Persediaan Jumlah

No Nama Obat Satuan

Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol -
1 0
Albendazole Tablet 400 mg Tablet 100
2 100
Alopurinol Tablet 100 mg Tablet 64 100 164
3
Ambroksol Tablet 30 mg Tablet 78 78
4
Ambroksol sirup 15 mg/5 ml Botol 2 10 12
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - -
6
Aminofillin Tablet 200 mg Tablet 20 20
7
Amitriptillin Hcl Tablet Salut 25 m Tablet - 100 100
8
Amlodipin Tablet 5 mg Tablet 43 100 143
9
Amlodipin Tablet 10 mg Tablet - -
10
Amoksisillin Kapsul 250 mg Kapsul 40 100 140
11
Amoksisillin Kaplet 500 mg Kaplet 55 500 555
12
Amoksisillin Serbuk Injeksi 1000 mg vial - -
13
Amoksisillin Sirup Kering 125 mg/5 Botol 8 15 23
14
Amoksisillin Double Strengh Sirup Botol
15 2 2
Kering 250 mg/5 ml
Ampisilin Kapsul 250 mg Kapsul - -
16
Ampisillin Kaplet 500 mg Tablet 42 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - -
18
Ampisillin Injeksi 1000 mg Vial - -
19
Analgetik Plus Tablet 40 40
20
Antasida Doen Suspensi Botol 1 5 6
21
Kombinasi : Magnesium
Antasida Doen
200 Tablet, Kombinasi Tablet
22 Hidroksida
:Hidroksida
Magnesium
mg+ Alumunium 46 600 646
200 mg/5 ml 200 mg+
Hidroksida
Antasida Plus
Alumunium Tablet 200 mg
Hidroksida Tablet - -
23
Antalgin (Metampiron) Tablet 500 Tablet 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - -
25
26 Anti Bakteri DOEN Salep Tube 4 4
Kombinasi :
Anti Hemoroid
Basitrasin Doen komb
500 IU/g + Supp - -
27
Polimiksin 1000 IU/g
Anti Fungi DOEN Kombinasi : Pot
28 - 5 5
Asam Benzoat
Antimigren 6% +
DOEN Asam Salisilat
Kombinasi : Tablet
29
3%
- -
Anti Diare Suspensi
Ergotamin Tartrat 1 mg + Kofein Botol - -
30
50 mg
Anti Diare Tablet Tablet 5 100 105
31
Anti Dotum Oral Tablet Tablet 70 70
32
Anti Hipertensi Kapsul Tablet - -
33
Antihistamin Tablet kombinasi Tablet 31 31
34
Antispasmodik Tablet Tablet 24 24
35
Antitusiva Sirup Botol 2 2
36
Antitusiva Tablet Tablet 20 20
37
Asam Folat Tablet 1 mg Tablet - -
38
Asam Askorbat 50 mg Tablet 80 80
39
Asam Mefenamat Kapsul 500 mg Kapsul 9 100 109
40
Asetosal 80 mg Tablet - -
41
Asetosal Tablet 100 mg Tablet - -
42
 Asetosal Tablet 500 mg Tablet - -
43
Asiklovir Krim 5 % Tube 2 2
44
Asiklovir Tablet 200 mg Tablet 7 50 57
45
Asiklovir Tablet 400 mg Tablet - -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul - -
47
Aqua Pro Injeksi Steril, bebas Piro Vial - -
48
Betahistin Mesilat 6 mg Tablet 4 100 104
49
Betametason Krim 0,1 %- 5g Tube 2 2
50
Bisakodil suppositoria 10 mg Supp - -
51
Bisoprolol Tablet 5 mg Tablet - -
52
Bromheksin 8 mg Tablet 30 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 2
54
Deksametason Tablet 0,5 mg Tablet 90 200 290
55
Devitalisasi Pasta (Non Arsen) Botol - -
56
Diazepam tablet 2 mg Tablet 28 28
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet - -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul 47 47
61
Digoksin Tablet 0,25 mg Tablet - -
62
Dimenhidrinat Tablet 50 mg Tablet - -
63
Domperidon Tablet 10 mg Tablet 40 40
64
Donperidon Suspensi 5 mg/5ml Botol 1 1
65
Efedrin Hcl Tablet 25 mg Tablet 60 60
66
Ekstrak Belladone Tablet 10 mg Tablet 282 282
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi 5

68 0,1%/- 1ml 5
Eritromisin Kapsul 250 mg Kapsul - -
69
Eritromisin Kapsul 500 mg Kapsul - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - -
71
Etambutol Tablet 500 mg Tablet - -
72
Etanol 70 % 100 ml Botol - -
73
Etil Klorida Semprot -100 ml Botol 1 1
74
Eugenol Cairan -10 ml Botol - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 100
76
Fenobarbital tablet 30 mg Tablet - -
77
Fenobarbital injeksi 50 mg / ml Ampul - -
78
Fenoksimeti Penisilin 250 mg table Tablet 100 100
79
Fenoksimeti Penisilin 500 mg tabl Tablet 70 70
80
Fitomenadion tablet 10 mg Tablet 85 85
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul 3 3
82
Furosemid Tablet 40 mg Tablet 27 27
83
Garam Oralit I serbuk, Kantong
84
kombinasi :
89 89
Gemfibrozil( Tablet 600gr,
Nacl 0,52 mgKalium Tablet - -
85
Klorida 0,30 gr, Trinatrium Sitrat
Gentamisin injeksi 80 mg / 2 ml Vial - -
86 dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air
 Gentamisin Salep Kulit 0,1 % Tube 2 2
87
Glibenklamid Tablet 5 mg Tablet 20 20
88
Glimepiride 2 mg Tablet - 100 100
89
Gliseril guayakolat tablet 100 mg Tablet 123 500 623
90
Gliseril Guayakolat sirup Botol 3 3
91
Glukonas Kalsikus injeksi Ampul - -
92
Glukosa Larutan Infus 5 % Botol 1 1
93
Glukosa Larutan Infus10 % Botol - -
94
Griseofulvin Tablet 125 mg,microni Tablet - 50 50
95
Haloperidol Tablet 0,5 mg Tablet 30 200 230
96
Haloperidol Tablet 1,5 mg Tablet 20 20
97
Haloperidol Tablet 5 mg Tablet - -
98
Hidrokloritiazid 25 mg Tablet 19 19
99
Hidrokortison Krim 2,5 % Tube 1 20 21
100
Ibuprofen Tablet 200 mg Tablet 92 100 192
101
Ibuprofen Tablet 400 mg Tablet - -
102
Ibuprofen Suspensi 100 mg/5 ml Botol 1 1
103
Ichtyol salep Kulit Pot - -
104
Ipatropium Bromide + Salbutamol Vial
-
105 Sulphate for inhalation 2,5 ml -
Isoniazid tablet 100 mg Tablet
-
106 -
Isosorbid Dinitrat 5 mg Tablet - -
107
Kalium Diklofenak Tablet 25 mg Tablet - -
108
Kalium Diklofenak Tablet 50 mg Tablet 47 50 97
109
Kalsium Hidroksida Pasta Tube - -
110
Kalsium Laktat Tablet 500 mg Tablet 96 200 296
111
Kaptopril 12,5 mg Tablet 52 200 252
112
Kaptopril 25 mg Tablet 5 5
113
Karbamazepin Tablet 200 mg Tablet - 50 50
114
Ketokonazole Krim 2 % - 15 gr Tube - 5 5
115
Ketokonazole Tablet 200 mg Tablet 12 12
116
Ketoprofen Tablet 100 mg Tablet - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - -
118
Ketorolac 10 mg injeksi Ampul - -
119
Ketorolac 30 mg injeksi Ampul - -
120
Klindamisin Kapsul 150 mg Kapsul - -
121
Klindamisin Kapsul 300 mg Kapsul - -
122
Kloramfenikol Kapsul 250 mg Kapsul 94 94
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 1 1
124
Kloramfenikol Tetes Mata -5 ml Botol - 10 10
125
Kloramfenikol Tetes Telinga 3%-5 Botol - 5 5
126
Klorfeniramin Maleat (CTM) Tablet Tablet 92 600 692
127
Klorpromazin Hcl Tablet Salut 25 Tablet - -
128
Klorpromazin Hcl Tablet Salut 100 Tablet 66 50 116
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul - -
130
 Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg + -
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet
50
132 Sulfametoksazol 400 mg + 50
Trimetroprim
Kotrimoksazol80 mg
Suspensi Kombinasi Botol
: - 10
133 Sulfametoksazol 200 mg + 10
Lansoprazole 30
Trimetroprim 40 mg Kapsul
mg/5 ml Tablet - -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28 -
135 -
mEq) /Asering
Larutan mengadung Elektrolit Botol -
136 (Nacl 1,125 gr , Dekstrosa 18,75
-
Larutan
gr) mengadung Karbohidrat + Botol
Elektrolit -
137 (Nacl 1,75 gr, KCL 1,5 gr, Na
-
Lidokain
Lactat injeksi
2,24 2%
gr, Dekstrosa 27 gr) Tablet 1 1
138
139 Lidokain Komp Injeksi, Ampul - -
Kombinasi :
Loperamid Tablet 2 mg Tablet - -
140 Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2
Loratadin tablet 10 mg ml Tablet
141 40 40
Magnesium Sulfat (IV) 20 %-25 ml Ampul - -
142
Meloksikam tablet 15 mg Tablet 42 42
143
Meloksikam Suppositoria Supp - -
144
Metformin Hcl Tablet 500 mg Tablet 20 50 70
145
Methisoprinol 500 mg Tablet - -
146
Metilergometrin Maleat (Metergin) Tablet - -
147
Metilergometrin Maleat Injeksi 0, Ampul 4 4
148
Metilprednisolon tablet 4 mg Tablet 48 48
149
Metoklopramid 10 mg Tablet 40
150 40
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151 0
Metronidazol Tablet 250 mg Tablet 40
152 40
Metronidazole Tablet 500 mg Tablet 100 130
153 30
Metronidazole Infus 500 mg /100 m Ampul -
154 0
Mikonazole KrIm 2 % - 10 gr Tube 2
155 2
Multivitamin + Mineral tablet Tablet 100 122
156 22
Multivitamin sirup Botol 10 10
157 0
Natrium Bikarbonat Tablet 500 mg Tablet 140
158 140
Natrum Diklofenak Tablet 25 mg Tablet -
159 0
Natrium Diklofenak Tablet 50 mg Tablet 100 143
160 43
Natrium Klorida Larutan infus 0,9%- Botol 2
161 2
Nipedifin Tablet 10 mg Tablet 3
162 3
Nistatin 100.000 IU/gram Tablet V Tablet 9
163 9
Nistatin 500.000 IU/gram Tablet Sa Tablet 50
164 50
Obat Antitiuberkolosis Kategori A Paket -
165 0
Obat Antitiuberkolosis Kategori 1 Paket -
166 0
Obat Antitiuberkolosis Kategori 2 Paket -
167 0
Obat Antitiuberkolosis Kategori 3 Paket -
168 0
Obat Anti Tuberkulosis FDC Kat A Paket -
169 0
Obat Anti Tuberkulosis FDC Kat I & Paket -
170 0
Obat Anti Tuberkulosis FDC Kat I & Paket -
171 0
 Obat Anti Tuberkolosis FDC Sisipa Paket -
172 0
Obat Batuk Hitam (OBH) Cairan 10 Botol 20 20
173 0
Obat Batuk Cair Sirup (Ekspektoran Botol 2
174 2
Obat Batuk Hitam Plus Sirup Botol -
175 0
Obat Flu Sirup Botol -
176 0
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube 5 5
178 0
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul 9
180 9
Omeprazole injeksi 40mg/10ml Ampul -
181 0
Omeprazole Kapsul 20 mg Tablet -
182 0
Ondansetron inj 4 mg/ 2 mL Ampul 0 -
183
Parasetamol drops Botol 0 1 1
184
Parasetamol Sirup 120 mg/5ml-60 Botol 5 35 40
185
Parasetamol Tablet 100 mg Tablet 0 -
186
Parasetamol Tablet 500 mg Tablet 63 1300 1,363
187
Pehacain injeksi Ampul 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube 0 -
189
Piracetam 400 mg Tablet 0 -
190
Piracetam Tablet 800 mg Tablet 0 -
191
Piroksikam Tablet 20 mg Tablet 4 4
192
Pirantel Pamoat Tablet 365 mg (Se Tablet 80 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet 62 400 462
194
Polikresulen (Kondensasi Botol
Metakresol 0 -
195
Sulfonat dan Metanal) 360
Povidon
mg/g-10 Iodida
ml 10% 30 ml Botol 2 2
196
Povidon Iodida 10% 300 ml Botol 1 1
197
Primakuin tablet 15 mg Tablet 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 0 10 10
199
Propilturasil Tablet 100 mg Tablet 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 -
201
Ranitidin Tablet 150 mg Tablet 9 150 159
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 186
204
Reserpin Tablet 0, 25 mg Tablet 40 40
205
Rifampisin Tablet 450 mg Tablet 0 -
206
Ringer Laktat Larutan Infus Steril Botol 3 3
207
Salbutamol Tablet 2 mg Tablet 3 50 53
208
Salbutamol Tablet 4 mg Tablet 0 -
209
Salbutamol solution for Inhalation Ampul 0 -
210
single dose units 2,5 ml
Salep 2-4 Kombinasi : Pot
211 0 -
Salisil Salisilat
Asam bedak 2% -50
2% gr
+ Belerang Kotak 2 20 22
212
Endap 4 % - 30 gram
Salep Luka Bakar Tube 1 1
213
Sefadroksil Sirup Kering 125 mg / Botol 0 -
214
Sefadroksil Tablet 500 mg Tablet 7 7
215
Sefiksim Kapsul 100 mg Kapsul 30 30
216
 Sefotaksim Injeksi 1 gr Ampul 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 -
218
Semen Seng Fosfat Serbuk & Caira Botol 0 -
219
Setirizin Tablet 10 mg Tablet 62 62
220
Setirizin Sirup 5 mg / 5 ml Botol 4 4
221
Sianokobalamin Injeksi 500 mcg/m Ampul 21 21
222
Sianokobalamin Tablet 50 mcg Tablet 10 10
223
Silver Amalgam Serbuk 65-75% Botol 0 -
224
Simetidin 200 mg Tablet Tablet 80 80
225
Simvastatin Tablet 10 mg Tablet 25 50 75
226
Siprofloksasin 500mg Tablet 10 100 110
227
Spironolakton Tablet 25 mg Tablet 70 70
228
Sulfacetamid Tetes Mata 15 %-5ml Botol 0 -
229
Tablet Tambah Darah Kombinasi: Tablet
230 20 200 220
Temporary
Besi II SulfatStopping
200 mg Fletcher
+ Asam Folat Set
231 (Fletcher)
0,25 mg Serbuk & Cairan 0 -
Trikesol formalin ( T K F ) Cairan 1 Botol 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 10
233
Tetrasiklin Kapsul 500 mg Kapsul 0 -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet 184 184
236
Thiamfenikol Kapsul 500 mg Kapsul 0 100 100
237
Tramadol Injeksi 50 mg/ ml Ampul 0 -
238
Tramadol Tablet 50 mg Tablet 0 -
239
Triheksifenidil Hidroklorida Tablet Tablet 42 50 92
240
Vitamin B .Komplek Tablet Tablet 27 500 527
241
Vitamin Neurotropik Tablet Tablet 69 100 169
242
Zinc Tablet 20 mg Tablet 133 133
243
Prednisone 54mg Tablet 308 308
244
flunax sy Botol 0 -
245
Set 0 -
246
Set 0 -
247
Tablet 0 -
248
Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
 Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
 RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEM
Bulan : Januari Ta
JUMLAH

3 4 5 6 7 8 9 10 11 12

10 20 10
10
1 2

10 10
10 30 10 10 10

10 10 10
20 50 20 20 40 20 20

1 1 1 1 1 1

10

1
50 10 10 10 10 50 10 20

1 1

20

12
1
 32

10

4 10

18 3 6
 20 10
20 35 4 10 10 10 15
1 1

10 10 10 10 10

2 1 1
10 10 10 30 10

30 20
20 7 10 22 10 15

10 10

1
1 1
36 75 9 16 18 22 33 25

5 5 20 10 5
 12

10

10 10

10

10 20 10 15
1 1

10 10 12 10
 1 1

2 1 1 1 3 1 1

80 60 30 50 58 82 70 40

30 20 45 10

10

18 20 10 6

1 1 1 3 1
1

10
 20

10
10 10 10

10 30 20

10 10 10

10 10
30 26 20 40 26 30 15
20 25 10 10 22
10
10 10
AN HARIAN PEMAKAIAN OBAT
ulan : Januari Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

13 14 15 16 17 18 19 20 21 22

5 20
10

10
10 10 10

10 10 10
20 20 10 30 20 70

1 1 1

1 1 1
20 50 30 20 10 10 20

10

10

1
 1
10

5 10

20

6
 30
10 5 19 20

20 10

2 9
10 10

8 8 10 8

30 40 20 20 40 6
10

10 15 25 41 25 72

10
 1

10

10

10 20

1
10 10

10
 1 3 2

1 2 1 1

10 10 48 60 45 76 40 40

20 20 50 38

10 10 10 10

10

1 1 1 1

10
10 10
10
20

30 40 20 20 10 30

10

10
10 10 40 20 20
8 6 10 10

90
 Jumlah
Pemakaian
23 24 25 26 27 28 29 30 31
0
0
65
20
1 4
0
0
30
10 110
0
20 10 10 100
20 50 10 20 40 30 16 546
0
2 1 12
0
0
10
0
0
0
1 5
30 20 50 20 40 60 20 570
0
0
0
1 1
0
1 3
0
0
8 10 10 58
0
0
10 20
12
2
0
0
10 10 20
20 20
0
0
 0
1
42
0
0
0
10 7 10 52
1 1 2
0
0
0
0
10 10 6 10 20 10 100
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
10 10
0
0
6 5 6 50
0
0
 0
10 10 20
60
10 25 10 9 212
2
0
0
0
10 10
20 20 10 30 160
0
0
10 10
1 16
10 10 10 10 130
0
0
0

0
0
0
10 8 8 68
0
206
20 10 10 20 154
0
10 30
1 2
10 10
0
0
0
0
0
0
0
0
1 2 1 6
1 1 4
56 36 10 35 30 15 10 614
0
15 10 5 20 105
0
 0

10 22

2 2 6
0

0
0

0
0
0
0
0
0
10
0
30
0
0
0
10 18
10
0
0
10 10 60
0
0
55
1 1 1 6
18 38
0
10 20 10 92
0
0
0
0
0
0
0
0
0
0
0
 0
1 2 2 1 14
1 1
0
0
0
1 2
0
0
0
0
0
1 1
2 1 7 5 6 36
0
88 50 68 60 100 106 36 1307
0
0
0
0
0
0
20 35 58 20 40 20 426

0
0
0
0
10
0
0
8 18 6 10 10 146
0
0
0
0
0
10
0
0
0
1 1 1 1 15
1
0
0
10 30
 0
0
0
20 10 50
1 1
0
0
0
0
30
10 10 10 10 80
20
0
10 220

0
0
0
0
0
10 10 30 10 90
10
0
0
10 20 60
30 30 10 26 20 45 448
10 25 10 166
10
4 10 124
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
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0
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0
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0
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0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
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0
0
0
0
0
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0
0
0
0
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0
0
0
Sisa Akhir
Bulan

-
100
99
58
8
-
20
70
33
-
40
9
-
11
2
-
32
-
-
40
1
76
-
40
-
3
-
2
-
-
47
70
-
11
12
-
20
-
60
89
-
-
 -
1
15
-
-
-
52
-
-
-
30
2
190
-
28
-
-
-
47
-
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40
1
60
282

5
-
-
-
-
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1
-
100
-
-
100
70
75
3
27
39
-
-
 2
-
40
411
1
-
1
-
40
70
20
-
9
5
62
-
1
-

-
-
-
29
-
90
98
5
20
3
2
-
-
-
-
-
-
94
1
4
1
78
-
11
-
 -

28

4
-

-
-

-
1
-
-
40
-
32
-
40
-
-
4
30
30
-
40
70
-
2
67
4
102
-
51
2
3
9
50
-
-
-
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 -
6
1
-
-
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3 7
2 2
9 9
-
-
-
-
4
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56
-
-
-
-
4
80
36

-
2
1
-
-
-
-
13
-
186
40
-
3
43
-
-
-
7
-
-
7
-
 -
-
-
12
3
21
10
-
80
45
30
50
-
-

-
-
10
-
-
94
90
-
-
32
79
3
123
184
-
-
-
-
-
-
-
-
-
-
-
-
5
-
-
7
3
43
3
-
-
-
-
3
-
-
-
-
2
-
7
1
-
-
-
-
2
1
-
-
-
10
1
-
-
-
-
-
-
4
-
-
3
7
-
-
-
2
-
-
-
-
-
-
-
-
-
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3 4
Air Raksa Dental Use Botol -
1 0
Albendazole Tablet 400 mg Tablet 100
2 100
Alopurinol Tablet 100 mg Tablet 99 99 20
3
Ambroksol Tablet 30 mg Tablet 58 58 10
4
Ambroksol sirup 15 mg/5 ml Botol 8 8
5
Aminofillin Injeksi 24 mg/ml-10 m Ampul - -
6
Aminofillin Tablet 200 mg Tablet 20 20
7
Amitriptillin Hcl Tablet Salut 25 Tablet 70 70
8
Amlodipin Tablet 5 mg Tablet
9 33 100 133
Amlodipin Tablet 10 mg Tablet - -
10
Amoksisillin Kapsul 250 mg Kapsul 40 40
11
Amoksisillin Kaplet 500 mg Kaplet 9 600 609 10 50 50
12 10
Amoksisillin Serbuk Injeksi 1000 m vial - -
13
Amoksisillin Sirup Kering 125 mg/ Botol 11 20 31 1 3
14 2
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml 2
15 2
Ampisilin Kapsul 250 mg Kapsul - -
16
Ampisillin Kaplet 500 mg Tablet 32 50 82
17
Ampisilin Sirup 125 mg / 5 ml Botol - -
18
Ampisillin Injeksi 1000 mg Vial - -
19
Analgetik Plus Tablet 40 40
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
21 Hidroksida 200 mg+ Alumunium 1 8 9 1 1
Hidroksida 200 Tablet,
Antasida Doen mg/5 ml Tablet
Kombinasi : Magnesium 76 600 20 40 50 50
22 Hidroksida 200 mg+ Alumunium 676
Hidroksida 200Tablet
Antasida Plus mg Tablet
23 - -
Antalgin (Metampiron) Tablet 500 Tablet 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - -
25
Anti Bakteri DOEN Salep Tube
Kombinasi : 3
26 Basitrasin 500 IU/g + 3
Anti Hemoroid
Polimiksin 1000Doen
IU/g komb Supp - -
27
Anti Fungi DOEN Kombinasi : Pot
28 2 2 1
Antimigren DOEN Kombinasi : Tablet
29 Asam Benzoat 6% + Asam Salisilat - -
3%
Anti Diare Suspensi
Ergotamin Tartrat 1 mg + Kofein Botol - -
30
50 mg
Anti Diare Tablet Tablet 47 80 127 32
31
Anti Dotum Oral Tablet Tablet 70 70
32
Anti Hipertensi Kapsul Tablet - -
33
Antihistamin Tablet kombinasi Tablet 11 200 211 10 10
34 10
Antispasmodik Tablet Tablet 12 12
35
 Antitusiva Sirup Botol - 5 5 1
36
Antitusiva Tablet Tablet 20 20 10
37
Asam Folat Tablet 1 mg Tablet - -
38
Asam Askorbat 50 mg Tablet 60 60
39
Asam Mefenamat Kapsul 500 mg Kapsul 89 50 139 10 10
40 60
Asetosal 80 mg Tablet - -
41
Asetosal Tablet 100 mg Tablet - -
42
Asetosal Tablet 500 mg Tablet - -
43
Asiklovir Krim 5 % Tube 1 1
44
Asiklovir Tablet 200 mg Tablet 15 15
45
Asiklovir Tablet 400 mg Tablet - -
46
Atropin Sulfat Injeksi 0,25 mg/ml Ampul - -
47
Aqua Pro Injeksi Steril, bebas Pir Vial - -
48
Betahistin Mesilat 6 mg Tablet 52 50 102
49 10 16
Betametason Krim 0,1 %- 5g Tube - 5 5
50
Bisakodil suppositoria 10 mg Supp - -
51
Bisoprolol Tablet 5 mg Tablet - -
52
Bromheksin 8 mg Tablet 30 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 2
54
Deksametason Tablet 0,5 mg Tablet 190 190 6 10 10
55 10
Devitalisasi Pasta (Non Arsen) Botol - -
56
Diazepam tablet 2 mg Tablet 28 28
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - -
58
Diazepam Larutan Rektal 5 mg/m Supp - -
59
Dietilkarbamazin Sitrat Tablet 10 Tablet - -
60
Difenhidramin HCl Injeksi 10 mg/ Ampul 47 47
61
Digoksin Tablet 0,25 mg Tablet - -
62
Dimenhidrinat Tablet 50 mg Tablet - 10 10
63
Domperidon Tablet 10 mg Tablet 40 40
64
Donperidon Suspensi 5 mg/5ml Botol 1 1
65
Efedrin Hcl Tablet 25 mg Tablet 60 60
66
Ekstrak Belladone Tablet 10 mg Tablet 282 282
67
Epinefrin HCl / Bitartrat Ampul
5
68 (Epinefrina / Adrenalina) 5
Eritromisin
Injeksi Kapsul
0,1%/- 1ml 250 mg Kapsul - -
69
Eritromisin Kapsul 500 mg Kapsul - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - -
71
Etambutol Tablet 500 mg Tablet - -
72
Etanol 70 % 100 ml Botol - -
73
Etil Klorida Semprot -100 ml Botol 1 1
74
Eugenol Cairan -10 ml Botol - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 100
76
Fenobarbital tablet 30 mg Tablet - -
77
 Fenobarbital injeksi 50 mg / ml Ampul - -
78
Fenoksimeti Penisilin 250 mg tabl Tablet 100 100
79
Fenoksimeti Penisilin 500 mg tabl Tablet 70 70
80
Fitomenadion tablet 10 mg Tablet 75 75
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul 3 3
82
Furosemid Tablet 40 mg Tablet 27 27 10
83
Garam Oralit I serbuk, Kantong
kombinasi : ( Nacl 0,52 gr, 39 100
84 Kalium Klorida 0,30 gr, 139 5 12
Trinatrium
GemfibrozilSitrat dihidrat
Tablet 600 mg0,58 Tablet
85 gr, Glukosa Anhidrat 2,70 g )200 - -
ml A
Gentamisin injeksi 80 mg / 2 ml Vial
86 - -
Gentamisin Salep Kulit 0,1 % Tube 2 2 1
87
Glibenklamid Tablet 5 mg Tablet - 50 50 10
88
Glimepiride 2 mg Tablet 40 150 190 20
89
Gliseril guayakolat tablet 100 mg Tablet 411 411 23 25
90 10
Gliseril Guayakolat sirup Botol 1 1
91
Glukonas Kalsikus injeksi Ampul - -
92
Glukosa Larutan Infus 5 % Botol 1 1
93
Glukosa Larutan Infus10 % Botol - -
94
Griseofulvin Tablet 125 mg,micron Tablet 40 40
95
Haloperidol Tablet 0,5 mg Tablet 70 100 170 10
96
Haloperidol Tablet 1,5 mg Tablet 20 20
97
Haloperidol Tablet 5 mg Tablet - -
98
Hidrokloritiazid 25 mg Tablet 9 50 59
99
Hidrokortison Krim 2,5 % Tube 5 10 15 1
100
Ibuprofen Tablet 200 mg Tablet 62 200 262 10
101 10
Ibuprofen Tablet 400 mg Tablet - -
102
Ibuprofen Suspensi 100 mg/5 ml Botol 1 1
103 1
Ichtyol salep Kulit Pot - -
104
Ipatropium Bromide + Vial
105 Salbutamol
- -
IsoniazidSulphate formg
tablet 100 inhalation Tablet - -
106 2,5 ml
Isosorbid Dinitrat 5 mg Tablet - -
107
Kalium Diklofenak Tablet 25 mg Tablet - -
108
Kalium Diklofenak Tablet 50 mg Tablet 29 50 79 8
109 10
Kalsium Hidroksida Pasta Tube - -
110
Kalsium Laktat Tablet 500 mg Tablet 90 90
111
Kaptopril 12,5 mg Tablet 98 200 298 30 10 30
112
Kaptopril 25 mg Tablet 5 5
113
Karbamazepin Tablet 200 mg Tablet 20 50 70
114
Ketokonazole Krim 2 % - 15 gr Tube 3 3
115
Ketokonazole Tablet 200 mg Tablet 2 2
116
Ketoprofen Tablet 100 mg Tablet - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - -
118
Ketorolac 10 mg injeksi Ampul - -
119
 Ketorolac 30 mg injeksi Ampul - -
120
Klindamisin Kapsul 150 mg Kapsul - -
121
Klindamisin Kapsul 300 mg Kapsul - -
122
Kloramfenikol Kapsul 250 mg Kapsul 94 94
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 1 5 6
124
Kloramfenikol Tetes Mata -5 ml Botol 4 4 1
125
Kloramfenikol Tetes Telinga 3%-5 Botol 1 5 6 1
126
Klorfeniramin Maleat (CTM) Table Tablet 78 400 478 10 33 31
127 13
Klorpromazin Hcl Tablet Salut 25 Tablet - -
128
Klorpromazin Hcl Tablet Salut 100 Tablet 11 200 211 10
129
Klorpromazin Hcl Injeksi 5 mg/ml Ampul - -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi : -
131 Sulfametoksazol 100 mg +
-
Kotrimoksazol
Trimetroprim 20Tablet,
mg Tablet
Kombinasi : 28
132 Sulfametoksazol 400 mg + 28 10
Kotrimoksazol
Trimetroprim 80Suspensi
mg Botol
Kombinasi : 4 10
133 14
Sulfametoksazol 200 mg +
Lansoprazole
Trimetroprim 30
40 mg Kapsul
mg/5 ml Tablet - -
134
Larutan mengadung Elektrolit Botol
(Na 130 mEq,Cl 109 mEq, Asetat -
135 28 mEq) /Asering -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75 -
136 gr) -
Larutan mengadung Karbohidrat Botol
+ Elektrolit -
137 (Nacl 1,75 gr, KCL 1,5 gr, Na -
Lactat 2,24
Lidokain gr, Dekstrosa
injeksi 2% 27 gr) Tablet
138 1 3 4
Lidokain Komp Injeksi, Kombinasi Ampul
139 : - -
Lidokain
LoperamidHclTablet
2% +Epinefrin
2 mg 1: Tablet - -
140
80.000-2 ml
Loratadin tablet 10 mg Tablet 40 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - -
142
Meloksikam tablet 15 mg Tablet 32 32 10
143 10
Meloksikam Suppositoria Supp - -
144
Metformin Hcl Tablet 500 mg Tablet 40 100 140 10
145 30
Methisoprinol 500 mg Tablet - -
146
Metilergometrin Maleat (Metergin) Tablet - -
147
Metilergometrin Maleat Injeksi 0, Ampul 4 4
148
Metilprednisolon tablet 4 mg Tablet 30 30 10
149
Metoklopramid 10 mg Tablet 10 40
150 30
Metoklorpropamid Injeksi 5 mg/ Ampul -
151 0
Metronidazol Tablet 250 mg Tablet 40
152 40
Metronidazole Tablet 500 mg Tablet 70
153 70
Metronidazole Infus 500 mg /100 Ampul -
154 0
Mikonazole KrIm 2 % - 10 gr Tube 3 5
155 2
Multivitamin + Mineral tablet Tablet 67
156 67
Multivitamin sirup Botol 4
157 4
 Natrium Bikarbonat Tablet 500 mg Tablet 102
158 102
Natrum Diklofenak Tablet 25 mg Tablet -
159 0
Natrium Diklofenak Tablet 50 mg Tablet 51
160 51
Natrium Klorida Larutan infus 0,9% Botol 2
161 2
Nipedifin Tablet 10 mg Tablet 3
162 3
Nistatin 100.000 IU/gram Tablet V Tablet 10 19 6
163 9 6
Nistatin 500.000 IU/gram Tablet S Tablet 50
164 50
Obat Antitiuberkolosis Kategori A Paket -
165 0
Obat Antitiuberkolosis Kategori 1 Paket -
166 0
Obat Antitiuberkolosis Kategori 2 Paket -
167 0
Obat Antitiuberkolosis Kategori 3 Paket -
168 0
Obat Anti Tuberkulosis FDC Kat Paket -
169 0
Obat Anti Tuberkulosis FDC Kat I Paket -
170 0
Obat Anti Tuberkulosis FDC Kat I Paket -
171 0
Obat Anti Tuberkolosis FDC Sisip Paket -
172 0
Obat Batuk Hitam (OBH) Cairan 10 Botol 5 11 2
173 6
Obat Batuk Cair Sirup (Ekspektora Botol 5 6
174 1
Obat Batuk Hitam Plus Sirup Botol 15 15
175 0
Obat Flu Sirup Botol -
176 0
Oksiterasiklin Hcl injeksi i.m.50 Vial -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube 3 1
178 3
Oksitetrasiklin Hcl Salep Kulit 3%- Tube 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul 9
180 9
Omeprazole injeksi 40mg/10ml Ampul -
181 0
Omeprazole Kapsul 20 mg Tablet -
182 0
Ondansetron inj 4 mg/ 2 mL Ampul
183 0 -
Parasetamol drops Botol 0 -
184
Parasetamol Sirup 120 mg/5ml-60 Botol 4 50 54 2 1 3
185
Parasetamol Tablet 100 mg Tablet 0 -
186
Parasetamol Tablet 500 mg Tablet 56 1100 1,156 50 116 110
187
Pehacain injeksi Ampul 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube 0 -
189
Piracetam 400 mg Tablet 0 -
190
Piracetam Tablet 800 mg Tablet 0 -
191
Piroksikam Tablet 20 mg Tablet 4 100 104 10
192
Pirantel Pamoat Tablet 365 mg (S Tablet 80 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 Tablet 36 500 536 10 10 30 20
194
Polikresulen (Kondensasi Botol
Metakresol
195 Sulfonat dan Metanal) 360 0 -
mg/g-10 ml
Povidon Iodida 10% 30 ml Botol
196 2 2
Povidon Iodida 10% 300 ml Botol 1 1
197
Primakuin tablet 15 mg Tablet 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 0 50 50 10
199
 Propilturasil Tablet 100 mg Tablet 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 -
201
Ranitidin Tablet 150 mg Tablet 13 100 113 10
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 186
204
Reserpin Tablet 0, 25 mg Tablet 40 40
205
Rifampisin Tablet 450 mg Tablet 0 -
206
Ringer Laktat Larutan Infus Steril Botol 3 3
207
Salbutamol Tablet 2 mg Tablet 43 43
208
Salbutamol Tablet 4 mg Tablet 0 -
209
Salbutamol solution for Ampul
Inhalation single dose units 2,5
ml
210 0 -
Salep 2-4 Kombinasi : Pot
211
Asam Salisilat 2 % + Belerang
0 5 5
Salisil bedak 2% -50 gr Kotak 7 7
212 Endap 4 % - 30 gram
Salep Luka Bakar Tube 0 -
213
Sefadroksil Sirup Kering 125 mg / Botol 0 3 3
214
Sefadroksil Tablet 500 mg Tablet 7 50 57
215
Sefiksim Kapsul 100 mg Kapsul 0 30 30
216
Sefotaksim Injeksi 1 gr Ampul 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 -
218
Semen Seng Fosfat Serbuk & Caira Botol 0 -
219
Setirizin Tablet 10 mg Tablet 12 50 62
220
Setirizin Sirup 5 mg / 5 ml Botol 3 3
221
Sianokobalamin Injeksi 500 mcg/m Ampul 21 21
222
Sianokobalamin Tablet 50 mcg Tablet 10 10
223
Silver Amalgam Serbuk 65-75% Botol 0 -
224
Simetidin 200 mg Tablet Tablet 80 80
225
Simvastatin Tablet 10 mg Tablet 45 100 145 10 10
226
Siprofloksasin 500mg Tablet 30 100 130 10 10
227
Spironolakton Tablet 25 mg Tablet 50 50
228
Sulfacetamid Tetes Mata 15 %-5ml Botol 0 -
229
Tablet Tambah Darah Kombinasi: Tablet
230 0 60 60
Besi II Sulfat 200 mg + Asam
Temporary
Folat 0,25 mgStopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 0 -
Trikesol formalin ( T K F ) Cairan Botol 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 50 60
233
Tetrasiklin Kapsul 500 mg Kapsul 0 -
234
Thiamin Hcl (Vit B1) Injeksi 100 Ampul 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) T Tablet 94 100 194 10 10
236
Thiamfenikol Kapsul 500 mg Kapsul 90 90
237
Tramadol Injeksi 50 mg/ ml Ampul 0 -
238
 Tramadol Tablet 50 mg Tablet 0 -
239
Triheksifenidil Hidroklorida Table Tablet 32 32
240
Vitamin B .Komplek Tablet Tablet 79 500 579 5 22 10 28
241
Vitamin Neurotropik Tablet Tablet 3 200 203 10 10 8
242
Zinc Tablet 20 mg Tablet 123 123
243
Prednisone 54mg Tablet 184 184
244
flunax sy Botol 0 -
245
Set 0 -
246
Set 0 -
247
Tablet 0 -
248
Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,0 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 m set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
 Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBAT
Bulan : Desember Tahun : 2016
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

5 6 7 8 9 10 11 12 13 14 15 16

1 1

10
16 20 10 10

10 20 10
30 40 10 30 10 60 30 50

3 1 2 1 2 1

10

1 1
10 40 50 40 50 10 40 20 75

10

10 20 6 20
 1 1

8 10
1 1

10 10 10
10 10

20 30
16 8 10 15 10 10 15

10 10
30 10 10

10
1 4
20 10 10 6 40 30

10 20

10
10 20 20 20 10 10 30

10
1
 1
1
22 14 16 6 35 6 16 15 25

30 10 10 10

10

1 1 2 1

10

20

5 10 6

10 20 10

1 1
10 6
 10 10

1 2 1

1 1 1 2 1

4 2 2 2 1 13

86 45 66 40 76 40 30 20 80

10 13 28 26 10 10 10 20
 10 10

10

1 1 1

10

5 10 4 10
1

10 10 10
40 40 10
10 10 10
20

10 10

20 10 30 20
10 10
40 37 46 25 10 18 46 20
20 10 6 7
10
5 5 16
BAT PADA TANGGAL

17 18 19 20 21 22 23 24 25 26 27

10
10 10 10
1

10
10 10 10

10 20 20 10 40 10 20 30 20

3 3 1 2 1 1

20 10

1 2
10 30 30 30 10 10 30 10

10 10 20 10 10

30 10 10 10 10
 10
10 10

6 10

10 10

8
 10 10

12 12 12 6 6 4 6

30
4 10 10

10 10
20 10 20 10 30

1 2 1 1
20 20 10 20 30

20

10 10
10 30 20 10 10 10

10 10
1
 2 1
1 1
1
15 30 34 20 10 17 29 16

20 20 20 10 30

1 1

10 10

10 10
6 8

10 10 10

1
10
1 1
 1
2 1
2 1 1 1

3 1 2 1 3 2

40 30 130 40 40 30 10 40 10

10 20 10

10 20 38 10 40 10 10 20
10 10

10 10

1
1

10 10 10

10
10 6 20 6

10 30

10 10 10

20 10 10 10
10
 10
20 10 26 30 30 26 10 36
15 10 10 7
10 10
10 6 14 7 7
 Jumlah Sisa Akhir
Pemakaian Bulan
28
0 -
0 100
20 55 44
40 18
1 4 4
0 -
0 20
20 50
86 47
0 -
40 -
10 570 39
0 -
1 28 3

1 1
0 -
40 42
0 -
0 -
0 40

7 2

655 21
0 -
0 40
0 -

0 3
0 -
1 1
0 -
0 -
102 25
0 70
0 -
156 55
0 12
 3 2
10 10
0 -
10 50
100 39
0 -
0 -
0 -
1 -
0 15
0 -
0 -
0 -
60 42
2 3
0 -
0 -
0 30
0 2
10 96 94
0 -
0 28
0 -
0 -
0 -
0 47
0 -
8 2
0 40
0 1
0 60
0 282

0 5
0 -
0 -
0 -
0 -
0 -
0 1
0 -
0 100
0 -
 0 -
0 100
0 70
40 35
0 3
10 17

7 88 51
0 -
0 -
2 -
10 40
50 150 40
166 245
0 1
0 -
0 1
0 -
40 -
150 20
0 20
0 -
10 49
11 4
10 246 16
0 -
1 -
0 -

0 -
0 -
0 -
0 -
68 11
0 -
30 60
280 18
0 5
30 40
2 1
0 2
0 -
0 -
0 -
 0 -
0 -
0 -
0 94
1 4 2
4 -
3 3
18 431 47
0 -
170 41
0 -

0 -

20 8

1 8 6
0 -

0 -

0 -

0 -
2 2
0 -
0 -
0 40
0 -
30 2
0 -
80 60
0 -
0 -
0 4
30 -
35 5
0 -
0 40
70 -
0 -
3 2
26 41
2 2
 20 82
0 -
10 10 41
0 2
0 3
12 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
7 4
1 4 2
11 4
0 -
0 -
1 2 1 5
0 2 2
0 9 9
0 -
0 -
0 -
0 -
8 50 4
0 -
1129 27
0 -
0 -
0 -
0 -
56 48
0 80
355 181

0 -
0 2
0 1
0 -
10 40
 0 -
0 -
50 63
0 -
0 186
0 40
0 -
0 3
30 13
0 -

0 -

4 1
1 6
0 -
1 2
30 27
10 20
0 -
0 -
0 -
29 33
1 2
0 21
0 10
0 -
30 50
20 140 5
92 38
20 30
0 -

40 20

0 -
0 -
50 10
0 -
0 -
150 44
10 80
0 -
 0 -
30 2
16 511 68
113 90
5 35 88
70 114
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 5
0 -
0 -
0 7
0 3
0 43
0 3
0 -
0 -
0 -
0 -
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
0 -
0 -
0 -
0 -
0 2
0 1
0 -
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol - v vv
1 0
Albendazole Tablet 400 mg Tablet 100
2 100
Alopurinol Tablet 100 mg Tablet 44 44
3
Ambroksol Tablet 30 mg Tablet 18 100 118 10
4 10 10
Ambroksol sirup 15 mg/5 ml Botol 4 10 14
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - -
6
Aminofillin Tablet 200 mg Tablet 20 20
7
Amitriptillin Hcl Tablet Salut 25 m Tablet 50 50
8
Amlodipin Tablet 5 mg Tablet 47 100 147
9
Amlodipin Tablet 10 mg Tablet - -
10
Amoksisillin Kapsul 250 mg Kapsul - 100 100
11
Amoksisillin Kaplet 500 mg Kaplet 39 600 639 30
12 40 25
Amoksisillin Serbuk Injeksi 1000 mg vial - -
13
Amoksisillin Sirup Kering 125 mg/5 Botol 3 20 23 1
14 1 1
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml 1 5
15 6
Ampisilin Kapsul 250 mg Kapsul - 100 100
16
Ampisillin Kaplet 500 mg Tablet 42 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - -
18
Ampisillin Injeksi 1000 mg Vial - -
19
Analgetik Plus Tablet 40 40
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 2 40 42 11
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg 21 800 50 30

22 821
Antasida Plus Tablet Tablet - -
23
Antalgin (Metampiron) Tablet 500 Tablet 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g + 3
Polimiksin 1000 IU/g
26 3
Anti Hemoroid Doen komb Supp - -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat 1

28 3% 1
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein -

29 50 mg -
Anti Diare Suspensi Botol - -
30
Anti Diare Tablet Tablet 25 50 75
31 10
Anti Dotum Oral Tablet Tablet 70 70
32
Anti Hipertensi Kapsul Tablet - -
33
Antihistamin Tablet kombinasi Tablet 55 200 255 10
34 15 15
Antispasmodik Tablet/SCOPMA Tablet 12 50 62
35
Antitusiva Sirup Botol 2 2
36
Antitusiva Tablet Tablet 10 10
37
Asam Folat Tablet 1 mg Tablet - -
38
Asam Askorbat 50 mg Tablet 50 50
39
Asam Mefenamat Kapsul 500 mg Kapsul 39 39
40
Asetosal 80 mg Tablet - -
41
Asetosal Tablet 100 mg Tablet - -
42
Asetosal Tablet 500 mg Tablet - -
43
Asiklovir Krim 5 % Tube - 5 5
44
Asiklovir Tablet 200 mg Tablet 15 15
45
Asiklovir Tablet 400 mg Tablet - -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul - -
47
Aqua Pro Injeksi Steril, bebas Piro Vial - -
48
Betahistin Mesilat 6 mg Tablet 42 42
49
Betametason Krim 0,1 %- 5g Tube 3 5 8
50
Bisakodil suppositoria 10 mg Supp - -
51
Bisoprolol Tablet 5 mg Tablet - -
52
Bromheksin 8 mg Tablet 30 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 2
54
Deksametason Tablet 0,5 mg Tablet 94 94
55 10
Devitalisasi Pasta (Non Arsen) Botol - -
56
Diazepam tablet 2 mg Tablet 28 28
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet - -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul 47 47
61
Digoksin Tablet 0,25 mg Tablet - -
62
Dimenhidrinat Tablet 50 mg Tablet 2 50 52
63
Domperidon Tablet 10 mg Tablet 40 40
64
Donperidon Suspensi 5 mg/5ml Botol 1 1
65
Efedrin Hcl Tablet 25 mg Tablet 60 60
66
Ekstrak Belladone Tablet 10 mg Tablet 282 282
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi 5

68 0,1%/- 1ml 5
 Eritromisin Kapsul 250 mg Kapsul - -
69
Eritromisin Kapsul 500 mg Kapsul - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - -
71
Etambutol Tablet 500 mg Tablet - -
72
Etanol 70 % 100 ml Botol - -
73
Etil Klorida Semprot -100 ml Botol 1 1
74
Eugenol Cairan -10 ml Botol - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 100
76
Fenobarbital tablet 30 mg Tablet - -
77
Fenobarbital injeksi 50 mg / ml Ampul - -
78
Fenoksimeti Penisilin 250 mg table Tablet 100 100
79
Fenoksimeti Penisilin 500 mg tabl Tablet 70 70
80
Fitomenadion tablet 10 mg Tablet 35 35
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul 3 3
82
Furosemid Tablet 40 mg Tablet 17 17
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat 51
2,70 g )200 ml Air

84 51 6 4
Gemfibrozil Tablet 600 mg Tablet - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - -
86
Gentamisin Salep Kulit 0,1 % Tube - 5 5
87
Glibenklamid Tablet 5 mg Tablet 40 40
88
Glimepiride 2 mg Tablet 40 50 90
89
Gliseril guayakolat tablet 100 mg Tablet 245 245 3
90
Gliseril Guayakolat sirup Botol 1 25 26
91 25
Glukonas Kalsikus injeksi Ampul - -
92
Glukosa Larutan Infus 5 % Botol 1 1
93
Glukosa Larutan Infus10 % Botol - -
94
Griseofulvin Tablet 125 mg,microni Tablet - 100 100
95 10
Haloperidol Tablet 0,5 mg Tablet 20 200 220
96 40
Haloperidol Tablet 1,5 mg Tablet 20 50 70
97 10
Haloperidol Tablet 5 mg Tablet - -
98
Hidrokloritiazid 25 mg Tablet 49 49
99
Hidrokortison Krim 2,5 % Tube 4 10 14 1
100 3
Ibuprofen Tablet 200 mg Tablet 16 100 116
101 20
Ibuprofen Tablet 400 mg Tablet - 200 200
102 10
Ibuprofen Suspensi 100 mg/5 ml Botol - 5 5
103 1
Ichtyol salep Kulit Pot - -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml -

105 -
 Isoniazid tablet 100 mg Tablet - -
106
Isosorbid Dinitrat 5 mg Tablet - -
107
Kalium Diklofenak Tablet 25 mg Tablet - -
108
Kalium Diklofenak Tablet 50 mg Tablet 11 100 111
109
Kalsium Hidroksida Pasta Tube - -
110
Kalsium Laktat Tablet 500 mg Tablet 60 60
111
Kaptopril 12,5 mg Tablet 18 300 318
112 10 40
Kaptopril 25 mg Tablet 5 5
113
Karbamazepin Tablet 200 mg Tablet 40 40
114 10
Ketokonazole Krim 2 % - 15 gr Tube 1 5 6
115
Ketokonazole Tablet 200 mg Tablet 2 100 102
116
Ketoprofen Tablet 100 mg Tablet - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - -
118
Ketorolac 10 mg injeksi Ampul - -
119
Ketorolac 30 mg injeksi Ampul - -
120
Klindamisin Kapsul 150 mg Kapsul - -
121
Klindamisin Kapsul 300 mg Kapsul - -
122
Kloramfenikol Kapsul 250 mg Kapsul 94 94
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 2 2
124
Kloramfenikol Tetes Mata -5 ml Botol - 5 5
125
Kloramfenikol Tetes Telinga 3%-5 Botol 3 3
126
Klorfeniramin Maleat (CTM) Tablet Tablet 47 400 447 4
127 20
Klorpromazin Hcl Tablet Salut 25 Tablet - 100 100
128 40
Klorpromazin Hcl Tablet Salut 100 Tablet 41 41
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul - -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg + -
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg + 8 100

Trimetroprim 80 mg
132 108 10
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg + 6 5
Trimetroprim 40 mg/5 ml
133 11 1
Lansoprazole 30 mg Kapsul Tablet - 50 50
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering -
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr) -
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr) -

137 -
Lidokain injeksi 2 % Tablet 2 2
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2% -
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet - -
140
Loratadin tablet 10 mg Tablet 40 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - -
142
Meloksikam tablet 15 mg Tablet 2 50 52
143 20
Meloksikam Suppositoria Supp - -
144
Metformin Hcl Tablet 500 mg Tablet 60 60
145
Methisoprinol 500 mg Tablet - -
146
Metilergometrin Maleat (Metergin) Tablet - -
147
Metilergometrin Maleat Injeksi 0, Ampul 4 4
148
Metilprednisolon tablet 4 mg Tablet - -
149
Metoklopramid 10 mg Tablet 50 55
150 5
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151 0
Metronidazol Tablet 250 mg Tablet 40
152 40
Metronidazole Tablet 500 mg Tablet 100 100
153 0
Metronidazole Infus 500 mg /100 m Ampul -
154 0
Mikonazole KrIm 2 % - 10 gr Tube 2
155 2 1
Multivitamin + Mineral tablet Tablet 41
156 41 10
Multivitamin sirup Botol 10 12
157 2
Natrium Bikarbonat Tablet 500 mg Tablet 82
158 82
Natrum Diklofenak Tablet 25 mg Tablet -
159 0
Natrium Diklofenak Tablet 50 mg Tablet 100 141
160 41 10
Natrium Klorida Larutan infus 0,9%- Botol 2
161 2
Nipedifin Tablet 10 mg Tablet 30 33
162 3
Nistatin 100.000 IU/gram Tablet V Tablet 7
163 7
Nistatin 500.000 IU/gram Tablet Sa Tablet 50
164 50
Obat Antitiuberkolosis Kategori A Paket -
165 0
Obat Antitiuberkolosis Kategori 1 Paket -
166 0
Obat Antitiuberkolosis Kategori 2 Paket -
167 0
Obat Antitiuberkolosis Kategori 3 Paket -
168 0
Obat Anti Tuberkulosis FDC Kat A Paket -
169 0
Obat Anti Tuberkulosis FDC Kat I & Paket -
170 0
Obat Anti Tuberkulosis FDC Kat I & Paket -
171 0
Obat Anti Tuberkolosis FDC Sisipa Paket -
172 0
Obat Batuk Hitam (OBH) Cairan 10 Botol 4
173 4
 Obat Batuk Cair Sirup (Ekspektoran Botol 10 12
174 2
Obat Batuk Hitam Plus Sirup Botol 6 10
175 4 1 1
Obat Flu Sirup/flutrop-c Botol 5 5
176 0
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube 3 4
178 1
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul 9
180 9
Omeprazole injeksi 40mg/10ml Ampul -
181 0
Omeprazole Kapsul 20 mg Tablet 1100 1,100 10
182 0
Ondansetron inj 4 mg/ 2 mL Ampul 0 -
183
Parasetamol drops Botol 0 3 3 1
184
Parasetamol Sirup 120 mg/5ml-60 Botol 4 50 54 1 3
185
Parasetamol Tablet 100 mg Tablet 0 100 100 70
186
Parasetamol Tablet 500 mg Tablet 27 1500 1,527 70 20
187
Pehacain injeksi Ampul 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube 0 -
189
Piracetam 400 mg Tablet 0 -
190
Piracetam Tablet 800 mg Tablet 0 -
191
Piroksikam Tablet 20 mg Tablet 48 100 148
192
Pirantel Pamoat Tablet 365 mg (Se Tablet 80 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet 181 300 481 40 30 10
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 0 -
Povidon Iodida 10% 30 ml Botol 2 2
196
Povidon Iodida 10% 300 ml Botol 1 1
197
Primakuin tablet 15 mg Tablet 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 40 40
199
Propilturasil Tablet 100 mg Tablet 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 -
201
Ranitidin Tablet 150 mg Tablet 63 63
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 186
204
Reserpin Tablet 0, 25 mg Tablet 40 40
205
Rifampisin Tablet 450 mg Tablet 0 -
206
Ringer Laktat Larutan Infus Steril Botol 3 3
207
Salbutamol Tablet 2 mg Tablet 13 13
208
Salbutamol Tablet 4 mg Tablet 0 -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 0 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram 1 3 4
Salisil bedak 2% -50 gr Kotak 6 8 14 2
212
Salep Luka Bakar Tube 0 -
213
Sefadroksil Sirup Kering 125 mg / Botol 2 2
214
Sefadroksil Tablet 500 mg Tablet 27 27
215
Sefiksim Kapsul 100 mg Kapsul 20 20
216
Sefotaksim Injeksi 1 gr Ampul 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 -
218
Semen Seng Fosfat Serbuk & Caira Botol 0 -
219
Setirizin Tablet 10 mg Tablet 33 100 133
220
Setirizin Sirup 5 mg / 5 ml Botol 2 2
221
Sianokobalamin Injeksi 500 mcg/m Ampul 21 21
222
Sianokobalamin Tablet 50 mcg Tablet 10 10
223
Silver Amalgam Serbuk 65-75% Botol 0 -
224
Simetidin 200 mg Tablet Tablet 50 50 10
225
Simvastatin Tablet 10 mg Tablet 5 100 105
226
Siprofloksasin 500mg Tablet 38 38
227
Spironolakton Tablet 25 mg Tablet 30 30
228
Sulfacetamid Tetes Mata 15 %-5ml Botol 0 -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 20 60 80
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 0 -
Trikesol formalin ( T K F ) Cairan 1 Botol 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 10
233
Tetrasiklin Kapsul 500 mg Kapsul 0 100 100
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul 0 100 100
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet 44 100 144
236
Thiamfenikol Kapsul 500 mg Kapsul 80 80
237
Tramadol Injeksi 50 mg/ ml Ampul 0 -
238
Tramadol Tablet 50 mg Tablet 0 -
239
Triheksifenidil Hidroklorida Tablet Tablet 2 2
240
Vitamin B .Komplek Tablet Tablet 68 400 468 40
241
Vitamin Neurotropik Tablet Tablet 90 200 290 20 20
242
Zinc Tablet 20 mg Tablet 88 88 7
243
Prednisone 54mg Tablet 114 114
244
flunax sy Botol 0 -
245
Dextrofen sy botol 0 3 3
246
Set 0 -
247
Tablet 0 -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43 2
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 4 5
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Maret Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13

10 10
1 1

10

10 20
20 30 40 40 50 40 10

3 2 2 1

10

20 50 20 45 90 70

1
 4

18 5 10 20 10 10
10

10
10 10

1 1

6
1 2

10 14

8
 7

15 10 4 10 35

10
20 40

1 1 1

10 30 30
 10 10

10
20 20 10 15 10

10 10
1

10

1 3

31 23 10 8 10 30 20
10 20

2
 1 1

10

10

20

1
6 10 10
1 3

27 10

10

1
 1 1 1
1

1 1

5 10 2 4 2 1 1

40 10 40 50 66 60 70 110

8 10 10

20 20 30 30 10 30

10

10 10

10
 1
1 1 1 2

10
20

10 10

14

10 10

30

10
10 30

10 20 10 30 10 30
16 20 40 10 20
10
6 10 10
3 1 1

4
N PEMAKAIAN OBAT
ret Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

10
10
2 1 2

10 10 20

20 30 20 60 10 40

1 1 1 2

1 1 2
10
10

1 10

60 20 20 10 30 40 10

1
 10 10

20 10 30

1 1

10

8 10
 10
10 6 10 10 10 20 29

20 40
10 10 10

2 1 1 1

10 10
 10 10 10

10
10 10 10 10 20 10

1 1
10 34 10 10 6 48 25 15
10 10
5 5 5

2 2
 10

1 1

10 10
 1 1 1 2
1 1 2 1
1 1

10

2 1 10 2 1 2 3

60 20 400 50 70 40 20 50 50

10 10

30 10 10 18 50 20 10

10
 1
1 1

7
10

10

10

30 20 20 20 20 10 20 10 20
10 20 10 10
10
6 18
1 1
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
10 20 24
10 70 48
1 8 6
0 -
0 20
10 10 40
10 20 10 5 95 52
0 -
1 10 10 51 49
10 30 20 10 30 605 34
0 -
16 7

5 1
10 90
10 10 30 12
0 -
0 -
0 40

1 33 9

40 10 20 50 60 10
755 66
0 -
0 40
0 -

1 2 1
0 -

1 -
 0 -
0 -
10 44 31
0 70
0 -
20 10 15 10 10 238 17
20 30 32
0 2
0 10
0 -
10 20 30
20 19
0 -
0 -
0 -
3 2
0 15
0 -
0 -
0 -
10 16 26
1 6 2
0 -
0 -
0 30
0 2
10 10 64 30
0 -
20 20 8
0 -
0 -
0 -
0 47
0 -
26 26
0 40
0 1
0 60
0 282

0 5
 0 -
0 -
0 -
0 -
0 -
0 1
0 -
0 100
0 -
0 -
0 100
0 70
0 35
0 3
0 17

6 23 28
0 -
0 -
1 4
10 10 30
10 30 50 40
10 10 192 53
25 1
0 -
0 1
0 -
20 80
20 180 40
10 50 20
0 -
10 10 39
1 13 1
20 96
10 10 10 130 70
1 4
0 -

0 -
 0 -
0 -
0 -
10 10 10 80 31
0 -
20 40
30 20 30 275 43
0 5
30 10
1 2 4
6 96
0 -
0 -
0 -
0 -
0 -
0 -
10 84
0 2
4 1
2 1
10 30 20 374 73
90 10
5 5 25 16
0 -

0 -

10 10 30 78

7 4
6 10 16 34

0 -

0 -
 0 -
2 -

0 -
0 -
0 40
0 -
20 32
0 -
30 10 50 10
0 -
0 -
0 4
0 -
10 45
0 -
0 40
30 70
0 -
2 -
36 5
1 2 9 3
0 82
0 -
67 74
0 2
10 23
0 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
1 3
 1 1 10 2
8 2
1 3 2
0 -
2 2
0 2
0 9
0 -
30 50 1,050
0 -
1 2
1 1 52 2
70 30
50 10 40 45 10 65 1516 11
0 -
0 -
0 -
0 -
30 10 88 60
0 80
20 10 30 428 53

0 -
0 2
0 1
0 -
10 30
0 -
0 -
10 40 23
0 -
0 186
0 40
0 -
0 3
10 3
0 -

0 -
 2 2
1 1 1 12 2
0 -
0 2
10 17
20 -
0 -
0 -
0 -
20 40 93
1 1 1
0 21
0 10
0 -
31 19
10 30 50 55
10 30 8
0 30
0 -

30 50

0 -
0 -
0 10
10 90
10 90
20 70 74
0 80
0 -
0 -
0 2
10 10 40 380 88
30 10 30 20 286 4
27 61
50 64
0 -
1 1 2
0 -
0 -
 0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 5
0 -
0 -
0 7
0 3
1 1 2 2 15 28
0 3
0 -
0 -
0 -
0 -
1 2
0 -
0 -
0 -
0 -
0 2
0 -
0 7
4 1
0 -
0 -
0 -
0 -
0 2
0 1
0 -
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 0
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 24 200 224
3 100
Ambroksol Tablet 30 mg Tablet 48 - 48
4
Ambroksol sirup 15 mg/5 ml Botol 6 3 9
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 40 - 40
8
Amlodipin Tablet 5 mg Tablet 52 200 252
9 5
Amlodipin Tablet 10 mg Tablet - - -
10
Amoksisillin Kapsul 250 mg Kapsul 49 - 49
11 10
Amoksisillin Kaplet 500 mg Kaplet 34 300 334
12
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 7 20 27
14 1
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 1 10
15 11
Ampisilin Kapsul 250 mg Kapsul 90 - 90
16
Ampisillin Kaplet 500 mg Tablet 12 100 112
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus Tablet 40 - 40
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 9 10 19
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 66 1,000 60
22 1,066
Antasida Plus Tablet/TRIANTA Tablet - 50 50
23
Antalgin (Metampiron) Tablet 500 mg Tablet 40 - 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g 1 3
26 4
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam - 3
28 Salisilat 3% 3
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol - 3 3
30
Anti Diare Tablet/New Diaform Tablet 31 30 61
31
Anti Dotum Oral Tablet Tablet 70 - 70
32
 Anti Hipertensi Kapsul Tablet - - -
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 17 200 217
34
Antispasmodik Tablet/SCOPMA Tablet 32 100 132
35
Antitusiva Sirup/DEXTROFEN SY Botol 2 5 7
36
Antitusiva Tablet Tablet 10 - 10
37
Asam Folat Tablet 1 mg Tablet - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 30 100 130
39
Asam Mefenamat Kapsul 500 mg Kapsul 19 30 49
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 2 3 5
44
Asiklovir Tablet 200 mg Tablet 15 - 15
45
Asiklovir Tablet 400 mg Tablet - - -
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet 26 30 56
49
Betametason Krim 0,1 %- 5g Tube 2 6 8
50 1
Bisakodil suppositoria 10 mg Supp - - -
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 30 100 130
55 10
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 8 100 108
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 47 - 47
61
Digoksin Tablet 0,25 mg Tablet - - -
62
Dimenhidrinat Tablet 50 mg Tablet 26 50 76
63
Domperidon Tablet 10 mg Tablet 40 100 140
64
Donperidon Suspensi 5 mg/5ml Botol 1 - 1
65
Efedrin Hcl Tablet 25 mg Tablet 60 - 60
66
Ekstrak Belladone Tablet 10 mg Tablet 282 282
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol 0 - -
71
Etambutol Tablet 500 mg Tablet 0 - -
72
Etanol 70 % 100 ml Botol 0 - -
73
 Etil Klorida Semprot -100 ml Botol 1 - 1
74
Eugenol Cairan -10 ml Botol 0 - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 - 100
76
Fenobarbital tablet 30 mg Tablet 0 - -
77
Fenobarbital injeksi 50 mg / ml Ampul 0 - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 35 - 35
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul 3 - 3
82
Furosemid Tablet 40 mg Tablet 17 - 17
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat 20
0,58 gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 28 48
Gemfibrozil Tablet 600 mg Tablet 0 - -
85
Gentamisin injeksi 80 mg / 2 ml Vial 0 - -
86
Gentamisin Salep Kulit 0,1 % Tube 4 4
87
Glibenklamid Tablet 5 mg Tablet 30 100 130
88
Glimepiride 2 mg Tablet 40 - 40
89
Gliseril guayakolat tablet 100 mg Tablet 53 100 153
90 30
Gliseril Guayakolat sirup Botol 1 - 1
91
Glukonas Kalsikus injeksi Ampul 0 - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol 0 - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 80 - 80
95
Haloperidol Tablet 0,5 mg Tablet 40 200 240
96
Haloperidol Tablet 1,5 mg Tablet 20 100 120
97 10
Haloperidol Tablet 5 mg Tablet 0 50 50
98
Hidrokloritiazid 25 mg Tablet 39 - 39
99
Hidrokortison Krim 2,5 % Tube 1 10 11
100 1
Ibuprofen Tablet 200 mg Tablet 96 - 96
101
Ibuprofen Tablet 400 mg Tablet 70 150 220
102
Ibuprofen Suspensi 100 mg/5 ml Botol 4 - 4
103
Ichtyol salep Kulit Pot 0 - -
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 -
105 ml 0 -
Isoniazid tablet 100 mg Tablet 0 - -
106
Isosorbid Dinitrat 5 mg Tablet 0 - -
107
Kalium Diklofenak Tablet 25 mg Tablet 0 - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 31 350 381
109 5
Kalsium Hidroksida Pasta Tube 0 - -
110
Kalsium Laktat Tablet 500 mg Tablet 40 100 140
111
Kaptopril 12,5 mg Tablet 43 600 643
112
Kaptopril 25 mg Tablet 5 100 105
113
 Karbamazepin Tablet 200 mg Tablet 10 40 50
114
Ketokonazole Krim 2 % - 15 gr Tube 4 - 4
115 1
Ketokonazole Tablet 200 mg Tablet 96 - 96
116
Ketoprofen Tablet 100 mg Tablet 0 - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 - -
118
Ketorolac 10 mg injeksi Ampul 0 - -
119
Ketorolac 30 mg injeksi Ampul 0 - -
120
Klindamisin Kapsul 150 mg Kapsul 0 - -
121
Klindamisin Kapsul 300 mg Kapsul 0 - -
122
Kloramfenikol Kapsul 250 mg Kapsul 84 - 84
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 2 6 8
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol 1 6 7
125 2
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 2 3
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 73 300 373
127 16
Klorpromazin Hcl Tablet Salut 25 mg Tablet 10 120 130
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 16 100 116
129 5
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg 20
131 0 20
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg 30
132 78 108
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 7
133 4 11
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering
-
135 0 -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 0 -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5
gr, Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 0 -
Lidokain injeksi 2 % Tablet 0 - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin
1 : 80.000-2 ml -
139 0 -
Loperamid Tablet 2 mg Tablet 0 - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 - -
142
Meloksikam tablet 15 mg Tablet 32 60 92
143
Meloksikam Suppositoria Supp 0 - -
144
Metformin Hcl Tablet 500 mg Tablet 10 200 210
145
 Methisoprinol 500 mg Tablet 0 - -
146
Metilergometrin Maleat (Metergin) Tablet 0,1 Tablet 0 20 20
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 0 30 30
149
Metoklopramid 10 mg/xilastin Tablet 45 - 45
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 - -
151
Metronidazol Tablet 250 mg Tablet 40 - 40
152
Metronidazole Tablet 500 mg Tablet 70 - 70
153
Metronidazole Infus 500 mg /100 ml Ampul 0 - -
154
Mikonazole KrIm 2 % - 10 gr Tube 0 5 5
155
Multivitamin + Mineral tablet/HEMAFORT Tablet 5 35 40
156
Multivitamin sirup/RECOVIT Botol 3 10 13
157
Natrium Bikarbonat Tablet 500 mg Tablet 82 - 82
158
Natrum Diklofenak Tablet 25 mg Tablet 0 - -
159
Natrium Diklofenak Tablet 50 mg Tablet 74 100 174
160 10
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161
Nipedifin Tablet 10 mg Tablet - 23
162 23
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 7
163 7
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 0
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 0 -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 0 -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 0 -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 0 -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 0 -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 0
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 0
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 10 13
173 3
Obat Batuk Cair Sirup (Ekspektoran)/COREDRY Botol 25 27
174 2
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 7 9
175 2
Obat Flu Sirup/ FLUTOP-C Botol 15 17
176 2 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube - 2
178 2
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 0
Omeprazole Kapsul 20 mg Tablet 30 58
182 28
Ondansetron inj 4 mg/ 2 mL Ampul 0 0 -
183
Parasetamol drops Botol 2 2 4
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 2 22 24
185
Parasetamol Tablet 100 mg Tablet 30 0 30
186
Parasetamol Tablet 500 mg Tablet 11 1700 1,711 68
187
Pehacain injeksi Ampul 0 0 -
188
 Perak Sulfadiazin krim 1 % 35 gr Tube 0 0 -
189
Piracetam 400 mg Tablet 0 0 -
190
Piracetam Tablet 800 mg Tablet 0 0 -
191
Piroksikam Tablet 20 mg Tablet 60 30 90
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 53 520 573 20
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml 0 0 -
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet 0 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 30 0 30
199
Propilturasil Tablet 100 mg Tablet 0 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 0 -
201
Ranitidin Tablet 150 mg Tablet 23 200 223
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet 0 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet 3 70 73 20
208
Salbutamol Tablet 4 mg Tablet 0 50 50
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 0 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 2 25 27
Salisil bedak 2% -50 gr Kotak 2 10 12 1
212
Salep Luka Bakar Tube 0 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 2 0 2
214
Sefadroksil Tablet 500 mg Tablet 17 0 17
215
Sefiksim Kapsul 100 mg Kapsul 0 30 30
216
Sefotaksim Injeksi 1 gr Ampul 0 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol 0 0 -
219
Setirizin Tablet 10 mg Tablet 93 50 143 10
220
Setirizin Sirup 5 mg / 5 ml Botol 1 2 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B1 Ampul 21 0 21
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol 0 0 -
224
Simetidin 200 mg Tablet Tablet 19 50 69
225
Simvastatin Tablet 10 mg Tablet 55 0 55
226
Siprofloksasin 500mg Tablet 8 100 108
227
Spironolakton Tablet 25 mg Tablet 30 0 30
228
 Sulfacetamid Tetes Mata 15 %-5ml Botol 0 2 2
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 50 150 200
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 0 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 0 10
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul 90 0 90
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 74 400 474
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul 0 0 -
238
Tramadol Tablet 50 mg Tablet 0 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 2 50 52 20
240
Vitamin B .Komplek Tablet Tablet 88 800 888 15
241
Vitamin Neurotropik Tablet Tablet 4 370 374 45
242
Zinc Tablet 20 mg Tablet 61 0 61
243
Prednisone 5 mg Tablet 64 0 64
244
flunax sy Botol 0 0 -
245
vit k Set 2 30 32
246
Gentian Violet Botol 6 4 10
247
Kloramfenikol 500 Tablet 100 0 100
248
Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 0 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 28 0 28
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cro Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
14
 Etanol 70 % 1.000 ml Botol 0 0 -
15
Folley Catheter no 14 Set 0 0 -
16
Folley Catheter no 16 Set 0 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set 0 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 5 5
22
Kapas Berlemak 500 gram Bungkus 0 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 0 -
28
Kertas Puyer Pcs 0 0 -
29
Lysol 1,000 ml Botol 0 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs 0 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
36
Rapid Test Syphilis Pcs 0 0 -
37
RPR Test Syphilis Pcs 0 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs 0 0 -
40
Sarung tangan Steril No 6 Pcs 0 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs 0 0 -
44
Sarung tangan Non Steril M Pcs 0 0 -
45
Sarung tangan Non Steril L Pcs 0 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set 0 0 -
48
Anuscopi Yamato Unit 0 0 -
49
Kaca Slide Box 0 0 -
50
Reagen Ziehl Nielson Kit 0 0 -
51
Rotator Unit 0 0 -
52
RTD Malaria Tes 0 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
54
Sound Timer Buah 0 0 -
55
SD Syphilis Pcs 0 0 -
56
 CATATAN HARIAN PEMAKAIAN O
Bulan : April Tahun : 2017
JUMLAH PEMA

3 4 5 6 7 8 9 10 11 12 13

17
10
1 1

10 5 30 10 30 10 10

10
30 10 20 10 30 40

1 10 1 1 1 1

1 2 2
20
10 40

1 1 1 1 4

60 30 10 10 10 10 30 30 66 20

10 5 10
 20 23 13 10 20
10 10 8
1 1 1

10 10
10 10

2 2 1

16 16

10
12
 6 6

1
20

3 6 3 3 8 20 13

10 20 20 20 20 20
10 10 10 20

20 10 10 10 20
1

10 10 10 10 10 10 20 18

10 8 20
10 10 40 40 20 20 10
10
 10
1
10

1 2
1 1
20 13 20 3 11 13 10 8 4

10 10 5 5 5 10 5 10

20

1 1 2 1

20
 10

1
10 10 10
2 1 2 2 1 1

10

1 2 1 1
1 1
1 1 1
2 2 1 1 1 1

10 10

2 1 1 1 3 2 2

40 70 50 70 36 40 48 40 90 70
20 10

30 20 6 10 40

30 10 20

10 10
10

2 1 1 4 3 2
1 1 1 1 1

10 10

10 10 10
1 1

10 12

20
20
 30 10

10 10
20 10 20

10
23 40 30 10 60 18 10 10
26 10 10 20 10 10 32
10
10 10 10 10

10
1

2
1
PEMAKAIAN OBAT
Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

10 30 20
10 10
1

10 20 20 10

30 20 50 10

1 2 1

1 1 1

1 1 1 1 3

50 100 50 20 350 30 10

10

1
8
 3 20 20 20
8
2 1

20 10 8 10
10 10

1 1

30

60

10 20 20
 5 17 6

110

13 13 10

10
40 40 10 10 20

1 1 1
10 10
10 76 10

10 10 178

10 10
10 30 20 291 10
10 20 10
20

1 1
1

38 18 13 53 10 10
30 10 10 20
10

10 10

1 1 1 1

20 44 10

10 120
 10

2
10
1
10

138 10

1 1 1 1 2
20 1 1
2
2 1 1

1 1

10

1
1 1 2 1 1

83 125 100 33 396 60 65

10 10

70 30 10 230 30

10 20

10
20 10

1 3 7 1
2

10 10 10

1 1

10 10 10
10 20
10 10
 1

30

20 10 360 10

10
18 30 20 3 396 10 6
20 20 40 6 107 10

10

5
3
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
177 47
8 38 10
3 6
0 -
0 20
0 40
170 82
0 -
20 29
20 20 10 300 34
0 -
1 2 1 2 26 1

1 1 10 1
20 70
50 62
0 -
0 -
0 40

2 17 2

20 30 10 10 20
1036 30
10 40
0 40
0 -

0 4
0 -

1 1 2

0 -
1 2
8 41 20
0 70
 0 -
20 10 179 38
6 42 90
6 1
0 10
0 -
68 62
40 9
0 -
0 -
0 -
2 3
0 15
0 -
0 -
0 -
8 8 16 40
7 1
0 -
0 -
0 30
0 2
6 78 52
0 -
64 44
0 -
0 -
0 -
0 47
0 -
60 16
12 128
0 1
60 -
0 282

0 5
0 -
0 -
0 -
0 -
0 -
 0 1
0 -
0 100
0 -
0 -
0 100
0 70
0 35
0 3
0 17

40 8
0 -
0 -
1 3
130 -
0 40
4 10 136 17
0 1
0 -
0 1
0 -
10 70
10 240 -
60 60
10 10 40
0 39
1 6 5
20 76
20 10 10 206 14
1 3
0 -

0 -
0 -
0 -
0 -
10 8 20 339 42
0 -
10 8 18 94 46
10 10 10 541 102
20 70 35
 5 10 45 5
2 2
10 86
0 -
0 -
0 -
0 -
0 -
0 -
0 84
3 2 7 1
1 7 -
2 1
10 10 14 18 10 322 51
20 20 10 120 10
75 41
0 -

8 12

10 50 58

1 10 1
0 34

0 -

0 -

0 -
0 -

0 -
0 -
0 40
0 -
74 18
0 -
150 60
 0 -
10 10
0 4
2 10 22 8
5 8 37
0 -
0 40
10 20 30 40
0 -
3 2
40 -
1 1 12 1
10 72
0 -
168 6
0 -
0 23
0 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
11 2
1 25 2
1 2 8 1
1 1 15 2
0 -
2 -
0 2
0 9
0 -
30 28
0 -
1 3
1 1 1 1 22 2
0 30
20 60 40 30 20 1654 57
0 -
 0 -
0 -
0 -
10 5 65 25
0 80
10 20 10 20 556 17

0 -
0 2
0 1
0 -
0 30
0 -
0 -
8 30 128 95
0 -
0 186
0 40
0 -
0 3
10 60 13
40 10

0 -

25 2
2 10 2
0 -
2 -
0 17
20 10
0 -
0 -
0 -
30 100 43
2 1
2 19
0 10
0 -
10 62 7
30 25
10 50 58
20 10
 1 1

60 10 10 150 50

0 -
0 -
0 10
0 90
10 10 40 50
10 460 14
0 80
0 -
0 -
40 12
30 36 34 10 10 819 69
10 376 (2)
10 51
50 14
0 -
10 22
2 8
10 10 90
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
0 7
0 3
1 1 9 19
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
4 1
0 -
0 -
0 -
0 2
0 1
0 -
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
4
2
9
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Mei Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
ei Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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0 1
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0 1
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0
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0
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Juni Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
ni Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Juli Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
li Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

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 Jumlah Sisa Akhir
Pemakaian Bulan
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0 -
0 -

0 -

0 -
0 -
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0 -
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0 -
0 -
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0 -
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0 -
0 -
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0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
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0 -

0 -
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0 -
0 5
0 -
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0 7
0 3
0 43
0 3
0 -
0 -
0 -
0 -
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
0 -
0 -
0 -
0 -
0 2
0 1
0 -
0 -
0 -
0 10
0 1
0 -
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0 -
0 -
0 -
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0 4
0 -
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0 7
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0
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0
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Agustus Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
stus Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0
0
0
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : September Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
mber Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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0 3
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0 1
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0 1
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0
0
0
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Oktober Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
ober Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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0
0
0
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : November Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
mber Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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0
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2 3
Air Raksa Dental Use Botol -
1
Albendazole Tablet 400 mg Tablet -
2
Alopurinol Tablet 100 mg Tablet -
3
Ambroksol Tablet 30 mg Tablet -
4
Ambroksol sirup 15 mg/5 ml Botol -
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul -
6
Aminofillin Tablet 200 mg Tablet -
7
Amitriptillin Hcl Tablet Salut 25 m Tablet -
8
Amlodipin Tablet 5 mg Tablet -
9
Amlodipin Tablet 10 mg Tablet -
10
Amoksisillin Kapsul 250 mg Kapsul -
11
Amoksisillin Kaplet 500 mg Kaplet -
12
Amoksisillin Serbuk Injeksi 1000 mg vial -
13
Amoksisillin Sirup Kering 125 mg/5 Botol -
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml
15 -
Ampisilin Kapsul 250 mg Kapsul -
16
Ampisillin Kaplet 500 mg Tablet -
17
Ampisilin Sirup 125 mg / 5 ml Botol -
18
Ampisillin Injeksi 1000 mg Vial -
19
Analgetik Plus Tablet -
20
Antasida Doen Suspensi Botol
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 -
Antasida Doen Tablet, Kombinasi Tablet
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 -
Antasida Plus Tablet Tablet -
23
Antalgin (Metampiron) Tablet 500 Tablet -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul -
25
Anti Bakteri DOEN Salep Tube
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 -
Anti Hemoroid Doen komb Supp -
27
Anti Fungi DOEN Kombinasi : Pot

Asam Benzoat 6% + Asam Salisilat

28 3% -
 Antimigren DOEN Kombinasi : Tablet

Ergotamin Tartrat 1 mg + Kofein

29 50 mg -
Anti Diare Suspensi Botol -
30
Anti Diare Tablet Tablet -
31
Anti Dotum Oral Tablet Tablet -
32
Anti Hipertensi Kapsul Tablet -
33
Antihistamin Tablet kombinasi Tablet -
34
Antispasmodik Tablet Tablet -
35
Antitusiva Sirup Botol -
36
Antitusiva Tablet Tablet -
37
Asam Folat Tablet 1 mg Tablet -
38
Asam Askorbat 50 mg Tablet -
39
Asam Mefenamat Kapsul 500 mg Kapsul -
40
Asetosal 80 mg Tablet -
41
Asetosal Tablet 100 mg Tablet -
42
Asetosal Tablet 500 mg Tablet -
43
Asiklovir Krim 5 % Tube -
44
Asiklovir Tablet 200 mg Tablet -
45
Asiklovir Tablet 400 mg Tablet -
46
Atropin Sulfat Injeksi 0,25 mg/ml- Ampul -
47
Aqua Pro Injeksi Steril, bebas Piro Vial -
48
Betahistin Mesilat 6 mg Tablet -
49
Betametason Krim 0,1 %- 5g Tube -
50
Bisakodil suppositoria 10 mg Supp -
51
Bisoprolol Tablet 5 mg Tablet -
52
Bromheksin 8 mg Tablet -
53
Deksametason Injeksi 5mg/ml-1ml Ampul -
54
Deksametason Tablet 0,5 mg Tablet -
55
Devitalisasi Pasta (Non Arsen) Botol -
56
Diazepam tablet 2 mg Tablet -
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul -
58
Diazepam Larutan Rektal 5 mg/ml Supp -
59
Dietilkarbamazin Sitrat Tablet 100 Tablet -
60
Difenhidramin HCl Injeksi 10 mg/m Ampul -
61
Digoksin Tablet 0,25 mg Tablet -
62
Dimenhidrinat Tablet 50 mg Tablet -
63
Domperidon Tablet 10 mg Tablet -
64
Donperidon Suspensi 5 mg/5ml Botol -
65
Efedrin Hcl Tablet 25 mg Tablet -
66
Ekstrak Belladone Tablet 10 mg Tablet -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi

68 0,1%/- 1ml -
 Eritromisin Kapsul 250 mg Kapsul -
69
Eritromisin Kapsul 500 mg Kapsul -
70
Eritromisin Sirup 200 mg / 5 ml Botol -
71
Etambutol Tablet 500 mg Tablet -
72
Etanol 70 % 100 ml Botol -
73
Etil Klorida Semprot -100 ml Botol -
74
Eugenol Cairan -10 ml Botol -
75
Fenitoin Natrium Kapsul 100 mg Kapsul -
76
Fenobarbital tablet 30 mg Tablet -
77
Fenobarbital injeksi 50 mg / ml Ampul -
78
Fenoksimeti Penisilin 250 mg table Tablet -
79
Fenoksimeti Penisilin 500 mg tabl Tablet -
80
Fitomenadion tablet 10 mg Tablet -
81
Fitomenadion (Vit K1) Injeksi 2 m Ampul -
82
Furosemid Tablet 40 mg Tablet -
83
Garam Oralit I serbuk, Kantong
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 -
Gemfibrozil Tablet 600 mg Tablet -
85
Gentamisin injeksi 80 mg / 2 ml Vial -
86
Gentamisin Salep Kulit 0,1 % Tube -
87
Glibenklamid Tablet 5 mg Tablet -
88
Glimepiride 2 mg Tablet -
89
Gliseril guayakolat tablet 100 mg Tablet -
90
Gliseril Guayakolat sirup Botol -
91
Glukonas Kalsikus injeksi Ampul -
92
Glukosa Larutan Infus 5 % Botol -
93
Glukosa Larutan Infus10 % Botol -
94
Griseofulvin Tablet 125 mg,microni Tablet -
95
Haloperidol Tablet 0,5 mg Tablet -
96
Haloperidol Tablet 1,5 mg Tablet -
97
Haloperidol Tablet 5 mg Tablet -
98
Hidrokloritiazid 25 mg Tablet -
99
Hidrokortison Krim 2,5 % Tube -
100
Ibuprofen Tablet 200 mg Tablet -
101
Ibuprofen Tablet 400 mg Tablet -
102
Ibuprofen Suspensi 100 mg/5 ml Botol -
103
Ichtyol salep Kulit Pot -
104
Ipatropium Bromide + Salbutamol Vial

Sulphate for inhalation 2,5 ml

105 -
 Isoniazid tablet 100 mg Tablet -
106
Isosorbid Dinitrat 5 mg Tablet -
107
Kalium Diklofenak Tablet 25 mg Tablet -
108
Kalium Diklofenak Tablet 50 mg Tablet -
109
Kalsium Hidroksida Pasta Tube -
110
Kalsium Laktat Tablet 500 mg Tablet -
111
Kaptopril 12,5 mg Tablet -
112
Kaptopril 25 mg Tablet -
113
Karbamazepin Tablet 200 mg Tablet -
114
Ketokonazole Krim 2 % - 15 gr Tube -
115
Ketokonazole Tablet 200 mg Tablet -
116
Ketoprofen Tablet 100 mg Tablet -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul -
118
Ketorolac 10 mg injeksi Ampul -
119
Ketorolac 30 mg injeksi Ampul -
120
Klindamisin Kapsul 150 mg Kapsul -
121
Klindamisin Kapsul 300 mg Kapsul -
122
Kloramfenikol Kapsul 250 mg Kapsul -
123
Kloramfenikol Salep Mata 1%-3,5 g Tube -
124
Kloramfenikol Tetes Mata -5 ml Botol -
125
Kloramfenikol Tetes Telinga 3%-5 Botol -
126
Klorfeniramin Maleat (CTM) Tablet Tablet -
127
Klorpromazin Hcl Tablet Salut 25 Tablet -
128
Klorpromazin Hcl Tablet Salut 100 Tablet -
129
Klorpromazin Hcl Injeksi 5 mg/ml- Ampul -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 -
Kotrimoksazol Tablet, Kombinasi : Tablet

Sulfametoksazol 400 mg +
Trimetroprim 80 mg
132 -
Kotrimoksazol Suspensi Kombinasi Botol
:
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
133 -
Lansoprazole 30 mg Kapsul Tablet -
134
Larutan mengadung Elektrolit (Na Botol
130 mEq,Cl 109 mEq, Asetat 28
mEq) /Asering
135 -
Larutan mengadung Elektrolit Botol
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
136 -
 Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

137 -
Lidokain injeksi 2 % Tablet -
138
Lidokain Komp Injeksi, Ampul
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
139 -
Loperamid Tablet 2 mg Tablet -
140
Loratadin tablet 10 mg Tablet -
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul -
142
Meloksikam tablet 15 mg Tablet -
143
Meloksikam Suppositoria Supp -
144
Metformin Hcl Tablet 500 mg Tablet -
145
Methisoprinol 500 mg Tablet -
146
Metilergometrin Maleat (Metergin) Tablet -
147
Metilergometrin Maleat Injeksi 0, Ampul -
148
Metilprednisolon tablet 4 mg Tablet -
149
Metoklopramid 10 mg Tablet -
150
Metoklorpropamid Injeksi 5 mg/ 5 Ampul -
151
Metronidazol Tablet 250 mg Tablet -
152
Metronidazole Tablet 500 mg Tablet -
153
Metronidazole Infus 500 mg /100 m Ampul -
154
Mikonazole KrIm 2 % - 10 gr Tube -
155
Multivitamin + Mineral tablet Tablet -
156
Multivitamin sirup Botol -
157
Natrium Bikarbonat Tablet 500 mg Tablet -
158
Natrum Diklofenak Tablet 25 mg Tablet -
159
Natrium Diklofenak Tablet 50 mg Tablet -
160
Natrium Klorida Larutan infus 0,9%- Botol -
161
Nipedifin Tablet 10 mg Tablet -
162
Nistatin 100.000 IU/gram Tablet V Tablet -
163
Nistatin 500.000 IU/gram Tablet Sa Tablet -
164
Obat Antitiuberkolosis Kategori A Paket -
165
Obat Antitiuberkolosis Kategori 1 Paket -
166
Obat Antitiuberkolosis Kategori 2 Paket -
167
Obat Antitiuberkolosis Kategori 3 Paket -
168
Obat Anti Tuberkulosis FDC Kat A Paket -
169
Obat Anti Tuberkulosis FDC Kat I & Paket -
170
Obat Anti Tuberkulosis FDC Kat I & Paket -
171
Obat Anti Tuberkolosis FDC Sisipa Paket -
172
Obat Batuk Hitam (OBH) Cairan 10 Botol -
173
 Obat Batuk Cair Sirup (Ekspektoran Botol -
174
Obat Batuk Hitam Plus Sirup Botol -
175
Obat Flu Sirup Botol -
176
Oksiterasiklin Hcl injeksi i.m.50 m Vial -
177
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178
Oksitetrasiklin Hcl Salep Kulit 3%-5 Tube -
179
Oksitosin Injeksi 10 IU/ml-1ml Ampul -
180
Omeprazole injeksi 40mg/10ml Ampul -
181
Omeprazole Kapsul 20 mg Tablet -
182
Ondansetron inj 4 mg/ 2 mL Ampul -
183
Parasetamol drops Botol -
184
Parasetamol Sirup 120 mg/5ml-60 Botol -
185
Parasetamol Tablet 100 mg Tablet -
186
Parasetamol Tablet 500 mg Tablet -
187
Pehacain injeksi Ampul -
188
Perak Sulfadiazin krim 1 % 35 gr Tube -
189
Piracetam 400 mg Tablet -
190
Piracetam Tablet 800 mg Tablet -
191
Piroksikam Tablet 20 mg Tablet -
192
Pirantel Pamoat Tablet 365 mg (Se Tablet -
193
Piridoksin Hcl (Vit.B6) Tablet 10 m Tablet -
194
Polikresulen (Kondensasi Botol
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 -
Povidon Iodida 10% 30 ml Botol -
196
Povidon Iodida 10% 300 ml Botol -
197
Primakuin tablet 15 mg Tablet -
198
Propanolol Hcl Tablet 40 mg Tablet -
199
Propilturasil Tablet 100 mg Tablet -
200
Ranitidin Injeksi 25 mg / ml Ampul -
201
Ranitidin Tablet 150 mg Tablet -
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul -
204
Reserpin Tablet 0, 25 mg Tablet -
205
Rifampisin Tablet 450 mg Tablet -
206
Ringer Laktat Larutan Infus Steril Botol -
207
Salbutamol Tablet 2 mg Tablet -
208
Salbutamol Tablet 4 mg Tablet -
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml

210 -
 Salep 2-4 Kombinasi : Pot

Asam Salisilat 2 % + Belerang

211 Endap 4 % - 30 gram -
Salisil bedak 2% -50 gr Kotak -
212
Salep Luka Bakar Tube -
213
Sefadroksil Sirup Kering 125 mg / Botol -
214
Sefadroksil Tablet 500 mg Tablet -
215
Sefiksim Kapsul 100 mg Kapsul -
216
Sefotaksim Injeksi 1 gr Ampul -
217
Seftriakson Injeksi 1 gr / vial Ampul -
218
Semen Seng Fosfat Serbuk & Caira Botol -
219
Setirizin Tablet 10 mg Tablet -
220
Setirizin Sirup 5 mg / 5 ml Botol -
221
Sianokobalamin Injeksi 500 mcg/m Ampul -
222
Sianokobalamin Tablet 50 mcg Tablet -
223
Silver Amalgam Serbuk 65-75% Botol -
224
Simetidin 200 mg Tablet Tablet -
225
Simvastatin Tablet 10 mg Tablet -
226
Siprofloksasin 500mg Tablet -
227
Spironolakton Tablet 25 mg Tablet -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol -
229
Tablet Tambah Darah Kombinasi: Tablet

Besi II Sulfat 200 mg + Asam Folat

0,25 mg
230 -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 -
Trikesol formalin ( T K F ) Cairan 1 Botol -
232
Tetrasiklin Kapsul 250 mg Kapsul -
233
Tetrasiklin Kapsul 500 mg Kapsul -
234
Thiamin Hcl (Vit B1) Injeksi 100 m Ampul -
235
Tiamin Hcl /Mononitrat (Vit.B1) Ta Tablet -
236
Thiamfenikol Kapsul 500 mg Kapsul -
237
Tramadol Injeksi 50 mg/ ml Ampul -
238
Tramadol Tablet 50 mg Tablet -
239
Triheksifenidil Hidroklorida Tablet Tablet -
240
Vitamin B .Komplek Tablet Tablet -
241
Vitamin Neurotropik Tablet Tablet -
242
Zinc Tablet 20 mg Tablet -
243
Prednisone 54mg Tablet -
244
flunax sy Botol -
245
Set -
246
Set -
247
Tablet -
248
 Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 43 43
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 -
9
Auto Disposable Syringe (ADS) 0,05 set 0 -
10
Auto Disposable Syringe (ADS) 0,5 set 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 -
12
Catgut/Benang Bedah No.2/0-3/0 ( Sachet 3 3
13
Etakridin Larutan (Rivanol) 0,1% - Botol 0 -
14
Etanol 70 % 1.000 ml Botol 0 -
15
Folley Catheter no 14 Set 0 -
16
Folley Catheter no 16 Set 0 -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set 0 -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 -
22
Kapas Berlemak 500 gram Bungkus 0 -
23
Kapas Pembalut / Adsorbens 250 g Bungkus 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 c Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 Rol 0 -
28
Kertas Puyer Pcs 0 -
29
Lysol 1,000 ml Botol 0 -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
36
 Rapid Test Syphilis Pcs 0 -
37
RPR Test Syphilis Pcs 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs 0 -
40
Sarung tangan Steril No 6 Pcs 0 -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs 0 -
44
Sarung tangan Non Steril M Pcs 0 -
45
Sarung tangan Non Steril L Pcs 0 -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set 0 -
48
Anuscopi Yamato Unit 0 -
49
Kaca Slide Box 0 -
50
Reagen Ziehl Nielson Kit 0 -
51
Rotator Unit 0 -
52
RTD Malaria Tes 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
54
Sound Timer Buah 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN OBA
Bulan : Desember Tahun : 2017
JUMLAH PEMAKAIAN JE

4 5 6 7 8 9 10 11 12 13
N PEMAKAIAN OBAT
mber Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
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0 5
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0 7
0 3
0 43
0 3
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0 3
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0 2
0 -
0 7
0 1
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0 1
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0 10
0 1
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0 4
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0
0
0
 jumlah Antispasmodik Tablet
pemaka Sisa 35 30 32
No Nama Obat
ian stok 36
Antitusiva Sirup 0 2
Air Raksa Dental Use Antitusiva Tablet
1 0 0 37 0 10
Albendazole Tablet 400 mg Asam Folat Tablet 1 mg
2 0 100 38 0 0
Alopurinol Tablet 100 mg Asam Askorbat 50 mg
3 20 24 39 20 30
Ambroksol Tablet 30 mg 70 48 Asam Mefenamat Kapsul 500 mg 20 19
4 40
Ambroksol sirup 15 mg/5 ml 8 6 Asetosal 80 mg 0 0
5 41
Aminofillin Injeksi 24 mg/ml-10 ml 0 0 Asetosal Tablet 100 mg 0 0
6 42
Aminofillin Tablet 200 mg 0 20 Asetosal Tablet 500 mg 0 0
7 43
Amitriptillin Hcl Tablet Salut 25 mg 10 40 Asiklovir Krim 5 % 3 2
8 44
Amlodipin Tablet 5 mg 95 52 Asiklovir Tablet 200 mg 0 15
9 45
Amlodipin Tablet 10 mg 0 0 Asiklovir Tablet 400 mg 0 0
10 46
Amoksisillin Kapsul 250 mg 51 49 Atropin Sulfat Injeksi 0,25 mg/ml 0 0
11 47
Amoksisillin Kaplet 500 mg 605 34 Aqua Pro Injeksi Steril, bebas Pir 0 0
12 48
Amoksisillin Serbuk Injeksi 1000 mg Betahistin Mesilat 6 mg
13 0 0 49 16 26
Amoksisillin Sirup Kering 125 mg/5ml 16 7 Betametason Krim 0,1 %- 5g 6 2
14 50
Amoksisillin Double Strengh Sirup Bisakodil suppositoria 10 mg
Kering 250 mg/5 ml
15 5 1 51 0 0
Ampisilin Kapsul 250 mg 10 90 Bisoprolol Tablet 5 mg 0 0
16 52
Ampisillin Kaplet 500 mg 30 12 Bromheksin 8 mg 0 30
17 53
Ampisilin Sirup 125 mg / 5 ml 0 0 Deksametason Injeksi 5mg/ml-1m 0 2
18 54
Ampisillin Injeksi 1000 mg 0 0 Deksametason Tablet 0,5 mg 64 30
19 55
Analgetik Plus Devitalisasi Pasta (Non Arsen)
20 0 40 56 0 0
Antasida Doen Suspensi Kombinasi : Diazepam tablet 2 mg
Magnesium Hidroksida 200 mg+
21 Alumunium Hidroksida 200 mg/5 ml 33 9 57 20 8
Antasida Doen Tablet, Kombinasi : Diazepam Injeksi i.v/i.m 5 mg/ml
Magnesium Hidroksida 200 mg+
22
Alumunium Hidroksida 200 mg
755 66 58 0 0
Antasida Plus Tablet Diazepam Larutan Rektal 5 mg/m
23 0 0 59 0 0
Antalgin (Metampiron) Tablet 500 mg Dietilkarbamazin Sitrat Tablet 1
24 0 40 60 0 0
Antalgin Injeksi 250 mg/ml-2ml Difenhidramin HCl Injeksi 10 mg/
25 0 0 61 0 47
Anti Bakteri DOEN Salep Kombinasi : Digoksin Tablet 0,25 mg
Basitrasin 500 2 1 0 0
26 62
IU/g + Polimiksin 1000 IU/g
Anti Hemoroid Doen komb Dimenhidrinat Tablet 50 mg
27 0 0 63 26 26
Anti Fungi DOEN Kombinasi : Domperidon Tablet 10 mg
Asam
28
Benzoat 6% + Asam Salisilat 3%
1 0 64 0 40
Antimigren DOEN Kombinasi : Donperidon Suspensi 5 mg/5ml
29 Ergotamin Tartrat 0 0 65 0 1
1 mgDiare
Anti + Kofein 50 mg
Suspensi Efedrin Hcl Tablet 25 mg
30 0 0 66 0 60
Anti Diare Tablet Ekstrak Belladone Tablet 10 mg
31 44 31 67 0 282
Anti Dotum Oral Tablet Epinefrin HCl / Bitartrat
32 0 70 68 0 5
Anti Hipertensi Kapsul (Epinefrina
Eritromisin / Adrenalina)
Kapsul 250 mg
33 0 0 69 Injeksi 0,1%/- 1ml 0 0
 Antihistamin Tablet kombinasi Eritromisin Kapsul 500 mg
34 238 17 70 0 0
Eritromisin Sirup 200 mg / 5 ml 0 0 Ketokonazole Tablet 200 mg 6 96
71 116
Etambutol Tablet 500 mg 0 0 Ketoprofen Tablet 100 mg 0 0
72 117
Etanol 70 % 100 ml 0 0 Ketoprofen Injeksi 100 mg / 1 ml 0 0
73 118
Etil Klorida Semprot -100 ml 0 1 Ketorolac 10 mg injeksi 0 0
74 119
Eugenol Cairan -10 ml 0 0 Ketorolac 30 mg injeksi 0 0
75 120
Fenitoin Natrium Kapsul 100 mg 0 100 Klindamisin Kapsul 150 mg 0 0
76 121
Fenobarbital tablet 30 mg 0 0 Klindamisin Kapsul 300 mg 0 0
77 122
Fenobarbital injeksi 50 mg / ml 0 0 Kloramfenikol Kapsul 250 mg 10 84
78 123
Fenoksimeti Penisilin 250 mg tablet 0 100 Kloramfenikol Salep Mata 1%-3,5 0 2
79 124
Fenoksimeti Penisilin 500 mg tablet 0 70 Kloramfenikol Tetes Mata -5 ml 4 1
80 125
Fitomenadion tablet 10 mg 0 35 Kloramfenikol Tetes Telinga 3%-5 2 1
81 126
Fitomenadion (Vit K1) Injeksi 2 mg/ml- 0 3 Klorfeniramin Maleat (CTM) Table 374 73
82 127
Furosemid Tablet 40 mg 0 17 Klorpromazin Hcl Tablet Salut 25 90 10
83 128
Garam Oralit I serbuk, kombinasi : Klorpromazin Hcl Tablet Salut 10
84
( Nacl
23 28 129 25 16
Gemfibrozil
0,52 Tablet
gr, Kalium 600 0,30
Klorida mg gr, 0 0 Klorpromazin Hcl Injeksi 5 mg/ml 0 0
85 130
Trinatrium Sitrat dihidrat 0,58 gr,
Gentamisin injeksi 80 mg / 2 ml Kotrimoksazol Pedriatik Tablet,
86 Glukosa Anhidrat 2,70 g )200 ml Air 0 0 131
Kombinasi :
0 0
87 Gentamisin Salep Kulit 0,1 % 1 4 132 Kotrimoksazol
Sulfametoksazol Tablet,
100 mg Kombinasi
+ 30 78
:Trimetroprim 20 mg
Glibenklamid Tablet 5 mg Kotrimoksazol Suspensi
88 10 30 133 Sulfametoksazol 400 mg +
Kombinasi :
7 4
Glimepiride 2 mg Trimetroprim 30
Lansoprazole 80 mg Kapsul
89 50 40 134 Sulfametoksazol mg 200 mg + 16 34
Trimetroprim 40 mg/5 ml
Gliseril guayakolat tablet 100 mg 192 53 Larutan mengadung Elektrolit 0 0
90 135
(Na 130 mEq,Cl 109 mEq, Asetat
91 Gliseril Guayakolat sirup 25 1 136 Larutan
28 mEq) mengadung
/Asering Elektrolit 0 0
(Nacl 1,125 gr , Dekstrosa 18,75
Glukonas Kalsikus injeksi 0 0 Larutan mengadung Karbohidrat 0 0
92 137 gr)
+ Elektrolit
Glukosa Larutan Infus 5 % 0 1 Lidokain injeksi
(Nacl 1,75 gr,2KCL
% 1,5 gr, Na 2 0
93 138
Glukosa Larutan Infus10 % Lactat 2,24
Lidokain Kompgr, Injeksi,
Dekstrosa 27 gr)
94 0 0 139 0 0
Kombinasi :
Griseofulvin Tablet 125 mg,micronized 20 80 LoperamidLidokain
Tablet 2Hcl
mg2% 0 0
95 140
Haloperidol Tablet 0,5 mg +Epinefrin
Loratadin tablet 10 mg ml
1 : 80.000-2
96 180 40 141 0 40
Haloperidol Tablet 1,5 mg 50 20 Magnesium Sulfat (IV) 20 %-25 ml 0 0
97 142
Haloperidol Tablet 5 mg 0 0 Meloksikam tablet 15 mg 20 32
98 143
Hidrokloritiazid 25 mg 10 39 Meloksikam Suppositoria 0 0
99 144
Hidrokortison Krim 2,5 % 13 1 Metformin Hcl Tablet 500 mg 50 10
100 145
Ibuprofen Tablet 200 mg 20 96 Methisoprinol 500 mg 0 0
101 146
Ibuprofen Tablet 400 mg 130 70 Metilergometrin Maleat (Metergin 0 0
102 147
Ibuprofen Suspensi 100 mg/5 ml 1 4 Metilergometrin Maleat Injeksi 0 0 4
103 148
Ichtyol salep Kulit 0 0 Metilprednisolon tablet 4 mg 0 0
104 149
105 Ipatropium Bromide + Salbutamol 0 0 150 Metoklopramid 10 mg 10 45
Sulphate for
106 Isoniazid
inhalationtablet
2,5 ml100 mg 0 0 151 Metoklorpropamid Injeksi 5 mg/ 0 0
Isosorbid Dinitrat 5 mg 0 0 Metronidazol Tablet 250 mg 0 40
107 152
Kalium Diklofenak Tablet 25 mg 0 0 Metronidazole Tablet 500 mg 30 70
108 153
Kalium Diklofenak Tablet 50 mg 80 31 Metronidazole Infus 500 mg /100 0 0
109 154
Kalsium Hidroksida Pasta 0 0 Mikonazole KrIm 2 % - 10 gr 2 0
110 155
Kalsium Laktat Tablet 500 mg 20 40 Multivitamin + Mineral tablet 36 5
111 156
Kaptopril 12,5 mg 275 43 Multivitamin sirup 9 3
112 157
 Kaptopril 25 mg 0 5 Natrium Bikarbonat Tablet 500 m 0 82
113 158
Karbamazepin Tablet 200 mg 30 10 Natrum Diklofenak Tablet 25 mg 0 0
114 159
Ketokonazole Krim 2 % - 15 gr 2 4 Natrium Diklofenak Tablet 50 mg 67 74
115 160
Natrium Klorida Larutan infus 0,9%-Steril 500 ml Rifampisin Tablet 450 mg 0 0
161 206
Nipedifin Tablet 10 mg 10 23 Ringer Laktat Larutan Infus Steril 0 3
162 207
Nistatin 100.000 IU/gram Tablet Vagina 0 7 Salbutamol Tablet 2 mg 10 3
163 208
Nistatin 500.000 IU/gram Tablet Salut 0 50 Salbutamol Tablet 4 mg 0 0
164 209
165 Obat Antitiuberkolosis Kategori Anak 0 0 210 Salbutamol solution for 0 0
Inhalation single dose units 2,5
166 Obat Antitiuberkolosis Kategori 1 Dewa 0 0 211 Salep
ml 2-4 Kombinasi : 2 2
Obat Antitiuberkolosis Kategori 2 Dewa 0 0 Salisil bedak 2% -50 gr 12 2
167 212 Asam Salisilat 2 % + Belerang
Obat Antitiuberkolosis Kategori 3 Dewa Endap 4 % -Bakar
Salep Luka 30 gram
168 0 0 213 0 0
Obat Anti Tuberkulosis FDC Kat Anak 0 0 Sefadroksil Sirup Kering 125 mg / 0 2
169 214
Obat Anti Tuberkulosis FDC Kat I & II 0 0 Sefadroksil Tablet 500 mg 10 17
170 215
Obat Anti Tuberkulosis FDC Kat I & III 0 0 Sefiksim Kapsul 100 mg 20 0
171 216
Obat Anti Tuberkolosis FDC Sisipan Dew 0 0 Sefotaksim Injeksi 1 gr 0 0
172 217
Obat Batuk Hitam (OBH) Cairan 100 ml 1 3 Seftriakson Injeksi 1 gr / vial 0 0
173 218
Obat Batuk Cair Sirup (Ekspektoran) 10 2 Semen Seng Fosfat Serbuk & Cair 0 0
174 219
Obat Batuk Hitam Plus Sirup 8 2 Setirizin Tablet 10 mg 40 93
175 220
176 Obat Flu Sirup 3 2 221 Setirizin Sirup 5 mg / 5 ml 1 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml 0 0 Sianokobalamin Injeksi 500 mcg/ 0 21
177 222
Oksiterasiklin Salep Mata 1%-3,5g 2 2 Sianokobalamin Tablet 50 mcg 0 10
178 223
Oksitetrasiklin Hcl Salep Kulit 3%-5g 0 2 Silver Amalgam Serbuk 65-75% 0 0
179 224
Oksitosin Injeksi 10 IU/ml-1ml 0 9 Simetidin 200 mg Tablet 31 19
180 225
Omeprazole injeksi 40mg/10ml 0 0 Simvastatin Tablet 10 mg 50 55
181 226
Omeprazole Kapsul 20 mg 1072 28 Siprofloksasin 500mg 30 8
182 227
183 Ondansetron inj 4 mg/ 2 mL 0 0 228 Spironolakton Tablet 25 mg 0 30
184 Parasetamol drops 1 2 229 Sulfacetamid Tetes Mata 15 %-5m 0 0
Parasetamol Sirup 120 mg/5ml-60 ml 52 2 Tablet Tambah Darah 30 50
185 230
Kombinasi:
186 Parasetamol Tablet 100 mg 70 30 231 TemporaryBesi
Stopping Fletcher
II Sulfat 200 mg + 0 0
(Fletcher)
Asam FolatSerbuk
0,25 mg & Cairan
Parasetamol Tablet 500 mg 1516 11 Trikesol formalin ( T K F ) Cairan 0 0
187 232
Pehacain injeksi 0 0 Tetrasiklin Kapsul 250 mg 0 10
188 233
Perak Sulfadiazin krim 1 % 35 gr 0 0 Tetrasiklin Kapsul 500 mg 10 90
189 234
Piracetam 400 mg 0 0 Thiamin Hcl (Vit B1) Injeksi 100 10 90
190 235
Piracetam Tablet 800 mg 0 0 Tiamin Hcl /Mononitrat (Vit.B1) 70 74
191 236
Piroksikam Tablet 20 mg 88 60 Thiamfenikol Kapsul 500 mg 0 80
192 237
Pirantel Pamoat Tablet 365 mg (Setara Tramadol Injeksi 50 mg/ ml
193
dng 125 mg Basa)
0 80 238 0 0
Piridoksin Hcl (Vit.B6) Tablet 10 mg 428 53 Tramadol Tablet 50 mg 0 0
194 239
Polikresulen (Kondensasi Metakresol Triheksifenidil Hidroklorida Table
195 Sulfonat dan
0 0 240 0 2
Povidon
Metanal)Iodida 10% 30 ml
360 mg/g-10 0 2 Vitamin B .Komplek Tablet 380 88
196 241
Povidon Iodida 10% 300 ml 0 1 Vitamin Neurotropik Tablet 286 4
197 242
Primakuin tablet 15 mg 0 0 Zinc Tablet 20 mg 27 61
198 243
Propanolol Hcl Tablet 40 mg 10 30 Prednisone 54mg 50 64
199 244
Propilturasil Tablet 100 mg 0 0 flunax sy 0 0
200 245
Ranitidin Injeksi 25 mg / ml 0 0 spasminal 1 2
201 246
 Ranitidin Tablet 150 mg 40 23
202 247
Retinol (Vit.A) 100.000 IU Kapsul 0 0
203 248
Retinol (Vit.A) 200.000 IU Kapsul 0 186
204 249
Reserpin Tablet 0, 25 mg 0 40
205 250

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES Urine Bag 0 2

no 47
Abbocath No 18 ( IV Chateter 18 ) 0 0 Wing Neddle No 23 0 0
1 48
Abbocath No 20 ( IV Chateter 20 ) 0 5 Anuscopi Yamato 0 0
2 49
Abbocath No 22 ( IV Chateter 22 ) 0 0 Kaca Slide 0 0
3 50
Abbocath No 24 ( IV Chateter 24 ) 0 0 Reagen Ziehl Nielson 0 0
4 51
Alat Suntik Sekali Pakai 10 ml 0 7 Rotator 0 0
5 52
Alat Suntik Sekali Pakai 1 ml 0 3 RTD Malaria 0 0
6 53
Alat Suntik Sekali Pakai 2,5 ml 15 28 Rapid HIV 3 (Oncoprobe HIV) 0 0
7 54
Alat Suntik Sekali Pakai 5 ml 0 3 Sound Timer 0 0
8 55
Alat Suntik Sekali Pakai 10 ml 0 0 SD Syphilis 0 0
9 56
Auto Disposable Syringe (ADS) 0,05 ml 0 0
10
Auto Disposable Syringe (ADS) 0,5 ml 0 0
11
Auto Disposable Syringe (ADS) 5 ml 0 0
12
Catgut/Benang Bedah No.2/0-3/0 (Plain 1 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 m 0 0
14
Etanol 70 % 1.000 ml 0 0
15
Folley Catheter no 14 0 0
16
Folley Catheter no 16 0 0
17
Folley Catheter no 18 0 2 .l,
18
Infus set Anak 0 0
19
Infus set Dewasa 0 7
20
Iodina Test 4 1
21
Kassa Hidrofil Steril 16 x 16 0 0
22
Kapas Berlemak 500 gram 0 0
23
Kapas Pembalut / Adsorbens 250 gram 0 0
24
Kassa Kompres 40 x 40 steril 0 0
25
26 Kassa Pembalut 2 m x 80 cm 0 2
27 Kassa Pembalut Hidrofil 4 m x 3 cm 0 1
28 Kassa Pembalut Hidrofil 4 m x 15 cm 0 0
29 Kertas Puyer 0 0
30 Lysol 1,000 ml 0 0
31 Masker 0 10
32 Plester 5 yard x 2 inchi 0 1
33 Pot Dahak 0 0
34 Rapid HIV 1 (SD HIV) 0 0
Rapid HIV 2 (Intec HIV) 0 0
35
Rapid HIV 2 (Biomeriux HIV) 0 0
36
37 Rapid Test Syphilis 0 0
38 RPR Test Syphilis 0 0
39 Silk( Benang Bedah Sutra ) No 3/0 0 4
40 Safety Box 0 0
41 Sarung tangan Steril No 6 0 0
42 Sarung tangan Steril No 7 0 3
43 Sarung tangan Steril No 7,5 0 7
44 Sarung tangan Non Steril S 0 0
45 Sarung tangan Non Steril M 0 0
46 Sarung tangan Non Steril L 0 0
 jumlah Antispasmodik Tablet
pemaka Sisa 35 42
No Nama Obat
ian stok 36
Antitusiva Sirup 6
Air Raksa Dental Use 0 0 Antitusiva Tablet 0
1 37
Albendazole Tablet 400 mg 0 100 Asam Folat Tablet 1 mg 0
2 38
Alopurinol Tablet 100 mg 177 47 Asam Askorbat 50 mg 68
3 39
Ambroksol Tablet 30 mg 38 10 Asam Mefenamat Kapsul 500 mg 40
4 40
Ambroksol sirup 15 mg/5 ml 3 6 Asetosal 80 mg 0
5 41
Aminofillin Injeksi 24 mg/ml-10 ml 0 0 Asetosal Tablet 100 mg 0
6 42
Aminofillin Tablet 200 mg 0 20 Asetosal Tablet 500 mg 0
7 43
Amitriptillin Hcl Tablet Salut 25 mg 0 40 Asiklovir Krim 5 % 2
8 44
Amlodipin Tablet 5 mg 170 82 Asiklovir Tablet 200 mg 0
9 45
Amlodipin Tablet 10 mg 0 0 Asiklovir Tablet 400 mg 0
10 46
Amoksisillin Kapsul 250 mg 20 29 Atropin Sulfat Injeksi 0,25 mg/ml 0
11 47
Amoksisillin Kaplet 500 mg 300 34 Aqua Pro Injeksi Steril, bebas Pir 0
12 48
Amoksisillin Serbuk Injeksi 1000 mg 0 0 Betahistin Mesilat 6 mg 16
13 49
Amoksisillin Sirup Kering 125 mg/5ml 26 1 Betametason Krim 0,1 %- 5g 7
14 50
Amoksisillin Double Strengh Sirup Kering 250 mg/5 ml Bisakodil suppositoria 10 mg
15 10 1 51 0
Ampisilin Kapsul 250 mg 20 70 Bisoprolol Tablet 5 mg 0
16 52
Ampisillin Kaplet 500 mg 50 62 Bromheksin 8 mg 0
17 53
Ampisilin Sirup 125 mg / 5 ml 0 0 Deksametason Injeksi 5mg/ml-1m 0
18 54
Ampisillin Injeksi 1000 mg 0 0 Deksametason Tablet 0,5 mg 78
19 55
Analgetik Plus 0 40 Devitalisasi Pasta (Non Arsen) 0
20 56
Antasida Doen Suspensi Kombinasi : Magnesium Diazepam tablet 2 mg
Hidroksida 200 mg+ Alumunium Hidroksida 200 mg/5 ml

21 17 2 57 64
Antasida Doen Tablet, Kombinasi : Magnesium Diazepam Injeksi i.v/i.m 5 mg/ml
Hidroksida 200 mg+ Alumunium Hidroksida 200 mg
22 1036 30 58 0
Antasida Plus Tablet 10 40 Diazepam Larutan Rektal 5 mg/m 0
23 59
Antalgin (Metampiron) Tablet 500 mg 0 40 Dietilkarbamazin Sitrat Tablet 1 0
24 60
Antalgin Injeksi 250 mg/ml-2ml 0 0 Difenhidramin HCl Injeksi 10 mg/ 0
25 61
Anti Bakteri DOEN Salep Kombinasi : Digoksin Tablet 0,25 mg
Basitrasin 500 IU/g + Polimiksin 1000 IU/g
26 0 4 62 0
Anti Hemoroid Doen komb 0 0 Dimenhidrinat Tablet 50 mg 60
27 63
Anti Fungi DOEN Kombinasi : Domperidon Tablet 10 mg
Asam Benzoat 6% + Asam Salisilat 3%
28 1 2 64 12
Antimigren DOEN Kombinasi : Donperidon Suspensi 5 mg/5ml
Ergotamin Tartrat 1 mg + Kofein 50 mg
29 0 0 65 0
Anti Diare Suspensi 1 2 Efedrin Hcl Tablet 25 mg 60
30 66
Anti Diare Tablet 41 20 Ekstrak Belladone Tablet 10 mg 0
31 67
Anti Dotum Oral Tablet Epinefrin HCl / Bitartrat

(Epinefrina / Adrenalina)
32 0 70 68 Injeksi 0,1%/- 1ml 0
Anti Hipertensi Kapsul 0 0 Eritromisin Kapsul 250 mg 0
33 69
Antihistamin Tablet kombinasi 179 38 Eritromisin Kapsul 500 mg 0
34 70

Page 443
 Eritromisin Sirup 200 mg / 5 ml 0 0 Ketokonazole Tablet 200 mg 10
71 116
Etambutol Tablet 500 mg 0 0 Ketoprofen Tablet 100 mg 0
72 117
Etanol 70 % 100 ml 0 0 Ketoprofen Injeksi 100 mg / 1 ml 0
73 118
Etil Klorida Semprot -100 ml 0 1 Ketorolac 10 mg injeksi 0
74 119
Eugenol Cairan -10 ml 0 0 Ketorolac 30 mg injeksi 0
75 120
Fenitoin Natrium Kapsul 100 mg 0 100 Klindamisin Kapsul 150 mg 0
76 121
Fenobarbital tablet 30 mg 0 0 Klindamisin Kapsul 300 mg 0
77 122
Fenobarbital injeksi 50 mg / ml 0 0 Kloramfenikol Kapsul 250 mg 0
78 123
Fenoksimeti Penisilin 250 mg tablet 0 100 Kloramfenikol Salep Mata 1%-3,5 7
79 124
Fenoksimeti Penisilin 500 mg tablet 0 70 Kloramfenikol Tetes Mata -5 ml 7
80 125
Fitomenadion tablet 10 mg 0 35 Kloramfenikol Tetes Telinga 3%-5 2
81 126
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml 0 3 Klorfeniramin Maleat (CTM) Table 322
82 127
Furosemid Tablet 40 mg 0 17 Klorpromazin Hcl Tablet Salut 25 120
83 128
Garam Oralit I serbuk, kombinasi : Klorpromazin Hcl Tablet Salut 10
( Nacl 0,52 gr, Kalium Klorida 0,30 gr,
Trinatrium Sitrat dihidrat 0,58 gr, Glukosa Anhidrat 2,70
g )200 ml Air
84 40 8 129 75
Gemfibrozil Tablet 600 mg 0 0 Klorpromazin Hcl Injeksi 5 mg/ml 0
85 130
Gentamisin injeksi 80 mg / 2 ml Kotrimoksazol Pedriatik Tablet,
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
86 0 0 131 8
Gentamisin Salep Kulit 0,1 % Kotrimoksazol Tablet, Kombinasi
:
Sulfametoksazol 400 mg +
Trimetroprim 80 mg
87 1 3 132 50
Glibenklamid Tablet 5 mg Kotrimoksazol Suspensi
Kombinasi :
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
88 130 0 133 10
Glimepiride 2 mg 0 40 Lansoprazole 30 mg Kapsul 0
89 134
Gliseril guayakolat tablet 100 mg Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat
28 mEq) /Asering

90 136 17 135 0
Gliseril Guayakolat sirup Larutan mengadung Elektrolit
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
91 0 1 136 0
Glukonas Kalsikus injeksi Larutan mengadung Karbohidrat
+ Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

92 0 0 137 0
Glukosa Larutan Infus 5 % 0 1 Lidokain injeksi 2 % 0
93 138
Glukosa Larutan Infus10 % Lidokain Komp Injeksi,
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
94 0 0 139 0

Page 444
 Griseofulvin Tablet 125 mg,micronized 10 70 Loperamid Tablet 2 mg 0
95 140
Haloperidol Tablet 0,5 mg 240 0 Loratadin tablet 10 mg 0
96 141
Haloperidol Tablet 1,5 mg 60 60 Magnesium Sulfat (IV) 20 %-25 ml 0
97 142
Haloperidol Tablet 5 mg 10 40 Meloksikam tablet 15 mg 74
98 143
Hidrokloritiazid 25 mg 0 39 Meloksikam Suppositoria 0
99 144
Hidrokortison Krim 2,5 % 6 5 Metformin Hcl Tablet 500 mg 150
100 145
Ibuprofen Tablet 200 mg 20 76 Methisoprinol 500 mg 0
101 146
Ibuprofen Tablet 400 mg 206 14 Metilergometrin Maleat (Metergin 10
102 147
Ibuprofen Suspensi 100 mg/5 ml 1 3 Metilergometrin Maleat Injeksi 0 0
103 148
Ichtyol salep Kulit 0 0 Metilprednisolon tablet 4 mg 22
104 149
Ipatropium Bromide + Salbutamol Metoklopramid 10 mg
Sulphate for inhalation 2,5 ml
105 0 0 150 8
Isoniazid tablet 100 mg 0 0 Metoklorpropamid Injeksi 5 mg/ 0
106 151
Isosorbid Dinitrat 5 mg 0 0 Metronidazol Tablet 250 mg 0
107 152
Kalium Diklofenak Tablet 25 mg 0 0 Metronidazole Tablet 500 mg 30
108 153
Kalium Diklofenak Tablet 50 mg 339 42 Metronidazole Infus 500 mg /100 0
109 154
Kalsium Hidroksida Pasta 0 0 Mikonazole KrIm 2 % - 10 gr 3
110 155
Kalsium Laktat Tablet 500 mg 94 46 Multivitamin + Mineral tablet 40
111 156
Kaptopril 12,5 mg 541 102 Multivitamin sirup 12
112 157
Kaptopril 25 mg 70 35 Natrium Bikarbonat Tablet 500 m 10
113 158
Karbamazepin Tablet 200 mg 45 5 Natrum Diklofenak Tablet 25 mg 0
114 159
Ketokonazole Krim 2 % - 15 gr 2 2 Natrium Diklofenak Tablet 50 mg 168
115 160
Natrium Klorida Larutan infus 0,9%-Steril 500 ml 0 0 Rifampisin Tablet 450 mg 0
161 206
Nipedifin Tablet 10 mg 0 23 Ringer Laktat Larutan Infus Steril 0
162 207
Nistatin 100.000 IU/gram Tablet Vagina 0 7 Salbutamol Tablet 2 mg 60
163 208
Nistatin 500.000 IU/gram Tablet Salut 0 50 Salbutamol Tablet 4 mg 40
164 209
Obat Antitiuberkolosis Kategori Anak Salbutamol solution for
Inhalation single dose units 2,5
ml
165 0 0 210 0
Obat Antitiuberkolosis Kategori 1 Dewasa Salep 2-4 Kombinasi :

Asam Salisilat 2 % + Belerang

166 0 0 211 Endap 4 % - 30 gram 25
Obat Antitiuberkolosis Kategori 2 Dewasa 0 0 Salisil bedak 2% -50 gr 10
167 212
Obat Antitiuberkolosis Kategori 3 Dewasa 0 0 Salep Luka Bakar 0
168 213
Obat Anti Tuberkulosis FDC Kat Anak 0 0 Sefadroksil Sirup Kering 125 mg / 2
169 214
Obat Anti Tuberkulosis FDC Kat I & II 0 0 Sefadroksil Tablet 500 mg 0
170 215
Obat Anti Tuberkulosis FDC Kat I & III 0 0 Sefiksim Kapsul 100 mg 20
171 216
Obat Anti Tuberkolosis FDC Sisipan Dewasa 0 0 Sefotaksim Injeksi 1 gr 0
172 217
Obat Batuk Hitam (OBH) Cairan 100 ml 11 2 Seftriakson Injeksi 1 gr / vial 0
173 218
Obat Batuk Cair Sirup (Ekspektoran) 25 2 Semen Seng Fosfat Serbuk & Cair 0
174 219
Obat Batuk Hitam Plus Sirup 8 1 Setirizin Tablet 10 mg 100
175 220
Obat Flu Sirup 15 2 Setirizin Sirup 5 mg / 5 ml 2
176 221
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml 0 0 Sianokobalamin Injeksi 500 mcg/ 2
177 222
Oksiterasiklin Salep Mata 1%-3,5g 2 0 Sianokobalamin Tablet 50 mcg 0
178 223

Page 445
 Oksitetrasiklin Hcl Salep Kulit 3%-5g 0 2 Silver Amalgam Serbuk 65-75% 0
179 224
Oksitosin Injeksi 10 IU/ml-1ml 0 9 Simetidin 200 mg Tablet 62
180 225
Omeprazole injeksi 40mg/10ml 0 0 Simvastatin Tablet 10 mg 30
181 226
Omeprazole Kapsul 20 mg 30 28 Siprofloksasin 500mg 50
182 227
Ondansetron inj 4 mg/ 2 mL 0 0 Spironolakton Tablet 25 mg 20
183 228
Parasetamol drops 1 3 Sulfacetamid Tetes Mata 15 %-5m 1
184 229
Parasetamol Sirup 120 mg/5ml-60 ml Tablet Tambah Darah
Kombinasi:
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
185 22 2 230 150
Parasetamol Tablet 100 mg Temporary Stopping Fletcher
(Fletcher) Serbuk & Cairan

186 0 30 231 0
Parasetamol Tablet 500 mg 1654 57 Trikesol formalin ( T K F ) Cairan 0
187 232
Pehacain injeksi 0 0 Tetrasiklin Kapsul 250 mg 0
188 233
Perak Sulfadiazin krim 1 % 35 gr 0 0 Tetrasiklin Kapsul 500 mg 0
189 234
Piracetam 400 mg 0 0 Thiamin Hcl (Vit B1) Injeksi 100 40
190 235
Piracetam Tablet 800 mg 0 0 Tiamin Hcl /Mononitrat (Vit.B1) 460
191 236
Piroksikam Tablet 20 mg 65 25 Thiamfenikol Kapsul 500 mg 0
192 237
Pirantel Pamoat Tablet 365 mg (Setara dng 125 mg Basa) Tramadol Injeksi 50 mg/ ml
193 0 80 238 0
Piridoksin Hcl (Vit.B6) Tablet 10 mg 556 17 Tramadol Tablet 50 mg 0
194 239
Polikresulen (Kondensasi Metakresol Triheksifenidil Hidroklorida Table
Sulfonat dan Metanal) 360 mg/g-10 ml
195 0 0 240 40
Povidon Iodida 10% 30 ml 0 2 Vitamin B .Komplek Tablet 819
196 241
Povidon Iodida 10% 300 ml 0 1 Vitamin Neurotropik Tablet 376
197 242
Primakuin tablet 15 mg 0 0 Zinc Tablet 20 mg 10
198 243
Propanolol Hcl Tablet 40 mg 0 30 Prednisone 54mg 50
199 244
Propilturasil Tablet 100 mg 0 0 flunax sy 0
200 245
Ranitidin Injeksi 25 mg / ml 0 0 vit k 10
201 246
Ranitidin Tablet 150 mg 128 95 gentian violet 2
202 247
Retinol (Vit.A) 100.000 IU Kapsul 0 0 kloramfenikol 500 10
203 248
Retinol (Vit.A) 200.000 IU Kapsul 0 186
204 249
Reserpin Tablet 0, 25 mg 0 40
205 250

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES Urine Bag 0

no 47
Abbocath No 18 ( IV Chateter 18 ) 0 0 Wing Neddle No 23 0
1 48
Abbocath No 20 ( IV Chateter 20 ) 0 10 Anuscopi Yamato 0
2 49
Abbocath No 22 ( IV Chateter 22 ) 0 0 Kaca Slide 0
3 50
Abbocath No 24 ( IV Chateter 24 ) 0 0 Reagen Ziehl Nielson 0
4 51
Alat Suntik Sekali Pakai 10 ml 0 7 Rotator 0
5 52
Alat Suntik Sekali Pakai 1 ml 0 3 RTD Malaria 0
6 53
Alat Suntik Sekali Pakai 2,5 ml 9 19 Rapid HIV 3 (Oncoprobe HIV) 0
7 54
Alat Suntik Sekali Pakai 5 ml 0 3 Sound Timer 0
8 55
Alat Suntik Sekali Pakai 10 ml 0 0 SD Syphilis 0
9 56

Page 446
 Auto Disposable Syringe (ADS) 0,05 ml 0 0
10
Auto Disposable Syringe (ADS) 0,5 ml 0 0
11
Auto Disposable Syringe (ADS) 5 ml 0 0
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic) 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml 0 0
14
Etanol 70 % 1.000 ml 0 0
15
Folley Catheter no 14 0 0
16
Folley Catheter no 16 0 0
17
Folley Catheter no 18 0 2
18
Infus set Anak 0 0
19
Infus set Dewasa 0 7
20
Iodina Test 0 1
21
Kassa Hidrofil Steril 16 x 16 4 1
22
Kapas Berlemak 500 gram 0 0
23
Kapas Pembalut / Adsorbens 250 gram 0 0
24
Kassa Kompres 40 x 40 steril 0 0
25
Kassa Pembalut 2 m x 80 cm 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm 0 0
28
Kertas Puyer 0 0
29
Lysol 1,000 ml 0 0
30
Masker 0 10
31
Plester 5 yard x 2 inchi 0 1
32
Pot Dahak 0 0
33
Rapid HIV 1 (SD HIV) 0 0
34
Rapid HIV 2 (Intec HIV) 0 0
35
Rapid HIV 2 (Biomeriux HIV) 0 0
36
Rapid Test Syphilis 0 0
37
RPR Test Syphilis 0 0
38
Silk( Benang Bedah Sutra ) No 3/0 0 4
39
Safety Box 0 0
40
Sarung tangan Steril No 6 0 0
41
Sarung tangan Steril No 7 0 3
42
Sarung tangan Steril No 7,5 0 7
43
Sarung tangan Non Steril S 0 0
44
Sarung tangan Non Steril M 0 0
45
Sarung tangan Non Steril L 0 0
46

Page 447
 90
1
10
0
62
9
0
0
0
3
15
0
0
0
40
1

0
0
30
2
52
0

44

0
0
0
47

0
16

128

1
0
282

5
0
0

Page 448
86
0
0
0
0
0
0
84
1
0
1
51
10

41
0

12

58

1
34

0
0

Page 449
 0
40
0
18
0
60
0
10
4
8

37
0
40
40
0
2
0
1
72
0
6
0
3
13
10

2
2
0
0
17
10
0
0
0
43
1
19
10

Page 450
 0
7
25
58
10
1

50

0
0
10
90
50
14
80

0
0

12
69
-2
51
14
0
22
8
90

2
0
0
0
0
0
0
0
0
0

Page 451
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 0
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 24 200 224
3 100
Ambroksol Tablet 30 mg Tablet 48 - 48
4
Ambroksol sirup 15 mg/5 ml Botol 6 3 9
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 40 - 40
8
Amlodipin Tablet 5 mg Tablet 52 200 252
9 5
Amlodipin Tablet 10 mg Tablet - - -
10
Amoksisillin Kapsul 250 mg Kapsul 49 - 49
11 10
Amoksisillin Kaplet 500 mg Kaplet 34 300 334
12
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 7 20 27
14 1
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 1 10
15 11
Ampisilin Kapsul 250 mg Kapsul 90 - 90
16
Ampisillin Kaplet 500 mg Tablet 12 100 112
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus Tablet 40 - 40
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 9 10 19
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 66 1,000 60
22 1,066
Antasida Plus Tablet/TRIANTA Tablet - 50 50
23
Antalgin (Metampiron) Tablet 500 mg Tablet 40 - 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g 1 3
26 4
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam - 3
28 Salisilat 3% 3
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol - 3 3
30
Anti Diare Tablet/New Diaform Tablet 31 30 61
31
Anti Dotum Oral Tablet Tablet 70 - 70
32
 Anti Hipertensi Kapsul Tablet - - -
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 17 200 217
34
Antispasmodik Tablet/SCOPMA Tablet 32 100 132
35
Antitusiva Sirup/DEXTROFEN SY Botol 2 5 7
36
Antitusiva Tablet Tablet 10 - 10
37
Asam Folat Tablet 1 mg Tablet - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 30 100 130
39
Asam Mefenamat Kapsul 500 mg Kapsul 19 30 49
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 2 3 5
44
Asiklovir Tablet 200 mg Tablet 15 - 15
45
Asiklovir Tablet 400 mg Tablet - - -
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet 26 30 56
49
Betametason Krim 0,1 %- 5g Tube 2 6 8
50 1
Bisakodil suppositoria 10 mg Supp - - -
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 30 100 130
55 10
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 8 100 108
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 47 - 47
61
Digoksin Tablet 0,25 mg Tablet - - -
62
Dimenhidrinat Tablet 50 mg Tablet 26 50 76
63
Domperidon Tablet 10 mg Tablet 40 100 140
64
Donperidon Suspensi 5 mg/5ml Botol 1 - 1
65
Efedrin Hcl Tablet 25 mg Tablet 60 - 60
66
Ekstrak Belladone Tablet 10 mg Tablet 282 282
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol 0 - -
71
Etambutol Tablet 500 mg Tablet 0 - -
72
Etanol 70 % 100 ml Botol 0 - -
73
 Etil Klorida Semprot -100 ml Botol 1 - 1
74
Eugenol Cairan -10 ml Botol 0 - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 - 100
76
Fenobarbital tablet 30 mg Tablet 0 - -
77
Fenobarbital injeksi 50 mg / ml Ampul 0 - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 35 - 35
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul 3 - 3
82
Furosemid Tablet 40 mg Tablet 17 - 17
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat 20
0,58 gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 28 48
Gemfibrozil Tablet 600 mg Tablet 0 - -
85
Gentamisin injeksi 80 mg / 2 ml Vial 0 - -
86
Gentamisin Salep Kulit 0,1 % Tube 4 4
87
Glibenklamid Tablet 5 mg Tablet 30 100 130
88
Glimepiride 2 mg Tablet 40 - 40
89
Gliseril guayakolat tablet 100 mg Tablet 53 100 153
90 30
Gliseril Guayakolat sirup Botol 1 - 1
91
Glukonas Kalsikus injeksi Ampul 0 - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol 0 - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 80 - 80
95
Haloperidol Tablet 0,5 mg Tablet 40 200 240
96
Haloperidol Tablet 1,5 mg Tablet 20 100 120
97 10
Haloperidol Tablet 5 mg Tablet 0 50 50
98
Hidrokloritiazid 25 mg Tablet 39 - 39
99
Hidrokortison Krim 2,5 % Tube 1 10 11
100 1
Ibuprofen Tablet 200 mg Tablet 96 - 96
101
Ibuprofen Tablet 400 mg Tablet 70 150 220
102
Ibuprofen Suspensi 100 mg/5 ml Botol 4 - 4
103
Ichtyol salep Kulit Pot 0 - -
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 -
105 ml 0 -
Isoniazid tablet 100 mg Tablet 0 - -
106
Isosorbid Dinitrat 5 mg Tablet 0 - -
107
Kalium Diklofenak Tablet 25 mg Tablet 0 - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 31 350 381
109 5
Kalsium Hidroksida Pasta Tube 0 - -
110
Kalsium Laktat Tablet 500 mg Tablet 40 100 140
111
Kaptopril 12,5 mg Tablet 43 600 643
112
Kaptopril 25 mg Tablet 5 100 105
113
 Karbamazepin Tablet 200 mg Tablet 10 40 50
114
Ketokonazole Krim 2 % - 15 gr Tube 4 - 4
115 1
Ketokonazole Tablet 200 mg Tablet 96 - 96
116
Ketoprofen Tablet 100 mg Tablet 0 - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 - -
118
Ketorolac 10 mg injeksi Ampul 0 - -
119
Ketorolac 30 mg injeksi Ampul 0 - -
120
Klindamisin Kapsul 150 mg Kapsul 0 - -
121
Klindamisin Kapsul 300 mg Kapsul 0 - -
122
Kloramfenikol Kapsul 250 mg Kapsul 84 - 84
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 2 6 8
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol 1 6 7
125 2
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 2 3
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 73 300 373
127 16
Klorpromazin Hcl Tablet Salut 25 mg Tablet 10 120 130
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 16 100 116
129 5
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg 20
131 0 20
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg 30
132 78 108
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 7
133 4 11
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering
-
135 0 -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 0 -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5
gr, Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 0 -
Lidokain injeksi 2 % Tablet 0 - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin
1 : 80.000-2 ml -
139 0 -
Loperamid Tablet 2 mg Tablet 0 - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 - -
142
Meloksikam tablet 15 mg Tablet 32 60 92
143
Meloksikam Suppositoria Supp 0 - -
144
Metformin Hcl Tablet 500 mg Tablet 10 200 210
145
 Methisoprinol 500 mg Tablet 0 - -
146
Metilergometrin Maleat (Metergin) Tablet 0,1 Tablet 0 20 20
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 0 30 30
149
Metoklopramid 10 mg/xilastin Tablet 45 - 45
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 - -
151
Metronidazol Tablet 250 mg Tablet 40 - 40
152
Metronidazole Tablet 500 mg Tablet 70 - 70
153
Metronidazole Infus 500 mg /100 ml Ampul 0 - -
154
Mikonazole KrIm 2 % - 10 gr Tube 0 5 5
155
Multivitamin + Mineral tablet/HEMAFORT Tablet 5 35 40
156
Multivitamin sirup/RECOVIT Botol 3 10 13
157
Natrium Bikarbonat Tablet 500 mg Tablet 82 - 82
158
Natrum Diklofenak Tablet 25 mg Tablet 0 - -
159
Natrium Diklofenak Tablet 50 mg Tablet 74 100 174
160 10
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161
Nipedifin Tablet 10 mg Tablet - 23
162 23
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 7
163 7
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 0
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 0 -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 0 -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 0 -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 0 -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 0 -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 0
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 0
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 10 13
173 3
Obat Batuk Cair Sirup (Ekspektoran)/COREDRY Botol 25 27
174 2
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 7 9
175 2
Obat Flu Sirup/ FLUTOP-C Botol 15 17
176 2 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube - 2
178 2
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 0
Omeprazole Kapsul 20 mg Tablet 30 58
182 28
Ondansetron inj 4 mg/ 2 mL Ampul 0 0 -
183
Parasetamol drops Botol 2 2 4
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 2 22 24
185
Parasetamol Tablet 100 mg Tablet 30 0 30
186
Parasetamol Tablet 500 mg Tablet 11 1700 1,711 68
187
Pehacain injeksi Ampul 0 0 -
188
 Perak Sulfadiazin krim 1 % 35 gr Tube 0 0 -
189
Piracetam 400 mg Tablet 0 0 -
190
Piracetam Tablet 800 mg Tablet 0 0 -
191
Piroksikam Tablet 20 mg Tablet 60 30 90
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 53 520 573 20
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml 0 0 -
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet 0 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 30 0 30
199
Propilturasil Tablet 100 mg Tablet 0 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 0 -
201
Ranitidin Tablet 150 mg Tablet 23 200 223
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet 0 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet 3 70 73 20
208
Salbutamol Tablet 4 mg Tablet 0 50 50
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 0 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 2 25 27
Salisil bedak 2% -50 gr Kotak 2 10 12 1
212
Salep Luka Bakar Tube 0 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 2 0 2
214
Sefadroksil Tablet 500 mg Tablet 17 0 17
215
Sefiksim Kapsul 100 mg Kapsul 0 30 30
216
Sefotaksim Injeksi 1 gr Ampul 0 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol 0 0 -
219
Setirizin Tablet 10 mg Tablet 93 50 143 10
220
Setirizin Sirup 5 mg / 5 ml Botol 1 2 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B1 Ampul 21 0 21
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol 0 0 -
224
Simetidin 200 mg Tablet Tablet 19 50 69
225
Simvastatin Tablet 10 mg Tablet 55 0 55
226
Siprofloksasin 500mg Tablet 8 100 108
227
Spironolakton Tablet 25 mg Tablet 30 0 30
228
 Sulfacetamid Tetes Mata 15 %-5ml Botol 0 2 2
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 50 150 200
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 0 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 0 10
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul 90 0 90
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 74 400 474
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul 0 0 -
238
Tramadol Tablet 50 mg Tablet 0 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 2 50 52 20
240
Vitamin B .Komplek Tablet Tablet 88 800 888 15
241
Vitamin Neurotropik Tablet Tablet 4 370 374 45
242
Zinc Tablet 20 mg Tablet 61 0 61
243
Prednisone 5 mg Tablet 64 0 64
244
flunax sy Botol 0 0 -
245
vit k Set 2 30 32
246
Gentian Violet Botol 6 4 10
247
Kloramfenikol 500 Tablet 100 0 100
248
Tablet 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 5 5 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 0 7
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 28 0 28
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cro Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
14
 Etanol 70 % 1.000 ml Botol 0 0 -
15
Folley Catheter no 14 Set 0 0 -
16
Folley Catheter no 16 Set 0 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set 0 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 0 5 5
22
Kapas Berlemak 500 gram Bungkus 0 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 0 -
28
Kertas Puyer Pcs 0 0 -
29
Lysol 1,000 ml Botol 0 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs 0 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
36
Rapid Test Syphilis Pcs 0 0 -
37
RPR Test Syphilis Pcs 0 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs 0 0 -
40
Sarung tangan Steril No 6 Pcs 0 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs 0 0 -
44
Sarung tangan Non Steril M Pcs 0 0 -
45
Sarung tangan Non Steril L Pcs 0 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set 0 0 -
48
Anuscopi Yamato Unit 0 0 -
49
Kaca Slide Box 0 0 -
50
Reagen Ziehl Nielson Kit 0 0 -
51
Rotator Unit 0 0 -
52
RTD Malaria Tes 0 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
54
Sound Timer Buah 0 0 -
55
SD Syphilis Pcs 0 0 -
56
 CATATAN HARIAN PEMAKAIAN O
Bulan : April Tahun : 2017
JUMLAH PEMA

3 4 5 6 7 8 9 10 11 12 13

17
10
1 1

10 5 30 10 30 10 10

10
30 10 20 10 30 40

1 10 1 1 1 1

1 2 2
20
10 40

1 1 1 1 4

60 30 10 10 10 10 30 30 66 20

10 5 10
 20 23 13 10 20
10 10 8
1 1 1

10 10
10 10

2 2 1

16 16

10
12
 6 6

1
20

3 6 3 3 8 20 13

10 20 20 20 20 20
10 10 10 20

20 10 10 10 20
1

10 10 10 10 10 10 20 18

10 8 20
10 10 40 40 20 20 10
10
 10
1
10

1 2
1 1
20 13 20 3 11 13 10 8 4

10 10 5 5 5 10 5 10

20

1 1 2 1

20
 10

1
10 10 10
2 1 2 2 1 1

10

1 2 1 1
1 1
1 1 1
2 2 1 1 1 1

10 10

2 1 1 1 3 2 2

40 70 50 70 36 40 48 40 90 70
20 10

30 20 6 10 40

30 10 20

10 10
10

2 1 1 4 3 2
1 1 1 1 1

10 10

10 10 10
1 1

10 12

20
20
 30 10

10 10
20 10 20

10
23 40 30 10 60 18 10 10
26 10 10 20 10 10 32
10
10 10 10 10

10
1

2
1
PEMAKAIAN OBAT
Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

10 30 20
10 10
1

10 20 20 10

30 20 50 10

1 2 1

1 1 1

1 1 1 1 3

50 100 50 20 350 30 10

10

1
8
 3 20 20 20
8
2 1

20 10 8 10
10 10

1 1

30

60

10 20 20
 5 17 6

110

13 13 10

10
40 40 10 10 20

1 1 1
10 10
10 76 10

10 10 178

10 10
10 30 20 291 10
10 20 10
20

1 1
1

38 18 13 53 10 10
30 10 10 20
10

10 10

1 1 1 1

20 44 10

10 120
 10

2
10
1
10

138 10

1 1 1 1 2
20 1 1
2
2 1 1

1 1

10

1
1 1 2 1 1

83 125 100 33 396 60 65

10 10

70 30 10 230 30

10 20

10
20 10

1 3 7 1
2

10 10 10

1 1

10 10 10
10 20
10 10
 1

30

20 10 360 10

10
18 30 20 3 396 10 6
20 20 40 6 107 10

10

5
3
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
177 47
8 38 10
3 6
0 -
0 20
0 40
170 82
0 -
20 29
20 20 10 300 34
0 -
1 2 1 2 26 1

1 1 10 1
20 70
50 62
0 -
0 -
0 40

2 17 2

20 30 10 10 20
1036 30
10 40
0 40
0 -

0 4
0 -

1 1 2

0 -
1 2
8 41 20
0 70
 0 -
20 10 179 38
6 42 90
6 1
0 10
0 -
68 62
40 9
0 -
0 -
0 -
2 3
0 15
0 -
0 -
0 -
8 8 16 40
7 1
0 -
0 -
0 30
0 2
6 78 52
0 -
64 44
0 -
0 -
0 -
0 47
0 -
60 16
12 128
0 1
60 -
0 282

0 5
0 -
0 -
0 -
0 -
0 -
 0 1
0 -
0 100
0 -
0 -
0 100
0 70
0 35
0 3
0 17

40 8
0 -
0 -
1 3
130 -
0 40
4 10 136 17
0 1
0 -
0 1
0 -
10 70
10 240 -
60 60
10 10 40
0 39
1 6 5
20 76
20 10 10 206 14
1 3
0 -

0 -
0 -
0 -
0 -
10 8 20 339 42
0 -
10 8 18 94 46
10 10 10 541 102
20 70 35
 5 10 45 5
2 2
10 86
0 -
0 -
0 -
0 -
0 -
0 -
0 84
3 2 7 1
1 7 -
2 1
10 10 14 18 10 322 51
20 20 10 120 10
75 41
0 -

8 12

10 50 58

1 10 1
0 34

0 -

0 -

0 -
0 -

0 -
0 -
0 40
0 -
74 18
0 -
150 60
 0 -
10 10
0 4
2 10 22 8
5 8 37
0 -
0 40
10 20 30 40
0 -
3 2
40 -
1 1 12 1
10 72
0 -
168 6
0 -
0 23
0 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
11 2
1 25 2
1 2 8 1
1 1 15 2
0 -
2 -
0 2
0 9
0 -
30 28
0 -
1 3
1 1 1 1 22 2
0 30
20 60 40 30 20 1654 57
0 -
 0 -
0 -
0 -
10 5 65 25
0 80
10 20 10 20 556 17

0 -
0 2
0 1
0 -
0 30
0 -
0 -
8 30 128 95
0 -
0 186
0 40
0 -
0 3
10 60 13
40 10

0 -

25 2
2 10 2
0 -
2 -
0 17
20 10
0 -
0 -
0 -
30 100 43
2 1
2 19
0 10
0 -
10 62 7
30 25
10 50 58
20 10
 1 1

60 10 10 150 50

0 -
0 -
0 10
0 90
10 10 40 50
10 460 14
0 80
0 -
0 -
40 12
30 36 34 10 10 819 69
10 376 (2)
10 51
50 14
0 -
10 22
2 8
10 10 90
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
0 7
0 3
1 1 9 19
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
4 1
0 -
0 -
0 -
0 2
0 1
0 -
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
4
2
9
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 0
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 47 100 147
3
Ambroksol Tablet 30 mg Tablet 10 100 110
4
Ambroksol sirup 15 mg/5 ml Botol 6 3 9
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 40 - 40
8 10
Amlodipin Tablet 5 mg Tablet 82 - 82
9
Amlodipin Tablet 10 mg Tablet - - -
10
Amoksisillin Kapsul 250 mg Kapsul 29 100 129
11
Amoksisillin Kaplet 500 mg Kaplet 34 700 734
12 20
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 1 15 16
14 1
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 1 25
15 26
Ampisilin Kapsul 250 mg Kapsul 70 - 70
16
Ampisillin Kaplet 500 mg Tablet 62 - 62
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet 40 160 200
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 2 5 7 1
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 30 700 55
22 730
Antasida Plus Tablet/TRIANTA Tablet 40 100 140
23
Antalgin (Metampiron) Tablet 500 mg Tablet 40 - 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g 4 -
26 4
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam 2 5
28 Salisilat 3% 7
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol 2 3 5
30
Anti Diare Tablet/New Diaform Tablet 20 100 120
31 10
Anti Dotum Oral Tablet Tablet 70 100 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet - 60 60
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 38 200 238
34
Antispasmodik Tablet/SCOPMA Tablet 90 - 90
35
Antitusiva Sirup/DEXTROFEN SY Botol 1 5 6
36
Antitusiva Tablet Tablet 10 - 10
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 500 562
39 10
Asam Mefenamat Kapsul 500 mg Kapsul 9 - 9
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 3 3 6
44
Asiklovir Tablet 200 mg Tablet 15 100 115
45
Asiklovir Tablet 400 mg Tablet - - -
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet 40 30 70
49
Betametason Krim 0,1 %- 5g Tube 1 5 6
50
Bisakodil suppositoria 10 mg Supp - - -
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 52 200 252
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 44 - 44
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 47 - 47
61
Digoksin Tablet 0,25 mg Tablet - - -
62
Dimenhidrinat Tablet 50 mg Tablet 16 100 116
63 10
Domperidon Tablet 10 mg Tablet 128 - 128
64
Donperidon Suspensi 5 mg/5ml Botol 1 3 4
65
Efedrin Hcl Tablet 25 mg Tablet - 60 60
66
Ekstrak Belladone Tablet 10 mg Tablet 282 - 282
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol 0 - -
71
Etambutol Tablet 500 mg Tablet 0 - -
72
Etanol 70 % 100 ml Botol 0 - -
73
 Etil Klorida Semprot -100 ml Botol 1 - 1
74
Eugenol Cairan -10 ml Botol 0 - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 - 100
76
Fenobarbital tablet 30 mg Tablet 0 - -
77
Fenobarbital injeksi 50 mg / ml Ampul 0 - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 35 100 135
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul 3 - 3
82
Furosemid Tablet 40 mg Tablet 17 - 17
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat 50
0,58 gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 8 58
Gemfibrozil Tablet 600 mg Tablet 0 - -
85
Gentamisin injeksi 80 mg / 2 ml Vial 0 - -
86
Gentamisin Salep Kulit 0,1 % Tube 3 5 8
87
Glibenklamid Tablet 5 mg Tablet 0 - -
88
Glimepiride 2 mg Tablet 40 30 70
89
Gliseril guayakolat tablet 100 mg Tablet 17 100 117
90
Gliseril Guayakolat sirup Botol 1 - 1
91
Glukonas Kalsikus injeksi Ampul 0 - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol 0 - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 70 - 70
95
Haloperidol Tablet 0,5 mg Tablet 0 100 100
96
Haloperidol Tablet 1,5 mg Tablet 60 - 60
97
Haloperidol Tablet 5 mg Tablet 40 100 140
98 30
Hidrokloritiazid 25 mg Tablet 39 - 39
99
Hidrokortison Krim 2,5 % Tube 5 10 15
100
Ibuprofen Tablet 200 mg Tablet 76 - 76
101
Ibuprofen Tablet 400 mg Tablet 14 200 214
102 10
Ibuprofen Suspensi 100 mg/5 ml Botol 3 3 6
103
Ichtyol salep Kulit Pot 0 - -
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 -
105 ml 0 -
Isoniazid tablet 100 mg Tablet 0 - -
106
Isosorbid Dinitrat 5 mg Tablet 0 - -
107
Kalium Diklofenak Tablet 25 mg Tablet 0 - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 42 100 142
109
Kalsium Hidroksida Pasta Tube 0 - -
110
Kalsium Laktat Tablet 500 mg Tablet 46 - 46
111
Kaptopril 12,5 mg Tablet 102 200 302
112 30
Kaptopril 25 mg Tablet 35 100 135
113
 Karbamazepin Tablet 200 mg Tablet 5 100 105
114
Ketokonazole Krim 2 % - 15 gr Tube 2 3 5
115
Ketokonazole Tablet 200 mg Tablet 86 - 86
116
Ketoprofen Tablet 100 mg Tablet 0 - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 - -
118
Ketorolac 10 mg injeksi Ampul 0 - -
119
Ketorolac 30 mg injeksi Ampul 0 - -
120
Klindamisin Kapsul 150 mg Kapsul 0 - 40
121
Klindamisin Kapsul 300 mg Kapsul 0 - -
122
Kloramfenikol Kapsul 250 mg Kapsul 84 - 84
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 1 7 8
124 2
Kloramfenikol Tetes Mata -5 ml/RECO Botol 0 - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 3 4
126 1
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 51 600 651
127 10
Klorpromazin Hcl Tablet Salut 25 mg Tablet 10 100 110
128 40
Klorpromazin Hcl Tablet Salut 100 mg Tablet 41 100 141
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg -
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg -
132 58 58 5
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 10
133 1 11
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering
-
135 0 -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 0 -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5
gr, Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 0 -
Lidokain injeksi 2 % Tablet 0 2 2
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin
1 : 80.000-2 ml
139 0 -
Loperamid Tablet 2 mg Tablet 0 - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 - -
142
Meloksikam tablet 15 mg Tablet 18 50 68
143
Meloksikam Suppositoria Supp 0 - -
144
Metformin Hcl Tablet 500 mg Tablet 60 - 60
145 10
 Methisoprinol 500 mg Tablet 0 - -
146
Metilergometrin Maleat (Metergin) Tablet 0,1 Tablet 10 - 10
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 8 6 14
149
Metoklopramid 10 mg/xilastin Tablet 37 100 137
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 - -
151
Metronidazol Tablet 250 mg Tablet 40 - 40
152
Metronidazole Tablet 500 mg Tablet 40 - 40
153
Metronidazole Infus 500 mg /100 ml Ampul 0 10 10
154
Mikonazole KrIm 2 % - 10 gr Tube 2 3 5
155
Multivitamin + Mineral tablet/HEMAFORT Tablet 0 - -
156
Multivitamin sirup/RECOVIT Botol 1 3 4
157
Natrium Bikarbonat Tablet 500 mg Tablet 72 100 172
158
Natrum Diklofenak Tablet 25 mg Tablet 0 - -
159
Natrium Diklofenak Tablet 50 mg Tablet 6 100 106
160
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161 0
Nipedifin Tablet 10 mg Tablet 100 123
162 23
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 7
163 7
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 0
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 0 -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 0 -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 0 -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 0 -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 0 -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 0
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 0
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 20 22
173 2 1
Obat Batuk Cair Sirup (Ekspektoran)/COREDRY Botol 7 9
174 2
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 12 13
175 1
Obat Flu Sirup/ FLUTOP-C Botol 12 14
176 2 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube 2 2
178 0
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 0
Omeprazole Kapsul 20 mg Tablet 0 28
182 28
Ondansetron inj 4 mg/ 2 mL Ampul 0 0 -
183
Parasetamol drops Botol 3 0 3
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 2 20 22
185
Parasetamol Tablet 100 mg Tablet 30 0 30
186
Parasetamol Tablet 500 mg Tablet 57 1600 1,657 80
187
Pehacain injeksi Ampul 0 0 -
188
 Perak Sulfadiazin krim 1 % 35 gr Tube 0 0 -
189
Piracetam 400 mg Tablet 0 0 -
190
Piracetam Tablet 800 mg Tablet 0 0 -
191
Piroksikam Tablet 20 mg Tablet 25 100 125
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 17 300 317
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml 0 0 -
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet 0 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 30 0 30
199
Propilturasil Tablet 100 mg Tablet 0 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 0 -
201
Ranitidin Tablet 150 mg Tablet 95 0 95
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet 0 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet 13 100 113
208
Salbutamol Tablet 4 mg Tablet 10 30 40
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 0 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 2 2 4
Salisil bedak 2% -50 gr Kotak 2 10 12 1
212
Salep Luka Bakar/neocenta Tube 0 2 2
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 0 2 2
214
Sefadroksil Tablet 500 mg Tablet 17 100 117
215
Sefiksim Kapsul 100 mg Kapsul 10 50 60
216
Sefotaksim Injeksi 1 gr Ampul 0 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol 0 0 -
219
Setirizin Tablet 10 mg Tablet 43 100 143 10
220
Setirizin Sirup 5 mg / 5 ml Botol 1 0 1
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B1 Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol 0 0 -
224
Simetidin 200 mg Tablet Tablet 7 100 107
225
Simvastatin Tablet 10 mg Tablet 25 0 25
226
Siprofloksasin 500mg Tablet 58 0 58
227
Spironolakton Tablet 25 mg Tablet 10 10 20
228
 Sulfacetamid Tetes Mata 15 %-5ml Botol 1 1 2
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 50 210 260
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 0 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 0 10
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul 50 0 50
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 14 300 314
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul 0 0 -
238
Tramadol Tablet 50 mg Tablet 0 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 12 100 112 10
240
Vitamin B .Komplek Tablet Tablet 69 230 299 40
241
Vitamin Neurotropik Tablet Tablet -2 80 78
242
Zinc Tablet 20 mg Tablet 51 0 51
243
Prednisone 5 mg Tablet 14 100 114
244
flunax sy Botol 0 0 -
245
vit k Set 22 0 22
246
Gentian Violet Botol 8 0 8
247
Kloramfenikol 500 Tablet 90 0 90
248
Teramysin salep mata tube 0 1 1
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 7 10 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 19 0 19
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cro Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
14
 Etanol 70 % 1.000 ml Botol 0 0 -
15
Folley Catheter no 14 Set 0 0 -
16
Folley Catheter no 16 Set 0 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set 0 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 1 1 2
22
Kapas Berlemak 500 gram Bungkus 0 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 5 5
28
Kertas Puyer Pcs 0 0 -
29
Lysol 1,000 ml Botol 0 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs 0 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
36
Rapid Test Syphilis Pcs 0 0 -
37
RPR Test Syphilis Pcs 0 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs 0 0 -
40
Sarung tangan Steril No 6 Pcs 0 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs 0 0 -
44
Sarung tangan Non Steril M Pcs 0 0 -
45
Sarung tangan Non Steril L Pcs 0 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set 0 0 -
48
Anuscopi Yamato Unit 0 0 -
49
Kaca Slide Box 0 0 -
50
Reagen Ziehl Nielson Kit 0 0 -
51
Rotator Unit 0 0 -
52
RTD Malaria Tes 0 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
54
Sound Timer Buah 0 0 -
55
SD Syphilis Pcs 0 -
56
 CATATAN HARIAN PEMAKAIAN O
Bulan : Mei Tahun : 2017
JUMLAH PEMA

3 4 5 6 7 8 9 10 11 12 13

10
10 2 10 10
1

10 10 5

10 20
20 10 40 10 40 20 40 60

1 2

10 1 1

30 30 40 20 40 10 70 10 10

20 10

1
10 15 10 10
10
10 10
8 10 10
1 1

10 10 20
10 10

30 6 10

10 6 10 20 60

15
10 10

10

6 11

1 1

10 10 10 30 10

10

5 5 15 10 5

2 1 1
10
10 30 10 20 10
1

20 10 10 10

20 30 20 10 10 20 30 10
 10 10

10

1
24 19 10 15 20 41 40 60
10 20 30

10

1
 5

10
1
10 10
1

10 10 10

1 2 2 1 2
1 1 1 2 1
1 1 1 1
1 1 1

1 1 1 1

60 83 60 56 40 105 110 100 110

20 10 10 20 35 10 10

10 20 20

10

1 1 1 2

10

10 10

10
 1 1

20 40 10

10 10 10 30 20 30

10 10
20 10 10 46 20 20 10 30
5 10 20 10 20
10
3 10 10

1
 PEMAKAIAN OBAT
Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

10 10
1 1

10 10

10 10
50 30 60 10 10 10

2 1 1 1

10

10

40 30 20 30 10

10 10

10
 10 10

20 10

1
10

1 1 1

18 20 5 10 20

1
10 10

1 1

5 5

20

1 2
10
20

10 10 20 20

10
20 10 10
10 10 10 10 20
 10
1

1
10 25 20 5 20

5 10 5

2 1 1

10
 10

10
10 10

10 10
2

10 6 6

10 10

1 1 1 1
1
1
1 2 1 1 1

1 1 1 1 6

110 90 20 10 60 20 70 20
 10

40 20 10 20

10 10

10 10
5

1
1 1

10

10

10
20
 10 10 40 70 10

10 30 10 20 36

10
10 5 10 10 10 10
10

10 20

1 1

4 1 2 1 2
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
20 10 20 30 90 57
10 10 10 20 102 8
1 4 5
0 -
0 20
10 30
10 10 65 17
0 -
50 79
10 20 20 10 20 70 580 154
0 -
2 1 12 4

3 2 1 20 6
0 70
10 52
0 -
0 -
200 -

1 3 4

30 20 40 10
545 185
40 90 50
40 -
0 -

1 4 -
0 -

1 6

0 -
1 4
65 55
0 170
 30 30
10 10 40 198
6 34 56
4 2
10 -
0 -
6 500 62
9 -
0 -
0 -
0 -
2 4
10 105
0 -
0 -
0 -
8 54 16
1 4 2
0 -
0 -
0 30
0 2
8 8 195 57
0 -
15 29
0 -
0 -
0 -
1 46
0 -
30 86
0 128
0 4
60 -
282 -

0 5
0 -
0 -
0 -
0 -
0 -
 1 -
0 -
0 100
0 -
0 -
0 100
0 70
40 95
0 3
10 7

5 6 28 30
0 -
0 -
4 4
0 -
20 10 20 50 20
10 90 27
1 -
0 -
0 1
0 -
10 60
20 80
0 60
20 20 15 130 10
0 39
2 3 12 3
20 56
10 120 94
1 5
0 -

0 -
0 -
0 -
0 -
110 32
0 -
10 20 26
10 26 10 266 36
10 10 10 10 30 130 5
 10 40 65
1 1 3 2
8 18 68
0 -
0 -
0 -
0 -
0 40
0 -
0 84
1 6 2
0 -
3 1
20 10 20 42 24 75 510 141
100 10
20 15 10 65 76
0 -

0 12

15 43

1 6 5
0 34

0 -

0 -

0 -
2 -

0 -
0 -
0 40
0 -
10 58
0 -
10 20 40
 0 -
10 -
0 4
4 6 8
8 10 43 94
0 -
0 40
10 10 30
10 -
1 2 3
10 20 0 -
1 4 -
0 172
0 -
10 10 72 34
0 -
20 103
0 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
1 2 2 1 19 3
1 8 1
1 1 1 8 5
1 1 1 13 1
0 -
1 1
0 2
0 9
0 -
0 28
0 -
3 -
3 1 1 1 20 2
30 -
50 60 40 40 50 100 1544 113
0 -
 0 -
0 -
0 -
10 10 30 95
0 80
10 10 60 10 10 305 12

0 -
0 2
0 1
0 -
0 30
0 -
0 -
8 78 17
0 -
0 186
0 40
0 -
0 3
8 10 10 58 55
10 15 25

0 -

1 1 3
1 1 9 3
2 -
2 -
10 20 97
10 10 50
0 -
0 -
0 -
10 30 113
0 1
0 19
0 10
0 -
30 77
0 25
10 30 28
20 -
 2 -

20 30 260 -

0 -
0 -
0 10
0 90
0 50
20 10 10 256 58
0 80
0 -
0 -
10 10 60 52
10 8 10 10 299 -
78 -
10 41
18 10 15 96 18
0 -
0 22
1 4 4
0 90
1 1 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
0 17
0 3
1 1 13 6
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
1 1
0 -
0 -
0 -
0 2
0 1
5 -
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
3
2
9
REKAPITULASI PENGELUARAN HARIAN APOTEK (Berdasarkan Jenis Pasien)
UPTD PUSKESMAS CIBEUREUM
BULAN : MARET 2017

1 2 3 4
No. Nama Obat Satuan
Umum JKN Umum JKN Umum JKN Umum JKN

A. O B A T
1 Air Raksa Dental Use Botol
2 Albendazole Tablet 400 mg Tablet
3 Alopurinol Tablet 100 mg Tablet 10 50 10
4 Alopurinol Tablet 300 mg Tablet
5 Alprazolam tablet 1 mg Tablet
6 Ambroksol Tablet 30 mg Tablet 10 10 20 5 10 10
7 Ambroksol sirup 15 mg/5 ml Botol 1 3 4 3 1
8 Aminofillin Injeksi 24 mg/ml-10 ml Ampul
9 Aminofillin Tablet 200 mg Tablet
10 Amitriptillin Hcl Tablet Salut 25 mg Tablet
11 Amlodipin Tablet 5 mg Tablet 15 20 10
12 Amlodipin Tablet 10 mg Tablet 10 5
13 Amoksisillin Kapsul 250 mg Kapsul 20 10 10
14 Amoksisillin Kaplet 500 mg Kaplet 40 20 70 10 50 30 60 10
15 Amoksisillin Serbuk Injeksi 1000 mg vial
16 Amoksisillin Sirup Kering 125 mg/5ml Botol 3 5 5 2 2

Amoksisillin Double Strengh Sirup Kering 250 mg/5

17 Botol 1 1 1
ml

18 Ampisilin Kapsul 250 mg Kapsul

19 Ampisillin Kaplet 500 mg Tablet
20 Ampisilin Sirup 125 mg / 5 ml Botol
21 Ampisillin Injeksi 1000 mg Vial
22 Analgetik Plus Tablet 10

Antasida Doen Suspensi Kombinasi : Magnesium

23 Hidroksida 200 mg+ Alumunium Hidroksida 200 Botol 1 1 1 1
mg/5 ml

Antasida Doen Tablet, Kombinasi : Magnesium

24 Tablet 60 20 60 40 90 30 30 30
Hidroksida 200 mg+ Alumunium Hidroksida 200 mg

25 Antasida Plus Tablet Tablet 10 10

26 Antalgin (Metampiron) Tablet 500 mg Tablet
27 Antalgin Injeksi 250 mg/ml-2ml Ampul
Anti Bakteri DOEN Salep Kombinasi :
28 Basitrasin 500 IU/g + Polimiksin 1000 Tube
IU/g
29 Anti Hemoroid Doen komb Supp 3 17

Anti Fungi DOEN Kombinasi :

30 Pot 1 1
Asam Benzoat 6% + Asam Salisilat 3%

Antimigren DOEN Kombinasi :

31 Tablet
Ergotamin Tartrat 1 mg + Kofein 50 mg

32 Anti Diare Suspensi Botol

33 Anti Diare Tablet Tablet
34 Anti Dotum Oral Tablet Tablet
35 Anti Hipertensi Kapsul Tablet
36 Antihistamin Tablet kombinasi Tablet 10
37 Antispasmodik Tablet Tablet
38 Antitusiva Sirup Botol
39 Antitusiva Tablet Tablet
40 Asam Folat Tablet 1 mg Tablet
41 Asam Askorbat (Vit. C) Tablet 50 mg Tablet 45 20 10 19 68 3
42 Asam Mefenamat Kapsul 500 mg Kapsul 5
43 Asetosal Tablet 80 mg Tablet
44 Asetosal Tablet 100 mg Tablet
45 Asetosal Tablet 500 mg Tablet
46 Asiklovir Krim 5 % Tube 1 2
47 Asiklovir Tablet 200 mg Tablet
48 Asiklovir Tablet 400 mg Tablet
49 Attapulgit Tablet 10 10
50 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul
51 Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial
52 Bahan Tambal Sementara Set
53 Betahistin Mesilat 6 mg Tablet
54 Betametason Krim 0,1 %- 5g Tube 5 5 1
55 Bisakodil suppositoria 10 mg Supp
56 Bisoprolol Tablet 5 mg Tablet
57 Bromheksin 8 mg Tablet
58 Deksametason Injeksi 5mg/ml-1ml Ampul
59 Deksametason Tablet 0,5 mg Tablet 90 20 64 50 82 5 25 28
60 Devitalisasi Pasta (Non Arsen) Botol
61 Diazepam tablet 2 mg Tablet
62 Diazepam tablet 5 mg Tablet
63 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul
64 Diazepam Larutan Rektal 5 mg/ml Supp
65 Diazepam Larutan Rektal 10 mg/ml Supp
66 Dietilkarbamazin Sitrat Tablet 100 mg Tablet
67 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul
68 Digoksin Tablet 0,25 mg Tablet
69 Dimenhidrinat Tablet 50 mg Tablet 6
70 Domperidon Tablet 10 mg Tablet 10 10
71 Domperidon Suspensi 5 mg/5ml Botol 1
72 Efedrin Hcl Tablet 25 mg Tablet 46
73 Ekstrak Belladone Tablet 10 mg Tablet
Epinefrin HCl / Bitartrat
74 (Epinefrina / Adrenalina) Injeksi Ampul
0,1%/- 1ml
75 Eritromisin Kapsul 250 mg Kapsul
76 Eritromisin Kapsul 500 mg Kapsul
77 Eritromisin Sirup 200 mg / 5 ml Botol
78 Etambutol Tablet 500 mg Tablet
79 Etanol 70 % 100 ml Botol
80 Etil Klorida Semprot -100 ml Botol
81 Eugenol Cairan -10 ml Botol
82 Fenitoin Natrium Kapsul 100 mg Kapsul
83 Fenobarbital tablet 30 mg Tablet
84 Fenobarbital injeksi 50 mg / ml Ampul
85 Fenoksimeti Penisilin 250 mg tablet Tablet
86 Fenoksimeti Penisilin 500 mg tablet Tablet
87 Fenol Gliserol TK Botol
88 Fitomenadion tablet 10 mg Tablet
89 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul
90 Furosemid Tablet 40 mg Tablet
91 Furosemid injeksi Ampul

Garam Oralit I serbuk, kombinasi :

( Nacl 0,52 gr, Kalium Klorida 0,30
92 Kantong 12 6
gr, Trinatrium Sitrat dihidrat 0,58 gr, Glukosa
Anhidrat 2,70 g )200 ml Air

93 Gemfibrozil Tablet 600 mg Tablet

94 Gentian Violet Botol 2
95 Gentamisin injeksi 80 mg / 2 ml Vial
96 Gentamisin Salep Kulit 0,1 % Tube 2 8 1
97 Glass Ionomer Set
98 Glibenklamid Tablet 5 mg Tablet 20 10
99 Glimepiride 2 mg Tablet 30
100 Gliseril Guayakolat Tablet 100 mg Tablet 27 13 52 5 9
101 Gliseril Guayakolat sirup Botol 4
102 Glukonas Kalsikus injeksi Ampul
103 Glukosa Larutan Infus 5 % Botol
104 Glukosa Larutan Infus10 % Botol
105 Griseofulvin Tablet 125 mg,micronized Tablet 10
106 Haloperidol Tablet 0,5 mg Tablet
107 Haloperidol Tablet 1,5 mg Tablet 13
108 Haloperidol Tablet 5 mg Tablet
109 Hidroklortiazid (HCT) Tablet 25 mg Tablet
110 Hidrokortison Krim 2,5 % Tube 3 1 1 1
111 Ibuprofen Tablet 200 mg Tablet
112 Ibuprofen Tablet 400 mg Tablet 20 10 40 30 20 10
113 Ibuprofen Suspensi 100 mg/5 ml Botol
114 Ichtyol salep Kulit Pot
115 Isoniazid tablet 100 mg Tablet
116 Isosorbid Dinitrat 5 mg Tablet
117 Kalium Diklofenak Tablet 25 mg Tablet
118 Kalium Diklofenak Tablet 50 mg Tablet
119 Kalsium Hidroksida Pasta Tube
120 Kalsium Laktat Tablet 500 mg Tablet 10 7 20 10
121 Kaptopril 12,5 mg Tablet
122 Kaptopril 25 mg Tablet
123 Karbamazepin Tablet 200 mg Tablet
124 Ketokonazole Krim 2 % - 15 gr Tube 1
125 Ketokonazole Tablet 200 mg Tablet
126 Ketoprofen Tablet 100 mg Tablet
127 Ketoprofen Injeksi 100 mg / 1 ml Ampul
128 Ketorolac 10 mg injeksi Ampul
129 Ketorolac 30 mg injeksi Ampul
130 Klindamisin Kapsul 150 mg Kapsul
131 Klindamisin Kapsul 300 mg Kapsul
132 Kloramfenikol Kapsul 250 mg Kapsul 10
133 Kloramfenikol suspensi125mg/5 ml Botol
134 Kloramfenikol Salep Mata 1%-3,5 g Tube 1 1
135 Kloramfenikol Salep Kulit 2% Tube
136 Kloramfenikol Tetes Mata -5 ml Botol 1 1
137 Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 1
138 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 115 45 79 46 111 23 96 33
139 Klorpromazin Hcl Tablet Salut 25 mg Tablet
140 Klorpromazin Hcl Tablet Salut 100 mg Tablet 13
141 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul
Kombinasi Ipatropium Bromide + Salbutamol
142 Sulphate for inhalation 2,5 Vial
ml
143 Kombipak Cefixime+ Azithromisin Kotak

Kotrimoksazol Pedriatik Tablet, Kombinasi :

144 Tablet
Sulfametoksazol 100 mg + Trimetroprim 20 mg

Kotrimoksazol Tablet, Kombinasi :

145 Tablet 10 10
Sulfametoksazol 400 mg + Trimetroprim 80 mg

Kotrimoksazol Suspensi Kombinasi :

146 Sulfametoksazol 200 mg + Trimetroprim 40 Botol 1 1 1 1
mg/5 ml

147 Lansoprazole 30 mg Kapsul Tablet

Larutan mengadung Elektrolit

148 (Na 130 mEq,Cl 109 mEq, Asetat Botol
28 mEq) /Asering

Larutan mengadung Elektrolit

149 Botol
(Nacl 1,125 gr , Dekstrosa 18,75 gr)

Larutan mengadung Karbohidrat + Elektrolit

150 (Nacl 1,75 gr, KCL 1,5 gr, Na Botol
Lactat 2,24 gr, Dekstrosa 27 gr)

151 Lidokain injeksi 2 % Tablet

Lidokain Komp Injeksi, Kombinasi :
152 Lidokain Hcl 2% +Epinefrin 1 : 80.000- Ampul
2 ml
153 Loperamid Tablet 2 mg Tablet
154 Loratadin tablet 10 mg Tablet
155 Magnesium Sulfat (IV) 20 %-25 ml Ampul
156 Magnesium Sulfat (IV) 40 %-25 ml Ampul
157 Meloksikam tablet 15 mg Tablet 16 10 20
158 Meloksikam Suppositoria Supp
159 Metformin Hcl Tablet 500 mg Tablet
160 Methisoprinol 500 mg Tablet

Metilergometrin Maleat (Metergin) Tablet 0,125

161 Tablet
mg

162 Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul

163 Metilprednisolon tablet 4 mg Tablet
164 Metoklopramid 10 mg Tablet
165 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul
166 Metronidazol Tablet 250 mg Tablet
167 Metronidazole Tablet 500 mg Tablet 10
168 Metronidazole sirup 125 mg/ml Botol 1
169 Metronidazole Infus 500 mg /100 ml Ampul
170 Mikonazole KrIm 2 % - 10 gr Tube 1
171 Multivitamin + Mineral tablet Tablet 10 10
172 Multivitamin sirup Botol 1
173 Mummifying Pasta Botol
174 Natrium Bikarbonat Tablet 500 mg Tablet
175 Natrum Diklofenak Tablet 25 mg Tablet
176 Natrium Diklofenak Tablet 50 mg Tablet 10 20 20

177 Natrium Klorida Larutan infus 0,9%-Steril 500 ml Botol

178 Nipedifin Tablet 10 mg Tablet

179 Nistatin 100.000 IU/gram Tablet Vagina Tablet
180 Nistatin 500.000 IU/gram Tablet Salut Tablet
181 Obat Antitiuberkolosis Kategori Anak Paket
182 Obat Antitiuberkolosis Kategori 1 Dewasa Paket
183 Obat Antitiuberkolosis Kategori 2 Dewasa Paket
184 Obat Antitiuberkolosis Kategori 3 Dewasa Paket
185 Obat Anti Tuberkulosis FDC Kat Anak Paket
186 Obat Anti Tuberkulosis FDC Kat I & II Paket
187 Obat Anti Tuberkulosis FDC Kat I & III Paket
188 Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket
189 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 1 3 8 2 2 1
190 Obat Batuk Cair Sirup (Ekspektoran) Botol 1
191 Obat Batuk Hitam Plus Sirup Botol 1 2
192 Obat Flu Sirup Botol 2 3 3 4
193 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial
194 Oksiterasiklin Salep Mata 1%-3,5g Tube
195 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube
196 Oksitosin Injeksi 10 IU/ml-1ml Ampul
197 Omeprazole injeksi 40mg/10ml Ampul
198 Omeprazole Kapsul 20 mg Tablet 6 6 6
199 Ondansetron inj 4 mg/ 2 mL Ampul
 Parasetamol drop 100 mg/ml btl @15ml
200 Botol
(60mg/0,6ml)

201 Parasetamol Sirup 120 mg/5ml-60 ml Botol 3 1 5 4 1

202 Parasetamol Tablet 100 mg Tablet
203 Parasetamol Tablet 500 mg Tablet 141 58 92 70 148 30 132 45
204 Pehacain injeksi Ampul
205 Perak Sulfadiazin krim 1 % 35 gr Tube
206 Permetrin krim 5 % Tube 1 1
207 Piracetam 400 mg Tablet
208 Piracetam Tablet 800 mg Tablet
209 Piroksikam Tablet 20 mg Tablet 10

Pirantel Pamoat Tablet 365 mg (Setara dng 125 mg

210 Tablet
Basa)

211 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 20 3 5 32 20 10

Polikresulen (Kondensasi Metakresol

212 Botol
Sulfonat dan Metanal) 360 mg/g-10 ml

213 Povidon Iodida 10% 30 ml Botol

214 Povidon Iodida 10% 60 ml Botol
215 Povidon Iodida 10% 300 ml Botol
216 Prednison Tablet 5 mg Tablet 60 10 10
217 Primakuin tablet 15 mg Tablet
218 Prokain Benzil Penisilin Injeksi 3,000,000 IU Vial
219 Propanolol Hcl Tablet 40 mg Tablet
220 Propilturasil Tablet 100 mg Tablet
221 Ranitidin Injeksi 25 mg / ml Ampul
222 Ranitidin Tablet 150 mg Tablet 10 20 10
223 Retinol (Vit. A) 100.000 IU Kapsul Kapsul
224 Retinol (Vit. A) 200.000 IU Kapsul Kapsul
225 Reserpin Tablet 0, 25 mg Tablet
226 Rifampisin Tablet 450 mg Tablet
227 Ringer Laktat Larutan Infus Steril 500 ml Botol
228 Salbutamol Tablet 2 mg Tablet 10 10 10
229 Salbutamol Tablet 4 mg Tablet

Salbutamol solution for Inhalation single dose units

230 Ampul
2,5 ml

Salep 2-4 Kombinasi :

231 Asam Salisilat 2 % + Belerang Pot
Endap 4 % - 30 gram

232 Salisil bedak 2% -50 gr Kotak 1 3 1

233 Salep Luka Bakar Tube
234 Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol
235 Sefadroksil Tablet 500 mg Tablet 30 6
236 Sefiksim Kapsul 100 mg Kapsul
237 Sefotaksim Injeksi 1 gr Ampul
238 Seftriakson Injeksi 1 gr / vial Ampul
239 Semen Seng Fosfat Serbuk & Cairan Botol
240 Setirizin Tablet 10 mg Tablet 10 10 10 6
241 Setirizin Sirup 5 mg / 5 ml Botol
242 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul
243 Sianokobalamin Tablet 50 mcg Tablet
244 Silver Amalgam Serbuk 65-75% Botol
245 Simetidin 200 mg Tablet Tablet 10 10
246 Simvastatin Tablet 10 mg Tablet 12 5
247 Siprofloksasin 500mg Tablet 10
248 Spironolakton Tablet 25 mg Tablet
249 Sulfacetamid Tetes Mata 15 %-5ml Botol
Tablet Tambah Darah Kombinasi:
250 Besi II Sulfat 200 mg + Asam Folat 0,25 Tablet
mg
Temporary Stopping Fletcher (Fletcher) Serbuk &
251 Set
Cairan

252 Trikesol formalin ( T K F ) Cairan 10 ml Botol

253 Tetrasiklin Kapsul 250 mg Kapsul
254 Tetrasiklin Kapsul 500 mg Kapsul
255 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul
256 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 30 20 30 10 10 20
257 Thiamfenikol Kapsul 500 mg Kapsul
258 Tramadol Injeksi 50 mg/ ml Ampul
259 Tramadol Tablet 50 mg Tablet
260 Triheksifenidil Hidroklorida Tablet 2 mg Tablet
261 Vitamin B .Komplek Tablet Tablet 31 30 10 55 40 52 10
262 Vitamin Neurotropik Tablet Tablet 10 20 30 10 45 15 5 15
263 Zinc Tablet 20 mg Tablet 10 10

B. BAHAN MEDIS HABIS PAKAI (BMHP)

264 Abbocath No 18 ( IV Chateter 18 ) Buah

265 Abbocath No 20 ( IV Chateter 20 ) Buah
266 Abbocath No 22 ( IV Chateter 22 ) Buah
267 Abbocath No 24 ( IV Chateter 24 ) Buah
268 Alat Gula, Kolesterol, Asam Urat Unit
269 Alat Suntik Sekali Pakai 1 ml Set
270 Alat Suntik Sekali Pakai 2,5 ml Set
271 Alat Suntik Sekali Pakai 5 ml Set
272 Alat Suntik Sekali Pakai 10 ml Set
273 Alkohol Swab Kotak
274 Auto Disposable Syringe (ADS) 0,05 ml set
275 Auto Disposable Syringe (ADS) 0,5 ml set
276 Auto Disposable Syringe (ADS) 5 ml set

277 Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic) Sachet

278 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol

279 Etanol 70 % 1.000 ml Botol
280 Folley Catheter no 14 Set
281 Folley Catheter no 16 Set
282 Folley Catheter no 18 Set
283 Infus set Anak Set
284 Infus set Dewasa Set
285 Iodina Test Botol
286 Kapas Berlemak 500 gram Bungkus
287 Kapas Pembalut / Adsorbens 250 gram Bungkus
288 Kassa Pembalut 2 m x 80 cm Rol
289 Kassa Pembalut Hidrofil 4 m x 3 cm Rol
290 Kassa Pembalut Hidrofil 4 m x 15 cm Rol
291 Kassa Hidrofil Steril 16 x 16 Kotak
292 Kassa Kompres 40 x 40 steril Bungkus
293 Kertas Puyer Pcs
294 Lysol 1,000 ml Botol
295 Masker Buah
296 Plester 5 yard x 2 inchi Rol
297 Polifix 5 cm x 5 m Rol
298 Pot Dahak Pcs
299 Rapid HIV 1 (SD HIV) Pcs
300 Rapid HIV 2 (Intec HIV) Pcs
301 Rapid HIV 2 (Biomeriux HIV) Pcs
302 Rapid Test Syphilis Pcs
303 RPR Test Syphilis Pcs
304 Silk( Benang Bedah Sutra ) No 3/0 Sachet
305 Safety Box Pcs
306 Sarung tangan Steril No 6 Pcs
307 Sarung tangan Steril No 7 Pcs
308 Sarung tangan Steril No 7,5 Pcs
309 Sarung tangan Non Steril S Pcs
310 Sarung tangan Non Steril M Pcs
311 Sarung tangan Non Steril L Pcs
312 Stik Pemeriksaan Gula Darah Test
313 Stik Pemeriksaan Kolesterol Test
314 Stik Pemeriksaan Asam Urat Test
315 Supratul Kotak
316 Urine Bag set
317 Wing Neddle No 23 Set
318 Cairan antiseptik Hands Rub Botol

C. VAKSIN DAN SERUM

319 Serum Anti Bisa Ular Polivalen Injeksi 5 ml (ABU I ) Vial
320 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul Ampul
 5 6 7 8 9 10 11 12 13
Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum

5 20 5 10 20 30 20 20 10

20 7 30 20 30 10 15
1 2 1 3 1

7
24 6 16 5 15
10 10 15 5 6
10 10 10 40
80 10 60 20 30 20 70 20 70 10 20 20 50

3 6 2 5 1 3 1 3

2 1 1 1 1

10

1 3 1 1 4 1 2 1 3

40 10 70 20 30 10 30 50 40 20 100 60 50

20 20 10 20

1
40 20 16 20 16
10

40 30 10 61 17 10

2 1

12 14
10 10 20 10 10 10

5 4 1 1 2 2

10 5

57 42 26 39 21 60 20 35 44 64

5 20 60

10 10 10
6 10 12
3 1

20 10
 20

10

10 5

10 5 5

6 24 70 6 12 12

3 1 3 4 1 1 1

10 10
10 20 10
95 2 69 10 26 20 27 10 18 18 45
2 1 1 1 2 2 3 5 1

20 10

14 20
60

2 1 1 1
10 10
30 30 10 40 20 10 30
2

5 5
 20 10 5 23 20 10 15
10
6 10

1 2 1
10

10 10 10

1 1 1 2
1 1 1 1 1
119 12 159 45 76 5 157 65 84 18 99 16 102
14 10
30

10 12 12 12

3 1 1 4 2 2

15 20
 10 10 5 10

20

20

10 10 6 20 10 10

3 1 1
10 10 20 30 50 10 30 10 20
5 3 1 3 1

20 10 3

10 10 20 10 10 20 20 10

10 10

1 1 2 2 1 1 2 2 2 2 5 1 3
4 1 1
2 3 3
1 10 2 2 1 10

2 3
1

6 22 10 5 5 5 5 11
 4 1 4 9 3 3 6 7

172 56 209 65 122 45 208 40 110 40 147 70 176

2 1

22

33 10 10 40 10 95 20 10 10 50 30 12

20 10 10 10

28 12 6 22 10 10 10

10 10 9 12 29
10 12

1 1 1

1 4 2 2 1 1 4
1

16 6 6 12 6 10 10
16
 5 10 5
1

6 6 12
5 35
10 10 10

10 30 30

20 5 40 30

145 30 38 35 43 40 10 30 78 20 62 10 35
20 10 10 20 20 30 15 5 20 26
10 30 20
13 14 15 16 17 18 19 20 21
JKN Umum JKN Umum JKN Umum JKN Dinkes JKN Umum JKN Umum JKN Umum JKN Umum JKN

10 20 10 40 5 10 10 10 20 15 10

30 10 4 15 10 30 10 20
4 2 2 1 1

15
5 5 5 15 10 10 30 10 20 25 10 10 10
10 5 5 30 20 5
20 20 20 10 10 10 10 10 10
20 60 20 80 20 20 20 50 10 30 20 90 10 40

4 12 3 8 1 6 1 7 2 7 1

1 2 2 1 1

1 2 1 2 2 1 1 1 5 1 2

20 40 100 80 170 30 40 40 80 120 100 110 30 50 30

10 10

1
12 15 10
5 10

26 18 25 6 33 16 52 20 50 20 4

1 2

12
10

1 2 2 4 2 1

10 20 10 10 10 40

40 45 58 80 49 71 33 27 10 66 23 113 51 127 15

10
10 10
10 10 10 26
1 1 1 1 1 1

10
 20

5 5

12 6 6 12 6 24

1 1 1 1

10
10
10 228 3 35 30 20 23 59 20 21 16 339 18 5
2 1 4 1 6 2 1 4 1

30 15
15
50
2 1 3 2 1 2 1 1
30
10 20 10 10 30 20 30 20 10 60 50 30 30 30 20
1 1 1

10 10 10 10
 10 90 10 10 20 10
10 10
50 20

1 1 1 1

2 1 1

1 1 1 1
1 2
57 78 92 135 141 52 18 143 61 149 75 131 74 68 15
30
15 30

14 20 22 20 30

3 2 1 6 2 5 2

5 15 10 20

10
 5 5 10 5

10 (10)

16 16 10

1 1
10 10 10 6 10 20 10 10
2 1 1 2 1 1 2

3 110 10

10 22 10 40 10 10 10 16 10

1 2 2 5 2 1 2 4 2 2 2 3 4 2
1 1 1 1 1
1 2
1 3 1 2 2 1 1

15 5 5 5 20
 3 2 5 1 2 5 9 2 10 1 1 1

60 178 110 199 191 55 34 142 135 127 195 244 72 99 10

20 10 10 10

19 20 10 13 10 20 47 10 80 13 10

10 10 10 30 10 10 10 10 10

26 6 10 16 10 16 30 26 36 20

10 10 4 10 10
23 10

1 1 2 1 1 1

2 1 1 1 2 1 1 1
 20 10 4

10
6 5 10
6 10 10 10 16 10 32

30 30

30 50 10 70 14 10 20 40 30 50 20 20

15
40 29 50 62 90 15 5 22 10 19 39 82 45
10 5 10 12 15 5 10 35 70 50 68 57 30 5 5
10 10 10 20 10 30
 22 23 24 25 26 27 28 29 30
Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum JKN Umum

10 10 10 70 10 10 15 10 10

20 15 10
1 1 2 1 1

15
10 35 20 5 10 32 10 10
5 5 5 10 10 10 11
30 10 30 10 20 10 10 20
20 40 40 50 50 10 50 50 120 60 40 30 90

3 5 3 1 1 7 1 4 1 5

1 2

3 1 1 1 1 3

40 20 20 20 70 30 20 20 50 40 30 40

10 10

1
 20 10 20

1 2

22 20 48 27 10 5 15 6

1 1

1 3 1 2 3 1 1 4

10 10 30 10 20 10 10

42 36 75 10 91 10 76 50 119 39 92 30 78

20 2

10 10 10 10
12
1 1

10
 5

5 16

12 18 6

1 1 3

10 10

5 28 10 11 24 20 172 3 24 13 34
3 2 4 6 3

12 34 10 20 10 10

30
30

3 1 1 1 1 2 2 2
20 10 24 20
20 20 20 10 20 40 70 30 20 40 100

10 10
 4 70 20 20 10 30 10
10
20 10

2 3 1 1
26 15

20 30

1 1 2 1

1 1 2 2 1 1
2 1
102 16 39 30 118 25 80 10 193 33 101 58 123
30 30

10 10

2 1

10 10 10 5 10

10 10
5 10 10 20 10

10

10

10 10 6 16

1 1 1
20 70 20 10 10 30 20 30 10 10
1 1 1 3 5 1

10 30 10 10 10 10

3 4 2 4 1 3 2 2 2 3 2
1 1 1 1 1
1 1 1 1 1 1
1 1

5 5
 5 4 2 4 7 6 3

93 50 96 35 136 25 84 20 240 50 69 48 85

10 20 30 10

34 10 24 10 30 30 10 10 22

23 10 20 10 10 10 22 40

10 40 50 10 10 40 16 10 10 40

10 10 40 20 10

1 2 1 1

1 2 1 1 2 1
1

10 16 6 6
 20 15
1

10 10
10 20 5 10 5
10 10 10 6 16 10 10

120 30 30 30

20 30 10 10 10 20 30

36 40 27 10 34 20 4 48 40 32 10 50
5 16 30 20 22 12 30 20 35 15 35
10 10 10 10
2
30 31 Jumlah Jumlah
Jumlah Total
JKN Umum JKN Umum JKN

- - -
- - -
10 280 255 535
- - -
- - -
256 115 371
2 28 10 38
- - -
- - -
37 - 37
5 248 165 413
10 5 107 100 207
10 270 110 380
10 30 40 1,410 580 1,990
- - -
4 115 13 128

1 13 7 20

- - -
- - -
- - -
- - -
10 10 20

1 1 34 18 52

20 50 150 1,400 1,150 2,550

20 10 90 70 160
- - -
- - -

- - -

8 20 28

4 2 6

- - -

1 1 2
 - - -
- - -
- - -
10 147 72 219
5 20 25
1 2 3
- - -
- - -
10 15 654 127 781
5 - 5
- - -
- - -
- - -
1 9 3 12
- - -
14 24 38
10 10 80 40 120
- - -
- - -
- - -
- - -
1 45 10 55
- - -
- - -
155 60 215
- - -
10 87 56 1,775 706 2,481
- - -
27 85 112
- - -
- - -
- - -
- - -
- - -
- - -
- 10 10
60 36 96
10 10 96 40 136
1 8 6 14
46 - 46
- - -

- - -

- - -
40 10 50
 - - -
- - -
- - -
- - -
- - -
30 70 - 70
- - -
- - -
- - -
10 - 10
- - -
25 - 25
- - -
10 51 10 61
- - -

6 6 226 36 262

- - -
- 2 2
- - -
23 11 34
- - -
50 30 80
80 - 80
35 16 1,452 216 1,668
1 1 54 10 64
- - -
- - -
- - -
106 30 136
- - -
94 28 122
10 - 115 115
50 - 50
2 22 17 39
74 50 124
20 650 440 1,090
3 2 5
- - -
- - -
- - -
- - -
45 25 70
- - -
10 10 239 245 484
30 10 40
100 16 116
- - -
2 1 13 6 19
20 15 71 15 86
- - -
- - -
- - -
- - -
- - -
60 20 80
- 10 10
- - -
1 9 5 14
- - -
1 13 7 20
9 4 13
10 123 122 2,832 1,145 3,977
84 30 114
10 - 98 98
- - -

- - -

- - -

- - -

10 128 74 202

3 39 5 44

15 10 80 75 155

- - -

- - -

- - -

- - -

- - -

10 - 10
10 10 20
- - -
 - - -
20 101 80 181
- - -
10 20 30
- - -

10 20 30

- - -
- - -
- - -
- - -
- - -
6 110 56 166
1 - 1
- - -
6 5 11
286 240 526
31 5 36
- - -
126 30 156
- - -
10 166 222 388

- - -

10 10 20
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
5 - 5
- - -
1 4 7 68 48 116
13 4 17
1 17 4 21
1 1 37 16 53
- - -
1 7 - 7
- 1 1
- - -
- - -
59 88 147
- - -
 - - -

4 1 119 10 129
- - -
40 156 200 3,660 1,794 5,454
- - -
- - -
7 - 7
- - -
- - -
52 100 152

- - -

20 10 676 206 882

- - -

- - -
- - -
- - -
10 235 160 395
- - -
- - -
- - -
- - -
- - -
10 358 222 580
- - -
- - -
- - -
- - -
- - -
10 145 99 244
12 43 55

3 4 - 4

11 4 15

29 9 38
1 1 2
- - -
76 64 140
16 - 16
- - -
- - -
- - -
 54 71 125
1 2 1 3
- - -
- - -
- - -
32 42 74
10 42 96 138
150 56 206
- - -
- - -

30 190 180 370

- - -

- - -
- - -
- - -
- - -
10 20 50 409 380 789
- - -
- - -
- - -
- 15 15
43 60 1,082 684 1,766
25 5 30 562 451 1,013
190 20 210
- - -

- - -

- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -

- - -

- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -

- 2 2
- - -
- - -
 jumlah Antispasmodik Tablet
pemaka Sisa 35 34 56
No Nama Obat
ian stok 36
Antitusiva Sirup 4 2
Air Raksa Dental Use 0 0 Antitusiva Tablet 10 0
1 37
Albendazole Tablet 400 mg 0 100 Asam Folat Tablet 1 mg 0 0
2 38
Alopurinol Tablet 100 mg 90 57 Asam Askorbat 50 mg 500 62
3 39
Ambroksol Tablet 30 mg 102 8 Asam Mefenamat Kapsul 500 mg 9 0
4 40
Ambroksol sirup 15 mg/5 ml 4 5 Asetosal 80 mg 0 0
5 41
Aminofillin Injeksi 24 mg/ml-10 ml 0 0 Asetosal Tablet 100 mg 0 0
6 42
Aminofillin Tablet 200 mg 0 20 Asetosal Tablet 500 mg 0 0
7 43
Amitriptillin Hcl Tablet Salut 25 m 10 30 Asiklovir Krim 5 % 2 4
8 44
Amlodipin Tablet 5 mg 65 17 Asiklovir Tablet 200 mg 10 105
9 45
Amlodipin Tablet 10 mg 0 0 Asiklovir Tablet 400 mg 0 0
10 46
Amoksisillin Kapsul 250 mg 50 79 Atropin Sulfat Injeksi 0,25 mg/ml 0 0
11 47
Amoksisillin Kaplet 500 mg 580 154 Aqua Pro Injeksi Steril, bebas Pir 0 0
12 48
Amoksisillin Serbuk Injeksi 1000 mg 0 0 Betahistin Mesilat 6 mg 54 16
13 49
Amoksisillin Sirup Kering 125 mg/5 12 4 Betametason Krim 0,1 %- 5g 4 2
14 50
Amoksisillin Double Strengh Sirup Bisakodil suppositoria 10 mg
Kering 250 mg/5 ml
15 20 6 51 0 0
Ampisilin Kapsul 250 mg 0 70 Bisoprolol Tablet 5 mg 0 0
16 52
Ampisillin Kaplet 500 mg 10 52 Bromheksin 8 mg 0 30
17 53
Ampisilin Sirup 125 mg / 5 ml 0 0 Deksametason Injeksi 5mg/ml-1m 0 2
18 54
Ampisillin Injeksi 1000 mg 0 0 Deksametason Tablet 0,5 mg 195 57
19 55
Analgetik Plus 200 0 Devitalisasi Pasta (Non Arsen) 0 0
20 56
Antasida Doen Suspensi Diazepam tablet 2 mg
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 3 4 57 15 29
Antasida Doen Tablet, Kombinasi Diazepam Injeksi i.v/i.m 5 mg/ml
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 545 185 58 0 0
Antasida Plus Tablet 90 50 Diazepam Larutan Rektal 5 mg/m 0 0
23 59
Antalgin (Metampiron) Tablet 500 40 0 Dietilkarbamazin Sitrat Tablet 1 0 0
24 60
Antalgin Injeksi 250 mg/ml-2ml 0 0 Difenhidramin HCl Injeksi 10 mg/ 1 46
25 61
Anti Bakteri DOEN Salep Digoksin Tablet 0,25 mg
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 4 0 62 0 0
Anti Hemoroid Doen komb 0 0 Dimenhidrinat Tablet 50 mg 30 86
27 63
Anti Fungi DOEN Kombinasi : Domperidon Tablet 10 mg

Asam Benzoat 6% + Asam Salisilat

28 3% 1 6 64 0 128
Antimigren DOEN Kombinasi : Donperidon Suspensi 5 mg/5ml

Ergotamin Tartrat 1 mg + Kofein

29 50 mg 0 0 65 0 4
Anti Diare Suspensi 1 4 Efedrin Hcl Tablet 25 mg 60 0
30 66
Anti Diare Tablet 65 55 Ekstrak Belladone Tablet 10 mg 282 0
31 67
 Anti Dotum Oral Tablet Epinefrin HCl / Bitartrat

(Epinefrina / Adrenalina)
32 0 170 68 Injeksi 0,1%/- 1ml 0 5
Anti Hipertensi Kapsul 30 30 Eritromisin Kapsul 250 mg 0 0
33 69
Antihistamin Tablet kombinasi 40 198 Eritromisin Kapsul 500 mg 0 0
34 70
Eritromisin Sirup 200 mg / 5 ml 0 0 Ketokonazole Tablet 200 mg 18 68
71 116
Etambutol Tablet 500 mg 0 0 Ketoprofen Tablet 100 mg 0 0
72 117
Etanol 70 % 100 ml 0 0 Ketoprofen Injeksi 100 mg / 1 ml 0 0
73 118
Etil Klorida Semprot -100 ml 1 0 Ketorolac 10 mg injeksi 0 0
74 119
Eugenol Cairan -10 ml 0 0 Ketorolac 30 mg injeksi 0 0
75 120
Fenitoin Natrium Kapsul 100 mg 0 100 Klindamisin Kapsul 150 mg 0 40
76 121
Fenobarbital tablet 30 mg 0 0 Klindamisin Kapsul 300 mg 0 0
77 122
Fenobarbital injeksi 50 mg / ml 0 0 Kloramfenikol Kapsul 250 mg 0 84
78 123
Fenoksimeti Penisilin 250 mg table 0 100 Kloramfenikol Salep Mata 1%-3,5 6 2
79 124
Fenoksimeti Penisilin 500 mg tabl 0 70 Kloramfenikol Tetes Mata -5 ml 0 0
80 125
Fitomenadion tablet 10 mg 40 95 Kloramfenikol Tetes Telinga 3%-5 3 1
81 126
Fitomenadion (Vit K1) Injeksi 2 m 0 3 Klorfeniramin Maleat (CTM) Table 510 141
82 127
Furosemid Tablet 40 mg 10 7 Klorpromazin Hcl Tablet Salut 25 100 10
83 128
Garam Oralit I serbuk, Klorpromazin Hcl Tablet Salut 10
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 28 30 129 65 76
Gemfibrozil Tablet 600 mg 0 0 Klorpromazin Hcl Injeksi 5 mg/ml 0 0
85 130
Gentamisin injeksi 80 mg / 2 ml Kotrimoksazol Pedriatik Tablet,
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
86 0 0 131 0 12
Gentamisin Salep Kulit 0,1 % Kotrimoksazol Tablet, Kombinasi
:
Sulfametoksazol 400 mg +
Trimetroprim 80 mg
87 4 4 132 15 43
Glibenklamid Tablet 5 mg Kotrimoksazol Suspensi
Kombinasi :
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
88 0 0 133 6 5
Glimepiride 2 mg 50 20 Lansoprazole 30 mg Kapsul 0 34
89 134
Gliseril guayakolat tablet 100 mg Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat
28 mEq) /Asering

90 90 27 135 0 0
Gliseril Guayakolat sirup Larutan mengadung Elektrolit
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
91 1 0 136 0 0
Glukonas Kalsikus injeksi Larutan mengadung Karbohidrat
+ Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

92 0 0 137 0 0
Glukosa Larutan Infus 5 % 0 1 Lidokain injeksi 2 % 2 0
93 138
 Glukosa Larutan Infus10 % Lidokain Komp Injeksi,
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
94 0 0 139 0 0
Griseofulvin Tablet 125 mg,microni 10 60 Loperamid Tablet 2 mg 0 0
95 140
Haloperidol Tablet 0,5 mg 20 80 Loratadin tablet 10 mg 0 40
96 141
Haloperidol Tablet 1,5 mg 0 60 Magnesium Sulfat (IV) 20 %-25 ml 0 0
97 142
Haloperidol Tablet 5 mg 130 10 Meloksikam tablet 15 mg 10 58
98 143
Hidrokloritiazid 25 mg 0 39 Meloksikam Suppositoria 0 0
99 144
Hidrokortison Krim 2,5 % 12 3 Metformin Hcl Tablet 500 mg 20 40
100 145
Ibuprofen Tablet 200 mg 20 56 Methisoprinol 500 mg 0 0
101 146
Ibuprofen Tablet 400 mg 120 94 Metilergometrin Maleat (Metergin 10 0
102 147
Ibuprofen Suspensi 100 mg/5 ml 1 5 Metilergometrin Maleat Injeksi 0 0 4
103 148
Ichtyol salep Kulit 0 0 Metilprednisolon tablet 4 mg 6 8
104 149
Ipatropium Bromide + Salbutamol Metoklopramid 10 mg

Sulphate for inhalation 2,5 ml

105 0 0 150 43 94
Isoniazid tablet 100 mg 0 0 Metoklorpropamid Injeksi 5 mg/ 0 0
106 151
Isosorbid Dinitrat 5 mg 0 0 Metronidazol Tablet 250 mg 0 40
107 152
Kalium Diklofenak Tablet 25 mg 0 0 Metronidazole Tablet 500 mg 10 30
108 153
Kalium Diklofenak Tablet 50 mg 110 32 Metronidazole Infus 500 mg /100 10 0
109 154
Kalsium Hidroksida Pasta 0 0 Mikonazole KrIm 2 % - 10 gr 2 3
110 155
Kalsium Laktat Tablet 500 mg 20 26 Multivitamin + Mineral tablet 0 0
111 156
Kaptopril 12,5 mg 266 36 Multivitamin sirup 4 0
112 157
Kaptopril 25 mg 130 5 Natrium Bikarbonat Tablet 500 m 0 172
113 158
Karbamazepin Tablet 200 mg 40 65 Natrum Diklofenak Tablet 25 mg 0 0
114 159
Ketokonazole Krim 2 % - 15 gr 3 2 Natrium Diklofenak Tablet 50 mg 72 34
115 160
Natrium Klorida Larutan infus 0,9%- 0 0 Rifampisin Tablet 450 mg 0 0
161 206
Nipedifin Tablet 10 mg 20 103 Ringer Laktat Larutan Infus Steril 0 3
162 207
Nistatin 100.000 IU/gram Tablet V 0 7 Salbutamol Tablet 2 mg 58 55
163 208
Nistatin 500.000 IU/gram Tablet Sa 0 50 Salbutamol Tablet 4 mg 15 25
164 209
Obat Antitiuberkolosis Kategori A Salbutamol solution for
Inhalation single dose units 2,5
ml
165 0 0 210 0 0
Obat Antitiuberkolosis Kategori 1 Salep 2-4 Kombinasi :

Asam Salisilat 2 % + Belerang

166 0 0 211 Endap 4 % - 30 gram 1 3
Obat Antitiuberkolosis Kategori 2 0 0 Salisil bedak 2% -50 gr 9 3
167 212
Obat Antitiuberkolosis Kategori 3 0 0 Salep Luka Bakar 2 0
168 213
Obat Anti Tuberkulosis FDC Kat A 0 0 Sefadroksil Sirup Kering 125 mg / 2 0
169 214
Obat Anti Tuberkulosis FDC Kat I & 0 0 Sefadroksil Tablet 500 mg 20 97
170 215
Obat Anti Tuberkulosis FDC Kat I & 0 0 Sefiksim Kapsul 100 mg 10 50
171 216
Obat Anti Tuberkolosis FDC Sisipa 0 0 Sefotaksim Injeksi 1 gr 0 0
172 217
Obat Batuk Hitam (OBH) Cairan 10 19 3 Seftriakson Injeksi 1 gr / vial 0 0
173 218
Obat Batuk Cair Sirup (Ekspektoran 8 1 Semen Seng Fosfat Serbuk & Cair 0 0
174 219
Obat Batuk Hitam Plus Sirup 8 5 Setirizin Tablet 10 mg 30 113
175 220
Obat Flu Sirup 13 1 Setirizin Sirup 5 mg / 5 ml 0 1
176 221
Oksiterasiklin Hcl injeksi i.m.50 m 0 0 Sianokobalamin Injeksi 500 mcg/ 0 19
177 222
 Oksiterasiklin Salep Mata 1%-3,5g 1 1 Sianokobalamin Tablet 50 mcg 0 10
178 223
Oksitetrasiklin Hcl Salep Kulit 3%-5 0 2 Silver Amalgam Serbuk 65-75% 0 0
179 224
Oksitosin Injeksi 10 IU/ml-1ml 0 9 Simetidin 200 mg Tablet 30 77
180 225
Omeprazole injeksi 40mg/10ml 0 0 Simvastatin Tablet 10 mg 0 25
181 226
Omeprazole Kapsul 20 mg 0 28 Siprofloksasin 500mg 30 28
182 227
Ondansetron inj 4 mg/ 2 mL 0 0 Spironolakton Tablet 25 mg 20 0
183 228
Parasetamol drops 3 0 Sulfacetamid Tetes Mata 15 %-5m 2 0
184 229
Parasetamol Sirup 120 mg/5ml-60 Tablet Tambah Darah
Kombinasi:
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
185 20 2 230 260 0
Parasetamol Tablet 100 mg Temporary Stopping Fletcher
(Fletcher) Serbuk & Cairan

186 30 0 231 0 0
Parasetamol Tablet 500 mg 1544 113 Trikesol formalin ( T K F ) Cairan 0 0
187 232
Pehacain injeksi 0 0 Tetrasiklin Kapsul 250 mg 0 10
188 233
Perak Sulfadiazin krim 1 % 35 gr 0 0 Tetrasiklin Kapsul 500 mg 0 90
189 234
Piracetam 400 mg 0 0 Thiamin Hcl (Vit B1) Injeksi 100 0 50
190 235
Piracetam Tablet 800 mg 0 0 Tiamin Hcl /Mononitrat (Vit.B1) 256 58
191 236
Piroksikam Tablet 20 mg 30 95 Thiamfenikol Kapsul 500 mg 0 80
192 237
Pirantel Pamoat Tablet 365 mg Tramadol Injeksi 50 mg/ ml
(Setara dng 125 mg Basa)
193 0 80 238 0 0
Piridoksin Hcl (Vit.B6) Tablet 10 m 305 12 Tramadol Tablet 50 mg 0 0
194 239
Polikresulen (Kondensasi Triheksifenidil Hidroklorida Table
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 0 0 240 60 52
Povidon Iodida 10% 30 ml 0 2 Vitamin B .Komplek Tablet 299 0
196 241
Povidon Iodida 10% 300 ml 0 1 Vitamin Neurotropik Tablet 78 0
197 242
Primakuin tablet 15 mg 0 0 Zinc Tablet 20 mg 10 41
198 243
Propanolol Hcl Tablet 40 mg 0 30 Prednisone 54mg 96 18
199 244
Propilturasil Tablet 100 mg 0 0 flunax sy 0 0
200 245
Ranitidin Injeksi 25 mg / ml 0 0 vit k 0 22
201 246
Ranitidin Tablet 150 mg 78 17 gentian violet 4 4
202 247
Retinol (Vit.A) 100.000 IU Kapsul 0 0 kloramfenikol 500 0 90
203 248
Retinol (Vit.A) 200.000 IU Kapsul 0 186 Teramysin sm 1 0
204 249
Reserpin Tablet 0, 25 mg 0 40
205 250

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES Urine Bag 0 2

no 47
Abbocath No 18 ( IV Chateter 18 ) 0 0 Wing Neddle No 23 0 0
1 48
Abbocath No 20 ( IV Chateter 20 ) 0 10 Anuscopi Yamato 0 0
2 49
Abbocath No 22 ( IV Chateter 22 ) 0 0 Kaca Slide 0 0
3 50
Abbocath No 24 ( IV Chateter 24 ) 0 0 Reagen Ziehl Nielson 0 0
4 51
Alat Suntik Sekali Pakai 10 ml 0 17 Rotator 0 0
5 52
Alat Suntik Sekali Pakai 1 ml 0 3 RTD Malaria 0 0
6 53
Alat Suntik Sekali Pakai 2,5 ml 13 6 Rapid HIV 3 (Oncoprobe HIV) 0 0
7 54
Alat Suntik Sekali Pakai 5 ml 0 3 Sound Timer 0 0
8 55
Alat Suntik Sekali Pakai 10 ml 0 0 SD Syphilis 0 0
9 56
 Auto Disposable Syringe (ADS) 0,05 0 0
10
Auto Disposable Syringe (ADS) 0,5 0 0
11
Auto Disposable Syringe (ADS) 5 ml 0 0
12
Catgut/Benang Bedah No.2/0-3/0 ( 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 0 0
14
Etanol 70 % 1.000 ml 0 0
15
Folley Catheter no 14 0 0
16
Folley Catheter no 16 0 0
17
Folley Catheter no 18 0 2
18
Infus set Anak 0 0
19
Infus set Dewasa 0 7
20
Iodina Test 0 1
21
Kassa Hidrofil Steril 16 x 16 1 1
22
Kapas Berlemak 500 gram 0 0
23
Kapas Pembalut / Adsorbens 250 g 0 0
24
Kassa Kompres 40 x 40 steril 0 0
25
Kassa Pembalut 2 m x 80 cm 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 c 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 5 0
28
Kertas Puyer 0 0
29
Lysol 1,000 ml 0 0
30
Masker 0 10
31
Plester 5 yard x 2 inchi 0 1
32
Pot Dahak 0 0
33
Rapid HIV 1 (SD HIV) 0 0
34
Rapid HIV 2 (Intec HIV) 0 0
35
Rapid HIV 2 (Biomeriux HIV) 0 0
36
Rapid Test Syphilis 0 0
37
RPR Test Syphilis 0 0
38
Silk( Benang Bedah Sutra ) No 3/0 0 4
39
Safety Box 0 0
40
Sarung tangan Steril No 6 0 0
41
Sarung tangan Steril No 7 0 3
42
Sarung tangan Steril No 7,5 0 7
43
Sarung tangan Non Steril S 0 0
44
Sarung tangan Non Steril M 0 0
45
Sarung tangan Non Steril L 0 0
46
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 0
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 57 50 107
3
Ambroksol Tablet 30 mg Tablet 8 100 108
4
Ambroksol sirup 15 mg/5 ml Botol 5 - 5
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 30 - 30
8
Amlodipin Tablet 5 mg Tablet 17 10 27
9
Amlodipin Tablet 10 mg Tablet - - -
10
Amoksisillin Kapsul 250 mg Kapsul 79 - 79
11
Amoksisillin Kaplet 500 mg Kaplet 154 300 454
12
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 4 10 14
14
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 6 5
15 11
Ampisilin Kapsul 250 mg Kapsul 70 - 70
16
Ampisillin Kaplet 500 mg Tablet 52 - 52
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 4 5 9
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 185 500 10
22 685
Antasida Plus Tablet/TRIANTA Tablet 50 - 50
23
Antalgin (Metampiron) Tablet 500 mg Tablet - 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - 4
26 4
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam 6 -
28 Salisilat 3% 6
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol 4 3 7
30 1
Anti Diare Tablet/New Diaform Tablet 55 - 55
31
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet 30 - 30
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 198 198
34
Antispasmodik Tablet/SCOPMA Tablet 56 50 106
35
Antitusiva Sirup/DEXTROFEN SY Botol 2 5 7
36
Antitusiva Tablet Tablet - 10 10
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 500 562
39 10
Asam Mefenamat Kapsul 500 mg Kapsul - 9 9
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 4 - 4
44
Asiklovir Tablet 200 mg Tablet 105 - 105
45
Asiklovir Tablet 400 mg Tablet - - -
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet 16 - 16
49
Betametason Krim 0,1 %- 5g Tube 2 8 10
50
Bisakodil suppositoria 10 mg/dulcolax Supp - 5 5
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 57 50 107
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 29 - 29
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet - - -
62
Dimenhidrinat Tablet 50 mg Tablet 86 - 86
63
Domperidon Tablet 10 mg Tablet 128 - 128
64
Donperidon Suspensi 5 mg/5ml Botol 4 - 4
65
Efedrin Hcl Tablet 25 mg Tablet - 60 60
66
Ekstrak Belladone Tablet 10 mg Tablet - 282 282
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol 0 - -
71
Etambutol Tablet 500 mg Tablet 0 - -
72
Etanol 70 % 100 ml Botol 0 - -
73
 Etil Klorida Semprot -100 ml Botol 0 1 1
74
Eugenol Cairan -10 ml Botol 0 - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 100 - 100
76
Fenobarbital tablet 30 mg Tablet 0 - -
77
Fenobarbital injeksi 50 mg / ml Ampul 0 - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 95 - 95
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul 3 - 3
82
Furosemid Tablet 40 mg Tablet 7 50 57
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat 50
0,58 gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 30 80
Gemfibrozil Tablet 600 mg Tablet 0 - -
85
Gentamisin injeksi 80 mg / 2 ml Vial 0 - -
86
Gentamisin Salep Kulit 0,1 % Tube 4 5 9
87
Glibenklamid Tablet 5 mg Tablet 0 100 100
88
Glimepiride 2 mg Tablet 20 50 70
89
Gliseril guayakolat tablet 100 mg Tablet 27 100 127
90 10
Gliseril Guayakolat sirup Botol 0 1 1
91
Glukonas Kalsikus injeksi Ampul 0 - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol 0 - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 60 - 60
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet 60 - 60
97
Haloperidol Tablet 5 mg Tablet 10 100 110
98
Hidrokloritiazid 25 mg Tablet 39 - 39
99
Hidrokortison Krim 2,5 % Tube 3 5 8
100 2
Ibuprofen Tablet 200 mg Tablet 56 - 56
101
Ibuprofen Tablet 400 mg Tablet 94 120 214
102
Ibuprofen Suspensi 100 mg/5 ml Botol 5 - 5
103
Ichtyol salep Kulit Pot 0 3 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 -
105 ml 0 -
Isoniazid tablet 100 mg Tablet 0 - -
106
Isosorbid Dinitrat 5 mg Tablet 0 - -
107
Kalium Diklofenak Tablet 25 mg Tablet 0 - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 32 100 132
109
Kalsium Hidroksida Pasta Tube 0 - -
110
Kalsium Laktat Tablet 500 mg Tablet 26 100 126
111
Kaptopril 12,5 mg Tablet 36 200 236
112
Kaptopril 25 mg Tablet 5 200 205
113
 Karbamazepin Tablet 200 mg Tablet 65 - 65
114
Ketokonazole Krim 2 % - 15 gr Tube 2 - 2
115
Ketokonazole Tablet 200 mg Tablet 68 - 68
116
Ketoprofen Tablet 100 mg Tablet 0 - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 - -
118
Ketorolac 10 mg injeksi Ampul 0 - -
119
Ketorolac 30 mg injeksi Ampul 0 - -
120
Klindamisin Kapsul 150 mg Kapsul 40 - -
121
Klindamisin Kapsul 300 mg Kapsul 0 - -
122
Kloramfenikol Kapsul 250 mg Kapsul 84 - 84
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 2 - 2
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol 0 - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 5 6
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 141 200 341
127 10
Klorpromazin Hcl Tablet Salut 25 mg Tablet 10 - 10
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 76 - 76
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg -
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg -
132 43 43
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 10
133 5 15 1
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering
-
135 0 -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 0 -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5
gr, Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 0 -
Lidokain injeksi 2 % Tablet 0 - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin
1 : 80.000-2 ml -
139 0 -
Loperamid Tablet 2 mg Tablet 0 - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 - -
142
Meloksikam tablet 15 mg Tablet 58 - 58
143
Meloksikam Suppositoria Supp 0 - -
144
Metformin Hcl Tablet 500 mg Tablet 40 - 40
145
 Methisoprinol 500 mg Tablet 0 - -
146
Metilergometrin Maleat (Metergin) Tablet 0,1 Tablet 0 - -
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 8 - 8
149
Metoklopramid 10 mg/xilastin Tablet 94 - 94
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 - -
151
Metronidazol Tablet 250 mg Tablet 40 - 40
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul 0 - -
154
Mikonazole KrIm 2 % - 10 gr Tube 3 - 3
155
Multivitamin + Mineral tablet/HEMAFORT Tablet 0 - -
156
Multivitamin sirup/RECOVIT Botol 0 - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 172 - 172
158
Natrum Diklofenak Tablet 25 mg Tablet 0 - -
159
Natrium Diklofenak Tablet 50 mg Tablet 34 50 84
160
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161 0
Nipedifin Tablet 10 mg Tablet - 103
162 103
Nistatin 100.000 IU/gram Tablet Vagina Tablet 20 27
163 7
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 0
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 0 -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 0 -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 0 -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 0 -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 0 -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 0
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 0
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 15 18
173 3
Obat Batuk Cair Sirup (Ekspektoran)/COREDRY Botol 1 2
174 1
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 1 6
175 5
Obat Flu Sirup/ FLUTOP-C Botol 8 9
176 1 2
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 0
Oksiterasiklin Salep Mata 1%-3,5g Tube - 1
178 1
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 0
Omeprazole Kapsul 20 mg Tablet 0 28
182 28
Ondansetron inj 4 mg/ 2 mL Ampul 0 0 -
183
Parasetamol drops Botol 0 3 3
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 2 30 32
185
Parasetamol Tablet 100 mg Tablet 0 0 -
186
Parasetamol Tablet 500 mg Tablet 113 1000 1,113 10
187
Pehacain injeksi Ampul 0 0 -
188
 Perak Sulfadiazin krim 1 % 35 gr Tube 0 0 -
189
Piracetam 400 mg Tablet 0 0 -
190
Piracetam Tablet 800 mg Tablet 0 0 -
191
Piroksikam Tablet 20 mg Tablet 95 0 95
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 12 500 512
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml 0 1 1
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet 0 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 30 0 30
199
Propilturasil Tablet 100 mg Tablet 0 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul 0 0 -
201
Ranitidin Tablet 150 mg Tablet 17 50 67
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet 0 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet 55 0 55
208
Salbutamol Tablet 4 mg Tablet 25 0 25
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 0 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 3 0 3
Salisil bedak 2% -50 gr Kotak 3 5 8
212
Salep Luka Bakar/neocenta Tube 0 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 0 2 2
214
Sefadroksil Tablet 500 mg Tablet 97 0 97
215
Sefiksim Kapsul 100 mg Kapsul 50 0 50
216
Sefotaksim Injeksi 1 gr Ampul 0 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul 0 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol 0 0 -
219
Setirizin Tablet 10 mg Tablet 113 0 113
220
Setirizin Sirup 5 mg / 5 ml Botol 1 3 4
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B1 Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol 0 0 -
224
Simetidin 200 mg Tablet Tablet 77 0 77
225
Simvastatin Tablet 10 mg Tablet 25 0 25
226
Siprofloksasin 500mg Tablet 28 20 48
227
Spironolakton Tablet 25 mg Tablet 0 20 20
228
 Sulfacetamid Tetes Mata 15 %-5ml Botol 0 1 1
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 0 140 140
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 0 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 0 10
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul 50 8 58
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 58 200 258
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul 0 0 -
238
Tramadol Tablet 50 mg Tablet 0 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 52 0 52
240
Vitamin B .Komplek Tablet Tablet 0 50 50 10
241
Vitamin Neurotropik Tablet Tablet 0 78 78
242
Zinc Tablet 20 mg Tablet 41 0 41
243
Prednisone 5 mg Tablet 18 100 118 10
244
flunax sy Botol 0 0 -
245
vit k Set 22 0 22
246
Gentian Violet Botol 4 0 4
247
Kloramfenikol 500 Tablet 90 0 90
248
Teramysin salep mata tube 0 0 -
249
Kotak 0 -
250
251 Ampul 0 -
252 Tablet 0 -
253 Vial 0 -
0 -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES 0 -
Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 6 20 26 2
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set 0 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
11
Auto Disposable Syringe (ADS) 5 ml set 0 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cro Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
14
 Etanol 70 % 1.000 ml Botol 0 0 -
15
Folley Catheter no 14 Set 0 0 -
16
Folley Catheter no 16 Set 0 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set 0 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 1 5 6
22
Kapas Berlemak 500 gram Bungkus 0 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
24
Kassa Kompres 40 x 40 steril Bungkus 0 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 0 -
28
Kertas Puyer Pcs 0 0 -
29
Lysol 1,000 ml Botol 0 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs 0 0 -
33
Rapid HIV 1 (SD HIV) Pcs 0 0 -
34
Rapid HIV 2 (Intec HIV) Pcs 0 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
36
Rapid Test Syphilis Pcs 0 0 -
37
RPR Test Syphilis Pcs 0 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs 0 0 -
40
Sarung tangan Steril No 6 Pcs 0 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs 0 0 -
44
Sarung tangan Non Steril M Pcs 0 0 -
45
Sarung tangan Non Steril L Pcs 0 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set 0 0 -
48
Anuscopi Yamato Unit 0 0 -
49
Kaca Slide Box 0 0 -
50
Reagen Ziehl Nielson Kit 0 0 -
51
Rotator Unit 0 0 -
52
RTD Malaria Tes 0 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
54
Sound Timer Buah 0 0 -
55
SD Syphilis Pcs 0 0 -
56
 CATATAN HARIAN PEMAKAIAN O
Bulan : Juni Tahun : 2017
JUMLAH PEMA

3 4 5 6 7 8 9 10 11 12 13

10 10
10 20 10
1 1

10
30 10 30 30 20 50 5 50 20

1 1 1 1 1

1 1

1 1

20 40 80 60 30 50 10 90

10 10
 10 10 20 5 20
8
1

20 12 10

1
10

10
1 1

8 3 10

8 10 10 10
6 8 10
 10

10 30 5

10 15 5 10 10 10
10
1 1 1 1
10
10 10 40 10 30 20
1

20 10 10 18 10

10
10 10 10 50
16 50 20 10 10 20
 10

12

1 1
30 10 20 30 13 35 5 5

5 15 5 5 5

1 1 1

10 10
 4

10 10

1 2 1 1 1 2
1 1
2 1
1 1 1 1

1 1 1 4 2 1

60 90 70 70 70 95 35 80 20
 10

46 20 20 20 40 20 10 90 20

6 10 10

10 10

1
1 2

10

10 10
 10 10

38
20 20 20 20 10 20

10
10

10 10

1 2 1 2 1 1
 PEMAKAIAN OBAT
i Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

20 20

20

20 20 10 26 30 10

1 1 1 1

1 1

10 20 10 20 50 30 10

1
10
10
10
1 2

1 1 1
3 2

10 18 10

20 10 8
 20

20

6 6

50
20 3 10 2

20

10 10 10 20 10

10 10

10 10 10 20 10 10
10
 10

1 1

1 1 1
15 13 10 10 26 12 10

5 15

1 1 1 1 1 1

10
 10

10 10

18 8

10 10

1 1 1

1
1 1

5 2 1 1 1 3

30 20 30 20 64 20 40 20 20
 10 10

10 20 36 10 10

10

1 1

10
20

10 10 10
1

10
10
20
 1

30 30 10

20
10 10 10

10

10 10 20
5

2 1 1
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
60 47
10 50 58
3 2
0 -
0 20
0 30
20 7
0 -
10 69
10 10 10 10 401 53
0 -
2 8 6

6 5
0 70
0 52
0 -
0 -
0 -

4 5

10 10 10 10
580 105
20 30
40 -
0 -

4 -
0 -

0 6

0 -
2 5
10 45
0 170
 0 30
6 81 117
18 88
1 5 2
10 -
0 -
10 20 500 62
9 -
0 -
0 -
0 -
1 3
10 95
0 -
0 -
0 -
10 6
1 2 8 2
5 -
0 -
0 30
0 2
10 10 79 28
0 -
0 29
0 -
0 -
0 -
0 46
0 -
30 56
24 104
0 4
60 -
282 -

0 5
0 -
0 -
0 -
0 -
0 -
 1 -
0 -
20 80
0 -
0 -
0 100
0 70
10 40 55
0 3
0 57

6 18 62
0 -
0 -
1 8
0 100
50 20
4 94 33
1 -
0 -
0 1
0 -
0 60
0 80
0 60
80 30
10 29
7 1
10 46
20 200 14
1 4
0 3

0 -
0 -
0 -
0 -
88 44
0 -
10 116
10 10 170 66
12 148 57
 20 45
0 2
0 68
0 -
0 -
0 -
0 -
0 -
0 -
12 72
2 -
0 -
5 1
10 26 6 20 10 326 15
0 10
55 21
0 -

0 12

0 43

1 1 12 3
0 34

0 -

0 -

0 -
0 -

0 -
0 -
0 40
0 -
10 48
0 -
20 20
 0 -
0 -
0 4
8 -
10 84
0 -
0 40
0 30
0 -
0 3
10 0 -
0 -
0 172
0 -
46 38
0 -
10 30 73
0 27
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
1 1 13 5
2 -
4 2
8 1
0 -
1 -
0 2
0 9
0 -
0 28
0 -
3 -
3 1 1 28 4
0 -
20 20 30 10 20 40 1004 109
0 -
 0 -
0 -
0 -
30 65
0 80
10 6 30 10 428 84

1 -
0 2
0 1
0 -
0 30
0 -
0 -
36 31
0 -
0 186
0 40
0 -
0 3
10 30 25
0 25

0 -

1 2
1 6 2
0 -
2 -
10 87
20 30
0 -
0 -
0 -
40 73
1 3
0 19
0 10
0 -
20 57
10 15
20 30 18
20 -
 1 -

10 40 140 -

0 -
0 -
0 10
0 90
58 -
30 170 88
0 80
0 -
0 -
20 32
10 30 20
12 10 78 -
5 36
30 88
0 -
0 22
4 -
0 90
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
0 17
0 3
1 1 2 18 8
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
1 5
0 -
0 -
0 -
0 2
0 1
5 (5)
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
 jumlah Antispasmodik Tablet
pemaka Sisa 35 18 88
No Nama Obat
ian stok 36
Antitusiva Sirup 5 2
Air Raksa Dental Use 0 0 Antitusiva Tablet 10 0
1 37
Albendazole Tablet 400 mg 0 100 Asam Folat Tablet 1 mg 0 0
2 38
Alopurinol Tablet 100 mg 60 47 Asam Askorbat 50 mg 500 62
3 39
Ambroksol Tablet 30 mg 50 58 Asam Mefenamat Kapsul 500 mg 9 0
4 40
Ambroksol sirup 15 mg/5 ml 3 2 Asetosal 80 mg 0 0
5 41
Aminofillin Injeksi 24 mg/ml-10 ml 0 0 Asetosal Tablet 100 mg 0 0
6 42
Aminofillin Tablet 200 mg 0 20 Asetosal Tablet 500 mg 0 0
7 43
Amitriptillin Hcl Tablet Salut 25 m 0 30 Asiklovir Krim 5 % 1 3
8 44
Amlodipin Tablet 5 mg 20 7 Asiklovir Tablet 200 mg 10 95
9 45
Amlodipin Tablet 10 mg 0 0 Asiklovir Tablet 400 mg 0 0
10 46
Amoksisillin Kapsul 250 mg 10 69 Atropin Sulfat Injeksi 0,25 mg/ml 0 0
11 47
Amoksisillin Kaplet 500 mg 401 53 Aqua Pro Injeksi Steril, bebas Pir 0 0
12 48
Amoksisillin Serbuk Injeksi 1000 mg 0 0 Betahistin Mesilat 6 mg 10 6
13 49
Amoksisillin Sirup Kering 125 mg/5 8 6 Betametason Krim 0,1 %- 5g 8 2
14 50
Amoksisillin Double Strengh Sirup Bisakodil suppositoria 10 mg
Kering 250 mg/5 ml
15 6 5 51 5 0
Ampisilin Kapsul 250 mg 0 70 Bisoprolol Tablet 5 mg 0 0
16 52
Ampisillin Kaplet 500 mg 0 52 Bromheksin 8 mg 0 30
17 53
Ampisilin Sirup 125 mg / 5 ml 0 0 Deksametason Injeksi 5mg/ml-1m 0 2
18 54
Ampisillin Injeksi 1000 mg 0 0 Deksametason Tablet 0,5 mg 79 28
19 55
Analgetik Plus 0 0 Devitalisasi Pasta (Non Arsen) 0 0
20 56
Antasida Doen Suspensi Diazepam tablet 2 mg
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 4 5 57 0 29
Antasida Doen Tablet, Kombinasi Diazepam Injeksi i.v/i.m 5 mg/ml
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 580 105 58 0 0
Antasida Plus Tablet 20 30 Diazepam Larutan Rektal 5 mg/m 0 0
23 59
Antalgin (Metampiron) Tablet 500 40 0 Dietilkarbamazin Sitrat Tablet 1 0 0
24 60
Antalgin Injeksi 250 mg/ml-2ml 0 0 Difenhidramin HCl Injeksi 10 mg/ 0 46
25 61
Anti Bakteri DOEN Salep Digoksin Tablet 0,25 mg
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 4 0 62 0 0
Anti Hemoroid Doen komb 0 0 Dimenhidrinat Tablet 50 mg 30 56
27 63
Anti Fungi DOEN Kombinasi : Domperidon Tablet 10 mg

Asam Benzoat 6% + Asam Salisilat

28 3% 0 6 64 24 104
Antimigren DOEN Kombinasi : Donperidon Suspensi 5 mg/5ml

Ergotamin Tartrat 1 mg + Kofein

29 50 mg 0 0 65 0 4
Anti Diare Suspensi 2 5 Efedrin Hcl Tablet 25 mg 60 0
30 66
 Anti Diare Tablet 10 45 Ekstrak Belladone Tablet 10 mg 282 0
31 67
Anti Dotum Oral Tablet Epinefrin HCl / Bitartrat

(Epinefrina / Adrenalina)
32 0 170 68 Injeksi 0,1%/- 1ml 0 5
Anti Hipertensi Kapsul 0 30 Eritromisin Kapsul 250 mg 0 0
33 69
Antihistamin Tablet kombinasi 81 117 Eritromisin Kapsul 500 mg 0 0
34 70
Eritromisin Sirup 200 mg / 5 ml 0 0 Ketokonazole Tablet 200 mg 0 68
71 116
Etambutol Tablet 500 mg 0 0 Ketoprofen Tablet 100 mg 0 0
72 117
Etanol 70 % 100 ml 0 0 Ketoprofen Injeksi 100 mg / 1 ml 0 0
73 118
Etil Klorida Semprot -100 ml 1 0 Ketorolac 10 mg injeksi 0 0
74 119
Eugenol Cairan -10 ml 0 0 Ketorolac 30 mg injeksi 0 0
75 120
Fenitoin Natrium Kapsul 100 mg 20 80 Klindamisin Kapsul 150 mg 0 0
76 121
Fenobarbital tablet 30 mg 0 0 Klindamisin Kapsul 300 mg 0 0
77 122
Fenobarbital injeksi 50 mg / ml 0 0 Kloramfenikol Kapsul 250 mg 12 72
78 123
Fenoksimeti Penisilin 250 mg table 0 100 Kloramfenikol Salep Mata 1%-3,5 2 0
79 124
Fenoksimeti Penisilin 500 mg tabl 0 70 Kloramfenikol Tetes Mata -5 ml 0 0
80 125
Fitomenadion tablet 10 mg 40 55 Kloramfenikol Tetes Telinga 3%-5 5 1
81 126
Fitomenadion (Vit K1) Injeksi 2 m 0 3 Klorfeniramin Maleat (CTM) Table 326 15
82 127
Furosemid Tablet 40 mg 0 57 Klorpromazin Hcl Tablet Salut 25 0 10
83 128
Garam Oralit I serbuk, Klorpromazin Hcl Tablet Salut 10
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 18 62 129 55 21
Gemfibrozil Tablet 600 mg 0 0 Klorpromazin Hcl Injeksi 5 mg/ml 0 0
85 130
Gentamisin injeksi 80 mg / 2 ml Kotrimoksazol Pedriatik Tablet,
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
86 0 0 131 0 12
Gentamisin Salep Kulit 0,1 % Kotrimoksazol Tablet, Kombinasi
:
Sulfametoksazol 400 mg +
Trimetroprim 80 mg
87 1 8 132 0 43
Glibenklamid Tablet 5 mg Kotrimoksazol Suspensi
Kombinasi :
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
88 0 100 133 12 3
Glimepiride 2 mg 50 20 Lansoprazole 30 mg Kapsul 0 34
89 134
Gliseril guayakolat tablet 100 mg Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat
28 mEq) /Asering

90 94 33 135 0 0
Gliseril Guayakolat sirup Larutan mengadung Elektrolit
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
91 1 0 136 0 0
 Glukonas Kalsikus injeksi Larutan mengadung Karbohidrat
+ Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

92 0 0 137 0 0
Glukosa Larutan Infus 5 % 0 1 Lidokain injeksi 2 % 0 0
93 138
Glukosa Larutan Infus10 % Lidokain Komp Injeksi,
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
94 0 0 139 0 0
Griseofulvin Tablet 125 mg,microni 0 60 Loperamid Tablet 2 mg 0 0
95 140
Haloperidol Tablet 0,5 mg 0 80 Loratadin tablet 10 mg 0 40
96 141
Haloperidol Tablet 1,5 mg 0 60 Magnesium Sulfat (IV) 20 %-25 ml 0 0
97 142
Haloperidol Tablet 5 mg 80 30 Meloksikam tablet 15 mg 10 48
98 143
Hidrokloritiazid 25 mg 10 29 Meloksikam Suppositoria 0 0
99 144
Hidrokortison Krim 2,5 % 7 1 Metformin Hcl Tablet 500 mg 20 20
100 145
Ibuprofen Tablet 200 mg 10 46 Methisoprinol 500 mg 0 0
101 146
Ibuprofen Tablet 400 mg 200 14 Metilergometrin Maleat (Metergin 0 0
102 147
Ibuprofen Suspensi 100 mg/5 ml 1 4 Metilergometrin Maleat Injeksi 0 0 4
103 148
Ichtyol salep Kulit 0 3 Metilprednisolon tablet 4 mg 8 0
104 149
Ipatropium Bromide + Salbutamol Metoklopramid 10 mg

Sulphate for inhalation 2,5 ml

105 0 0 150 10 84
Isoniazid tablet 100 mg 0 0 Metoklorpropamid Injeksi 5 mg/ 0 0
106 151
Isosorbid Dinitrat 5 mg 0 0 Metronidazol Tablet 250 mg 0 40
107 152
Kalium Diklofenak Tablet 25 mg 0 0 Metronidazole Tablet 500 mg 0 30
108 153
Kalium Diklofenak Tablet 50 mg 88 44 Metronidazole Infus 500 mg /100 0 0
109 154
Kalsium Hidroksida Pasta 0 0 Mikonazole KrIm 2 % - 10 gr 0 3
110 155
Kalsium Laktat Tablet 500 mg 10 116 Multivitamin + Mineral tablet 0 0
111 156
Kaptopril 12,5 mg 170 66 Multivitamin sirup 0 0
112 157
Kaptopril 25 mg 148 57 Natrium Bikarbonat Tablet 500 m 0 172
113 158
Karbamazepin Tablet 200 mg 20 45 Natrum Diklofenak Tablet 25 mg 0 0
114 159
Ketokonazole Krim 2 % - 15 gr 0 2 Natrium Diklofenak Tablet 50 mg 46 38
115 160
Natrium Klorida Larutan infus 0,9%- 0 0 Rifampisin Tablet 450 mg 0 0
161 206
Nipedifin Tablet 10 mg 30 73 Ringer Laktat Larutan Infus Steril 0 3
162 207
Nistatin 100.000 IU/gram Tablet V 0 27 Salbutamol Tablet 2 mg 30 25
163 208
Nistatin 500.000 IU/gram Tablet Sa 0 50 Salbutamol Tablet 4 mg 0 25
164 209
Obat Antitiuberkolosis Kategori A Salbutamol solution for
Inhalation single dose units 2,5
ml
165 0 0 210 0 0
Obat Antitiuberkolosis Kategori 1 Salep 2-4 Kombinasi :

Asam Salisilat 2 % + Belerang

166 0 0 211 Endap 4 % - 30 gram 1 2
Obat Antitiuberkolosis Kategori 2 0 0 Salisil bedak 2% -50 gr 6 2
167 212
Obat Antitiuberkolosis Kategori 3 0 0 Salep Luka Bakar 0 0
168 213
Obat Anti Tuberkulosis FDC Kat A 0 0 Sefadroksil Sirup Kering 125 mg / 2 0
169 214
Obat Anti Tuberkulosis FDC Kat I & 0 0 Sefadroksil Tablet 500 mg 10 87
170 215
 Obat Anti Tuberkulosis FDC Kat I & 0 0 Sefiksim Kapsul 100 mg 20 30
171 216
Obat Anti Tuberkolosis FDC Sisipa 0 0 Sefotaksim Injeksi 1 gr 0 0
172 217
Obat Batuk Hitam (OBH) Cairan 10 13 5 Seftriakson Injeksi 1 gr / vial 0 0
173 218
Obat Batuk Cair Sirup (Ekspektoran 2 0 Semen Seng Fosfat Serbuk & Cair 0 0
174 219
Obat Batuk Hitam Plus Sirup 4 2 Setirizin Tablet 10 mg 40 73
175 220
Obat Flu Sirup 8 1 Setirizin Sirup 5 mg / 5 ml 1 3
176 221
Oksiterasiklin Hcl injeksi i.m.50 m 0 0 Sianokobalamin Injeksi 500 mcg/ 0 19
177 222
Oksiterasiklin Salep Mata 1%-3,5g 1 0 Sianokobalamin Tablet 50 mcg 0 10
178 223
Oksitetrasiklin Hcl Salep Kulit 3%-5 0 2 Silver Amalgam Serbuk 65-75% 0 0
179 224
Oksitosin Injeksi 10 IU/ml-1ml 0 9 Simetidin 200 mg Tablet 20 57
180 225
Omeprazole injeksi 40mg/10ml 0 0 Simvastatin Tablet 10 mg 10 15
181 226
Omeprazole Kapsul 20 mg 0 28 Siprofloksasin 500mg 30 18
182 227
Ondansetron inj 4 mg/ 2 mL 0 0 Spironolakton Tablet 25 mg 20 0
183 228
Parasetamol drops 3 0 Sulfacetamid Tetes Mata 15 %-5m 1 0
184 229
Parasetamol Sirup 120 mg/5ml-60 Tablet Tambah Darah
Kombinasi:
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
185 28 4 230 140 0
Parasetamol Tablet 100 mg Temporary Stopping Fletcher
(Fletcher) Serbuk & Cairan

186 0 0 231 0 0
Parasetamol Tablet 500 mg 1004 109 Trikesol formalin ( T K F ) Cairan 0 0
187 232
Pehacain injeksi 0 0 Tetrasiklin Kapsul 250 mg 0 10
188 233
Perak Sulfadiazin krim 1 % 35 gr 0 0 Tetrasiklin Kapsul 500 mg 0 90
189 234
Piracetam 400 mg 0 0 Thiamin Hcl (Vit B1) Injeksi 100 58 0
190 235
Piracetam Tablet 800 mg 0 0 Tiamin Hcl /Mononitrat (Vit.B1) 170 88
191 236
Piroksikam Tablet 20 mg 30 65 Thiamfenikol Kapsul 500 mg 0 80
192 237
Pirantel Pamoat Tablet 365 mg Tramadol Injeksi 50 mg/ ml
(Setara dng 125 mg Basa)
193 0 80 238 0 0
Piridoksin Hcl (Vit.B6) Tablet 10 m 428 84 Tramadol Tablet 50 mg 0 0
194 239
Polikresulen (Kondensasi Triheksifenidil Hidroklorida Table
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 1 0 240 20 32
Povidon Iodida 10% 30 ml 0 2 Vitamin B .Komplek Tablet 30 20
196 241
Povidon Iodida 10% 300 ml 0 1 Vitamin Neurotropik Tablet 78 0
197 242
Primakuin tablet 15 mg 0 0 Zinc Tablet 20 mg 5 36
198 243
Propanolol Hcl Tablet 40 mg 0 30 Prednisone 54mg 30 88
199 244
Propilturasil Tablet 100 mg 0 0 flunax sy 0 0
200 245
Ranitidin Injeksi 25 mg / ml 0 0 vit k 0 22
201 246
Ranitidin Tablet 150 mg 36 31 gentian violet 4 0
202 247
Retinol (Vit.A) 100.000 IU Kapsul 0 0 kloramfenikol 500 0 90
203 248
Retinol (Vit.A) 200.000 IU Kapsul 0 186 Teramysin sm 0 0
204 249
Reserpin Tablet 0, 25 mg 0 40
205 250

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES Urine Bag 0 2

no 47
 Abbocath No 18 ( IV Chateter 18 ) 0 0 Wing Neddle No 23 0 0
1 48
Abbocath No 20 ( IV Chateter 20 ) 0 10 Anuscopi Yamato 0 0
2 49
Abbocath No 22 ( IV Chateter 22 ) 0 0 Kaca Slide 0 0
3 50
Abbocath No 24 ( IV Chateter 24 ) 0 0 Reagen Ziehl Nielson 0 0
4 51
Alat Suntik Sekali Pakai 10 ml 0 17 Rotator 0 0
5 52
Alat Suntik Sekali Pakai 1 ml 0 3 RTD Malaria 0 0
6 53
Alat Suntik Sekali Pakai 2,5 ml 18 8 Rapid HIV 3 (Oncoprobe HIV) 0 0
7 54
Alat Suntik Sekali Pakai 5 ml 0 3 Sound Timer 0 0
8 55
Alat Suntik Sekali Pakai 10 ml 0 0 SD Syphilis 0 0
9 56
Auto Disposable Syringe (ADS) 0,05 0 0
10
Auto Disposable Syringe (ADS) 0,5 0 0
11
Auto Disposable Syringe (ADS) 5 ml 0 0
12
Catgut/Benang Bedah No.2/0-3/0 ( 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 0 0
14
Etanol 70 % 1.000 ml 0 0
15
Folley Catheter no 14 0 0
16
Folley Catheter no 16 0 0
17
Folley Catheter no 18 0 2
18
Infus set Anak 0 0
19
Infus set Dewasa 0 7
20
Iodina Test 0 1
21
Kassa Hidrofil Steril 16 x 16 1 5
22
Kapas Berlemak 500 gram 0 0
23
Kapas Pembalut / Adsorbens 250 g 0 0
24
Kassa Kompres 40 x 40 steril 0 0
25
Kassa Pembalut 2 m x 80 cm 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 c 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 5 -5
28
Kertas Puyer 0 0
29
Lysol 1,000 ml 0 0
30
Masker 0 10
31
Plester 5 yard x 2 inchi 0 1
32
Pot Dahak 0 0
33
Rapid HIV 1 (SD HIV) 0 0
34
Rapid HIV 2 (Intec HIV) 0 0
35
Rapid HIV 2 (Biomeriux HIV) 0 0
36
Rapid Test Syphilis 0 0
37
RPR Test Syphilis 0 0
38
Silk( Benang Bedah Sutra ) No 3/0 0 4
39
Safety Box 0 0
40
Sarung tangan Steril No 6 0 0
41
Sarung tangan Steril No 7 0 3
42
Sarung tangan Steril No 7,5 0 7
43
Sarung tangan Non Steril S 0 0
44
 Sarung tangan Non Steril M 0 0
45
Sarung tangan Non Steril L 0 0
46
 Persediaan
Jumlah
No Nama Obat Satuan 1
Persediaan
Awal Tambahan UMUM JKN
Air Raksa Dental Use Botol -
1 -
Albendazole Tablet 400 mg Tablet 100
2 100
Alopurinol Tablet 100 mg Tablet 47 47
3
Ambroksol Tablet 30 mg Tablet 58 58
4
Ambroksol sirup 15 mg/5 ml Botol 2 2
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - -
6
Aminofillin Tablet 200 mg Tablet 20 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 30 30
8
Amlodipin Tablet 5 mg Tablet 7 7
9
Amlodipin Tablet 10 mg Tablet - -
10
Amoksisillin Kapsul 250 mg Kapsul 69 69
11
Amoksisillin Kaplet 500 mg Kaplet 53 53
12
Amoksisillin Serbuk Injeksi 1000 mg vial - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 6 6
14
Amoksisillin Double Strengh Sirup Botol
Kering 250 mg/5 ml 5
15 5
Ampisilin Kapsul 250 mg Kapsul 70 70
16
Ampisillin Kaplet 500 mg Tablet 52 52
17
Ampisilin Sirup 125 mg / 5 ml Botol - -
18
Ampisillin Injeksi 1000 mg Vial - -
19
Analgetik Plus Tablet - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg/5 ml

21 5 5
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg 105
22 105
Antasida Plus Tablet/TRIANTA Tablet 30 30
23
Antalgin (Metampiron) Tablet 500 mg Tablet - -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin
500 IU/g + Polimiksin 1000 IU/g -

26 -
Anti Hemoroid Doen komb Supp - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam
Benzoat 6% + Asam Salisilat 3% 6
28 6
 Antimigren DOEN Kombinasi : Tablet
Ergotamin
Tartrat 1 mg + Kofein 50 mg -
29 -
Anti Diare Suspensi/Novadiar Botol 5 5
30
Anti Diare Tablet/New Diaform Tablet 45 45
31
Anti Dotum Oral Tablet Tablet 170 170
32
Anti Hipertensi Kapsul Tablet 30 30
33
Antihistamin Tablet kombinasi/SOLDE Tablet 117 117
34
Antispasmodik Tablet/SCOPMA Tablet 88 88
35
Antitusiva Sirup/DEXTROFEN SY Botol 2 2
36
Antitusiva Tablet Tablet - -
37
Asam Folat Tablet 1 mg Tablet - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 62
39
Asam Mefenamat Kapsul 500 mg Kapsul - -
40
Asetosal 80 mg Tablet - -
41
Asetosal Tablet 100 mg Tablet - -
42
Asetosal Tablet 500 mg Tablet - -
43
Asiklovir Krim 5 % Tube 3 3
44
Asiklovir Tablet 200 mg Tablet 95 95
45
Asiklovir Tablet 400 mg Tablet - -
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - -
47
Aqua Pro Injeksi Steril, bebas Pirogen Vial - -
48
Betahistin Mesilat 6 mg Tablet 6 6
49
Betametason Krim 0,1 %- 5g Tube 2 2
50
Bisakodil suppositoria 10 mg Supp - -
51
Bisoprolol Tablet 5 mg Tablet - -
52
Bromheksin 8 mg Tablet 30 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 28 28
55
Devitalisasi Pasta (Non Arsen) Botol - -
56
Diazepam tablet 2 mg Tablet 29 29
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1 Ampul 46 46
61
Digoksin Tablet 0,25 mg Tablet - -
62
Dimenhidrinat Tablet 50 mg Tablet 56 56
63
Domperidon Tablet 10 mg Tablet 104 104
64
Donperidon Suspensi 5 mg/5ml Botol 4 4
65
Efedrin Hcl Tablet 25 mg Tablet - -
66
Ekstrak Belladone Tablet 10 mg Tablet - -
67
Epinefrin HCl / Bitartrat Ampul

(Epinefrina / Adrenalina) Injeksi 5

68 0,1%/- 1ml 5
 Eritromisin Kapsul 250 mg Kapsul - -
69
Eritromisin Kapsul 500 mg Kapsul - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - -
71
Etambutol Tablet 500 mg Tablet - -
72
Etanol 70 % 100 ml Botol - -
73
Etil Klorida Semprot -100 ml Botol - -
74
Eugenol Cairan -10 ml Botol - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 80 80
76
Fenobarbital tablet 30 mg Tablet - -
77
Fenobarbital injeksi 50 mg / ml Ampul - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 70
80
Fitomenadion tablet 10 mg Tablet 55 55
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml Ampul 3 3
82
Furosemid Tablet 40 mg Tablet 57 57
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl
0,52 gr, Kalium Klorida 0,30 gr,
Trinatrium Sitrat dihidrat 0,58 gr,
Glukosa Anhidrat 2,70 g )200 ml Air

84 62 62
Gemfibrozil Tablet 600 mg Tablet - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - -
86
Gentamisin Salep Kulit 0,1 % Tube 8 8
87
Glibenklamid Tablet 5 mg Tablet 100 100
88
Glimepiride 2 mg Tablet 20 20
89
Gliseril guayakolat tablet 100 mg Tablet 33 33
90
Gliseril Guayakolat sirup Botol - -
91
Glukonas Kalsikus injeksi Ampul - -
92
Glukosa Larutan Infus 5 % Botol 1 1
93
Glukosa Larutan Infus10 % Botol - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 60 60
95
Haloperidol Tablet 0,5 mg Tablet 80 80
96
Haloperidol Tablet 1,5 mg Tablet 60 60
97
Haloperidol Tablet 5 mg Tablet 30 30
98
Hidrokloritiazid 25 mg Tablet 29 29
99
Hidrokortison Krim 2,5 % Tube 1 1
100
Ibuprofen Tablet 200 mg Tablet 46 46
101
Ibuprofen Tablet 400 mg Tablet 14 14
102
Ibuprofen Suspensi 100 mg/5 ml Botol 4 4
103
Ichtyol salep Kulit Pot 3 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate
105 for inhalation 2,5 ml - -
Isoniazid tablet 100 mg Tablet - -
106
 Isosorbid Dinitrat 5 mg Tablet - -
107
Kalium Diklofenak Tablet 25 mg Tablet - -
108
Kalium Diklofenak Tablet 50 mg/KADIT Tablet 44 44
109
Kalsium Hidroksida Pasta Tube - -
110
Kalsium Laktat Tablet 500 mg Tablet 116 116
111
Kaptopril 12,5 mg Tablet 66 66
112
Kaptopril 25 mg Tablet 57 57
113
Karbamazepin Tablet 200 mg Tablet 45 45
114
Ketokonazole Krim 2 % - 15 gr Tube 2 2
115
Ketokonazole Tablet 200 mg Tablet 68 68
116
Ketoprofen Tablet 100 mg Tablet - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - -
118
Ketorolac 10 mg injeksi Ampul - -
119
Ketorolac 30 mg injeksi Ampul - -
120
Klindamisin Kapsul 150 mg Kapsul - -
121
Klindamisin Kapsul 300 mg Kapsul - -
122
Kloramfenikol Kapsul 250 mg Kapsul 72 72
123
Kloramfenikol Salep Mata 1%-3,5 g Tube - -
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 1
126
Klorfeniramin Maleat (CTM) Tablet 4 m Tablet 15 15
127
Klorpromazin Hcl Tablet Salut 25 mg Tablet 10 10
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 21 21
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol
400 mg + Trimetroprim 80 mg
132 43 43
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200
mg + Trimetroprim 40 mg/5 ml

133 3 3
Lansoprazole 30 mg Kapsul Tablet 34 34
134
Larutan mengadung Elektrolit (Na 130 Botol
mEq,Cl 109 mEq, Asetat 28 mEq)
/Asering
135 - -
Larutan mengadung Elektrolit (Nacl Botol
1,125 gr , Dekstrosa 18,75 gr)

136 - -
Larutan mengadung Karbohidrat + Botol
Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na Lactat
2,24 gr, Dekstrosa 27 gr)
137 - -
 Lidokain injeksi 2 % Ampul - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain
Hcl 2% +Epinefrin 1 : 80.000-2 ml

139 - -
Loperamid Tablet 2 mg Tablet - -
140
Loratadin tablet 10 mg Tablet 40 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - -
142
Meloksikam tablet 15 mg Tablet 48 48
143
Meloksikam Suppositoria Supp - -
144
Metformin Hcl Tablet 500 mg Tablet 20 20
145
Methisoprinol 500 mg Tablet - -
146
Metilergometrin Maleat (Metergin) Ta Tablet - -
147
Metilergometrin Maleat Injeksi 0,200 Ampul 4 4
148
Metilprednisolon tablet 4 mg Tablet - -
149
Metoklopramid 10 mg/xilastin Tablet 84 84
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - -
151
Metronidazol Tablet 250 mg Tablet 40 40
152
Metronidazole Tablet 500 mg Tablet 30 30
153
Metronidazole Infus 500 mg /100 ml Ampul - -
154
Mikonazole KrIm 2 % - 10 gr Tube 3 3
155
Multivitamin + Mineral tablet/HEMAF Tablet - -
156
Multivitamin sirup/RECOVIT Botol - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 172 172
158
Natrum Diklofenak Tablet 25 mg Tablet - -
159
Natrium Diklofenak Tablet 50 mg Tablet 38 38
160
Natrium Klorida Larutan infus 0,9%-Ste Botol -
161 -
Nipedifin Tablet 10 mg Tablet 73
162 73
Nistatin 100.000 IU/gram Tablet Vagin Tablet 27
163 27
Nistatin 500.000 IU/gram Tablet Salut Tablet 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket -
165 -
Obat Antitiuberkolosis Kategori 1 Dew Paket -
166 -
Obat Antitiuberkolosis Kategori 2 Dew Paket -
167 -
Obat Antitiuberkolosis Kategori 3 Dew Paket -
168 -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 -
Obat Anti Tuberkulosis FDC Kat I & III Paket -
171 -
Obat Anti Tuberkolosis FDC Sisipan De Paket -
172 -
Obat Batuk Hitam (OBH) Cairan 100 m Botol 5
173 5
Obat Batuk Cair Sirup (Ekspektoran)/ Botol -
174 -
Obat Batuk Hitam Plus Sirup/INDOPL Botol 2
175 2
Obat Flu Sirup/ FLUTOP-C Botol 1
176 1
Oksiterasiklin Hcl injeksi i.m.50 mg/m Vial -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube -
178 -
 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul 9
180 9
Omeprazole injeksi 40mg/10ml Ampul -
181 -
Omeprazole Kapsul 20 mg Tablet 28
182 28
Ondansetron inj 4 mg/ 2 mL Ampul - -
183
Parasetamol drops Botol - -
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 4 4
185
Parasetamol Tablet 100 mg Tablet - -
186
Parasetamol Tablet 500 mg Tablet 109 109 30
187
Pehacain injeksi Ampul - -
188
Perak Sulfadiazin krim 1 % 35 gr Tube - -
189
Piracetam 400 mg Tablet - -
190
Piracetam Tablet 800 mg Tablet - -
191
Piroksikam Tablet 20 mg Tablet 65 65
192
Pirantel Pamoat Tablet 365 mg (Setara Tablet 80 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 84 84
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan
Metanal) 360 mg/g-10 ml

195 - -
Povidon Iodida 10% 30 ml Botol 2 2
196
Povidon Iodida 10% 300 ml Botol 1 1
197
Primakuin tablet 15 mg Tablet - -
198
Propanolol Hcl Tablet 40 mg Tablet 30 30
199
Propilturasil Tablet 100 mg Tablet - -
200
Ranitidin Injeksi 25 mg / ml Ampul - -
201
Ranitidin Tablet 150 mg Tablet 31 31 6
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 186
204
Reserpin Tablet 0, 25 mg Tablet 40 40
205
Rifampisin Tablet 450 mg Tablet - -
206
Ringer Laktat Larutan Infus Steril 500 Botol 3 3
207
Salbutamol Tablet 2 mg Tablet 25 25
208
Salbutamol Tablet 4 mg Tablet 25 25
209
Salbutamol solution for Inhalation Ampul
single dose units 2,5 ml
210 - -
Salep 2-4 Kombinasi : Pot
Asam
Salisilat 2 % + Belerang Endap 4 % - 30
211 gram 2 2
Salisil bedak 2% -50 gr Kotak 2 2
212
Salep Luka Bakar Tube - -
213
Sefadroksil Sirup Kering 125 mg / 5 ml Botol - -
214
Sefadroksil Tablet 500 mg Tablet 87 87
215
Sefiksim Kapsul 100 mg Kapsul 30 30
216
 Sefotaksim Injeksi 1 gr Ampul - -
217
Seftriakson Injeksi 1 gr / vial Ampul - -
218
Semen Seng Fosfat Serbuk & Cairan Botol - -
219
Setirizin Tablet 10 mg Tablet 73 73
220
Setirizin Sirup 5 mg / 5 ml Botol 3 3
221
Sianokobalamin Injeksi 500 mcg/ml-1m Ampul 19 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 10
223
Silver Amalgam Serbuk 65-75% Botol - -
224
Simetidin 200 mg Tablet Tablet 57 57
225
Simvastatin Tablet 10 mg Tablet 15 15
226
Siprofloksasin 500mg Tablet 18 18
227
Spironolakton Tablet 25 mg Tablet - -
228
Sulfacetamid Tetes Mata 15 %-5ml Botol - -
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II
Sulfat 200 mg + Asam Folat 0,25 mg
230 - -
Temporary Stopping Fletcher Set
(Fletcher) Serbuk & Cairan
231 - -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 10
233
Tetrasiklin Kapsul 500 mg Kapsul 90 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/m Ampul - -
235
Tiamin Hcl /Mononitrat (Vit.B1) Table Tablet 88 88
236
Thiamfenikol Kapsul 500 mg Kapsul 80 80
237
Tramadol Injeksi 50 mg/ ml Ampul - -
238
Tramadol Tablet 50 mg Tablet - -
239
Triheksifenidil Hidroklorida Tablet 2 m Tablet 32 32
240
Vitamin B .Komplek Tablet Tablet 20 20
241
Vitamin Neurotropik Tablet Tablet - -
242
Zinc Tablet 20 mg Tablet 36 36
243
Prednisone 5 mg Tablet 88 88
244
flunax sy Botol - -
245
vit k Set 22 22
246
Gentian Violet Botol - -
247
Kloramfenikol 500 Tablet 90 90
248
Kloramfenikol Salep Mata 1%-3,5 g Tablet - -
249
Kotak -
250
251 Ampul -
252 Tablet -
253 Vial -
-
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES -
Abbocath No 18 ( IV Chateter 18 ) Buah - -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 10
2
 Abbocath No 22 ( IV Chateter 22 ) Buah - -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - -
4
Alat Suntik Sekali Pakai 10 ml Set 17 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 8 8
7
Alat Suntik Sekali Pakai 5 ml Set 3 3
8
Alat Suntik Sekali Pakai 10 ml Set - -
9
Auto Disposable Syringe (ADS) 0,05 ml set - -
10
Auto Disposable Syringe (ADS) 0,5 ml set - -
11
Auto Disposable Syringe (ADS) 5 ml set - -
12
Catgut/Benang Bedah No.2/0-3/0 (Plai Sachet 2 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 Botol - -
14
Etanol 70 % 1.000 ml Botol - -
15
Folley Catheter no 14 Set - -
16
Folley Catheter no 16 Set - -
17
Folley Catheter no 18 Set 2 2
18
Infus set Anak Set - -
19
Infus set Dewasa Set 7 7
20
Iodina Test Botol 1 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 5 5
22
Kapas Berlemak 500 gram Bungkus - -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - -
24
Kassa Kompres 40 x 40 steril Bungkus - -
25
Kassa Pembalut 2 m x 80 cm Rol 2 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol (5) (5)
28
Kertas Puyer Pcs - -
29
Lysol 1,000 ml Botol - -
30
Masker Buah 10 10
31
Plester 5 yard x 2 inchi Rol 1 1
32
Pot Dahak Pcs - -
33
Rapid HIV 1 (SD HIV) Pcs - -
34
Rapid HIV 2 (Intec HIV) Pcs - -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - -
36
Rapid Test Syphilis Pcs - -
37
RPR Test Syphilis Pcs - -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 4
39
Safety Box Pcs - -
40
Sarung tangan Steril No 6 Pcs - -
41
Sarung tangan Steril No 7 Pcs 3 3
42
Sarung tangan Steril No 7,5 Pcs 7 7
43
Sarung tangan Non Steril S Pcs - -
44
Sarung tangan Non Steril M Pcs - -
45
 Sarung tangan Non Steril L Pcs - -
46
Urine Bag set 2 2
47
Wing Neddle No 23 Set - -
48
Anuscopi Yamato Unit - -
49
Kaca Slide Box - -
50
Reagen Ziehl Nielson Kit - -
51
Rotator Unit - -
52
RTD Malaria Tes - -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - -
54
Sound Timer Buah
55 - -
SD Syphilis Pcs
56 - -
 2 3 4 5 6
UMUM JKN UMUM JKN UMUM JKN UMUM JKN UMUM JKN
 7 8 9 10 11
UMUM JKN UMUM JKN UMUM JKN UMUM JKN UMUM JKN
 CATATAN HARIAN PEMAKAIAN OBAT
Bulan : JULI Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGA
12 13 14 15 16
UMUM JKN UMUM JKN UMUM JKN UMUM JKN UMUM JKN
OBAT

NIS OBAT PADA TANGGAL

17 18 19 20 21
UMUM JKN UMUM JKN UMUM JKN UMUM JKN UMUM JKN
 22 23 24 25 26
UMUM JKN UMUM JKN UMUM JKN UMUM JKN UMUM JKN
 27 28 29 30 31
UMUM JKN UMUM JKN UMUM JKN UMUM JKN UMUM JKN
jumlah jumlah
Jumlah Sisa Akhir
Pemakaian Bulan
umum jkn
- 0 - -
- 0 0 100
- 0 0 47
- 0 0 58
- 0 0 2
- 0 0 -
- 0 0 20
- 0 0 30
- 0 0 7
- 0 0 -
- 0 0 69
- 0 0 53
- 0 0 -
- 0 0 6

- 0 0 5
- 0 0 70
- 0 0 52
- 0 0 -
- 0 0 -
- 0 0 -

- 0 0 5

- 0 0 105
- 0 0 30
- 0 0 -
- 0 0 -

- 0 0 -
- 0 0 -

- 0 0 6
- 0 0 -
- 0 0 5
- 0 0 45
- 0 0 170
- 0 0 30
- 0 0 117
- 0 0 88
- 0 0 2
- 0 0 -
- 0 0 -
- 0 0 62
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 3
- 0 0 95
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 6
- 0 0 2
- 0 0 -
- 0 0 -
- 0 0 30
- 0 0 2
- 0 0 28
- 0 0 -
- 0 0 29
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 46
- 0 0 -
- 0 0 56
- 0 0 104
- 0 0 4
- 0 60 (60)
- 0 0 -

- 0 0 5
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 80
- 0 0 -
- 0 0 -
- 0 0 100
- 0 0 70
- 0 0 55
- 0 0 3
- 0 0 57

- 0 0 62
- 0 0 -
- 0 0 -
- 0 0 8
- 0 0 100
- 0 0 20
- 0 0 33
- 0 0 -
- 0 0 -
- 0 0 1
- 0 0 -
- 0 0 60
- 0 0 80
- 0 0 60
- 0 0 30
- 0 0 29
- 0 0 1
- 0 0 46
- 0 0 14
- 0 0 4
- 0 0 3

- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 44
- 0 0 -
- 0 0 116
- 0 0 66
- 0 0 57
- 0 0 45
- 0 0 2
- 0 0 68
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 72
- 0 0 -
- 0 0 -
- 0 0 1
- 0 0 15
- 0 0 10
- 0 0 21
- 0 0 -

- 0 0 12

- 0 0 43

- 0 0 3
- 0 0 34

- 0 0 -

- 0 0 -

- 0 0 -
- 0 0 -

- 0 0 -
- 0 0 -
- 0 0 40
- 0 0 -
- 0 0 48
- 0 0 -
- 0 0 20
- 0 0 -
- 0 0 -
- 0 0 4
- 0 0 -
- 0 0 84
- 0 0 -
- 0 0 40
- 0 0 30
- 0 0 -
- 0 0 3
- 0 0 -
- 0 0 -
- 0 0 172
- 0 0 -
- 0 0 38
- 0 0 -
- 0 0 73
- 0 0 27
- 0 0 50
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 5
- 0 0 -
- 0 0 2
- 0 0 1
- 0 0 -
- 0 0 - 0
 - 0 0 2 2
- 0 0 9 9
- 0 0 -
- 0 0 28
- 0 0 -
- 0 0 -
- 0 0 4
- 0 0 -
30 0 0 109
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 65
- 0 0 80
- 0 0 84

- 0 0 -
- 0 0 2
- 0 0 1
- 0 0 -
- 0 0 30
- 0 0 -
- 0 0 -
6 0 0 31
- 0 0 -
- 0 0 186
- 0 0 40
- 0 0 -
- 0 0 3
- 0 0 25
- 0 0 25

- 0 0 -

- 0 0 2
- 0 0 2
- 0 0 -
- 0 2 (2)
- 0 0 87
- 0 0 30
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 73
- 0 0 3
- 0 0 19
- 0 0 10
- 0 0 -
- 0 0 57
- 0 0 15
- 0 0 18
- 0 0 -
- 0 0 -

- 0 0 -

- 0 0 -
- 0 0 -
- 0 0 10
- 0 0 90
- 0 0 -
- 0 0 88
- 0 0 80
- 0 0 -
- 0 0 -
- 0 0 32
- 0 0 20
- 0 0 -
- 0 0 36
- 0 0 88
- 0 0 -
- 0 0 22
- 0 0 -
- 0 0 90
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 10
- 0 0 -
- 0 0 -
- 0 0 17
- 0 0 3
- 0 0 8
- 0 0 3
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 2
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 2
- 0 0 -
- 0 0 7
- 0 0 1
- 0 0 5
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 2
- 0 0 1
- 0 0 (5)
- 0 0 -
- 0 0 -
- 0 0 10
- 0 0 1
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 4
- 0 0 -
- 0 0 -
- 0 0 3
- 0 0 7
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 2
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
- 0 0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 -
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 47 50 97
3
Ambroksol Tablet 30 mg Tablet 58 100 158
4 10
Ambroksol sirup 15 mg/5 ml Botol 2 5 7
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 30 - 30
8
Amlodipin Tablet 5 mg Tablet 7 - 7
9
Amlodipin Tablet 10 mg Tablet - - -
10
Amoksisillin Kapsul 250 mg Kapsul 69 - 69
11
Amoksisillin Kaplet 500 mg Kaplet 53 700 753
12 10
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 6 10 16
14
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 5 10
15 15
Ampisilin Kapsul 250 mg Kapsul 70 - 70
16
Ampisillin Kaplet 500 mg Tablet 52 50 102
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 5 0 5
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 105 600 10
22 705
Antasida Plus Tablet/TRIANTA Tablet 30 - 30
23
Antalgin (Metampiron) Tablet 500 mg Tablet - 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - 4
26 4
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam 6 -
28 Salisilat 3% 6
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol 5 - 5
30
Anti Diare Tablet/New Diaform Tablet 45 50 95
31
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet 30 - 30
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 117 117
34 12
Antispasmodik Tablet/SCOPMA Tablet 88 - 88
35
Antitusiva Sirup/DEXTROFEN SY Botol 2 - 2
36 1
Antitusiva Tablet Tablet - 10 10
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 500 562
39
Asam Mefenamat Kapsul 500 mg Kapsul - 9 9
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 3 3 6
44
Asiklovir Tablet 200 mg Tablet 95 - 95
45
Asiklovir Tablet 400 mg Tablet - - -
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet 6 12 18
49
Betametason Krim 0,1 %- 5g Tube 2 15 17
50
Bisakodil suppositoria 10 mg/dulcolax Supp - 7 7
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 28 1,000 1,028
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 29 - 29
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet - 50 50
62
Dimenhidrinat Tablet 50 mg Tablet 56 - 56
63
Domperidon Tablet 10 mg Tablet 104 - 104
64
Donperidon Suspensi 5 mg/5ml Botol 4 - 4
65
Efedrin Hcl Tablet 25 mg Tablet - 60 60
66
Ekstrak Belladone Tablet 10 mg Tablet - - -
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - - -
71
Etambutol Tablet 500 mg Tablet - - -
72
Etanol 70 % 100 ml Botol - - -
73
 Etil Klorida Semprot -100 ml Botol - 1 1
74
Eugenol Cairan -10 ml Botol - - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 80 - 80
76
Fenobarbital tablet 30 mg Tablet - - -
77
Fenobarbital injeksi 50 mg / ml Ampul - - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 55 - 55
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul 3 7 10
82
Furosemid Tablet 40 mg Tablet 57 - 57
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat -
0,58 gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 62 62
Gemfibrozil Tablet 600 mg Tablet - - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - - -
86
Gentamisin Salep Kulit 0,1 % Tube 8 - 8
87
Glibenklamid Tablet 5 mg Tablet 100 - 100
88
Glimepiride 2 mg Tablet 20 - 20
89
Gliseril guayakolat tablet 100 mg Tablet 33 1,000 1,033
90
Gliseril Guayakolat sirup Botol - 1 1
91
Glukonas Kalsikus injeksi Ampul - - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol - - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 60 - 60
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet 60 - 60
97
Haloperidol Tablet 5 mg Tablet 30 100 130
98
Hidrokloritiazid 25 mg Tablet 29 - 29
99
Hidrokortison Krim 2,5 % Tube 1 30 31
100
Ibuprofen Tablet 200 mg Tablet 46 100 146
101
Ibuprofen Tablet 400 mg Tablet 14 100 114
102 10
Ibuprofen Suspensi 100 mg/5 ml Botol 4 - 4
103
Ichtyol salep Kulit Pot 3 - 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 -
105 ml - -
Isoniazid tablet 100 mg Tablet - - -
106
Isosorbid Dinitrat 5 mg Tablet - - -
107
Kalium Diklofenak Tablet 25 mg Tablet - - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 44 50 94
109
Kalsium Hidroksida Pasta Tube - - -
110
Kalsium Laktat Tablet 500 mg Tablet 116 - 116
111
Kaptopril 12,5 mg Tablet 66 100 166
112
Kaptopril 25 mg Tablet 57 150 207
113
 Karbamazepin Tablet 200 mg Tablet 45 - 45
114
Ketokonazole Krim 2 % - 15 gr Tube 2 3 5
115
Ketokonazole Tablet 200 mg Tablet 68 - 68
116
Ketoprofen Tablet 100 mg Tablet - - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
118
Ketorolac 10 mg injeksi Ampul - - -
119
Ketorolac 30 mg injeksi Ampul - - -
120
Klindamisin Kapsul 150 mg Kapsul - - -
121
Klindamisin Kapsul 300 mg Kapsul - - -
122
Kloramfenikol Kapsul 250 mg Kapsul 72 - 72
123
Kloramfenikol Salep Mata 1%-3,5 g Tube - 3 3
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol - - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 5 6
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 15 700 715
127
Klorpromazin Hcl Tablet Salut 25 mg Tablet 10 26 36
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 21 100 121
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg -
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg 50
132 43 93
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 10
133 3 13
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering
-
135 - -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 - -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5
gr, Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 - -
Lidokain injeksi 2 % Tablet - - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin
1 : 80.000-2 ml -
139 - -
Loperamid Tablet 2 mg Tablet - - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
142
Meloksikam tablet 15 mg Tablet 48 - 48
143
Meloksikam Suppositoria Supp - - -
144
Metformin Hcl Tablet 500 mg Tablet 20 100 120
145
 Methisoprinol 500 mg Tablet - - -
146
Metilergometrin Maleat (Metergin) Tablet 0,1 Tablet - - -
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet - 8 8
149
Metoklopramid 10 mg/xilastin Tablet 84 - 84
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
151
Metronidazol Tablet 250 mg Tablet 40 - 40
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul - - -
154
Mikonazole KrIm 2 % - 10 gr Tube 3 5 8
155
Multivitamin + Mineral tablet/HEMAFORT Tablet - - -
156
Multivitamin sirup/RECOVIT Botol - - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 172 - 172
158
Natrum Diklofenak Tablet 25 mg Tablet - - -
159
Natrium Diklofenak Tablet 50 mg Tablet 38 100 138
160
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161 -
Nipedifin Tablet 10 mg Tablet - 73
162 73
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 27
163 27
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 -
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 - -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 - -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 - -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 - -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 - -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 -
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 -
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 15 20
173 5 1
Obat Batuk Cair Sirup (Ekspektoran)/COREDRY Botol - -
174 -
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 10 12
175 2
Obat Flu Sirup/ FLUTOP-C Botol 15 16
176 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube 3 3
178 -
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 -
Omeprazole Kapsul 20 mg Tablet 0 28
182 28
Ondansetron inj 4 mg/ 2 mL Ampul - 0 -
183
Parasetamol drops Botol - 3 3
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 4 0 4
185
Parasetamol Tablet 100 mg Tablet - 0 -
186
Parasetamol Tablet 500 mg Tablet 109 0 109 30
187
Pehacain injeksi Ampul - 0 -
188
 Perak Sulfadiazin krim 1 % 35 gr Tube - 0 -
189
Piracetam 400 mg Tablet - 0 -
190
Piracetam Tablet 800 mg Tablet - 0 -
191
Piroksikam Tablet 20 mg Tablet 65 0 65
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 84 300 384
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml - 1 1
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet - 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 30 0 30
199
Propilturasil Tablet 100 mg Tablet - 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul - 0 -
201
Ranitidin Tablet 150 mg Tablet 31 100 131 6
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet - 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet 25 100 125
208
Salbutamol Tablet 4 mg Tablet 25 0 25
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 - 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 2 15 17
Salisil bedak 2% -50 gr Kotak 2 5 7
212
Salep Luka Bakar/neocenta Tube - 1 1
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol - 2 2
214
Sefadroksil Tablet 500 mg Tablet 87 0 87
215
Sefiksim Kapsul 100 mg Kapsul 30 30 60
216
Sefotaksim Injeksi 1 gr Ampul - 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul - 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol - 0 -
219
Setirizin Tablet 10 mg Tablet 73 0 73 10
220
Setirizin Sirup 5 mg / 5 ml Botol 3 0 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B1 Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol - 0 -
224
Simetidin 200 mg Tablet Tablet 57 0 57
225
Simvastatin Tablet 10 mg Tablet 15 30 45
226
Siprofloksasin 500mg Tablet 18 0 18 10
227
Spironolakton Tablet 25 mg Tablet - 0 -
228
 Sulfacetamid Tetes Mata 15 %-5ml Botol - 2 2
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 - 0 -
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 - 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul 10 0 10
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 88 300 388 10
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul - 0 -
238
Tramadol Tablet 50 mg Tablet - 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 32 0 32
240
Vitamin B .Komplek Tablet Tablet 20 200 220
241
Vitamin Neurotropik Tablet Tablet - 78 78
242
Zinc Tablet 20 mg Tablet 36 0 36
243
Prednisone 5 mg Tablet 88 0 88
244
flunax sy Botol - 0 -
245
vit k Set 22 0 22
246
Gentian Violet Botol - 4 4
247
Kloramfenikol 500 Tablet 90 0 90
248
Teramysin salep mata tube - 0 -
249
Kotak - -
250
251 Ampul - -
252 Tablet - -
253 Vial - -
- -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES - -
Abbocath No 18 ( IV Chateter 18 ) Buah - 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah - 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 8 5 13
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set - 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set - 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set - 0 -
11
Auto Disposable Syringe (ADS) 5 ml set - 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cro Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - 0 -
14
 Etanol 70 % 1.000 ml Botol - 0 -
15
Folley Catheter no 14 Set - 0 -
16
Folley Catheter no 16 Set - 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set - 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 5 0 5
22
Kapas Berlemak 500 gram Bungkus - 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - 0 -
24
Kassa Kompres 40 x 40 steril Bungkus - 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol (5) 15 10
28
Kertas Puyer Pcs - 0 -
29
Lysol 1,000 ml Botol - 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs - 0 -
33
Rapid HIV 1 (SD HIV) Pcs - 0 -
34
Rapid HIV 2 (Intec HIV) Pcs - 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - 0 -
36
Rapid Test Syphilis Pcs - 0 -
37
RPR Test Syphilis Pcs - 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs - 0 -
40
Sarung tangan Steril No 6 Pcs - 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs - 0 -
44
Sarung tangan Non Steril M Pcs - 0 -
45
Sarung tangan Non Steril L Pcs - 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set - 0 -
48
Anuscopi Yamato Unit - 0 -
49
Kaca Slide Box - 0 -
50
Reagen Ziehl Nielson Kit - 0 -
51
Rotator Unit - 0 -
52
RTD Malaria Tes - 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - 0 -
54
Sound Timer Buah - 0 -
55
SD Syphilis Pcs - 0 -
56
 CATATAN HARIAN PEMAKAIAN O
Bulan : Juli Tahun : 2017
JUMLAH PEMA

3 4 5 6 7 8 9 10 11 12 13

15 10 10
10 10 10
1 1

20 20 70 50 60 30 30 50

1 1 1

2 1 1 2 1

20

1 1

70 30 30 40 40 20 10 20

1 1 1

20 10 10
10 10
10
1

10 20 5

8 10
2 1 2
7

50 30 10 20 10 10 20

10
10 10
 30

10

10
10 10 10 30 40 10

10

10 10 10 30
8
12 2
30 10 10 10
10 10 10 10

10 30 18

30 10 10 5 20 10
30 10 10 8 20 20
10
1
7 7

1 1
33 10 86 20 30 50 53 15 10 20

20 5 15

20

1 1

8 10

10 30
 40 10

2 1 1

8 10 8

8 18 10

18 2

1 1 1 3

2 1 2 1
1 1 1 1 1

10

1 1 1 1 1 1 2 4 2

70 16 30 50 90 90 35 20 60
90 20 36 10 10 10 6

10

8 10

20 10

3
1
1

10
20

20
30
 1

10 10 10 20 10

10
10 10 16 10 41 10

20 5 6 10

2 1 1 1
 PEMAKAIAN OBAT
Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

10
10

10
30 10 20 10 10 20

2 1 1 1

1 1

40

20 20 10 10 50 10 10

10 20
10 10
10 6 10 6

30 5

1 1

18 15 10

8 6 8 16 8

1
 10

10 3 10 5

10 5

1 1 1
8
10
1

10

20 10 10
10 30 12 10
 1

20 3 29 20 20 20 15

10 5

10

10
 1

8 8 8

1 1 3

2
2 2

1 1 5 1 1 5

60 10 20 40 58 55 33
10 10 5

6 6 30 10 16

10 10 18 6 10

10

1 1 1

10
10

10 10
 1

10

10 18 16 18 30 20 10

10
10 24 4

3 6 10
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
45 52
10 60 98
1 1 4 3
0 -
0 20
3 27
0 7
0 -
10 20 49
20 20 130 40 20 10 30 710 43
0 -
2 2 12 4

9 6
0 70
60 42
0 -
0 -
0 -

1 4 1

30 10 50 30 20 10 30
580 125
0 30
40 -
0 -

4 -
0 -

4 2

0 -
1 1 4
70 25
0 170
 0 30
6 58 59
16 58 30
2 -
10 -
0 -
20 30 10 500 62
9 -
0 -
0 -
0 -
1 2 4
0 95
0 -
0 -
0 -
18 -
6 1 14 3
7 -
0 -
0 30
0 2
125 10 10 8 346 682
0 -
0 29
0 -
0 -
0 -
0 46
10 40
30 26
0 104
1 3
60 -
282 (282)

0 5
0 -
0 -
0 -
0 -
0 -
 1 -
0 -
30 50
0 -
0 -
0 100
0 70
0 55
10 -
10 47

3 6 20 42
0 -
0 -
1 2 6
0 100
10 10
20 40 10 10 6 224 809
1 -
0 -
0 1
0 -
10 50
0 80
0 60
5 5 85 45
8 21
1 4 2 2 26 5
20 88 58
22 16 98 16
1 3
0 3

0 -
0 -
0 -
0 -
10 78 16
0 -
0 116
10 135 31
5 10 10 185 22
 10 20 25
1 3 2
14 54
0 -
0 -
0 -
0 -
0 -
0 -
12 12 60
1 2
0 -
1 3 3
36 30 146 10 6 682 33
36 36 -
5 5 65 56
0 -

0 12

10 10 50 43

1 1 1 1 7 6
0 34

0 -

0 -

0 -
0 -

0 -
0 -
0 40
0 -
28 20
0 -
40 80
 0 -
0 -
0 4
8 -
1 51 33
0 -
0 40
0 30
0 -
1 6 2
0 -
0 -
26 146
0 -
20 6 86 52
0 -
0 73
20 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
2 1 1 1 1 18 2
0 -
8 4
1 1 11 5
0 -
1 2
0 2
0 9
0 -
10 18
0 -
3 -
2 1 3 1 1 36 (32)
0 -
48 50 68 56 58 30 56 1133 (1,024)
0 -
 0 -
0 -
0 -
25 40
0 80
3 20 10 40 10 333 51

1 -
0 2
0 1
0 -
10 20
0 -
0 -
6 16 100 31
0 -
0 186
0 40
0 -
0 3
5 10 45 80
2 12 13

0 -

10 13 4
2 6 1
1 -
2 -
20 67
10 40 20
0 -
0 -
0 -
30 43
0 3
0 19
0 10
0 -
6 26 31
30 15
10 8
0 -
 2 -

0 -

0 -
0 -
10 -
0 90
0 -
40 20 10 20 10 20 312 76
0 80
0 -
0 -
20 12
6 16 20 177 43
78 -
0 36
10 3 73 15
0 -
0 22
4 -
0 90
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
0 17
0 3
3 3 11 2
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 2
0 -
0 7
0 1
1 4
0 -
0 -
0 -
0 2
0 1
5 5
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
 jumlah Antispasmodik Tablet
pemaka Sisa 35 58 30
No Nama Obat
ian stok 36
Antitusiva Sirup 2 0
Air Raksa Dental Use 0 0 Antitusiva Tablet 10 0
1 37
Albendazole Tablet 400 mg 0 100 Asam Folat Tablet 1 mg 0 0
2 38
Alopurinol Tablet 100 mg 45 52 Asam Askorbat 50 mg 500 62
3 39
Ambroksol Tablet 30 mg 60 98 Asam Mefenamat Kapsul 500 mg 9 0
4 40
Ambroksol sirup 15 mg/5 ml 4 3 Asetosal 80 mg 0 0
5 41
Aminofillin Injeksi 24 mg/ml-10 ml 0 0 Asetosal Tablet 100 mg 0 0
6 42
Aminofillin Tablet 200 mg 0 20 Asetosal Tablet 500 mg 0 0
7 43
Amitriptillin Hcl Tablet Salut 25 m 3 27 Asiklovir Krim 5 % 2 4
8 44
Amlodipin Tablet 5 mg 0 7 Asiklovir Tablet 200 mg 0 95
9 45
Amlodipin Tablet 10 mg 0 0 Asiklovir Tablet 400 mg 0 0
10 46
Amoksisillin Kapsul 250 mg 20 49 Atropin Sulfat Injeksi 0,25 mg/ml 0 0
11 47
Amoksisillin Kaplet 500 mg 710 43 Aqua Pro Injeksi Steril, bebas Pir 0 0
12 48
Amoksisillin Serbuk Injeksi 1000 mg 0 0 Betahistin Mesilat 6 mg 18 0
13 49
Amoksisillin Sirup Kering 125 mg/5 12 4 Betametason Krim 0,1 %- 5g 14 3
14 50
Amoksisillin Double Strengh Sirup Bisakodil suppositoria 10 mg
Kering 250 mg/5 ml
15 9 6 51 7 0
Ampisilin Kapsul 250 mg 0 70 Bisoprolol Tablet 5 mg 0 0
16 52
Ampisillin Kaplet 500 mg 60 42 Bromheksin 8 mg 0 30
17 53
Ampisilin Sirup 125 mg / 5 ml 0 0 Deksametason Injeksi 5mg/ml-1m 0 2
18 54
Ampisillin Injeksi 1000 mg 0 0 Deksametason Tablet 0,5 mg 346 682
19 55
Analgetik Plus 0 0 Devitalisasi Pasta (Non Arsen) 0 0
20 56
Antasida Doen Suspensi Diazepam tablet 2 mg
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 4 1 57 0 29
Antasida Doen Tablet, Kombinasi Diazepam Injeksi i.v/i.m 5 mg/ml
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 580 125 58 0 0
Antasida Plus Tablet 0 30 Diazepam Larutan Rektal 5 mg/m 0 0
23 59
Antalgin (Metampiron) Tablet 500 40 0 Dietilkarbamazin Sitrat Tablet 1 0 0
24 60
Antalgin Injeksi 250 mg/ml-2ml 0 0 Difenhidramin HCl Injeksi 10 mg/ 0 46
25 61
Anti Bakteri DOEN Salep Digoksin Tablet 0,25 mg
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 4 0 62 10 40
Anti Hemoroid Doen komb 0 0 Dimenhidrinat Tablet 50 mg 30 26
27 63
Anti Fungi DOEN Kombinasi : Domperidon Tablet 10 mg

Asam Benzoat 6% + Asam Salisilat

28 3% 4 2 64 0 104
Antimigren DOEN Kombinasi : Donperidon Suspensi 5 mg/5ml

Ergotamin Tartrat 1 mg + Kofein

29 50 mg 0 0 65 1 3
 Anti Diare Suspensi 1 4 Efedrin Hcl Tablet 25 mg 60 0
30 66
Anti Diare Tablet 70 25 Ekstrak Belladone Tablet 10 mg 282 -282
31 67
Anti Dotum Oral Tablet Epinefrin HCl / Bitartrat

(Epinefrina / Adrenalina)
32 0 170 68 Injeksi 0,1%/- 1ml 0 5
Anti Hipertensi Kapsul 0 30 Eritromisin Kapsul 250 mg 0 0
33 69
Antihistamin Tablet kombinasi 58 59 Eritromisin Kapsul 500 mg 0 0
34 70
Eritromisin Sirup 200 mg / 5 ml 0 0 Ketokonazole Tablet 200 mg 14 54
71 116
Etambutol Tablet 500 mg 0 0 Ketoprofen Tablet 100 mg 0 0
72 117
Etanol 70 % 100 ml 0 0 Ketoprofen Injeksi 100 mg / 1 ml 0 0
73 118
Etil Klorida Semprot -100 ml 1 0 Ketorolac 10 mg injeksi 0 0
74 119
Eugenol Cairan -10 ml 0 0 Ketorolac 30 mg injeksi 0 0
75 120
Fenitoin Natrium Kapsul 100 mg 30 50 Klindamisin Kapsul 150 mg 0 0
76 121
Fenobarbital tablet 30 mg 0 0 Klindamisin Kapsul 300 mg 0 0
77 122
Fenobarbital injeksi 50 mg / ml 0 0 Kloramfenikol Kapsul 250 mg 12 60
78 123
Fenoksimeti Penisilin 250 mg table 0 100 Kloramfenikol Salep Mata 1%-3,5 1 2
79 124
Fenoksimeti Penisilin 500 mg tabl 0 70 Kloramfenikol Tetes Mata -5 ml 0 0
80 125
Fitomenadion tablet 10 mg 0 55 Kloramfenikol Tetes Telinga 3%-5 3 3
81 126
Fitomenadion (Vit K1) Injeksi 2 m 10 0 Klorfeniramin Maleat (CTM) Table 682 33
82 127
Furosemid Tablet 40 mg 10 47 Klorpromazin Hcl Tablet Salut 25 36 0
83 128
Garam Oralit I serbuk, Klorpromazin Hcl Tablet Salut 10
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 20 42 129 65 56
Gemfibrozil Tablet 600 mg 0 0 Klorpromazin Hcl Injeksi 5 mg/ml 0 0
85 130
Gentamisin injeksi 80 mg / 2 ml Kotrimoksazol Pedriatik Tablet,
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
86 0 0 131 0 12
Gentamisin Salep Kulit 0,1 % Kotrimoksazol Tablet, Kombinasi
:
Sulfametoksazol 400 mg +
Trimetroprim 80 mg
87 2 6 132 50 43
Glibenklamid Tablet 5 mg Kotrimoksazol Suspensi
Kombinasi :
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
88 0 100 133 7 6
Glimepiride 2 mg 10 10 Lansoprazole 30 mg Kapsul 0 34
89 134
Gliseril guayakolat tablet 100 mg Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat
28 mEq) /Asering

90 224 809 135 0 0

Gliseril Guayakolat sirup Larutan mengadung Elektrolit
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
91 1 0 136 0 0
 Glukonas Kalsikus injeksi Larutan mengadung Karbohidrat
+ Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

92 0 0 137 0 0
Glukosa Larutan Infus 5 % 0 1 Lidokain injeksi 2 % 0 0
93 138
Glukosa Larutan Infus10 % Lidokain Komp Injeksi,
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
94 0 0 139 0 0
Griseofulvin Tablet 125 mg,microni 10 50 Loperamid Tablet 2 mg 0 0
95 140
Haloperidol Tablet 0,5 mg 0 80 Loratadin tablet 10 mg 0 40
96 141
Haloperidol Tablet 1,5 mg 0 60 Magnesium Sulfat (IV) 20 %-25 ml 0 0
97 142
Haloperidol Tablet 5 mg 85 45 Meloksikam tablet 15 mg 28 20
98 143
Hidrokloritiazid 25 mg 8 21 Meloksikam Suppositoria 0 0
99 144
Hidrokortison Krim 2,5 % 26 5 Metformin Hcl Tablet 500 mg 40 80
100 145
Ibuprofen Tablet 200 mg 88 58 Methisoprinol 500 mg 0 0
101 146
Ibuprofen Tablet 400 mg 98 16 Metilergometrin Maleat (Metergin 0 0
102 147
Ibuprofen Suspensi 100 mg/5 ml 1 3 Metilergometrin Maleat Injeksi 0 0 4
103 148
Ichtyol salep Kulit 0 3 Metilprednisolon tablet 4 mg 8 0
104 149
Ipatropium Bromide + Salbutamol Metoklopramid 10 mg

Sulphate for inhalation 2,5 ml

105 0 0 150 51 33
Isoniazid tablet 100 mg 0 0 Metoklorpropamid Injeksi 5 mg/ 0 0
106 151
Isosorbid Dinitrat 5 mg 0 0 Metronidazol Tablet 250 mg 0 40
107 152
Kalium Diklofenak Tablet 25 mg 0 0 Metronidazole Tablet 500 mg 0 30
108 153
Kalium Diklofenak Tablet 50 mg 78 16 Metronidazole Infus 500 mg /100 0 0
109 154
Kalsium Hidroksida Pasta 0 0 Mikonazole KrIm 2 % - 10 gr 6 2
110 155
Kalsium Laktat Tablet 500 mg 0 116 Multivitamin + Mineral tablet 0 0
111 156
Kaptopril 12,5 mg 135 31 Multivitamin sirup 0 0
112 157
Kaptopril 25 mg 185 22 Natrium Bikarbonat Tablet 500 m 26 146
113 158
Karbamazepin Tablet 200 mg 20 25 Natrum Diklofenak Tablet 25 mg 0 0
114 159
Ketokonazole Krim 2 % - 15 gr 3 2 Natrium Diklofenak Tablet 50 mg 86 52
115 160
Natrium Klorida Larutan infus 0,9%- 0 0 Rifampisin Tablet 450 mg 0 0
161 206
Nipedifin Tablet 10 mg 0 73 Ringer Laktat Larutan Infus Steril 0 3
162 207
Nistatin 100.000 IU/gram Tablet V 20 7 Salbutamol Tablet 2 mg 45 80
163 208
Nistatin 500.000 IU/gram Tablet Sa 0 50 Salbutamol Tablet 4 mg 12 13
164 209
Obat Antitiuberkolosis Kategori A Salbutamol solution for
Inhalation single dose units 2,5
ml
165 0 0 210 0 0
Obat Antitiuberkolosis Kategori 1 Salep 2-4 Kombinasi :

Asam Salisilat 2 % + Belerang

166 0 0 211 Endap 4 % - 30 gram 13 4
Obat Antitiuberkolosis Kategori 2 0 0 Salisil bedak 2% -50 gr 6 1
167 212
Obat Antitiuberkolosis Kategori 3 0 0 Salep Luka Bakar 1 0
168 213
Obat Anti Tuberkulosis FDC Kat A 0 0 Sefadroksil Sirup Kering 125 mg / 2 0
169 214
 Obat Anti Tuberkulosis FDC Kat I & 0 0 Sefadroksil Tablet 500 mg 20 67
170 215
Obat Anti Tuberkulosis FDC Kat I & 0 0 Sefiksim Kapsul 100 mg 40 20
171 216
Obat Anti Tuberkolosis FDC Sisipa 0 0 Sefotaksim Injeksi 1 gr 0 0
172 217
Obat Batuk Hitam (OBH) Cairan 10 18 2 Seftriakson Injeksi 1 gr / vial 0 0
173 218
Obat Batuk Cair Sirup (Ekspektoran 0 0 Semen Seng Fosfat Serbuk & Cair 0 0
174 219
Obat Batuk Hitam Plus Sirup 8 4 Setirizin Tablet 10 mg 30 43
175 220
Obat Flu Sirup 11 5 Setirizin Sirup 5 mg / 5 ml 0 3
176 221
Oksiterasiklin Hcl injeksi i.m.50 m 0 0 Sianokobalamin Injeksi 500 mcg/ 0 19
177 222
Oksiterasiklin Salep Mata 1%-3,5g 1 2 Sianokobalamin Tablet 50 mcg 0 10
178 223
Oksitetrasiklin Hcl Salep Kulit 3%-5 0 2 Silver Amalgam Serbuk 65-75% 0 0
179 224
Oksitosin Injeksi 10 IU/ml-1ml 0 9 Simetidin 200 mg Tablet 26 31
180 225
Omeprazole injeksi 40mg/10ml 0 0 Simvastatin Tablet 10 mg 30 15
181 226
Omeprazole Kapsul 20 mg 10 18 Siprofloksasin 500mg 10 8
182 227
Ondansetron inj 4 mg/ 2 mL 0 0 Spironolakton Tablet 25 mg 0 0
183 228
Parasetamol drops 3 0 Sulfacetamid Tetes Mata 15 %-5m 2 0
184 229
Parasetamol Sirup 120 mg/5ml-60 Tablet Tambah Darah
Kombinasi:
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
185 36 -32 230 0 0
Parasetamol Tablet 100 mg Temporary Stopping Fletcher
(Fletcher) Serbuk & Cairan

186 0 0 231 0 0
Parasetamol Tablet 500 mg 1133 -1024 Trikesol formalin ( T K F ) Cairan 0 0
187 232
Pehacain injeksi 0 0 Tetrasiklin Kapsul 250 mg 10 0
188 233
Perak Sulfadiazin krim 1 % 35 gr 0 0 Tetrasiklin Kapsul 500 mg 0 90
189 234
Piracetam 400 mg 0 0 Thiamin Hcl (Vit B1) Injeksi 100 0 0
190 235
Piracetam Tablet 800 mg 0 0 Tiamin Hcl /Mononitrat (Vit.B1) 312 76
191 236
Piroksikam Tablet 20 mg 25 40 Thiamfenikol Kapsul 500 mg 0 80
192 237
Pirantel Pamoat Tablet 365 mg Tramadol Injeksi 50 mg/ ml
(Setara dng 125 mg Basa)
193 0 80 238 0 0
Piridoksin Hcl (Vit.B6) Tablet 10 m 333 51 Tramadol Tablet 50 mg 0 0
194 239
Polikresulen (Kondensasi Triheksifenidil Hidroklorida Table
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 1 0 240 20 12
Povidon Iodida 10% 30 ml 0 2 Vitamin B .Komplek Tablet 177 43
196 241
Povidon Iodida 10% 300 ml 0 1 Vitamin Neurotropik Tablet 78 0
197 242
Primakuin tablet 15 mg 0 0 Zinc Tablet 20 mg 0 36
198 243
Propanolol Hcl Tablet 40 mg 10 20 Prednisone 54mg 73 15
199 244
Propilturasil Tablet 100 mg 0 0 flunax sy 0 0
200 245
Ranitidin Injeksi 25 mg / ml 0 0 vit k 0 22
201 246
Ranitidin Tablet 150 mg 100 31 gentian violet 4 0
202 247
Retinol (Vit.A) 100.000 IU Kapsul 0 0 kloramfenikol 500 0 90
203 248
Retinol (Vit.A) 200.000 IU Kapsul 0 186 Teramysin sm 0 0
204 249
Reserpin Tablet 0, 25 mg 0 40
205 250
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES Urine Bag 0 0
no 47
Abbocath No 18 ( IV Chateter 18 ) 0 0 Wing Neddle No 23 0 2
1 48
Abbocath No 20 ( IV Chateter 20 ) 0 10 Anuscopi Yamato 0 0
2 49
Abbocath No 22 ( IV Chateter 22 ) 0 0 Kaca Slide 0 0
3 50
Abbocath No 24 ( IV Chateter 24 ) 0 0 Reagen Ziehl Nielson 0 0
4 51
Alat Suntik Sekali Pakai 10 ml 0 17 Rotator 0 0
5 52
Alat Suntik Sekali Pakai 1 ml 0 3 RTD Malaria 0 0
6 53
Alat Suntik Sekali Pakai 2,5 ml 11 2 Rapid HIV 3 (Oncoprobe HIV) 0 0
7 54
Alat Suntik Sekali Pakai 5 ml 0 3 Sound Timer 0 0
8 55
Alat Suntik Sekali Pakai 10 ml 0 0 SD Syphilis 0 0
9 56
Auto Disposable Syringe (ADS) 0,05 0 0
10
Auto Disposable Syringe (ADS) 0,5 0 0
11
Auto Disposable Syringe (ADS) 5 ml 0 0
12
Catgut/Benang Bedah No.2/0-3/0 ( 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 0 0
14
Etanol 70 % 1.000 ml 0 0
15
Folley Catheter no 14 0 0
16
Folley Catheter no 16 0 0
17
Folley Catheter no 18 0 2
18
Infus set Anak 0 0
19
Infus set Dewasa 0 7
20
Iodina Test 0 1
21
Kassa Hidrofil Steril 16 x 16 1 4
22
Kapas Berlemak 500 gram 0 0
23
Kapas Pembalut / Adsorbens 250 g 0 0
24
Kassa Kompres 40 x 40 steril 0 0
25
Kassa Pembalut 2 m x 80 cm 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 c 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 5 5
28
Kertas Puyer 0 0
29
Lysol 1,000 ml 0 0
30
Masker 0 10
31
Plester 5 yard x 2 inchi 0 1
32
Pot Dahak 0 0
33
Rapid HIV 1 (SD HIV) 0 0
34
Rapid HIV 2 (Intec HIV) 0 0
35
Rapid HIV 2 (Biomeriux HIV) 0 0
36
Rapid Test Syphilis 0 0
37
RPR Test Syphilis 0 0
38
Silk( Benang Bedah Sutra ) No 3/0 0 4
39
Safety Box 0 0
40
Sarung tangan Steril No 6 0 0
41
 Sarung tangan Steril No 7 0 3
42
Sarung tangan Steril No 7,5 0 7
43
Sarung tangan Non Steril S 0 0
44
Sarung tangan Non Steril M 0 0
45
Sarung tangan Non Steril L 0 0
46
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 -
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 52 - 52
3
Ambroksol Tablet 30 mg Tablet 98 - 98
4
Ambroksol sirup 15 mg/5 ml Botol 3 10 13
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 30 - 30
8
Amlodipin Tablet 5 mg Tablet 10 - 10
9
Amlodipin Tablet 10 mg Tablet - - -
10
Amoksisillin Kapsul 250 mg Kapsul 49 100 149
11
Amoksisillin Kaplet 500 mg Kaplet 43 600 643
12 10 10
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 4 25 29
14 1
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 6 10
15 16
Ampisilin Kapsul 250 mg Kapsul 70 - 70
16
Ampisillin Kaplet 500 mg Tablet 42 - 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 1 10 11
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 125 600 30 20
22 725
Antasida Plus Tablet/TRIANTA Tablet 30 - 30
23
Antalgin (Metampiron) Tablet 500 mg Tablet - 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - 5
26 5
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam 2 -
28 Salisilat 3% 2
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol 4 - 4
30 1
Anti Diare Tablet/New Diaform Tablet 25 50 75
31
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet 30 - 30
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 59 200 259
34
Antispasmodik Tablet/SCOPMA Tablet 30 - 30
35
Antitusiva Sirup/DEXTROFEN SY Botol - 5 5
36
Antitusiva Tablet Tablet - -
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 500 562
39 10
Asam Mefenamat Kapsul 500 mg Kapsul - - -
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 4 - 4
44
Asiklovir Tablet 200 mg Tablet 95 - 95
45
Asiklovir Tablet 400 mg Tablet - 100 100
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet - - -
49
Betametason Krim 0,1 %- 5g Tube 3 6 9
50 1 1
Bisakodil suppositoria 10 mg/dulcolax Supp - - -
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 682 - 682
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 29 - 29
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet 40 - 40
62
Dimenhidrinat Tablet 50 mg Tablet 26 100 126
63 8
Domperidon Tablet 10 mg Tablet 104 - 104
64
Donperidon Suspensi 5 mg/5ml Botol 3 - 3
65
Efedrin Hcl Tablet 25 mg Tablet - - -
66
Ekstrak Belladone Tablet 10 mg Tablet - - -
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - - -
71
Etambutol Tablet 500 mg Tablet - - -
72
Etanol 70 % 100 ml Botol - - -
73
 Etil Klorida Semprot -100 ml Botol - - -
74
Eugenol Cairan -10 ml Botol - - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 50 50 100
76
Fenobarbital tablet 30 mg Tablet - - -
77
Fenobarbital injeksi 50 mg / ml Ampul - - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 55 - 55
81 10
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul - - -
82
Furosemid Tablet 40 mg Tablet 47 - 47
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat -
0,58 gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 42 42 6
Gemfibrozil Tablet 600 mg Tablet - - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - - -
86
Gentamisin Salep Kulit 0,1 % Tube 6 - 6
87
Glibenklamid Tablet 5 mg Tablet 100 - 100
88 10
Glimepiride 2 mg Tablet 10 - 10
89
Gliseril guayakolat tablet 100 mg Tablet 809 - 809
90 16
Gliseril Guayakolat sirup Botol - - -
91
Glukonas Kalsikus injeksi Ampul - - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol - - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 50 - 50
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet 60 - 60
97
Haloperidol Tablet 5 mg Tablet 45 100 145
98 5 10
Hidrokloritiazid 25 mg Tablet 21 - 21
99
Hidrokortison Krim 2,5 % Tube 5 15 20
100 2 1
Ibuprofen Tablet 200 mg Tablet 58 100 158
101 10
Ibuprofen Tablet 400 mg Tablet 16 - 16
102 20
Ibuprofen Suspensi 100 mg/5 ml Botol 3 - 3
103
Ichtyol salep Kulit Pot 3 - 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 -
105 ml - -
Isoniazid tablet 100 mg Tablet - - -
106
Isosorbid Dinitrat 5 mg Tablet - - -
107
Kalium Diklofenak Tablet 25 mg Tablet - - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 16 200 216
109
Kalsium Hidroksida Pasta Tube - - -
110
Kalsium Laktat Tablet 500 mg Tablet 116 - 116
111
Kaptopril 12,5 mg Tablet 31 300 331
112 40
Kaptopril 25 mg Tablet 22 - 22
113 20
 Karbamazepin Tablet 200 mg Tablet 25 30 55
114
Ketokonazole Krim 2 % - 15 gr Tube 2 - 2
115
Ketokonazole Tablet 200 mg Tablet 54 - 54
116
Ketoprofen Tablet 100 mg Tablet - - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
118
Ketorolac 10 mg injeksi Ampul - - -
119
Ketorolac 30 mg injeksi Ampul - - -
120
Klindamisin Kapsul 150 mg Kapsul - - -
121
Klindamisin Kapsul 300 mg Kapsul - - -
122
Kloramfenikol Kapsul 250 mg Kapsul 60 - 60
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 2 1 3
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol - - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 3 - 3
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 33 300 333
127 5 10
Klorpromazin Hcl Tablet Salut 25 mg Tablet - - -
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 56 100 156
129 5 10
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg -
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg -
132 43 43
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml -
133 6 6 1
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering
-
135 - -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 - -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5
gr, Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 - -
Lidokain injeksi 2 % Tablet - - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin
1 : 80.000-2 ml -
139 - -
Loperamid Tablet 2 mg Tablet - - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
142
Meloksikam tablet 15 mg Tablet 20 - 20
143
Meloksikam Suppositoria Supp - - -
144
Metformin Hcl Tablet 500 mg Tablet 80 100 180
145 10
 Methisoprinol 500 mg Tablet - - -
146
Metilergometrin Maleat (Metergin) Tablet 0,1 Tablet - - -
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet - - -
149
Metoklopramid 10 mg/xilastin Tablet 33 - 33
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
151
Metronidazol Tablet 250 mg Tablet 40 - 40
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul - - -
154
Mikonazole KrIm 2 % - 10 gr Tube 2 - 2
155
Multivitamin + Mineral tablet/HEMAFORT Tablet - - -
156
Multivitamin sirup/RECOVIT Botol - - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 146 - 146
158
Natrum Diklofenak Tablet 25 mg Tablet - - -
159
Natrium Diklofenak Tablet 50 mg Tablet 52 - 52
160
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161 -
Nipedifin Tablet 10 mg Tablet - 73
162 73 10
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 7
163 7
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 -
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 - -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 - -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 - -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 - -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 - -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 -
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 -
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 15 17
173 2
Obat Batuk Cair Sirup (Ekspektoran)/COREDRY Botol - -
174 -
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 5 9
175 4
Obat Flu Sirup/ FLUTOP-C Botol 5 10
176 5 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube - 2
178 2
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 -
Omeprazole Kapsul 20 mg Tablet 0 18
182 18
Ondansetron inj 4 mg/ 2 mL Ampul - 0 -
183
Parasetamol drops Botol - 0 -
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol (32) 70 38 1
185
Parasetamol Tablet 100 mg Tablet - 0 -
186
Parasetamol Tablet 500 mg Tablet (1,024) 2300 1,276 58 54
187
Pehacain injeksi Ampul - 0 -
188
 Perak Sulfadiazin krim 1 % 35 gr Tube - 0 -
189
Piracetam 400 mg Tablet - 0 -
190
Piracetam Tablet 800 mg Tablet - 0 -
191
Piroksikam Tablet 20 mg Tablet 40 0 40
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 51 400 451 6 20
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml - 1 1
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet - 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 20 0 20
199
Propilturasil Tablet 100 mg Tablet - 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul - 0 -
201
Ranitidin Tablet 150 mg Tablet 31 100 131
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet - 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet 80 0 80
208
Salbutamol Tablet 4 mg Tablet 13 50 63
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 - 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 4 0 4
Salisil bedak 2% -50 gr Kotak 1 10 11
212
Salep Luka Bakar/neocenta Tube - 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol - 3 3
214
Sefadroksil Tablet 500 mg Tablet 67 0 67
215
Sefiksim Kapsul 100 mg Kapsul 20 0 20
216
Sefotaksim Injeksi 1 gr Ampul - 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul - 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol - 0 -
219
Setirizin Tablet 10 mg Tablet 43 0 43 10
220
Setirizin Sirup 5 mg / 5 ml Botol 3 0 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B1 Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol - 0 -
224
Simetidin 200 mg Tablet Tablet 31 0 31
225
Simvastatin Tablet 10 mg Tablet 15 30 45
226
Siprofloksasin 500mg Tablet 8 20 28
227
Spironolakton Tablet 25 mg Tablet - 0 -
228
 Sulfacetamid Tetes Mata 15 %-5ml Botol - 2 2
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 - 40 40
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 - 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul - 0 -
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 76 400 476 16
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul - 0 -
238
Tramadol Tablet 50 mg Tablet - 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 12 60 72 20
240
Vitamin B .Komplek Tablet Tablet 43 100 143
241
Vitamin Neurotropik Tablet Tablet - 0 -
242
Zinc Tablet 20 mg Tablet 36 0 36
243
Prednisone 5 mg Tablet 15 100 115
244
flunax sy Botol - 0 -
245
vit k Set 22 100 100
246
Gentian Violet Botol - 0 -
247
Kloramfenikol 500 Tablet 90 0 90
248
Rivanol 300 ml Kotak - 2 2
249
Alkohol 70%100 ml - 1 1
250 Ampul
251 Tablet - -
252 Vial - -
- -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES - -
Abbocath No 18 ( IV Chateter 18 ) Buah - 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah - 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 2 20 22
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set - 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set - 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set - 0 -
11
Auto Disposable Syringe (ADS) 5 ml set - 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cro Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - 0 -
14
Etanol 70 % 1.000 ml Botol - 0 -
15
 Folley Catheter no 14 Set - 0 -
16
Folley Catheter no 16 Set - 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set - 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 4 0 4
22
Kapas Berlemak 500 gram Bungkus - 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - 0 -
24
Kassa Kompres 40 x 40 steril Bungkus - 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol 5 0 5
28
Kertas Puyer Pcs - 0 -
29
Lysol 1,000 ml Botol - 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs - 0 -
33
Rapid HIV 1 (SD HIV) Pcs - 0 -
34
Rapid HIV 2 (Intec HIV) Pcs - 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - 0 -
36
Rapid Test Syphilis Pcs - 0 -
37
RPR Test Syphilis Pcs - 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs - 0 -
40
Sarung tangan Steril No 6 Pcs - 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs - 0 -
44
Sarung tangan Non Steril M Pcs - 0 -
45
Sarung tangan Non Steril L Pcs - 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set - 0 -
48
Anuscopi Yamato Unit - 0 -
49
Kaca Slide Box - 0 -
50
Reagen Ziehl Nielson Kit - 0 -
51
Rotator Unit - 0 -
52
RTD Malaria Tes - 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - 0 -
54
Sound Timer Buah - 0 -
55
SD Syphilis Pcs - 0 -
56
 CATATAN HARIAN PEMAKAIAN O
Bulan : Agustus Tahun : 2017
JUMLAH PEMA

3 4 5 6 7 8 9 10 11 12 13

16
10
10 10
1 1 1

10 20

10
30 10 20 10 10 10 20 10

1 2 2 1 1 1 1

1 2

26 10 20 30 20 10 30 30

20

8 10 10
 10
10 5 10
6 6
1

10 20 10 10

12

1 1

10 10 5 8

10
30

10 10

12 6 6

10 35 10 10

5 5 10 10 20
7 7
3 1 1 1
10 10 10 10
10

20 10 10

8 10
20 10 30 10
10 10 20 10 10 10
 10

24 10 32 9 10 16

5 5 5 5 5 10

30 10
 6

8 12

1 1 1

1 1
2 2

1 4 3 1 1

52 20 20 25 76 30 36 70 40
 10

16 10 40 10 20 10

10 12

10
5

2 1 1 1

10 10 10

6
10
8
 1 1

18 16 20 5 10 30 10

10
6 30

11 10

1 2 1
 PEMAKAIAN OBAT
tus Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

14 15 16 17 18 19 20 21 22 23

10
20 10
1 1

10
10 50 30 20 40 30 38

2 2 1

2 1
10

1 1

20 30 30 10 20 40 30 20

10
 10
5 10 20

5 30 20 8

12

10

8 8
 6

14 10 10

10 5 15 7

1 2 1
10 20 30

10 18 10

10
20 20 10 20 20 10
 1 1

24 10 20 10 20 20 10 18

10 5 10

20
 10

20

1 3 1

2 1
1

4 2 1

50 80 70 50 20 50 62 40
 10 10

40 30 20 20 30 30 10

6 10 10

5 10

1 1 1

10
 10 10

50 40 20 10 20

10 15 10
6 10 17

1
1

2 2 1
1
 Jumlah Sisa Akhir
Pemakaian Bulan
24 25 26 27 28 29 30 31
0 -
0 100
10 30 22
10 60 38
1 2 8 5
0 -
0 20
30 -
10 10 -
0 -
10 30 119
30 10 20 40 40 30 528 115
0 -
1 3 1 1 1 22 7

1 2 1 2 12 4
10 60
0 42
0 -
0 -
0 -

2 1 1 7 4

20 20 10 30 38 10
554 171
20 10
40 -
0 -

4 1
0 -

1 1

0 -
1 3
38 37
0 170
 20 10
5 20 10 95 164
8 20 10
1 2 3
0 -
0 -
10 10 500 62
0 -
0 -
0 -
0 -
1 3
12 83
12 88
0 -
0 -
0 -
1 1 7 2
0 -
0 -
0 30
0 2
10 10 10 73 609
0 -
0 29
0 -
0 -
0 -
0 46
0 40
30 96
0 104
0 3
0 -
0 -

0 5
0 -
0 -
0 -
0 -
0 -
 0 -
0 -
30 60 40
0 -
0 -
0 100
0 70
30 25
0 -
10 13 34

6 42 -
0 -
0 -
0 6
10 90
0 10
6 6 10 13 150 659
0 -
0 -
0 1
0 -
0 50
0 80
0 60
10 15 5 132 13
14 7
1 1 15 5
10 10 6 20 158 -
16 -
0 3
0 3

0 -
0 -
0 -
0 -
8 10 20 20 30 16 182 34
0 -
28 88
10 10 10 20 10 10 280 51
22 -
 30 40 15
0 2
0 54
0 -
0 -
0 -
0 -
0 -
0 -
0 60
1 3 -
0 -
1 1 2
3 10 6 20 10 3 300 33
0 -
10 5 5 95 61
0 -

0 12

10 10 33

2 6 -
0 34

0 -

0 -

0 -
0 -

0 -
0 -
0 40
0 -
0 20
0 -
20 90 90
 0 -
0 -
0 4
0 -
5 21 12
0 -
10 10 30
0 30
0 -
0 2
0 -
0 -
8 138
0 -
10 36 16
0 -
30 43
0 7
0 50
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
1 1 3 3 16 1
0 -
1 1 1 8 1
1 1 1 9 1
0 -
1 1 1 1
0 2
0 9
0 -
0 18
0 -
0 -
2 3 1 1 6 3 3 37 1
0 -
44 30 60 50 46 36 48 1217 59
0 -
 0 -
0 -
0 -
30 10
0 80
25 20 30 20 407 44

1 -
0 2
0 1
0 -
0 20
0 -
0 -
20 10 78 53
0 -
0 186
0 40
0 -
0 3
10 70
10 30 33

0 -

0 4
1 1 10 1
0 -
1 1 1 2 1
0 67
10 10 10
0 -
0 -
0 -
10 43 -
0 3
0 19
0 10
0 -
10 16 15
10 10 30 15
10 28 -
0 -
 2 -

10 10 40 -

0 -
0 -
0 -
0 90
0 -
10 20 20 20 20 18 12 385 91
0 80
0 -
0 -
10 72 -
30 6 12 17 10 143 -
0 -
0 36
30 85
0 -
30 70
0 -
0 90
1 2 -
1 -
0 -
0 -
0 -
0 -
0 -
0 10
0 -
0 -
0 17
0 3
2 1 12 10
0 3
0 -
0 -
0 -
0 -
0 2
0 -
0 -
 0 -
0 -
0 2
0 -
0 7
0 1
1 1 3
0 -
0 -
0 -
0 2
0 1
5 -
0 -
0 -
0 10
0 1
0 -
0 -
0 -
0 -
0 -
0 -
0 4
0 -
0 -
0 3
0 7
0 -
0 -
0 -
0 2
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
 STOK HARIAN BULAN AGUSTUS TAHUN 2017
NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Air Raksa Dental Use Botol 0 0 -
2 Albendazole Tablet 400 mg Tablet 0 0 100
3 Alopurinol Tablet 100 mg Tablet 0 30 22
4 Ambroksol Tablet 30 mg Tablet 60 0 38
5 Ambroksol sirup 15 mg/5 ml Botol 8 0 5
6 Aminofillin Injeksi 24 mg/ml-10 ml Ampul 0 0 -
7 Aminofillin Tablet 200 mg Tablet 0 0 20
8 Amitriptillin Hcl Tablet Salut 25 mg Tablet 0 30 -
9 Amlodipin Tablet 5 mg Tablet 10 0 -
10 Amlodipin Tablet 10 mg Tablet 0 0 -
11 Amoksisillin Kapsul 250 mg Kapsul 0 30 119
12 Amoksisillin Kaplet 500 mg Kaplet 528 0 115
13 Amoksisillin Serbuk Injeksi 1000 mg vial 0 0 -
14 Amoksisillin Sirup Kering 125 mg/5ml Botol 22 0 7
15 Amoksisillin Double Strengh Sirup Kering Botol 12 0 4
16 Ampisilin Kapsul 250 mg Kapsul 10 0 60
17 Ampisillin Kaplet 500 mg Tablet 0 0 42
18 Ampisilin Sirup 125 mg / 5 ml Botol 0 0 -
19 Ampisillin Injeksi 1000 mg Vial 0 0 -
20 Analgetik Plus Tablet 0 0 -
21 Antasida Doen Suspensi Kombinasi : Mag Botol 7 0 4
22 Antasida Doen Tablet, Kombinasi : Magn Tablet 554 0 171
23 Antasida Plus Tablet Tablet 20 0 10
24 Antalgin (Metampiron) Tablet 500 mg Tablet 40 0 -
25 Antalgin Injeksi 250 mg/ml-2ml Ampul 0 0 -
26 Anti Bakteri DOEN Salep Kombinasi : Tube 4 0 1
27 Anti Hemoroid Doen komb Supp 0 0 -
28 Anti Fungi DOEN Kombinasi : Pot 1 0 1
29 Antimigren DOEN Kombinasi : Tablet 0 0 -
30 Anti Diare Suspensi Botol 1 0 3
31 Anti Diare Tablet Tablet 0 38 37
32 Anti Dotum Oral Tablet Tablet 0 0 170
33 Anti Hipertensi Kapsul Tablet 20 0 10
34 Antihistamin Tablet kombinasi Tablet 95 0 164
35 Antispasmodik Tablet Tablet 20 0 10
36 Antitusiva Sirup Botol 2 0 3
37 Antitusiva Tablet Tablet 0 0 -
38 Asam Folat Tablet 1 mg Tablet 0 0 -
39 Asam Askorbat 50 mg Tablet 500 0 62
40 Asam Mefenamat Kapsul 500 mg Kapsul 0 0 -
41 Asetosal 80 mg Tablet 0 0 -
42 Asetosal Tablet 100 mg Tablet 0 0 -
43 Asetosal Tablet 500 mg Tablet 0 0 -
44 Asiklovir Krim 5 % Tube 1 0 3
45 Asiklovir Tablet 200 mg Tablet 12 0 83
46 Asiklovir Tablet 400 mg Tablet 12 0 88
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul 0 0 -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 mVial 0 0 -
49 Betahistin Mesilat 6 mg Tablet 0 0 -
50 Betametason Krim 0,1 %- 5g Tube 7 0 2
51 Bisakodil suppositoria 10 mg Supp 0 0 -
52 Bisoprolol Tablet 5 mg Tablet 0 0 -
53 Bromheksin 8 mg Tablet 0 0 30
54 Deksametason Injeksi 5mg/ml-1ml Ampul 0 0 2
55 Deksametason Tablet 0,5 mg Tablet 73 0 609
56 Devitalisasi Pasta (Non Arsen) Botol 0 0 -
57 Diazepam tablet 2 mg Tablet 0 0 29
58 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul 0 0 -
59 Diazepam Larutan Rektal 5 mg/ml Supp 0 0 -
60 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 0 0 -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 0 0 46
62 Digoksin Tablet 0,25 mg Tablet 0 0 40
63 Dimenhidrinat Tablet 50 mg Tablet 30 0 96
64 Domperidon Tablet 10 mg Tablet 0 0 104
65 Donperidon Suspensi 5 mg/5ml Botol 0 0 3
66 Efedrin Hcl Tablet 25 mg Tablet 0 0 -
67 Ekstrak Belladone Tablet 10 mg Tablet 0 0 -
68 Epinefrin HCl / Bitartrat Ampul 0 0 5
69 Eritromisin Kapsul 250 mg Kapsul 0 0 -
70 Eritromisin Kapsul 500 mg Kapsul 0 0 -
71 Eritromisin Sirup 200 mg / 5 ml Botol 0 0 -
72 Etambutol Tablet 500 mg Tablet 0 0 -
73 Etanol 70 % 100 ml Botol 0 0 -
74 Etil Klorida Semprot -100 ml Botol 0 0 -
75 Eugenol Cairan -10 ml Botol 0 0 -
76 Fenitoin Natrium Kapsul 100 mg Kapsul 0 60 40
77 Fenobarbital tablet 30 mg Tablet 0 0 -
78 Fenobarbital injeksi 50 mg / ml Ampul 0 0 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 0 0 100
80 Fenoksimeti Penisilin 500 mg tablet Tablet 0 0 70
81 Fitomenadion tablet 10 mg Tablet 30 0 25
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mlAmpul 0 0 -
83 Furosemid Tablet 40 mg Tablet 13 0 34
84 Garam Oralit I serbuk, kombinasi : Kantong 42 0 -
85 Gemfibrozil Tablet 600 mg Tablet 0 0 -
86 Gentamisin injeksi 80 mg / 2 ml Vial 0 0 -
87 Gentamisin Salep Kulit 0,1 % Tube 0 0 6
88 Glibenklamid Tablet 5 mg Tablet 10 0 90
89 Glimepiride 2 mg Tablet 0 0 10
90 Gliseril guayakolat tablet 100 mg Tablet 150 0 659
91 Gliseril Guayakolat sirup Botol 0 0 -
92 Glukonas Kalsikus injeksi Ampul 0 0 -
93 Glukosa Larutan Infus 5 % Botol 0 0 1
 94 Glukosa Larutan Infus10 % Botol 0 0 -
95 Griseofulvin Tablet 125 mg,micronized Tablet 0 0 50
96 Haloperidol Tablet 0,5 mg Tablet 0 0 80
97 Haloperidol Tablet 1,5 mg Tablet 0 0 60
98 Haloperidol Tablet 5 mg Tablet 132 0 13
99 Hidrokloritiazid 25 mg Tablet 14 0 7
100 Hidrokortison Krim 2,5 % Tube 15 0 5
101 Ibuprofen Tablet 200 mg Tablet 0 158 -
102 Ibuprofen Tablet 400 mg Tablet 16 0 -
103 Ibuprofen Suspensi 100 mg/5 ml Botol 0 0 3
104 Ichtyol salep Kulit Pot 0 0 3
105 Ipatropium Bromide + Salbutamol Vial 0 0 -
106 Isoniazid tablet 100 mg Tablet 0 0 -
107 Isosorbid Dinitrat 5 mg Tablet 0 0 -
108 Kalium Diklofenak Tablet 25 mg Tablet 0 0 -
109 Kalium Diklofenak Tablet 50 mg Tablet 182 0 34
110 Kalsium Hidroksida Pasta Tube 0 0 -
111 Kalsium Laktat Tablet 500 mg Tablet 28 0 88
112 Kaptopril 12,5 mg Tablet 280 0 51
113 Kaptopril 25 mg Tablet 22 0 -
114 Karbamazepin Tablet 200 mg Tablet 40 0 15
115 Ketokonazole Krim 2 % - 15 gr Tube 0 0 2
116 Ketokonazole Tablet 200 mg Tablet 0 0 54
117 Ketoprofen Tablet 100 mg Tablet 0 0 -
118 Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 0 -
119 Ketorolac 10 mg injeksi Ampul 0 0 -
120 Ketorolac 30 mg injeksi Ampul 0 0 -
121 Klindamisin Kapsul 150 mg Kapsul 0 0 -
122 Klindamisin Kapsul 300 mg Kapsul 0 0 -
123 Kloramfenikol Kapsul 250 mg Kapsul 0 0 60
124 Kloramfenikol Salep Mata 1%-3,5 g Tube 3 0 -
125 Kloramfenikol Tetes Mata -5 ml Botol 0 0 -
126 Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 0 2
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 300 0 33
128 Klorpromazin Hcl Tablet Salut 25 mg Tablet 0 0 -
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 95 0 61
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 0 -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi :Tablet 0 0 12
132 Kotrimoksazol Tablet, Kombinasi : Tablet 0 10 33
133 Kotrimoksazol Suspensi Kombinasi : Botol 6 0 -
134 Lansoprazole 30 mg Kapsul Tablet 0 0 34
135 Larutan mengadung Elektrolit (Na 130 mEqBotol 0 0 -
136 Larutan mengadung Elektrolit (Nacl 1,125 grBotol 0 0 -
137 Larutan mengadung Karbohidrat + ElektrolitBotol 0 0 -
138 Lidokain injeksi 2 % Tablet 0 0 -
139 Lidokain Komp Injeksi, Kombinasi : Ampul 0 0 -
140 Loperamid Tablet 2 mg Tablet 0 0 -
141 Loratadin tablet 10 mg Tablet 0 0 40
142 Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 0 -
143 Meloksikam tablet 15 mg Tablet 0 0 20
144 Meloksikam Suppositoria Supp 0 0 -
145 Metformin Hcl Tablet 500 mg Tablet 90 0 90
146 Methisoprinol 500 mg Tablet 0 0 -
147 Metilergometrin Maleat (Metergin) TabletTablet 0 0 -
148 Metilergometrin Maleat Injeksi 0,200 mg- Ampul 0 0 4
149 Metilprednisolon tablet 4 mg Tablet 0 0 -
150 Metoklopramid 10 mg Tablet 21 0 12
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 0 -
152 Metronidazol Tablet 250 mg Tablet 10 0 30
153 Metronidazole Tablet 500 mg Tablet 0 0 30
154 Metronidazole Infus 500 mg /100 ml Ampul 0 0 -
155 Mikonazole KrIm 2 % - 10 gr Tube 0 0 2
156 Multivitamin + Mineral tablet Tablet 0 0 -
157 Multivitamin sirup Botol 0 0 -
158 Natrium Bikarbonat Tablet 500 mg Tablet 8 0 138
159 Natrum Diklofenak Tablet 25 mg Tablet 0 0 -
160 Natrium Diklofenak Tablet 50 mg Tablet 0 36 16
161 Natrium Klorida Larutan infus 0,9%-Steril Botol 0 0 -
162 Nipedifin Tablet 10 mg Tablet 30 0 43
163 Nistatin 100.000 IU/gram Tablet Vagina Tablet 0 0 7
164 Nistatin 500.000 IU/gram Tablet Salut Tablet 0 0 50
165 Obat Antitiuberkolosis Kategori Anak Paket 0 0 -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Paket 0 0 -
167 Obat Antitiuberkolosis Kategori 2 Dewasa Paket 0 0 -
168 Obat Antitiuberkolosis Kategori 3 Dewasa Paket 0 0 -
169 Obat Anti Tuberkulosis FDC Kat Anak Paket 0 0 -
170 Obat Anti Tuberkulosis FDC Kat I & II Paket 0 0 -
171 Obat Anti Tuberkulosis FDC Kat I & III Paket 0 0 -
172 Obat Anti Tuberkolosis FDC Sisipan DewasaPaket 0 0 -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 16 0 1
174 Obat Batuk Cair Sirup (Ekspektoran) Botol 0 0 -
175 Obat Batuk Hitam Plus Sirup Botol 8 0 1
176 Obat Flu Sirup Botol 0 9 1
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 Vial 0 0 -
178 Oksiterasiklin Salep Mata 1%-3,5g Tube 1 0 1
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 0 0 2
180 Oksitosin Injeksi 10 IU/ml-1ml Ampul 0 0 9
181 Omeprazole injeksi 40mg/10ml Ampul 0 0 -
182 Omeprazole Kapsul 20 mg Tablet 0 0 18
183 Ondansetron inj 4 mg/ 2 mL Ampul 0 0 -
184 Parasetamol drops Botol 0 0 -
185 Parasetamol Sirup 120 mg/5ml-60 ml Botol 37 0 1
186 Parasetamol Tablet 100 mg Tablet 0 0 -
187 Parasetamol Tablet 500 mg Tablet 1217 0 59
188 Pehacain injeksi Ampul 0 0 -
189 Perak Sulfadiazin krim 1 % 35 gr Tube 0 0 -
190 Piracetam 400 mg Tablet 0 0 -
191 Piracetam Tablet 800 mg Tablet 0 0 -
192 Piroksikam Tablet 20 mg Tablet 30 0 10
193 Pirantel Pamoat Tablet 365 mg (Setara dngTablet 0 0 80
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 407 0 44
195 Polikresulen (Kondensasi Metakresol Botol 1 0 -
196 Povidon Iodida 10% 30 ml Botol 0 0 2
197 Povidon Iodida 10% 300 ml Botol 0 0 1
198 Primakuin tablet 15 mg Tablet 0 0 -
199 Propanolol Hcl Tablet 40 mg Tablet 0 0 20
200 Propilturasil Tablet 100 mg Tablet 0 0 -
201 Ranitidin Injeksi 25 mg / ml Ampul 0 0 -
202 Ranitidin Tablet 150 mg Tablet 78 0 53
203 Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 0 -
204 Retinol (Vit.A) 200.000 IU Kapsul Kapsul 0 0 186
205 Reserpin Tablet 0, 25 mg Tablet 0 0 40
206 Rifampisin Tablet 450 mg Tablet 0 0 -
207 Ringer Laktat Larutan Infus Steril 500 ml Botol 0 0 3
208 Salbutamol Tablet 2 mg Tablet 10 0 70
209 Salbutamol Tablet 4 mg Tablet 30 0 33
210 Salbutamol solution for Inhalation single doAmpul 0 0 -
211 Salep 2-4 Kombinasi : Pot 0 0 4
212 Salisil bedak 2% -50 gr Kotak 10 0 1
213 Salep Luka Bakar Tube 0 0 -
214 Sefadroksil Sirup Kering 125 mg / 5 ml siruBotol 2 0 1
215 Sefadroksil Tablet 500 mg Tablet 0 0 67
216 Sefiksim Kapsul 100 mg Kapsul 0 10 10
217 Sefotaksim Injeksi 1 gr Ampul 0 0 -
218 Seftriakson Injeksi 1 gr / vial Ampul 0 0 -
219 Semen Seng Fosfat Serbuk & Cairan Botol 0 0 -
220 Setirizin Tablet 10 mg Tablet 0 43 -
221 Setirizin Sirup 5 mg / 5 ml Botol 0 0 3
222 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul 0 0 19
223 Sianokobalamin Tablet 50 mcg Tablet 0 0 10
224 Silver Amalgam Serbuk 65-75% Botol 0 0 -
225 Simetidin 200 mg Tablet Tablet 16 0 15
226 Simvastatin Tablet 10 mg Tablet 30 0 15
227 Siprofloksasin 500mg Tablet 0 28 -
228 Spironolakton Tablet 25 mg Tablet 0 0 -
229 Sulfacetamid Tetes Mata 15 %-5ml Botol 2 0 -
230 Tablet Tambah Darah Kombinasi: Tablet 40 0 -
231 Temporary Stopping Fletcher (Fletcher) Se Set 0 0 -
232 Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 0 -
233 Tetrasiklin Kapsul 250 mg Kapsul 0 0 -
234 Tetrasiklin Kapsul 500 mg Kapsul 0 0 90
235 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1mlAmpul 0 0 -
236 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 Tablet 0 386 91
237 Thiamfenikol Kapsul 500 mg Kapsul 0 0 80
 238 Tramadol Injeksi 50 mg/ ml Ampul 0 0 -
239 Tramadol Tablet 50 mg Tablet 0 0 -
240 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 72 0 -
241 Vitamin B .Komplek Tablet Tablet 0 143 -
242 Vitamin Neurotropik Tablet Tablet 0 0 -
243 Zinc Tablet 20 mg Tablet 0 30 36
244 Prednisone 54mg Tablet 30 0 85
245 flunax sy Botol 0 0 -
246 vit k tablet 30 0 70
247 gentian violet Botol 0 0 -
248 kloramfenikol 500 Tablet 0 0 90
249 Rivanol 300 ml Botol 2 0 -
250 Alkohol 70%100 ml Botol 1 0 -

no B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES

NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
2 Abbocath No 20 ( IV Chateter 20 ) Buah 0 0 10
3 Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
4 Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
5 Alat Suntik Sekali Pakai 10 ml Set 0 0 17
6 Alat Suntik Sekali Pakai 1 ml Set 0 0 3
7 Alat Suntik Sekali Pakai 2,5 ml Set 0 0 10
8 Alat Suntik Sekali Pakai 5 ml Set 12 0 3
9 Alat Suntik Sekali Pakai 10 ml Set 0 0 -
10 Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
11 Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
12 Auto Disposable Syringe (ADS) 5 ml set 0 0 -
13 Catgut/Benang Bedah No.2/0-3/0 (Plain & Sachet 0 0 2
14 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
15 Etanol 70 % 1.000 ml Botol 0 0 -
16 Folley Catheter no 14 Set 0 0 -
17 Folley Catheter no 16 Set 0 0 -
18 Folley Catheter no 18 Set 0 0 2
19 Infus set Anak Set 0 0 -
20 Infus set Dewasa Set 0 0 7
21 Iodina Test Botol 0 0 1
22 Kassa Hidrofil Steril 16 x 16 Kotak 0 0 3
23 Kapas Berlemak 500 gram Bungkus 1 0 -
24 Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
25 Kassa Kompres 40 x 40 steril Bungkus 0 0 -
26 Kassa Pembalut 2 m x 80 cm Rol 0 0 2
27 Kassa Pembalut Hidrofil 4 m x 3 cm Rol 0 0 1
28 Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 0 -
29 Kertas Puyer Pcs 5 0 -
30 Lysol 1,000 ml Botol 0 0 -
31 Masker Buah 0 0 10
32 Plester 5 yard x 2 inchi Rol 0 0 1
33 Pot Dahak Pcs 0 0 -
34 Rapid HIV 1 (SD HIV) Pcs 0 0 -
35 Rapid HIV 2 (Intec HIV) Pcs 0 0 -
36 Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
37 Rapid Test Syphilis Pcs 0 0 -
38 RPR Test Syphilis Pcs 0 0 -
39 Silk( Benang Bedah Sutra ) No 3/0 Sachet 0 0 4
40 Safety Box Pcs 0 0 -
41 Sarung tangan Steril No 6 Pcs 0 0 -
42 Sarung tangan Steril No 7 Pcs 0 0 3
43 Sarung tangan Steril No 7,5 Pcs 0 0 7
44 Sarung tangan Non Steril S Pcs 0 0 -
45 Sarung tangan Non Steril M Pcs 0 0 -
46 Sarung tangan Non Steril L Pcs 0 0 -
47 Urine Bag set 0 0 2
48 Wing Neddle No 23 Set 0 0 -
49 Anuscopi Yamato Unit 0 0 -
50 Kaca Slide Box 0 0 -
51 Reagen Ziehl Nielson Kit 0 0 -
52 Rotator Unit 0 0 -
53 RTD Malaria Tes 0 0 -
54 Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
55 Sound Timer Buah 0 0 -
56 SD Syphilis Pcs 0 0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 -
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 22 100 122
3
Ambroksol Tablet 30 mg Tablet 38 100 138
4
Ambroksol sirup 15 mg/5 ml Botol 5 - 5
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet - 100 100
8
Amlodipin Tablet 5 mg Tablet - 90 90
9
Amlodipin Tablet 10 mg Tablet - 60 60
10
Amoksisillin Kapsul 250 mg Kapsul 119 - 119
11
Amoksisillin Kaplet 500 mg Kaplet 115 600 715
12 20
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 7 5 12
14 1
Amoksisillin Double Strengh Sirup Kering Botol
250 mg/5 ml 4 10
15 14
Ampisilin Kapsul 250 mg Kapsul 60 - 60
16
Ampisillin Kaplet 500 mg Tablet 42 - 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 4 15 19 1
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 171 700 30
22 871
Antasida Plus Tablet/TRIANTA Tablet 10 100 110
23
Antalgin (Metampiron) Tablet 500 mg Tablet - 40 40
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - -
26 -
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + 1 -
28 Asam Salisilat 3% 1
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + - -
29 Kofein 50 mg -
Anti Diare Suspensi/Novadiar Botol 3 - 3
30
Anti Diare Tablet/New Diaform Tablet 37 50 87
31 10
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet - - -
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 164 100 264
34
Antispasmodik Tablet/SCOPMA Tablet 10 100 110
35
Antitusiva Sirup/DEXTROFEN SY Botol 3 - 3
36
Antitusiva Tablet Tablet - -
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 500 562
39 6
Asam Mefenamat Kapsul 500 mg Kapsul - - -
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 3 - 3
44
Asiklovir Tablet 200 mg Tablet 83 - 83
45
Asiklovir Tablet 400 mg Tablet 88 - 88
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet - - -
49
Betametason Krim 0,1 %- 5g Tube 2 5 7
50
Bisakodil suppositoria 10 mg/dulcolax Supp - - -
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 609 - 609
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 29 - 29
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet 40 - 40
62
Dimenhidrinat Tablet 50 mg Tablet 96 - 96
63
Domperidon Tablet 10 mg Tablet 104 - 104
64
Donperidon Suspensi 5 mg/5ml Botol 3 - 3
65
Efedrin Hcl Tablet 25 mg Tablet - - -
66
Ekstrak Belladone Tablet 10 mg Tablet - - -
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - - -
71
Etambutol Tablet 500 mg Tablet - - -
72
Etanol 70 % 100 ml Botol - - -
73
 Etil Klorida Semprot -100 ml Botol - - -
74
Eugenol Cairan -10 ml Botol - - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 40 - 40
76
Fenobarbital tablet 30 mg Tablet - - -
77
Fenobarbital injeksi 50 mg / ml Ampul - - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 25 - 25
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul - - -
82
Furosemid Tablet 40 mg Tablet 34 - 34
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr,
Kalium Klorida 0,30 gr, Trinatrium Sitrat 100
dihidrat 0,58 gr, Glukosa Anhidrat 2,70 g )
200 ml Air
84 - 100 6
Gemfibrozil Tablet 600 mg Tablet - - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - - -
86
Gentamisin Salep Kulit 0,1 % Tube 6 - 6
87
Glibenklamid Tablet 5 mg Tablet 90 - 90
88
Glimepiride 2 mg Tablet 10 - 10
89
Gliseril guayakolat tablet 100 mg Tablet 659 - 659
90 10
Gliseril Guayakolat sirup Botol - - -
91
Glukonas Kalsikus injeksi Ampul - - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol - - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 50 - 50
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet 60 - 60
97
Haloperidol Tablet 5 mg Tablet 13 57 70
98
Hidrokloritiazid 25 mg Tablet 7 - 7
99
Hidrokortison Krim 2,5 % Tube 5 10 15
100
Ibuprofen Tablet 200 mg Tablet - 200 200
101
Ibuprofen Tablet 400 mg Tablet - 100 100
102
Ibuprofen Suspensi 100 mg/5 ml Botol 3 - 3
103
Ichtyol salep Kulit Pot 3 - 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation -
105 2,5 ml - -
Isoniazid tablet 100 mg Tablet - - -
106
Isosorbid Dinitrat 5 mg Tablet - - -
107
Kalium Diklofenak Tablet 25 mg Tablet - - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 34 150 184
109
Kalsium Hidroksida Pasta Tube - - -
110
Kalsium Laktat Tablet 500 mg Tablet 88 - 88
111
Kaptopril 12,5 mg Tablet 51 28 79
112 17
Kaptopril 25 mg Tablet - 100 100
113
 Karbamazepin Tablet 200 mg Tablet 15 100 115
114
Ketokonazole Krim 2 % - 15 gr Tube 2 1 3
115
Ketokonazole Tablet 200 mg Tablet 54 - 54
116
Ketoprofen Tablet 100 mg Tablet - - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
118
Ketorolac 10 mg injeksi Ampul - - -
119
Ketorolac 30 mg injeksi Ampul - - -
120
Klindamisin Kapsul 150 mg Kapsul - - -
121
Klindamisin Kapsul 300 mg Kapsul - - -
122
Kloramfenikol Kapsul 250 mg Kapsul 60 - 60
123
Kloramfenikol Salep Mata 1%-3,5 g Tube - 2 2
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol - - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 2 - 2
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 33 500 533
127 10
Klorpromazin Hcl Tablet Salut 25 mg Tablet - - -
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 61 100 161
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi : Sulfametoksazol
100 mg + Trimetroprim 20 mg -

131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg 100
132 33 133 12
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 5
133 - 5
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 Botol
mEq,Cl 109 mEq, Asetat 28 mEq) /Asering
-
135 - -
Larutan mengadung Elektrolit (Nacl 1,125 Botol
gr , Dekstrosa 18,75 gr) -
136 - -
Larutan mengadung Karbohidrat + Botol
Elektrolit (Nacl
1,75 gr, KCL 1,5 gr, Na Lactat 2,24 gr, -
Dekstrosa 27 gr)
137 - -
Lidokain injeksi 2 % Tablet - - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml -
139 - -
Loperamid Tablet 2 mg Tablet - - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
142
Meloksikam tablet 15 mg Tablet 20 - 20
143
Meloksikam Suppositoria Supp - - -
144
 Metformin Hcl Tablet 500 mg Tablet 90 - 90
145
Methisoprinol 500 mg Tablet - - -
146
Metilergometrin Maleat (Metergin) Tablet 0 Tablet - - -
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet - 100 100
149
Metoklopramid 10 mg/xilastin Tablet 12 100 112
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
151
Metronidazol Tablet 250 mg Tablet 30 - 30
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul - - -
154
Mikonazole KrIm 2 % - 10 gr Tube 2 3 5
155
Multivitamin + Mineral tablet/HEMAFORT Tablet - - -
156
Multivitamin sirup/RECOVIT Botol - - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 138 - 138
158
Natrum Diklofenak Tablet 25 mg Tablet - - -
159
Natrium Diklofenak Tablet 50 mg Tablet 16 100 116
160
Natrium Klorida Larutan infus 0,9%-Steril 50 Botol - -
161 -
Nipedifin Tablet 10 mg Tablet - 43
162 43
Nistatin 100.000 IU/gram Tablet Vagina Tablet 5 12
163 7
Nistatin 500.000 IU/gram Tablet Salut Tablet - 50
164 50
Obat Antitiuberkolosis Kategori Anak Paket - -
165 -
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 - -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 - -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 - -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 - -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 - -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 -
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 -
Obat Batuk Hitam (OBH) Cairan 100 ml/BERL Botol 6 7
173 1
Obat Batuk Cair Sirup (Ekspektoran)/CORED Botol - -
174 -
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 10 11
175 1
Obat Flu Sirup/ FLUTOP-C Botol 15 16
176 1 2
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 m Vial - -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube - 1
178 1
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 -
Omeprazole Kapsul 20 mg Tablet 0 18
182 18
Ondansetron inj 4 mg/ 2 mL Ampul - 0 -
183
Parasetamol drops Botol - 0 -
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 1 10 11
185
Parasetamol Tablet 100 mg Tablet - 0 -
186
Parasetamol Tablet 500 mg Tablet 59 4100 4,159 50
187
 Pehacain injeksi Ampul - 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube - 0 -
189
Piracetam 400 mg Tablet - 0 -
190
Piracetam Tablet 800 mg Tablet - 0 -
191
Piroksikam Tablet 20 mg Tablet 10 100 110
192
Pirantel Pamoat Tablet 365 mg (Setara dng Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 44 500 544 10
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal)
195 360 mg/g-10 ml - 1 1
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet - 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 20 0 20
199
Propilturasil Tablet 100 mg Tablet - 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul - 0 -
201
Ranitidin Tablet 150 mg Tablet 53 100 153 10
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet - 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet - 0 -
208
Salbutamol Tablet 4 mg Tablet 33 100 133
209
Salbutamol solution for Inhalation single Ampul
dose units 2,5 ml
210 - 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 %
+ Belerang Endap 4 % - 30 gram
211 4 0 4
Salisil bedak 2% -50 gr Kotak 1 10 11 1
212
Salep Luka Bakar/neocenta Tube - 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 1 5 6
214
Sefadroksil Tablet 500 mg Tablet 67 0 67
215
Sefiksim Kapsul 100 mg Kapsul 10 10 20
216
Sefotaksim Injeksi 1 gr Ampul - 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul - 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol - 0 -
219
Setirizin Tablet 10 mg Tablet - 43 43
220
Setirizin Sirup 5 mg / 5 ml Botol 3 0 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol - 0 -
224
Simetidin 200 mg Tablet Tablet 15 100 115
225
Simvastatin Tablet 10 mg Tablet 15 30 45 10
226
Siprofloksasin 500mg Tablet - 100 100
227
 Spironolakton Tablet 25 mg Tablet - 100 100
228
Sulfacetamid Tetes Mata 15 %-5ml Botol - 0 -
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 - 0 -
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 - 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul - 0 -
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 m Tablet 91 400 491 10
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul - 0 -
238
Tramadol Tablet 50 mg Tablet - 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet - 100 100
240
Vitamin B .Komplek Tablet Tablet - 200 200 26
241
Vitamin Neurotropik Tablet Tablet - 0 -
242
Zinc Tablet 20 mg Tablet 36 0 36
243
Prednisone 5 mg Tablet 85 0 85
244
flunax sy Botol - 0 -
245
vit k Set 70 0 100
246
Gentian Violet Botol - 0 -
247
Kloramfenikol 500 Tablet 90 0 90
248
Rivanol 300 ml Kotak - 0 -
249
Alkohol 70%100 ml - 0 -
250 Ampul
251 Tablet - -
252 Vial - -
- -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES - -
Abbocath No 18 ( IV Chateter 18 ) Buah - 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah - 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 10 0 10 1
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set - 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set - 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set - 0 -
11
Auto Disposable Syringe (ADS) 5 ml set - 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & C Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - 0 -
14
 Etanol 70 % 1.000 ml Botol - 1 1
15
Folley Catheter no 14 Set - 0 -
16
Folley Catheter no 16 Set - 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set - 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 3 2 5
22
Kapas Berlemak 500 gram Bungkus - 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - 0 -
24
Kassa Kompres 40 x 40 steril Bungkus - 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol - 5 5
28
Kertas Puyer Pcs - 0 -
29
Lysol 1,000 ml Botol - 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs - 0 -
33
Rapid HIV 1 (SD HIV) Pcs - 0 -
34
Rapid HIV 2 (Intec HIV) Pcs - 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - 0 -
36
Rapid Test Syphilis Pcs - 0 -
37
RPR Test Syphilis Pcs - 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs - 0 -
40
Sarung tangan Steril No 6 Pcs - 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs - 0 -
44
Sarung tangan Non Steril M Pcs - 0 -
45
Sarung tangan Non Steril L Pcs - 100 100
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set - 0 -
48
Anuscopi Yamato Unit - 0 -
49
Kaca Slide Box - 0 -
50
Reagen Ziehl Nielson Kit - 0 -
51
Rotator Unit - 0 -
52
RTD Malaria Tes - 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - 0 -
54
Sound Timer Buah - 0 -
55
SD Syphilis Pcs - 0 -
56
supraptul/bioplacenton tule lembar - 1 1
57
 CATATAN HARIAN PEMAKAIA
Bulan : September Tahun : 2
JUMLAH PE

3 4 5 6 7 8 9 10 11 12

10
1

20 10 10
60 80 40 30 20 10

2 2

1 1 2 1

40 30 40 10 60 10 40 20

10

20 10
10 55 10 20 10
10 6 6
1

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20 10

1
10

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10 20 6 10 6

8
10
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5 10 20

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10 20 6

10 10 8 12 16

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12
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10 6 15

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3 1

64 126 82 96 70 77 25
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10 26 10 20 20 20

16 8

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10 6 6

10
 10

10 32 10 50 26 8 5 8

10 10
10 30 12 15 20 6 21 6

10 6 4 10

1 2 1
1
HARIAN PEMAKAIAN OBAT
: September Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

13 14 15 16 17 18 19 20 21 22

10 10 20
18 10

10 20
30
10
40 40 20 60 20 10 40

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30 50 10 20 16 30 60 50

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8 10
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66 10 20 40 30 46 45 58
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5 10

1
1 1 1 1

10

10 10
10
 10

10 10 10 20 10

10
26 14 3 10 12 6 34 32

12 30 20 6 5

1 1
 Jumlah
Pemakaian
23 24 25 26 27 28 29 30 31
0
0
40
10 10 58
1
0
0
30
20 20 70
30
10 60
80 20 30 10 20 650
0
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3 1 2 1 12
0
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2 1 2 18

5 60 30 40 10 10 170
871
10 20
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0

0
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1 1 2
10 70
0
 0
10 20 10 210
38
3
0
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10 30 10 10 500
10 10 0
0
0
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3
10
0
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0
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1 4
0
0
0
0
20 122
0
10 10
0
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10
0
0
0

0
0
0
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0
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0
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0
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6 6 6 42
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50 158
10 16
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140
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79
10 31 10 15 20 91 22
10 10 10 10 70
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15 20 10 16 5 410
0
5 5 10 5 10 105
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6 54
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41
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0
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1 1 1 7
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1 2 2 15
0
1 1 1 1
0
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1 2 1 9
0
77 136 40 46 6 46 160 4116
 0
0
0
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20 30 65
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25 50 30 10 16 40 436

1
0
0
0
0
0
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20 10 20 10 132
0
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10 10 20
0
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0
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6 28
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10 20 20 28
 20 10 50
0

0
0
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30 132 20 8 10 10 30 459
0
0
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10 10 72
31 32 10 10 20 6 130 143
0
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10 10 10 30
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1 1
Sisa Akhir
Bulan

-
100
82
80
4
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20
70
20
30
59
65
-
3

2
60
42
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17
170
 -
54
72
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88
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487
-
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-
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100
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15
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474
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50
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7
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84
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-
56
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-
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4
90
58
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138
-
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-
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45
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108

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20
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186
40
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93

3
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87
15
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50
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90
-
32
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28
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-
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-
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10
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-
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-
4
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7
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-
-
 STOK HARIAN BULAN AGUSTUS TAHUN 2017
NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Air Raksa Dental Use Botol 0 0 -
2 Albendazole Tablet 400 mg Tablet 0 0 100
3 Alopurinol Tablet 100 mg Tablet 0 40 82
4 Ambroksol Tablet 30 mg Tablet 58 0 80
5 Ambroksol sirup 15 mg/5 ml Botol 1 0 4
6 Aminofillin Injeksi 24 mg/ml-10 ml Ampul 0 0 -
7 Aminofillin Tablet 200 mg Tablet 0 0 20
8 Amitriptillin Hcl Tablet Salut 25 mg Tablet 30 0 70
9 Amlodipin Tablet 5 mg Tablet 70 0 20
10 Amlodipin Tablet 10 mg Tablet 30 0 30
11 Amoksisillin Kapsul 250 mg Kapsul 60 0 59
12 Amoksisillin Kaplet 500 mg Kaplet 650 0 65
13 Amoksisillin Serbuk Injeksi 1000 mg vial 0 0 -
14 Amoksisillin Sirup Kering 125 mg/5ml Botol 9 0 3
15 Amoksisillin Double Strengh Sirup Kering Botol 12 0 2
16 Ampisilin Kapsul 250 mg Kapsul 0 0 60
17 Ampisillin Kaplet 500 mg Tablet 0 0 42
18 Ampisilin Sirup 125 mg / 5 ml Botol 0 0 -
19 Ampisillin Injeksi 1000 mg Vial 0 0 -
20 Analgetik Plus Tablet 0 0 -
21 Antasida Doen Suspensi Kombinasi : Mag Botol 18 0 1
22 Antasida Doen Tablet, Kombinasi : Magn Tablet 871 0 -
23 Antasida Plus Tablet Tablet 20 0 90
24 Antalgin (Metampiron) Tablet 500 mg Tablet 40 0 -
25 Antalgin Injeksi 250 mg/ml-2ml Ampul 0 0 -
26 Anti Bakteri DOEN Salep Kombinasi : Tube 0 0 -
27 Anti Hemoroid Doen komb Supp 0 0 -
28 Anti Fungi DOEN Kombinasi : Pot 0 0 1
29 Antimigren DOEN Kombinasi : Tablet 0 0 -
30 Anti Diare Suspensi Botol 0 2 1
31 Anti Diare Tablet Tablet 70 0 17
32 Anti Dotum Oral Tablet Tablet 0 0 170
33 Anti Hipertensi Kapsul Tablet 0 0 -
34 Antihistamin Tablet kombinasi Tablet 210 0 54
35 Antispasmodik Tablet Tablet 38 0 72
36 Antitusiva Sirup Botol 3 0 -
37 Antitusiva Tablet Tablet 0 0 -
38 Asam Folat Tablet 1 mg Tablet 0 0 -
39 Asam Askorbat 50 mg Tablet 500 0 62
40 Asam Mefenamat Kapsul 500 mg Kapsul 0 0 -
41 Asetosal 80 mg Tablet 0 0 -
42 Asetosal Tablet 100 mg Tablet 0 0 -
43 Asetosal Tablet 500 mg Tablet 0 0 -
44 Asiklovir Krim 5 % Tube 3 0 -
45 Asiklovir Tablet 200 mg Tablet 10 0 73
46 Asiklovir Tablet 400 mg Tablet 0 0 88
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul 0 0 -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 mVial 0 0 -
49 Betahistin Mesilat 6 mg Tablet 0 0 -
50 Betametason Krim 0,1 %- 5g Tube 4 0 3
51 Bisakodil suppositoria 10 mg Supp 0 0 -
52 Bisoprolol Tablet 5 mg Tablet 0 0 -
53 Bromheksin 8 mg Tablet 0 0 30
54 Deksametason Injeksi 5mg/ml-1ml Ampul 0 0 2
55 Deksametason Tablet 0,5 mg Tablet 122 0 487
56 Devitalisasi Pasta (Non Arsen) Botol 0 0 -
57 Diazepam tablet 2 mg Tablet 10 0 19
58 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul 0 0 -
59 Diazepam Larutan Rektal 5 mg/ml Supp 0 0 -
60 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 0 0 -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 0 0 46
62 Digoksin Tablet 0,25 mg Tablet 0 0 40
63 Dimenhidrinat Tablet 50 mg Tablet 30 0 66
64 Domperidon Tablet 10 mg Tablet 10 0 94
65 Donperidon Suspensi 5 mg/5ml Botol 0 0 3
66 Efedrin Hcl Tablet 25 mg Tablet 0 0 -
67 Ekstrak Belladone Tablet 10 mg Tablet 0 0 -
68 Epinefrin HCl / Bitartrat Ampul 0 0 5
69 Eritromisin Kapsul 250 mg Kapsul 0 0 -
70 Eritromisin Kapsul 500 mg Kapsul 0 0 -
71 Eritromisin Sirup 200 mg / 5 ml Botol 0 0 -
72 Etambutol Tablet 500 mg Tablet 0 0 -
73 Etanol 70 % 100 ml Botol 0 0 -
74 Etil Klorida Semprot -100 ml Botol 0 0 -
75 Eugenol Cairan -10 ml Botol 0 0 -
76 Fenitoin Natrium Kapsul 100 mg Kapsul 10 0 30
77 Fenobarbital tablet 30 mg Tablet 0 0 -
78 Fenobarbital injeksi 50 mg / ml Ampul 0 0 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 0 0 100
80 Fenoksimeti Penisilin 500 mg tablet Tablet 0 0 70
81 Fitomenadion tablet 10 mg Tablet 10 0 15
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mlAmpul 0 0 -
83 Furosemid Tablet 40 mg Tablet 20 0 14
84 Garam Oralit I serbuk, kombinasi : Kantong 42 0 58
85 Gemfibrozil Tablet 600 mg Tablet 0 0 -
86 Gentamisin injeksi 80 mg / 2 ml Vial 0 0 -
87 Gentamisin Salep Kulit 0,1 % Tube 3 0 3
88 Glibenklamid Tablet 5 mg Tablet 40 0 50
89 Glimepiride 2 mg Tablet 0 0 10
90 Gliseril guayakolat tablet 100 mg Tablet 185 0 474
91 Gliseril Guayakolat sirup Botol 0 0 -
92 Glukonas Kalsikus injeksi Ampul 0 0 -
93 Glukosa Larutan Infus 5 % Botol 0 0 1
 94 Glukosa Larutan Infus10 % Botol 0 0 -
95 Griseofulvin Tablet 125 mg,micronized Tablet 0 0 50
96 Haloperidol Tablet 0,5 mg Tablet 0 0 80
97 Haloperidol Tablet 1,5 mg Tablet 60 0 -
98 Haloperidol Tablet 5 mg Tablet 70 0 -
99 Hidrokloritiazid 25 mg Tablet 0 0 7
100 Hidrokortison Krim 2,5 % Tube 13 0 2
101 Ibuprofen Tablet 200 mg Tablet 158 0 42
102 Ibuprofen Tablet 400 mg Tablet 16 0 84
103 Ibuprofen Suspensi 100 mg/5 ml Botol 1 0 2
104 Ichtyol salep Kulit Pot 0 0 3
105 Ipatropium Bromide + Salbutamol Vial 0 0 -
106 Isoniazid tablet 100 mg Tablet 0 0 -
107 Isosorbid Dinitrat 5 mg Tablet 0 0 -
108 Kalium Diklofenak Tablet 25 mg Tablet 0 0 -
109 Kalium Diklofenak Tablet 50 mg Tablet 140 0 44
110 Kalsium Hidroksida Pasta Tube 0 0 -
111 Kalsium Laktat Tablet 500 mg Tablet 10 0 78
112 Kaptopril 12,5 mg Tablet 79 0 -
113 Kaptopril 25 mg Tablet 22 0 78
114 Karbamazepin Tablet 200 mg Tablet 70 0 45
115 Ketokonazole Krim 2 % - 15 gr Tube 3 0 -
116 Ketokonazole Tablet 200 mg Tablet 18 0 36
117 Ketoprofen Tablet 100 mg Tablet 0 0 -
118 Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 0 -
119 Ketorolac 10 mg injeksi Ampul 0 0 -
120 Ketorolac 30 mg injeksi Ampul 0 0 -
121 Klindamisin Kapsul 150 mg Kapsul 0 0 -
122 Klindamisin Kapsul 300 mg Kapsul 0 0 -
123 Kloramfenikol Kapsul 250 mg Kapsul 0 0 60
124 Kloramfenikol Salep Mata 1%-3,5 g Tube 2 0 -
125 Kloramfenikol Tetes Mata -5 ml Botol 0 0 -
126 Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 0 1
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 410 0 123
128 Klorpromazin Hcl Tablet Salut 25 mg Tablet 0 0 -
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 105 0 56
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 0 -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi :Tablet 0 0 12
132 Kotrimoksazol Tablet, Kombinasi : Tablet 0 46 87
133 Kotrimoksazol Suspensi Kombinasi : Botol 4 0 1
134 Lansoprazole 30 mg Kapsul Tablet 0 0 34
135 Larutan mengadung Elektrolit (Na 130 mEqBotol 0 0 -
136 Larutan mengadung Elektrolit (Nacl 1,125 grBotol 0 0 -
137 Larutan mengadung Karbohidrat + ElektrolitBotol 0 0 -
138 Lidokain injeksi 2 % Tablet 0 0 -
139 Lidokain Komp Injeksi, Kombinasi : Ampul 0 0 -
140 Loperamid Tablet 2 mg Tablet 0 0 -
141 Loratadin tablet 10 mg Tablet 0 0 40
142 Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 0 -
143 Meloksikam tablet 15 mg Tablet 0 18 2
144 Meloksikam Suppositoria Supp 0 0 -
145 Metformin Hcl Tablet 500 mg Tablet 10 0 80
146 Methisoprinol 500 mg Tablet 0 0 -
147 Metilergometrin Maleat (Metergin) TabletTablet 0 0 -
148 Metilergometrin Maleat Injeksi 0,200 mg- Ampul 0 0 4
149 Metilprednisolon tablet 4 mg Tablet 10 0 90
150 Metoklopramid 10 mg Tablet 54 0 58
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 0 -
152 Metronidazol Tablet 250 mg Tablet 0 0 30
153 Metronidazole Tablet 500 mg Tablet 0 0 30
154 Metronidazole Infus 500 mg /100 ml Ampul 0 0 -
155 Mikonazole KrIm 2 % - 10 gr Tube 0 3 2
156 Multivitamin + Mineral tablet Tablet 0 0 -
157 Multivitamin sirup Botol 0 0 -
158 Natrium Bikarbonat Tablet 500 mg Tablet 0 0 138
159 Natrum Diklofenak Tablet 25 mg Tablet 0 0 -
160 Natrium Diklofenak Tablet 50 mg Tablet 0 80 36
161 Natrium Klorida Larutan infus 0,9%-Steril Botol 0 0 -
162 Nipedifin Tablet 10 mg Tablet 41 0 2
163 Nistatin 100.000 IU/gram Tablet Vagina Tablet 8 0 4
164 Nistatin 500.000 IU/gram Tablet Salut Tablet 17 0 33
165 Obat Antitiuberkolosis Kategori Anak Paket 0 0 -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Paket 0 0 -
167 Obat Antitiuberkolosis Kategori 2 Dewasa Paket 0 0 -
168 Obat Antitiuberkolosis Kategori 3 Dewasa Paket 0 0 -
169 Obat Anti Tuberkulosis FDC Kat Anak Paket 0 0 -
170 Obat Anti Tuberkulosis FDC Kat I & II Paket 0 0 -
171 Obat Anti Tuberkulosis FDC Kat I & III Paket 0 0 -
172 Obat Anti Tuberkolosis FDC Sisipan DewasaPaket 0 0 -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 7 0 -
174 Obat Batuk Cair Sirup (Ekspektoran) Botol 0 0 -
175 Obat Batuk Hitam Plus Sirup Botol 9 0 2
176 Obat Flu Sirup Botol 0 15 1
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 Vial 0 0 -
178 Oksiterasiklin Salep Mata 1%-3,5g Tube 1 0 -
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 0 0 2
180 Oksitosin Injeksi 10 IU/ml-1ml Ampul 0 0 9
181 Omeprazole injeksi 40mg/10ml Ampul 0 0 -
182 Omeprazole Kapsul 20 mg Tablet 0 0 18
183 Ondansetron inj 4 mg/ 2 mL Ampul 0 0 -
184 Parasetamol drops Botol 0 0 -
185 Parasetamol Sirup 120 mg/5ml-60 ml Botol 9 0 2
186 Parasetamol Tablet 100 mg Tablet 0 0 -
187 Parasetamol Tablet 500 mg Tablet 4116 0 43
188 Pehacain injeksi Ampul 0 0 -
189 Perak Sulfadiazin krim 1 % 35 gr Tube 0 0 -
190 Piracetam 400 mg Tablet 0 0 -
191 Piracetam Tablet 800 mg Tablet 0 0 -
192 Piroksikam Tablet 20 mg Tablet 65 0 45
193 Pirantel Pamoat Tablet 365 mg (Setara dngTablet 0 0 80
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 436 0 108
195 Polikresulen (Kondensasi Metakresol Botol 1 0 -
196 Povidon Iodida 10% 30 ml Botol 0 0 2
197 Povidon Iodida 10% 300 ml Botol 0 0 1
198 Primakuin tablet 15 mg Tablet 0 0 -
199 Propanolol Hcl Tablet 40 mg Tablet 0 0 20
200 Propilturasil Tablet 100 mg Tablet 0 0 -
201 Ranitidin Injeksi 25 mg / ml Ampul 0 0 -
202 Ranitidin Tablet 150 mg Tablet 132 0 21
203 Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 0 -
204 Retinol (Vit.A) 200.000 IU Kapsul Kapsul 0 0 186
205 Reserpin Tablet 0, 25 mg Tablet 0 0 40
206 Rifampisin Tablet 450 mg Tablet 0 0 -
207 Ringer Laktat Larutan Infus Steril 500 ml Botol 0 0 3
208 Salbutamol Tablet 2 mg Tablet 0 0 -
209 Salbutamol Tablet 4 mg Tablet 40 0 93
210 Salbutamol solution for Inhalation single doAmpul 0 0 -
211 Salep 2-4 Kombinasi : Pot 1 0 3
212 Salisil bedak 2% -50 gr Kotak 8 0 3
213 Salep Luka Bakar Tube 0 0 -
214 Sefadroksil Sirup Kering 125 mg / 5 ml siruBotol 2 0 4
215 Sefadroksil Tablet 500 mg Tablet 20 0 47
216 Sefiksim Kapsul 100 mg Kapsul 0 20 -
217 Sefotaksim Injeksi 1 gr Ampul 0 0 -
218 Seftriakson Injeksi 1 gr / vial Ampul 0 0 -
219 Semen Seng Fosfat Serbuk & Cairan Botol 0 0 -
220 Setirizin Tablet 10 mg Tablet 43 0 -
221 Setirizin Sirup 5 mg / 5 ml Botol 0 0 3
222 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul 0 0 19
223 Sianokobalamin Tablet 50 mcg Tablet 0 0 10
224 Silver Amalgam Serbuk 65-75% Botol 0 0 -
225 Simetidin 200 mg Tablet Tablet 28 0 87
226 Simvastatin Tablet 10 mg Tablet 30 0 15
227 Siprofloksasin 500mg Tablet 0 28 72
228 Spironolakton Tablet 25 mg Tablet 50 0 50
229 Sulfacetamid Tetes Mata 15 %-5ml Botol 0 0 -
230 Tablet Tambah Darah Kombinasi: Tablet 0 0 -
231 Temporary Stopping Fletcher (Fletcher) Se Set 0 0 -
232 Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 0 -
233 Tetrasiklin Kapsul 250 mg Kapsul 0 0 -
234 Tetrasiklin Kapsul 500 mg Kapsul 0 0 90
235 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1mlAmpul 0 0 -
236 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 Tablet 0 459 32
237 Thiamfenikol Kapsul 500 mg Kapsul 0 0 80
 238 Tramadol Injeksi 50 mg/ ml Ampul 0 0 -
239 Tramadol Tablet 50 mg Tablet 0 0 -
240 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 72 0 28
241 Vitamin B .Komplek Tablet Tablet 143 0 57
242 Vitamin Neurotropik Tablet Tablet 0 0 -
243 Zinc Tablet 20 mg Tablet 0 0 36
244 Prednisone 54mg Tablet 30 0 55
245 flunax sy Botol 0 0 -
246 vit k tablet 30 0 70
247 gentian violet Botol 0 0 -
248 kloramfenikol 500 Tablet 0 0 90
249 Rivanol 300 ml Botol 0 0 -
250 Alkohol 70%100 ml Botol 0 0 -

no B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES

NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
2 Abbocath No 20 ( IV Chateter 20 ) Buah 0 0 10
3 Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
4 Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
5 Alat Suntik Sekali Pakai 10 ml Set 0 0 17
6 Alat Suntik Sekali Pakai 1 ml Set 0 0 3
7 Alat Suntik Sekali Pakai 2,5 ml Set 9 0 1
8 Alat Suntik Sekali Pakai 5 ml Set 0 0 3
9 Alat Suntik Sekali Pakai 10 ml Set 100 0 -
10 Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
11 Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
12 Auto Disposable Syringe (ADS) 5 ml set 0 0 -
13 Catgut/Benang Bedah No.2/0-3/0 (Plain & Sachet 0 0 2
14 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
15 Etanol 70 % 1.000 ml Botol 1 0 -
16 Folley Catheter no 14 Set 0 0 -
17 Folley Catheter no 16 Set 0 0 -
18 Folley Catheter no 18 Set 0 0 2
19 Infus set Anak Set 0 0 -
20 Infus set Dewasa Set 0 0 7
21 Iodina Test Botol 0 0 1
22 Kassa Hidrofil Steril 16 x 16 Kotak 3 0 2
23 Kapas Berlemak 500 gram Bungkus 0 0 -
24 Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
25 Kassa Kompres 40 x 40 steril Bungkus 0 0 -
26 Kassa Pembalut 2 m x 80 cm Rol 0 0 2
27 Kassa Pembalut Hidrofil 4 m x 3 cm Rol 0 0 1
28 Kassa Pembalut Hidrofil 4 m x 15 cm Rol 5 0 -
29 Kertas Puyer Pcs 0 0 -
30 Lysol 1,000 ml Botol 0 0 -
31 Masker Buah 0 0 10
32 Plester 5 yard x 2 inchi Rol 0 0 1
33 Pot Dahak Pcs 0 0 -
34 Rapid HIV 1 (SD HIV) Pcs 0 0 -
35 Rapid HIV 2 (Intec HIV) Pcs 0 0 -
36 Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
37 Rapid Test Syphilis Pcs 0 0 -
38 RPR Test Syphilis Pcs 0 0 -
39 Silk( Benang Bedah Sutra ) No 3/0 Sachet 0 0 4
40 Safety Box Pcs 0 0 -
41 Sarung tangan Steril No 6 Pcs 0 0 -
42 Sarung tangan Steril No 7 Pcs 0 0 3
43 Sarung tangan Steril No 7,5 Pcs 0 0 7
44 Sarung tangan Non Steril S Pcs 0 0 -
45 Sarung tangan Non Steril M Pcs 0 0 -
46 Sarung tangan Non Steril L Pcs 100 0 -
47 Urine Bag set 0 0 2
48 Wing Neddle No 23 Set 0 0 -
49 Anuscopi Yamato Unit 0 0 -
50 Kaca Slide Box 0 0 -
51 Reagen Ziehl Nielson Kit 0 0 -
52 Rotator Unit 0 0 -
53 RTD Malaria Tes 0 0 -
54 Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
55 Sound Timer Buah 0 0 -
56 SD Syphilis Pcs 0 0 -
57 supraptul/bioplacenton tulle lembar 1 0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 -
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 82 - 82
3
Ambroksol Tablet 30 mg Tablet 80 100 180
4
Ambroksol sirup 15 mg/5 ml Botol 4 5 9
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 70 - 70
8
Amlodipin Tablet 5 mg Tablet 20 200 220
9
Amlodipin Tablet 10 mg Tablet 30 60 90
10
Amoksisillin Kapsul 250 mg Kapsul 59 100 159
11
Amoksisillin Kaplet 500 mg Kaplet 65 700 765
12 20
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 3 20 23
14 1
Amoksisillin Double Strengh Sirup Kering Botol
250 mg/5 ml 2 15
15 17
Ampisilin Kapsul 250 mg Kapsul 60 - 60
16
Ampisillin Kaplet 500 mg Tablet 42 - 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 1 25 26 1
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg - 900 30
22 900
Antasida Plus Tablet/TRIANTA Tablet 90 - 90
23
Antalgin (Metampiron) Tablet 500 mg Tablet - - -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - -
26 -
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + 1 3
28 Asam Salisilat 3% 4
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + - -
29 Kofein 50 mg -
Anti Diare Suspensi/Novadiar Botol 1 3 4
30
Anti Diare Tablet/New Diaform Tablet 17 100 117
31 10
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet - - -
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 54 100 154
34
Antispasmodik Tablet/SCOPMA Tablet 72 - 72
35
Antitusiva Sirup/DEXTROFEN SY Botol - 5 5
36
Antitusiva Tablet Tablet - -
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 62 100 162
39 6
Asam Mefenamat Kapsul 500 mg Kapsul - 100 100
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube - 3 3
44
Asiklovir Tablet 200 mg Tablet 73 - 73
45
Asiklovir Tablet 400 mg Tablet 88 - 88
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet - - -
49
Betametason Krim 0,1 %- 5g Tube 3 10 13
50
Bisakodil suppositoria 10 mg/dulcolax Supp - - -
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 30 - 30
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 487 - 487
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet 19 28 47
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet 40 - 40
62
Dimenhidrinat Tablet 50 mg Tablet 66 100 166
63
Domperidon Tablet 10 mg Tablet 94 - 94
64
Donperidon Suspensi 5 mg/5ml Botol 3 - 3
65
Efedrin Hcl Tablet 25 mg Tablet - - -
66
Ekstrak Belladone Tablet 10 mg Tablet - - -
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - - -
71
Etambutol Tablet 500 mg Tablet - - -
72
Etanol 70 % 100 ml Botol - - -
73
 Etil Klorida Semprot -100 ml Botol - - -
74
Eugenol Cairan -10 ml Botol - - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul 30 20 50
76
Fenobarbital tablet 30 mg Tablet - - -
77
Fenobarbital injeksi 50 mg / ml Ampul - - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg Tablet 15 100 115
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul - - -
82
Furosemid Tablet 40 mg Tablet 14 - 14
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr,
Kalium Klorida 0,30 gr, Trinatrium Sitrat -
dihidrat 0,58 gr, Glukosa Anhidrat 2,70 g )
200 ml Air
84 58 58 6
Gemfibrozil Tablet 600 mg Tablet - - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - - -
86
Gentamisin Salep Kulit 0,1 % Tube 3 - 3
87
Glibenklamid Tablet 5 mg Tablet 50 - 50
88
Glimepiride 2 mg Tablet 10 - 10
89
Gliseril guayakolat tablet 100 mg Tablet 474 - 474
90 10
Gliseril Guayakolat sirup Botol - - -
91
Glukonas Kalsikus injeksi Ampul - - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol - - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 50 - 50
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet - 100 100
97
Haloperidol Tablet 5 mg Tablet - 200 200
98
Hidrokloritiazid 25 mg Tablet 7 - 7
99
Hidrokortison Krim 2,5 % Tube 2 15 17
100
Ibuprofen Tablet 200 mg Tablet 42 88 130
101
Ibuprofen Tablet 400 mg Tablet 84 46 130
102
Ibuprofen Suspensi 100 mg/5 ml Botol 2 - 2
103
Ichtyol salep Kulit Pot 3 - 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation -
105 2,5 ml - -
Isoniazid tablet 100 mg Tablet - - -
106
Isosorbid Dinitrat 5 mg Tablet - - -
107
Kalium Diklofenak Tablet 25 mg Tablet - - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 44 100 144
109
Kalsium Hidroksida Pasta Tube - - -
110
Kalsium Laktat Tablet 500 mg Tablet 78 - 78
111
Kaptopril 12,5 mg Tablet - 100 100
112 17
Kaptopril 25 mg Tablet 78 - 78
113
 Karbamazepin Tablet 200 mg Tablet 45 15 60
114
Ketokonazole Krim 2 % - 15 gr Tube - - -
115
Ketokonazole Tablet 200 mg Tablet 36 - 36
116
Ketoprofen Tablet 100 mg Tablet - - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
118
Ketorolac 10 mg injeksi Ampul - - -
119
Ketorolac 30 mg injeksi Ampul - - -
120
Klindamisin Kapsul 150 mg Kapsul - - -
121
Klindamisin Kapsul 300 mg Kapsul - - -
122
Kloramfenikol Kapsul 250 mg Kapsul 60 - 60
123
Kloramfenikol Salep Mata 1%-3,5 g Tube - - -
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol - - -
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 - 1
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 123 400 523
127 10
Klorpromazin Hcl Tablet Salut 25 mg Tablet - - -
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 56 100 156
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
130
Kotrimoksazol Pedriatik Tablet, Tablet
Kombinasi : Sulfametoksazol
100 mg + Trimetroprim 20 mg -

131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg -
132 87 87 12
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 10
133 1 11
Lansoprazole 30 mg Kapsul Tablet 34 - 34
134
Larutan mengadung Elektrolit (Na 130 Botol
mEq,Cl 109 mEq, Asetat 28 mEq) /Asering
-
135 - -
Larutan mengadung Elektrolit (Nacl 1,125 Botol
gr , Dekstrosa 18,75 gr) -
136 - -
Larutan mengadung Karbohidrat + Botol
Elektrolit (Nacl
1,75 gr, KCL 1,5 gr, Na Lactat 2,24 gr, -
Dekstrosa 27 gr)
137 - -
Lidokain injeksi 2 % Tablet - - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml -
139 - -
Loperamid Tablet 2 mg Tablet - - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
142
Meloksikam tablet 15 mg Tablet 2 10 12
143
Meloksikam Suppositoria Supp - - -
144
 Metformin Hcl Tablet 500 mg Tablet 80 - 80
145
Methisoprinol 500 mg Tablet - - -
146
Metilergometrin Maleat (Metergin) Tablet 0 Tablet - 100 100
147
Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 90 - 90
149
Metoklopramid 10 mg/xilastin Tablet 58 - 58
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
151
Metronidazol Tablet 250 mg Tablet 30 - 30
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul - - -
154
Mikonazole KrIm 2 % - 10 gr Tube 2 10 12
155
Multivitamin + Mineral tablet/HEMAFORT Tablet - - -
156
Multivitamin sirup/RECOVIT Botol - - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 138 - 138
158
Natrum Diklofenak Tablet 25 mg Tablet - - -
159
Natrium Diklofenak Tablet 50 mg Tablet 36 - 36
160
Natrium Klorida Larutan infus 0,9%-Steril 50 Botol - -
161 -
Nipedifin Tablet 10 mg Tablet - 2
162 2
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 4
163 4
Nistatin 500.000 IU/gram Tablet Salut Tablet - 33
164 33
Obat Antitiuberkolosis Kategori Anak Paket - -
165 -
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 - -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 - -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 - -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 - -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 - -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 -
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 -
Obat Batuk Hitam (OBH) Cairan 100 ml/BERL Botol 10 10
173 -
Obat Batuk Cair Sirup (Ekspektoran)/CORED Botol - -
174 -
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 10 12
175 2
Obat Flu Sirup/ FLUTOP-C Botol 20 21
176 1 2
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 m Vial - -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube 1 1
178 -
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube - 2
179 2
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 -
Omeprazole Kapsul 20 mg Tablet 30 48
182 18
Ondansetron inj 4 mg/ 2 mL Ampul - 0 -
183
Parasetamol drops Botol - 0 -
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol 2 19 21
185
Parasetamol Tablet 100 mg Tablet - 0 -
186
Parasetamol Tablet 500 mg Tablet 43 1500 1,543 50
187
 Pehacain injeksi Ampul - 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube - 0 -
189
Piracetam 400 mg Tablet - 0 -
190
Piracetam Tablet 800 mg Tablet - 0 -
191
Piroksikam Tablet 20 mg Tablet 45 50 95
192
Pirantel Pamoat Tablet 365 mg (Setara dng Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 108 300 408 10
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal)
195 360 mg/g-10 ml - 0 -
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet - 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 20 0 20
199
Propilturasil Tablet 100 mg Tablet - 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul - 0 -
201
Ranitidin Tablet 150 mg Tablet 21 200 221 10
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet - 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet - 7 7
208
Salbutamol Tablet 4 mg Tablet 93 0 93
209
Salbutamol solution for Inhalation single Ampul
dose units 2,5 ml
210 - 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 %
+ Belerang Endap 4 % - 30 gram
211 3 0 3
Salisil bedak 2% -50 gr Kotak 3 20 23 1
212
Salep Luka Bakar/neocenta Tube - 11 11
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 4 0 4
214
Sefadroksil Tablet 500 mg Tablet 47 100 147
215
Sefiksim Kapsul 100 mg Kapsul - 0 -
216
Sefotaksim Injeksi 1 gr Ampul - 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul - 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol - 0 -
219
Setirizin Tablet 10 mg Tablet - 50 50
220
Setirizin Sirup 5 mg / 5 ml Botol 3 0 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol - 0 -
224
Simetidin 200 mg Tablet Tablet 87 0 87
225
Simvastatin Tablet 10 mg Tablet 15 0 15 10
226
Siprofloksasin 500mg Tablet 72 0 72
227
 Spironolakton Tablet 25 mg Tablet 50 0 50
228
Sulfacetamid Tetes Mata 15 %-5ml Botol - 4 4
229
Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
230 - 120 120
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 - 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul - 0 -
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 m Tablet 32 400 432 10
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul - 0 -
238
Tramadol Tablet 50 mg Tablet - 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 28 100 128
240
Vitamin B .Komplek Tablet Tablet 57 600 657 26
241
Vitamin Neurotropik Tablet Tablet - 0 -
242
Zinc Tablet 20 mg Tablet 36 4 40
243
Prednisone 5 mg Tablet 55 100 155
244
flunax sy Botol - 0 -
245
vit k Set 70 0 100
246
Gentian Violet Botol - 0 -
247
Kloramfenikol 500 Tablet 90 0 90
248
Rivanol 300 ml Kotak - 0 -
249
Alkohol 70%100 ml - 0 -
250 Ampul
251 Tablet - -
252 Vial - -
- -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES - -
Abbocath No 18 ( IV Chateter 18 ) Buah - 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah - 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 1 20 21 1
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set - 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set - 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set - 0 -
11
Auto Disposable Syringe (ADS) 5 ml set - 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & C Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - 1 1
14
 Etanol 70 % 1.000 ml Botol - 0 -
15
Folley Catheter no 14 Set - 0 -
16
Folley Catheter no 16 Set - 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set - 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak 2 3 5
22
Kapas Berlemak 500 gram Bungkus - 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - 0 -
24
Kassa Kompres 40 x 40 steril Bungkus - 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol - 5 5
28
Kertas Puyer Pcs - 0 -
29
Lysol 1,000 ml Botol - 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs - 0 -
33
Rapid HIV 1 (SD HIV) Pcs - 0 -
34
Rapid HIV 2 (Intec HIV) Pcs - 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - 0 -
36
Rapid Test Syphilis Pcs - 0 -
37
RPR Test Syphilis Pcs - 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs - 0 -
40
Sarung tangan Steril No 6 Pcs - 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs - 0 -
44
Sarung tangan Non Steril M Pcs - 0 -
45
Sarung tangan Non Steril L Pcs - 100 100
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set - 0 -
48
Anuscopi Yamato Unit - 0 -
49
Kaca Slide Box - 0 -
50
Reagen Ziehl Nielson Kit - 0 -
51
Rotator Unit - 0 -
52
RTD Malaria Tes - 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - 0 -
54
Sound Timer Buah - 0 -
55
SD Syphilis Pcs - 0 -
56
supraptul/bioplacenton tule lembar - 0 -
57
 CATATAN HARIAN PEMAKAIA
Bulan : Oktober Tahun : 201
JUMLAH PE

3 4 5 6 7 8 9 10 11 12

10 20 10 20
1 1 1

10 10 20 10 10
10 10
10 20
70 30 60 30 20 10 30 10 40

1 2 1 1 2 1

2 1 1 3

1 1 1 1

30 30 10 20 40 20 40 70

20 20

1 1

10 10 20 10
20 25 15 20
20 10 10

20 6 10 10 10
10 10 10

2 1 2

10

6 16 6

30 4

8 30 8 10
10
 6

12 6 6

1
10

10
1 2 1

10

20
10 5 5 5 10

2 2 2 1
10
10 10 10

18 21 8 6 10

20
20 10 30
10 10 10

10

30 3 20 2 24 10 40

10 10 5 5 10

10

1 2
 10

10
6

1 2 2

10

10

1 1 2

2 1 1 1
1 1 1 1 1 1 2

1 1 2 1

56 46 65 45 56 50 35 112 86
10 10

16 15 10 20 20 30

10 20 10 16

2 5
6 5

2 2 2 3
1 10

10 10 20

10 8 10

10
 1

10 10

10 10 8 30 10 10 10 10

10 20
16 21 42 18 20 30 15 20 34

10 10
10 20

1
1
HARIAN PEMAKAIAN OBAT
an : Oktober Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

13 14 15 16 17 18 19 20 21 22

10
10 10 10 6
1 1

30 30 10 10
10 10 10
10
30 10 50 20 40 20

1 2 1 1

1 1 1 1 1

1 1 2 2

20 10 30 10 30 50 5 10

10 20 10

1 1
10 12 10
 10 16

10 10 10
10 40

10 10 10

3 10

10 10 10

1
 10

10

6 12 6

20

10 50
2

15 10 5

1 1
10 10
10 10 10 10
1

6 10 6
 20 10

1
15 10 30 20 26 10

10 10 5

1 1
20
20 20

5 6

10 10

1 1

1
1 1 2 1

10

1 1 4 2

66 34 40 35 85 50 51 30
 30

20 10 40 50 10

10 10

4 10

1 1 3

1
20

10

10 10 10
 1

10

10 10 30 50 10

10
50 10 10 34 10 21 20

10
40 10

1 3 1 2
 Jumlah
Pemakaian
23 24 25 26 27 28 29 30 31
0
0
10
10 106
3 8
0
0
30
20 20 180
10 10 10 80
10 10 60
10 10 30 40 20 40 20 60 720
0
1 2 1 1 19

1 1 1 15
0
0
0
0
0

2 2 1 1 1 2 2 2 24

40 60 70 30 40 50 50 10
805
10 90
0
0

0
0

0
2
92
0
 0
10 5 10 131
6 8 54
2 2
0
0
10 10 10 122
80
0
0
0
1 1
10 10
0
0
0
0
1 1 8
0
0
10 20
0
8 10 6 18 100
0
47
0
0
0
0
0
10 6 102
10 20
1
0
0

0
0
0
0
0
0
 0
0
40 50
0
0
0
0
10 26
0
0

54
0
0
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10 40
0
20 10 110
1 0
0
0
0
10
0
20
10 5 15 20 115
0
2 2 2 15
10 10 30 20 10 20 130
10 20 10 10 10 130
1 2
0

0
0
0
0
10 10 10 93
0
10 10
37
25 20 20 5 22
 60
0
10
0
0
0
0
0
0
0
0
0
1
5 40 16 41 16 40 10 10 428
0
5 5 15 20 110
0

10 32

1 1 7
20

0
0

0
0
0
0
10 10
0
 40
0
10
0
10
8 25
0
0
0
0
1 1 9
0
0
10 40
0
6 10 10 36
0
0
2
0
0
0
0
0
0
0
0
0
1 1 1 9
1 0
1 1 1 1 1 11
1 3 19
0
1
2
0
0
10 20
0
0
1 1 4 1 1 21
0
68 97 46 40 90 90 61 56 1540
 0
0
0
0
10 60
0
6 30 10 40 10 8 355

0
0
0
0
0
0
0
20 10 30 10 8 164
0
0
0
0
0
7
4 10 39

0
1 1 1 18
11
1
10 70
0
0
0
0
10 50
0
0
0
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10 10 8 10 10 48
10
10 10 60
 0
1 1 4

30 10 40 10 120

0
0
0
0
0
70 30 50 20 388
0
0
0
20 60
20 10 26 26 20 36 46 10 591
0
10 40
4 5 89
0
0
0
0
0
0
0
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0
0
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0
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0
0
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 0
0
0
0
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0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
Sisa Akhir
Bulan

-
100
72
74
1
-
20
40
40
10
99
45
-
4

2
60
42
-
-
-

95
-
-
-

-
-

-
2
25
170
 -
23
18
3
-
-
40
20
-
-
-
2
63
88
-
-
-
5
-
-
10
2
387
-
-
-
-
-
46
40
64
74
2
-
-

5
-
-
-
-
-
 -
-
-
-
-
100
70
89
-
14

4
-
-
2
10
10
364
-
-
1
-
40
80
80
85
7
2
-
-
-
3

-
-
-
-
51
-
68
63
56
 -
-
26
-
-
-
-
-
-
60
-
-
-
95
-
46
-

12

55

4
14

-
-

-
-
40
-
2
-
40
-
90
4
80
33
-
30
30
-
3
-
-
98
-
-
-
2
2
33
-
-
-
-
-
-
-
-
1
-
1
2
-
-
-
9
-
28
-
-
-
-
3
 -
-
-
-
35
80
53

-
2
1
-
20
-
-
57
-
186
40
-
3
-
54

3
5
-
3
77
-
-
-
-
-
3
19
10
-
39
5
12
50
-

-
-
-
90
-
44
80
-
-
68
66
-
-
66
-
100
-
90
-
-
-
-
-
-
-
10
-
-
17
3
10
3
-
-
-
-
2
-
 -
-
-
2
-
7
1
-
-
-
-
2
1
-
-
-
10
1
-
-
-
-
-
-
4
-
-
3
7
-
-
-
2
-
-
-
-
-
-
-
-
-
-
 STOK HARIAN BULAN OKTOBER TAHUN 2017
NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Air Raksa Dental Use Botol 0 -
2 Albendazole Tablet 400 mg Tablet 0 100
3 Alopurinol Tablet 100 mg Tablet 0 10 72
4 Ambroksol Tablet 30 mg Tablet 106 74
5 Ambroksol sirup 15 mg/5 ml Botol 8 1
6 Aminofillin Injeksi 24 mg/ml-10 ml Ampul 0 -
7 Aminofillin Tablet 200 mg Tablet 0 20
8 Amitriptillin Hcl Tablet Salut 25 mg Tablet 30 40
9 Amlodipin Tablet 5 mg Tablet 180 40
10 Amlodipin Tablet 10 mg Tablet 80 10
11 Amoksisillin Kapsul 250 mg Kapsul 60 99
12 Amoksisillin Kaplet 500 mg Kaplet 720 45
13 Amoksisillin Serbuk Injeksi 1000 mg vial 0 -
14 Amoksisillin Sirup Kering 125 mg/5ml Botol 19 4
15 Amoksisillin Double Strengh Sirup Kering Botol 15 2
16 Ampisilin Kapsul 250 mg Kapsul 0 60
17 Ampisillin Kaplet 500 mg Tablet 0 42
18 Ampisilin Sirup 125 mg / 5 ml Botol 0 -
19 Ampisillin Injeksi 1000 mg Vial 0 -
20 Analgetik Plus Tablet 0 -
21 Antasida Doen Suspensi Kombinasi : Mag Botol 24 2
22 Antasida Doen Tablet, Kombinasi : Magn Tablet 805 95
23 Antasida Plus Tablet Tablet 90 -
24 Antalgin (Metampiron) Tablet 500 mg Tablet 0 -
25 Antalgin Injeksi 250 mg/ml-2ml Ampul 0 -
26 Anti Bakteri DOEN Salep Kombinasi : Tube 0 -
27 Anti Hemoroid Doen komb Supp 0 -
28 Anti Fungi DOEN Kombinasi : Pot 2 2
29 Antimigren DOEN Kombinasi : Tablet 0 -
30 Anti Diare Suspensi Botol 2 2
31 Anti Diare Tablet Tablet 92 25
32 Anti Dotum Oral Tablet Tablet 0 170
33 Anti Hipertensi Kapsul Tablet 0 -
34 Antihistamin Tablet kombinasi Tablet 131 23
35 Antispasmodik Tablet Tablet 54 18
36 Antitusiva Sirup Botol 2 3
37 Antitusiva Tablet Tablet 0 -
38 Asam Folat Tablet 1 mg Tablet 0 -
39 Asam Askorbat 50 mg Tablet 122 40
40 Asam Mefenamat Kapsul 500 mg Kapsul 80 20
41 Asetosal 80 mg Tablet 0 -
42 Asetosal Tablet 100 mg Tablet 0 -
43 Asetosal Tablet 500 mg Tablet 0 -
44 Asiklovir Krim 5 % Tube 1 2
45 Asiklovir Tablet 200 mg Tablet 10 63
46 Asiklovir Tablet 400 mg Tablet 0 88
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul 0 -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 mVial 0 -
49 Betahistin Mesilat 6 mg Tablet 0 -
50 Betametason Krim 0,1 %- 5g Tube 8 5
51 Bisakodil suppositoria 10 mg Supp 0 -
52 Bisoprolol Tablet 5 mg Tablet 0 -
53 Bromheksin 8 mg Tablet 20 10
54 Deksametason Injeksi 5mg/ml-1ml Ampul 0 2
55 Deksametason Tablet 0,5 mg Tablet 100 387
56 Devitalisasi Pasta (Non Arsen) Botol 0 -
57 Diazepam tablet 2 mg Tablet 47 -
58 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul 0 -
59 Diazepam Larutan Rektal 5 mg/ml Supp 0 -
60 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 0 -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 0 46
62 Digoksin Tablet 0,25 mg Tablet 0 40
63 Dimenhidrinat Tablet 50 mg Tablet 102 64
64 Domperidon Tablet 10 mg Tablet 20 74
65 Donperidon Suspensi 5 mg/5ml Botol 1 2
66 Efedrin Hcl Tablet 25 mg Tablet 0 -
67 Ekstrak Belladone Tablet 10 mg Tablet 0 -
68 Epinefrin HCl / Bitartrat Ampul 0 5
69 Eritromisin Kapsul 250 mg Kapsul 0 -
70 Eritromisin Kapsul 500 mg Kapsul 0 -
71 Eritromisin Sirup 200 mg / 5 ml Botol 0 -
72 Etambutol Tablet 500 mg Tablet 0 -
73 Etanol 70 % 100 ml Botol 0 -
74 Etil Klorida Semprot -100 ml Botol 0 -
75 Eugenol Cairan -10 ml Botol 0 -
76 Fenitoin Natrium Kapsul 100 mg Kapsul 50 -
77 Fenobarbital tablet 30 mg Tablet 0 -
78 Fenobarbital injeksi 50 mg / ml Ampul 0 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 0 100
80 Fenoksimeti Penisilin 500 mg tablet Tablet 0 70
81 Fitomenadion tablet 10 mg Tablet 26 89
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mlAmpul 0 -
83 Furosemid Tablet 40 mg Tablet 0 14
84 Garam Oralit I serbuk, kombinasi : Kantong 54 4
85 Gemfibrozil Tablet 600 mg Tablet 0 -
86 Gentamisin injeksi 80 mg / 2 ml Vial 0 -
87 Gentamisin Salep Kulit 0,1 % Tube 1 2
 88 Glibenklamid Tablet 5 mg Tablet 40 10
89 Glimepiride 2 mg Tablet 0 10
90 Gliseril guayakolat tablet 100 mg Tablet 110 364
91 Gliseril Guayakolat sirup Botol 0 -
92 Glukonas Kalsikus injeksi Ampul 0 -
93 Glukosa Larutan Infus 5 % Botol 0 1
94 Glukosa Larutan Infus10 % Botol 0 -
95 Griseofulvin Tablet 125 mg,micronized Tablet 10 40
96 Haloperidol Tablet 0,5 mg Tablet 0 80
97 Haloperidol Tablet 1,5 mg Tablet 20 80
98 Haloperidol Tablet 5 mg Tablet 115 85
99 Hidrokloritiazid 25 mg Tablet 0 7
100 Hidrokortison Krim 2,5 % Tube 15 2
101 Ibuprofen Tablet 200 mg Tablet 130 -
102 Ibuprofen Tablet 400 mg Tablet 130 -
103 Ibuprofen Suspensi 100 mg/5 ml Botol 2 -
104 Ichtyol salep Kulit Pot 0 3
105 Ipatropium Bromide + Salbutamol Vial 0 -
106 Isoniazid tablet 100 mg Tablet 0 -
107 Isosorbid Dinitrat 5 mg Tablet 0 -
108 Kalium Diklofenak Tablet 25 mg Tablet 0 -
109 Kalium Diklofenak Tablet 50 mg Tablet 93 51
110 Kalsium Hidroksida Pasta Tube 0 -
111 Kalsium Laktat Tablet 500 mg Tablet 10 68
112 Kaptopril 12,5 mg Tablet 37 63
113 Kaptopril 25 mg Tablet 22 56
114 Karbamazepin Tablet 200 mg Tablet 60 -
115 Ketokonazole Krim 2 % - 15 gr Tube 0 -
116 Ketokonazole Tablet 200 mg Tablet 10 26
117 Ketoprofen Tablet 100 mg Tablet 0 -
118 Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 -
119 Ketorolac 10 mg injeksi Ampul 0 -
120 Ketorolac 30 mg injeksi Ampul 0 -
121 Klindamisin Kapsul 150 mg Kapsul 0 -
122 Klindamisin Kapsul 300 mg Kapsul 0 -
123 Kloramfenikol Kapsul 250 mg Kapsul 0 60
124 Kloramfenikol Salep Mata 1%-3,5 g Tube 0 -
125 Kloramfenikol Tetes Mata -5 ml Botol 0 -
126 Kloramfenikol Tetes Telinga 3%-5 ml Botol 1 -
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 428 95
128 Klorpromazin Hcl Tablet Salut 25 mg Tablet 0 -
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 110 46
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi :Tablet 0 12
132 Kotrimoksazol Tablet, Kombinasi : Tablet 32 55
133 Kotrimoksazol Suspensi Kombinasi : Botol 7 4
134 Lansoprazole 30 mg Kapsul Tablet 20 14
135 Larutan mengadung Elektrolit (Na 130 mEqBotol 0 -
136 Larutan mengadung Elektrolit (Nacl 1,125 grBotol 0 -
137 Larutan mengadung Karbohidrat + ElektrolitBotol 0 -
138 Lidokain injeksi 2 % Tablet 0 -
139 Lidokain Komp Injeksi, Kombinasi : Ampul 0 -
140 Loperamid Tablet 2 mg Tablet 0 -
141 Loratadin tablet 10 mg Tablet 0 40
142 Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 -
143 Meloksikam tablet 15 mg Tablet 10 2
144 Meloksikam Suppositoria Supp 0 -
145 Metformin Hcl Tablet 500 mg Tablet 40 40
146 Methisoprinol 500 mg Tablet 0 -
147 Metilergometrin Maleat (Metergin) TabletTablet 10 90
148 Metilergometrin Maleat Injeksi 0,200 mg- Ampul 0 4
149 Metilprednisolon tablet 4 mg Tablet 10 80
150 Metoklopramid 10 mg Tablet 25 33
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 -
152 Metronidazol Tablet 250 mg Tablet 0 30
153 Metronidazole Tablet 500 mg Tablet 0 30
154 Metronidazole Infus 500 mg /100 ml Ampul 0 -
155 Mikonazole KrIm 2 % - 10 gr Tube 9 3
156 Multivitamin + Mineral tablet Tablet 0 -
157 Multivitamin sirup Botol 0 -
158 Natrium Bikarbonat Tablet 500 mg Tablet 40 98
159 Natrum Diklofenak Tablet 25 mg Tablet 0 -
160 Natrium Diklofenak Tablet 50 mg Tablet 36 -
161 Natrium Klorida Larutan infus 0,9%-Steril Botol 0 -
162 Nipedifin Tablet 10 mg Tablet 0 2
163 Nistatin 100.000 IU/gram Tablet Vagina Tablet 2 2
164 Nistatin 500.000 IU/gram Tablet Salut Tablet 0 33
165 Obat Antitiuberkolosis Kategori Anak Paket 0 -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Paket 0 -
167 Obat Antitiuberkolosis Kategori 2 Dewasa Paket 0 -
168 Obat Antitiuberkolosis Kategori 3 Dewasa Paket 0 -
169 Obat Anti Tuberkulosis FDC Kat Anak Paket 0 -
170 Obat Anti Tuberkulosis FDC Kat I & II Paket 0 -
171 Obat Anti Tuberkulosis FDC Kat I & III Paket 0 -
172 Obat Anti Tuberkolosis FDC Sisipan DewasaPaket 0 -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 9 1
174 Obat Batuk Cair Sirup (Ekspektoran) Botol 0 -
175 Obat Batuk Hitam Plus Sirup Botol 11 1
176 Obat Flu Sirup Botol 19 2
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 Vial 0 -
178 Oksiterasiklin Salep Mata 1%-3,5g Tube 1 -
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 2 -
180 Oksitosin Injeksi 10 IU/ml-1ml Ampul 0 9
181 Omeprazole injeksi 40mg/10ml Ampul 0 -
182 Omeprazole Kapsul 20 mg Tablet 20 28
183 Ondansetron inj 4 mg/ 2 mL Ampul 0 -
184 Parasetamol drops Botol 0 -
185 Parasetamol Sirup 120 mg/5ml-60 ml Botol 21 -
186 Parasetamol Tablet 100 mg Tablet 0 -
187 Parasetamol Tablet 500 mg Tablet 1540 3
188 Pehacain injeksi Ampul 0 -
189 Perak Sulfadiazin krim 1 % 35 gr Tube 0 -
190 Piracetam 400 mg Tablet 0 -
191 Piracetam Tablet 800 mg Tablet 0 -
192 Piroksikam Tablet 20 mg Tablet 60 35
193 Pirantel Pamoat Tablet 365 mg (Setara dngTablet 0 80
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 355 53
195 Polikresulen (Kondensasi Metakresol Botol 0 -
196 Povidon Iodida 10% 30 ml Botol 0 2
197 Povidon Iodida 10% 300 ml Botol 0 1
198 Primakuin tablet 15 mg Tablet 0 -
199 Propanolol Hcl Tablet 40 mg Tablet 0 20
200 Propilturasil Tablet 100 mg Tablet 0 -
201 Ranitidin Injeksi 25 mg / ml Ampul 0 -
202 Ranitidin Tablet 150 mg Tablet 164 57
203 Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 -
204 Retinol (Vit.A) 200.000 IU Kapsul Kapsul 0 186
205 Reserpin Tablet 0, 25 mg Tablet 0 40
206 Rifampisin Tablet 450 mg Tablet 0 -
207 Ringer Laktat Larutan Infus Steril 500 ml Botol 0 3
208 Salbutamol Tablet 2 mg Tablet 7 -
209 Salbutamol Tablet 4 mg Tablet 39 54
210 Salbutamol solution for Inhalation single doAmpul 0 -
211 Salep 2-4 Kombinasi : Pot 0 3
212 Salisil bedak 2% -50 gr Kotak 18 5
213 Salep Luka Bakar Tube 11 -
214 Sefadroksil Sirup Kering 125 mg / 5 ml siruBotol 1 3
215 Sefadroksil Tablet 500 mg Tablet 70 77
216 Sefiksim Kapsul 100 mg Kapsul 0 -
217 Sefotaksim Injeksi 1 gr Ampul 0 -
218 Seftriakson Injeksi 1 gr / vial Ampul 0 -
219 Semen Seng Fosfat Serbuk & Cairan Botol 0 -
220 Setirizin Tablet 10 mg Tablet 50 -
221 Setirizin Sirup 5 mg / 5 ml Botol 2 3
222 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul 0 19
 223 Sianokobalamin Tablet 50 mcg Tablet 0 10
224 Silver Amalgam Serbuk 65-75% Botol 0 -
225 Simetidin 200 mg Tablet Tablet 48 39
226 Simvastatin Tablet 10 mg Tablet 10 5
227 Siprofloksasin 500mg Tablet 60 12
228 Spironolakton Tablet 25 mg Tablet 0 50
229 Sulfacetamid Tetes Mata 15 %-5ml Botol 4 -
230 Tablet Tambah Darah Kombinasi: Tablet -
231 Temporary Stopping Fletcher (Fletcher) Se Set 0 -
232 Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 -
233 Tetrasiklin Kapsul 250 mg Kapsul 0 -
234 Tetrasiklin Kapsul 500 mg Kapsul 0 90
235 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1mlAmpul 0 -
236 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 Tablet 388 44
237 Thiamfenikol Kapsul 500 mg Kapsul 0 80
238 Tramadol Injeksi 50 mg/ ml Ampul 0 -
239 Tramadol Tablet 50 mg Tablet 0 -
240 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 60 68
241 Vitamin B .Komplek Tablet Tablet 591 66
242 Vitamin Neurotropik Tablet Tablet 0 -
243 Zinc Tablet 20 mg Tablet -
244 Prednisone 54mg Tablet 89 66
245 flunax sy Botol 0 -
246 vit k tablet 0 100
247 gentian violet Botol 0 -
248 kloramfenikol 500 Tablet 0 90
249 Rivanol 300 ml Botol 0 -
250 Alkohol 70%100 ml Botol 0 -

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES

NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
2 Abbocath No 20 ( IV Chateter 20 ) Buah 0 0 10
3 Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
4 Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
5 Alat Suntik Sekali Pakai 10 ml Set 0 0 17
6 Alat Suntik Sekali Pakai 1 ml Set 0 0 3
7 Alat Suntik Sekali Pakai 2,5 ml Set 11 0 10
8 Alat Suntik Sekali Pakai 5 ml Set 0 0 3
9 Alat Suntik Sekali Pakai 10 ml Set 0 0 -
10 Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
11 Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
12 Auto Disposable Syringe (ADS) 5 ml set 0 0 -
13 Catgut/Benang Bedah No.2/0-3/0 (Plain & Sachet 0 0 2
14 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 1 0 -
15 Etanol 70 % 1.000 ml Botol 0 0 -
16 Folley Catheter no 14 Set 0 0 -
17 Folley Catheter no 16 Set 0 0 -
18 Folley Catheter no 18 Set 0 0 2
19 Infus set Anak Set 0 0 -
20 Infus set Dewasa Set 0 0 7
21 Iodina Test Botol 0 0 1
22 Kassa Hidrofil Steril 16 x 16 Kotak 5 0 -
23 Kapas Berlemak 500 gram Bungkus 0 0 -
24 Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
25 Kassa Kompres 40 x 40 steril Bungkus 0 0 -
26 Kassa Pembalut 2 m x 80 cm Rol 0 0 2
27 Kassa Pembalut Hidrofil 4 m x 3 cm Rol 0 0 1
28 Kassa Pembalut Hidrofil 4 m x 15 cm Rol 5 0 -
29 Kertas Puyer Pcs 0 0 -
30 Lysol 1,000 ml Botol 0 0 -
31 Masker Buah 0 0 10
32 Plester 5 yard x 2 inchi Rol 0 0 1
33 Pot Dahak Pcs 0 0 -
34 Rapid HIV 1 (SD HIV) Pcs 0 0 -
35 Rapid HIV 2 (Intec HIV) Pcs 0 0 -
36 Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
37 Rapid Test Syphilis Pcs 0 0 -
38 RPR Test Syphilis Pcs 0 0 -
39 Silk( Benang Bedah Sutra ) No 3/0 Sachet 0 0 4
40 Safety Box Pcs 0 0 -
41 Sarung tangan Steril No 6 Pcs 0 0 -
42 Sarung tangan Steril No 7 Pcs 0 0 3
43 Sarung tangan Steril No 7,5 Pcs 0 0 7
44 Sarung tangan Non Steril S Pcs 0 0 -
45 Sarung tangan Non Steril M Pcs 0 0 -
46 Sarung tangan Non Steril L Pcs 100 0 -
47 Urine Bag set 0 0 2
48 Wing Neddle No 23 Set 0 0 -
49 Anuscopi Yamato Unit 0 0 -
50 Kaca Slide Box 0 0 -
51 Reagen Ziehl Nielson Kit 0 0 -
52 Rotator Unit 0 0 -
53 RTD Malaria Tes 0 0 -
54 Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
55 Sound Timer Buah 0 0 -
56 SD Syphilis Pcs 0 0 -
57 supraptul/bioplacenton tulle lembar 0 0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 -
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 72 - 72
3
Ambroksol Tablet 30 mg Tablet 74 - 74
4
Ambroksol sirup 15 mg/5 ml Botol 1 5 6
5 1
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 40 - 40
8
Amlodipin Tablet 5 mg Tablet 40 60 100
9
Amlodipin Tablet 10 mg Tablet 10 30 40
10 10
Amoksisillin Kapsul 250 mg Kapsul 100 100 200
11
Amoksisillin Kaplet 500 mg Kaplet 45 500 545
12 20 30
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 4 15 19
14 1
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 2 15
15 17 1
Ampisilin Kapsul 250 mg Kapsul 60 - 60
16
Ampisillin Kaplet 500 mg Tablet 42 - 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 2 10 12 1
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 95 600 30 30
22 695
Antasida Plus Tablet/TRIANTA Tablet - - -
23
Antalgin (Metampiron) Tablet 500 mg Tablet - - -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - -
26 -
Anti Hemoroid Doen komb Supp - - -
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam 2 -
28 Salisilat 3% 2
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol 2 - 2
30
Anti Diare Tablet/New Diaform Tablet 25 100 125
31 20
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet - - -
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 23 200 223
34
Antispasmodik Tablet/SCOPMA Tablet 18 100 118
35 6
Antitusiva Sirup/DEXTROFEN SY Botol 3 - 3
36
Antitusiva Tablet Tablet - -
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 40 100 140
39 20 10
Asam Mefenamat Kapsul 500 mg Kapsul 20 100 120
40
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube 2 - 2
44
Asiklovir Tablet 200 mg Tablet 63 - 63
45
Asiklovir Tablet 400 mg Tablet 88 - 88
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet - - -
49
Betametason Krim 0,1 %- 5g Tube 5 5 10
50
Bisakodil suppositoria 10 mg/dulcolax Supp - 3 3
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 10 - 10
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 387 - 387
55 10
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet - 107 107
57 10
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml Supp - - -
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet 40 - 40
62
Dimenhidrinat Tablet 50 mg Tablet 64 100 164
63 10 10
Domperidon Tablet 10 mg Tablet 74 - 74
64
Donperidon Suspensi 5 mg/5ml Botol 2 - 2
65
Efedrin Hcl Tablet 25 mg Tablet - - -
66
Ekstrak Belladone Tablet 10 mg Tablet - - -
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - - -
71
Etambutol Tablet 500 mg Tablet - - -
72
Etanol 70 % 100 ml Botol - - -
73
 Etil Klorida Semprot -100 ml Botol - - -
74
Eugenol Cairan -10 ml Botol - - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul - - -
76
Fenobarbital tablet 30 mg Tablet - - -
77
Fenobarbital injeksi 50 mg / ml Ampul - - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg/vit K Tablet 89 - 89
81 10
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul - - -
82
Furosemid Tablet 40 mg Tablet 14 - 14
83
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat 0,58 70
gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 4 74 6
Gemfibrozil Tablet 600 mg Tablet - - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - - -
86
Gentamisin Salep Kulit 0,1 % Tube 2 - 2
87
Glibenklamid Tablet 5 mg Tablet 10 100 110
88
Glimepiride 2 mg Tablet 10 - 10
89
Gliseril guayakolat tablet 100 mg Tablet 364 - 364
90 10
Gliseril Guayakolat sirup Botol - - -
91
Glukonas Kalsikus injeksi Ampul - - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol - - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 40 - 40
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet 80 - 80
97
Haloperidol Tablet 5 mg Tablet 85 100 185
98 20 10
Hidrokloritiazid 25 mg Tablet 7 - 7
99
Hidrokortison Krim 2,5 % Tube 2 10 12
100 1
Ibuprofen Tablet 200 mg Tablet - 100 100
101
Ibuprofen Tablet 400 mg Tablet - 50 50
102
Ibuprofen Suspensi 100 mg/5 ml Botol - 5 5
103 1
Ichtyol salep Kulit Pot 3 - 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 ml -
105 - -
Isoniazid tablet 100 mg Tablet - - -
106
Isosorbid Dinitrat 5 mg Tablet - 10 10
107
Kalium Diklofenak Tablet 25 mg Tablet - - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet 51 5 56
109 10
Kalsium Hidroksida Pasta Tube - - -
110
Kalsium Laktat Tablet 500 mg Tablet 68 - 68
111
Kaptopril 12,5 mg Tablet 63 - 63
112
Kaptopril 25 mg Tablet 56 100 156
113
 Karbamazepin Tablet 200 mg Tablet - 60 60
114 10
Ketokonazole Krim 2 % - 15 gr Tube - 3 3
115
Ketokonazole Tablet 200 mg Tablet 26 - 26
116
Ketoprofen Tablet 100 mg Tablet - - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
118
Ketorolac 10 mg injeksi Ampul - - -
119
Ketorolac 30 mg injeksi Ampul - - -
120
Klindamisin Kapsul 150 mg Kapsul - - -
121
Klindamisin Kapsul 300 mg Kapsul - - -
122
Kloramfenikol Kapsul 250 mg Kapsul 60 - 60
123
Kloramfenikol Salep Mata 1%-3,5 g Tube - 3 3
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol - 3 3
125
Kloramfenikol Tetes Telinga 3%-5 ml Botol - 13 13
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 95 300 395
127 17 15
Klorpromazin Hcl Tablet Salut 25 mg Tablet - - -
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet 46 59 105
129 20 10
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg -
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg -
132 55 55
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 6
133 4 10 1
Lansoprazole 30 mg Kapsul Tablet 14 - 14
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering -
135 - -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 - -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5 gr,
Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 - -
Lidokain injeksi 2 % Tablet - - -
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin 1 -
139 : 80.000-2 ml - -
Loperamid Tablet 2 mg Tablet - - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
142
Meloksikam tablet 15 mg Tablet 2 - 2
143
Meloksikam Suppositoria Supp - - -
144
Metformin Hcl Tablet 500 mg Tablet 40 - 40
145
Methisoprinol 500 mg Tablet - - -
146
Metilergometrin Maleat (Metergin) Tablet 0,12 Tablet 90 - 90
147
 Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 80 - 80
149
Metoklopramid 10 mg/xilastin Tablet 33 - 33
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
151
Metronidazol Tablet 250 mg Tablet 30 - 30
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul - - -
154
Mikonazole KrIm 2 % - 10 gr Tube 3 - 3
155
Multivitamin + Mineral tablet/HEMAFORT Tablet - - -
156
Multivitamin sirup/RECOVIT Botol - - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 98 - 98
158
Natrum Diklofenak Tablet 25 mg Tablet - - -
159
Natrium Diklofenak Tablet 50 mg Tablet - 150 150
160
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161 -
Nipedifin Tablet 10 mg Tablet 100 102
162 2
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 2
163 2
Nistatin 500.000 IU/gram Tablet Salut Tablet - 33
164 33
Obat Antitiuberkolosis Kategori Anak Paket - -
165 -
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 - -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 - -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 - -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 - -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 - -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 -
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 -
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol - 1
173 1 1
Obat Batuk Cair Sirup (Ekspektoran)/COREDRYL Botol - -
174 -
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 10 11
175 1
Obat Flu Sirup/ FLUTOP-C Botol 25 27
176 2
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube 3 3
178 -
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 3 3
179 -
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 -
Omeprazole Kapsul 20 mg Tablet 0 28
182 28
Ondansetron inj 4 mg/ 2 mL Ampul - 0 -
183
Parasetamol drops Botol - 0 -
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol - 0 -
185
Parasetamol Tablet 100 mg Tablet - 0 -
186
Parasetamol Tablet 500 mg Tablet 3 1200 1,203 66 30
187
Pehacain injeksi Ampul - 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube - 0 -
189
Piracetam 400 mg Tablet - 0 -
190
 Piracetam Tablet 800 mg Tablet - 0 -
191
Piroksikam Tablet 20 mg Tablet 35 100 135 20
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 53 200 253 30
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml - 1 1
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet - 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 20 0 20
199
Propilturasil Tablet 100 mg Tablet - 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul - 0 -
201
Ranitidin Tablet 150 mg Tablet 57 100 157 10
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet - 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 3 0 3
207
Salbutamol Tablet 2 mg Tablet - 0 -
208
Salbutamol Tablet 4 mg Tablet 54 100 154 10
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 - 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 3 0 3
Salisil bedak 2% -50 gr Kotak 5 5 10 1
212
Salep Luka Bakar/neocenta Tube - 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 3 3 6
214
Sefadroksil Tablet 500 mg Tablet 77 0 77 10
215
Sefiksim Kapsul 100 mg Kapsul - 0 -
216
Sefotaksim Injeksi 1 gr Ampul - 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul - 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol - 0 -
219
Setirizin Tablet 10 mg Tablet - 100 100
220
Setirizin Sirup 5 mg / 5 ml Botol 3 0 3
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B12 Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol - 0 -
224
Simetidin 200 mg Tablet Tablet 39 0 39
225
Simvastatin Tablet 10 mg Tablet 5 30 35
226
Siprofloksasin 500mg Tablet 12 100 112
227
Spironolakton Tablet 25 mg Tablet 50 0 50 10
228
Sulfacetamid Tetes Mata 15 %-5ml Botol - 0 -
229
 Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg + Asam
Folat 0,25 mg
230 - 0 -
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 - 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul - 0 -
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 44 300 344
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul - 0 -
238
Tramadol Tablet 50 mg Tablet - 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 68 100 168 20
240
Vitamin B .Komplek Tablet Tablet 66 400 466 20 36
241
Vitamin Neurotropik Tablet Tablet - 100 100
242
Zinc Tablet 20 mg Tablet - 15 15
243
Prednisone 5 mg Tablet 66 0 66 3
244
flunax sy Botol - 0 -
245
vit k Set 100 0 100
246
Gentian Violet Botol - 0 -
247
Kloramfenikol 500 Tablet 90 0 90
248
Rivanol 300 ml Kotak - 0 -
249
Alkohol 70%100 ml - 0 -
250 Ampul
251 Tablet - -
252 Vial - -
- -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES - -
Abbocath No 18 ( IV Chateter 18 ) Buah - 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah - 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 10 0 10
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set - 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set - 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set - 0 -
11
Auto Disposable Syringe (ADS) 5 ml set - 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Crom Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - 0 -
14
Etanol 70 % 1.000 ml Botol - 0 -
15
Folley Catheter no 14 Set - 0 -
16
 Folley Catheter no 16 Set - 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set - 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak - 0 -
22
Kapas Berlemak 500 gram Bungkus - 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - 0 -
24
Kassa Kompres 40 x 40 steril Bungkus - 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol - 0 -
28
Kertas Puyer Pcs - 0 -
29
Lysol 1,000 ml Botol - 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs - 0 -
33
Rapid HIV 1 (SD HIV) Pcs - 0 -
34
Rapid HIV 2 (Intec HIV) Pcs - 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - 0 -
36
Rapid Test Syphilis Pcs - 0 -
37
RPR Test Syphilis Pcs - 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs - 0 -
40
Sarung tangan Steril No 6 Pcs - 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs - 0 -
44
Sarung tangan Non Steril M Pcs - 0 -
45
Sarung tangan Non Steril L Pcs - 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set - 0 -
48
Anuscopi Yamato Unit - 0 -
49
Kaca Slide Box - 0 -
50
Reagen Ziehl Nielson Kit - 0 -
51
Rotator Unit - 0 -
52
RTD Malaria Tes - 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - 0 -
54
Sound Timer Buah - 0 -
55
SD Syphilis Pcs - 0 -
56
supraptul/bioplacenton tule lembar - 0 -
57
 CATATAN HARIAN PEMAKAIAN
Bulan : November Tahun : 201
JUMLAH PE

3 4 5 6 7 8 9 10 11 12

10

10

10 30
20 10 30 40 20 20

1 2 1 1

3 4 2

1 2

50 10 30 10 50 10

10 8
 6 10 10 6 20

10 5
10 10 24 6

1 1
2 1

20 8

10

20 30
 10

11 6 6

10

10 20 30 20 10 11

10 10

1
10 10 10
10
1

10

18

10 1

10 10 10 5
 20

1 11 1
5 20 6 15 28 10 10 6

5 10

1 1 1

10
 10 8 8

10 10

1
1 1 1 1
2 1 10 1

60 40 30 11 94 76 20 40
 10 10

10 10

10 12

10 20 5

1
10

10

10 10 10 10 10
10 20 10 10

10 10 21 5 72 50 2
6 10
10
10
ARIAN PEMAKAIAN OBAT
: November Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

13 14 15 16 17 18 19 20 21 22

10 20
10
1

20 15 10 10
10
10 20 20
20 10 10 20 10 80 10 10

1 2 1

1 1 2

10 30 16 20 30 50 40 40

10 10
 15 10
6 6 27
1 1

20

1 1

10 6 10 18

40 20 4

30 8 16
 10 10

10

10 10 3 3 20

10 15 10

1 1 1 2
20 10 10
20 10 10
1

10 18

12

26 6 40 10 10
 20
1

10 16 9 3 20 28 30

5 15 15

2 1

20 10
 6 8

30 8

20 8 38

1 1 1
1 1 1 1
4 1 1

1
1

85 10 46 77 101 52 16
10 10 5

20 20 30 16

6 10 6 8

20 15

1 1

1
10

30

10 10
10
20 10 10 10 20 18 30 18

10 12 10 26 10 10
7 10

10 9 4

1 1
 Jumlah
Pemakaian
23 24 25 26 27 28 29 30 31
0
0
10 50
10
1 1 5
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Sisa Akhir
Bulan

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 STOK HARIAN BULAN NOVEMBER TAHUN 2017
NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Air Raksa Dental Use Botol 0 -
2 Albendazole Tablet 400 mg Tablet 0 100
3 Alopurinol Tablet 100 mg Tablet 50 22
4 Ambroksol Tablet 30 mg Tablet 10 64
5 Ambroksol sirup 15 mg/5 ml Botol 5 1
6 Aminofillin Injeksi 24 mg/ml-10 ml Ampul 0 -
7 Aminofillin Tablet 200 mg Tablet 0 20
8 Amitriptillin Hcl Tablet Salut 25 mg Tablet 0 40
9 Amlodipin Tablet 5 mg Tablet 75 25
10 Amlodipin Tablet 10 mg Tablet 30 10
11 Amoksisillin Kapsul 250 mg Kapsul 100 100
12 Amoksisillin Kaplet 500 mg Kaplet 490 55
13 Amoksisillin Serbuk Injeksi 1000 mg vial 0 -
14 Amoksisillin Sirup Kering 125 mg/5ml Botol 18 1
15 Amoksisillin Double Strengh Sirup Kering Botol 12 5
16 Ampisilin Kapsul 250 mg Kapsul 0 60
17 Ampisillin Kaplet 500 mg Tablet 0 42
18 Ampisilin Sirup 125 mg / 5 ml Botol 0 -
19 Ampisillin Injeksi 1000 mg Vial 0 -
20 Analgetik Plus Tablet 0 -
21 Antasida Doen Suspensi Kombinasi : Mag Botol 11 1
22 Antasida Doen Tablet, Kombinasi : Magn Tablet 616 79
23 Antasida Plus Tablet Tablet 0 -
24 Antalgin (Metampiron) Tablet 500 mg Tablet 0 -
25 Antalgin Injeksi 250 mg/ml-2ml Ampul 0 -
26 Anti Bakteri DOEN Salep Kombinasi : Tube 0 -
27 Anti Hemoroid Doen komb Supp 0 -
28 Anti Fungi DOEN Kombinasi : Pot 0 2
29 Antimigren DOEN Kombinasi : Tablet 0 -
30 Anti Diare Suspensi Botol 0 2
31 Anti Diare Tablet Tablet 88 37
32 Anti Dotum Oral Tablet Tablet 0 170
33 Anti Hipertensi Kapsul Tablet 0 -
34 Antihistamin Tablet kombinasi Tablet 117 106
35 Antispasmodik Tablet Tablet 51 67
36 Antitusiva Sirup Botol 3 -
37 Antitusiva Tablet Tablet 0 -
38 Asam Folat Tablet 1 mg Tablet 0 -
39 Asam Askorbat 50 mg Tablet 55 85
40 Asam Mefenamat Kapsul 500 mg Kapsul 70 50
41 Asetosal 80 mg Tablet 0 -
42 Asetosal Tablet 100 mg Tablet 0 -
43 Asetosal Tablet 500 mg Tablet 0 -
44 Asiklovir Krim 5 % Tube 2 -
45 Asiklovir Tablet 200 mg Tablet 0 63
46 Asiklovir Tablet 400 mg Tablet 0 88
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul 0 -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 mVial 0 -
49 Betahistin Mesilat 6 mg Tablet 0 -
50 Betametason Krim 0,1 %- 5g Tube 6 4
51 Bisakodil suppositoria 10 mg Supp 0 3 -
52 Bisoprolol Tablet 5 mg Tablet 0 -
53 Bromheksin 8 mg Tablet 0 10
54 Deksametason Injeksi 5mg/ml-1ml Ampul 0 2
55 Deksametason Tablet 0,5 mg Tablet 92 295
 56 Devitalisasi Pasta (Non Arsen) Botol 0 -
57 Diazepam tablet 2 mg Tablet 107 -
58 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul 0 -
59 Diazepam Larutan Rektal 5 mg/ml Supp 0 -
60 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 0 -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 0 46
62 Digoksin Tablet 0,25 mg Tablet 0 40
63 Dimenhidrinat Tablet 50 mg Tablet 124 40
64 Domperidon Tablet 10 mg Tablet 0 74
65 Donperidon Suspensi 5 mg/5ml Botol 0 2
66 Efedrin Hcl Tablet 25 mg Tablet 0 -
67 Ekstrak Belladone Tablet 10 mg Tablet 0 -
68 Epinefrin HCl / Bitartrat Ampul 0 5
69 Eritromisin Kapsul 250 mg Kapsul 0 -
70 Eritromisin Kapsul 500 mg Kapsul 0 -
71 Eritromisin Sirup 200 mg / 5 ml Botol 0 -
72 Etambutol Tablet 500 mg Tablet 0 -
73 Etanol 70 % 100 ml Botol 0 -
74 Etil Klorida Semprot -100 ml Botol 0 -
75 Eugenol Cairan -10 ml Botol 0 -
76 Fenitoin Natrium Kapsul 100 mg Kapsul 0 -
77 Fenobarbital tablet 30 mg Tablet 0 -
78 Fenobarbital injeksi 50 mg / ml Ampul 0 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 0 100
80 Fenoksimeti Penisilin 500 mg tablet Tablet 0 70
81 Fitomenadion tablet 10 mg Tablet 0 60 29
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mlAmpul 0 -
83 Furosemid Tablet 40 mg Tablet 0 14
84 Garam Oralit I serbuk, kombinasi : Kantong 52 22
85 Gemfibrozil Tablet 600 mg Tablet 0 -
86 Gentamisin injeksi 80 mg / 2 ml Vial 0 -
87 Gentamisin Salep Kulit 0,1 % Tube 0 2
88 Glibenklamid Tablet 5 mg Tablet 30 80
89 Glimepiride 2 mg Tablet 0 10
90 Gliseril guayakolat tablet 100 mg Tablet 187 177
91 Gliseril Guayakolat sirup Botol 0 -
92 Glukonas Kalsikus injeksi Ampul 0 -
93 Glukosa Larutan Infus 5 % Botol 0 1
94 Glukosa Larutan Infus10 % Botol 0 -
95 Griseofulvin Tablet 125 mg,micronized Tablet 0 40
96 Haloperidol Tablet 0,5 mg Tablet 0 80
97 Haloperidol Tablet 1,5 mg Tablet 0 80
98 Haloperidol Tablet 5 mg Tablet 130 55
99 Hidrokloritiazid 25 mg Tablet 0 7
100 Hidrokortison Krim 2,5 % Tube 8 4
101 Ibuprofen Tablet 200 mg Tablet 95 5
102 Ibuprofen Tablet 400 mg Tablet 50 -
103 Ibuprofen Suspensi 100 mg/5 ml Botol 0 5 -
104 Ichtyol salep Kulit Pot 0 3
105 Ipatropium Bromide + Salbutamol Vial 0 -
106 Isoniazid tablet 100 mg Tablet 0 -
107 Isosorbid Dinitrat 5 mg Tablet 10 -
108 Kalium Diklofenak Tablet 25 mg Tablet 0 -
109 Kalium Diklofenak Tablet 50 mg Tablet 56 -
110 Kalsium Hidroksida Pasta Tube 0 -
111 Kalsium Laktat Tablet 500 mg Tablet 23 45
112 Kaptopril 12,5 mg Tablet 0 63
113 Kaptopril 25 mg Tablet 142 14
114 Karbamazepin Tablet 200 mg Tablet 60 -
115 Ketokonazole Krim 2 % - 15 gr Tube 2 1
116 Ketokonazole Tablet 200 mg Tablet 0 26
117 Ketoprofen Tablet 100 mg Tablet 0 -
118 Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 -
119 Ketorolac 10 mg injeksi Ampul 0 -
120 Ketorolac 30 mg injeksi Ampul 0 -
121 Klindamisin Kapsul 150 mg Kapsul 0 -
122 Klindamisin Kapsul 300 mg Kapsul 0 -
123 Kloramfenikol Kapsul 250 mg Kapsul 0 60
124 Kloramfenikol Salep Mata 1%-3,5 g Tube 1 2
125 Kloramfenikol Tetes Mata -5 ml Botol 1 2
126 Kloramfenikol Tetes Telinga 3%-5 ml Botol 13 -
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 308 87
128 Klorpromazin Hcl Tablet Salut 25 mg Tablet 0 -
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 105 (59)
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi :Tablet 0 12
132 Kotrimoksazol Tablet, Kombinasi : Tablet 0 20 35
133 Kotrimoksazol Suspensi Kombinasi : Botol 10 (6)
134 Lansoprazole 30 mg Kapsul Tablet 0 14
135 Larutan mengadung Elektrolit (Na 130 mEqBotol 0 -
136 Larutan mengadung Elektrolit (Nacl 1,125 grBotol 0 -
137 Larutan mengadung Karbohidrat + ElektrolitBotol 0 -
138 Lidokain injeksi 2 % Tablet 0 -
139 Lidokain Komp Injeksi, Kombinasi : Ampul 0 -
140 Loperamid Tablet 2 mg Tablet 0 -
141 Loratadin tablet 10 mg Tablet 0 40
142 Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 -
143 Meloksikam tablet 15 mg Tablet 0 2
144 Meloksikam Suppositoria Supp 0 -
145 Metformin Hcl Tablet 500 mg Tablet 40 -
146 Methisoprinol 500 mg Tablet 0 -
147 Metilergometrin Maleat (Metergin) TabletTablet 0 90
148 Metilergometrin Maleat Injeksi 0,200 mg- Ampul 0 4
149 Metilprednisolon tablet 4 mg Tablet 0 80
150 Metoklopramid 10 mg Tablet 14 19
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 -
152 Metronidazol Tablet 250 mg Tablet 0 30
153 Metronidazole Tablet 500 mg Tablet 0 30
154 Metronidazole Infus 500 mg /100 ml Ampul 0 -
155 Mikonazole KrIm 2 % - 10 gr Tube 0 3
156 Multivitamin + Mineral tablet Tablet 0 -
157 Multivitamin sirup Botol 0 -
158 Natrium Bikarbonat Tablet 500 mg Tablet 64 34
159 Natrum Diklofenak Tablet 25 mg Tablet 0 -
160 Natrium Diklofenak Tablet 50 mg Tablet 0 108 42
161 Natrium Klorida Larutan infus 0,9%-Steril Botol 0 -
162 Nipedifin Tablet 10 mg Tablet 20 82
163 Nistatin 100.000 IU/gram Tablet Vagina Tablet 0 2
164 Nistatin 500.000 IU/gram Tablet Salut Tablet 0 33
165 Obat Antitiuberkolosis Kategori Anak Paket 0 -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Paket 0 -
167 Obat Antitiuberkolosis Kategori 2 Dewasa Paket 0 -
168 Obat Antitiuberkolosis Kategori 3 Dewasa Paket 0 -
169 Obat Anti Tuberkulosis FDC Kat Anak Paket 0 -
170 Obat Anti Tuberkulosis FDC Kat I & II Paket 0 -
171 Obat Anti Tuberkulosis FDC Kat I & III Paket 0 -
172 Obat Anti Tuberkolosis FDC Sisipan DewasaPaket 0 -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 1 -
174 Obat Batuk Cair Sirup (Ekspektoran) Botol 0 -
175 Obat Batuk Hitam Plus Sirup Botol 10 1
176 Obat Flu Sirup Botol 0 26 1
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 Vial 0 -
178 Oksiterasiklin Salep Mata 1%-3,5g Tube 1 2
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 2 1
180 Oksitosin Injeksi 10 IU/ml-1ml Ampul 0 9
181 Omeprazole injeksi 40mg/10ml Ampul 0 -
182 Omeprazole Kapsul 20 mg Tablet 0 28
183 Ondansetron inj 4 mg/ 2 mL Ampul 0 -
184 Parasetamol drops Botol 0 -
185 Parasetamol Sirup 120 mg/5ml-60 ml Botol 0 -
186 Parasetamol Tablet 100 mg Tablet 0 -
187 Parasetamol Tablet 500 mg Tablet 1145 0 58
188 Pehacain injeksi Ampul 0 -
189 Perak Sulfadiazin krim 1 % 35 gr Tube 0 -
190 Piracetam 400 mg Tablet 0 -
191 Piracetam Tablet 800 mg Tablet 0 -
192 Piroksikam Tablet 20 mg Tablet 75 60
193 Pirantel Pamoat Tablet 365 mg (Setara dngTablet 0 80
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 207 46
195 Polikresulen (Kondensasi Metakresol Botol 1 -
196 Povidon Iodida 10% 30 ml Botol 0 2
197 Povidon Iodida 10% 300 ml Botol 0 1
198 Primakuin tablet 15 mg Tablet 0 -
199 Propanolol Hcl Tablet 40 mg Tablet 0 20
200 Propilturasil Tablet 100 mg Tablet 0 -
201 Ranitidin Injeksi 25 mg / ml Ampul 0 -
202 Ranitidin Tablet 150 mg Tablet 82 75
203 Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 -
204 Retinol (Vit.A) 200.000 IU Kapsul Kapsul 0 186
205 Reserpin Tablet 0, 25 mg Tablet 0 40
206 Rifampisin Tablet 450 mg Tablet 0 -
207 Ringer Laktat Larutan Infus Steril 500 ml Botol 1 2
208 Salbutamol Tablet 2 mg Tablet 0 -
209 Salbutamol Tablet 4 mg Tablet 116 38
210 Salbutamol solution for Inhalation single doAmpul 0 -
211 Salep 2-4 Kombinasi : Pot 0 3
212 Salisil bedak 2% -50 gr Kotak 0 7 3
213 Salep Luka Bakar Tube 0 -
214 Sefadroksil Sirup Kering 125 mg / 5 ml siruBotol 4 2
215 Sefadroksil Tablet 500 mg Tablet 30 47
216 Sefiksim Kapsul 100 mg Kapsul 0 -
217 Sefotaksim Injeksi 1 gr Ampul 0 -
218 Seftriakson Injeksi 1 gr / vial Ampul 0 -
219 Semen Seng Fosfat Serbuk & Cairan Botol 0 -
220 Setirizin Tablet 10 mg Tablet 40 60
221 Setirizin Sirup 5 mg / 5 ml Botol 0 1 2
222 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul 0 19
223 Sianokobalamin Tablet 50 mcg Tablet 0 10
224 Silver Amalgam Serbuk 65-75% Botol 0 -
225 Simetidin 200 mg Tablet Tablet 20 19
226 Simvastatin Tablet 10 mg Tablet 0 20 15
227 Siprofloksasin 500mg Tablet 60 52
228 Spironolakton Tablet 25 mg Tablet 10 40
229 Sulfacetamid Tetes Mata 15 %-5ml Botol 0 -
 230 Tablet Tambah Darah Kombinasi: Tablet 0 -
231 Temporary Stopping Fletcher (Fletcher) Se Set 0 -
232 Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 -
233 Tetrasiklin Kapsul 250 mg Kapsul 0 -
234 Tetrasiklin Kapsul 500 mg Kapsul 0 90
235 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1mlAmpul 0 -
236 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 Tablet 246 98
237 Thiamfenikol Kapsul 500 mg Kapsul 0 80
238 Tramadol Injeksi 50 mg/ ml Ampul 0 -
239 Tramadol Tablet 50 mg Tablet 0 -
240 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 80 88
241 Vitamin B .Komplek Tablet Tablet 395 71
242 Vitamin Neurotropik Tablet Tablet 53 47
243 Zinc Tablet 20 mg Tablet 15 -
244 Prednisone 54mg Tablet 36 30
245 flunax sy Botol 0 -
246 vit k tablet 0 100
247 gentian violet Botol 0 -
248 kloramfenikol 500 Tablet 0 90
249 Rivanol 300 ml Botol 0 -
250 Alkohol 70%100 ml Botol 0 -

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES

NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Abbocath No 18 ( IV Chateter 18 ) Buah 0 0 -
2 Abbocath No 20 ( IV Chateter 20 ) Buah 0 0 10
3 Abbocath No 22 ( IV Chateter 22 ) Buah 0 0 -
4 Abbocath No 24 ( IV Chateter 24 ) Buah 0 0 -
5 Alat Suntik Sekali Pakai 10 ml Set 0 0 17
6 Alat Suntik Sekali Pakai 1 ml Set 0 0 3
7 Alat Suntik Sekali Pakai 2,5 ml Set 2 0 8
8 Alat Suntik Sekali Pakai 5 ml Set 0 0 3
9 Alat Suntik Sekali Pakai 10 ml Set 0 0 -
10 Auto Disposable Syringe (ADS) 0,05 ml set 0 0 -
11 Auto Disposable Syringe (ADS) 0,5 ml set 0 0 -
12 Auto Disposable Syringe (ADS) 5 ml set 0 0 -
13 Catgut/Benang Bedah No.2/0-3/0 (Plain & Sachet 0 0 2
14 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 0 -
15 Etanol 70 % 1.000 ml Botol 0 0 -
16 Folley Catheter no 14 Set 0 0 -
17 Folley Catheter no 16 Set 0 0 -
18 Folley Catheter no 18 Set 0 0 2
19 Infus set Anak Set 0 0 -
20 Infus set Dewasa Set 0 0 7
21 Iodina Test Botol 0 0 1
22 Kassa Hidrofil Steril 16 x 16 Kotak 0 0 -
23 Kapas Berlemak 500 gram Bungkus 0 0 -
24 Kapas Pembalut / Adsorbens 250 gram Bungkus 0 0 -
25 Kassa Kompres 40 x 40 steril Bungkus 0 0 -
26 Kassa Pembalut 2 m x 80 cm Rol 0 0 2
27 Kassa Pembalut Hidrofil 4 m x 3 cm Rol 0 0 1
28 Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 0 -
29 Kertas Puyer Pcs 0 0 -
30 Lysol 1,000 ml Botol 0 0 -
31 Masker Buah 0 0 10
32 Plester 5 yard x 2 inchi Rol 0 0 1
33 Pot Dahak Pcs 0 0 -
34 Rapid HIV 1 (SD HIV) Pcs 0 0 -
35 Rapid HIV 2 (Intec HIV) Pcs 0 0 -
36 Rapid HIV 2 (Biomeriux HIV) Pcs 0 0 -
37 Rapid Test Syphilis Pcs 0 0 -
38 RPR Test Syphilis Pcs 0 0 -
39 Silk( Benang Bedah Sutra ) No 3/0 Sachet 0 0 4
40 Safety Box Pcs 0 0 -
41 Sarung tangan Steril No 6 Pcs 0 0 -
42 Sarung tangan Steril No 7 Pcs 0 0 3
43 Sarung tangan Steril No 7,5 Pcs 0 0 7
44 Sarung tangan Non Steril S Pcs 0 0 -
45 Sarung tangan Non Steril M Pcs 0 0 -
46 Sarung tangan Non Steril L Pcs 0 0 -
47 Urine Bag set 0 0 2
48 Wing Neddle No 23 Set 0 0 -
49 Anuscopi Yamato Unit 0 0 -
50 Kaca Slide Box 0 0 -
51 Reagen Ziehl Nielson Kit 0 0 -
52 Rotator Unit 0 0 -
53 RTD Malaria Tes 0 0 -
54 Rapid HIV 3 (Oncoprobe HIV) Pcs 0 0 -
55 Sound Timer Buah 0 0 -
56 SD Syphilis Pcs 0 0 -
57 supraptul/bioplacenton tulle lembar 0 0 -
 Persediaan Jumlah
No Nama Obat Satuan
Persediaan
Awal Tambahan 1 2
Air Raksa Dental Use Botol - -
1 -
Albendazole Tablet 400 mg Tablet - 100
2 100
Alopurinol Tablet 100 mg Tablet 22 150 172
3
Ambroksol Tablet 30 mg Tablet 64 - 64
4
Ambroksol sirup 15 mg/5 ml Botol 1 5 6
5
Aminofillin Injeksi 24 mg/ml-10 ml Ampul - - -
6
Aminofillin Tablet 200 mg Tablet 20 - 20
7
Amitriptillin Hcl Tablet Salut 25 mg Tablet 40 - 40
8
Amlodipin Tablet 5 mg Tablet 25 150 175
9
Amlodipin Tablet 10 mg Tablet 10 60 70
10
Amoksisillin Kapsul 250 mg Kapsul 100 100 200
11
Amoksisillin Kaplet 500 mg Kaplet 55 500 555
12 10
Amoksisillin Serbuk Injeksi 1000 mg vial - - -
13
Amoksisillin Sirup Kering 125 mg/5ml Botol 1 15 16
14
Amoksisillin Double Strengh Sirup Kering 250 Botol
mg/5 ml 5 15
15 20
Ampisilin Kapsul 250 mg Kapsul 60 - 60
16
Ampisillin Kaplet 500 mg Tablet 42 - 42
17
Ampisilin Sirup 125 mg / 5 ml Botol - - -
18
Ampisillin Injeksi 1000 mg Vial - - -
19
Analgetik Plus /Neurovar Tablet - - -
20
Antasida Doen Suspensi Kombinasi : Botol
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml
21 1 10 11 1
Antasida Doen Tablet, Kombinasi : Tablet
Magnesium Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg 79 800 30
22 879
Antasida Plus Tablet/TRIANTA Tablet - - -
23
Antalgin (Metampiron) Tablet 500 mg Tablet - - -
24
Antalgin Injeksi 250 mg/ml-2ml Ampul - - -
25
Anti Bakteri DOEN Salep Kombinasi : Tube
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g - 1
26 1
Anti Hemoroid Doen komb Supp - 1 1
27
Anti Fungi DOEN Kombinasi : Pot
Asam Benzoat 6% + Asam 2 -
28 Salisilat 3% 2
Antimigren DOEN Kombinasi : Tablet
Ergotamin Tartrat 1 mg + Kofein - -
29 50 mg -
Anti Diare Suspensi/Novadiar Botol 2 5 7
30 1
Anti Diare Tablet/New Diaform Tablet 37 100 137
31 10
Anti Dotum Oral Tablet Tablet 170 - 170
32
 Anti Hipertensi Kapsul/Tensigard Tablet - - -
33
Antihistamin Tablet kombinasi/SOLDEXTAM Tablet 106 200 306
34
Antispasmodik Tablet/SCOPMA Tablet 67 100 167
35
Antitusiva Sirup/DEXTROFEN SY Botol - 5 5
36
Antitusiva Tablet Tablet - -
37
Asam Folat Tablet 1 mg Tablet - - -
38
Asam Askorbat 50 mg/Vitamin c Tablet 85 100 185
39 10
Asam Mefenamat Kapsul 500 mg Kapsul 50 100 150
40 10
Asetosal 80 mg Tablet - - -
41
Asetosal Tablet 100 mg Tablet - - -
42
Asetosal Tablet 500 mg Tablet - - -
43
Asiklovir Krim 5 % Tube - 5 5
44
Asiklovir Tablet 200 mg Tablet 63 - 63
45
Asiklovir Tablet 400 mg Tablet 88 - 88
46
Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul - - -
47
Aqua Pro Injeksi Steril, bebas Pirogen 20 ml Vial - - -
48
Betahistin Mesilat 6 mg Tablet - 10 10
49
Betametason Krim 0,1 %- 5g Tube 4 5 9
50
Bisakodil suppositoria 10 mg/dulcolax Supp - 5 5
51
Bisoprolol Tablet 5 mg Tablet - - -
52
Bromheksin 8 mg Tablet 10 - 10
53
Deksametason Injeksi 5mg/ml-1ml Ampul 2 - 2
54
Deksametason Tablet 0,5 mg/FLACOID Tablet 295 - 295
55
Devitalisasi Pasta (Non Arsen) Botol - - -
56
Diazepam tablet 2 mg Tablet - 200 200
57
Diazepam Injeksi i.v/i.m 5 mg/ml Ampul - - -
58
Diazepam Larutan Rektal 5 mg/ml(Stesolid) Supp - 1 1
59
Dietilkarbamazin Sitrat Tablet 100 mg Tablet - - -
60
Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 46 - 46
61
Digoksin Tablet 0,25 mg Tablet 40 - 40
62
Dimenhidrinat Tablet 50 mg Tablet 40 100 140
63
Domperidon Tablet 10 mg Tablet 74 - 74
64
Donperidon Suspensi 5 mg/5ml Botol 2 - 2
65
Efedrin Hcl Tablet 25 mg Tablet - - -
66
Ekstrak Belladone Tablet 10 mg Tablet - - -
67
Epinefrin HCl / Bitartrat Ampul
(Epinefrina /
Adrenalina) Injeksi 0,1%/- 1ml 5 -
68 5
Eritromisin Kapsul 250 mg Kapsul - - -
69
Eritromisin Kapsul 500 mg Kapsul - - -
70
Eritromisin Sirup 200 mg / 5 ml Botol - - -
71
Etambutol Tablet 500 mg Tablet - - -
72
Etanol 70 % 100 ml Botol - - -
73
 Etil Klorida Semprot -100 ml Botol - - -
74
Eugenol Cairan -10 ml Botol - - -
75
Fenitoin Natrium Kapsul 100 mg Kapsul - - -
76
Fenobarbital tablet 30 mg Tablet - - -
77
Fenobarbital injeksi 50 mg / ml Ampul - - -
78
Fenoksimeti Penisilin 250 mg tablet Tablet 100 - 100
79
Fenoksimeti Penisilin 500 mg tablet Tablet 70 - 70
80
Fitomenadion tablet 10 mg/vit K Tablet 29 100 129
81
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Ampul - - -
82
Furosemid Tablet 40 mg Tablet 14 100 114
83 10
Garam Oralit I serbuk, kombinasi : Kantong
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat dihidrat 0,58 70
gr, Glukosa Anhidrat 2,70 g )200 ml Air
84 22 92
Gemfibrozil Tablet 600 mg Tablet - - -
85
Gentamisin injeksi 80 mg / 2 ml Vial - - -
86
Gentamisin Salep Kulit 0,1 % Tube 2 - 2
87
Glibenklamid Tablet 5 mg Tablet 80 100 180
88
Glimepiride 2 mg Tablet 10 - 10
89
Gliseril guayakolat tablet 100 mg Tablet 177 - 177
90
Gliseril Guayakolat sirup Botol - - -
91
Glukonas Kalsikus injeksi Ampul - - -
92
Glukosa Larutan Infus 5 % Botol 1 - 1
93
Glukosa Larutan Infus10 % Botol - - -
94
Griseofulvin Tablet 125 mg,micronized Tablet 40 - 40
95
Haloperidol Tablet 0,5 mg Tablet 80 - 80
96
Haloperidol Tablet 1,5 mg Tablet 80 - 80
97
Haloperidol Tablet 5 mg Tablet 55 115 170
98
Hidrokloritiazid 25 mg Tablet 7 100 107
99
Hidrokortison Krim 2,5 % Tube 4 10 14
100
Ibuprofen Tablet 200 mg Tablet 5 100 105
101
Ibuprofen Tablet 400 mg Tablet - 50 50
102 10
Ibuprofen Suspensi 100 mg/5 ml Botol - 5 5
103
Ichtyol salep Kulit Pot 3 - 3
104
Ipatropium Bromide + Salbutamol Vial
Sulphate for inhalation 2,5 ml -
105 - -
Isoniazid tablet 100 mg Tablet - - -
106
Isosorbid Dinitrat 5 mg Tablet - 10 10
107
Kalium Diklofenak Tablet 25 mg Tablet - - -
108
Kalium Diklofenak Tablet 50 mg/KADITIC Tablet - 50 50
109
Kalsium Hidroksida Pasta Tube - - -
110
Kalsium Laktat Tablet 500 mg Tablet 45 - 45
111
Kaptopril 12,5 mg Tablet 63 - 63
112
Kaptopril 25 mg Tablet 14 300 314
113
 Karbamazepin Tablet 200 mg Tablet - 100 100
114
Ketokonazole Krim 2 % - 15 gr Tube 1 10 11
115 1
Ketokonazole Tablet 200 mg Tablet 26 - 26
116
Ketoprofen Tablet 100 mg Tablet - - -
117
Ketoprofen Injeksi 100 mg / 1 ml Ampul - - -
118
Ketorolac 10 mg injeksi Ampul - - -
119
Ketorolac 30 mg injeksi Ampul - - -
120
Klindamisin Kapsul 150 mg Kapsul - - -
121
Klindamisin Kapsul 300 mg Kapsul - - -
122
Kloramfenikol Kapsul 250 mg Kapsul 60 - 60
123
Kloramfenikol Salep Mata 1%-3,5 g Tube 2 3 5
124
Kloramfenikol Tetes Mata -5 ml/RECO Botol 2 5 7
125 1
Kloramfenikol Tetes Telinga 3%-5 ml Botol - 13 13
126
Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 87 300 387
127
Klorpromazin Hcl Tablet Salut 25 mg Tablet - 170 170
128
Klorpromazin Hcl Tablet Salut 100 mg Tablet - 30 30
129
Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul - - -
130
Kotrimoksazol Pedriatik Tablet, Kombinasi : Tablet
Sulfametoksazol 100 mg +
Trimetroprim 20 mg -
131 12 12
Kotrimoksazol Tablet, Kombinasi : Tablet
Sulfametoksazol 400 mg +
Trimetroprim 80 mg 100
132 35 135 10
Kotrimoksazol Suspensi Kombinasi : Botol
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml 10
133 - 10
Lansoprazole 30 mg Kapsul Tablet 14 - 14
134
Larutan mengadung Elektrolit (Na 130 mEq,Cl Botol
109 mEq, Asetat 28 mEq) /Asering -
135 - -
Larutan mengadung Elektrolit (Nacl 1,125 gr , Botol
Dekstrosa 18,75 gr) -
136 - -
Larutan mengadung Karbohidrat + Elektrolit Botol
(Nacl 1,75 gr, KCL 1,5 gr,
Na Lactat 2,24 gr, Dekstrosa 27 gr) -

137 - -
Lidokain injeksi 2 % Tablet - 1 1
138
Lidokain Komp Injeksi, Kombinasi : Ampul
Lidokain Hcl 2% +Epinefrin 1 -
139 : 80.000-2 ml - -
Loperamid Tablet 2 mg Tablet - - -
140
Loratadin tablet 10 mg Tablet 40 - 40
141
Magnesium Sulfat (IV) 20 %-25 ml Ampul - - -
142
Meloksikam tablet 15 mg Tablet 2 10 12
143
Meloksikam Suppositoria Supp - - -
144
Metformin Hcl Tablet 500 mg Tablet - 40 40
145
Methisoprinol 500 mg Tablet - - -
146
Metilergometrin Maleat (Metergin) Tablet 0,12 Tablet 90 - 90
147
 Metilergometrin Maleat Injeksi 0,200 mg-1ml Ampul 4 - 4
148
Metilprednisolon tablet 4 mg Tablet 80 - 80
149
Metoklopramid 10 mg/xilastin Tablet 19 - 19
150
Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul - - -
151
Metronidazol Tablet 250 mg Tablet 30 - 30
152
Metronidazole Tablet 500 mg Tablet 30 - 30
153
Metronidazole Infus 500 mg /100 ml Ampul - - -
154
Mikonazole KrIm 2 % - 10 gr Tube 3 - 3
155
Multivitamin + Mineral tablet/HEMAFORT Tablet - - -
156
Multivitamin sirup/RECOVIT Botol - - -
157
Natrium Bikarbonat Tablet 500 mg Tablet 34 4 38
158 10
Natrum Diklofenak Tablet 25 mg Tablet - - -
159
Natrium Diklofenak Tablet 50 mg Tablet 42 350 392
160
Natrium Klorida Larutan infus 0,9%-Steril 500 m Botol - -
161 -
Nipedifin Tablet 10 mg Tablet 100 182
162 82
Nistatin 100.000 IU/gram Tablet Vagina Tablet - 2
163 2
Nistatin 500.000 IU/gram Tablet Salut Tablet - 33
164 33
Obat Antitiuberkolosis Kategori Anak Paket - -
165 -
Obat Antitiuberkolosis Kategori 1 Dewasa Paket -
166 - -
Obat Antitiuberkolosis Kategori 2 Dewasa Paket -
167 - -
Obat Antitiuberkolosis Kategori 3 Dewasa Paket -
168 - -
Obat Anti Tuberkulosis FDC Kat Anak Paket -
169 - -
Obat Anti Tuberkulosis FDC Kat I & II Paket -
170 - -
Obat Anti Tuberkulosis FDC Kat I & III Paket - -
171 -
Obat Anti Tuberkolosis FDC Sisipan Dewasa Paket - -
172 -
Obat Batuk Hitam (OBH) Cairan 100 ml/BERLIC Botol 4 4
173 - 1
Obat Batuk Cair Sirup (Ekspektoran)/COREDRYL Botol - -
174 -
Obat Batuk Hitam Plus Sirup/INDOPLUS Botol 20 21
175 1 2
Obat Flu Sirup/ FLUTOP-C Botol 25 26
176 1 1
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Vial - -
177 -
Oksiterasiklin Salep Mata 1%-3,5g Tube 3 5
178 2
Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 3 4
179 1
Oksitosin Injeksi 10 IU/ml-1ml Ampul - 9
180 9
Omeprazole injeksi 40mg/10ml Ampul 0 -
181 -
Omeprazole Kapsul 20 mg Tablet 60 88
182 28
Ondansetron inj 4 mg/ 2 mL Ampul - 0 -
183
Parasetamol drops(Fasidol) Botol - 5 5
184
Parasetamol Sirup 120 mg/5ml-60 ml Botol - 20 20
185
Parasetamol Tablet 100 mg Tablet - 0 -
186
Parasetamol Tablet 500 mg Tablet 58 1400 1,458 36
187
Pehacain injeksi Ampul - 0 -
188
Perak Sulfadiazin krim 1 % 35 gr Tube - 0 -
189
Piracetam 400 mg Tablet - 0 -
190
 Piracetam Tablet 800 mg Tablet - 0 -
191
Piroksikam Tablet 20 mg Tablet 60 150 210
192
Pirantel Pamoat Tablet 365 mg (Setara dng 125 Tablet 80 0 80
193
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 46 400 446 26
194
Polikresulen (Kondensasi Metakresol Botol
Sulfonat dan Metanal) 360
195 mg/g-10 ml - 1 1
Povidon Iodida 10% 30 ml Botol 2 0 2
196
Povidon Iodida 10% 300 ml Botol 1 0 1
197
Primakuin tablet 15 mg Tablet - 0 -
198
Propanolol Hcl Tablet 40 mg Tablet 20 0 20
199
Propilturasil Tablet 100 mg Tablet - 0 -
200
Ranitidin Injeksi 25 mg / ml Ampul - 0 -
201
Ranitidin Tablet 150 mg Tablet 75 150 225 10
202
Retinol (Vit.A) 100.000 IU Kapsul Kapsul - 0 -
203
Retinol (Vit.A) 200.000 IU Kapsul Kapsul 186 0 186
204
Reserpin Tablet 0, 25 mg Tablet 40 0 40
205
Rifampisin Tablet 450 mg Tablet - 0 -
206
Ringer Laktat Larutan Infus Steril 500 ml Botol 2 0 2
207
Salbutamol Tablet 2 mg Tablet - 0 -
208
Salbutamol Tablet 4 mg Tablet 38 100 138
209
Salbutamol solution for Inhalation single dose Ampul
units 2,5 ml
210 - 0 -
Salep 2-4 Kombinasi : Pot
Asam Salisilat 2 % +
Belerang Endap 4 % - 30 gram
211 3 0 3
Salisil bedak 2% -50 gr Kotak 3 12 15
212
Salep Luka Bakar/neocenta Tube - 0 -
213
Sefadroksil Sirup Kering 125 mg / 5 ml sirup Botol 2 3 5
214
Sefadroksil Tablet 500 mg Tablet 47 0 47 10
215
Sefiksim Kapsul 100 mg Kapsul - 100 100
216
Sefotaksim Injeksi 1 gr Ampul - 0 -
217
Seftriakson Injeksi 1 gr / vial Ampul - 0 -
218
Semen Seng Fosfat Serbuk & Cairan Botol - 0 -
219
Setirizin Tablet 10 mg Tablet 60 100 160
220
Setirizin Sirup 5 mg / 5 ml Botol 2 0 2
221
Sianokobalamin Injeksi 500 mcg/ml-1ml/Vit B12 Ampul 19 0 19
222
Sianokobalamin Tablet 50 mcg Tablet 10 0 10
223
Silver Amalgam Serbuk 65-75% Botol - 0 -
224
Simetidin 200 mg Tablet Tablet 19 100 119
225
Simvastatin Tablet 10 mg Tablet 15 60 75
226
Siprofloksasin 500mg Tablet 52 100 152
227
Spironolakton Tablet 25 mg Tablet 40 0 40
228
Sulfacetamid Tetes Mata 15 %-5ml Botol - 0 -
229
 Tablet Tambah Darah Kombinasi: Tablet
Besi II Sulfat 200 mg + Asam
Folat 0,25 mg
230 - 200 200
Temporary Stopping Fletcher (Fletcher) Set
Serbuk & Cairan
231 - 0 -
Trikesol formalin ( T K F ) Cairan 10 ml Botol - 0 -
232
Tetrasiklin Kapsul 250 mg Kapsul - 100 100
233
Tetrasiklin Kapsul 500 mg Kapsul 90 0 90
234
Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml Ampul - 0 -
235
Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg Tablet 98 500 598 16
236
Thiamfenikol Kapsul 500 mg Kapsul 80 0 80
237
Tramadol Injeksi 50 mg/ ml Ampul - 0 -
238
Tramadol Tablet 50 mg Tablet - 0 -
239
Triheksifenidil Hidroklorida Tablet 2 mg Tablet 88 100 188
240
Vitamin B .Komplek Tablet Tablet 71 400 471 10
241
Vitamin Neurotropik Tablet Tablet 47 350 397 10
242
Zinc Tablet 20 mg Tablet - 15 15
243
Prednisone 5 mg Tablet 30 100 130
244
flunax sy Botol - 0 -
245
vit k Set 100 0 100
246
Gentian Violet Botol - 0 -
247
Kloramfenikol 500 Tablet 90 0 90
248
Rivanol 300 ml Kotak - 0 -
249
Alkohol 70%100 ml - 0 -
250 Ampul
251 Tablet - -
252 Vial - -
- -
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES - -
Abbocath No 18 ( IV Chateter 18 ) Buah - 0 -
1
Abbocath No 20 ( IV Chateter 20 ) Buah 10 0 10
2
Abbocath No 22 ( IV Chateter 22 ) Buah - 0 -
3
Abbocath No 24 ( IV Chateter 24 ) Buah - 0 -
4
Alat Suntik Sekali Pakai 10 ml Set 17 0 17
5
Alat Suntik Sekali Pakai 1 ml Set 3 0 3
6
Alat Suntik Sekali Pakai 2,5 ml Set 8 50 58 1
7
Alat Suntik Sekali Pakai 5 ml Set 3 0 3
8
Alat Suntik Sekali Pakai 10 ml Set - 0 -
9
Auto Disposable Syringe (ADS) 0,05 ml set - 0 -
10
Auto Disposable Syringe (ADS) 0,5 ml set - 0 -
11
Auto Disposable Syringe (ADS) 5 ml set - 0 -
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Crom Sachet 2 0 2
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol - 0 -
14
Etanol 70 % 1.000 ml Botol - 0 -
15
Folley Catheter no 14 Set - 0 -
16
 Folley Catheter no 16 Set - 0 -
17
Folley Catheter no 18 Set 2 0 2
18
Infus set Anak Set - 0 -
19
Infus set Dewasa Set 7 0 7
20
Iodina Test Botol 1 0 1
21
Kassa Hidrofil Steril 16 x 16 Kotak - 1 1
22
Kapas Berlemak 500 gram Bungkus - 0 -
23
Kapas Pembalut / Adsorbens 250 gram Bungkus - 0 -
24
Kassa Kompres 40 x 40 steril Bungkus - 0 -
25
Kassa Pembalut 2 m x 80 cm Rol 2 0 2
26
Kassa Pembalut Hidrofil 4 m x 3 cm Rol 1 0 1
27
Kassa Pembalut Hidrofil 4 m x 15 cm Rol - 0 -
28
Kertas Puyer Pcs - 0 -
29
Lysol 1,000 ml Botol - 0 -
30
Masker Buah 10 0 10
31
Plester 5 yard x 2 inchi Rol 1 0 1
32
Pot Dahak Pcs - 0 -
33
Rapid HIV 1 (SD HIV) Pcs - 0 -
34
Rapid HIV 2 (Intec HIV) Pcs - 0 -
35
Rapid HIV 2 (Biomeriux HIV) Pcs - 0 -
36
Rapid Test Syphilis Pcs - 0 -
37
RPR Test Syphilis Pcs - 0 -
38
Silk( Benang Bedah Sutra ) No 3/0 Sachet 4 0 4
39
Safety Box Pcs - 0 -
40
Sarung tangan Steril No 6 Pcs - 0 -
41
Sarung tangan Steril No 7 Pcs 3 0 3
42
Sarung tangan Steril No 7,5 Pcs 7 0 7
43
Sarung tangan Non Steril S Pcs - 0 -
44
Sarung tangan Non Steril M Pcs - 0 -
45
Sarung tangan Non Steril L Pcs - 0 -
46
Urine Bag set 2 0 2
47
Wing Neddle No 23 Set - 0 -
48
Anuscopi Yamato Unit - 0 -
49
Kaca Slide Box - 0 -
50
Reagen Ziehl Nielson Kit - 0 -
51
Rotator Unit - 0 -
52
RTD Malaria Tes - 0 -
53
Rapid HIV 3 (Oncoprobe HIV) Pcs - 0 -
54
Sound Timer Buah - 0 -
55
SD Syphilis Pcs - 0 -
56
supraptul/bioplacenton tule lembar - 0 -
57
 CATATAN HARIAN PEMAKAIAN
Bulan : Desember Tahun : 201
JUMLAH PE

3 4 5 6 7 8 9 10 11 12

20 30

20 10 10 10

10 10 10 20

1 1

1 2 1 2 2

30 30 30 20 30 30 20 70

2
10 10 10
 10 10 6 10
10
1

10 20 4 20
10 10

10 10 8

10 20 10

8 10 18
 10

5 8

10

20 10 10

10

15 10 10 10 10

1
10

10

10

10 5 10 30
 20 10
1 1

1 2 1
10 10 10 20
10 10
15 5

10

1 1
 6

10

5 30 18 10 80

1 1 1
1 1 1
1 1 1 2

70 30 40 70 44 56 30 105
10 10 10 10 10

10 23 10 20 40 10 29

10 10 20 6 12 8 16

10

10 5

10 10

10 20
 30 30 30 10 10 10

10 30 30 90

20
30 10 30 32 30 10 6 30
10 5 10 20 10 10 12 30

10

1 1 1
ARIAN PEMAKAIAN OBAT
n : Desember Tahun : 2017
JUMLAH PEMAKAIAN JENIS OBAT PADA TANGGAL

13 14 15 16 17 18 19 20 21 22

30 10 10
10

30 10 10 7
20
10
20 20 20 10 20 40 10 20

1 1 1

2 1 2

70 40 80 30 30 40 20 30 10

10 10
 10 10 10 5

10 10 10 10 10
10

6
1 1 1

10 6

10 40

10
10 8
6
10 10

5 10

10 10

30 5 10
1 1

10

5 20 5 35 5
8
1 1

10 10
1 2

10 10

33 5 10 5 15 10 6
 20 30
2
10

1 1
1 1
10 10 21 15 20 30 10
10 10 40 10 20
5

10 10

1 2

10

10
 1

8 10

30 20 10 10 10 20 20

10

1 2
1
4 2 1 1
2 1 1 1 2

1 1
2 1

120 60 60 40 60 80 50 40 41
 15 10 10 10 20

20 10 25 12 20 10 30 10 10

10 30 10 20

10 10

2 1 1 1 1 1

10

10 10

6 10 10 10

10 10 10
 10 10 20

10

30 50 10 10 10 10 30 10 40

20 30
30 55 10 10 10 15 20
10 50 10 10 10 7 10 5

6 10 10

1 32 1 2 6
1
 Jumlah
Pemakaian
23 24 25 26 27 28 29 30 15-Nov
0
0
10 20 130
10
1 1 2
0
0
0
10 10 40 167
10 30 60
20 30
10 20 60 40 10 360
0
1 1 7

1 1 2 10
0
0
0
0
0

1 11

10 40 20 50 80 10
850
0
0
0

1
0

0
2 5
10 10 10 20 110
0
 0
20 91
100 110
1 2
0
0
114
10 10 60
0
0
0
1 1 2
0
0
0
0
6
1 2 1 8
0
0
0
0
6 10 60
0
96 186
0
1
0
0
10
10 8 72
10 16
0
0
0

0
0
0
0
0
0
 0
0
0
0
0
0
0
10 10 40
0
10 45

8 10 20 5 11 6 73
0
0
1 1
10 10 50
0
10 50 10 6 161
0
0
0
0
20
0
0
20 15 5 5 170
8
2 5
10 10 10 20 30 90
10 40
3
0

0
0
0
0
30
0
10 20
0
5 20 30 30 224
 20 100
1 1 1 8
10 20
0
0
0
0
0
0
0
0
1 4
6
20 33 18 30 267
30 30 170
5 30
0

10 10 10 70

1 1 1 8
0

0
1

0
0
10
0
10 10
0
10 10 10 40
0
0
 0
0
0
0
5 11
0
0
1
0
0
38
0
14 10 38 20 5 350
0
40 50
0
0
0
0
0
0
0
0
0
0
4
1 0
1 1 3 18
2 1 16
0
1
1 2
0
0
10 56 66
0
1 3
3 1 1 3 15
0
30 70 50 70 70 30 1352
0
0
0
 0
10 10 20 10 165
0
20 25 10 10 20 25 425

0
0
0
0
0
0
0
10 10 182
0
0
0
0
0
0
5 35

1 2
1 1 1 10
0
0
10
10 20
0
0
0
10 45
0
1
0
0
10 66
40 10 50
60
0
0
 30 190

0
0
10
10 10
0
18 20 20 50 50 534
0
0
0
10 10 90
5 16 6 30 10 10 415
6 10 30 30 305
5 5
70 6 10 5 127
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 1 1 49
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Sisa Akhir
Bulan

-
100
42
54
4
-
20
40
8
10
170
195
-
9

10
60
42
-
-
-

29
-
-
-

-
1

-
2
27
170
 -
215
57
3
-
-
71
90
-
-
-
3
63
88
-
-
4
1
5
-
10
2
235
-
14
-
-
-
46
30
68
58
2
-
-

5
-
-
-
-
-
 -
-
-
-
-
100
70
89
-
69

19
-
-
1
130
10
16
-
-
1
-
20
80
80
-
99
9
15
10
2
3

-
-
10
-
20
-
25
63
90
 -
3
6
-
-
-
-
-
-
60
5
3
7
120
-
-
-

12

65

2
14

-
-

-
-
30
-
2
-
-
-
90
 4
80
19
-
19
30
-
2
-
-
-
-
42
-
132
2
33
-
-
-
-
-
-
-
-
-
-
3
10
-
4
2
9
-
22
-
2
5
-
106
-
-
-
 -
45
80
21

1
2
1
-
20
-
-
43
-
186
40
-
2
-
103

1
5
-
5
37
80
-
-
-
115
2
18
10
-
53
25
92
40
-
10

-
-
90
80
-
64
80
-
-
98
56
92
10
3
-
100
-
90
-
-
-
-
-
-
-
10
-
-
17
3
9
3
-
-
-
-
2
-
-
-
 -
2
-
7
1
-
-
-
-
2
1
-
-
-
10
1
-
-
-
-
-
-
4
-
-
3
7
-
-
-
2
-
-
-
-
-
-
-
-
-
-
 jumlah Antispasmodik Tablet
pemaka Sisa 35
No Nama Obat
ian stok 36
Antitusiva Sirup
Air Raksa Dental Use Antitusiva Tablet
1 37
Albendazole Tablet 400 mg Asam Folat Tablet 1 mg
2 38
Alopurinol Tablet 100 mg Asam Askorbat 50 mg
3 39
Ambroksol Tablet 30 mg Asam Mefenamat Kapsul 500 mg
4 40
Ambroksol sirup 15 mg/5 ml Asetosal 80 mg
5 41
Aminofillin Injeksi 24 mg/ml-10 ml Asetosal Tablet 100 mg
6 42
Aminofillin Tablet 200 mg Asetosal Tablet 500 mg
7 43
Amitriptillin Hcl Tablet Salut 25 mg Asiklovir Krim 5 %
8 44
Amlodipin Tablet 5 mg Asiklovir Tablet 200 mg
9 45
Amlodipin Tablet 10 mg Asiklovir Tablet 400 mg
10 46
Amoksisillin Kapsul 250 mg Atropin Sulfat Injeksi 0,25 mg/ml-1ml
11 47
Amoksisillin Kaplet 500 mg Aqua Pro Injeksi Steril, bebas Pirogen 20 ml
12 48
Amoksisillin Serbuk Injeksi 1000 mg Betahistin Mesilat 6 mg
13 49
Amoksisillin Sirup Kering 125 mg/5ml Betametason Krim 0,1 %- 5g
14 50
Amoksisillin Double Strengh Sirup Bisakodil suppositoria 10 mg
Kering 250 mg/5 ml
15 51
Ampisilin Kapsul 250 mg Bisoprolol Tablet 5 mg
16 52
Ampisillin Kaplet 500 mg Bromheksin 8 mg
17 53
Ampisilin Sirup 125 mg / 5 ml Deksametason Injeksi 5mg/ml-1ml
18 54
Ampisillin Injeksi 1000 mg Deksametason Tablet 0,5 mg
19 55
Analgetik Plus Devitalisasi Pasta (Non Arsen)
20 56
Antasida Doen Suspensi Diazepam tablet 2 mg
Kombinasi : Magnesium
Hidroksida 200 mg+ Alumunium
Hidroksida 200 mg/5 ml

21 57
Antasida Doen Tablet, Kombinasi Diazepam Injeksi i.v/i.m 5 mg/ml
: Magnesium Hidroksida 200 mg+
Alumunium Hidroksida 200 mg

22 58
Antasida Plus Tablet Diazepam Larutan Rektal 5 mg/ml
23 59
Antalgin (Metampiron) Tablet 500 mg Dietilkarbamazin Sitrat Tablet 100 mg
24 60
Antalgin Injeksi 250 mg/ml-2ml Difenhidramin HCl Injeksi 10 mg/ml-1ml
25 61
Anti Bakteri DOEN Salep Digoksin Tablet 0,25 mg
Kombinasi :
Basitrasin 500 IU/g +
Polimiksin 1000 IU/g
26 62
Anti Hemoroid Doen komb Dimenhidrinat Tablet 50 mg
27 63
Anti Fungi DOEN Kombinasi : Domperidon Tablet 10 mg

Asam Benzoat 6% + Asam Salisilat

28 3% 64
Antimigren DOEN Kombinasi : Donperidon Suspensi 5 mg/5ml

Ergotamin Tartrat 1 mg + Kofein

29 50 mg 65
 Anti Diare Suspensi Efedrin Hcl Tablet 25 mg
30 66
Anti Diare Tablet Ekstrak Belladone Tablet 10 mg
31 67
Anti Dotum Oral Tablet Epinefrin HCl / Bitartrat

(Epinefrina / Adrenalina)
32 68 Injeksi 0,1%/- 1ml
Anti Hipertensi Kapsul Eritromisin Kapsul 250 mg
33 69
Antihistamin Tablet kombinasi Eritromisin Kapsul 500 mg
34 70
Eritromisin Sirup 200 mg / 5 ml Ketokonazole Tablet 200 mg
71 116
Etambutol Tablet 500 mg Ketoprofen Tablet 100 mg
72 117
Etanol 70 % 100 ml Ketoprofen Injeksi 100 mg / 1 ml
73 118
Etil Klorida Semprot -100 ml Ketorolac 10 mg injeksi
74 119
Eugenol Cairan -10 ml Ketorolac 30 mg injeksi
75 120
Fenitoin Natrium Kapsul 100 mg Klindamisin Kapsul 150 mg
76 121
Fenobarbital tablet 30 mg Klindamisin Kapsul 300 mg
77 122
Fenobarbital injeksi 50 mg / ml Kloramfenikol Kapsul 250 mg
78 123
Fenoksimeti Penisilin 250 mg tablet Kloramfenikol Salep Mata 1%-3,5 g
79 124
Fenoksimeti Penisilin 500 mg tablet Kloramfenikol Tetes Mata -5 ml
80 125
Fitomenadion tablet 10 mg Kloramfenikol Tetes Telinga 3%-5 ml
81 126
Fitomenadion (Vit K1) Injeksi 2 mg/ml-1ml Klorfeniramin Maleat (CTM) Tablet 4 mg
82 127
Furosemid Tablet 40 mg Klorpromazin Hcl Tablet Salut 25 mg
83 128
Garam Oralit I serbuk, Klorpromazin Hcl Tablet Salut 100 mg
kombinasi :
( Nacl 0,52 gr, Kalium
Klorida 0,30 gr, Trinatrium Sitrat
dihidrat 0,58 gr, Glukosa Anhidrat
2,70 g )200 ml Air

84 129
Gemfibrozil Tablet 600 mg Klorpromazin Hcl Injeksi 5 mg/ml-2ml
85 130
Gentamisin injeksi 80 mg / 2 ml Kotrimoksazol Pedriatik Tablet,
Kombinasi :
Sulfametoksazol 100 mg +
Trimetroprim 20 mg
86 131
Gentamisin Salep Kulit 0,1 % Kotrimoksazol Tablet, Kombinasi
:
Sulfametoksazol 400 mg +
Trimetroprim 80 mg
87 132
Glibenklamid Tablet 5 mg Kotrimoksazol Suspensi
Kombinasi :
Sulfametoksazol 200 mg +
Trimetroprim 40 mg/5 ml
88 133
Glimepiride 2 mg Lansoprazole 30 mg Kapsul
89 134
Gliseril guayakolat tablet 100 mg Larutan mengadung Elektrolit
(Na 130 mEq,Cl 109 mEq, Asetat
28 mEq) /Asering

90 135
Gliseril Guayakolat sirup Larutan mengadung Elektrolit
(Nacl 1,125 gr , Dekstrosa 18,75
gr)
91 136
 Glukonas Kalsikus injeksi Larutan mengadung Karbohidrat
+ Elektrolit
(Nacl 1,75 gr, KCL 1,5 gr, Na
Lactat 2,24 gr, Dekstrosa 27 gr)

92 137
Glukosa Larutan Infus 5 % Lidokain injeksi 2 %
93 138
Glukosa Larutan Infus10 % Lidokain Komp Injeksi,
Kombinasi :
Lidokain Hcl 2%
+Epinefrin 1 : 80.000-2 ml
94 139
Griseofulvin Tablet 125 mg,micronized Loperamid Tablet 2 mg
95 140
Haloperidol Tablet 0,5 mg Loratadin tablet 10 mg
96 141
Haloperidol Tablet 1,5 mg Magnesium Sulfat (IV) 20 %-25 ml
97 142
Haloperidol Tablet 5 mg Meloksikam tablet 15 mg
98 143
Hidrokloritiazid 25 mg Meloksikam Suppositoria
99 144
Hidrokortison Krim 2,5 % Metformin Hcl Tablet 500 mg
100 145
Ibuprofen Tablet 200 mg Methisoprinol 500 mg
101 146
Ibuprofen Tablet 400 mg Metilergometrin Maleat (Metergin) Tablet 0,125 mg
102 147
Ibuprofen Suspensi 100 mg/5 ml Metilergometrin Maleat Injeksi 0,200 mg-1ml
103 148
Ichtyol salep Kulit Metilprednisolon tablet 4 mg
104 149
Ipatropium Bromide + Salbutamol Metoklopramid 10 mg

Sulphate for inhalation 2,5 ml

105 150
Isoniazid tablet 100 mg Metoklorpropamid Injeksi 5 mg/ 5 ml
106 151
Isosorbid Dinitrat 5 mg Metronidazol Tablet 250 mg
107 152
Kalium Diklofenak Tablet 25 mg Metronidazole Tablet 500 mg
108 153
Kalium Diklofenak Tablet 50 mg Metronidazole Infus 500 mg /100 ml
109 154
Kalsium Hidroksida Pasta Mikonazole KrIm 2 % - 10 gr
110 155
Kalsium Laktat Tablet 500 mg Multivitamin + Mineral tablet
111 156
Kaptopril 12,5 mg Multivitamin sirup
112 157
Kaptopril 25 mg Natrium Bikarbonat Tablet 500 mg
113 158
Karbamazepin Tablet 200 mg Natrum Diklofenak Tablet 25 mg
114 159
Ketokonazole Krim 2 % - 15 gr Natrium Diklofenak Tablet 50 mg
115 160
Natrium Klorida Larutan infus 0,9%-Steril 500 ml Rifampisin Tablet 450 mg
161 206
Nipedifin Tablet 10 mg Ringer Laktat Larutan Infus Steril 500 ml
162 207
Nistatin 100.000 IU/gram Tablet Vagina Salbutamol Tablet 2 mg
163 208
Nistatin 500.000 IU/gram Tablet Salut Salbutamol Tablet 4 mg
164 209
Obat Antitiuberkolosis Kategori Anak Salbutamol solution for
Inhalation single dose units 2,5
ml
165 210
Obat Antitiuberkolosis Kategori 1 Dewasa Salep 2-4 Kombinasi :

Asam Salisilat 2 % + Belerang

166 211 Endap 4 % - 30 gram
Obat Antitiuberkolosis Kategori 2 Dewasa Salisil bedak 2% -50 gr
167 212
Obat Antitiuberkolosis Kategori 3 Dewasa Salep Luka Bakar
168 213
Obat Anti Tuberkulosis FDC Kat Anak Sefadroksil Sirup Kering 125 mg / 5 ml sirup
169 214
 Obat Anti Tuberkulosis FDC Kat I & II Sefadroksil Tablet 500 mg
170 215
Obat Anti Tuberkulosis FDC Kat I & III Sefiksim Kapsul 100 mg
171 216
Obat Anti Tuberkolosis FDC Sisipan Dewasa Sefotaksim Injeksi 1 gr
172 217
Obat Batuk Hitam (OBH) Cairan 100 ml Seftriakson Injeksi 1 gr / vial
173 218
Obat Batuk Cair Sirup (Ekspektoran) Semen Seng Fosfat Serbuk & Cairan
174 219
Obat Batuk Hitam Plus Sirup Setirizin Tablet 10 mg
175 220
Obat Flu Sirup Setirizin Sirup 5 mg / 5 ml
176 221
Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 ml Sianokobalamin Injeksi 500 mcg/ml-1ml
177 222
Oksiterasiklin Salep Mata 1%-3,5g Sianokobalamin Tablet 50 mcg
178 223
Oksitetrasiklin Hcl Salep Kulit 3%-5g Silver Amalgam Serbuk 65-75%
179 224
Oksitosin Injeksi 10 IU/ml-1ml Simetidin 200 mg Tablet
180 225
Omeprazole injeksi 40mg/10ml Simvastatin Tablet 10 mg
181 226
Omeprazole Kapsul 20 mg Siprofloksasin 500mg
182 227
Ondansetron inj 4 mg/ 2 mL Spironolakton Tablet 25 mg
183 228
Parasetamol drops Sulfacetamid Tetes Mata 15 %-5ml
184 229
Parasetamol Sirup 120 mg/5ml-60 ml Tablet Tambah Darah
Kombinasi:
Besi II Sulfat 200 mg +
Asam Folat 0,25 mg
185 230
Parasetamol Tablet 100 mg Temporary Stopping Fletcher
(Fletcher) Serbuk & Cairan

186 231
Parasetamol Tablet 500 mg Trikesol formalin ( T K F ) Cairan 10 ml
187 232
Pehacain injeksi Tetrasiklin Kapsul 250 mg
188 233
Perak Sulfadiazin krim 1 % 35 gr Tetrasiklin Kapsul 500 mg
189 234
Piracetam 400 mg Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1ml
190 235
Piracetam Tablet 800 mg Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 mg
191 236
Piroksikam Tablet 20 mg Thiamfenikol Kapsul 500 mg
192 237
Pirantel Pamoat Tablet 365 mg Tramadol Injeksi 50 mg/ ml
(Setara dng 125 mg Basa)
193 238
Piridoksin Hcl (Vit.B6) Tablet 10 mg Tramadol Tablet 50 mg
194 239
Polikresulen (Kondensasi Triheksifenidil Hidroklorida Tablet 2 mg
Metakresol
Sulfonat dan Metanal) 360
mg/g-10 ml
195 240
Povidon Iodida 10% 30 ml Vitamin B .Komplek Tablet
196 241
Povidon Iodida 10% 300 ml Vitamin Neurotropik Tablet
197 242
Primakuin tablet 15 mg Zinc Tablet 20 mg
198 243
Propanolol Hcl Tablet 40 mg Prednisone 54mg
199 244
Propilturasil Tablet 100 mg flunax sy
200 245
Ranitidin Injeksi 25 mg / ml vit k
201 246
Ranitidin Tablet 150 mg gentian violet
202 247
Retinol (Vit.A) 100.000 IU Kapsul kloramfenikol 500
203 248
Retinol (Vit.A) 200.000 IU Kapsul Teramysin sm
204 249
Reserpin Tablet 0, 25 mg
205 250
B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES Urine Bag
no 47
Abbocath No 18 ( IV Chateter 18 ) Wing Neddle No 23
1 48
Abbocath No 20 ( IV Chateter 20 ) Anuscopi Yamato
2 49
Abbocath No 22 ( IV Chateter 22 ) Kaca Slide
3 50
Abbocath No 24 ( IV Chateter 24 ) Reagen Ziehl Nielson
4 51
Alat Suntik Sekali Pakai 10 ml Rotator
5 52
Alat Suntik Sekali Pakai 1 ml RTD Malaria
6 53
Alat Suntik Sekali Pakai 2,5 ml Rapid HIV 3 (Oncoprobe HIV)
7 54
Alat Suntik Sekali Pakai 5 ml Sound Timer
8 55
Alat Suntik Sekali Pakai 10 ml SD Syphilis
9 56
Auto Disposable Syringe (ADS) 0,05 ml
10
Auto Disposable Syringe (ADS) 0,5 ml
11
Auto Disposable Syringe (ADS) 5 ml
12
Catgut/Benang Bedah No.2/0-3/0 (Plain & Cromic)
13
Etakridin Larutan (Rivanol) 0,1% - 300 ml
14
Etanol 70 % 1.000 ml
15
Folley Catheter no 14
16
Folley Catheter no 16
17
Folley Catheter no 18
18
Infus set Anak
19
Infus set Dewasa
20
Iodina Test
21
Kassa Hidrofil Steril 16 x 16
22
Kapas Berlemak 500 gram
23
Kapas Pembalut / Adsorbens 250 gram
24
Kassa Kompres 40 x 40 steril
25
Kassa Pembalut 2 m x 80 cm
26
Kassa Pembalut Hidrofil 4 m x 3 cm
27
Kassa Pembalut Hidrofil 4 m x 15 cm
28
Kertas Puyer
29
Lysol 1,000 ml
30
Masker
31
Plester 5 yard x 2 inchi
32
Pot Dahak
33
Rapid HIV 1 (SD HIV)
34
Rapid HIV 2 (Intec HIV)
35
Rapid HIV 2 (Biomeriux HIV)
36
Rapid Test Syphilis
37
RPR Test Syphilis
38
Silk( Benang Bedah Sutra ) No 3/0
39
Safety Box
40
Sarung tangan Steril No 6
41
 Sarung tangan Steril No 7
42
Sarung tangan Steril No 7,5
43
Sarung tangan Non Steril S
44
Sarung tangan Non Steril M
45
Sarung tangan Non Steril L
46
 STOK HARIAN BULAN DESEMBER TAHUN 2017
NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Air Raksa Dental Use Botol 0 -
2 Albendazole Tablet 400 mg Tablet 0 100
3 Alopurinol Tablet 100 mg Tablet 130 42
4 Ambroksol Tablet 30 mg Tablet 10 54
5 Ambroksol sirup 15 mg/5 ml Botol 2 4
6 Aminofillin Injeksi 24 mg/ml-10 ml Ampul 0 -
7 Aminofillin Tablet 200 mg Tablet 0 20
8 Amitriptillin Hcl Tablet Salut 25 mg Tablet 0 40
9 Amlodipin Tablet 5 mg Tablet 167 8
10 Amlodipin Tablet 10 mg Tablet 60 10
11 Amoksisillin Kapsul 250 mg Kapsul 30 170
12 Amoksisillin Kaplet 500 mg Kaplet 360 195
13 Amoksisillin Serbuk Injeksi 1000 mg vial 0 -
14 Amoksisillin Sirup Kering 125 mg/5ml Botol 7 9
15 Amoksisillin Double Strengh Sirup Kering Botol 10 10
16 Ampisilin Kapsul 250 mg Kapsul 0 60
17 Ampisillin Kaplet 500 mg Tablet 0 42
18 Ampisilin Sirup 125 mg / 5 ml Botol 0 -
19 Ampisillin Injeksi 1000 mg Vial 0 -
20 Analgetik Plus Tablet 0 -
21 Antasida Doen Suspensi Kombinasi : Mag Botol 11 -
22 Antasida Doen Tablet, Kombinasi : Magn Tablet 850 29
23 Antasida Plus Tablet Tablet 0 -
24 Antalgin (Metampiron) Tablet 500 mg Tablet 0 -
25 Antalgin Injeksi 250 mg/ml-2ml Ampul 0 -
26 Anti Bakteri DOEN Salep Kombinasi : Tube 1 -
27 Anti Hemoroid Doen komb Supp 0 1
28 Anti Fungi DOEN Kombinasi : Pot 1 1
29 Antimigren DOEN Kombinasi : Tablet 0 -
30 Anti Diare Suspensi Botol 5 2
31 Anti Diare Tablet Tablet 110 27
32 Anti Dotum Oral Tablet Tablet 0 170
33 Anti Hipertensi Kapsul Tablet 0 -
34 Antihistamin Tablet kombinasi Tablet 91 215
35 Antispasmodik Tablet Tablet 110 57
36 Antitusiva Sirup Botol 2 3
37 Antitusiva Tablet Tablet 0 -
38 Asam Folat Tablet 1 mg Tablet 0 -
39 Asam Askorbat 50 mg Tablet 114 71
40 Asam Mefenamat Kapsul 500 mg Kapsul 60 90
41 Asetosal 80 mg Tablet 0 -
42 Asetosal Tablet 100 mg Tablet 0 -
43 Asetosal Tablet 500 mg Tablet 0 -
44 Asiklovir Krim 5 % Tube 2 3
45 Asiklovir Tablet 200 mg Tablet 0 63
46 Asiklovir Tablet 400 mg Tablet 0 88
47 Atropin Sulfat Injeksi 0,25 mg/ml-1ml Ampul 0 -
48 Aqua Pro Injeksi Steril, bebas Pirogen 20 mVial 0 -
49 Betahistin Mesilat 6 mg Tablet 6 4
50 Betametason Krim 0,1 %- 5g Tube 8 1
51 Bisakodil suppositoria 10 mg Supp 0 5
52 Bisoprolol Tablet 5 mg Tablet 0 -
53 Bromheksin 8 mg Tablet 0 10
54 Deksametason Injeksi 5mg/ml-1ml Ampul 0 2
55 Deksametason Tablet 0,5 mg Tablet 60 235
56 Devitalisasi Pasta (Non Arsen) Botol 0 -
57 Diazepam tablet 2 mg Tablet 186 14
58 Diazepam Injeksi i.v/i.m 5 mg/ml Ampul 0 -
59 Diazepam Larutan Rektal 5 mg/ml Supp 1 -
60 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 0 -
61 Difenhidramin HCl Injeksi 10 mg/ml-1ml Ampul 0 46
62 Digoksin Tablet 0,25 mg Tablet 10 30
63 Dimenhidrinat Tablet 50 mg Tablet 72 68
64 Domperidon Tablet 10 mg Tablet 16 58
65 Donperidon Suspensi 5 mg/5ml Botol 0 2
66 Efedrin Hcl Tablet 25 mg Tablet 0 -
67 Ekstrak Belladone Tablet 10 mg Tablet 0 -
68 Epinefrin HCl / Bitartrat Ampul 0 5
69 Eritromisin Kapsul 250 mg Kapsul 0 -
70 Eritromisin Kapsul 500 mg Kapsul 0 -
71 Eritromisin Sirup 200 mg / 5 ml Botol 0 -
72 Etambutol Tablet 500 mg Tablet 0 -
73 Etanol 70 % 100 ml Botol 0 -
74 Etil Klorida Semprot -100 ml Botol 0 -
75 Eugenol Cairan -10 ml Botol 0 -
76 Fenitoin Natrium Kapsul 100 mg Kapsul 0 -
77 Fenobarbital tablet 30 mg Tablet 0 -
78 Fenobarbital injeksi 50 mg / ml Ampul 0 -
79 Fenoksimeti Penisilin 250 mg tablet Tablet 0 100
80 Fenoksimeti Penisilin 500 mg tablet Tablet 0 70
81 Fitomenadion tablet 10 mg Tablet 40 89
82 Fitomenadion (Vit K1) Injeksi 2 mg/ml-1mlAmpul 0 -
83 Furosemid Tablet 40 mg Tablet 45 69
84 Garam Oralit I serbuk, kombinasi : Kantong 73 19
85 Gemfibrozil Tablet 600 mg Tablet 0 -
86 Gentamisin injeksi 80 mg / 2 ml Vial 0 -
87 Gentamisin Salep Kulit 0,1 % Tube 1 1
 88 Glibenklamid Tablet 5 mg Tablet 50 130
89 Glimepiride 2 mg Tablet 0 10
90 Gliseril guayakolat tablet 100 mg Tablet 161 16
91 Gliseril Guayakolat sirup Botol 0 -
92 Glukonas Kalsikus injeksi Ampul 0 -
93 Glukosa Larutan Infus 5 % Botol 0 1
94 Glukosa Larutan Infus10 % Botol 0 -
95 Griseofulvin Tablet 125 mg,micronized Tablet 20 20
96 Haloperidol Tablet 0,5 mg Tablet 0 80
97 Haloperidol Tablet 1,5 mg Tablet 0 80
98 Haloperidol Tablet 5 mg Tablet 170 -
99 Hidrokloritiazid 25 mg Tablet 8 99
100 Hidrokortison Krim 2,5 % Tube 5 9
101 Ibuprofen Tablet 200 mg Tablet 90 15
102 Ibuprofen Tablet 400 mg Tablet 40 10
103 Ibuprofen Suspensi 100 mg/5 ml Botol 3 2
104 Ichtyol salep Kulit Pot 0 3
105 Ipatropium Bromide + Salbutamol Vial 0 -
106 Isoniazid tablet 100 mg Tablet 0 -
107 Isosorbid Dinitrat 5 mg Tablet 0 10
108 Kalium Diklofenak Tablet 25 mg Tablet 0 -
109 Kalium Diklofenak Tablet 50 mg Tablet 30 20
110 Kalsium Hidroksida Pasta Tube 0 -
111 Kalsium Laktat Tablet 500 mg Tablet 20 25
112 Kaptopril 12,5 mg Tablet 0 63
113 Kaptopril 25 mg Tablet 224 90
114 Karbamazepin Tablet 200 mg Tablet 100 -
115 Ketokonazole Krim 2 % - 15 gr Tube 8 3
116 Ketokonazole Tablet 200 mg Tablet 20 6
117 Ketoprofen Tablet 100 mg Tablet 0 -
118 Ketoprofen Injeksi 100 mg / 1 ml Ampul 0 -
119 Ketorolac 10 mg injeksi Ampul 0 -
120 Ketorolac 30 mg injeksi Ampul 0 -
121 Klindamisin Kapsul 150 mg Kapsul 0 -
122 Klindamisin Kapsul 300 mg Kapsul 0 -
123 Kloramfenikol Kapsul 250 mg Kapsul 0 60
124 Kloramfenikol Salep Mata 1%-3,5 g Tube 0 5
125 Kloramfenikol Tetes Mata -5 ml Botol 4 3
126 Kloramfenikol Tetes Telinga 3%-5 ml Botol 6 7
127 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 267 120
128 Klorpromazin Hcl Tablet Salut 25 mg Tablet 170 -
129 Klorpromazin Hcl Tablet Salut 100 mg Tablet 30 -
130 Klorpromazin Hcl Injeksi 5 mg/ml-2ml Ampul 0 -
131 Kotrimoksazol Pedriatik Tablet, Kombinasi :Tablet 0 12
132 Kotrimoksazol Tablet, Kombinasi : Tablet 70 65
133 Kotrimoksazol Suspensi Kombinasi : Botol 8 2
134 Lansoprazole 30 mg Kapsul Tablet 0 14
135 Larutan mengadung Elektrolit (Na 130 mEqBotol 0 -
136 Larutan mengadung Elektrolit (Nacl 1,125 grBotol 0 -
137 Larutan mengadung Karbohidrat + ElektrolitBotol 0 -
138 Lidokain injeksi 2 % Tablet 1 -
139 Lidokain Komp Injeksi, Kombinasi : Ampul 0 -
140 Loperamid Tablet 2 mg Tablet 0 -
141 Loratadin tablet 10 mg Tablet 10 30
142 Magnesium Sulfat (IV) 20 %-25 ml Ampul 0 -
143 Meloksikam tablet 15 mg Tablet 10 2
144 Meloksikam Suppositoria Supp 0 -
145 Metformin Hcl Tablet 500 mg Tablet 40 -
146 Methisoprinol 500 mg Tablet 0 -
147 Metilergometrin Maleat (Metergin) TabletTablet 0 90
148 Metilergometrin Maleat Injeksi 0,200 mg- Ampul 0 4
149 Metilprednisolon tablet 4 mg Tablet 0 80
150 Metoklopramid 10 mg Tablet 0 19
151 Metoklorpropamid Injeksi 5 mg/ 5 ml Ampul 0 -
152 Metronidazol Tablet 250 mg Tablet 11 19
153 Metronidazole Tablet 500 mg Tablet 0 30
154 Metronidazole Infus 500 mg /100 ml Ampul 0 -
155 Mikonazole KrIm 2 % - 10 gr Tube 1 2
156 Multivitamin + Mineral tablet Tablet 0 -
157 Multivitamin sirup Botol 0 -
158 Natrium Bikarbonat Tablet 500 mg Tablet 38 -
159 Natrum Diklofenak Tablet 25 mg Tablet 0 -
160 Natrium Diklofenak Tablet 50 mg Tablet 350 42
161 Natrium Klorida Larutan infus 0,9%-Steril Botol 0 -
162 Nipedifin Tablet 10 mg Tablet 50 132
163 Nistatin 100.000 IU/gram Tablet Vagina Tablet 0 2
164 Nistatin 500.000 IU/gram Tablet Salut Tablet 0 33
165 Obat Antitiuberkolosis Kategori Anak Paket 0 -
166 Obat Antitiuberkolosis Kategori 1 Dewasa Paket 0 -
167 Obat Antitiuberkolosis Kategori 2 Dewasa Paket 0 -
168 Obat Antitiuberkolosis Kategori 3 Dewasa Paket 0 -
169 Obat Anti Tuberkulosis FDC Kat Anak Paket 0 -
170 Obat Anti Tuberkulosis FDC Kat I & II Paket 0 -
171 Obat Anti Tuberkulosis FDC Kat I & III Paket 0 -
172 Obat Anti Tuberkolosis FDC Sisipan DewasaPaket 0 -
173 Obat Batuk Hitam (OBH) Cairan 100 ml Botol 4 -
174 Obat Batuk Cair Sirup (Ekspektoran) Botol 0 -
175 Obat Batuk Hitam Plus Sirup Botol 18 3
176 Obat Flu Sirup Botol 16 10
177 Oksiterasiklin Hcl injeksi i.m.50 mg/ml-10 Vial 0 -
178 Oksiterasiklin Salep Mata 1%-3,5g Tube 1 4
179 Oksitetrasiklin Hcl Salep Kulit 3%-5g Tube 2 2
180 Oksitosin Injeksi 10 IU/ml-1ml Ampul 0 9
181 Omeprazole injeksi 40mg/10ml Ampul 0 -
182 Omeprazole Kapsul 20 mg Tablet 66 22
183 Ondansetron inj 4 mg/ 2 mL Ampul 0 -
184 Parasetamol drops Botol 3 2
185 Parasetamol Sirup 120 mg/5ml-60 ml Botol 15 5
186 Parasetamol Tablet 100 mg Tablet 0 -
187 Parasetamol Tablet 500 mg Tablet 1352 106
188 Pehacain injeksi Ampul 0 -
189 Perak Sulfadiazin krim 1 % 35 gr Tube 0 -
190 Piracetam 400 mg Tablet 0 -
191 Piracetam Tablet 800 mg Tablet 0 -
192 Piroksikam Tablet 20 mg Tablet 165 45
193 Pirantel Pamoat Tablet 365 mg (Setara dngTablet 0 80
194 Piridoksin Hcl (Vit.B6) Tablet 10 mg Tablet 425 21
195 Polikresulen (Kondensasi Metakresol Botol 0 1
196 Povidon Iodida 10% 30 ml Botol 0 2
197 Povidon Iodida 10% 300 ml Botol 0 1
198 Primakuin tablet 15 mg Tablet 0 -
199 Propanolol Hcl Tablet 40 mg Tablet 0 20
200 Propilturasil Tablet 100 mg Tablet 0 -
201 Ranitidin Injeksi 25 mg / ml Ampul 0 -
202 Ranitidin Tablet 150 mg Tablet 182 43
203 Retinol (Vit.A) 100.000 IU Kapsul Kapsul 0 -
204 Retinol (Vit.A) 200.000 IU Kapsul Kapsul 0 186
205 Reserpin Tablet 0, 25 mg Tablet 0 40
206 Rifampisin Tablet 450 mg Tablet 0 -
207 Ringer Laktat Larutan Infus Steril 500 ml Botol 0 2
208 Salbutamol Tablet 2 mg Tablet 0 -
209 Salbutamol Tablet 4 mg Tablet 35 103
210 Salbutamol solution for Inhalation single doAmpul 0 -
211 Salep 2-4 Kombinasi : Pot 2 1
212 Salisil bedak 2% -50 gr Kotak 10 5
213 Salep Luka Bakar Tube 0 -
214 Sefadroksil Sirup Kering 125 mg / 5 ml siruBotol 0 5
215 Sefadroksil Tablet 500 mg Tablet 10 37
216 Sefiksim Kapsul 100 mg Kapsul 20 80
217 Sefotaksim Injeksi 1 gr Ampul 0 -
218 Seftriakson Injeksi 1 gr / vial Ampul 0 -
219 Semen Seng Fosfat Serbuk & Cairan Botol 0 -
220 Setirizin Tablet 10 mg Tablet 45 115
221 Setirizin Sirup 5 mg / 5 ml Botol 0 2
222 Sianokobalamin Injeksi 500 mcg/ml-1ml Ampul 1 18
 223 Sianokobalamin Tablet 50 mcg Tablet 0 10
224 Silver Amalgam Serbuk 65-75% Botol 0 -
225 Simetidin 200 mg Tablet Tablet 66 53
226 Simvastatin Tablet 10 mg Tablet 50 25
227 Siprofloksasin 500mg Tablet 60 92
228 Spironolakton Tablet 25 mg Tablet 0 40
229 Sulfacetamid Tetes Mata 15 %-5ml Botol 0 -
230 Tablet Tambah Darah Kombinasi: Tablet 190 10
231 Temporary Stopping Fletcher (Fletcher) Se Set 0 -
232 Trikesol formalin ( T K F ) Cairan 10 ml Botol 0 -
233 Tetrasiklin Kapsul 250 mg Kapsul 10 90
234 Tetrasiklin Kapsul 500 mg Kapsul 10 80
235 Thiamin Hcl (Vit B1) Injeksi 100 mg/ml-1mlAmpul 0 -
236 Tiamin Hcl /Mononitrat (Vit.B1) Tablet 50 Tablet 534 64
237 Thiamfenikol Kapsul 500 mg Kapsul 0 80
238 Tramadol Injeksi 50 mg/ ml Ampul 0 -
239 Tramadol Tablet 50 mg Tablet 0 -
240 Triheksifenidil Hidroklorida Tablet 2 mg Tablet 90 98
241 Vitamin B .Komplek Tablet Tablet 415 56
242 Vitamin Neurotropik Tablet Tablet 305 92
243 Zinc Tablet 20 mg Tablet 5 10
244 Prednisone 54mg Tablet 127 3
245 flunax sy Botol 0 -
246 vit k tablet 0 100
247 gentian violet Botol 0 -
248 kloramfenikol 500 Tablet 0 90
249 Rivanol 300 ml Botol 0 -
250 Alkohol 70%100 ml Botol 0 -

B. BAHAN MEDIS HABIS PAKAI (BMHP) DAN ALKES

NO NAMA OBAT SATUAN PEMAKAIAN SISA STOK
UMUM JKN
1 Abbocath No 18 ( IV Chateter 18 ) Buah 0 -
2 Abbocath No 20 ( IV Chateter 20 ) Buah 0 10
3 Abbocath No 22 ( IV Chateter 22 ) Buah 0 -
4 Abbocath No 24 ( IV Chateter 24 ) Buah 0 -
5 Alat Suntik Sekali Pakai 10 ml Set 0 17
6 Alat Suntik Sekali Pakai 1 ml Set 0 3
7 Alat Suntik Sekali Pakai 2,5 ml Set 49 9
8 Alat Suntik Sekali Pakai 5 ml Set 0 3
9 Alat Suntik Sekali Pakai 10 ml Set 0 -
10 Auto Disposable Syringe (ADS) 0,05 ml set 0 -
11 Auto Disposable Syringe (ADS) 0,5 ml set 0 -
12 Auto Disposable Syringe (ADS) 5 ml set 0 -
13 Catgut/Benang Bedah No.2/0-3/0 (Plain & Sachet 0 2
14 Etakridin Larutan (Rivanol) 0,1% - 300 ml Botol 0 -
15 Etanol 70 % 1.000 ml Botol 0 -
16 Folley Catheter no 14 Set 0 -
17 Folley Catheter no 16 Set 0 -
18 Folley Catheter no 18 Set 0 2
19 Infus set Anak Set 0 -
20 Infus set Dewasa Set 0 7
21 Iodina Test Botol 0 1
22 Kassa Hidrofil Steril 16 x 16 Kotak 1 -
23 Kapas Berlemak 500 gram Bungkus 0 -
24 Kapas Pembalut / Adsorbens 250 gram Bungkus 0 -
25 Kassa Kompres 40 x 40 steril Bungkus 0 -
26 Kassa Pembalut 2 m x 80 cm Rol 0 2
27 Kassa Pembalut Hidrofil 4 m x 3 cm Rol 0 1
28 Kassa Pembalut Hidrofil 4 m x 15 cm Rol 0 -
29 Kertas Puyer Pcs 0 -
30 Lysol 1,000 ml Botol 0 -
31 Masker Buah 0 10
32 Plester 5 yard x 2 inchi Rol 0 1
33 Pot Dahak Pcs 0 -
34 Rapid HIV 1 (SD HIV) Pcs 0 -
35 Rapid HIV 2 (Intec HIV) Pcs 0 -
36 Rapid HIV 2 (Biomeriux HIV) Pcs 0 -
37 Rapid Test Syphilis Pcs 0 -
38 RPR Test Syphilis Pcs 0 -
39 Silk( Benang Bedah Sutra ) No 3/0 Sachet 0 4
40 Safety Box Pcs 0 -
41 Sarung tangan Steril No 6 Pcs 0 -
42 Sarung tangan Steril No 7 Pcs 0 3
43 Sarung tangan Steril No 7,5 Pcs 0 7
44 Sarung tangan Non Steril S Pcs 0 -
45 Sarung tangan Non Steril M Pcs 0 -
46 Sarung tangan Non Steril L Pcs 0 -
47 Urine Bag set 0 2
48 Wing Neddle No 23 Set 0 -
49 Anuscopi Yamato Unit 0 -
50 Kaca Slide Box 0 -
51 Reagen Ziehl Nielson Kit 0 -
52 Rotator Unit 0 -
53 RTD Malaria Tes 0 -
54 Rapid HIV 3 (Oncoprobe HIV) Pcs 0 -
55 Sound Timer Buah 0 -
56 SD Syphilis Pcs 0 -
57 supraptul/bioplacenton tulle lembar 0 -