PANGKALAN UTAMA TNI AL XI

RUMKITAL MERAUKE

LAPORAN KEGIATAN KESEHATAN TRIWULAN

BIDANG MATERIAL KESEHATAN
SATPOR : RUMKITAL MERAUKE
TRIWULAN II TA. 2017

1. Penerimaan/Pemakaian Material Kesehatan

PERSE- PENERIMAAN JUMLAH SISA
HARGA ( Rp )
NO NAMA MATKES SATUAN DIAAN PEMAKAIAN AKHIR
NATURA PEMBELIAN (4+5+6)
AWAL (7-8) SAT
1 2 3 4 5 6 7 8 9 10
1 Acarbose 100mg Tablet 4700 0 4700 0 4700 2,085
2 Acilaz 30 mg Tablet 1200 0 1200 0 1200 15,730
3 Acyclovir 200mg 50' Tablet 250 0 250 250 0 582
4 Acyclovir 400mg Kaplet 10900 0 10900 0 10900 700
5 Acyclovir 400mg 100' Tablet 850 0 850 300 550 790
6 Acyclovir 5 % Krim SK Tube 450 0 450 0 450 8,850
7 Allopurinol 100mg 100' Tablet 0 0 0 0 0 139
8 Alprazolam 0.5mg Tablet 4610 0 4610 79 4531 2,354
9 Ambroxol Syr Botol 40 0 40 10 30 9,000
10 Ambroxol Tab 100' Tablet 6300 0 6300 4000 2300 129
11 Aminophyline Inj 30' Ampul 150 0 150 150 0 4,008
12 Amlodopin 10mg 100' Berno Tablet 5400 0 5400 900 4500 1,847
13 Amlodopin 5mg 100' Tablet 10450 0 10450 0 10450 1,047
14 Amoxan Drops 15 ml Botol 80 0 80 10 70 22,160
15 Amoxan Dry Syr 60 ml Botol 50 0 50 50 0 22,745
16 Amoxicilin 500mg Kaplet 20300 0 20300 0 20300 550
17 Amoxicilin 500mg Tablet 3700 0 3700 2500 1200 700
18 Amoxilin Dry Syr Botol 0 0 0 0 0 5,610
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
19 Anesfar Ampul 105 0 105 20 85 22,000
20 Antalgidon Inj Vial 29 0 29 0 29 17,710
21 Antalgin 500mg Tablet 19600 0 19600 3000 16600 150
22 Antasida Doen Box 100' Tablet 1200 0 1200 1200 0 155
23 Antasida Syr Botol 0 0 0 0 0 5,198
24 Antrain Inj Ampul 0 0 0 0 0 9,520
25 Anti Diare Tablet 9500 0 9500 2000 7500 480
26 Antiflu Tablet 57200 0 57200 2200 55000 470
27 Aqua pro Inj Vial 22 0 22 0 22 6,655
28 Aqua pro Inj @10vial Vial 1060 0 1060 0 1060 6,000
29 Arco Tab Tablet 430 0 430 400 30 39,215
30 Arthem Inj Ampul 12 0 12 0 12 70,125
31 Asam Mefenamat Kaplet Kaplet 200 0 200 200 0 270
32 Asam Tranexamat 250 Inj Ampul 350 0 350 150 200 15,200
33 Asam Tranexamat 500 Inj Ampul 520 0 520 70 450 23,500
34 Ascardia 80 mg Tablet 180 0 180 0 180 473
35 Aspar K Tablet 0 0 0 0 0 2,165
36 Aspilet Chew 100' Box 800 0 800 500 300 568
37 Atostin/Truvaz Tablet 30 0 30 0 30 19,700
38 Atropin Inj 0,25 mg/ml Ampul 600 0 600 100 500 6,523
39 Bamgetol Tablet 130 0 130 0 130 2,200
40 Batugin Elixir 120 ml Botol 0 0 0 0 0 18,694
41 Batugin Elixir 300 ml Botol 0 0 0 0 0 32,402
42 Betablox Tablet 0 0 0 0 0 1,020
43 Betahistin Mesylate Tablet 4000 0 4000 0 4000 1,035
44 Betason N Cream Tube 24 0 24 24 0 10,470
45 Bevalex Cream Tube 270 0 270 0 270 12,485
46 Bioxon Inj Vial 54 0 54 0 54 223,850
47 Bisolvon elixir 60 ml Botol 0 0 0 0 0 27,744
48 Bisoprolol Tablet 0 0 0 0 0 1,902
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
49 Bromifar Kaplet 360 0 360 0 360 286
50 Bronchifar Tablet 1260 0 1260 0 1260 578
51 Bupivacain spinal (AAM) Ampul 30 0 30 30 0 24,000
52 Burnazin Krim Tube 5 2 7 5 2 48,231
53 Buscopan 20 mg/ml Inj Ampul 20 0 20 20 0 24,949
54 Buscopan Tab 100' Tablet 0 0 0 0 0 2,297
55 Calsium Gluconas Inj Ampul 9 0 9 0 9 13,045
56 Calsium Lactate Tablet 2000 0 2000 0 2000 236
57 Candesartan 8mg 30' Tablet 0 0 0 0 0 5,400
58 Captopril 25 Tablet 360 0 360 0 360 165
59 Captopril Lafial Tablet 8300 0 8300 2600 5700 180
60 Captopril 12,5 mg Tablet 0 0 0 0 0 175
61 Captopril 25 mg 100' Tablet 0 0 0 0 0 150
62 Carbazochrome Inj 10' Ampul 52 0 52 52 0 11,920
63 Caviplex 100' Tablet 0 0 0 0 0 402
64 Caviplex Syr Botol 70 0 70 64 6 6,636
65 Cefadroxil 500mg Kapsul 13500 0 13500 0 13500 1,100
66 Cefadroxil 500mg Kaps 100' Kapsul 10700 0 10700 4700 6000 764
67 Cefadroxil dry syr Botol 55 0 55 55 0 8,045
68 Cefixime 100 mg Kapsul 3000 0 3000 3000 0 2,612
69 Cefixime dry Syr Botol 10 0 10 0 10 33,000
70 Cefoporazoen+Sulbactam Vial 0 0 0 0 0 120,923
71 Cefotaxime Inj 1 gr Vial 90 0 90 0 90 6,050
72 Cefotaxime Inj Vial 1010 0 1010 200 810 9,355
73 Cefspan Syr Botol 5 0 5 0 5 95,000
74 Ceftriaxone Inj box/100 vial Vial 2400 0 2400 1300 1100 25,000
75 Cendo Asthenof 0,6 ml Unit 0 0 0 0 0 20,500
76 Cendo Catarlent 0,6 ml Unit 20 0 20 0 20 20,000
77 Cendo Cyclon 1% Unit 1 0 1 0 1 15,875
78 Cendo Eyefresh 0,6 ml Unit 0 0 0 0 0 23,125
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
79 Cendo Fenicol Botol 9 0 9 0 9 27,500
80 Cendo Floxa 0,6 ml Unit 20 0 20 20 0 36,046
81 Cendo LFX 0,6 ml Unit 0 0 0 0 0 69,000
82 Cendo Mycetin EO 3,5 G Unit 0 0 0 0 0 12,750
83 Cendo Mycos EO 3,5 G Unit 20 0 20 20 0 26,250
84 Cendo Pantocain Unit 21 0 21 11 10 12,375
85 Cendo Polydex 0,6 ml Unit 0 0 0 0 0 26,500
86 Cendo Polygran 5 ml Botol 9 0 9 0 9 38,500
87 Cendo Polynel 0,6 ml Unit 0 0 0 0 0 17,875
88 Cendo Siloxan 0,6 ml Unit 0 0 0 0 0 35,625
89 Cendo Timol 0,5% Unit 20 0 20 10 10 25,750
90 Cendo Tobro 0,6ml Unit 20 0 20 0 20 19,125
91 Cendo Xytrol Botol 9 0 9 0 9 33,000
92 Ceterizine 10mg Tablet 0 0 0 0 0 960
93 Cetinal Syr Botol 0 0 0 0 0 50,000
94 Chloramfecort Krim 10 mg Tube 72 0 72 0 72 13,668
95 Chlorampenicol SK Tube 600 0 600 600 0 5,250
96 Chloramphenicol Krim Tube 96 0 96 96 0 4,050
97 Choracort Krim Tube 1050 0 1050 300 750 11,000
 98 Ciprofloxacin 500mg Kaplet 18200 0 18200 3000 15200 850
99 Ciprofloxacin infus Botol 0 0 0 0 0 62,182
100 Ciprofloxacin Tab (berno) Tablet 0 0 0 0 0 700
101 Cisapride 5 mg Tablet 200 0 200 0 200 830
102 Citicoline Inj 125mg/10 Amp Ampul 570 0 570 120 450 13,000
103 Citicolin Kaplet 0 0 0 0 0 16,500
104 Clavamox 60ml Botol 20 0 20 0 20 65,000
105 Clindamycine 150mg Kapsul 4400 0 4400 400 4000 393
106 Clindamycine 300mg Kapsul 2800 0 2800 300 2500 670
107 Clonidin Tablet 1400 0 1400 300 1100 1,768
108 Clopidogrel 75 mg Tablet 54 0 54 0 54 10,890
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
109 Clopidogrel Tab Tablet 600 0 600 300 300 16,000
110 Codein 20mg Tablet 4928 0 4928 249 4679 1,350
111 Compound (influrane) Botol 0 0 0 0 0 1,450,000
112 Combiven Nebu Ampul 260 0 260 260 0 12,620
113 Cotrimoxazole 480mg Tablet 9700 0 9700 700 9000 1,250
114 Cotrimoxazole Syr Botol 110 0 110 0 110 8,250
115 Counterpain Cream 30 gr Tube 8 0 8 5 3 33,240
116 CPG Tablet 350 0 350 350 0 19,556
117 CTM Tablet 18900 0 18900 0 18900 45
118 Curacil Kemo Vial 18 0 18 0 18 88,000
119 Curcuma Plus 60 ml Botol 55 0 55 55 0 9,270
120 Curcuma Tab Tablet 0 0 0 0 0 874
121 Cyclovid 1g Vial 6 0 6 0 6 660,000
122 Cyclovid 500mg Vial 20 0 20 0 20 440,000
123 Cygest 400mg Ampul 0 0 0 0 0 399,300
124 Demacolin Tab 100' Tablet 1700 0 1700 1700 0 331
125 Dexametason 0,5 mg Tablet 30100 0 30100 0 30100 165
126 Dexametason 0,5 mg 1000' Tablet 14000 0 14000 5000 9000 54,450
127 Dexametason 5mg/ml Inj Ampul 900 0 900 800 100 2,184
128 Dextamin Tab 100'S Box 2000 1600 3600 1100 2500 1,683
129 Dextrose 5% 500 ml Botol 90 0 90 0 90 10,890
130 Dicoflam 50 mg Tablet 1800 0 1800 0 1800 798
131 Diklofal 100mg Tablet 0 0 0 0 0 137
132 Diklofal 50mg Tablet 2850 0 2850 0 2850 81
133 Diuvar Inj Ampul 90 0 90 0 90 15,125
134 Dobutamin Inj Ampul 0 0 0 0 0 72,765
135 Domperidone Syr Botol 0 0 0 0 0 13,800
136 Domperidone Tab 100' Tablet 800 0 800 500 300 440
137 Doxixciklin 100mg Tablet 4300 0 4300 300 4000 3,415
138 Doxorubicin 10mg Vial 12 0 12 0 12 80,700
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
139 Doxorubicin 50mg Vial 18 0 18 0 18 381,400
140 Dulcolax 5 mg Tablet 9000 0 9000 600 8400 1,405
141 Dulcolax 10mg Adult Supp 6 0 6 6 0 16,790
142 Ecossol Nacl 500 ml Botol 300 0 300 0 300 10,890
143 Ecossol RL 500 ml Botol 300 0 300 0 300 12,100
144 Endoxan 1g Vial 4 0 4 0 4 931,934
146 Ephineprine Inj Ampul 36 0 36 0 36 8,910
147 Ephineprine Inj Ampul 578 0 578 23 555 11,875
148 Erytromicin 500 Tablet 3000 0 3000 600 2400 1,533
149 Etambutol Tablet 300 0 300 300 0 1,523
150 Etason Inj Ampul 90 0 90 0 90 8,030
Evothyl 100mg Kapsul 240 0 240 0 240 4,537
Extropect Tablet 300 0 300 0 300 928
151 Farsiretik Tablet 72 0 72 0 72 473
152 Fentanyl Inj Ampul 25 0 25 25 0 44,000
153 Flexor DS Box 0 0 0 0 0 5,000
154 Flexotide Nebulies 0,5mg Ampul 600 0 600 330 270 17,748
155 Flunarizine Tablet 2100 0 2100 400 1700 4,375
156 Foransi 20 mg Tablet 36 0 36 0 36 5,445
157 Furosemide Inj Ampul 75 0 75 0 75 2,061
158 Furosemide Tab Tablet 1700 0 1700 200 1500 137
160 Garexin SM Tube 7 0 7 0 7 12,100
161 Gentamicin Inj Ampul 27 0 27 0 27 4,070
162 Gentamycin Inj Ampul 150 0 150 10 140 4,990
163 Gentamycin SK Tube 650 0 650 0 650 5,500
164 Gentian Violet 10 ml '25 Amp Botol 72 0 72 0 72 3,120
165 Glibenclamid 5mg Tablet 120 0 120 0 120 110
166 Gliceril Guacolate 1000' Tablet 4000 0 4000 3000 1000 50
167 Gliclazid 80 mg Tablet 100 0 100 0 100 1,685
168 Glimepiride Tab 2mg 50' Tablet 1000 0 1000 400 600 1,564
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
169 Gliquidone 30 mg Tablet 700 0 700 0 700 948
170 Halothane Liquid 250 ml Botol 2 0 2 2 0 1,175,000
171 HCT tab Tablet 9000 0 9000 500 8500 160
172 Hidrocortison SK Tube 570 0 570 0 570 4,250
173 Hidrocortison Zalf Tube 250 0 250 50 200 7,024
174 Ibuporofen Syrup Botol 60 0 60 40 20 18,084
175 Ibuporofen Tab Tablet 100 0 100 100 0 319
176 Idesar Gold Suspensi Botol 0 0 0 0 0 52,000
177 Idesar Plus Box 0 0 0 0 0 202,500
178 Ikadril Inj Vial 119 0 119 5 114 12,100
179 Ikamicetin SK Tube 17 0 17 0 17 7,975
180 Imodial Tablet 3300 0 3300 0 3300 650
181 Induxin 1 ml 10' Ampul 0 0 0 0 0 8,000
182 Infus Asering Botol 440 0 440 260 180 155,000
183 Infus D5 Botol 860 0 860 80 780 14,300
184 Infus D5 1/2 NS Botol 640 0 640 100 540 45,000
185 Infus KAEN 1B Botol 200 0 200 180 20 45,000
186 Infus KAEN 3A Botol 260 0 260 40 220 45,000
187 Infus KAEN 3B Botol 440 0 440 40 400 45,000
188 Infus KAEN 4A Botol 180 0 180 0 180 45,000
189 Infus KAEN 4B Botol 200 0 200 0 200 45,001
189 Infus NaCl Botol 880 0 880 200 680 14,300
190 Infus RL Botol 1700 0 1700 1510 190 14,300
191 Insec Repellent Botol 60 0 60 0 60 16,000
192 Interhistin Tablet 900 0 900 0 900 799
193 Interhistin Tablet 1400 0 1400 200 1200 907
194 ISDN Tablet 3100 0 3100 0 3100 131
195 Isoflurane 250ml Botol 3 0 3 0 3 1,625,000
196 Isosorbide Dinitrat 5 mg Tablet 900 0 900 0 900 165
197 Isosorbide Dinitrat 5 mg Tablet 3100 0 3100 0 3100 105
198 Kaflam 50 mg Tablet 0 0 0 0 0 3,333
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
199 Kalium Diklofenak 50 mg Tablet 0 0 0 0 0 772
200 Kalnex Tab Tablet 200 0 200 200 0 3,820
201 Kaltrofen Supp 2x5 Supp 200 0 200 30 170 12,500
202 Kanamicin Inj Vial 0 0 0 0 0 8,150
203 Kcl drip Ampul 20 0 20 0 20 3,000
204 Ketamin Inj Ampul 40 0 40 10 30 187,550
205 Ketokonazole Krim Tube 813 0 813 0 813 6,250
206 Ketorolac 30 Inj Ampul 270 0 270 0 270 14,740
207 Ketorolac 3% Ampul 1300 0 1300 1300 0 20,047
208 Ketokonazole Tablet 1550 0 1550 0 1550 512
209 Ketokonazole Krim Tube 24 0 24 12 12 9,450
210 Kliran 4 mg Kaplet 450 0 450 0 450 14,520
211 Lanzoprazole 30 mg Kapsul 11220 0 11220 2020 9200 2,206
212 Laktafit Tablet 2620 0 2620 840 1780 3,593
213 Laxadine Syr 60ml Botol 20 0 20 20 0 34,170
214 Laxana Tablet 72 0 72 0 72 798
215 Lexaprofen 400 Tablet 1800 0 1800 0 1800 484
216 Lexicam 10 mg Kapsul 450 0 450 0 450 220
217 Lexicam 20 mg Kapsul 450 0 450 0 450 275
218 Levofloxzcine Infus Botol 5 0 5 0 5 137,500
219 Levofloxacin 500 mg Kaplet 0 0 0 0 0 31,394
220 Lidocain Inj 2 ml Ampul 900 0 900 0 900 1,210
221 Lidocain 2% Inj 100 Amp Ampul 600 0 600 300 300 1,138
222 Lidodex Inj Box 155 0 155 20 135 275,000
223 Liprolax vanila 30 Sachet Sachet 0 0 0 0 0 6,000
224 Lisinopril 10mg 30' Tablet 210 0 210 0 210 561
225 Lisinopril 5mg 30' Tablet 70 0 70 70 0 360
226 Lodia Tablet 1320 0 1320 420 900 1,237
227 Lodomer 2 mg Tablet 73 0 73 0 73 1,361
228 Lodomer 5 mg Tablet 55 0 55 0 55 2,344
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
229 Loratadine Tab Tablet 2850 0 2850 0 2850 449
230 Lovask 5 mg Tablet 90 0 90 0 90 6,215
231 Lovask 10 mg Tablet 60 0 60 0 60 10,285
232 Lysinku Gold 100 ml Botol 0 0 0 0 0 28,000
233 Maag Tablet Tablet 6000 0 6000 0 6000 600
234 Matsunaflam 50 Tablet 0 0 0 0 0 2,250
235 Mediamer Tablet 300 0 300 200 100 3,500
236 Meclam Inj Ampul 180 0 180 0 180 10,285
237 Melocid Tab Tablet 1800 0 1800 0 1800 2,420
238 Meloxicam 15 mg Tablet 1400 0 1400 1150 250 1,308
239 Meloxicam 7,5 mg Tablet 400 0 400 400 0 754
240 Meropenem 1 g Inj Box 170 0 170 25 145 200,000
241 Mertigo Tablet 2500 0 2500 1000 1500 4,326
242 Methyl Prednisolon Tablet 8100 0 8100 0 8100 600
243 Metformin 500 Tablet 600 0 600 0 600 248
244 Metformin 500 Tablet 5000 0 5000 2000 3000 226
245 Methyl Prednisolon Inj Vial 90 0 90 0 90 91,410
246 Methyl Prednisolon 125 Inj Vial 0 0 0 0 0 61,875
247 Methyl Prednisolon 4 mg Tablet 4200 0 4200 2200 2000 438
248 Methyl Prednisolon 8 mg Tablet 6200 0 6200 200 6000 638
249 Metolon Inj Ampul 2730 0 2730 0 2730 12,375
250 Metronidazole 500mg Tab Tablet 2000 0 2000 1500 500 278
251 Metronidazole Inf Botol 650 0 650 150 500 50,000
252 Miconazol CR Tube 24 0 24 0 24 3,300
253 Microlax Gel Tube 180 0 180 0 180 19,360
254 Microlax Gel Tube 5 0 5 5 0 18,743
255 Molasma 2,5 mg Tablet 270 0 270 0 270 341
256 Molazol Tab Tablet 1800 0 1800 0 1800 385
257 Myomergin 10 Ampul Ampul 219 0 219 69 150 5,500
258 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0 350
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
259 Neciblok Susp 100ml Botol 0 0 0 0 0 47,500
260 Neurobion Dual Ampul Ampul 620 0 620 260 360 8,339
261 Neurindo Tablet 75 0 75 0 75 1,930
262 Neurodex tab Tablet 0 0 0 0 0 807
263 New Diatab Tablet 2600 0 2600 600 2000 517
264 Nifedipin Tablet 900 0 900 0 900 174
265 Nifedipine 10 mg Tablet 3200 0 3200 400 2800 165
266 Noflam Tablet 750 0 750 0 750 5,115
267 Nokoba Vial 10 0 10 10 0 87,500
268 Norephineprine 4mg/4ml Ampul 85 0 85 20 65 60,000
269 Norit Tablet 0 0 0 0 0 735
270 Norvorm Kaplet 900 0 900 0 900 605
271 Notrixum 50 Inj 5ml/5 Amp Ampul 230 75 305 100 205 42,000
272 Novalgin Inj Ampul 0 0 0 0 0 16,700
273 Nufaprazole 30 mg Kapsul 0 0 0 0 0 12,420
274 Nystatin Botol 0 0 0 0 0 30,250
275 Omeprazole 20 mg Kapsul 0 0 0 0 0 627
276 Omeprazole Inj Ampul 180 0 180 0 180 82,280
277 Omeprazole Inj Box 290 0 290 20 270 81,600
278 Ondansentron 4 mg Tab Tablet 4072 0 4072 360 3712 1,400
279 Ondansentron 4mg/2ml Ampul 2000 0 2000 850 1150 3,500
280 Ondansentron 4 mg Inj Ampul 360 0 360 0 360 6,050
281 Oralit Sachet 1500 0 1500 200 1300 519
282 Orasic Inj Ampul 105 0 105 0 105 18,150
283 Ottopain TT Botol 3 0 3 3 0 40,150
284 Otsu D40 25 ml Botol 22 0 22 0 22 8,800
285 Oxytoxin inj Amp 0 100 100 23 77 3,437
286 Oxytetra Zalf Tube 125 0 125 50 75 2,716
287 Pantoprazole Inj Ampul 25 0 25 10 15 110,000
288 Paracetamol 500mg Kaplet 37700 0 37700 0 37700 254
RAHASIA
 Formulir C

1 2 3 4 5 6 7 8 9 10
289 Parasetamol 500 mg Kaplet Tablet 11800 0 11800 4300 7500 150
290 Parasetamol Infus Botol 378 0 378 50 328 60,000
291 Parasetamol Syr 60ml Botol 0 0 0 0 0 5,000
292 Paratusin Tab Tablet 8600 0 8600 800 7800 10,313
293 Petidin Inj Ampul 20 0 20 0 20 17,808
294 Phenobarbital 30mg Tablet 3394 0 3394 209 3185 88
295 Phenytoin Inj Ampul 90 0 90 0 90 61,600
296 Piracetam 1200mg Tablet 390 0 390 180 210 1,617
297 Piracetam Inj 3G 4 Amp Ampul 32 0 32 32 0 18,660
298 Piralen Tablet 100 0 100 0 100 6,187
299 Piroxicam 20mg Tablet 100 0 100 100 0 147
Ponstal Tablet 18600 0 18600 800 17800 245
301 Pritasma Tab Tablet 3000 0 3000 0 3000 165
302 Propanolol Tablet 600 0 600 0 600 1,435
303 PK Pot 168 0 168 168 0 7,600
304 Primaquin Tablet 8300 0 8300 0 8300 362
305 Pritanol 100 mg Tablet 360 0 360 0 360 330
306 Proneuron Tablet 300 0 300 0 300 1,210
307 Propiretic Supp 160 Supp 497 0 497 27 470 6,938
308 Propiretic Supp 80 Supp 504 15 519 21 498 6,542
309 Psidii Syr 60 ml Botol 70 0 70 10 60 33,000
310 Pyrantel Pamoat Tablet 200 0 200 100 100 455
311 Pyrazinamid 500mg Tablet 0 2000 2000 400 1600 3,875
312 Ranitidin 150 mg Tablet 5200 0 5200 800 4400 350
313 Ranitidin Inj 0,25 mg/ml Ampul 2900 0 2900 2200 700 3,150
314 Ranitidin Tab 150mg 100' Tablet 4300 0 4300 3300 1000 740
315 Reco SM Tube 9 0 9 0 9 6,050
316 Reco TT Botol 9 0 9 0 9 7,920
317 Redusec Kapsul 480 0 480 0 480 12,705
318 Recofol N @5 Amp Ampul 295 0 295 125 170 85,000
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
319 Rhinos Junior Syr Botol 35 0 35 35 0 28,000
320 Rhinos Neo Drop Botol 10 0 10 10 0 39,000
321 Rifampicin 450mg Tablet 2000 0 2000 200 1800 170
322 Ringer Lactat Pipih OGB Botol 0 0 0 0 0 6,630
323 Ritez drop 10ml Botol 40 0 40 35 5 52,500
324 Ritez Syr 60 ml Botol 55 0 55 25 30 50,000
325 Ronazol Inf Falcon 30 0 30 0 30 84,700
326 Roverton Tablet 126 0 126 0 126 880
327 Salbutamol 2 mg Tablet 5500 0 5500 2500 3000 94
328 Salep 2-4 Pot 120 0 120 0 120 1,720
329 Salycil Talk Pot 0 18 18 6 12 6,520
330 Sanmol drops 15 ml Btl 0 0 0 0 0 14,100
331 Sanmol Syr Botol 4 0 4 4 0 10,450
332 Scopamin Tablet 300 0 300 0 300 1,221
333 Scopamin Inj Ampul 36 0 36 0 36 17,303
334 Sibital 50mg Tablet 74 0 74 0 74 1,664
335 Simvastatin 10mg Tablet 2550 0 2550 1650 900 280
336 Sistenol Tab Tablet 180 0 180 0 180 2,200
337 Smart Diagnostic Test 120 0 120 0 120 67,100
338 Spinorolactone Kaplet 0 0 0 0 0 468
339 Staforin Dry Syr Botol 0 0 0 0 0 38,500
340 Stelosi Tablet 300 0 300 100 200 6,875
341 Stesolid 5mg Tab Tablet 0 0 0 0 0 2,117
342 Stesolid Rectal 10 mg Tube 0 0 0 0 0 49,000
343 Stesolid Rectal 5 mg Tube 0 0 0 0 0 45,000
344 Sulfatrim Tablet 9800 0 9800 0 9800 298
345 Superhoid Supp Supp 0 0 0 0 0 3,450
346 Synbio box/30sachet Sachet 0 0 0 0 0 4,000
347 Synbio Kapsul Kapsul 60 0 60 60 0 3,500
348 Teosal Tab Tablet 4400 0 4400 200 4200 190
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
349 Tetrasiklin Tablet 4900 0 4900 400 4500 100
350 Thiampenal 500mg Tablet 7100 0 7100 0 7100 850
351 Thiamphenicol 500mg Kapsul 6900 0 6900 300 6600 576
352 Thrombophop Gel 20gr Tube 5 0 5 5 0 49,400
353 Tramadol 50 mg Kapsul 3600 0 3600 0 3600 385
354 Tramadol 50 mg Kapsul 3387 300 3687 591 3096 750
355 Tramadol Inj Ampul 48 0 48 48 0 15,000
356 Tranec Tablet 180 0 180 0 180 3,410
357 Transpulmin Balm Tube 9 0 9 0 9 50,398
358 Tranxa Inj Ampul 36 0 36 0 36 14,520
359 Triamcinolon 4mg Tablet 800 0 800 100 700 1,116
360 Trifed Tab Tablet 1450 0 1450 350 1100 2,543
361 Udopa Inj Vial 12 0 12 0 12 28,270
362 Ulceranin Inj Ampul 270 0 270 0 270 24,200
363 Ulsidex Tab Tablet 0 0 0 0 0 34,000
364 Valsartan 80 mg Tablet 540 0 540 0 540 4,840
365 Vectrine 300mg Kapsul 60 0 60 0 60 3,850
366 Vectrine Dry Syr Botol 25 0 25 5 20 34,000
367 Venosmil 20' Kaplet 0 0 0 0 0 7,500
368 Venosmil Gel 60 G Box 1 0 1 0 1 135,000
369 Ventolin Nebulies 20' Ampul 1260 0 1260 660 600 8,731
370 Versyl Tablet 0 0 0 0 0 2,750
371 Vestein DS Botol 4 0 4 4 0 35,000
372 Vit B Comp Inj Vial 50 0 50 0 50 8,433
373 Vit B Comp Tab Tablet 0 0 0 0 0 450
374 Vit B1 1000' Tablet 3000 0 3000 0 3000 56,319
375 Vit B6 10mg Tablet 4000 0 4000 0 4000 35,500
376 Vit C Inj/ 100' Amp Ampul 200 0 200 200 0 6,296
377 Vitaneuron Tablet 44100 0 44100 0 44100 450
378 Vitanorm Tab 30' Tablet 0 0 0 0 0 3,330
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
379 Vitarma Tablet 13000 0 13000 0 13000 1,030
380 Vitazym Tablet 0 0 0 0 0 663
381 Vometa Drops Botol 40 0 40 10 30 37,500
382 Vomitas Syr Botol 16 0 16 16 0 39,900
383 Winatin Kaplet 900 0 900 0 900 1,100
384 Xylestesin-A Box 0 0 0 0 0 450,000
385 Zantifar Tablet 900 0 900 0 900 946
386 Zinc 20mg Tablet 800 0 800 800 0 641
387 Zinkid 10mg/ml Syr Botol 0 0 0 0 0 27,200
388 Zolastin 0,5mg Tablet 39 0 39 0 39 2,470
BEKKES UMUM
1 Alkohol 70% 1000ml Botol 150 0 150 0 150 55,838
2 Alkohol 70% 1 Ltr Botol 0 0 0 0 0 37,950
3 Alkohol Swab Box 3 0 3 0 3 42,800
4 Ansell Gammex Sterill No. 7 Pasang 90 0 90 0 90 19,360
5 Ansell Gammex Sterill No. 7,5 Pasang 120 0 120 0 120 19,360
6 Ansell Gammex Sterill No. 8 Pasang 90 0 90 0 90 19,360
7 Asco Needle Burner Unit 0 0 0 0 0 1,300,000
8 Aseptic Gel 500ml Botol 32 0 32 0 32 35,000
9 Arm sling Pcs 12 0 12 0 12 155,200
10 Benang Nylon 4.0 Pcs 0 0 0 0 0 130,000
11 Benang Nylon 10.0 Pcs 24 0 24 0 24 130,000
12 Benang PGA 8.0 Pcs 0 0 0 0 0 170,000
13 Betadine Solution 1 Liter Botol 12 0 12 0 12 189,500
14 Bisturi No 11 Pcs 600 0 600 0 600 4,200
15 Bisturi No 10 Pcs 1700 0 1700 0 1700 4,200
16 Bisturi No 20 Pcs 400 0 400 0 400 4,200
17 Bisturi No 22 Pcs 700 0 700 100 600 4,200
18 Bisturi No 15 Pcs 1000 0 1000 0 1000 4,200
19 Blood Lancet Tube 0 0 0 0 0 45,000
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
20 Colar Neck Pcs 6 0 6 0 6 130,000
21 Cap Kepala Pcs 200 0 200 100 100 2,000
22 Cut Gut 3/0 DS 24 75 cm Bks 94 0 94 0 94 83,050
23 D40 Ampul 90 0 90 15 75 2,850
24 Desinfectan handwash 1ltr Botol 1 0 1 0 1 211,475
25 Desinfectan handwash 2ltr Galon 0 0 0 0 0 1,551,000
26 Disposible syringe 3 cc Pcs 1200 0 1200 0 1200 5,610
27 Disposible syringe 5 cc Pcs 1200 0 1200 0 1200 6,820
28 Dop Mata Plastik Pcs 10 0 10 10 0 20,000
29 Elastic Verband 3 Inc Pcs 27 0 27 3 24 37,000
30 Elastic Verband 4 Inc Pcs 24 0 24 12 12 37,000
31 Elastic Verband 6 Inc Pcs 24 0 24 12 12 37,000
32 Elastic Verband 10 Inc Roll 20 0 20 0 20 67,650
33 Elastic Verband 15 Inc Roll 20 0 20 0 20 85,250
34 ETT no 5 Pcs 2 0 2 0 2 57,500
35 ETT no 5,5 Pcs 3 0 3 0 3 57,500
36 ETT no 6 Pcs 4 0 4 0 4 57,500
37 ETT no 6,5 Pcs 2 0 2 0 2 57,500
38 ETT no 7 Pcs 3 0 3 0 3 57,500
39 ETT no 7,5 Pcs 4 0 4 0 4 57,500
40 NGT Fiding Tube 3,5 Pcs 30 0 30 0 30 19,100
41 Foley Cath 14 Pcs 30 0 30 0 30 24,300
42 Foley Cath 16 Pcs 0 0 0 0 0 19,900
43 Foley Cath 18 Pcs 30 0 30 10 20 19,500
44 Foley Cath 20 Pcs 15 0 15 5 10 9,900
45 Foley Cath 22 Pcs 20 0 20 0 20 12,500
46 Foley Cath 10 Pcs 0 0 0 0 0 16,500
47 Foley Cath 8 Pcs 35 0 35 15 20 24,300
48 Folley Catheter 3 Way no 20 Buah 30 0 30 0 30 24,300
49 Folley Catheter 3 Way no 22 Buah 10 0 10 0 10 24,300
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
50 Folley Catheter 3 Way no 24 Buah 20 0 20 10 10 24,300
51 Gelang Pasien Bayi Blue Box 20 0 20 0 20 180,000
52 Gelang Pasien Bayi Pink Box 21 0 21 0 21 180,000
53 Gelang Pasien Dws Blue Box 28 0 28 4 24 180,000
54 Gelang Pasien Dws Pink Box 28 0 28 3 25 180,000
55 Gipsona 3 Inch (7,5x5M) Roll 91 0 91 0 91 25,506
56 Gipsona 4 Inch (10x2,75) Roll 75 0 75 5 70 35,708
57 Gipsona 6 Inch Roll 43 0 43 10 33 49,826
58 Guidel no.1 Pcs 4 0 4 0 4 137,500
59 Guidel no.2 Pcs 4 0 4 0 4 137,500
60 Guidel no.3 Pcs 4 0 4 0 4 137,500
61 Guidel no.4 Pcs 4 0 4 0 4 137,500
62 Guidel no.5 Pcs 4 0 4 0 4 137,500
63 Guidel no.6 Pcs 4 0 4 0 4 137,500
64 H2O2 Botol 65 0 65 5 60 55,000
65 Handscon Tissue Pcs 0 0 0 0 0 2,000
66 Hansaplast Strip 100' Box 0 0 0 0 0 21,946
67 Hypafix 10x5 Pcs 4 0 4 2 2 103,500
68 Hypafix 20x5 Pcs 7 0 7 5 2 186,100
69 Hypafix 5x1M Roll 0 0 0 0 0 11,300
70 Hypafix 5x5M Pcs 22 0 22 6 16 53,300
71 Infusion Set Pcs 300 0 300 0 300 15,125
72 Infuset Anak Buah 220 100 320 100 220 23,650
73 Infuset Dewasa Buah 400 400 800 500 300 23,650
74 IOL AC 16,5 Pcs 4 0 4 0 4 200,000
75 IOL AC 17,5 Pcs 4 0 4 0 4 200,000
76 IOL AC 18 Pcs 6 0 6 0 6 200,000
77 IOL PC 18 Pcs 4 0 4 0 4 150,000
78 IOL PC 19 Pcs 1 0 1 0 1 150,000
79 IOL PC 20,5 Pcs 1 0 1 0 1 150,000
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
80 IOL PC 21 Pcs 3 0 3 0 3 150,000
81 IV Catheter 18 G Pcs 180 0 180 0 180 32,670
82 IV Catheter 20 G Pcs 180 0 180 0 180 32,670
83 kapas Murni 1/2 kg Bungkus 41 0 41 0 41 79,750
84 Kapas Pembalut Biasa 100gr Roll 20 0 20 0 20 8,950
85 Kapas 250 gr Bks 45 0 45 15 30 15,200
86 Kapas 500 gr Bks 5 0 5 0 5 38,720
87 Kassa pmblt hidrofil 4 y x 5 cm Roll 90 0 90 0 90 2,585
88 Kassa pmblt hidrofil 4 y x 10 cm Roll 44 0 44 0 44 4,950
89 Kassa pmblt hidrofil 40y x 80cm Roll 3 0 3 0 3 228,800
90 Kassa 80 cm x 30 y Roll 0 0 0 0 0 125,750
 91 Kassa Steril 16 x 16 Box 900 0 900 0 900 16,060
92 Kertas EKG 50mm x 30 m Roll 4 0 4 0 4 22,000
93 Kertas EKG 63mm x 30 m Roll 4 0 4 0 4 55,000
94 Lancet 30GA 100'S Box 0 0 0 0 0 143,788
95 Leukoplast 1625 Box 180 0 180 40 140 40,318
96 Lomateull Lbr 36 0 36 0 36 18,150
97 Masker O2 Pcs 33 0 33 0 33 17,000
98 Masker Nebulizer Anak Pcs 41 0 41 3 38 40,000
99 Masker Nebulizer Dewasa Pcs 41 0 41 2 39 40,000
100 Microphore 2 inc Roll 45 0 45 0 45 34,100
101 Nassal Canul Child Pcs 35 0 35 0 35 25,000
102 Nassal Canul Bayi Pcs 25 0 25 3 22 25,000
103 Masker (Tali)/Karet Box 92 0 92 82 10 33,201
104 Needle 23 Pcs 1600 0 1600 1500 100 570
105 Needle 25 Pcs 600 0 600 200 400 570
106 Needle 27 Pcs 700 0 700 0 700 570
107 Neoulus Needle 23G Pcs 600 0 600 0 600 2,200
108 NGT no 5 Pcs 30 0 30 10 20 15,000
109 NGT no 8 Pcs 10 0 10 5 5 15,000
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
110 NGT no 12 Pcs 20 0 20 5 15 15,000
111 NGT no 14 Pcs 20 0 20 5 15 15,000
112 NGT no 16 Pcs 20 0 20 5 15 15,000
113 NGT no 18 Pcs 0 0 0 0 0 15,000
114 Oposite Pcs 8 0 8 0 8 25,000
115 Povidone Iodine 60 ml Botol 105 0 105 0 105 11,000
116 Povidone Iodine 1 Ltr Botol 68 0 68 0 68 170,000
117 Handscon Steril 6,5 40' Pcs 0 0 0 0 0 8,750
118 Handscon Steril 7 40' Pcs 70 0 70 70 0 8,750
119 Handscon Steril 7,5 40' Pcs 153 0 153 153 0 8,750
120 Handscon Steril 8 40' Pcs 120 0 120 120 0 8,750
121 Silk 3/0 hr 36 Bks 54 0 54 0 54 78,870
122 Softban 4inch 10x2,7 Roll 31 0 31 0 31 23,000
123 Softban 3inch Roll 47 0 47 0 47 22,000
124 Softban 6inch 15x2,7 Roll 73 0 73 0 73 35,000
125 Spalk Rifavi Pcs 4 0 4 0 4 99,000
126 Spinocain No 25 Pcs 200 0 200 0 200 44,000
127 Spinocain No 27 Pcs 225 0 225 75 150 51,700
128 Spuit 1 cc Box 4900 0 4900 500 4400 2,500
129 Spuit 10 cc Box 200 0 200 200 0 3,500
130 Spuit 20 cc Pcs 450 0 450 50 400 6,500
131 Spuit 50 cc Pcs 350 0 350 0 350 35,500
132 Spuit 3 cc Box 1800 0 1800 1800 0 1,650
133 Spuit 5 cc Box 4000 0 4000 700 3300 2,550
134 Suction cath 10 Pcs 10 0 10 0 10 12,500
135 Suction cath 12 Pcs 10 0 10 0 10 12,500
136 Suction cath 14 Pcs 10 0 10 0 10 12,500
137 Suction cath 16 Pcs 9 0 9 0 9 12,500
138 Suction cath 8 Pcs 10 0 10 0 10 12,500
139 Sufratulle Box 10 0 10 10 0 13,750
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
140 Abocath No.16 Pcs 450 0 450 0 450 22,000
141 Abocath No.18 Pcs 1250 0 1250 50 1200 22,000
142 Abocath No.20 Pcs 2500 0 2500 150 2350 22,000
143 Abocath No.22 Pcs 850 1000 1850 900 950 26,000
144 Abocath No.24 Pcs 1450 0 1450 200 1250 26,000
145 Syring Pump Unit 2 0 2 0 2 9,250,000
146 Tab Edta Pcs 400 1000 1400 800 600 1,450
147 Tab Edta 0,5ml Pcs 200 0 200 200 0 900
148 Tab non Edta Pcs 300 0 300 300 0 900
149 Tab Pyrex Box 0 0 0 0 0 712,500
150 Test Asam Urat Pcs 61 0 61 21 40 11,780
151 Test Cholesterol Pcs 0 0 0 0 0 19,110
152 Test Glucosa Pcs 40 0 40 22 18 8,627
153 Tranfusi Set Pcs 200 0 200 100 100 25,500
154 Lene 0 Pcs 24 0 24 0 24 53,000
155 Lene 1 Pcs 36 36 72 0 72 53,000
156 Lene 2,0 Pcs 48 36 84 0 84 57,000
157 Lene 3,0 Pcs 24 36 60 24 36 55,000
158 Lene 4,0 Pcs 12 36 48 0 48 53,000
159 T-Chromic 0 Pcs 36 0 36 0 36 60,000
160 T-Chromic 1 Pcs 12 36 48 0 48 69,000
161 T-Chromic 2 Pcs 48 0 48 12 36 69,000
162 T-Chromic 2-0 Pcs 36 24 60 24 36 60,000
163 T-Chromic 2-0 Roll Roll 2 0 2 0 2 1,250,000
164 T-Chromic 3.0 Pcs 72 24 96 0 96 65,000
165 T-Nylon 10,0 Pcs 24 0 24 0 24 85,000
166 T-Nylon 4,0 Pcs 0 0 0 0 0 87,000
167 T-Plain 0 Pcs 72 0 72 0 72 55,000
168 T-Plain 1 Pcs 48 0 48 0 48 55,000
169 T-Plain 2,0 Pcs 36 36 72 48 24 57,000
RAHASIA

Formulir C

1 2 3 4 5 6 7 8 9 10
170 T-Plain 2,0 Roll 2 0 2 0 2 1,250,000
171 T-Plain 3-0 Roll 2 0 2 0 2 1,250,000
172 T-Plain 3-0 Pcs 36 36 72 12 60 57,000
173 T-Plain 4-0 Pcs 48 36 84 12 72 57,000
174 T-Silk 1 Roll 0 36 36 0 36 600,000
175 T-Silk 0 Pcs 36 60 96 12 84 47,000
176 T-Silk 2-0 Roll 2 0 2 0 2 45,000
177 T-Silk 2-0 Pcs 60 36 96 12 84 44,000
178 T-Silk 3-0 Roll 2 0 2 0 2 600,000
179 T-Silk 3-0 Pcs 60 36 96 24 72 45,000
180 T-Silk 4-0 Pcs 36 0 36 12 24 42,000
181 T-Vio 0 Pcs 24 36 60 24 36 82,000
182 T-Vio 1 Pcs 108 0 108 0 108 83,000
183 T-Vio 2-0 Pcs 72 0 72 24 48 78,000
184 T-Vio 4-0 Pcs 36 0 36 0 36 83,000
185 T-Vio 3-0 Pcs 36 0 36 12 24 83,000
186 Urine Bag Pcs 200 0 200 40 160 13,915
187 Visco Sol HPMC 2% Pcs 15 0 15 0 15 110,000
188 Wing needle 21 G Buah 0 0 0 0 0 12,100
189 Wing needle 25 G Buah 0 0 0 0 0 12,100
190 Cresent Knife Pcs 67 6 73 3 70 150,000
BEKAL RADIOLOGI
X-Ray Film (AGFA)
1 Ukuran 35 x 35 cm Box 2 0 2 0 2 5,505,500
2 Ukuran 30 x 40 cm Box 2 0 2 0 2 5,505,500
3 Ukuran 24 x 30 cm Box 1 0 1 0 1 2,435,125
4 Ukuran 18 x 24 cm Box 1 0 1 0 1 1,613,818
Chemical For Manual 0
5 Developer Botol 1 0 1 0 1 1,048,080
6 Fixer 20 Ltr Galon 5 0 5 1 4 870,100
7 Fixer Botol 1 0 1 0 1 898,480
RAHASIA

Formulir C
1 2 3 4 5 6 7 8 9 10
Chemical For Automatis
8 Developer 20 Ltr Galon 5 0 5 1 4 1,410,860
9 Developer Box 1 0 1 0 1 2,250,000
10 Control Normal 3ml Btl 1 0 1 0 1 1,300,000
11 Diluent 20 Ltr Gln 1 0 1 0 1 3,250,000
12 EZ Cleanzer 100ml Botol 2 0 2 0 2 1,105,000
13 Rinse 20 Ltr Gln 2 0 2 0 2 2,210,000
14 SHR-U 24x30cm 100' Box 1 0 1 0 1 1,998,000
15 SHR-U 30x40cm 100' Box 2 0 2 0 2 3,177,000
16 SHR-U 35x35cm 100' Box 5 0 5 0 5 3,450,000
17 Thermal Roll Roll 6 0 6 0 6 25,000
18 Yellow Tip Bks 1 0 1 0 1 120,000
1 2 3 4 5 6 7 8 9 10
LAIN-LAIN
1 Kelambu Buah 15 0 15 0 15

Merauke, Juli 2017

Karumkital Merauke

dr. Tutut Sandy Waskito, Sp. B

Mayor Laut (K) NRP 15664/P
HARGA ( Rp )

TOTAL
11
9,799,500
18,876,000
-
7,630,000
434,500
3,982,500
-
10,665,974
270,000
296,700
-
8,311,500
10,941,150
1,551,200
-
11,165,000
 840,000
-

11
1,870,000
513,590
2,490,000
-
-
-
3,600,000
25,850,000
146,410
6,360,000
1,176,450
841,500
-
3,040,000
10,575,000
85,140
-
170,400
591,000
3,261,500
286,000
-
-
-
4,140,000
 -
3,370,950
12,087,900
-
-

11
102,960
727,650
-
96,462
-
-
117,405
472,000
-
59,400
1,026,000
-
-
-
-
39,816
14,850,000
4,584,000
-
-
330,000
-
 544,500
7,577,550
475,000
27,500,000
-
400,000
15,875
-

11
247,500
-
-
-
-
123,750
-
346,500
-
-
257,500
382,500
297,000
-
-
984,096
-
-
8,250,000
12,920,000
-
-
166,000
5,850,000
-
1,300,000
1,572,000
1,675,000
1,944,800
588,060

11
4,800,000
6,316,650
-
-
11,250,000
907,500
99,720
-
850,500
1,584,000
-
-
3,960,000
8,800,000
-
-
 4,966,500
490,050,000
218,400
4,207,500
980,100
1,435,500
-
230,850
1,361,250
-
-
132,000
13,660,000
968,400

11
6,865,200
11,802,000
-
3,267,000
3,630,000
3,727,736
320,760
6,590,625
3,679,200
-
722,700
1,088,880
278,400
 34,056
-
-
4,791,960
7,437,500
196,020
154,575
205,500
84,700
109,890
698,600
3,575,000
224,640
13,200
50,000
168,500
938,400

11
663,600
-
1,360,000
2,422,500
1,404,800
361,680
-
-
-
1,379,400
 135,575
2,145,000
-
27,900,000
11,154,000
24,300,000
900,000
9,900,000
18,000,000
8,100,000
9,000,200
9,724,000
2,717,000
960,000
718,650
1,088,400
406,100
4,875,000
148,500
325,500
-

11
-
-
2,125,000
-
60,000
5,626,500
 5,081,250
3,979,800
-
793,600
113,400
6,534,000
20,295,200
6,395,540
-
57,456
871,200
99,000
123,750
687,500
-
1,089,000
341,400
37,125,000
-
117,810
-
1,113,300
99,353
128,920

11
1,279,650
559,350
617,100
 -
3,600,000
-
350,000
1,851,300
4,356,000
327,000
-
29,000,000
6,489,000
4,860,000
148,500
678,000
8,226,900
-
876,000
3,828,000
33,783,750
139,000
25,000,000
79,200
3,484,800
-
92,070
693,000
825,000
-

11
 -
3,002,040
144,750
-
1,034,000
156,600
462,000
3,836,250
-
3,900,000
-
544,500
8,610,000
-
-
-
-
14,810,400
22,032,000
5,196,800
4,025,000
2,178,000
674,700
1,905,750
-
193,600
264,649
203,700
1,650,000
9,575,800
 11
1,125,000
19,680,000
-
80,441,400
356,160
280,280
5,544,000
339,570
-
618,700
-
4,361,000
495,000
861,000
-
3,004,600
118,800
363,000
3,260,860
3,257,916
1,980,000
45,500
6,200,000
1,540,000
2,205,000
740,000
54,450
71,280
6,098,400
14,450,000

11
-
-
306,000
-
262,500
1,500,000
2,541,000
110,880
282,000
206,400
78,240
-
-
366,300
622,908
123,136
252,000
396,000
8,052,000
-
-
1,375,000
-
-
-
2,920,400
 -
-
-
798,000

11
450,000
6,035,000
3,801,600
-
1,386,000
2,322,000
-
613,800
453,582
522,720
781,200
2,797,300
339,240
6,534,000
-
2,613,600
231,000
680,000
-
135,000
5,238,600
-
-
 421,650
-
168,957,000
142,000,000
-
19,845,000
-

11
13,390,000
-
1,125,000
-
990,000
-
851,400
-
-
96,330

8,375,700
-
128,400
1,742,400
2,323,200
1,742,400
-
1,120,000
1,862,400
 -
3,120,000
-
2,274,000
2,520,000
7,140,000
1,680,000
2,520,000
4,200,000
-

11
780,000
200,000
7,806,700
213,750
211,475
-
6,732,000
8,184,000
-
888,000
444,000
444,000
1,353,000
1,705,000
115,000
172,500
230,000
 115,000
172,500
230,000
573,000
729,000
-
390,000
99,000
250,000
-
486,000
729,000
243,000

11
243,000
3,600,000
3,780,000
4,320,000
4,500,000
2,321,046
2,499,560
1,644,258
550,000
550,000
550,000
550,000
550,000
550,000
3,300,000
-
-
207,000
372,200
-
852,800
4,537,500
5,203,000
7,095,000
800,000
800,000
1,200,000
600,000
150,000
150,000

11
450,000
5,880,600
5,880,600
3,269,750
179,000
456,000
193,600
232,650
217,800
686,400
-
14,454,000
88,000
220,000
-
5,644,520
653,400
561,000
1,520,000
1,560,000
1,534,500
875,000
550,000
332,010
57,000
228,000
399,000
1,320,000
300,000
75,000

11
225,000
225,000
225,000
-
200,000
1,155,000
11,560,000
-
 -
-
-
4,258,980
713,000
1,034,000
2,555,000
396,000
8,800,000
7,755,000
11,000,000
-
2,600,000
12,425,000
-
8,415,000
125,000
125,000
125,000
112,500
125,000
-

11
9,900,000
26,400,000
51,700,000
24,700,000
32,500,000
18,500,000
870,000
-
-
-
471,200
-
155,286
2,550,000
1,272,000
3,816,000
4,788,000
1,980,000
2,544,000
2,160,000
3,312,000
2,484,000
2,160,000
2,500,000
6,240,000
2,040,000
-
3,960,000
2,640,000
1,368,000

11
2,500,000
2,500,000
 3,420,000
4,104,000
21,600,000
3,948,000
90,000
3,696,000
1,200,000
3,240,000
1,008,000
2,952,000
8,964,000
3,744,000
2,988,000
1,992,000
2,226,400
1,650,000
-
-
10,500,000

11,011,000
11,011,000
2,435,125
1,613,818

1,048,080
3,480,400
898,480
 11

5,643,440
2,250,000
1,300,000
3,250,000
2,210,000
4,420,000
1,998,000
6,354,000
17,250,000
150,000
120,000
11

17
e

Sp. B
664/P
7. Dukungan Lain-Lain

JENIS DUKUNGAN
NO KEGIATAN TANGGAL
OBAT ALKES PENGOBATAN PERSONIL KETERANGAN
1 2 3 4 5 6 7 8
Amlodipin 5 mg 400 Tablet
Antalgin 500 mg 1200 Tablet
Cefadroxil 500 2000 Tablet
Chloramphenicol SK 50 Tube
Ciprofloxacin 500 1600 Tablet
1. Posal Torasi Gentamicin Krim 1 Personil 200 Tube
Ketokonazol SK 12 Tube
Meloxicam 7,5 500 Tablet
Simvastatin 1100 Tablet
Versyl 500 Tablet
Vitalex 200 Tablet

Merauke, November 2016

a.n Karumkital Merauke
Kasijangklin

dr. Afdal Riza

Lettu Laut (K) NRP 20450/P
7. Dukungan Lain-Lain

JENIS DUKUNGAN
NO KEGIATAN TANGGAL
OBAT ALKES
1 2 3 4 5
Acyclovir 400 mg
Amoxicilin 500 mg
Antalgin 500 mg
Anti Diare
Anti Flu
Captopril 12,5 mg
Cefadroxil 500
Ciprofloxacin 500
CTM
1. Posal Torasi 5/2/2016
Dexametason 0,5
Gemfibrozil
Loperamid
Methyl Prednisolon 4 mg
Parasetamol 500
Ranitidin
Thiampenal 500
Vitaneuron Tab
Vitarma tab

Merauke, J
Karumkital M

dr. Agung Suma

Mayor Laut (K) N
S DUKUNGAN
PENGOBATAN PERSONIL KETERANGAN
6 7 8
2500 Tablet
2500 Tablet
5000 Tablet
1500 Tablet
7000 Tablet
5000 Tablet
5000 Tablet
3000 Tablet
2000 Tablet
- 1 Personil
3000 Tablet
1000 Tablet
2500 Tablet
1000 Tablet
5000 Tablet
500 Tablet
1500 Tablet
4000 Tablet
4000 Tablet

Merauke, Juli 2016

Karumkital Merauke

dr. Agung Sumastoro, Sp. B

Mayor Laut (K) NRP 14587/P