PUSKESMAS : UPTD BLUD Puskesmas Cidolog

ALAMAT :Jl. Raya Cidolog No. 40

KECAMATAN : Cidolog

RENCANA KEBUTUHAN OBAT PELAYANAN DASAR TAHUN 2021

NO NAMA OBAT/SEDIAAN SEDIAAN HARGA

OBAT
1 Albendazol tablet 400 mg Tab 0
2 Allupurinol 100 mg Tablet Tab 0
3 Aloclair plus gel BOTOL 0
4 Aminofillin inj 24 mg /ml-10ml ampul 0
5 Aminophylin tablet 200mg Tab 0
6 Amitriptilin HCl tablet salut 25 mg Tab 0
7 Amlodipin 5 mg Tab 0
8 Amoksisilin kaplet 500 mg kaplet 249
9 Amoksisilin kapsul 250 mg KAPSUL 0
10 Amoksisilin sirup kering 125 mg/5 ml BOTOL 0
11 Amoksisilin sirup kering Forte 250 mg/5 ml BOTOL 0
12 ampisilin inj IM/IV 1000 mg/ml ampul 0
13 Antalgin (Metampiron) tablet 500 mg Tab 0
14 Antasida Suspensi 60 ml BOTOL 0
15 Antasida DOEN tablet kombinasi Tab 0
16 Anti Bakteri DOEN salep kombinasi tube 0
17 Anti fungi DOEN komb sk tube 0
18 Anti Hemoroid DOEN kombinasi supp 3,250
19 Antimigren DOEN kombinasi Tab 0
20 Antiparkinson DOEN Tab 0
21 Artesunat serb inj 60 mg/ml ampul 0
22 Artesunate tablet (ACT) Tab 0
23 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
24 Asam Askorbat (Vit.C) tablet 50 mg Tab 42
25 asam folat tablet 1 mg Tab 0
26 Asam mefenamat 500 mg kaplet 111
27 Asam Mefenamat Kapsul 250 mg KAPSUL 0
28 Asiklovir Krem 5% tube 0
29 Asiklovir tablet 200 mg Tab 0
30 Asiklovir Tablet 400 mg Tab 0
31 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 1,718
32 Atropin Sulfat tablet 0,5 mg Tab 0
33 Attalpugite tab 600 mg Tab 0
34 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
35 Betahistin maleat Tab 0
36 Betametasone Krim 0.1% tube 0
37 Bisakodil Supp 10 mg supp 0
38 Captopril 12,5 mg Tab 0
39 Captopril tablet 25 mg Tab 75
40 Ciprofloksasin 500 mg tablet Tab 0
41 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
42 Deksametasone tablet 0.5mg Tab 0
43 Diasepam 5 mg tablet Tab 0
44 Diazepam Inj 5 ml/2ml ampul 0
45 Diazepam lar rektal 5mg/2,5ml tube 0
46 Dietilkarbamazin sitrat tablet 100 mg Tab 0
47 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 0
48 Digoksin tablet 0,25 mg Tab 0
49 Doksisiklin 100 mg ampul 0
50 Domperidon Syrup BOTOL 0
51 Domperidon tablet 10 mg Tab 0
52 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 0
53 Erytromycin 250 mg KAPSUL 0
54 Erytromycin syr 200mg/5 ml BOTOL 0
55 Etambutol HCL 250 mg Tab 0
56 Fenitoin Na kaps 100 mg KAPSUL 0
57 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
58 Fenobarbital tablet 30 mg Tab 0
59 Fenofibrat kaps 100 mg KAPSUL 0
60 Fenoksimetil Penisilina tablet 250 mg Tab 0
61 Fenoksimetil Penisilina tablet 500 mg Tab 0
62 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
63 Fitomenadion injeksi 2 mg/ml ampul 0
64 Furosemid tablet 40 mg Tab 0
65 Garam oralit 200 ml air sachet 0
66 Gentamicin inj 40 mg//ml ampul 0
67 Gentamisin tetes mata BOTOL 0
68 Glibenklamid tablet 5 mg Tab 0
69 Gliseril Guayakolat tablet 100 mg Tab 0
70 Gliserin guayakolat syrup BOTOL 0
71 Griseofulvin tablet 125 mg, micronized Tab 0
72 Haloperidol 0,5 mg tablet Tab 0
73 Haloperidol 1,5 mg tablet Tab 0
74 Haloperidol 5 mg Tab 0
75 Hidroklorotiazid (HCT) tablet 25 mg Tab 148
 76 Hidrokortison krim 2,5 % tube 0
77 Ibuprofen tablet 200 mg Tab 0
78 Ibuprofen tablet 400 mg Tab 0
79 Isoniazid tablet 100 mg Tab 0
80 Isoniazid tablet 300 mg Tab 0
81 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
82 Kalsium alginate gel tube 0
83 Kalsium Glukonat Inj 100 mg/ml ampul 0
84 Kalsium lakate (kalk) tablet Tab 0
85 Karbamazepin tablet 200 mg Tab 0
86 Karbogliserin Tetes Telinga 10% BOTOL 3,300
87 Ketokonazol krim 2 % tube 0
88 Ketokonazol Tablet 200 mg Tab 0
89 Klindamicin 300 mg KAPSUL 0
90 Klopidogrel tab 75 mg Tab 0
91 Kloramfenikol kapsul 500 mg KAPSUL 1,174
92 Kloramfenikol salep kulit 2% (bufacetin) tube 0
93 Kloramfenikol Salep Mata 1% - 3,5 gr BOTOL 0
94 Kloramfenikol Tetes Telinga 3% - 5 ml BOTOL 0
95 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 24
96 Klorpromazin HCL tablet 100 mg Tab 0
97 Klorpromazin inj. 25 mg/ml ampul 0
98 Kodein HCl tablet 10 mg Tab 0
99 Kotrimoksazol forte tablet Tab 0
100 Kotrimoksazol suspensi kombinasi BOTOL 0
101 Kuinin (Kina) tablet 200 mg Tab 0
102 Kuinin dihidroklorida inj 25 %-2 ml ampul 0
103 Lansoprazol 30 mg Tab 0
104 Lidokain inj. 2% ampul 0
105 Lidokain komp. injeksi kombinasi ampul 0
106 Loratadin tab 10 mg Tab 0
107 Magnesium Sulfat injeksi (IV) 40% - 25 ml ampul 0
108 Mebendazol tablet 100 mg Tab 0
109 Metformin tablet 500 mg Tab 0
110 metil dopa tab 250 mg Tab 985
111 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
112 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
113 Metilprednisolon tablet Tab 0
114 Metoklorpropamid tablet 5 mg Tab 117
115 Metronidazol sirup 125mg/5ml BOTOL 0
116 Metronidazol tablet 250 mg Tab 0
117 Metronidazol tablet 500 mg Tab 0
118 Miconazol SK tube 0
119 Multivitamin sirup BOTOL 0
120 Multivitamin Tablet Dewasa Tab 0
121 Natrium bikarbonat tablet 500 mg Tab 0
122 Natrium Diklofenac 25 mg Tab 0
123 Nifedifin tablet 10 mg Tab 0
124 Nistatin 100.000 IU/gram tablet vaginal supp 0
125 Nistatin tablet salut gula 500.000 IU/g Tab 0
126 Obat batuk Hitam (OBH) BOTOL 0
127 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
128 Oksitosin injeksi 10 IU/ml - 1 ml ampul 0
129 Omeprazol 20mg Tab 0
130 Ondansentron tab 8 mg Tab 0
131 parasetamol drop BOTOL 0
132 Parasetamol kaplet 500 mg Tab 0
133 Parasetamol sirup BOTOL 0
134 Permetrin/scabimite krim 5 % tube 0
135 Pirantel Pamoat tablet 125 mg Tab 0
136 Pirazinamid tablet 500 mg Tab 0
137 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
138 Prednison tablet 5 mg Tab 0
139 Probiokid kapsul 0
140 Propiltiourasil tablet 100 mg Tab 0
141 Propranolol HCl tablet 10 mg Tab 0
142 Pyrazinamid tablet 500 mg Tab 0
143 Ranitidin Injeksi 25 mg/ml ampul 0
144 Ranitidin tablet 150 mg Tab 0
145 Retinol (Vit.A) 100.000 IU kapsul KAPSUL 0
146 Retinol (Vit.A) 200.000 IU kapsul KAPSUL 0
147 Rifampisin kapsul 300 mg KAPSUL 0
148 Rifampisin kapsul 450 mg KAPSUL 0
149 Rifampisin kapsul 600 mg KAPSUL 0
150 Salbutamol Cairan ih 0,1% BOTOL 0
151 Salbutamol tablet 4 mg Tab 0
152 Salep 2 - 4 kombinasi tube 0
153 Salisil Bedak 2% - 50 gram tube 0
154 Sefadroksil Kapsul 500 mg KAPSUL 0
155 Sefadroksil Syrup 250 mg BOTOL 0
156 Sefiksim kapsul 100 mg KAPSUL 0
157 Sertirizin tablet 10 mg Tab 0
158 Setirizin sir 5 mg/ 5 ml BOTOL 0
159 Sianokobalamin (Vitamin B12) 50 mg Tab 0
160 Simvastatin 20 mg Tab 0
161 Tablet ferro fumarat 60mg as folat 0.400mg Tab 0
162 Teofilin tab 150 mg Tab 0
163 Tetrasiklin HCl kapsul 250 mg KAPSUL 0
164 Tetrasiklin HCl kapsul 500 mg KAPSUL 0
165 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
166 Triheksifenidil HCl 2 mg tablet Tab 0
167 Vermox tablet (obat cacing) Tab 0
168 Vitamin B komplek tablet Tab 0
169 Zink syrup 20 mg/5 ml BOTOL 0
170 Zink tablet disp 20 mg Tab 0

CAIRAN
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Vial 0
2 Glukosa Larutan infus 5% steril 500 ml BOTOL 6,627
3 Natrium Klorida lart.infus 0,9% steril - 500 ml BOTOL 6,800
4 Ringer Laktat larutan infus steril - 500 ml BOTOL 7,630

Mengetahui,
Kepala UPTD BLUD Puskesmas Cidolog

Cepi Hermansyah,Am.Kep, SKM

NIP.197407211993031002
uskesmas Cidolog

YANAN DASAR TAHUN 2021

PERMINTAAN/PENGADAAN
NILAI PENGADAAN

0 0
0 0 Jumlah RAB 2021
0 0 Pengadaan E-Catalog
0 0 Pengadaan PL
0 0
0 0
0 0
40,000 9960000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 325000
0 0
0 0
0 0
0 0
0 0
5,000 210000
0 0
8,000 888000
0 0
0 0
0 0
0 0
 100 171800
0 0
0 0
0 0
0 0
0 0
0 0
0 0
8,000 600000
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 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
1,000 148000
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 330000
0 0
0 0
0 0
0 0
2,000 2348000
0 0
0 0
0 0
10,000 240000
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
700 689500
0 0
0 0
0 0
2,000 234000
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 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
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 0
0 0
0 0
0 0

0 0
80 530160
41 278800
1,125 8583750

Jumlah Total Belanja Rp 25,537,010

Jumlah Anggaran E-Catalog Rp 25,538,053
Selisih Rp 1,043

Cidolog, 28 April 2021

Petugas Pengelola Obat,

Dede Ginanjar, Am.Kep

 %
Rp 51,076,106 50
Rp 25,538,053
Rp 25,538,053
 PUSKESMAS
ALAMAT
KECAMATAN

RENCANA KEBUTUHAN OBAT PELAYANAN DASAR

NO NAMA OBAT/SEDIAAN

OBAT
1 Acetylcystein 200 mg kap
2 Acyclovir 400 mg
3 Acyclovir Cream
4 Ambroxol 30 mg tab.
5 Ambroxol syr 15 mg/5 ml
6 Aminophilin 200 mg Tablet
7 Amitriptylin 25 mg
8 Amlodipin 10 mg
9 Amoxisilin 500 mg
10 Amoksisilin sirup kering 125 mg/5 ml
11 Antasida Syrup doen Susp
12 Antasida Tablet
13 Aqua pri inj
14 Asam Folat tab 1 mg
15 Asam mefenamat 500mg
16 Asam tranexamat Tablet 500mg
17 Asetosal tab 100 mg
18 Betametason N Cream 0,1 gr
19 Betahistin
20 Bicnat (Sodium Bicarbonat)
21 Bisakodil 5 mg
22 BisopRolol 5 mg
23 Calcii Glukonat inj
24 Captopril 12,5 mg
25 Captopril 25 mg
26 Carbamazepin 200 mg tab
27 Cefixim Tab 200mg
28 Ceftriaxone inj
29 Cetrizin syrup
30 Cetrizine Tab
31 Chlorfeniramin maleat (CTM)
32 Ciprofloxacin 500 tab
33 Clindamycin 300 mg
34 Curcuma tab (Cavicur)
35 Deksametasone tablet 0.5mg
36 Dexametason Inj.
37 Dextrosa 40%
38 Diazepam Tablet 2 mg
39 Digoxin Tablet 0,25mg
40 Diphenhidramin inj.
41 Domperidone syrup
42 Domperidone Tablet
43 Dulcolac Supp. Anak 5 mg
44 Ephineprin injeksi
45 Erytromicin tab 500 mg (Eryra)
46 Gentamicin cream
47 Gentamisin 0,3% OTM
48 Gentamisin sulfat salep mata (Genoint zalf mata)
49 Glibenklamide tab.
50 Haloperidol 0,5 mg tab
51 Haloperidol tab. 1,5 mg
52 Hexymer 2mg (THF)
53 Hydrokortison Cream
54 Ibuprofen syrup
55 Ibuprofen tab.400 mg
56 ISDN (Isosorbid Dinitrat) 5 mg
57 Kalium Diklofenak 50 mg
58 Ketoconazol Tablet 200 mg
59 Ketokonazole krim 2% 15gr
60 KetoRolac injeksi
61 KetoRolac injeksi
62 Kotrimoksazol tab 480 mg (dewasa)
63 L Zinc Syr 100 ml
 64 Lansoprazole Kapsul 30mg
65 Loratadine 10mg
66 Meloxicam 15 mg
67 Metillprednisolon 4 mg
68 Metillprednisolon 8 mg
69 Metronidazole 500 mg
70 Mg SO4 40% - 25 ml
71 Na - diklofenak 50 mg
72 Na - diklofenak 50 mg
73 New Diatab 600 mg
74 Nipedipin 10 mg
75 Nystatin Drops 12 ml
O B H syr O B H syr
76 Omeprazole 20 mg
77 Omeprazole inj Omeprazole inj, dus 10 vial @ 40 mg
78 Ondansetron 4mg/2ml inj Ondansetron 2mg/ ml inj, Dus 5 Am
79 Oralit/Ramolit 4,1gr
80 Oxytocin 10 IU/ ml inj Oxytocin 10 IU/ ml inj, Dus 100 Amp @ 1 ml
81 Paracetamol Syr Paracetamol Syr, botol plastik 60 ml
82 Parasetamol infus Parasetamol infus, Dus 1 Botol @ 100 ml
83 Paracetamol Tab 500mg
84 Paracetamol 500 mg Paracetamol 500 mg, Dus 10 Blister @ 10 table
85 Phenobarbital Tablet 30 mg
86 Phenobarbital 50 mg/ml inj Phenobarbital 50 mg/ml inj, dus 30 Am
87 Piroxicam tab. 20 mg
88 Prednison Prednison Tab, Dus, 10 strip @ 10 tablet
89 Primakuin 15mg
90 Primperan 5mg
91 Propanolol tab. 10 mg
92 Ranitidin 50mg/2ml Inj Ranitidin 50mg/2ml Inj
93 Ranitidin Tab 150 mg Ranitidin 150 mg, Dus, 10 strip @ 10 tablet sa
94 Salbutamol 2 mg Salbutamol 2 mg, Dus, 10 strip @10 tablet
95 Salbutamol Tablet 4 mg
96 Salep 2-4
97 Salep 2-4
98 Salisil talk
99 Salisil talk
100 Serum Anti Tetanus (ATS) 1.500 SI
101 Simvastatin 20 mg Simvastatin 20 mg, Dus, 50 strip @ 10 tablet salu
102 Sotatic inj ( Metoclopiramide )
103 Sotatic tab (Metoclopramid)
104 Streptomycin Injeksi 1 g
105 Sukralfat 500 mg/ 5 ml syr Sukralfat 500 mg/ 5 ml syr, Botol @ 100
106 Tambah Darah Ferro Fumarate 60 mg + Asam Folat 0,4 Mg, dus 3 str
107 Vit B1 Tablet (Thiamin HCl) 50 mg
108 Vitamin B12 25mcg Vitamin B12 25mcg, Dus, 10 Strip @ 10 Tablet
109 Vit B6 Tablet (Piridoksin HCl) 10 mg
110 Vitamin B Komplex Vitamin B Komplex
111 Vitamin C 50 mg Vitamin C 250 mg, Dus 10 strip @ 10 tablet
112 Vit K1 2 mg/ml Inj Phytomenadion (vitamin K1) inj 10 mg/ml, Dus,
113 Vit. K1 Tablet (Phytamenadion tab.)
114 Zink Sulfate syr Zinc sulfate monohydrate/ Zinc/ Zink sir 20 mg/5 ml
115 Zinc 20 mg

Mengetahui,
Kepala UPTD BLUD Puskesmas Cidolog

Cepi Hermansyah,Am.Kep, SKM

NIP.197407211993031002
 : UPTD BLUD Puskesmas Cidolog
:Jl. Raya Cidolog No. 40
: Cidolog

UHAN OBAT PELAYANAN DASAR TAHUN 2021

SEDIAAN HARGA PERMINTAAN/PENGADAAN

NILAI PENGADAAN

Kapsul 1,210 - -
Tablet 603 - -
Tube 3,465 -
Tablet 142 4,000 568,000
Botol 60 ml 5,421 - -
Tablet salut 116 - -
Table 185 - -
Tablet 184 - -
Tablet 297 - -
Botol 2,069 - -
Botol 4,235 - -
Tablet 136 8,000 1,088,000
Ampul 3,146 - -
Tablet 81 - -
Tablet 147 - -
Tablet 1,764 - -
Tablet 138 - -
Tube 2,904 - -
tab 121 - -
Tablet 54 - -
Tablet 330 - -
Tablet 270 - -
Ampul 8,360 - -
Tablet 98 - -
Tablet 110 - -
Tablet 251 - -
Kapsul 3,105 - -
Vial 8,250 - -
Botol 3,135 - -
Tablet 132 - -
Tablet 41 - -
Tablet 352 4,000 1,408,000
Kapsul 1,321 - -
Tablet 964 2,000 1,928,000
Tab 99 10,000 990,000
Ampul 1,681 - -
Vial 9,559 40 382,360
Tablet 75 - -
Tablet 114 - -
Ampul 1,337 - -
Botol 8,349 - -
Tablet 220 - -
Suppo 6,190 100 619,000
Ampul 5,688 - -
Tablet 1,375 - -
Tube 2,420 - -
Fls 4,587 - -
Tube 3,256 - -
Tablet 101 - -
Tablet 64 - -
Tablet 73 - -
Tablet 424 - -
Tube 3,528 - -
Botol 5,437 - -
Tablet 211 9,000 1,899,000
Tablet 103 - -
Tablet 584 8,000 4,672,000
Tablet 339 5,000 1,695,000
Tube 4,876 - -
Ampul 2,200 - -
Ampul 1,651 200 330,200
Tablet 211 - -
Botol 29,948 - -
Kapsul 1,041 4,000 4,164,000
Tablet 135 - -
Tablet 459 - -
Tablet 276 4,000 1,104,000
Tablet 463 - -
Tablet 197 - -
Ampul 4,176 - -
Tablet 252 - -
Tablet 127 - -
Tablet 613 - -
Tablet 109 - -
Botol 21,296 - -
btl 7,438 100 743,820
Kapsul 315 - -
Vial 11,952 40 478,078
Ampul 1,293 92 118,919
Sachet 418 - -
Ampul 1,379 - -
Botol 1,358 - -
Botol 14,247 - -
Tablet 145 20,000 2,900,000
Tablet 380 - -
Tablet 196 - -
Ampul 2,279 - -
Tablet 109 - -
Tablet 84 - -
Tablet 246 - -
Tablet 799 - -
Tablet 66 - -
Ampul 1,366 - -
Tablet 129 2,000 257,600
Tablet 77 - -
Tablet 105 - -
Tube 2,780 - -
Tube 3,374 - -
Pak 2,723 - -
Pak 6,607 - -
Ampul 176,963 - -
Tablet 250 - -
Ampul 3,335 - -
Tablet 283 - -
Vial 5,980 - -
Botol 7,808 - -
Tablet 406 - -
Tablet 89 - -
Tablet 56 - -
Tablet 61 - -
Tablet 102 - -
Tablet 137 - -
Ampul 4,234 - -
Tablet 765 - -
Botol 3,647 - -
Tablet 531 - -

Jumlah Total Belanja Rp 25,345,977

Jumlah Anggaran PL Rp 25,538,053
Selisih Rp 192,076

Cidolog, 28 April 2021

Petugas Pengelola Obat,

Dede Ginanjar, Am.Kep

Jumlah Anggaran PL Rp 25,538,053