STOK ID Nama Obat OBAT ID HARGA

AC Swab 126 197

Alat Hirup Salbutamol 200 mvg/kapsul 121 6,550
Alat suntik sekali pakai 1 ml 122 1,150
Alat suntik sekali pakai 10 ml 125 1,553
Alat suntik sekali pakai 3 ml 123 920
Alat suntik sekali pakai 3 ml 123 920
Alat suntik sekali pakai 5 ml 124 1,208
Alat suntik sekali pakai 5 ml 124 1,208
Albendazol susp 200 mg/ 5ml 179 4,811
Albendazol susp 200 mg/ 5ml 179 4,811
Albendazol tablet 400 ng 2 492
Alcohol swab 2 % One Med 128 123
Alcohol swab 2 % Remedi 127 142
Alcohol swab 2 % Remedi 127 153
Alopurinol tablet 100 mg 3 127
Alopurinol tablet 300 mg 3 275
Aminofilin injeksi 24mg/ml - 10 ml 4 3,349
Aminofilin injeksi 24mg/ml - 10 ml 4 3,520
Amlodipin 10 mg 6 110
Amlodipin tablet 5 mg 5 110
Amlodipin tablet 5 mg 5 95
Amoksilin 250 mg kapsul 7 224
Amoksilin 250 mg kapsul 7 207
Amoksilin 500 mg 8 245
Amoksilin 500 mg 8 192
Amoksilin sirup forte 250 mg/5 ml 9 4,296
Antasida doen tablet, kombinasi 10 74
Anti bakteri DOEN salep kombinasi : Basitrasin
12 3,658
500 IU/g + Polimiksin 10.000 IU/g
Anti Tetanus (Human tetanus imunoglobulin) 11 170,000
Antifungi doen kombinasi / 3 - 6 salf 13 3,900
Aqua proinjeksi steril, bebas pirogen 20 ml 120 2,400
Asam Askorbat (Vit. C) tablet 250 mg 14 133
Asam Askorbat (Vit. C) tablet 50 mg 16 49
Asam Askorbat (Vit. C) tablet 50 mg 16 130
Asam Folat 0,4 mg (PROFOLAT ) 18 68
Asam mefenamat tablet 500 mg 17 120
Aseptic gel 500 cc + dispenser 129 28,600
Aseptic gel 500 cc + dispenser 129 28,050
Asiklovir 200 mg 19 310
Asiklovir 200 mg 19 287
Atropin sulfat injeksi 0.25 mg/ml - 1 ml 20 1,650
Attapulgit tablet 600 mg 21 219
Attapulgit tablet 600 mg 21 216
Betametason krim 0.1 % 22 1,444
Betametason krim 0.1 % 22 1,550
Bisakodil sup 10 mg - adult 23 5,800
Bisakodil sup 5 mg- infant 24 5,800
Blood Lanchet 130 175
Blood Lanchet 130 179
Catgut Chromic/Benang Bdh no.2/0 dg jrm bdh 131 6,980
Catgut Chromic/Benang Bdh no.3/0 dg jrm bdh 132 6,980
Catgut Plain/Benang Bedah No.2/0 dg jrm bdh 133 6,980
Catgut Plain/Benang Bedah No.3/0 dg jrm bdh 134 6,980
Deksametason 0.5 mg 25 54
Deksametason 0.5 mg 25 48
Deksametason inj.5 mg/ml 26 1,910
Deksametason inj.5 mg/ml 26 1,965
Dermafix 10 x 15 cm 135 9,980
Dermafix 10 x 25 cm 136 16,524
Diazepam lar. Rectal 10 mg / 2,5 ml 27 20,141
Diazepam lar. Rectal 5 mg / 2,5 ml 28 13,904
Difenhidramin hcl inj. 10 mg/ml @ 1 ml 30 1,469
Difenhidramin hcl inj. 10 mg/ml @ 1 ml 30 1,329
Dimenhidrinat tablet 50 mg 32 110
Doksisiklin 100 mg 33 336
Doksisiklin 100 mg 33 325
Domperidon tablet 10 mg 34 122
Efinefrin hcl/ (adrenalin) inj. 0.1% - 1 ml 36 3,193
Erytromisin capsul 250 mg 37 704
Erytromisin capsul 500 mg 37 829
Etakridin (rivanol) larutan 0.1 % 137 3,900
Etakridin (rivanol) larutan 0.1 % 137 3,825
Etanol 70% 1000 ML 138 32,500
Etanol 70% 1000 ML 138 31,875
Fenitoin natrium kapsul 100/120 mg 39 152
Fenitoin natrium kapsul 30 mg (DECATONA) 38 142
Fenobarbital injeksi i.m/i.v. 50 mg/ml 40 2,153
Fenoksi metil pensilina tablet 250 mg 41 438
Fenoksi metil pensilina tablet 250 mg 41 438
Fenoksi metil pensilina tablet 500 mg 42 756
Fenoksi metil pensilina tablet 500 mg 42 756
Fitomenadion (vit. K1) injeksi 10 mg/ml @ 1 ml 43 4,167
Fitomenadion (vit. K1) tablet salut 10 mg 44 475
Fitomenadion (vit. K1) tablet salut 10 mg 44 858
Foley catheter 2 way anak 139 11,960
Foley catheter 2 way no. 16 140 10,580
Garam Oralit I serbuk
Foley catheter kombinasi
2 way no. 18 : Natrium 141 10,580
klorida 0,52 g + kalsium klorin 30 g +
45 293
Trinatrium dihidrat 0.58 + Glukosa Anhidrinat
Gemfibrozil
2,70 g kaplet 300 mg 46 475
Gemfibrozil kaplet 300 mg 46 440
Gemfibrozil kaplet 600 mg 47 927
Gemfibrozil kaplet 600 mg 47 964
Gentamisin inj 40 mg/ ml 48 4,235
Gentamycin Salep mata 0,3% 49 3,700
Gentamycin Tetes mata 0,3% 50 5,220
Glukosa larutan infus 10 % steril 143 7,500
Glukosa larutan infus 5 % steril 142 6,900
Griseofulfin tablet 125 mg, micronized 51 283
Haloperidol 1,5 mg 52 71
Hidroklorotiazid (HCT) tablet 25 mg 53 178
Hidroklorotiazid (HCT) tablet 25 mg 53 186
Hidrokortison krim 2.5 mg 54 3,036
I.V Chateter no. 22 G 144 4,830
Ibuprofen Suspensi 200 mg/5 ml 57 6,182
Ibuprofen tablet 200 mg 55 117
Ibuprofen tablet 400 mg 56 118
Infusion set anak 145 4,920
Isoniazid 58 78
Isosorbid dinitrat tablet sublingual 5 mg 59 111
Kalsium Glukonat inj 10% 60 9,955
Kalsium laktat (kalk) tablet 500 mg 61 75
Kapas Pembalut / Absorben 250 gram 146 15,625
Kapas Pembalut / Absorben 250 gram 146 14,700
Kaptopril tab 25 mg 62 94
Kasa Hydrophile 40yd x 80 cm 155 123,600
Kasa Kompres 40/40 steril 147 2,000
Kasa Kompres 40/40 steril 147 1,800
Kasa Pembalut 2 m x 80 cm 148 9,625
Kasa Pembalut 2 m x 80 cm 148 8,760
Kasa Pembalut Hidrofil 4 m x 10 cm 149 1,728
Kasa Pembalut Hidrofil 4 m x 15 cm elastic 150 2,448
Kasa Pembalut Hidrofil 4 m x 3 cm elastic 151 696
Kasa Pembalut Hidrofil 4 m x 5 cm 152 884
Kasa Pembalut Steril 18 x 22 cm elastic 153 9,188
Kasa steril 16x16 154 10,000
Kasa steril 16x16 154 6,600
Ketamin injeksii.v.100 mg/ml (IVANES) 66 51,750
Ketokonazole 200 mg 64 322
Ketokonazole krim 2% 63 2,988
Ketoprofen suppo 100 mg 65 2,850
Ketoprofen suppo 100 mg 65 2,640
Kloramfenicol kapsul 500 mg 67 1,254
Kloramfenikol Salep kulit 68 4,193
Kloramfenikol Salep kulit 68 4,108
Kloramfenikol salep mata 1 % 69 1,900
Kloramfenikol tetes mata 0,5 % 70 4,750
Klorfeniramin maleat (CTM) tablet 4 mg 71 48
Kodein 10 mg (anak) kombinasi tiap 5 ml
Kotrimoksazol 72 688
suspensi : sulfametoksazol 200 mg + 73 2,650
trimetoprim
Kuinin sulfat 40 mg 200 mg (h2o)
tablet 74 804
Lancet 184 5,950.00
Lansoprazol capsul 30 mg 75 370
Lidokain Compusitum ( Lidokain Inj 2 % (HCL)
76 2,424
+ epineprin 1 : 800.000 2 ml )
Lidokain injeksi 2 % 77 1,390
Lisol 156 53,300
Lisol 156 52,275
Loperamide tablet 2 mg 78 100
Loperamide tablet 2 mg 78 95
Loratadin 10 mg 79 180
Loratadin 10 mg 79 172
Magnesium sulfat injeksi (iv) 20% - 25 ml 80 3,200
Magnesium sulfat injeksi (iv) 40% - 25 ml 81 3,650
Masker 157 741
Masker 157 744
Maxter Exam Glove No powder L 158 715
Mebendazol tablet 100 mg (500 MG) ( VERMOX) 82 8,800
Metformin tablet 500 mg 83 120
Metformin tablet 500 mg 83 113
Metilergometrin maleat tablet salut 0.125 mg 84 185
Metilprednisolon tablet 4 mg 85 180
Metronidazol tablet 250 mg 86 99
Metronidazol tablet 500 mg 87 151
Metronidazol tablet 500 mg 157 119
Metronidazole ovula 500 mg 88 5,125
Metronidazole ovula 500 mg 88 5,125
Natrium Diklofenak 25 mg 89 160
Natrium klorida larutan infus 0.9% steril 159 5,880
Nifedipine tablet 10 mg 90 139
Nistatin 100.000 iu/g tablet vaginal 91 576
Nistatin 100.000 iu/g tablet vaginal 91 682
Oksitosin injeksi 10 iu/ml @ 1 ml 92 1,900
Omeprazole capsul 20 mg 93 161
Pirantel tablet Score (base) 125 mg 94 334
Piridoksin hcl tablet 10 mg 95 148
Plesterin Non Moven Roll 5 cm x 5 m 160 29,106
Povidon Iodida lar. 10 % 30 ml 161 2,590
Povidon Iodida lar. 10 % 30 ml 161 3,770
Povidon Iodida lar. 10 % 30 ml 161 3,698
Povidon Iodida lar. 10 % 300 ml 162 23,400
 Povidon Iodida lar. 10 % 300 ml 162 22,950
Prednison tablet 5 mg 182 91
Propranolol hcl tablet 10 mg 98 64
Propranolol hcl tablet 40 mg 99 89
Ranitidin tablet 150 mg 100 121
Rapid Test Frambusia 185 ###
Ringer laktat larutan infus steril 163 6,240
Salbutamol serb ih 200 mcg/kapsul (VENTOLIN
105 450
ROTACAPS
Salbutamol serbuk 200 mcg/kapsul 101 450
Salbutamol suspensi 2 mg/ 5ml 102 5,938
Salbutamol tablet 2 mg 103 87
Salbutamol tablet 4 mg 104 95
Salbutamol tablet 4 mg 104 100
Salep 2-4 kombinasi 106 2,400
Salep 2-4 kombinasi 106 3,040
Salisil bedak 2 % 107 1,142
Sarung tangan No. 7 164 5,405
Sarung tangan No. 7,5 165 5,405
Sarung tangan No. 8 166 5,405
Sianokobalamin (vit. b 12) 50 mcg 108 60
Sianokobalamin (vit. b 12) inj 500 mcg/ml 109 1,423
Silk (Benang Bdh Sutera) No. 2/0 dgn jrm bdh 167 3,820
Silk (Benang Bdh Sutera) No. 3/0 dgn jrm bdh 168 3,820
Simvastatin 20 mg 110 250
Siprofloksasin tab 500 mg 111 323
Siprofloksasin
Tablet koTambahtabDarah
500 mg
Kombinasi : ferro 111 276
fumarat 50 mg + as. Folat 0,4 mg tablet salut 112 444
gula
Tetrasiklin hcl kapsul 250 mg 113 195
Tetrasiklin hcl kapsul 500 mg 114 357
Tetrasiklin hcl kapsul 500 mg 114 357
Tiamin hcl mononitrat (vit. b1) tablet 50 mg 115 95
Tiamin hcl mononitrat (vit. b1) tablet 50 mg 115 94
Umbilical cord klem steril 169 1,625
Urine bag standar sterill 2 ltr 170 3,750
Vitamin B kompleks tablet 116 54
Vitamin B kompleks tablet 116 144
Water for Injection 25 ml 117 2,750
Zinc sirup 20 mg/5 ml 119 5,289
Zinc tab 20 mg 118 644
1 Primakuin tablet 210
#REF!
 Sumber
Expired Batch Noreg Tahun
Dana
2019-06-01 12071688AKD 20903210149 1 2016
2014-12-01 SV 144649DKI 9282000267 A1 1 2017
2021-07-01 0710 AKD 20902510448 1 2016
2021-07-01 0710 AKD 20902510449 1 2016
2021-09-01 0910 AKD 20902510448 1 2016
2022-05-01 0510 AKD 20902510448 1 2017
2021-07-01 0710 AKD 20902510448 1 2016
2022-05-01 0510 AKD 20902510448 1 2017
2018-06-01 1606006GKL 0920936233 A1 1 2016
2019-04-01 1704020 GKL 092093623 A1 1 2017
2019-05-01 1705106GKL 9917107563 A1 1 2017
2019-06-01 6242016 AKL 21604410664 1 2017
2019-09-01 10102016AKL 21604410664 1 2016
2020-03-01 03041788AKD 10903010280 1 2017
2020-07-01 1707-20-106GKL 0634005710 A1 1 2017
2020-04-01 HTALOE72004GKL 0708514410 B1 1 2017
2019-02-01 95307003-1GKL 9619905143 A1 1 2016
2021-04-01 97LD0061 GKL 0106709743 A1 1 2017
2020-07-01 H6098029 GKL 1240700804 B1 1 2017
2019-02-01 031267 GKL 1522723610 A1 1 2016
2020-06-01 1606-59-51GKL 0634006201 A1 1 2017
2021-08-01 HH018324 GKL 1040700204 A1 1 2016
2020-08-01 PHO 182505GKL 1040700204 A1 1 2017
2019-06-01 1706234GKL 9517101501 A2 1 2016
2019-07-01 5707010GKL 1017109938 B1 1 2017
2019-07-01 5551108GBL 0106305410 A2 1 2017
2021-07-01 1707007GKL 9620908130 A1 1 2016
2018-10-01 34145832 DKI
C 9894900543 A2 1 2017
2018-08-01 130560171 GBL 9514101330 A1 1 2016
2020-06-01 16SF028C GBL 9514101330 A1 1 2014
2020-05-01 250552 GKL 7209321243 A1 1 2015
2019-04-01 041567 POM SD 141545621 1 2017
2019-08-01 21303608POM SD 141544901 1 2016
2020-02-01 B 70009 B1GBL 0112508410 C1 1 2017
2019-05-01 19617E0050 POM SD 141546091 1 2017
2018-09-01 161067 GKL 1633313009 A1 1 2016
2019-07-01 19081688PKD 20501900056 1 2016
2020-04-01 10051788PKD 20501900056 1 2017
2020-12-01 A 1302 LSGKL 9832703710 A1 1 2016
2022-05-01 E70713JGKL 9812415010 A1 1 2017
2020-10-01 97KJ0080GKL 0106703143 A1 1 2017
2020-06-01 AF 0991DBL 9326001510 A1 1 2016
2021-07-01 M60351DBL 9326D01510 A1 1 2017
2019-05-01 E 60575 TGKL 9912700129 A1 1 2016
2020-05-01 E 704581GKL 9912700129 A1 1 2017
2019-04-01 15040828DTL 0133701253 B1 1 2017
2019-01-01 15020301DTL 0133701253 A1 1 2017
2021-08-01 09091688AKL 11603013528 1 2016
2020-04-01 15051788AKL 11603013528 1 2017
2021-09-01 30102014AKL 21603012426 1 2016
2021-08-01 30092014AKL 21603012426 1 2016
2021-07-01 1607148 AKL 21603012641 1 2016
2021-07-01 1607148 AKL 21603012641 1 2016
2019-07-01 0071GG0080 GKL 0133202910 A1 1 2016
2020-06-01 1706-05-150GKL 0734007810 A1 1 2017
2018-09-01 1409079GKL 8619906143 A1 1 2016
2019-07-01 95337013BF GKL 8619906143 A1 1 2017
2020-07-01 01081588AKD 10902510091 1 2016
2020-10-01 01111588AKL 10902013525 1 2016
2018-08-01 T23681721 DPL 780551 1 2016
2018-08-01 T23681721 DPL 780551 1 2012
2019-03-01 85342011GKL 8919905243 A1 1 2016
2020-05-01 171 E 003GKL 9613606043 A1 1 2017
2022-06-01 671147 BGTL 8912507410 A1 1 2017
2019-03-01 85342011-1 1 2016
2020-05-01 EM062 GKL 1321019401 A1 1 2017
2020-03-01 EAC093 GKL 0433512817 A1 1 2017
2019-01-01 95344001-2 GKL 8919905843 A1 1 2016
2020-05-01 17CE013GKL 9613606101 A1 1 2017
2020-04-01 DM092 GKL 1421021104 A1 1 2017
2018-09-01 01101588PKD 20501900057 1 2016
2019-07-01 08081688PKD 20501900057 1 2017
2020-08-01 19091688PKD 20501900054 1 2016
2021-03-01 07041788PKD 20501900054 1 2017
2019-09-01 370909 GKL 7809320501 A1 1 2017
2019-06-01 7F409312DKL 8107900501 B1 1 2017
2020-05-01 95803882-1 GPL 8919915443 A1 1 2017
2018-08-01 85377004GKL 9219913410 A1 1 2016
2019-06-01 95578004GKL 9219913410 B1 1 2017
2019-05-01 95378002GKL 9219913410 B1 1 2016
2019-06-01 95378005GKL 9219913410 B1 1 2017
2020-06-01 06382006-2 - 1 2017
2018-05-01 85381002GKL 9419914816 A1 1 2016
2019-06-01 95381005GKL 9419914816 A1 1 2017
2021-04-01 1605020672 AKL 20805311986 1 2016
2021-04-01 1605020672 AKL 20805311986 1 2016
2021-05-01 1606020988 AKL 20805311986 1 2016
2020-06-01 P 06003 A6GBL 1428912323 A1 1 2017
2020-05-01 95441007 - 1 2016
2020-05-01 95441010GKL 0319925301 A1 1 2017
2019-09-01 1609003GKL 9620919904 A1 1 2016
2019-08-01 1706002GKL 9620919904 A1 1 2017
2019-10-01 BF16H124 - 1 2017
2021-03-01 1652022DKL 9306308431 A1 1 2017
2020-06-01 0252009GKL 1506316946 A1 1 2017
2019-11-01 261223 GKL 9230500249 C1 1 2017
2020-02-01 270316 GKL 9130500249 C1 1 2017
2020-07-01 06354003 GKL 8919910010 A1 1 2017
2020-06-01 1706084GPL 9817105710 B1 1 2017
2020-08-01 H 1512028 - 1 2015
2022-04-01 E 70592 B GKL 7212524810 A1 1 2017
2021-06-01 F70715TGKL 1212701629 A1 1 2017
2021-06-01 3171716 GAKL 20902013575 1 2016
2019-06-01 1706009GTL 0920936733 B1 1 2017
2020-07-01 1707-06-177GTL 0934008817 A1 1 2017
2021-09-01 B1 911911 GKL 9130007610 A1 1 2017
2020-07-01 21081588AKD 20902700191 1 2016
2019-05-01 ZE91201GKL 9130004510 A2 1 2015
2020-05-01 A 2314 ET GKL 9832705374 A1 1 2016
2020-09-01 97KI0083GKL 7206715543 A1 1 2017
2018-09-01 161131 GBL 1633312910 A1 1 2016
2020-06-01 082188 LPAKD 11604300142 1 2016
2020-06-01 45064 AKG P1705-518420 1 2017
2019-06-01 20F052 GKL 0619611210 A1 1 2017
2020-12-01 45064 AKD 11603700251 1 2017
2022-06-01 082188 LPAKD 10902900140 1 2016
2022-06-01 45064 AKS-P1705-518420 1 2017
2022-07-01 082188MXAKD 10902900146 1 2016
2022-07-01 45064 AKD 11603700251 1 2017
2022-06-01 45064 AKD 11603700251 1 2017
2022-06-01 45064 AKS-P1705-518420 1 2017
2022-06-01 45064 AKD 11603700251 1 2017
2022-06-01 45064 11603700251 1 2017
2021-10-01 14111688AKD 10902900140 1 2017
2020-09-01 19101588AKD 10902900140 1 2016
2022-06-01 45064 AKS-P1705-518420 1 2017
2019-08-01 270811 DKL 9909313243 B1 1 2017
2020-08-01 170808103 GKL 0534005310 A1 1 2017
2020-08-01 1708-08-103GTL 0612701429 A1 1 2017
2019-04-01 G 60064DKL 0315616553 A1 1 2016
2019-04-01 R003G034 DKL 0617621553 A1 1 2017
2019-07-01 T2388137DKL 9605500901 B1 1 2016
2018-08-01 10208612DKL 8500900230 A1 1 2016
2020-05-01 E 71179 W GKL 9732300531 A1 1 2017
2020-05-01 E117900GKL 9732300531 A1 1 2017
2020-08-01 7H504108 DKL 9907912346 B1 1 2017
2018-08-01 T 3060 AEGTL 0334003110 A1 1 2016
2019-11-01 ME 2993 GNL9712411810A2 1 2016
2019-08-01 2768021GKL 9817104933 A1 1 2017
2020-01-01 A150036 B GTL 9712503017 A1 1 2016
2019-03-01 222022 GKL 0308508601 A1 5 2018
2021-05-01 1716024GKL 9713606343 A1 1 2017
2019-02-01 85362001GKL 8119900243 A1 1 2017
2020-06-01 95362046-1 GKL 8119900243 A1 1 2017
2019-08-01 23091688PKD 20502900046 1 2016
2020-05-01 03061788 PKD 2050299046 1 2017
2020-04-01 60506 GKL 8509202810 A1 1 2016
2020-04-01 70304 GKL 1019928210 A1 1 2017
2019-04-01 10216D0020 GKL 0733209310 A1 1 2016
2020-04-01 10217D0010 GKL 0733209310 A1 1 2017
2019-03-01 86C47A DKL 0318700643 A1 1 2017
2019-04-01 82D47A DKL 0318700643 B1 1 2017
2022-06-01 001-001-001 AKD 21603010267 1 2016
2021-04-01 6717348386 AKL 10903906888 1 2017
2021-11-01 6M0521 DTL 1124402663 A1 1 2017
2018-09-01 090136 GKL 1522723709 A1 1 2017
2019-04-01 HTMFNA72005 GKL 0608513117 A1 1 2016
2020-02-01 97LB0044GKL 8106700443 A1 1 2017
2020-04-01 DE 1082 GKL
J 8912400417 A2 1 2015
2020-05-01 ZY 022 GKL 1130911110 A1 1 2017
2021-07-01 B691277GKL 9330009010 A1 1 2017
2020-06-01 AF 911266 GKL 9330009010 B1 1 2016
2021-07-01 BG 91276GKL 9330009010 A1 1 2017
2020-05-01 056149 WDKJ 0232302050 A1 1 2016
2021-02-01 B70147WDKJ 0232302050 A1 1 2017
2021-09-01 95364025GKL 9819920415 A1 1 2017
2018-07-01 130811 GKL 9230500149 A1 1 2013
2020-07-01 47H4256GKL 9005008117 A1 1 2016
2019-08-01 85372009GKL 8919909318 A1 1 2015
2020-09-01 95372013GKL 8919909318 A1 1 2017
2020-12-01 97KL GKL 8606703943 A1 1 2017
2021-08-01 1708-03-53GKL 0934008501 A1 1 2017
2019-07-01 1707094GTL 9917106310 A1 1 2017
2020-02-01 C70175BPOM SD 151547471 1 2017
2022-06-01 12071788 AKD 1 2017
2018-07-01 10902510
G 28502 PKD 20501010542 1 2015
2019-08-01 78789 225
- 1 2016
2020-04-01 24051788PKD 20501900053 1 2017
2019-07-01 240615 AKD 20501010542 1 2016
2020-05-01 06061788PKD 20501900053 1 2017
2019-07-01 1707080GKL 9817104510 A1 1 2017
2019-06-01 1706232GKL 9817103910 B1 1 2017
2019-07-01 1707036GKL 9817103910 A1 1 2017
2020-05-01 HTRNTA73042 GKL 0308509017 A1 1 2017
2018-07-01 075097W - 5 2018
2018-09-01 PS0006 DKI 9282000267 A1 1 2013
2018-09-01 PS0006 - 1 2017
2019-05-01 1705018GKL 0920936937 A1 1 2017
2018-08-01 1608011 - 1 2016
2019-07-01 6,481,017
GKL 1019928210 A1 1 2017
2021-07-01 G 16092713 GKL 8912512010 A1 1 2016
2019-05-01 T.7952015 GKL 1306314910 A1 1 2017
2019-06-01 15SF137GBL 9600701930 A1 1 2015
2019-05-01 14057002 GBL 9600701930 A1 1 2016
2020-08-01 NA 18110400292 48OH6A0330 1 2017
2022-03-01 3017870 AKL 11603510916 1 2017
2022-01-01 29676759AKL 11603510916 1 2017
2020-03-01 2551180 AKL 11603510916 1 2016
2021-02-01 B 160095 B SP 151546951 1 2016
2019-07-01 161G013GKL 7813601043 B1 1 2016
2021-05-01 1607148 AKL 21603200436 1 2016
2021-05-01 1607148 AKL 21603012639 1 2016
2020-03-01 D70312BGKL 0512522410 B1 1 2017
2020-06-01 1606-22-108 GKL 0634005917 A1 1 2016
2020-06-01 170708108 GKL 0634005917 A1 1 2017
2019-03-01 D70290BGBL 1612526126 A1 1 2017
2019-06-01 1706236GKL 9517101501 A2 1 2017
2020-07-01 1607-03-53 0734007501 A1 1 2016
2021-06-01 1706-12-52 GKL 0734007501 A1 1 2017
2018-09-01 090026 POM SD141545601 1 2016
2021-06-01 1706-41-158 SD 161548071 1 2017
2020-08-01 1091588 AKD 20805200132 1 2016
2021-07-01 10081688AKD 20805200132 1 2016
2019-08-01 21509608 SD 141544641 1 2016
2020-04-01 D.70370T SD 151547161 1 2017
2020-03-01 95C47A DKI 9918705343 A1 1 2017
2020-04-01 E7D202 GTL 1515624337 A1 1 2017
2020-01-01 16120511706070000027482 1 2017
1/7/2018 85386004 GKL 8519904810 A1 2015
 UNIT STOK
PUSKESMAS XYZ 0
0
0
0
100
0
0
0
0
0
180
0
0
0
0
2400
30
0
0
790
210
500
0
0
0
0
0
0
2
10
0
0
0
0
0
0
0
0
200
0
0
200
0
0
 0
0
36
0
0
28
0
0
0
500
0
0
0
0
0
0
0
10
0
0
0
0
0
60
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5800
0
10
10
2000
0
 0
200
0
10
0
0
0
0
0
0
300
0
27
10
0
0
1000
0
0
0
0
8500
0
0
500
0
0
0
0
0
0
3
0
0
0
0
0
0
0
10
0
0
0
0
0
 0
0
10500
0
0
440
0
0
0
0
3
0
600
0
500
0
5
5
0
0
0
0
500
100
600
0
1000
1200
0
0
0
50
40
700
280
0
0
0
100
0
0
10
16
0
6
 0
500
0
0
0
0
0
0
0
98
0
1500
0
0
0
28
50
50
50
3500
0
0
0
0
0
0
0
1000
2000
0
41000
0
0
0
0
0
0
0
800
200
ID NAMA
1 DAK
2 APBD Provinsi
3 APBN
4 BSP
5 BF
 PEMERINTAH KABUPATEN SUMBA BARA
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DAN

NOMOR: DINKES. 04/ BASTO. / /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
6 Alopurinol tablet 300 mg tablet 500 299.00 149,500
11 Amlodipin tablet 5 mg tablet 900 110.00 99,000
14 Amoksilin 250 mg kapsul tablet 6000 223.99 1,343,958
16 Amoksilin 500 mg kaplet 7000 245.00 1,715,000
20 Antasida doen tablet, kombinasi tablet 4000 74.00 296,000

Anti bakteri DOEN salep kombinasi :

22 Basitrasin 500 IU/g + Polimiksin 10.000 tube 25 3,658.00 91,450
IU/g

26 Asam Askorbat (Vit. C) tablet 50 mg tablet 6000 49.00 294,000

28 Asam mefenamat tablet 500 mg kaplet 5000 120.00 600,000
29 Asam Folat 0,4 mg (PROFOLAT ) tablet 1000 68.00 68,000
36 Betametason krim 0.1 % tube 50 1,444.00 72,200
42 Deksametason 0.5 mg tablet 4000 54.00 216,000
44 Deksametason inj.5 mg/ml ampul 100 1,910.00 191,000
48 Difenhidramin hcl inj. 10 mg/ml @ 1 ml ampul 30 1,469.00 44,070
53 Domperidon tablet 10 mg tablet 200 122.00 24,400
62 Fenoksi metil pensilina tablet 250 mg tablet 1000 438.00 438,000
64 Fenoksi metil pensilina tablet 500 mg tablet 1000 756.00 756,000
68 Fitomenadion (vit. K1) tablet salut 10 mg tablet 5000 866.00 4,330,000
77 Gentamycin Salep mata 0,3% tube 48 3,700.00 177,600
78 Gentamycin Tetes mata 0,3% botol 24 5,220.00 125,280
83 Hidrokortison krim 2.5 mg tube 72 3,047.00 219,384
85 Ibuprofen tablet 200 mg tablet 6000 117.00 702,000
86 Ibuprofen tablet 400 mg tablet 7000 143.00 1,001,000
88 Ibuprofen Suspensi 200 mg/5 ml botol 50 6,182.00 309,100
91 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00 450,000
92 Kaptopril tab 25 mg tablet 300 94.00 28,200
NO Nama Obat satuan Jumlah Harga Total Harga

93 Ketokonazole krim 2% tube 50 2,988.00 149,400

94 Ketokonazole 200 mg tablet 500 322.00 161,000
98 Kloramfenicol kapsul 500 mg kapsul 300 1,254.00 376,200
99 Kloramfenikol Salep kulit tube 24 4,193.00 100,632
102 Kloramfenikol salep mata 1 % tube 48 1,900.00 91,200
104 Klorfeniramin maleat (CTM) tablet 4 mg tablet 21000 48.00 1,008,000
Kotrimoksazol (anak) kombinasi tiap 5
105 ml suspensi : sulfametoksazol 200 mg + botol 50 2,650.00 132,500
trimetoprim 40 mg
108 Lansoprazol capsul 30 mg kapsul 100 370.00 37,000
115 Loratadin 10 mg tablet 400 180.00 72,000
123 Metilergometrin maleat tablet salut 0.12 tablet 200 185.00 37,000
125 Metronidazol tablet 250 mg tablet 2500 106.00 265,000
127 Metronidazol tablet 500 mg tablet 3500 151.00 528,500
129 Metronidazole ovula 500 mg tablet 20 5,125.00 102,500
131 Natrium Diklofenak 25 mg tablet 700 178.00 124,600
137 Nistatin 500.000 iu tablet salut tablet 300 768.00 230,400
138 Oksitosin injeksi 10 iu/ml @ 1 ml ampul 100 1,900.00 190,000
142 Piridoksin hcl tablet 10 mg tablet 2500 148.00 370,000
144 Primakuin tablet 15 mg tablet 500 210.00 105,000
149 Salbutamol serbuk 200 mcg/kapsul kapsul 128 450.00 57,600
150 Salbutamol suspensi 2 mg/ 5ml botol 49 5,936.00 290,864
152 Salbutamol tablet 4 mg tablet 1000 95.00 95,000
159 Sianokobalamin (vit. b 12) 50 mcg tablet 3500 60.00 210,000
160 Sianokobalamin (vit. b 12) inj 500 mcg/ml ampul 100 1,423.00 142,300
162 Siprofloksasin tab 500 mg tablet 2000 323.00 646,000
Tablet koTambah Darah Kombinasi : ferro
164 fumarat 50 mg + as. Folat 0,4 mg tablet tablet 4000 444.00 1,776,000
salut gula
166 Tetrasiklin hcl kapsul 500 mg tablet 2000 357.00 714,000
168 Tiamin hcl mononitrat (vit. b1) tablet 50 tablet 23000 95.00 2,185,000
170 Vitamin B kompleks tablet tablet 3500 54.00 189,000
173 Zinc tab 20 mg tablet 300 644.00 193,200
BHP 0 -
175 Aqua proinjeksi steril, bebas pirogen 20 m vial 10 2,400.00 24,000
176 Alat Hirup Salbutamol 200 mvg/kapsul pcs 10 6,550.00 65,500
NO Nama Obat satuan Jumlah Harga Total Harga

178 Alat suntik sekali pakai 2,5 ml pcs 200 796.00 159,200
179 Alat suntik sekali pakai 3 ml pcs 200 920.00 183,999
184 AC Swab kotak 100 19,663.00 1,966,300
188 Aseptic gel 500 cc + dispenser botol 2 28,600.00 57,200
190 Blood Lanchet pcs 100 175.00 17,500
199 Etakridin (rivanol) larutan 0.1 % botol 10 3,900.00 39,000
201 Etanol 70% 1000 ML botol 7 32,500.00 227,500
206 Glukosa larutan infus 5 % steril flabot 40 6,900.00 276,000
208 I.V Chateter no. 22 G pcs 100 4,830.00 483,000
209 Infusion set anak pcs 50 4,920.00 246,000
210 Infusion set dewasa pcs 50 5,280.00 264,000
217 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 100 1,728.00 172,800
220 Kasa Pembalut Hidrofil 4 m x 5 cm Rol 50 883.00 44,150
221 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 30 9,188.00 275,640
222 Kasa steril 16x16 Bungkus 30 10,000.00 300,000
224 Kasa Hydrophile 40yd x 80 cm Bungkus 1 ### 123,600
225 Lisol botol 1 53,300.00 53,300
227 Masker pcs 300 741.00 222,300
229 Maxter Exam Glove No powder L pcs 200 729.00 145,800
231 Natrium klorida larutan infus 0.9% steril botol 200 5,880.00 1,176,000
232 Plesterin Non Moven Roll 5 cm x 5 m Roll 12 29,106.00 349,272
233 Povidon Iodida lar. 10 % 30 ml botol 30 2,590.00 77,700
236 Povidon Iodida lar. 10 % 300 ml botol 12 23,400.00 280,800
240 Ringer laktat larutan infus steril botol 100 6,240.00 624,000
240 Sarung tangan No. 7 pcs 150 5,405.00 810,750
242 Sarung tangan No. 7,5 pcs 100 5,405.00 540,500
243 Sarung tangan No. 8 pcs 50 5,405.00 270,250
245 Silk (Benang Bdh Sutera) No. 3/0 dgn jrm pcs 36 3,819.00 137,484
246 Umbilical cord klem steril pcs 501 1,625.00 814,125
248 USG Gel 25 ml botol 1 16,045.00 16,045
###

PIHAK PERTAMA PIHAK KEDUA

NO Nama Obat satuan Jumlah Harga Total Harga

Sesilia Th.N Matutina, S.Farm.,Apt. Laurensia N Wuwur, S.Far

NIP. 19850403 200903 2012 NIP: 19900810 201402 2

Setuju dikeluarkan Mengetahui

Kepala Seksi Kefarmasian Kepala Bidang Sumber Da

Paulina Maghu,S.Farm,Apt Yublina Wigira Malo, S.Far

NIP: 19790529 200903 2 002 NIP. 19800115 200501 2
UMBA BARAT DAYA
ATAN
Kadula

OBAT DAN BAHAN HABIS PAKAI

/ /2018

SUMBER
ED Batch KET
DANA
7 8 9 10
DAK2016 JUNI 2019 62404
DAK2016 JUNI 2018 17716 F 0080
DAK2016 JUNI 2020 1606-59-51
DAK2016 AGUSTUS 2020 PHO 182505
DAK2016 JULI 2019 5551108

DAK 2017
JULI 2021 1707007
DAK2016 AGUSTUS 2019 21303608
DAK2016 SEPTEMBER 2018 161067
DAK 2017 MEI 2019 19617E0050
DAK2016 MEI 2019 E 60575 T
DAK2016 JULI 2019 0071GG0080
DAK2016 SEPTEMBER 2018 1409079
DAK2016 MARET 2019 85342011
DAK 2017 MARET 2020 EAC093

DAK 2016 AGUSTUS 2018 85377004

DAK 2016 MEI 2019 95378002
DAK 2016 MEI 2018 85381002
DAK 2017 MARET 2021 1652022

DAK 2017 JUNI 2020 0252009

DAK 2016 AGUSTUS 2019 H 60905 T
DAK 2017 JULI 2020 1707-06-177
DAK 2016 JULI 2020 AG 911936
DAK 2017 'JUNI 2019 1706009
DAK 2016 SEPTEMBER 2018 161131
DAK 2017 JUNI 2019 20F052
SUMBER
ED Batch KET
DANA
DAK 2017 AGUSTUS 2020 1708-08-103

DAK 2017 AGUSTUS 2020 170808103

DAK 2016 JULI 2019 T2388137
DAK 2016 AGUSTUS 2018 10208612
DAK 2017 MEI 2020 E117900

DAK 2016 AGUSTUS 2018 T 3060 AE

AGUSTUS 2019 2768021
DAK 2017

DAK 2017 31 MARET 2019 222022

DAK 2016 APRIL 2019 10216D0020

DAK 2015 APRIL 2020 DE 1082 J
DAK 2016 MEI 2020 AE 91278
DAK 2016 JUNI 2020 AF 911266
DAK 2016 MEI 2020 056149 W
DAK 2016 JULI 2021 95364018
DAK 2015 APRIL 2018 85371002
DAK 2017 DESEMBER 2019 97KL

DAK 2017 PEBRUARI 2020 C70175B

DAK 2015 01 JULI 2018 85386004

DAK 2017 28 SEPTEMBER 2018 PS0006

DAK 2016 AGUSTUS 2018 1608011

DAK 2016 JULI 2021 G 16092713
DAK 2016 PEBRUARI 2021 B 160095 B
DAK 2016 JULI 2019 161G013
DAK 2016 JUNI 2020 1606-22-108
MARET 2019 D70290B
DAK 2017

DAK 2016 JULI 2020 1607-03-53

DAK 2016 SEPTEMBER 2018 090026
DAK 2016 AGUSTUS 2019 21509608
DAK 2017 JANUARI 2020 1612051

DAK 2015 MEI 2020 250552

DAK 2017 2014-12 SV 144649
 SUMBER
ED Batch KET
DANA
DAK 2017 JUNI 2020 01071588
DAK 2016 SEPTEMBER 2021 0910
DAK 2016 JUNI 2019 12071688
DAK 2016 JULI 2019 19081688
DAK 2016 AGUSTUS 2021 09091688
DAK 2016 MEY 2020 08061788
DAK 2016 AGUSTUS 2020 19091688
DAK 2017 FEBRUARI 2020 270316
DAK 2016 JUNI 2021 3171716 G
DAK 2016 JULI 2020 21081588
DAK 2016 JUNI 2021 20160608
DAK 2017 JUNI 2022 45064

DAK 2017 JUNI 2022 45064

DAK 2017 OKTOBER 2021 14111688

DAK 2016 SEPTEMBER 2020 19101588
DAK 2017 DESEMBER 2020 45064

DAK 2016 AGUSTUS 2019 23091688

DAK 2016 APRIL 2022 IP E752113
DAK 2016 AGUSTUS 2021 6634326198
DAK 2013 JULI 2018 130811
DAK 2017 JUNI 2022 12071788

DAK 2015 JULI 2018 G 28502

DAK 2016 JULI 2019 240615
DAK 2013 JULI 2018 130812
DAK 2017 MARET 2022 3017870
DAK 2017 JANUARI 2022 29676759
DAK 2016 MARET 2020 2551180
DAK 2016 MEI 2021 1607148
DAK 2016 AGUSTUS 2020 1091588
DAK 2017 APRIL 2019 31051788

EDUA
 SUMBER
ED Batch KET
DANA

ia N Wuwur, S.Farm,Apt
900810 201402 2 002

Bidang Sumber Daya Kesehatan

Wigira Malo, S.Farm.,Apt

00115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA BARAT
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DAN B

NOMOR: DINKES. 04/ BASTO. 39 /III /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
1 Albendazol tablet 400 ng tablet 300 492.00 147,600
2 Amlodipin tablet 5 mg tablet 1020 110.00 112,200
3 Alopurinol tablet 300 mg tablet 100 299.00 29,900
4 Amoksilin sirup forte 250 mg/5 ml botol 100 4,296.00 429,600
5 Amoksilin 250 mg kapsul tablet 1000 223.99 223,993
6 Amoksilin 500 mg kaplet 2000 245.00 490,000
7 Antasida doen tablet, kombinasi tablet 1300 74.00 96,200
Anti Tetanus (Human tetanus
8 ampul 5 ### 850,000
imunoglobulin)
9 Asam Askorbat (Vit. C) tablet 50 mg tablet 1200 49.00 58,800
3 Asam mefenamat tablet 500 mg kaplet 6000 120.00 720,000
7 Atropin sulfat injeksi 0.25 mg/ml - 1 ml ampul 100 1,650.00 165,000
8 Betametason krim 0.1 % tube 50 1,444.00 72,200
9 Deksametason 0.5 mg tablet 2000 54.00 108,000
10 Erytromisin capsul 500 mg kapsul 1000 829.00 829,000
11 Fitomenadion (vit. K1) tablet salut 10 mg tablet 6000 866.00 5,196,000
12 Hidrokortison krim 2.5 mg tube 72 3,047.00 219,384
13 Ibuprofen tablet 200 mg tablet 1500 117.00 175,500
14 Ibuprofen tablet 400 mg tablet 1500 143.00 214,500
15 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00 450,000
16 Kaptopril tab 25 mg tablet 1000 94.00 94,000
17 Kloramfenikol salep mata 1 % tube 48 1,900.00 91,200
18 Klorfeniramin maleat (CTM) tablet 4 mg tablet 3000 48.00 144,000
19 Lansoprazol capsul 30 mg kapsul 1000 370.00 370,000
20 Metformin tablet 500 mg tablet 600 120.00 72,000
21 Metronidazol tablet 250 mg tablet 200 106.00 21,200
22 Magnesium sulfat injeksi (iv) 20% - 25 ml vial 10 3,200.00 32,000
NO Nama Obat satuan Jumlah Harga Total Harga

23 Magnesium sulfat injeksi (iv) 40% - 25 ml vial 10 3,650.00 36,500

24 Metronidazol tablet 500 mg tablet 300 151.00 45,300
25 Oksitosin injeksi 10 iu/ml @ 1 ml ampul 100 1,900.00 190,000
26 Omeprazole capsul 20 mg tablet 300 184.00 55,200
27 Piridoksin hcl tablet 10 mg tablet 300 148.00 44,400
28 Prednison tablet 5 mg tablet 1000 91.00 91,000
29 Primakuin tablet 15 mg tablet 300 210.00 63,000
29 Ranitidin tablet 150 mg tablet 1000 121.00 121,000
30 Salbutamol suspensi 2 mg/ 5ml botol 22 5,936.00 130,592
31 Salbutamol tablet 4 mg tablet 500 100.00 50,000
32 Sianokobalamin (vit. b 12) 50 mcg tablet 1600 60.00 96,000
33 Simvastatin 20 mg tablet 300 250.00 75,000
34 Siprofloksasin tab 500 mg tablet 600 323.00 193,800
35 Tiamin hcl mononitrat (vit. b1) tablet 50 tablet 23000 95.00 2,185,000
36 Vitamin B kompleks tablet tablet 2000 54.00 108,000
37 Zinc tab 20 mg tablet 300 644.00 193,200
BHP 0 -
1 Alat suntik sekali pakai 3 ml pcs 100 920.00 92,000
2 Alat suntik sekali pakai 5 ml pcs 100 1,208.00 120,800
3 Aseptic gel 500 cc + dispenser botol 3 28,600.00 85,800
4 Catgut Chromic/Benang Bdh no.2/0 dg jr pcs 48 6,979.00 334,992
5 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 100 1,728.00 172,800
6 Kasa Hydrophile 40yd x 80 cm Bungkus 2 ### 247,200
7 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 20 9,188.00 183,760
8 Lisol botol 3 53,300.00 159,900
9 Masker pcs 200 741.00 148,200
10 Maxter Exam Glove No powder L pcs 300 729.00 218,700

11 Plesterin Non Moven Roll 5 cm x 5 m Roll 2 29,106.00 58,212

12 Povidon Iodida lar. 10 % 30 ml botol 26 3,698.00 96,148
13 Povidon Iodida lar. 10 % 300 ml botol 20 23,400.00 468,000
14 Sarung tangan No. 7,5 pcs 100 5,405.00 540,500
JUMLAH 18,017,281
NO Nama Obat satuan Jumlah Harga Total Harga

PIHAK PERTAMA PIHAK KEDUA

Sesilia Th.N Matutina, S.Farm.,ApAdolof Malo, Amd.Kep

NIP. 19850403 200903 2012 NIP: 19840321 200604 2

Setuju dikeluarkan Mengetahui

Kepala Seksi Kefarmasian Kepala Bidang Sumber D

Paulina Maghu,S.Farm,Apt Yublina Wigira Malo, S.Fa

NIP: 19790529 200903 2 002 NIP. 19800115 200501 2
BA BARAT DAYA
AN
ula

BAT DAN BAHAN HABIS PAKAI

I /2018

SUMBER
ED Batch KET
DANA
7 8 9 10
DAK 2017 MEI 2019 1705106

DAK2016 JUNI 2018 17716 F 0080

DAK2016 JUNI 2019 62404
DAK 2017 JULI 2019 5707010

DAK2016 JUNI 2020 1606-59-51

DAK2016 AGUSTUS 2020 PHO 182505
DAK2016 JULI 2019 5551108

DAK2016
OKTOBER 2018 34145832 C
DAK2016 AGUSTUS 2019 21303608
DAK2016 SEPTEMBER 2018 161067
DAK 2017 OKTOBER 2020 97KJ0080

DAK2016 MEI 2019 E 60575 T

DAK2016 JULI 2019 0071GG0080
DAK 2017 30 APRIL 2020 DM092

DAK 2016 MEI 2018 85381002

DAK 2016 AGUSTUS 2019 H 60905 T
DAK 2017 JULI 2020 1707-06-177
DAK 2016 JULI 2020 AG 911936
DAK 2016 SEPTEMBER 2018 161131
DAK 2017 JUNI 2019 20F052

DAK 2017 MEI 2020 E117900

DAK 2016 AGUSTUS 2018 T 3060 AE

DAK 2017 31 MARET 2019 222022

DAK 2016 SEPTEMBER 2018 090136

DAK 2016 MEI 2020 AE 91278
DAK 2017 17 MARET 2019 86C47A
SUMBER
ED Batch KET
DANA
DAK 2017 13 APRIL 2019 82D47A

DAK 2016 JUNI 2020 AF 911266

DAK 2017 DESEMBER 2019 97KL

DAK 2016 01 AGUSTUS 2020 1608-19-53

DAK 2017 PEBRUARI 2020 C70175B

DAK 2017 JULI 2019 1707080

DAK 2015 01 JULI 2018 85386004

DAK 2017 31 MEI 2020 HTRNTA73042

DAK 2016 AGUSTUS 2018 1608011

DAK 2017 MEI 2019 T.7952015

DAK 2016 PEBRUARI 2021 B 160095 B

DAK 2017 MARET 2020 D70312B

DAK 2016 JUNI 2020 1606-22-108

DAK 2016 SEPTEMBER 2018 090026
DAK 2016 AGUSTUS 2019 21509608
DAK 2017 JANUARI 2020 1612051

DAK 2017 MEI 2022 0510

DAK 2016 JULI 2021 0710
DAK 2016 JULI 2019 19081688
DAK 2016 SEPTEMBER 2021 30102014
DAK 2017 JUNI 2022 45064

DAK 2017 DESEMBER 2020 45064

DAK 2017 OKTOBER 2021 14111688

DAK 2016 AGUSTUS 2019 23091688
DAK 2016 APRIL 2022 IP E752113
DAK 2016 AGUSTUS 2021 6634326198

DAK 2017 JUNI 2022 12071788

DAK 2017 APRIL 2020 24051788

DAK 2016 JULI 2019 240615
DAK 2017 JANUARI 2022 29676759
 SUMBER
ED Batch KET
DANA

DUA

lo, Amd.Kep
0321 200604 2015

dang Sumber Daya Kesehatan

igira Malo, S.Farm.,Apt

0115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA B
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT D

NOMOR: DINKES. 04/ BASTO. / /201

NO Nama Obat satuan Jumlah Harga

1 2 3 4 5.00
3 Albendazol susp 200 mg/ 5ml botol 20
11 Amlodipin tablet 5 mg tablet 3000 110.00
13 Amlodipin 10 mg tablet 2100 110.00
14 Amoksilin 250 mg kapsul tablet 1000 223.99
16 Amoksilin 500 mg kaplet 2000 245.00
20 Antasida doen tablet, kombinasi tablet 6000 74.00
26 Asam Askorbat (Vit. C) tablet 50 mg tablet 1000 49.00
28 Asam mefenamat tablet 500 mg kaplet 5000 120.00
30 Asiklovir 200 mg tablet 200 310.00
38 Bisakodil sup 10 mg - adult suppositoria 10 5,800.00
40 Bisakodil sup 5 mg- infant suppositoria 10 5,670.00
42 Deksametason 0.5 mg tablet 7000 54.00
53 Domperidon tablet 10 mg tablet 1000 122.00
60 Fenitoin natrium kapsul 120 mg kapsul 300 152.00
62 Fenoksi metil pensilina tablet 250 mg tablet 500 438.00
64 Fenoksi metil pensilina tablet 500 mg tablet 2000 756.00
66 Fitomenadion (vit. K1) injeksi 10 mg/ml @ 1 ampul 90 4,167.00
68 Fitomenadion (vit. K1) tablet salut 10 mg tablet 6000 866.00
77 Gentamycin Salep mata 0,3% tube 24 3,700.00
82 Hidroklorotiazid (HCT) tablet 25 mg tablet 200 186.00
83 Hidrokortison krim 2.5 mg tube 48 3,047.00
85 Ibuprofen tablet 200 mg tablet 6000 117.00
86 Ibuprofen tablet 400 mg tablet 6000 143.00
88 Ibuprofen Suspensi 200 mg/5 ml botol 50 6,182.00
91 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00
92 Kaptopril tab 25 mg tablet 1000 94.00
93 Ketokonazole krim 2% tube 50 2,988.00
NO Nama Obat satuan Jumlah Harga

94 Ketokonazole 200 mg tablet 100 322.00

95 Ketoprofen suppo 100 mg suppositoria 10 2,849.99
99 Kloramfenikol Salep kulit tube 25 4,193.00
104 Klorfeniramin maleat (CTM) tablet 4 mg tablet 21000 48.00
108 Lansoprazol capsul 30 mg kapsul 1000 370.00
115 Loratadin 10 mg tablet 500 180.00
120 Metformin tablet 500 mg tablet 500 120.00
127 Metronidazol tablet 500 mg tablet 500 151.00
132 Natrium Diklofenak 25 mg tablet 2000 160.00
135 Nistatin 100.000 iu/g tablet vaginal tab vag 100 576.00
137 Nistatin 500.000 iu tablet salut tablet 500 768.00
142 Piridoksin hcl tablet 10 mg tablet 500 148.00
144 Primakuin tablet 15 mg tablet 500 210.00
147 Ranitidin tablet 150 mg tablet 1000 121.00
149 Salbutamol serbuk 200 mcg/kapsul kapsul 128 450.00
159 Sianokobalamin (vit. b 12) 50 mcg tablet 3500 60.00
162 Siprofloksasin tab 500 mg tablet 2000 323.00
Tablet koTambah Darah Kombinasi : ferro
164 fumarat 50 mg + as. Folat 0,4 mg tablet tablet 5000 444.00
salut gula
166 Tetrasiklin hcl kapsul 500 mg tablet 500 357.00
168 Tiamin hcl mononitrat (vit. b1) tablet 50 mg tablet 23000 95.00
170 Vitamin B kompleks tablet tablet 1000 54.00
173 Zinc tab 20 mg tablet 100 644.00
174 Zinc sirup 20 mg/5 ml botol 20 5,289.00
BHP 0
176 Alat Hirup Salbutamol 200 mvg/kapsul pcs 5 6,550.00
184 AC Swab kotak 5 19,663.00
185 Alcohol swab 2 % box 5 14,145.00
188 Aseptic gel 500 cc + dispenser botol 5 28,600.00
206 Glukosa larutan infus 5 % steril flabot 100 6,900.00
210 Infusion set dewasa pcs 50 5,280.00
211 Kapas Pembalut / Absorben 250 gram Bungkus 5 15,625.00
217 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 50 1,728.00
220 Kasa Pembalut Hidrofil 4 m x 5 cm Rol 50 883.00
NO Nama Obat satuan Jumlah Harga

221 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 10 9,188.00

222 Kasa steril 16x16 Bungkus 10 10,000.00
225 Lisol botol 5 53,300.00
227 Masker pcs 200 741.00
229 Maxter Exam Glove No powder L pcs 300 729.00
231 Natrium klorida larutan infus 0.9% steril botol 200 5,880.00
232 Plesterin Non Moven Roll 5 cm x 5 m Roll 10 29,106.00
238 Ringer laktat larutan infus steril botol 200 6,240.00
242 Sarung tangan No. 7,5 pcs 50 5,405.00
JUMLAH

PIHAK PERTAMA

Sesilia Th.N Matutina, S.Farm.,Apt.

NIP. 19850403 200903 2012

Setuju dikeluarkan
Kepala Seksi Kefarmasian

Paulina Maghu,S.Farm,Apt
NIP: 19790529 200903 2 002
TEN SUMBA BARAT DAYA
ESEHATAN
o - Puspem Kadula
BOLAKA

ERIMA OBAT DAN BAHAN HABIS PAKAI

4/ BASTO. / /2018

SUMBER
Total Harga ED Batch KET
DANA
6 7 8 9 10
DAK 2017 APRIL 2019 1704020

330,000 DAK2016 JUNI 2018 17716 F 0080

231,000 DAK 2017 JULI 2020 H6098029

223,993 DAK2016 JUNI 2020 1606-59-51

490,000 DAK2016 AGUSTUS 2020 PHO 182505
444,000 DAK2016 JULI 2019 5551108
49,000 DAK2016 AGUSTUS 2019 21303608
600,000 DAK2016 SEPTEMBER 2018 161067
62,000 DAK2016 DESEMBER 2019 A 1302 LS
58,000 DAK2016 PEBRUARI 2019 15030501
56,700 DAK2016 JANUARI 2019 15020297
378,000 DAK2016 JULI 2019 0071GG0080
122,000 DAK 2017 MARET 2020 EAC093

45,600 DAK 2017 SEPTEMBER 2019 370909

219,000 DAK 2016 AGUSTUS 2018 85377004
1,512,000 DAK 2016 MEI 2019 95378002
375,030 DAK 2017 JUNI 2020 06382006-2

5,196,000 DAK 2016 MEI 2018 85381002

88,800 DAK 2017 MARET 2021 1652022

37,200 DAK 2017 APRIL 2022 E 70592 B

146,256 DAK 2016 AGUSTUS 2019 H 60905 T
702,000 DAK 2017 JULI 2020 1707-06-177
858,000 DAK 2016 JULI 2020 AG 911936
309,100 DAK 2017 'JUNI 2019 1706009
450,000 DAK 2016 SEPTEMBER 2018 161131
94,000 DAK 2017 JUNI 2019 20F052

149,400 DAK 2017 AGUSTUS 2020 1708-08-103

 SUMBER
Total Harga ED Batch KET
DANA
32,200 DAK 2017 AGUSTUS 2020 170808103
28,500 DAK 2016 APRIL 2019 G 60064
104,825 DAK 2016 AGUSTUS 2018 10208612
1,008,000 DAK 2016 AGUSTUS 2018 T 3060 AE
370,000 DAK 2017 31 MARET 2019 222022

90,000 DAK 2016 APRIL 2019 10216D0020

60,000 DAK 2016 SEPTEMBER 2018 090136
75,500 DAK 2016 JUNI 2020 AF 911266
320,000 DAK 2017 SEPTEMBER 2021 95364025

57,600 DAK 2015 AGUSTUS 2019 85372009

384,000 DAK 2015 APRIL 2018 85371002
74,000 DAK 2017 PEBRUARI 2020 C70175B

105,000 DAK 2015 01 JULI 2018 85386004

121,000 DAK 2017 31 MEI 2020 HTRNTA73042

57,600 DAK 2017 28 SEPTEMBER 2018 PS0006

210,000 DAK 2016 PEBRUARI 2021 B 160095 B

646,000 DAK 2016 JUNI 2020 1606-22-108
MARET 2019 D70290B
2,220,000 DAK 2017

178,500 DAK 2016 JULI 2020 1607-03-53

2,185,000 DAK 2016 SEPTEMBER 2018 090026
54,000 DAK 2016 AGUSTUS 2019 21509608
64,400 DAK 2017 JANUARI 2020 1612051

105,780 DAK 2017 APRIL 2020 E7D202

-
32,750 DAK 2017 2014-12 SV 144649
98,315 DAK 2016 JUNI 2019 12071688
70,725 DAK 2016 JUNI 2019 6242016
143,000 DAK 2016 JULI 2019 19081688
690,000 DAK 2017 FEBRUARI 2020 270316
264,000 DAK 2016 JUNI 2021 20160608
78,125 DAK 2016 - 082188 LP
86,400 DAK 2017 JUNI 2022 45064

44,150 DAK 2017 JUNI 2022 45064

 SUMBER
Total Harga ED Batch KET
DANA
91,880 DAK 2017 OKTOBER 2021 14111688
100,000 DAK 2016 SEPTEMBER 2020 19101588
266,500 DAK 2016 AGUSTUS 2019 23091688
148,200 DAK 2016 APRIL 2022 IP E752113
218,700 DAK 2016 AGUSTUS 2021 6634326198
1,176,000 DAK 2013 JULI 2018 130811
291,060 DAK 2017 JUNI 2022 12071788

1,248,000 DAK 2013 JULI 2018 130812

270,250 DAK 2017 JANUARI 2022 29676759
27,097,039

PIHAK KEDUA

Martina Peda Luba, Amd.Kep

NIP: 19840321 200604 2015

Mengetahui
Kepala Bidang Sumber Daya Kesehatan

Yublina Wigira Malo, S.Farm.,Apt

NIP. 19800115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA BAR
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DA

NOMOR: DINKES. 04/ BASTO. / /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
1 Alopurinol tablet 300 mg tablet 700 299.00 209,300
2 Amlodipin tablet 5 mg tablet 1,200 110.00 132,000
3 Amoksilin 250 mg kapsul tablet 1,500 223.99 335,990
4 Amoksilin 500 mg kaplet 4,000 245.00 980,000
5 Amoksilin sirup forte 250 mg/5 ml botol 50 4,296.00 214,800
6 Antasida doen tablet, kombinasi tablet 3,000 74.00 222,000

Anti bakteri DOEN salep kombinasi :

7 Basitrasin 500 IU/g + Polimiksin 10.000 tube 25 3,658.00 91,450
IU/g

8 Antifungi doen kombinasi / 3 - 6 salf pot 24 3,900.00 93,600

9 Asam Askorbat (Vit. C) tablet 250 mg tablet 1,000 133.00 133,000

10 Asam Askorbat (Vit. C) tablet 50 mg tablet 3,000 49.00 147,000
11 Asam mefenamat tablet 500 mg kaplet 4,000 120.00 480,000
12 Betametason krim 0.1 % tube 50 1,444.00 72,200
13 Bisakodil sup 10 mg - adult suppositoria 20 5,800.00 116,000
14 Bisakodil sup 5 mg- infant suppositoria 24 5,800.00 139,200
15 Deksametason 0.5 mg tablet 5,000 54.00 270,000

16 Difenhidramin hcl inj. 10 mg/ml @ 1 ml ampul 30 1,260.00 37,800

17 Dimenhidrinat tablet 50 mg tablet 3,000 110.00 330,000

18 Domperidon tablet 10 mg tablet 2,000 122.00 244,000
19 Fenoksi metil pensilina tablet 250 mg tablet 200 438.00 87,600
20 Fenoksi metil pensilina tablet 500 mg tablet 200 756.00 151,200
21 Fitomenadion (vit. K1) injeksi 10 mg/ml @ ampul 30 4,167.00 125,010
22 Fitomenadion (vit. K1) tablet salut 10 mg tablet 6,000 866.00 5,196,000
23 Gemfibrozil kaplet 300 mg kaplet 200 475.00 95,000
24 Gentamycin Tetes mata 0,3% botol 24 5,220.00 125,280
NO Nama Obat satuan Jumlah Harga Total Harga

25 Hidroklorotiazid (HCT) tablet 25 mg tablet 500 178.00 89,000

26 Hidrokortison krim 2.5 mg tube 24 3,047.00 73,128
27 Ibuprofen tablet 200 mg tablet 2,500 117.00 292,500
28 Ibuprofen tablet 400 mg tablet 5,500 118.00 649,000
29 Kalsium laktat (kalk) tablet 500 mg tablet 7,000 75.00 525,000
30 Kaptopril tab 25 mg tablet 3,000 94.00 282,000
31 Ketokonazole krim 2% tube 25 2,988.00 74,700
32 Ketokonazole 200 mg tablet 500 322.00 161,000
33 Ketoprofen suppo 100 mg suppositoria 50 2,849.99 142,500
34 Kloramfenikol Salep kulit tube 48 4,193.00 201,264
35 Kloramfenikol tetes mata 0,5 % botol 24 4,750.00 114,000
36 Klorfeniramin maleat (CTM) tablet 4 mg tablet 21,000 48.00 1,008,000
37 Lidokain injeksi 2 % ampul 100 887.00 88,700
38 Loratadin 10 mg tablet 1,000 180.00 180,000
39 Metformin tablet 500 mg tablet 400 120.00 48,000
40 Metronidazol tablet 250 mg tablet 500 106.00 53,000
41 Metronidazol tablet 500 mg tablet 1,000 151.00 151,000
42 Natrium Diklofenak 25 mg tablet 3,000 178.00 534,000
43 Nistatin 500.000 iu tablet salut tablet 1,000 768.00 768,000
44 Omeprazole capsul 20 mg tablet 1,740 161.00 280,140
45 Pirantel tablet Score (base) 125 mg tablet 500 334.00 167,000
46 Piridoksin hcl tablet 10 mg tablet 500 148.00 74,000
47 Prednison tablet 5 mg tablet 500 91.00 45,500
48 Primakuin tablet 15 mg tablet 200 210.00 42,000
49 Ranitidin tablet 150 mg tablet 500 121.00 60,500
50 Salbutamol suspensi 2 mg/ 5ml botol 22 5,936.00 130,592
51 Salbutamol tablet 4 mg tablet 1,000 95.00 95,000
52 Salisil bedak 2 % pot 10 1,142.00 11,420
53 Sianokobalamin (vit. b 12) 50 mcg tablet 100 60.00 6,000
54 Sianokobalamin (vit. b 12) inj 500 mcg/ml ampul 2,500 1,423.00 3,557,500
55 Siprofloksasin tab 500 mg tablet 1,000 323.00 323,000
Tablet koTambah Darah Kombinasi : ferro
56 fumarat 50 mg + as. Folat 0,4 mg tablet tablet 4,500 444.00 1,998,000
salut gula
57 Tetrasiklin hcl kapsul 500 mg tablet 200 357.00 71,400
NO Nama Obat satuan Jumlah Harga Total Harga

58 Tiamin hcl mononitrat (vit. b1) tablet 50 tablet 23,000 95.00 2,185,000
59 Vitamin B kompleks tablet tablet 4,000 54.00 216,000
60 Zinc tab 20 mg tablet 500 644.00 322,000
BHP -
61 Alat suntik sekali pakai 2,5 ml pcs 500 796.00 398,000
62 Alat suntik sekali pakai 3 ml pcs 300 920.00 275,999
63 Alat suntik sekali pakai 10 ml pcs 100 1,553.00 155,300
64 Alcohol swab 2 % box 1 14,145.00 14,145
65 Aseptic gel 500 cc + dispenser botol 5 28,600.00 143,000
66 Blood Lanchet pcs 200 175.00 35,000
67 Etakridin (rivanol) larutan 0.1 % botol 5 -
68 Etanol 70% 1000 ML botol 5 32,500.00 162,500
69 Glukosa larutan infus 5 % steril flabot 40 6,900.00 276,000
70 Kapas Pembalut / Absorben 250 gram Bungkus 6 15,625.00 93,750
71 Kasa Kompres 40/40 steril Bungkus 20 2,000.00 40,000
72 Kasa Pembalut Hidrofil 4 m x 5 cm Rol 100 883.00 88,300
73 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 10 9,188.00 91,880
74 Kasa steril 16x16 Bungkus 5 10,000.00 50,000
75 Kasa Hydrophile 40yd x 80 cm Bungkus 4 ### 494,400
76 Lisol botol 2 53,300.00 106,600
77 Masker pcs 100 741.00 74,100
78 Maxter Exam Glove No powder L pcs 100 729.00 72,900
79 Natrium klorida larutan infus 0.9% steril botol 200 5,880.00 1,176,000
80 Plesterin Non Moven Roll 5 cm x 5 m Roll 6 29,106.00 174,636
81 Povidon Iodida lar. 10 % 30 ml botol 26 2,590.00 67,340
82 Povidon Iodida lar. 10 % 300 ml botol 20 23,400.00 468,000
83 Ringer laktat larutan infus steril botol 100 6,240.00 624,000
84 Sarung tangan No. 7 pcs 100 5,405.00 540,500
30,670,623
NO Nama Obat satuan Jumlah Harga Total Harga

PIHAK PERTAMA PIHAK KEDUA

Sesilia Th.N Matutina, S.Farm.,Apt. Maria Kartini Wisang,

NIP. 19850403 200903 2012 NIP: 19850507 20140

Setuju dikeluarkan Mengetahui

Kepala Seksi Kefarmasian Kepala Bidang Sumbe

Paulina Maghu,S.Farm,Apt Yublina Wigira Malo, S

NIP: 19790529 200903 2 002 NIP. 19800115 200501
MBA BARAT DAYA
TAN
adula

BAT DAN BAHAN HABIS PAKAI

/ /2018

SUMBER
ED Batch KET
DANA
7 8 9 10
DAK2016 JUNI 2019 62404
DAK2016 JUNI 2018 17716 F 0080
DAK2016 JUNI 2020 1606-59-51
DAK2016 AGUSTUS 2020 PHO 182505
DAK 2017 JULI 2019 5707010

DAK2016 JULI 2019 5551108

DAK 2017
JULI 2021 1707007
DAK/DAU
2014 AGUSTUS 2018 130560171
DAK 2017 APRIL 2019 041567
DAK2016 AGUSTUS 2019 21303608
DAK2016 SEPTEMBER 2018 161067
DAK2016 MEI 2019 E 60575 T
DAK 2017 APRIL 2019 15040828
DAK 2017 JANUARI 2019 15020301
DAK2016 JULI 2019 0071GG0080
DAK/DAU
2015 MARET 2019 85342011-1
DAK 2017 JUNI 2022 671147 B
DAK 2017 MARET 2020 EAC093

DAK 2016 AGUSTUS 2018 85377004

DAK 2016 MEI 2019 95378002
DAK 2017 JUNI 2020 06382006-2

DAK 2016 MEI 2018 85381002

DAK 2016 MEI 2020 95441007
DAK 2017 JUNI 2020 0252009
SUMBER
ED Batch KET
DANA
DAK 2015 AGUSTUS 2020 H 1512028
DAK 2016 AGUSTUS 2019 H 60905 T
DAK 2017 JULI 2020 1707-06-177
DAK 2017 SEPTEMBER 2021 B1 911911
DAK 2016 SEPTEMBER 2018 161131
DAK 2017 JUNI 2019 20F052

DAK 2017 AGUSTUS 2020 1708-08-103

DAK 2017 AGUSTUS 2020 170808103

DAK 2016 APRIL 2019 G 60064
DAK 2016 AGUSTUS 2018 10208612
DAK 2017 AGUSTUS 2020 7H504108

DAK 2016 AGUSTUS 2018 T 3060 AE

DAK 2016 FEBRUARI 2019 85362001
DAK 2016 APRIL 2019 10216D0020
DAK 2016 SEPTEMBER 2018 090136
DAK 2016 MEI 2020 AE 91278
DAK 2016 JUNI 2020 AF 911266
DAK 2016 JULI 2021 95364018
DAK 2015 APRIL 2018 85371002
DAK 2017 AGUSTUS 2021 1708-03-53
DAK 2017 JULI 2019 1707094

DAK 2017 PEBRUARI 2020 C70175B

DAK 2017 JULI 2019 1707080

DAK 2015 01 JULI 2018 85386004

DAK 2017 31 MEI 2020 HTRNTA73042

DAK 2016 AGUSTUS 2018 1608011

DAK 2016 JULI 2021 G 16092713
DAK 2017 AGUSTUS 2020 NA 18110400292

DAK 2016 PEBRUARI 2021 B 160095 B

DAK 2016 JULI 2019 161G013
DAK 2016 JUNI 2020 1606-22-108
MARET 2019 D70290B
DAK 2017

DAK 2016 JULI 2020 1607-03-53

SUMBER
ED Batch KET
DANA
DAK 2016 SEPTEMBER 2018 090026
DAK 2016 AGUSTUS 2019 21509608
DAK 2017 JANUARI 2020 1612051

DAK 2017 JUNI 2020 01071588

DAK 2016 SEPTEMBER 2021 0910
DAK 2016 JULI 2021 0710
DAK 2016 JUNI 2019 6242016
DAK 2016 JULI 2019 19081688
DAK 2016 AGUSTUS 2021 09091688
DAK 2016 SEPTEMBER 2018 01101588
DAK 2016 AGUSTUS 2020 19091688
DAK 2017 FEBRUARI 2020 270316
DAK 2016 - 082188 LP
DAK 2016 - 082188 LP
DAK 2017 JUNI 2022 45064

DAK 2017 OKTOBER 2021 14111688

DAK 2016 SEPTEMBER 2020 19101588
DAK 2017 DESEMBER 2020 45064

DAK 2016 AGUSTUS 2019 23091688

DAK 2016 APRIL 2022 IP E752113
DAK 2016 AGUSTUS 2021 6634326198
DAK 2013 JULI 2018 130811
DAK 2017 JUNI 2022 12071788

DAK 2015 JULI 2018 G 28502

DAK 2016 JULI 2019 240615
DAK 2013 JULI 2018 130812
DAK 2017 MARET 2022 3017870
 SUMBER
ED Batch KET
DANA
DUA

ini Wisang, S.Farm

0507 201402 2 007

dang Sumber Daya Kesehatan

gira Malo, S.Farm.,Apt

0115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA BARA
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DAN

NOMOR: DINKES. 04/ BASTO. / III /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
1 Albendazol susp 200 mg/ 5ml btl 10 4,811.00 48,110
2 Alopurinol tablet 100 mg tablet 300 127.00 38,100
3 Aminofilin injeksi 24mg/ml - 10 ml ampul 30 3,349.00 100,470
4 Amlodipin tablet 5 mg tablet 1080 110.00 118,800
5 Amlodipin 10 mg tablet 300 110.00 33,000
6 Amoksilin 250 mg kapsul tablet 2000 223.99 447,986
7 Amoksilin 500 mg kaplet 5500 245.00 1,347,500
8 Amoksilin sirup forte 250 mg/5 ml botol 50 4,296.00 214,800
9 Antasida doen tablet, kombinasi tablet 2500 74.00 185,000
Anti bakteri DOEN salep kombinasi :
10 Basitrasin 500 IU/g + Polimiksin 10.000 tube 50 3,658.00 182,900
IU/g
11 Asam Askorbat (Vit. C) tablet 250 mg tablet 1000 133.00 133,000
12 Asam Askorbat (Vit. C) tablet 50 mg tablet 3000 49.00 147,000
13 Asam mefenamat tablet 500 mg kaplet 2500 120.00 300,000
14 Asam Folat 0,4 mg (PROFOLAT ) tablet 1000 68.00 68,000
15 Atropin sulfat injeksi 0.25 mg/ml - 1 ml ampul 100 1,650.00 165,000
16 Attapulgit tablet 600 mg tablet 300 216.00 64,800
17 Betametason krim 0.1 % tube 50 1,444.00 72,200
18 Bisakodil sup 10 mg - adult suppositoria 10 5,800.00 58,000
19 Bisakodil sup 5 mg- infant suppositoria 24 5,670.00 136,080
20 Deksametason 0.5 mg tablet 3500 54.00 189,000
21 Doksisiklin 100 mg kapsul 500 336.00 168,000
22 Domperidon tablet 10 mg tablet 1200 122.00 146,400
23 Fenitoin natrium kapsul 30 mg (DECATON kapsul 100 142.00 14,200
24 Fenobarbital injeksi i.m/i.v. 50 mg/ml ampul 30 2,153.00 64,590
25 Fenoksi metil pensilina tablet 250 mg tablet 200 438.00 87,600
26 Fenoksi metil pensilina tablet 500 mg tablet 600 756.00 453,600
NO Nama Obat satuan Jumlah Harga Total Harga

27 Fitomenadion (vit. K1) injeksi 10 mg/ml @ ampul 30 4,167.00 125,010

28 Fitomenadion (vit. K1) tablet salut 10 mg tablet 5300 759.00 4,022,700
Garam Oralit I serbuk kombinasi :
Natrium klorida 0,52 g + kalsium klorin
29 sachet 200 293.00 58,600
30 g + Trinatrium dihidrat 0.58 +
Glukosa Anhidrinat 2,70 g
30 Gentamycin Salep mata 0,3% tube 48 3,700.00 177,600
31 Hidroklorotiazid (HCT) tablet 25 mg tablet 1100 178.00 195,800
32 Ibuprofen tablet 200 mg tablet 2000 117.00 234,000
33 Ibuprofen tablet 400 mg tablet 3200 118.00 377,600
34 Ibuprofen Suspensi 200 mg/5 ml botol 50 6,182.00 309,100
35 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00 450,000
36 Kaptopril tab 25 mg tablet 1500 94.00 141,000
37 Ketokonazole krim 2% tube 25 2,988.00 74,700
38 Kloramfenicol kapsul 500 mg kapsul 300 1,254.00 376,200
39 Kloramfenikol tetes mata 0,5 % botol 10 4,750.00 47,500
40 Klorfeniramin maleat (CTM) tablet 4 mg tablet 21000 48.00 1,008,000
41 Kodein 10 mg tablet 200 688.00 137,600
Kotrimoksazol (anak) kombinasi tiap 5
42 ml suspensi : sulfametoksazol 200 mg + botol 50 2,650.00 132,500
trimetoprim 40 mg
43 Lansoprazol capsul 30 mg kapsul 300 370.00 111,000
44 Loratadin 10 mg tablet 700 172.00 120,400
45 Metformin tablet 500 mg tablet 1000 120.00 120,000
46 Metronidazol tablet 250 mg tablet 500 106.00 53,000
47 Metronidazol tablet 500 mg tablet 1000 151.00 151,000
48 Natrium Diklofenak 25 mg tablet 800 178.00 142,400
49 Nifedipine tablet 10 mg tablet 600 139.00 83,400
50 Nistatin 500.000 iu tablet salut tablet 500 768.00 384,000

51 Omeprazole capsul 20 mg tablet 1200 161.00 193,200

52 Primakuin tablet 15 mg tablet 200 210.00 42,000
53 Ranitidin tablet 150 mg tablet 1000 121.00 121,000
54 Salbutamol suspensi 2 mg/ 5ml botol 49 5,936.00 290,864
55 Salbutamol tablet 2 mg tablet 300 87.00 26,100
56 Salbutamol tablet 4 mg tablet 1000 95.00 95,000
57 Sianokobalamin (vit. b 12) 50 mcg tablet 1000 60.00 60,000
NO Nama Obat satuan Jumlah Harga Total Harga

58 Simvastatin 20 mg tablet 200 250.00 50,000

59 Siprofloksasin tab 500 mg tablet 1000 323.00 323,000
Tablet koTambah Darah Kombinasi : ferro
60 fumarat 50 mg + as. Folat 0,4 mg tablet tablet 4000 444.00 1,776,000
salut gula
61 Vitamin B kompleks tablet tablet 5000 54.00 270,000
62 Zinc tab 20 mg tablet 300 644.00 193,200
63 Zinc sirup 20 mg/5 ml botol 20 5,289.00 105,780
64 BHP
65 Alat suntik sekali pakai 2,5 ml pcs 200 796.00 159,200
66 Alat suntik sekali pakai 3 ml pcs 200 920.00 183,999
67 Alat suntik sekali pakai 5 ml pcs 200 1,208.00 241,600
68 AC Swab kotak 2 ### 39,326
69 Alcohol swab 2 % box 2 ### 28,290
70 Aseptic gel 500 cc + dispenser botol 3 ### 85,800
71 Blood Lanchet pcs 200 175.00 35,000
72 Etanol 70% 1000 ML botol 5 ### 162,500
73 Glukosa larutan infus 5 % steril flabot 40 6,900.00 276,000
74 I.V Chateter no. 22 G pcs 100 4,830.00 483,000
75 Kasa Pembalut 2 m x 80 cm Rol 20 9,625.00 192,500
76 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 50 1,728.00 86,400
77 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 30 9,188.00 275,640
78 Kasa steril 16x16 Bungkus 40 ### 400,000
79 Kasa Hydrophile 40yd x 80 cm Bungkus 5 ### 618,000
80 Masker pcs 400 741.00 296,400
81 Maxter Exam Glove No powder L pcs 400 729.00 291,600
82 Natrium klorida larutan infus 0.9% steril botol 80 5,880.00 470,400
83 Plesterin Non Moven Roll 5 cm x 5 m Roll 3 ### 87,318
84 Povidon Iodida lar. 10 % 30 ml botol 26 2,590.00 67,340
85 Povidon Iodida lar. 10 % 300 ml botol 12 ### 280,800
86 Ringer laktat larutan infus steril botol 60 6,240.00 374,400
87 Sarung tangan No. 7 pcs 100 5,405.00 540,500
88 Sarung tangan No. 7,5 pcs 100 5,405.00 540,500
89 Silk (Benang Bdh Sutera) No. 2/0 dgn jrm pcs 36 3,819.00 137,484
90 Silk (Benang Bdh Sutera) No. 3/0 dgn jrm pcs 36 3,819.00 137,484
NO Nama Obat satuan Jumlah Harga Total Harga

24,054,871

PIHAK PERTAMA

Yulius Nani,Amd.Farm
NIP. 19810703 200803 1 003

Menyetujui,
Kepala Seksi Kefarmasian

Paulina Maghu,S.Farm,Apt
NIP: 19790529 200903 2 002
MBA BARAT DAYA
TAN
adula

OBAT DAN BAHAN HABIS PAKAI

/ III /2018

SUMBER
ED Batch KET
DANA
7 8 9 10
DAK 2017 APRIL 2019 1704020

DAK 2017 JULI 2020 1707-20-106

DAK 2016 MARET 2018 95307003-1

DAK2016 JUNI 2018 17716 F 0080
DAK 2017 JULI 2020 H6098029

DAK2016 JUNI 2020 1606-59-51

DAK2016 AGUSTUS 2020 PHO 182505
DAK 2017 JULI 2019 5707010

DAK2016 JULI 2019 5551108

DAK 2017
JULI 2021 1707007
DAK 2017 APRIL 2019 041567
DAK2016 AGUSTUS 2019 21303608
DAK2016 SEPTEMBER 2018 161067
DAK 2017 MEI 2019 19617E0050
DAK 2017 OKTOBER 2020 97KJ0080

DAK 2017 JULI 2021 M60351

DAK2016 MEI 2019 E 60575 T

DAK2016 PEBRUARI 2019 15030501
DAK2016 JANUARI 2019 15020297
DAK2016 JULI 2019 0071GG0080
DAK2016 MARET 2019 85342011-1
DAK 2017 MARET 2020 EAC093

DAK 2017 JUNI 2019 7F409312

DAK 2017 31 MEI 2020 95803882-1

DAK 2016 AGUSTUS 2018 85377004

DAK 2016 MEI 2019 95378002
SUMBER
ED Batch KET
DANA
DAK 2017 JUNI 2020 06382006-2

DAK 2015
JUNI 2020 P 06003 A6

DAK 2017

DAK 2017 MARET 2021 1652022

DAK 2015 AGUSTUS 2020 H 1512028

DAK 2017 JULI 2020 1707-06-177
DAK 2017 SEPTEMBER 2021 B1 911911
DAK 2017 'JUNI 2019 1706009
DAK 2016 SEPTEMBER 2018 161131
DAK 2017 JUNI 2019 20F052

DAK 2017 AGUSTUS 2020 1708-08-103

DAK 2016 JULI 2019 T2388137

DAK 2017 AGUSTUS 2020 7H504108

DAK 2016 AGUSTUS 2018 T 3060 AE

DAK 2016
AGUSTUS 2019 2768021
DAK 2017

DAK 2017 31 MARET 2019 222022

DAK 2017 APRIL 2020 10217D0010

DAK 2016 SEPTEMBER 2018 090136

DAK 2016 MEI 2020 AE 91278
DAK 2016 JUNI 2020 AF 911266
DAK 2016 JULI 2021 95364018
DAK 2016 JULI 2020 47H4256
DAK 2015 APRIL 2018 85371002

DAK 2017 AGUSTUS 2021 1708-03-53

DAK 2015 01 JULI 2018 85386004
DAK 2017 31 MEI 2020 HTRNTA73042

DAK 2016 AGUSTUS 2018 1608011

DAK 2017 JULI 2019 6,481,017

DAK 2016 JULI 2021 G 16092713

DAK 2016 PEBRUARI 2021 B 160095 B
SUMBER
ED Batch KET
DANA
DAK 2017 MARET 2020 D70312B

DAK 2016 JUNI 2020 1606-22-108

MARET 2019 D70290B
DAK 2017

DAK 2016 AGUSTUS 2019 21509608

DAK 2017 JANUARI 2020 1612051

DAK 2017 APRIL 2020 E7D202

DAK 2017 JUNI 2020 01071588

DAK 2016 SEPTEMBER 2021 0910
DAK 2016 JULI 2021 0710
DAK 2016 JUNI 2019 12071688
DAK 2016 JUNI 2019 6242016
DAK 2016 JULI 2019 19081688
DAK 2016 AGUSTUS 2021 09091688
DAK 2016 AGUSTUS 2020 19091688
DAK 2017 FEBRUARI 2020 270316
DAK 2016 JUNI 2021 3171716 G
DAK 2016 - 082188MX
DAK 2017 JUNI 2022 45064

DAK 2017 OKTOBER 2021 14111688

DAK 2016 SEPTEMBER 2020 19101588
DAK 2017 DESEMBER 2020 45064

DAK 2016 APRIL 2022 IP E752113

DAK 2016 AGUSTUS 2021 6634326198
DAK 2013 JULI 2018 130811
DAK 2017 JUNI 2022 12071788

DAK 2015 JULI 2018 G 28502

DAK 2016 JULI 2018 240615
DAK 2013 JULI 2018 130812
DAK 2017 MARET 2022 3017870
DAK 2017 JANUARI 2022 29676759
DAK 2016 MEI 2021 1607148
DAK 2016 MEI 2021 1607148
SUMBER
ED Batch KET
DANA

PIHAK KEDUA

Sisilia Rani Thoma, S.Farm.,Apt

NIP:19890131 201402 2 002

Mengetahui
Kepala Bidang Sumber Daya Kesehatan

Yublina Wigira Malo, S.Farm.,Apt

NIP. 19800115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA BA
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DA

NOMOR: DINKES. 04/ BASTO. / /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
1 Albendazol tablet 400 ng tablet 600 492.00 295,200
2 Alopurinol tablet 100 mg tablet 500 127.00 63,500
3 Amlodipin tablet 5 mg tablet 1020 110.00 112,200
4 Amoksilin 250 mg kapsul tablet 3000 223.99 671,979
5 Amoksilin 500 mg kaplet 3000 245.00 735,000
6 Amoksilin sirup forte 250 mg/5 ml botol 50 4,296.00 214,800
7 Antasida doen tablet, kombinasi tablet 3000 74.00 222,000
Anti Tetanus (Human tetanus
8 ampul 5 170,000.00 850,000
imunoglobulin)

Anti bakteri DOEN salep kombinasi :

9 Basitrasin 500 IU/g + Polimiksin 10.000 tube 50 3,658.00 182,900
IU/g

10 Antifungi doen kombinasi / 3 - 6 salf pot 48 5,198.00 249,504

11 Asam Askorbat (Vit. C) tablet 50 mg tablet 3000 49.00 147,000
12 Asam mefenamat tablet 500 mg kaplet 4000 120.00 480,000
13 Asam Folat 0,4 mg (PROFOLAT ) tablet 3000 68.00 204,000
14 Asiklovir 200 mg tablet 1000 310.00 310,000
15 Bisakodil sup 5 mg- infant suppositoria 12 5,670.00 68,040
16 Deksametason 0.5 mg tablet 3000 54.00 162,000
17 Diazepam lar. Rectal 10 mg / 2,5 ml ampul 5 20,141.00 100,705
18 Domperidon tablet 10 mg tablet 1000 122.00 122,000
19 Erytromisin capsul 250 mg kapsul 500 704.00 352,000
Garam Oralit I serbuk kombinasi :
Natrium klorida 0,52 g + kalsium klorin
20 sachet 200 293.00 58,600
30 g + Trinatrium dihidrat 0.58 +
Glukosa Anhidrinat 2,70 g
21 Gentamycin Salep mata 0,3% tube 24 3,700.00 88,800
22 Gentamycin Tetes mata 0,3% botol 24 5,220.00 125,280
NO Nama Obat satuan Jumlah Harga Total Harga

23 Griseofulfin tablet 125 mg, micronized tablet 2000 283.00 566,000

24 Ibuprofen tablet 200 mg tablet 3000 117.00 351,000
25 Ibuprofen tablet 400 mg tablet 3500 118.00 413,000
26 Ibuprofen Suspensi 200 mg/5 ml botol 50 6,182.00 309,100
27 Kalsium Glukonat inj 10% ampul 24 9,955.00 238,920
28 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00 450,000
29 Ketokonazole krim 2% tube 50 2,988.00 149,400
30 Ketokonazole 200 mg tablet 500 322.00 161,000
31 Kloramfenicol kapsul 500 mg kapsul 1000 1,254.00 1,254,000
32 Kloramfenikol Salep kulit tube 24 4,193.00 100,632
33 Kloramfenikol salep mata 1 % tube 24 1,900.00 45,600
34 Kloramfenikol tetes mata 0,5 % botol 24 4,750.00 114,000
35 Klorfeniramin maleat (CTM) tablet 4 mg tablet 7000 48.00 336,000
Kotrimoksazol (anak) kombinasi tiap 5
36 ml suspensi : sulfametoksazol 200 mg + botol 100 2,650.00 265,000
trimetoprim 40 mg
37 Loratadin 10 mg tablet 1000 180.00 180,000
38 Metformin tablet 500 mg tablet 500 120.00 60,000
39 Metronidazol tablet 500 mg tablet 500 151.00 75,500
40 Natrium Diklofenak 25 mg tablet 500 178.00 89,000
41 Nistatin 500.000 iu tablet salut tablet 300 768.00 230,400
42 Omeprazole capsul 20 mg tablet 900 184.00 165,600
43 Pirantel tablet Score (base) 125 mg tablet 500 334.00 167,000
44 Piridoksin hcl tablet 10 mg tablet 3000 148.00 444,000
45 Prednison tablet 5 mg tablet 1000 91.00 91,000
46 Primakuin tablet 15 mg tablet 200 210.00 42,000
47 Ranitidin tablet 150 mg tablet 1000 121.00 121,000
48 Salbutamol suspensi 2 mg/ 5ml botol 25 5,936.00 148,400
49 Salep 2-4 kombinasi pot 24 3,040.00 72,960
50 Salisil bedak 2 % pot 20 1,142.00 22,840

51 Sianokobalamin (vit. b 12) 50 mcg tablet 3000 60.00 180,000

52 Sianokobalamin (vit. b 12) inj 500 mcg/ml ampul 200 1,423.00 284,600
53 Siprofloksasin tab 500 mg tablet 1000 323.00 323,000
NO Nama Obat satuan Jumlah Harga Total Harga

Tablet koTambah Darah Kombinasi : ferro

54 fumarat 50 mg + as. Folat 0,4 mg tablet tablet 4000 444.00 1,776,000
salut gula
55 Tetrasiklin hcl kapsul 250 mg tablet 1000 195.00 195,000
56 Tetrasiklin hcl kapsul 500 mg tablet 1000 357.00 357,000
57 Tiamin hcl mononitrat (vit. b1) tablet 50 tablet 22000 95.00 2,090,000
58 Vitamin B kompleks tablet tablet 3000 54.00 162,000
59 Zinc tab 20 mg tablet 500 644.00 322,000
BHP 0 -
60 Alat suntik sekali pakai 1 ml pcs 300 1,151.00 345,300
61 Alat suntik sekali pakai 2,5 ml pcs 100 796.00 79,600
62 Alat suntik sekali pakai 3 ml pcs 300 920.00 275,999
63 Alcohol swab 2 % box 200 14,145.00 2,829,000
64 Aseptic gel 500 cc + dispenser botol 5 28,600.00 143,000
65 Catgut Chromic/Benang Bdh no.2/0 dg jr pcs 24 6,979.00 167,496
66 Etanol 70% 1000 ML botol 10 32,500.00 325,000
67 Glukosa larutan infus 5 % steril flabot 40 6,900.00 276,000
68 I.V Chateter no. 22 G pcs 50 4,830.00 241,500
69 Infusion set anak pcs 100 4,920.00 492,000
70 Kapas Pembalut / Absorben 250 gram Bungkus 3 15,625.00 46,875
71 Kasa Kompres 40/40 steril Bungkus 10 2,000.00 20,000
72 Kasa Pembalut 2 m x 80 cm Rol 10 9,625.00 96,250
73 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 50 1,728.00 86,400
74 Kasa Pembalut Hidrofil 4 m x 15 cm elasti Rol 50 2,448.00 122,400
75 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 20 9,188.00 183,760
76 Kasa steril 16x16 Bungkus 20 10,000.00 200,000
77 Kasa Hydrophile 40yd x 80 cm Bungkus 3 123,600.00 370,800
78 Masker pcs 200 741.00 148,200
79 Maxter Exam Glove No powder L pcs 100 729.00 72,900
80 Natrium klorida larutan infus 0.9% steril botol 200 5,880.00 1,176,000
81 Sarung tangan No. 7 pcs 200 5,405.00 1,081,000
82 Sarung tangan No. 7,5 pcs 200 5,405.00 1,081,000
28,028,940
NO Nama Obat satuan Jumlah Harga Total Harga

PIHAK PERTAMA PIHAK KEDUA

Yulius Nani,Amd.Farm Marthinus L.Mesa.,S

NIP. 19810703 200803 1 003 NIP: 19880606 201

Setuju dikeluarkan Mengetahui

Kepala Seksi Kefarmasian Kepala Bidang Sum

Paulina Maghu,S.Farm,Apt Yublina Wigira Malo

NIP: 19790529 200903 2 002 NIP. 19800115 2005
BA BARAT DAYA
AN
dula

BAT DAN BAHAN HABIS PAKAI

/2018

SUMBER
ED Batch KET
DANA
7 8 9 10
DAK 2017 MEI 2019 1705106

DAK 2017 JULI 2020 1707-20-106

DAK2016 JUNI 2018 17716 F 0080

DAK2016 JUNI 2020 1606-59-51
DAK2016 AGUSTUS 2020 PHO 182505
DAK 2017 JULI 2019 5707010

DAK2016 JULI 2019 5551108

DAK2016
OKTOBER 2018 34145832 C

DAK 2017
JULI 2021 1707007
DAK2016 JUNI 2020 16SF028C
DAK2016 AGUSTUS 2019 21303608
DAK2016 SEPTEMBER 2018 161067
DAK 2017 MEI 2019 19617E0050
DAK2016 DESEMBER 2019 A 1302 LS
DAK2016 JANUARI 2019 15020297
DAK2016 JULI 2019 0071GG0080
DAK2016 AGUSTUS 2018 T23681721
DAK 2017 MARET 2020 EAC093

DAK 2017 MEI 2020 17CE013

JUNI 2020 P 06003 A6

DAK 2017

DAK 2017 MARET 2021 1652022

DAK 2017 JUNI 2020 0252009

SUMBER
ED Batch KET
DANA
DAK 2017 JULI 2020 06354003

DAK 2017 JULI 2020 1707-06-177

DAK 2017 SEPTEMBER 2021 B1 911911
DAK 2017 'JUNI 2019 1706009
DAK 2017 SEPTEMBER 2020 97KI0083

DAK 2016 SEPTEMBER 2018 161131

DAK 2017 AGUSTUS 2020 1708-08-103

DAK 2017 AGUSTUS 2020 170808103

DAK 2016 JULI 2019 T2388137
DAK 2016 AGUSTUS 2018 10208612
DAK 2017 MEI 2020 E117900

DAK 2017 AGUSTUS 2020 7H504108

DAK 2016 AGUSTUS 2018 T 3060 AE

AGUSTUS 2019 2768021
DAK 2017

DAK 2016 APRIL 2019 10216D0020

DAK 2016 SEPTEMBER 2018 090136
DAK 2016 JUNI 2020 AF 911266
DAK 2016 JULI 2021 95364018
DAK 2015 APRIL 2018 85371002
DAK 2016 01 AGUSTUS 2020 1608-19-53
DAK 2017 JULI 2019 1707094

DAK 2017 PEBRUARI 2020 C70175B

DAK 2017 JULI 2019 1707080

DAK 2015 01 JULI 2018 85386004

DAK 2017 31 MEI 2020 HTRNTA73042

DAK 2016 AGUSTUS 2018 1608011

DAK 2016 MEY 2019 14057002
DAK 2017 AGUSTUS 2020 NA 18110400292

DAK 2016 PEBRUARI 2021 B 160095 B

DAK 2016 JULI 2019 161G013
DAK 2016 JUNI 2020 1606-22-108
SUMBER
ED Batch KET
DANA
MARET 2019 D70290B
DAK 2017

DAK 2017 JUNI 2019 1706236

DAK 2016 JULI 2020 1607-03-53

DAK 2016 SEPTEMBER 2018 090026
DAK 2016 AGUSTUS 2019 21509608
DAK 2017 JANUARI 2020 1612051

DAK 2016 JULI 2021 0710

DAK 2017 JUNI 2020 01071588
DAK 2016 SEPTEMBER 2021 0910
DAK 2016 JUNI 2019 6242016
DAK 2016 JULI 2019 19081688
DAK 2016 SEPTEMBER 2021 30102014
DAK 2016 AGUSTUS 2020 19091688
DAK 2017 FEBRUARI 2020 270316
DAK 2016 JUNI 2021 3171716 G
DAK 2016 JULI 2020 21081588
DAK 2016 - 082188 LP
DAK 2016 - 082188 LP
DAK 2016 - 082188MX
DAK 2017 JUNI 2022 45064

DAK 2017 JUNI 2022 45064

DAK 2017 OKTOBER 2021 14111688

DAK 2016 SEPTEMBER 2020 19101588
DAK 2017 DESEMBER 2020 45064

DAK 2016 APRIL 2022 IP E752113

DAK 2016 AGUSTUS 2021 6634326198
DAK 2013 JULI 2018 130811
DAK 2017 MARET 2022 3017870
DAK 2016 MEI 2021 2784275
 SUMBER
ED Batch KET
DANA

DUA

L.Mesa.,S.Kep.Ns
0606 201502 1 002

dang Sumber Daya Kesehatan

gira Malo, S.Farm.,Apt

0115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA BAR
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DAN

NOMOR: DINKES. 04/ BASTO. / /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
1 Albendazol tablet 400 ng tablet 600 492.00 295,200
2 Amlodipin tablet 5 mg tablet 1020 110.00 112,200
3 Amoksilin 250 mg kapsul tablet 1000 223.99 223,993
4 Amoksilin 500 mg kaplet 1000 245.00 245,000
5 Amoksilin sirup forte 250 mg/5 ml botol 50 4,296.00 214,800
6 Antasida doen tablet, kombinasi tablet 1000 74.00 74,000
Anti bakteri DOEN salep kombinasi :
7 Basitrasin 500 IU/g + Polimiksin 10.000 tube 50 3,658.00 182,900
IU/g
8 Asam mefenamat tablet 500 mg kaplet 1000 120.00 120,000
9 Asam Folat 0,4 mg (PROFOLAT ) tablet 500 68.00 34,000
10 Diazepam lar. Rectal 5 mg / 2,5 ml ampul 10 13,904.00 139,040
11 Diazepam lar. Rectal 10 mg / 2,5 ml ampul 10 20,141.00 201,410
12 Fitomenadion (vit. K1) tablet salut 10 mg tablet 5000 866.00 4,330,000
Garam Oralit I serbuk kombinasi :
Natrium klorida 0,52 g + kalsium klorin
13 sachet 200 293.00 58,600
30 g + Trinatrium dihidrat 0.58 +
Glukosa Anhidrinat 2,70 g
14 Ibuprofen tablet 400 mg tablet 2500 118.00 295,000
15 Ibuprofen Suspensi 200 mg/5 ml botol 25 6,182.00 154,550
16 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00 450,000
17 Kloramfenikol salep mata 1 % tube 48 1,900.00 91,200
18 Kloramfenikol tetes mata 0,5 % botol 30 4,750.00 142,500
19 Magnesium sulfat injeksi (iv) 20% - 25 ml vial 10 3,200.00 32,000
20 Magnesium sulfat injeksi (iv) 40% - 25 ml vial 10 3,650.00 36,500
21 Metformin tablet 500 mg tablet 400 120.00 48,000
22 Primakuin tablet 15 mg tablet 200 210.00 42,000
23 Ranitidin tablet 150 mg tablet 500 121.00 60,500
24 Salbutamol suspensi 2 mg/ 5ml botol 49 5,936.00 290,864
NO Nama Obat satuan Jumlah Harga Total Harga

25 Salisil bedak 2 % pot 20 1,142.00 22,840

26 Simvastatin 20 mg tablet 500 250.00 125,000
27 Tiamin hcl mononitrat (vit. b1) tablet 50 tablet 22000 95.00 2,090,000
28 Vitamin B kompleks tablet tablet 3000 54.00 162,000
29 Zinc sirup 20 mg/5 ml botol 25 5,289.00 132,225
BHP 0 -
30 Povidon Iodida lar. 10 % 30 ml botol 22 2,590.00 56,980
31 Povidon Iodida lar. 10 % 300 ml botol 20 23,400.00 468,000
###

PIHAK PERTAMA

Yulius Nani,Amd.Farm
NIP. 19810703 200803 1 003

Setuju dikeluarkan
Kepala Seksi Kefarmasian

Paulina Maghu,S.Farm,Apt
NIP: 19790529 200903 2 002
MBA BARAT DAYA
TAN
adula

BAT DAN BAHAN HABIS PAKAI

/ /2018

SUMBER
ED Batch KET
DANA
7 8 9 10
DAK 2017 MEI 2019 1705106

DAK2016 JUNI 2018 17716 F 0080

DAK2016 JUNI 2020 1606-59-51
DAK2016 AGUSTUS 2020 PHO 182505
DAK 2017 JULI 2019 5707010

DAK2016 JULI 2019 5551108

DAK 2017
JULI 2021 1707007
DAK2016 SEPTEMBER 2018 161067
DAK 2017 MEI 2019 19617E0050
DAK2016 AGUSTUS 2018 T23681721

DAK2016 AGUSTUS 2018 T23681721

DAK 2016 MEI 2018 85381002
JUNI 2020 P 06003 A6

DAK 2017

DAK 2017 SEPTEMBER 2021 B1 911911

DAK 2017 'JUNI 2019 1706009
DAK 2016 SEPTEMBER 2018 161131
DAK 2017 MEI 2020 E117900

DAK 2017 AGUSTUS 2020 7H504108

DAK 2017 17 MARET 2019 86C47A

DAK 2017 13 APRIL 2019 82D47A

DAK 2016 SEPTEMBER 2018 090136

DAK 2015 01 JULI 2018 85386004
DAK 2017 31 MEI 2020 HTRNTA73042

DAK 2016 AGUSTUS 2018 1608011

SUMBER
ED Batch KET
DANA
DAK 2017 AGUSTUS 2020 NA 18110400292

DAK 2017 MARET 2020 D70312B

DAK 2016 SEPTEMBER 2018 090026

DAK 2016 AGUSTUS 2019 21509608
DAK 2017 APRIL 2020 E7D202

DAK 2015 JULI 2018 G 28502

DAK 2016 JULI 2019 240615

PIHAK KEDUA

Maria Rosa Lamunde, S.Kep

NIP: 19810705 201101 2 008

Mengetahui
Kepala Bidang Sumber Daya Kesehatan

Yublina Wigira Malo, S.Farm.,Apt

NIP. 19800115 200501 2 006
 PEMERINTAH KABUPATEN SUMBA BARAT DA
DINAS KESEHATAN
JL. Ir. Soekarno - Puspem Kadula
TAMBOLAKA

LAMPIRAN BERITA ACARA SERAH TERIMA OBAT DAN BAH

NOMOR: DINKES. 04/ BASTO. / /2018

NO Nama Obat satuan Jumlah Harga Total Harga

1 2 3 4 5.00 6
1 Albendazol tablet 400 ng tablet 450 492.00 221,400
2 Amlodipin tablet 5 mg tablet 1020 110.00 112,200
3 Amoksilin 250 mg kapsul tablet 1000 223.99 223,993
4 Amoksilin 500 mg kaplet 2000 245.00 490,000
5 Amoksilin sirup forte 250 mg/5 ml botol 50 4,296.00 214,800
Anti Tetanus (Human tetanus
6 ampul 2 ### 340,000
imunoglobulin)
7 Asam Askorbat (Vit. C) tablet 50 mg tablet 3000 49.00 147,000
8 Asam mefenamat tablet 500 mg kaplet 3000 120.00 360,000
9 Atropin sulfat injeksi 0.25 mg/ml - 1 ml ampul 100 1,650.00 165,000
10 Betametason krim 0.1 % tube 25 1,444.00 36,100
11 Deksametason 0.5 mg tablet 3000 54.00 162,000
12 Deksametason inj.5 mg/ml ampul 100 1,910.00 191,000

13 Difenhidramin hcl inj. 10 mg/ml @ 1 ml ampul 30 1,260.00 37,800

14 Fitomenadion (vit. K1) injeksi 10 mg/ml @ ampul 30 4,167.00 125,010

15 Fitomenadion (vit. K1) tablet salut 10 mg tablet 6000 866.00 5,196,000
Garam Oralit I serbuk kombinasi :
Natrium klorida 0,52 g + kalsium klorin
16 sachet 100 293.00 29,300
30 g + Trinatrium dihidrat 0.58 +
Glukosa Anhidrinat 2,70 g
17 Ibuprofen tablet 200 mg tablet 1500 117.00 175,500
18 Ibuprofen tablet 400 mg tablet 1500 118.00 177,000
19 Kalsium Glukonat inj 10% ampul 8 9,955.00 79,640
20 Kalsium laktat (kalk) tablet 500 mg tablet 6000 75.00 450,000
21 Kloramfenikol salep mata 1 % tube 24 1,900.00 45,600
22 Klorfeniramin maleat (CTM) tablet 4 mg tablet 3000 48.00 144,000
NO Nama Obat satuan Jumlah Harga Total Harga

Kotrimoksazol (anak) kombinasi tiap 5

23 ml suspensi : sulfametoksazol 200 mg + botol 50 2,650.00 132,500
trimetoprim 40 mg
24 Lansoprazol capsul 30 mg kapsul 500 370.00 185,000
25 Loperamide tablet 2 mg tablet 200 100.00 20,000
26 Magnesium sulfat injeksi (iv) 20% - 25 ml vial 10 3,200.00 32,000
27 Magnesium sulfat injeksi (iv) 40% - 25 ml vial 10 3,650.00 36,500
28 Metformin tablet 500 mg tablet 500 120.00 60,000
29 Oksitosin injeksi 10 iu/ml @ 1 ml ampul 100 1,900.00 190,000
30 Omeprazole capsul 20 mg tablet 1200 184.00 220,800
31 Pirantel tablet Score (base) 125 mg tablet 200 334.00 66,800
32 Piridoksin hcl tablet 10 mg tablet 1000 148.00 148,000
33 Primakuin tablet 15 mg tablet 200 210.00 42,000
34 Salbutamol tablet 4 mg tablet 500 95.00 47,500
35 Salbutamol sirup botol 22 5,344.00 117,568
36 Sianokobalamin (vit. b 12) 50 mcg tablet 1000 60.00 60,000
37 Siprofloksasin tab 500 mg tablet 500 323.00 161,500
Tablet koTambah Darah Kombinasi : ferro
38 fumarat 50 mg + as. Folat 0,4 mg tablet tablet 3000 444.00 1,332,000
salut gula
39 Tetrasiklin hcl kapsul 500 mg tablet 500 357.00 178,500
40 Tiamin hcl mononitrat (vit. b1) tablet 50 tablet 23000 95.00 2,185,000
41 Vitamin B kompleks tablet tablet 5000 54.00 270,000
42 Zinc tab 20 mg tablet 300 644.00 193,200
BHP 0 -
43 Aseptic gel 500 cc + dispenser botol 5 28,600.00 143,000
44 Etakridin (rivanol) larutan 0.1 % botol 4 3,900.00 15,600
45 Etanol 70% 1000 ML botol 5 32,500.00 162,500
46 Kapas Pembalut / Absorben 250 gram Bungkus 5 15,625.00 78,125
47 Kasa Pembalut Steril 18 x 22 cm elastic Bungkus 20 9,188.00 183,760
48 Kasa steril 16x16 Bungkus 10 10,000.00 100,000
49 Maxter Exam Glove No powder L pcs 200 729.00 145,800
50 Natrium klorida larutan infus 0.9% steril botol 20 5,880.00 117,600
51 Plesterin Non Moven Roll 5 cm x 5 m Roll 10 29,106.00 291,060
52 Povidon Iodida lar. 10 % 30 ml botol 26 2,590.00 67,340
53 Povidon Iodida lar. 10 % 300 ml botol 20 23,400.00 468,000
NO Nama Obat satuan Jumlah Harga Total Harga

54 Sarung tangan No. 7 pcs 50 5,405.00 270,250

16,975,838

PIHAK PERTAMA

Yulius Nani,Amd.Farm
NIP. 19810703 200803 1 003

Setuju dikeluarkan
Kepala Seksi Kefarmasian

Paulina Maghu,S.Farm,Apt
NIP: 19790529 200903 2 002
ARAT DAYA

AN BAHAN HABIS PAKAI

SUMBER
ED Batch
DANA
7 8 9
DAK 2017 MEI 2019 1705106

DAK2016 JUNI 2018 17716 F 0080

DAK2016 JUNI 2020 1606-59-51
DAK2016 AGUSTUS 2020 PHO 182505
DAK 2017 JULI 2019 5707010

DAK2016
OKTOBER 2018 34145832 C
DAK2016 AGUSTUS 2019 21303608
DAK2016 SEPTEMBER 2018 161067
DAK 2017 OKTOBER 2020 97KJ0080

DAK2016 MEI 2019 E 60575 T

DAK2016 JULI 2019 0071GG0080
DAK2016 SEPTEMBER 2018 1409079
DAK/DAU
2015 MARET 2019 85342011-1
DAK 2017 JUNI 2020 06382006-2

DAK 2016 MEI 2018 85381002

JUNI 2020 P 06003 A6

DAK 2017

DAK 2017 JULI 2020 1707-06-177

DAK 2017 SEPTEMBER 2021 B1 911911
DAK 2017 SEPTEMBER 2020 97KI0083

DAK 2016 SEPTEMBER 2018 161131

DAK 2017 MEI 2020 E117900

DAK 2016 AGUSTUS 2018 T 3060 AE

SUMBER
ED Batch
DANA
AGUSTUS 2019 2768021
DAK 2017

DAK 2017 31 MARET 2019 222022

DAK 2016 APRIL 2020 70304

DAK 2017 17 MARET 2019 86C47A

DAK 2017 13 APRIL 2019 82D47A

DAK 2016 SEPTEMBER 2018 090136

DAK 2017 DESEMBER 2019 97KL

DAK 2016 01 AGUSTUS 2020 1608-19-53

DAK 2017 JULI 2019 1707094

DAK 2017 PEBRUARI 2020 C70175B

DAK 2015 01 JULI 2018 85386004

DAK 2016 JULI 2021 G 16092713
DAK 2017 APRIL 2019 1704017

DAK 2016 PEBRUARI 2021 B 160095 B

DAK 2016 JUNI 2020 1606-22-108
MARET 2019 D70290B
DAK 2017

DAK 2016 JULI 2020 1607-03-53

DAK 2016 SEPTEMBER 2018 090026
DAK 2016 AGUSTUS 2019 21509608
DAK 2017 JANUARI 2020 1612051

DAK 2016 JULI 2019 19081688

DAK 2016 MEY 2020 08061788
DAK 2016 AGUSTUS 2020 19091688
DAK 2016 - 082188 LP
DAK 2017 OKTOBER 2021 14111688
DAK 2016 SEPTEMBER 2020 19101588
DAK 2016 AGUSTUS 2021 6634326198
DAK 2013 JULI 2018 130811
DAK 2017 JUNI 2022 12071788

DAK 2015 JULI 2018 G 28502

DAK 2016 JULI 2019 240615
SUMBER
ED Batch
DANA
DAK 2017 MARET 2022 3017870

PIHAK KEDUA

Mariyana Bli, A.Md, Farm

NIP: 19880330 2011 01 20

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