62
84 Prednison tablet 5 mg TABLET Rp 96.00
85 Primakuin tablet 15 mg TABLET Rp -
86 Propanolol HCL tablet 10 mg TABLET Rp 52.00
87 Propiltiourasil tablet 100 mg TABLET Rp 100.00
88 Ranitidin tablet 150 mg TABLET Rp 105.00 9 6 12 16 6 10 6 6 3 12
89 Salbutamol tablet 2 mg TABLET Rp 66.00 16 30 3 16 6 10
90 Salbutamol tablet 4 mg TABLET Rp 80.00 23
91 Simvastatin 10 mg TABLET Rp 131.00 20 46 30 20 20 60 10 30 50 40
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
92 Siprofloksazin tablet 500 mg TABLET Rp 281.00 8 22 10 10 10 6
93 Spironolactone 25 mg TABLET Rp 315.00 10 10 30 10 30 13 20 20 15 60 40 10 20
94 Tablet Tambah Darah Kombinasi : Besi sulfat TABLET 5 60 30 255 5 35 35 10 35 10
200mg+Asam folat 0,25mg Rp 355.00
95 Tetrasiklin HCL kapsul 250 mg KAPSUL Rp 163.00
96 Tetrasiklin HCL kapsul 500 mg KAPSUL Rp 310.00
97 Thiamfenikol 500mg kapsul KAPSUL Rp 1,000.00
98 Tiamin HCL (VitB1) 50 mg TABLET Rp 86.00
99 Vitamin B Kompleks TABLET Rp 115.00 55 20 60 132 155 72 57 125 71 130 112 57 125 123 92
100 Zinc 10 mg TABLET Rp 513.00 3 3 3 5 10 5
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL Rp 2,998.00
2 Amoxillin 1000 mg VIAL Rp 10,500.00
3 Ampisillin im/iv 1000mg/ml VIAL Rp -
4 Antalgin 250 mg/ml - 2 ml AMPUL Rp -
5 Asam Tranexamat Injeksi AMPUL Rp 1,956.00
6 Atropin sulfat 0,25mg/ml-1 ml AMPUL Rp 1,672.00
7 Calsium Gluconas injeksi 10 % BOTOL Rp 9,955.00
8 Ceftriaxone 1 gr injeksi VIAL Rp -
9 Deksametason injeksi 5 mg/ml-1ml AMPUL Rp 1,518.00
10 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL Rp 1,175.00
11 Epinefrin injeksi AMPUL Rp 2,204.00
12 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL Rp 3,550.00
13 Fitomenadion (Vit K1)inj infant AMPUL Rp -
14 Furosemid injeksi AMPUL Rp 2,300.00
15 Gentamisin injeksi AMPUL Rp 3,386.00
16 Hyosin n butilbromid inj 250mg/ml AMPUL Rp 4,500.00
17 Kloramfenikol injeksi VIAL Rp -
18 Lidokain komp injeksi,Kombinasi:Lidokain HCl2% AMPUL
+Epinefrin1:80000-2ml Rp 1,937.00
19 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL Rp 3,200.00
20 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL Rp 3,650.00
21 Metilergometrin Maleat inj. 0,200mg-1ml AMPUL Rp 2,684.00
22 Metoklopramid inj. 5mg / ml AMPUL Rp 3,395.00
23 Natrium Tiosulfat injeksi 25 % - 10 ml BOTOL Rp -
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
24 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL Rp -
25 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL Rp 1,900.00
26 Omeprazole Injeksi AMPUL Rp 11,868.00
27 Ondansetron injeksi AMPUL Rp 1,650.00
28 Piracetam injeksi 1 gr / 5 ml BOTOL Rp -
29 Piracetam injeksi 3 gr / 5 ml BOTOL Rp -
30 Ranitidin injeksi 25mg/2ml AMPUL Rp 1,458.00
31 Sefotaksim injeksi 1 gram VIAL Rp 4,898.00
32 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL Rp 1,098.00
33 Streptomisin serbuk injeksi iv 1000mg/ml VIAL Rp -
34 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL Rp 1,100.00
35 Vitamin B Kompleks injeksi AMPUL Rp -
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT Rp 4,323.00
2 Asiklovir krim 5% TUBE Rp 4,000.00 1 1
3 Bacitracin-polymixin TUBE 1 1 1 1
4 Betametason krim 0,1 % TUBE Rp 1,349.00 1 2 1 1 1 1 3 1 2
5 Bufacetin Salep Kulit TUBE Rp 3,008.00 1 1
6 Gameksan emulsi 1 % 30ml TUBE Rp -
7 Gentamisin salep kulit 0.1%-5gr TUBE Rp 3,000.00 1
8 Gentamisin salep mata 0,3% TUBE Rp 2,000.00
9 Hidrokortison krim 2,5 % TUBE Rp 2,650.00 1 1 1 1 2 1 2 1 1 1
10 Ketokonazol krim 2% TUBE Rp - 1 1 1 1
11 Kloramfenikol salep mata 1 % TUBE Rp 1,810.00 2 3 1 1 2 1
12 Miconazol cream 2 % TUBE Rp 3,000.00 4 1
13 Oksitetrasiklin HCL 1 % salep mata TUBE Rp 2,000.00
14 Oksitetrasiklin HCL salep 3 % TUBE Rp 2,500.00
15 Sulfadiazin Salep Kulit TUBE Rp 20,700.00 2
16 Salep 2-4 Komb: As salisilat2%+Belerang endap4% POT Rp 2,429.00
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET Rp 288.00 8 3 3 3
2 Salisil Bedak 2 % POT Rp 1,025.00 1 1 2
e. Sirup
1 Amoksilin 125mg/5ml VIAL Rp 1,881.00 1 1 1 1 1 2 2 1
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL Rp 1,923.00 1 1 2 4 2 3 3 8 2 4 5 6 3 2
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
3 Cetirizin Syr BOTOL Rp - 2
4 Dekstrometorfan 10 mg / 5 ml BOTOL Rp -
5 Eritromisin sirup BOTOL Rp 6,150.00
6 Ibuprofen suspensi 100mg/5ml BOTOL Rp 4,499.00 1 1 1 1
7 Kloramfenikol suspensi 125mg/5ml BOTOL Rp 4,700.00
8 Kotrimoksazol Suspensi komb: Sulfametoksazol BOTOL 1 1 1 1
200mg+Trimetoprim40mg/5ml Rp 2,286.00
9 Mebendazol sirup 100 mg/5ml BOTOL Rp -
10 Metronidazole Sirup BOTOL Rp 9,950.00
11 Obat Batuk Hitam ( O B H ) cairan BOTOL Rp 4,840.00 1 1 1
12 Parasetamol sirup 120mg/5ml BOTOL Rp 1,010.00 1 4 1 7 6 3 4 7 4 3 6 2
13 Parasetamol drop 100mg/ml btl @ 15ml BOTOL Rp 5,200.00
14 Sefadroxil 125 mg/5 ml BOTOL Rp 3,980.00 1 2
15 Thiamfenikol syr BOTOL Rp -
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL Rp 2,500.00 1 2
2 Gentamisin tetes mata 0.3% BOTOL Rp 4,170.00 1 1 1 1
3 Gentian violet larutan 1 % BOTOL Rp - 1
4 Karbo Glycerin BOTOL Rp -
5 Kloramfenikol tetes mata BOTOL Rp -
6 Kloramfenikol tetes telinga 3 % BOTOL Rp 1,540.00
7 Polikresulen ( Albothyl ) BOTOL Rp -
8 Sulfasetamid Natrium tetes mata 15 % BOTOL Rp -
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET Rp 990.00
2 Alat suntik sekali pakai 3 ml SET Rp 792.00
3 Alat suntik sekali pakai 5 ml SET Rp 979.00
4 Alat suntik sekali pakai 10 ml SET Rp 1,298.00
5 Alkohol swab PAK Rp 11,000.00
6 Aqua pro injeksi, bebas pirogen BOTOL Rp -
7 Aquadest steril BOTOL Rp 14,960.00
8 Blood Lancet PCS Rp 14,566.00
9 Blood Tranfusion set PCS Rp 14,300.00
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET Rp 34,170.00
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET Rp 35,740.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
12 Daryantulle LEMBAR Rp 8,990.00
13 Etanol 70 % BOTOL Rp -
14 Etanol 70 % 100 ml BOTOL Rp 2,000.00
15 Etanol 70 % 1000 ml BOTOL Rp 25,000.00
16 Foley Catheter no.16 PCS Rp 18,450.00
17 Female Catheter no.16 PCS Rp 18,450.00
18 Female Catheter no.18 PCS Rp 18,450.00
19 Folley cath no. 18 PCS Rp 18,450.00
20 Hanschoen "50 KOTAK Rp 46,200.00
21 Hanschoen steril no 6.5 PCS Rp 9,854.00
22 Hanschoen steril no 7 PCS Rp 9,854.00
23 Hansaplast 5 cm ROLL Rp 25,404.00
24 Hansaplast 7,5 cm ROLL Rp 31,265.00
25 I.V. Catheter No 18 PCS Rp 8,700.00
26 I.V. Catheter No 20 PCS Rp 8,700.00
27 I.V. Catheter No 22 PCS Rp 8,700.00
28 I.V. Catheter No 24 PCS Rp 8,700.00
29 I.V. Catheter No 26 PCS Rp 8,700.00
30 I.V. Catheter No 26 with wings & port PCS Rp 8,700.00
31 Infusion set anak PCS Rp 7,000.00
32 Infusion set dewasa PCS Rp 7,000.00
33 Kapas Pembalut / Absorben 250 gr ROL Rp 28,530.00
34 Kasa Pembalut 2 m x 80 cm ROL Rp 9,400.00
35 Kasa Gulung 40 x 80 ROL Rp 149,158.00
36 Kasa Pembalut elastic 3 inchi ROL Rp 8,000.00
37 Kasa Pembalut Hidrofil 4 m x 15 cm ROL Rp 3,800.00
38 Kasa Pembalut Hidrofil 4 m x 3 cm ROL Rp 800.00
39 Kasa Steril PAK Rp 7,900.00
40 Kasa 4m x 5 cm PAK Rp 1,100.00
41 Lisol, mengandung Kresol tersabun 50% BOTOL Rp 41,000.00
42 Masker breathing (+ selang) PCS Rp 24,000.00
43 Masker non breathing PCS Rp 21,945.00
44 Masker N95 PCS Rp 390,000.00
45 My Jelly 82 gram TUBE Rp 29,550.00
46 Nasal kanul S PCS Rp 6,600.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
47 Nasal kanul L PCS Rp 6,600.00
48 NGT 7 x 75/80 PCS Rp -
49 Non woven fixation 5cm x 10 m BOX
50 One Med H2 O2 3 % BOTOL Rp -
51 One Med Surgical Blade PCS Rp -
52 Plester 5 yards x 2 inch ROL Rp 18,086.00
53 Plester infus (tegaderm) PCS Rp 224,200.00
54 Plester infus (e care + pot) PCS Rp 220,000.00
55 Plesterin PCS Rp 30,800.00
56 Policlean BOTOL Rp 608,000.00
57 Polyfix PAK Rp 43,850.00
58 Rivanol larutan 0,1 % 300ml BOTOL Rp 1,000.00
59 Spalk PCS Rp 61,600.00
60 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET Rp 35,740.00
61 Tensocrepe ( FM CREPE 10 cm x 4,55 m ) PAK Rp 43,897.00
62 Urine Bag PCS Rp -
63 Umbilical Cord "50 PAK Rp 65,000.00
64 Underpeds BIJI Rp 1,000.00
65 Unolab supercare Nitril powder BOX Rp 77,493.00
66 Wing Needle No. 18 - 27 SACHET Rp 6,000.00
67 Yodium Povidon larutan 10 % 30 ml BOTOL Rp 2,900.00
68 Yodium Povidon larutan 10 % 60 ml BOTOL Rp -
69 Yodium Povidon larutan 10 % 300 ml BOTOL Rp 18,000.00
INFUS
1 Asering Larutan infus BOTOL Rp 9,275.00
2 Glukosa larutan infus 10 % steril BOTOL Rp 6,900.00
3 Glukosa larutan infus 40 % steril BOTOL Rp 7,000.00
4 Glukosa larutan infus 5 % steril BOTOL Rp 6,900.00
5 KAEN 3B BOTOL Rp 10,050.00
6 KAEN 4B BOTOL Rp 15,730.00
7 Metronidazol infus BOTOL Rp 9,950.00
8 Natrium Klorida larutan infus 0,9 % steril BOTOL Rp 6,410.00
9 Parasetamol Infus BOTOL Rp 12,940.00
10 Ringer Lactate infus steril BOTOL Rp 7,150.00
OBAT PATEN
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 Aptil BOTOL Rp 23,100.00
2 Bioplasenton Jelly TUBE Rp 14,175.00
3 Bisakodil suppositoria 5mg TUBE Rp 5,800.00
4 Bisakodil suppositoria 10mg BIJI Rp 15,000.00 3 6 3
5 Bufacomb TUBE Rp 3,008.00 1
6 Calporosis TABLET Rp 430.00
7 Cendo Lyters tetes mata BOTOL Rp 430.00
8 Cendo Xitrol tetes mata BOTOL Rp -
9 Chloramex 500 mg KAPSUL Rp -
10 Combivent Nebule BOTOL Rp 4,995.00
11 Citicholin inj. 250 mg / 2ml AMPUL Rp -
12 Hiopar TABLET Rp 1,360.00
13 Laxadin sirup BOTOL Rp 12,450.00 2 1 1
14 Lactodiar SACHET Rp -
15 Lytamin syrup BOTOL Rp 5,000.00 2 4 1 2 1
16 Mecobion tablet TABLET Rp 1,000.00
17 Metamizole injeksi 500mg AMPUL Rp 8,635.00
18 Microlax BIJI Rp -
19 Neucompli TABLET Rp 5,500.00 30 16 6 10 6 20 6 10
20 Neurotropik plus TABLET Rp -
21 Neurotropik injeksi 5000mcg AMPUL Rp 362.00
22 Novalgin/Antrain injeksi AMPUL Rp 3,575.00
23 Noza TABLET Rp 11,500.00 6 10 6 6 4 19 8 30
24 Obat Batuk Anak sirup (Babys Cough ) BOTOL Rp 3,575.00 1
25 Pantocain Tetes Mata BOTOL Rp 11,500.00
26 Parasetamol supp BIJI Rp 1,500.00
27 Pehacain injeksi AMPUL Rp 12,155.00
28 Permetrin/Scabicid krim 5% TUBE Rp 6,600.00 1 3 1 2 1 2 1 2
29 Salbutamol rotacaps KAPSUL Rp 450.00
30 Salbutamol rotahaler PCS Rp -
31 Sotatic Inj AMPUL Rp 1,650.00
32 Spasminal/Scopma TABLET Rp 1,360.00 10 10
33 Puralex TABLET Rp 140.00 10 10 15 10 30 10 30 10 20 10 10
34 Ulsidex TABLET Rp 424.00 6 6 12 6 6 6 24
35 Ventolin nebulizer BOTOL Rp 4,000.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
36 Zirkum syr BOTOL Rp 14,980.00
OBAT KHUSUS
f. Gizi
1 Retinol ( Vit A ) kapsul 100.000 IU KAPSUL Rp 284.00
2 Retinol ( Vit A ) kapsul 200.000 IU KAPSUL Rp 459.00
3 Mineral Mix PAKET
g. Jiwa
1 Amitriptyllin 25 mg TABLET Rp 143.00 6 6 3 3 6 3 3
2 Clobazam 10mg tab TABLET Rp 967.00
3 Fenitoin Natrium inj. 50 mg/ml AMPUL Rp -
4 Fenitoin Natrium 100 mg KAPSUL Rp 154.00
5 Fenitoin Natrium 30 mg KAPSUL Rp -
6 Haldol decanoat 50mg/ml inj AMPUL Rp -
7 Haloperidol 1,5 mg TABLET Rp 66.00
8 Haloperidol 5mg TABLET Rp 69.00
9 Karbamazepin 200 mg TABLET Rp 228.00
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL Rp -
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL Rp -
12 Klorpromazin HCL tablet salut 100 mg TABLET Rp 144.00
13 Klorpromazin HCL tablet salut 25 mg TABLET Rp -
14 Lodomer 5mg/ml inj AMPUL Rp -
15 Risperidone 2mg TABLET Rp 347.00
16 Sikzonoat 25mg/ml inj AMPUL Rp -
17 Trifluoperazin tablet 5 mg TABLET Rp 296.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET Rp 80.00
k. Psikotropik & Narkotik
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL Rp 4,180.00
2 Diazepam 2 mg TABLET Rp 45.00
3 Diazepam 5 mg TABLET Rp 80.00
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL Rp -
5 Fenobarbital 30 mg TABLET Rp -
6 Kodein tablet 10mg TABLET Rp 550.00
7 Stesolid rectal supp 5 mg BIJI Rp 11,517.00
8 Stesolid rectal supp 10 mg BIJI Rp 16,742.00
9 Valdimex Inj AMPUL Rp 12,100.00
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
m. Serum
1 Serum Anti Bisa Ular Polivalen inj.5 ml(ABUI) VIAL Rp 462,000.00
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) VIAL Rp -
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS) VIAL Rp 170,000.00
n. TB Paru
1 Isoniazid (INH) 100mg TABLET
2 Kombipack Kategori 1 PAKET Rp -
3 Obat Antituberkulosis Anak PAKET Rp 214,900.00
4 Obat Antituberkulosis kategori 2 ( FDC ) PAKET Rp 1,199,990.00
5 Obat Antituberkulosis kategori 3 (FDC) PAKET Rp 154,000.00
6 Obat Antituberkulosis kategori I ( FDC ) PAKET Rp 359,990.00
7 Obat Antituberkulosis Sisipan PAKET Rp -
8 Slide PAK
9 Slide box BOX Rp -
10 Sputum pot BIJI Rp 2,728.00
11 Streptomycin inj./iv 1500 mg/ml VIAL Rp -
12 Ziehl nelseen PAKET Rp 276,600.00
UMUM
BPJS JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RAWAT JALAN RAWA
RAWAT RAWAT T
RAWAT INAP JALAN RAWAT JALAN RAWAT JALAN
0
Mengetahui Yang Menyerahkan Yang meminta/melapor
Kepala Seksi Pengelolaan Obat Petugas Perbekalan Farmasi Kepala Puskesmas
dan Pengawasan Farmasi
dr.Nur Syamsu Dhuha
TANGGAL
NO NAMA OBAT SATUAN harga satuan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
NIP.19771202 201001 1 002
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
10 30
0
0
6 10 10 10 136
10
42 37 110 88 102 49 20 3 19 20 1172
30 46 10 10 10 10 30 5 20 25 684
105 10 129 40 92 60 150 110 86 100 50 2049
3
10 10
40 33 115 41 30 25 45 95 41 81 139 1343
0
2 10 20 30 40 30 20 10 10 423
3 3 12
0
24 18 15 125
6 61 6 3 13 22 18 4 4 163
0
20 30 75 30 20 10 10 80 10 25 19 800
10
30 233
26 20 10 10 10 10 260
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
20 20 20 16 25 31 338
152
24 8 40 30 6 20 46 457 10 20 8 1001
63 2 5 25 912
11 38 10 53 3 11 29 30 10 32 495
0
0
0
10 71
6
10 10 12 26 6 10 10 121
0
30
5 10
13 5 10 5 5 70
10 10 30
20 60 30 35 20 40 15 40 25 661
34 9 27 21 18 18 47 45 10 33 31 552
0
0
6 10 53
30 51 70 20 80 6 297
30 6 8 20 364
10 10
0
10 15 530 5 5 25 20 4 20 26 895
25 10 10 25 10 10 10 6 186
20 15 10 15 10 25 10 25 10 20 355
5 10 5 10 10 46
35 38 15 30 20 10 10 29 20 25 19 393
0
0
44 60 117 48 101 67 112 121 114 86 126 1457
0
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
20
0
0
10 11 30 22 17 5 34 16 21 10 32 234
0
17 12 5 5 6 29 10 30 47 62 324
25 30 35 30 71 25 10 40 68 55 70 1127
24 12 40 15 74 6 26 12 19 49 621
0
2 4
0
10 35
10 36 10 20 68 103 68 50 45 556
0
88 40 70 48 52 27 24 85 43 42 73 1428
10 62
3 3 3 12
65 35 54 29 48 30 36 106 46 54 50 1230
16 20 9 20 10 215
0
157 70 119 126 173 125 299 223 150 196 3467
0
0
8 133 30 80 10 74 735
0
0
0
0
16 10 10 12 18 24 15 12 6 209
6 52 10 6 10 5 170
10 33
230 50 50 70 40 10 60 50 20 906
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
10 6 10 20 8 46 10 5 181
10 10 40 20 10 10 10 10 20 428
20 25 640 15 35 90 60 1365
0
0
0
0
159 84 113 92 84 89 116 164 138 117 182 2724
5 1 7 5 5 15 5 72
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1 4
1 2 2 1 10
1 1 1 2 2 20
1 3
0
1
2 2
2 2 1 1 1 1 1 21
2 6
1 1 1 13
1 1 1 8
0
0
2
1 1 5 7
0
3 20
4
0
2 1 5 1 2 1 22
6 3 3 2 9 2 4 1 76
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
1 3
0
0
1 1 1 7
0
0
0
1 1 5
5 2 6 3 2 1 2 4 2 1 76
0
1 4
0
0
1 1 1 6
1 5
1
0
0
1 1 1 3
0
0
0
0
0
0
0
0
0
0
0
0
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
12
1
0
0
0
0
0
0
0
1 1 6
0
2 3 1 16
0
0
0
10 45 159
0
0
0
8 12 6 12 26 6 6 20 4 189
1 2
0
0
0
2 3 18
0
0
0
20
10 10 15 10 20 10 20 10 8 278
66
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
6 9 19 10 74
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
GGAL
TOTAL
19 20 21 22 23 24 25 26 27 28 29 30 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
You might also like
- Laporan Pemakaian Dan Lembar Permintaan Obat (Lplpo) Puskesmas Sungai SembilanNo ratings yetLaporan Pemakaian Dan Lembar Permintaan Obat (Lplpo) Puskesmas Sungai Sembilan95 pages
- LAPORAN MUTASI & STOCK OPNAME PUSKESMAS .............. BULAN ................... 2019v1No ratings yetLAPORAN MUTASI & STOCK OPNAME PUSKESMAS .............. BULAN ................... 2019v166 pages
- Stok Opname Puskesmas Mondokan Per 31 Desember 2016No ratings yetStok Opname Puskesmas Mondokan Per 31 Desember 201610 pages
- E-Katalog Obat Puskesmas Paal Lima JambiNo ratings yetE-Katalog Obat Puskesmas Paal Lima Jambi13 pages
- Lampiran Penerimaan Obat BMHP Puskesmas Ajibarang 1No ratings yetLampiran Penerimaan Obat BMHP Puskesmas Ajibarang 128 pages
- Laporan Persediaan Dan Mutasi Puskesmas Kabupaten Aceh UtaraNo ratings yetLaporan Persediaan Dan Mutasi Puskesmas Kabupaten Aceh Utara129 pages
- Berita Acara Stok Opname Per 28 Februari 2021 ApotekNo ratings yetBerita Acara Stok Opname Per 28 Februari 2021 Apotek16 pages
- No Nama Barang Stok Awal Barang Masuk Barang Keluar Sisa Stock Harga SatuanNo ratings yetNo Nama Barang Stok Awal Barang Masuk Barang Keluar Sisa Stock Harga Satuan16 pages
- No Nama Barang Stok Awal Baran G Masuk Baran G Keluar Sisa Stock Harga SatuanNo ratings yetNo Nama Barang Stok Awal Baran G Masuk Baran G Keluar Sisa Stock Harga Satuan18 pages
- Analisis ABC Puskesmas Bringkoning 2025 FixNo ratings yetAnalisis ABC Puskesmas Bringkoning 2025 Fix402 pages
- Rekap Sehat Inti Permata Tahap 2 Fix PKM Non BludNo ratings yetRekap Sehat Inti Permata Tahap 2 Fix PKM Non Blud3 pages
- Kistamma Singanaboina and Venkateshwar Chinna PDF50% (2)Kistamma Singanaboina and Venkateshwar Chinna PDF10 pages
- Indian Pharmaceutical Market 2023 by Sumit LahaNo ratings yetIndian Pharmaceutical Market 2023 by Sumit Laha24 pages
- Cold Chain - 16th To 21 March 2015 - Mumbai100% (1)Cold Chain - 16th To 21 March 2015 - Mumbai35 pages
- Development and Validation of RP - HPLC Method For The Estimation of Tylosin Tartrate in Pure and Pharmaceutical FormulationNo ratings yetDevelopment and Validation of RP - HPLC Method For The Estimation of Tylosin Tartrate in Pure and Pharmaceutical Formulation8 pages
- Daftar Harga Yang Berlaku Sampe Akhir Ini AprilNo ratings yetDaftar Harga Yang Berlaku Sampe Akhir Ini April24 pages
- 2009年度中国医药研发外包 (CRO) 市场深度研究及2010年投资分析报告No ratings yet2009年度中国医药研发外包 (CRO) 市场深度研究及2010年投资分析报告141 pages
- Adverse Cutaneous Reactions To Drugs: Types of Clinical ReactionNo ratings yetAdverse Cutaneous Reactions To Drugs: Types of Clinical Reaction5 pages
- Empirical Antibiotic Therapy in Children: Clinical GuidelineNo ratings yetEmpirical Antibiotic Therapy in Children: Clinical Guideline2 pages
- Industrial Pharmacy Arranged Past PapersNo ratings yetIndustrial Pharmacy Arranged Past Papers10 pages
- Application of Polymers in The Design of CrddsNo ratings yetApplication of Polymers in The Design of Crdds4 pages