Stok Opname Tahun 2022

Lampiran : Berita Acara Stock Opname
Nomor : 900 / 1331 / 402.102.26 / 2021

Tanggal : 31 Desember 2021
LAPORAN PENGECEKAN FISIK (STOCK OPNAME)

PERSEDIAAN
PER 31 DESEMBER 2021
OPD / UNIT KERJA : PUSKESMAS GANTRUNG

KABUPATEN : MADIUN
PROVINSI : JAWA TIMUR
Kode Akun Nama Akun Volume Satuan Harga Jumlah Ket
1 2 3 4 5 6 7
1.1.7.2.4 Persediaan Obat-Obatan
1 Allopurinol 300 mg 4130 Tablet Rp 200.00 Rp 826,000.00
2 Amitriptilin 25 mg 1503 Tablet Rp 167.00 Rp 251,001.00
3 Amlodipin 10 mg 1990 Tablet Rp 70.00 Rp 139,300.00
4 Amlodipin 5 mg 2375 Tablet Rp 53.00 Rp 125,875.00
5 Ampisilin serbuk injeksi 1000mg (i.v.) 20 Vial Rp 8,539.00 Rp 170,780.00
6 Amoksisillin 500 mg 8344 Tablet Rp 201.00 Rp 1,677,144.00
7 Antasida kombinasi suspensi 82 Botol Rp 1,679.00 Rp 137,678.00
8 Antacida Tablet 400 Mg 5370 Tablet Rp 54.00 Rp 289,980.00
9 Anti Bakteri Komb. Polymixin+Bacitracin Salep 11 Tube Rp 5,060.00 Rp 55,660.00
11 Anti Fungi kombinasi salep 29 Tube Rp 4,798.00 Rp 139,142.00
12 Anti Hemoroid kombinasi suppositoria 39 Suppo Rp 3,167.00 Rp 123,513.00
13 Aqua Pro Injeksi 130 Vial Rp 2,650.00 Rp 344,500.00
14 Asam Askorbat 50 mg (Vitamin C) 7431 Tablet Rp 105.00 Rp 780,255.00
15 Asam Askorbat 500 mg (Vitamin C) 4633 Tablet Rp 198.00 Rp 917,334.00
16 Asam Folat 400 mcg 900 Tablet Rp 131.00 Rp 117,900.00
17 Asam Mefenamat 500 mg 3480 Tablet Rp 227.50 Rp 791,700.00
18 Asetyl Sistein 200 mg 24661 Kapsul Rp 373.00 Rp 9,198,553.00
19 Asiklovir 400 mg 939 Tablet Rp 405.00 Rp 380,295.00
20 ASPIRIN (ASETOSAL) TABLET 80 MG 2670 Tablet Rp 105.00 Rp 280,350.00
21 ATTAPULGITE 630 MG / PULAREX 1435 Tablet Rp 162.00 Rp 232,470.00
22 Azithromycin 500 mg 15 Tablet Rp 1,136.35 Rp 17,045.25
23 Bedak Salicyl Serbuk 2% 74 Kotak Rp 6,265.60 Rp 463,654.40
24 Betahistine 6 mg 3970 Tablet Rp 88.00 Rp 349,360.00
25 Betamethasone krim 0,1% 562 Tube Rp 1,430.00 Rp 803,660.00
26 Bisakodyl 5mg 165 Tablet Rp 216.00 Rp 35,640.00
27 Ciprofloxaxin 500 mg 2000 Tablet Rp 248.00 Rp 496,000.00
28 Clozapin 25 mg 530 Tablet Rp 473.00 Rp 250,690.00
29 Deksamethasone 0,5 mg (BLUD) 1605 Tablet Rp 137.34 Rp 220,424.65
30 Diazepam injeksi 5mg/ml (i.v./i.m.) 10 Ampul Rp 1,545.00 Rp 15,450.00
31 Diazepam 2 mg 179 Tablet Rp 86.00 Rp 15,394.00
32 DIAZEPAM RECTAL 10MG / STESOLID (5/BOX) 14 Tube Rp 18,279.00 Rp 255,906.00
33 Difenhidramin injeksi 10mg/ml (i.v./i.m.) 33 Ampul Rp 781.00 Rp 25,773.00
34 Dimenhidrinat 50 mg 846 Tablet Rp 112.00 Rp 94,752.00
35 Domperidon 10 mg 1600 Tablet Rp 91.00 Rp 145,600.00
36 Domperidon 10 mg 2000 Tablet Rp 71.00 Rp 142,000.00
ERGOTAMINE TARTRATE|CAFFEINE TABLET Rp 0.14 Rp 66,600.00
37 (ANTI MIGRAIN) 465590 Tablet
ERLAMYCETIN SM (CHLORAMPHENICOL SM)-
43 Tube Rp 10,230.00 Rp 439,890.00
38 JKN GANTRUNG
39 Favipiravir 200 mg 160 Tablet Rp 15,000.00 Rp 2,400,000.00
40 Fenitoin 100 mg 910 Kapsul Rp 605.00 Rp 550,550.00
41 Fenobarbital 30 mg 500 Tablet Rp 214.56 Rp 107,280.00
Ferro Fumarat 60mg + Asam Folat 0,4mg / TTD
7266 Tablet Rp 354.00 Rp 2,572,164.00
42 untuk ibu hamil
43 Fitomenadion 10 mg (Vitamin K) 100 Tablet Rp 748.00 Rp 74,800.00
44 Fitomenadion injeksi 10mg/ml (i.m.) 23 Ampul Rp 3,450.00 Rp 79,350.00
45 Fitomenadion injeksi 2mg/ml (i.m.) / INFANT 80 Ampul Rp 1,386.00 Rp 110,880.00
46 Flufenazin injeksi 25mg/ml (i.m.)/SIKZONOATE 5 Ampul Rp 79,860.00 Rp 399,300.00
47 Furosemid 40 mg 170 Tablet Rp 80.86 Rp 13,745.86
48 Furosemid 40 mg 1000 Tablet Rp 82.00 Rp 82,000.00
49 Garam Oralit Kombinasi Serbuk (200 ml air) 294 Sachet Rp 377.52 Rp 110,991.00
50 Gentamisin Sulfate tetes mata 0,3% 40 Botol Rp 4,230.44 Rp 169,217.60
51 Glibenklamid 5 mg 15 Tablet Rp 119.00 Rp 1,785.00
52 Glimepiride 1 mg 4508 Tablet Rp 93.00 Rp 419,244.00
53 Glimepiride 3 mg 4220 Tablet Rp 245.00 Rp 1,033,900.00
54 Gliseril Guaiyakolat 100 mg 3134 Tablet Rp 99.00 Rp 310,266.00
55 Griseofulvin (micronized) 125 mg 1190 Tablet Rp 224.00 Rp 266,560.00
56 Haloperidol 0,5 mg 300 Tablet Rp 50.00 Rp 15,000.00
57 Haloperidol 1,5 mg 2980 Tablet Rp 59.00 Rp 175,820.00
58 Hidrokortison Krim 2,5% 91 Tube Rp 2,475.00 Rp 225,225.00
Human Tetanus imunoglobulin (i.m.) 250 IU injeksi
7 Vial Rp 146,800.00 Rp 1,027,600.00
59 / TETAGAM
60 Ibuprofen 400 mg 1990 Tablet Rp 310.00 Rp 616,900.00
61 Infus Ringer Asetat / ASERING 128 Botol Rp 9,723.12 Rp 1,244,558.76
62 Isosorbid DiNitrat 5 mg (ISDN) (BLUD) 1990 Tablet Rp 121.00 Rp 240,790.00
63 Kalsium Laktat 500 mg (KALK) 7500 Tablet Rp 60.00 Rp 450,000.00
64 KAPTOPRIL 25MG 980 Tablet Rp 75.00 Rp 73,500.00
65 Kaptopril 12,5 mg 1100 Tablet Rp 88.00 Rp 96,800.00
66 Karbamazepin 200 mg 330 Tablet Rp 189.00 Rp 62,370.00
Karbogliserin tetes telinga 10% / FENOL
59 Botol Rp 3,300.00 Rp 194,700.00
67 GLISEROL
68 Ketokonazole Krim 2% 40 Tube Rp 2,518.00 Rp 100,720.00
69 Ketorolac 30mg/ml injeksi (BLUD) 50 Ampul Rp 1,750.00 Rp 87,500.00
70 Kloramfenikol 250 mg 240 Kapsul Rp 334.50 Rp 80,279.97
71 Kloramfenikol salep kulit 2% 15 g (Bufacetin) 50 Tube Rp 3,242.00 Rp 162,100.00
Kloramfenikol salep mata 1% / Erlamycetin SM
43 Tube Rp 10,230.00 Rp 439,890.00
72 (BLUD)
73 Klorfeniramin Maleat 4 mg (CTM) 7850 Tablet Rp 24.00 Rp 188,400.00
74 Klorpromazin 100 mg (CEPEZET) (BLUD) 1910 Tablet Rp 605.00 Rp 1,155,550.00
75 Klorpromazin 25 mg 130 Tablet Rp 181.00 Rp 23,530.00
76 Kodein 10 mg 225 Tablet Rp 571.00 Rp 128,475.00
77 Kotrimoksazol Kombinasi 480 mg (dewasa) 810 Tablet Rp 134.69 Rp 109,095.04
78 Kotrimoksazol Kombinasi 480 mg (dewasa) 500 Tablet Rp 126.00 Rp 63,000.00
Lidokain 2%+Epinefrin 1:80.000 Injeksi 2ml Rp 30,550.00
25 Ampul Rp 1,222.00
79 (COMP.)
80 Lidokain 2% injeksi 269 Ampul Rp 1,149.00 Rp 309,081.00
81 Lidokain 2% injeksi 400 Ampul Rp 847.00 Rp 338,800.00
82 linfus KA_EN 3A 27 Botol Rp 10,696.00 Rp 288,792.00
83 Loratadin 10 mg 983 Tablet Rp 109.00 Rp 107,147.00
84 Metformin 500 mg 8908 Tablet Rp 77.00 Rp 685,916.00
85 Metil Ergometrin 0,125 mg 90 Tablet Rp 224.00 Rp 20,160.00
86 Metil Prednisolon 4 mg 230 Tablet Rp 102.00 Rp 23,460.00
87 Metronidazole 500 mg 400 Tablet Rp 406.28 Rp 162,510.00
88 Mikonazole Krim 2% (Nitrat) 42 Tube Rp 4,622.20 Rp 194,132.40
89 Natrium Diklofenak 25 mg 320 Tablet Rp 128.00 Rp 40,960.00
92 Natrium Klorida infus 0,9% (NaCl) 76 Botol Rp 3,280.00 Rp 249,280.00
93 Obat Batuk Hitam ( OBH ) 178 Botol Rp 5,362.50 Rp 954,525.00
94 ONDANSETRON HCL 4mg/2ml (BLUD) 4 Ampul Rp 7,392.00 Rp 29,568.00
95 OSELTAMIVIR PHOSPHATE TABLET 75 MG 34 Tablet Rp 7,000.00 Rp 238,000.00
96 ORALIT (RAMOLIT) (BLUD) 1000 Sachet Rp 570.00 Rp 570,000.00
97 Parasetamol 500 mg 15551 Tablet Rp 196.00 Rp 3,047,996.00
98 Parasetamol Syrup 120mg/5ml 138 Botol Rp 1,181.00 Rp 162,978.00
99 Permetrin Krim 5% / SCABIMITE 1 Tube Rp 11,825.00 Rp 11,825.00
100 Piridoksin 10 mg (Vitamin B6) 5652 Tablet Rp 131.00 Rp 740,412.00
101 Prednison 5 mg 1010 Tablet Rp 73.00 Rp 73,730.00
102 Prednison 5 mg 2000 Tablet Rp 68.00 Rp 136,000.00
103 Propranolol 10 mg 130 Tablet Rp 58.00 Rp 7,540.00
104 Ranitidin 150 mg 1594 Tablet Rp 220.00 Rp 350,680.00
Rp 23,184.00
Retinol kapsul lunak 200.000 IU (Vitamin A Merah) 42 Kapsul Rp 552.00
105
106 Ringer Laktat larutan infus (RL) 20 Botol Rp 7,630.00 Rp 152,600.00
107 risperidon 1mg 20 Tablet Rp 240.00 Rp 4,800.00
110 Salbutamol 2 mg 3034 Tablet Rp 67.00 Rp 203,278.00
111 Salep 2 - 4 Kombinasi 82 Tube Rp 1,410.00 Rp 115,620.00
112 Sefadroksil 500 mg 580 Kapsul Rp 388.00 Rp 225,040.00
113 Sefadroksil sirup kering 125mg/5ml 30 Botol Rp 4,185.00 Rp 125,550.00
114 Sianokobalamin injeksi 500mcg/ml 59 Ampul Rp 1,104.00 Rp 65,136.00
115 Sianokobalamin tablet 50 mcg (Vitamin B12) 1090 Tablet Rp 49.00 Rp 53,410.00
Sianokobalamin tablet 50 mcg (Vitamin B12) Rp 61,600.00
880 Tablet Rp 70.00
116 (BLUD)
117 Simvastatin 20 mg (salut selaput) 13850 Tablet Rp 150.00 Rp 2,077,500.00
TERBUTALIN SULFAT 2.5 MG NEBUL / Rp 268,625.00
35 Vial Rp 7,675.00
118 BRICASMA
119 Thiamin 50 mg (Vitamin B1) (BLUD) 4860 Tablet Rp 283.87 Rp 1,379,588.20
120 Trifluoperazine 5 mg (salut selaput) 290 Tablet Rp 287.00 Rp 83,230.00
121 Triheksifenidil 2 mg 3395 Tablet Rp 63.00 Rp 213,885.00
122 Vitamin B Kompleks 4004 Tablet Rp 57.00 Rp 228,228.00
123 Zinc 20 mg (dispersible) 1485 Tablet Rp 208.00 Rp 308,880.00
124 Zinc sirup (Sulfate) 20mg/5ml 46 Botol Rp 3,171.00 Rp 145,866.00
125 Aminofilin 200 mg (BLUD) 500 Tablet Rp 235.00 Rp 117,500.00
126 Citicolin Inj (BLUD) 15 Ampul Rp 10,450.00 Rp 156,750.00
127 Asam Mefenamat 500 mg (BLUD) 60 Tablet Rp 297.00 Rp 17,820.00
128 Ibuprofen 400 mg (BLUD) 340 Tablet Rp 319.00 Rp 108,460.00
129 SIPROFLOXACIN HCL 500MG jkn -gantrung- 1390 Tablet Rp 385.00 Rp 535,150.00
130 SIPROFLOXACIN HCL 500MG jkn -gantrung- 1000 Tablet Rp 660.00 Rp 660,000.00
131 Yusimox Syrup (BLUD) 16 Botol Rp 4,400.00 Rp 70,400.00
132 MgSo4 (BLUD) 2 Vial Rp 12,100.00 Rp 24,200.00
133 Methil Ergometrin Inj (BLUD) 15 Ampul Rp 5,426.67 Rp 81,400.00
134 Protocin Inj (BLUD) 38 Ampul Rp 6,600.00 Rp 250,800.00
1.1.7.1.12 Persediaan Alat Kesehatan Habis Pakai

1 Alat Suntik Sekali pakai 0,5 ml oneject (BLUD) 1600 PCS Rp 1,650.00 Rp 2,640,000.00
2 Alat Suntik Sekali pakai 1 ml 127 PCS Rp 1,430.00 Rp 181,610.00
3 Alat Suntik Sekali pakai 3 ml 600 PCS Rp 569.00 Rp 341,400.00
4 Alat Suntik Sekali pakai 5 ml 200 PCS Rp 1,470.00 Rp 294,000.00
5 Alkohol 70% 1 Liter 92 Botol Rp 35,000.00 Rp 3,220,000.00
6 Alkohol swabs 3000 PCS Rp 79.00 Rp 237,000.00
Aseptic Gel (Ethyl Alkohol 70%) + Dispenser /
7 22 Botol Rp 179,000.00 Rp 3,938,000.00
cairan pembersih tangan
Aseptic Gel (Ethyl Alkohol 70%) + Dispenser / 34 Botol Rp 26,500.00 Rp 901,000.00
8 cairan pembersih tangan
9 ASEPTIK GEL 5LT 45 Botol Rp 228,000.00 Rp 10,260,000.00
10 Baju APD (disposable protective cover all)/hazmat 655 PCS Rp 90,000.00 Rp 58,950,000.00
11 ECG Gell 1000 ML 3 Botol Rp 28,500.00 Rp 85,500.00
13 Bioanallitika H2O2 3% 100ml (Bok Gantrung) 10 Botol Rp 68,200.00 Rp 682,000.00
14 Chromic catgut with needle surgical sutures 2/0 24 PCS Rp 120,000.00 Rp 2,880,000.00
15 Face Shield Helm 17 PCS Rp 150,000.00 Rp 2,550,000.00
16 Face Shield Mika 16 PCS Rp 20,000.00 Rp 320,000.00
17 Hand Sanitizer 33 Botol Rp 65,340.00 Rp 2,156,220.00
18 Hand schoen non steril free powder Uk. S 900 PCS Rp 1,240.00 Rp 1,116,000.00
19 Hand schoen non steril free powder Uk. M 2000 PCS Rp 1,240.00 Rp 2,480,000.00
20 Hand schoen non steril free powder Uk. L 900 PCS Rp 1,240.00 Rp 1,116,000.00
21 Hand schoen steril ukuran 6,5 2050 Pasang Rp 5,330.00 Rp 10,926,500.00
22 Hand Schoen steril ukuran 7,5 50 Pasang Rp 3,938.00 Rp 196,900.00
23 Sarung tangan obgin 20 Pasang Rp 19,000.00 Rp 380,000.00
24 I.V Catether No.18 26 PCS Rp 6,269.00 Rp 162,994.00
27 Infusion Set Dewasa (NIPRO / OTSUKA) 152 PCS Rp 6,200.00 Rp 942,400.00
28 Kacamata Google 39 PCS Rp 27,600.00 Rp 1,076,400.00
29 Kapas Pembalut 250 gram 18 Roll Rp 12,500.00 Rp 225,000.00
30 Karbol liquid 5 Sach Rp 12,500.00 Rp 62,500.00
31 Kasa Hidrofil 16x16cm 95 Kotak Rp 8,000.00 Rp 760,000.00
32 Kasa Kompres 40x40 Steril 40 PCS Rp 1,600.00 Rp 64,000.00
33 Kasa Pembalut Hidrofil 2mx80cm 70 PCS Rp 7,525.14 Rp 526,760.00
34 Masker Hijab earloop @50 7350 PCS Rp 980.00 Rp 7,203,000.00
35 Masker Tali (face mask ties on) 2100 PCS Rp 2,600.00 Rp 5,460,000.00
36 Masker Karet (face mask ear loop) 12400 PCS Rp 600.00 Rp 7,440,000.00
37 Masker N95 990 PCS Rp 19,296.97 Rp 19,104,000.00
38 Masker KN95 80 PCS Rp 5,000.00 Rp 400,000.00
39 Nasal Oksigen Kanula dewasa 35 PCS Rp 5,090.91 Rp 178,181.85
40 Nurse Cap 200 PCS Rp 300.00 Rp 60,000.00
41 Plain catgut with needle surgical sutures 2/0 12 PCS Rp 5,000.00 Rp 60,000.00
42 Plain catgut with needle surgical sutures 3/0 24 PCS Rp 5,000.00 Rp 120,000.00
43 plester non woven 10cm x 5m 10 Kotak Rp 41,360.00 Rp 413,600.00
44 plester non woven 5cm x 5m 7 Kotak Rp 23,760.00 Rp 166,320.00
45 Pot Sputum 210 PCS Rp 2,275.00 Rp 477,750.00
46 Povidon Iodine larutan 100mg/ml kemasan 30ml 32 Botol Rp 3,200.00 Rp 102,400.00
47 Sofra-Tulle (BLUD) 3 Kotak Rp 308,000.00 Rp 924,000.00
48 Underpad 50 PCS Rp 49,500.00 Rp 2,475,000.00
49 USG Paper (BLUD) 3 Roll Rp 313,500.00 Rp 940,500.00
50 Kantong Jenazah 25 PCS Rp 125,000.00 Rp 3,125,000.00
51 Poliwash 500 ml (BLUD) 1 Botol Rp 58,300.00 Rp 58,300.00
52 Mucus Ekstractor (BLUD) 42 PCS Rp 13,750.00 Rp 577,500.00
53 Sarung Tangan Obgyn Steril (BLUD) 5 Pasang Rp 68,200.00 Rp 341,000.00
54 Delee Besar (BLUD) 4 PCS Rp 22,000.00 Rp 88,000.00
55 Bayzime Detergent Alkali Enzimatic 1 L (BLUD) 7 Botol Rp 645,256.57 Rp 4,516,796.00
56 Baymed Handscrub 4% 500 ml (BLUD) 20 Botol Rp 85,000.30 Rp 1,700,006.00
IV Catheter with Injection No. 22, Cosmomed 32 PCS Rp 8,000.00 Rp 256,000.00
57 (BLUD)
58 Dermafix 5X7 cm, Onemed (BLUD) 4 Kotak Rp 65,000.00 Rp 260,000.00
1.1.7.2.5 Persediaan Bahan Laborat

1 Blood lancet 200 PCS Rp 158.50 Rp 31,700.00
2 Blue Tip (BLUD) 2 Pak Rp 143,000.00 Rp 286,000.00
3 Cholesterol Test (Benecheck) 3 Kotak Rp 250,000.00 Rp 750,000.00
4 Glucose Test (Benecheck) 5 Kotak Rp 160,000.00 Rp 800,000.00
5 HBSAG strip 50 Strip Rp 7,419.00 Rp 370,950.00
6 Rapid diagnostic syphilis test (sd bioline) 200 Strip Rp 8,870.00 Rp 1,774,000.00
7 COVID-19 Ag TEST 350 Kit Rp 43,000.00 Rp 15,050,000.00
8 Reagent HIV (I) RAPID 30 Strip Rp 8,024.00 Rp 240,720.00
9 Uric Acid Test (Benecheck) 5 Kotak Rp 150,000.00 Rp 750,000.00
Madiun, 31 Desember 2021

MENGETAHUI
KEPALA PUSKESMAS GANTRUNG Pejabat Penyimpan Barang
drg. DYAH ARIANA DARMAYANI GALUH MARISTA, S.Farm., Apt.

NIP. 19781021 201001 2 008 NIP. 19940312 202012 2 009
Rp 54,138,634.12
Rp 166,890,689.17
Rp 20,053,370.00
Rp 241,082,693.29
Nomor : 900 / 1331 / 402.102.26 / 2021

PERSEDIAAN
PER 30 NOVEMBER 2022

KABUPATEN : MADIUN
Rincian Mutasi Persediaan OBAT Pakai TA. 2022 pada Puskesmas Gantrung
Saldo per 1 Januari 2021 Penambahan Pengurangan Saldo Per 30 November 2022 HASIL STOCK OPNAME
No Rincian Nama Persediaan Nilai Persediaan
Jumlah Jumlah Nilai Persediaan ( Rp ) Jumlah Nilai Persediaan ( Rp ) Jumlah Nilai Persediaan ( Rp ) Jumlah
( Rp )
1 2 3 4 5 6 7 8 9 ( 3+5-7) 10 (4+6-8) 11

1 Albendazole 400 mg 15 Rp 6,060.00 0 Rp - 15 Rp 6,060.00 0 Rp - 0
2 Allopurinol 100mg 801 Rp 146,262.60 0 Rp - 801 Rp 146,262.60 0 Rp - 0
3 Allopurinol 100 mg (BLUD) 0 Rp - 1000 Rp 272,250.00 1000 Rp 272,250.00 0 Rp - 0
4 Allopurinol 300 mg 0 Rp - 4500 Rp 900,000.00 370 Rp 74,000.00 4130 Rp 826,000.00 4130
5 Ambroksol 30 mg 3759 Rp 762,997.00 0 Rp - 3759 Rp 762,997.00 0 Rp - 0
6 Aminofilin 200 mg 1010 Rp 89,890.00 0 Rp - 1010 Rp 89,890.00 0 Rp - 0
7 Aminofilin 200 mg 0 Rp - 2000 Rp 190,000.00 2000 Rp 190,000.00 0 Rp - 0
8 Aminofilin Injeksi 24 mg/ml 0 Rp - 90 Rp 267,840.00 90 Rp 267,840.00 0 Rp - 0
9 Amitriptilin 25 mg 800 Rp 133,600.00 3500 Rp 584,500.00 2797 Rp 467,099.00 1503 Rp 251,001.00 1503
10 Amlodipin 10 mg 2000 Rp 198,000.00 0 Rp - 2000 Rp 198,000.00 0 Rp - 0
11 Amlodipin 10 mg 0 Rp - 10000 Rp 700,000.00 8010 Rp 560,700.00 1990 Rp 139,300.00 1990
12 Amlodipin 10 mg (ZEVASK) (BLUD) 0 Rp - 800 Rp 325,600.00 800 Rp 325,600.00 0 Rp - 0
14 Amlodipin 5 mg 15300 Rp 810,900.00 12925 Rp 685,025.00 2375 Rp 125,875.00 2375
15 Ampisilin serbuk injeksi 1000mg (i.v.) 20 Rp 164,740.00 0 Rp - 20 Rp 164,740.00 0 Rp - 0
16 Ampisilin serbuk injeksi 1000mg (i.v.) 0 Rp - 20 Rp 170,780.00 0 Rp - 20 Rp 170,780.00 20
17 Amoksisillin 500 mg 7661 Rp 1,907,589.00 0 Rp - 7661 Rp 1,907,589.00 0 Rp - 0
18 Amoksisillin 500 mg 0 Rp - 13000 Rp 2,613,000.00 4656 Rp 935,856.00 8344 Rp 1,677,144.00 8344
19 Antasida kombinasi suspensi 0 Rp - 100 Rp 167,900.00 18 Rp 30,222.00 82 Rp 137,678.00 82
20 Antacida Tablet 400 Mg 5234 Rp 303,572.00 Rp - 5234 Rp 303,572.00 0 Rp - 0
21 Antacida Tablet 400 Mg 0 Rp - 17000 Rp 918,000.00 11630 Rp 628,020.00 5370 Rp 289,980.00 5370
22 Anti Bakteri komb. Polymixin+Bacitracin salep 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
23 Anti Bakteri Komb. Polymixin+Bacitracin Salep 56 Rp 283,360.00 0 Rp - 45 Rp 227,700.00 11 Rp 55,660.00 11
24 Anti Flu / DEMACOLIN / Paraflu 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
25 Anti Fungi kombinasi salep 63 Rp 302,274.00 0 Rp - 58 Rp 278,284.00 5 Rp 23,990.00 5
26 Anti Fungi kombinasi salep 0 Rp - 24 Rp 115,152.00 0 Rp - 24 Rp 115,152.00 24
27 Anti Hemoroid kombinasi suppositoria 50 Rp 158,350.00 20 Rp 63,340.00 31 Rp 98,177.00 39 Rp 123,513.00 39
28 Aqua Pro Injeksi 24 Rp 68,640.00 0 Rp - 24 Rp 68,640.00 0 Rp - 0
29 Aqua Pro Injeksi 0 Rp - 200 Rp 530,000.00 70 Rp 185,500.00 130 Rp 344,500.00 130
30 Asam Askorbat 50 mg (Vitamin C) 7341 Rp 770,805.00 8000 Rp 840,000.00 7910 Rp 830,550.00 7431 Rp 780,255.00 7431
31 Asam Askorbat 500 mg (Vitamin C) 0 Rp - 9300 Rp 1,841,400.00 4667 Rp 924,066.00 4633 Rp 917,334.00 4633
32 Asam Folat 1 mg 570 Rp 39,900.00 0 Rp - 570 Rp 39,900.00 0 Rp - 0
33 Asam Folat 400 mcg 500 Rp 65,500.00 1500 Rp 196,500.00 1100 Rp 144,100.00 900 Rp 117,900.00 900
34 Asam Mefenamat 500 mg 0 Rp - 4000 Rp 910,000.00 520 Rp 118,300.00 3480 Rp 791,700.00 3480
35 Asetyl Sistein 200 mg 1170 Rp 436,410.00 27700 Rp 10,332,100.00 4209 Rp 1,569,957.00 24661 Rp 9,198,553.00 24661
36 Asiklovir 400 mg 1510 Rp 611,550.00 0 Rp - 571 Rp 231,255.00 939 Rp 380,295.00 939
37 ASPIRIN (ASETOSAL) TABLET 80 MG 1166 Rp 122,430.00 7000 Rp 735,000.00 5496 Rp 577,080.00 2670 Rp 280,350.00 2670
38 Atapulgit 600 mg / NEW ANTIDES 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
39 ATTAPULGITE 630 MG / PULAREX 2149 Rp 348,138.00 1000 Rp 162,000.00 1714 Rp 277,668.00 1435 Rp 232,470.00 1435
40 Azithromycin 500 mg 0 Rp - 25 Rp 28,408.75 10 Rp 11,363.50 15 Rp 17,045.25 15
41 Bedak Salicyl Serbuk 2% 0 Rp - 100 Rp 626,560.00 26 Rp 162,905.60 74 Rp 463,654.40 74
42 Betahistine 6 mg 1210 Rp 133,100.00 0 Rp - 1210 Rp 133,100.00 0 Rp - 0
43 Betahistine 6 mg 0 Rp - 6100 Rp 536,800.00 2130 Rp 187,440.00 3970 Rp 349,360.00 3970
44 Betamethasone krim 0,1% 114 Rp 163,020.00 650 Rp 929,500.00 202 Rp 288,860.00 562 Rp 803,660.00 562
45 Bisakodyl 5mg 0 Rp - 210 Rp 45,360.00 45 Rp 9,720.00 165 Rp 35,640.00 165
46 Ciprofloxaxin 500 mg 0 Rp - 2000 Rp 496,000.00 0 Rp - 2000 Rp 496,000.00 2000
47 Clozapin 25 mg 590 Rp 661,390.00 Rp - 590 Rp 661,390.00 0 Rp - 0
48 Clozapin 25 mg 0 Rp - 1000 Rp 473,000.00 470 Rp 222,310.00 530 Rp 250,690.00 530
49 Deksamethasone 0,5 mg (BLUD) 4223 Rp 257,603.00 Rp - 4223 Rp 257,603.00 0 Rp - 0
50 Deksamethasone 0,5 mg (BLUD) 0 Rp - 3000 Rp 412,000.00 1395 Rp 191,575.35 1605 Rp 220,424.65 1605
51 Deksamethasone 5mg/ml (BLUD) 200 Rp 528,000.00 0 Rp - 200 Rp 528,000.00 0 Rp - 0
52 Diazepam injeksi 5mg/ml (i.v./i.m.) 0 Rp - 10 Rp 15,450.00 0 Rp - 10 Rp 15,450.00 10
53 Diazepam 2 mg 373 Rp 32,078.00 0 Rp - 194 Rp 16,684.00 179 Rp 15,394.00 179
54 DIAZEPAM RECTAL 10MG / STESOLID (5/BOX) 9 Rp 164,511.00 5 Rp 91,395.00 0 Rp - 14 Rp 255,906.00 14
55 Difenhidramin injeksi 10mg/ml (i.v./i.m.) 50 Rp 58,400.00 0 Rp - 50 Rp 58,400.00 0 Rp - 0
56 Difenhidramin injeksi 10mg/ml (i.v./i.m.) 0 Rp - 150 Rp 117,150.00 117 Rp 91,377.00 33 Rp 25,773.00 33
57 Digoksin 0,25 mg 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
58 Dimenhidrinat 50 mg 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
59 Dimenhidrinat 50 mg 902 Rp 101,024.00 1000 Rp 112,000.00 1056 Rp 118,272.00 846 Rp 94,752.00 846
60 Domperidon 10 mg 4232 Rp 385,112.00 0 Rp - 2632 Rp 239,512.00 1600 Rp 145,600.00 1600
61 Domperidon 10 mg 0 Rp - 2000 Rp 142,000.00 0 Rp - 2000 Rp 142,000.00 2000
62 Domperidon suspensi 5mg/5ml 31 Rp 83,700.00 0 Rp - 31 Rp 83,700.00 0 Rp - 0
63 Epinefrin (adrenalin) injeksi 0,1% (i.v./s.k./i.m.) 40 Rp 56,320.00 0 Rp - 40 Rp 56,320.00 0 Rp - 0
64 Epinefrin (adrenalin) injeksi 0,1% (i.v./s.k./i.m.) 0 Rp - 17 Rp 94,017.99 17 Rp 94,017.99 0 Rp - 0
ERGOTAMINE TARTRATE|CAFFEINE TABLET Rp - 465590
200 Rp 74,000.00 20 Rp 7,400.00 465590 Rp 66,600.00
65 (ANTI MIGRAIN) 465410
66 Eritromisin 250 mg 280 Rp 163,240.00 Rp - 280 Rp 163,240.00 0 Rp - 0
ERLAMYCETIN SM (CHLORAMPHENICOL SM)- 43
0 Rp - 48 Rp 491,040.00 5 Rp 51,150.00 43 Rp 439,890.00
67 JKN GANTRUNG
68 Favipiravir 200 mg 0 Rp - 160 Rp 2,400,000.00 0 Rp - 160 Rp 2,400,000.00 160
69 Fenitoin 100 mg 290 Rp 45,820.00 Rp - 290 Rp 45,820.00 0 Rp - 0
70 Fenitoin 100 mg 0 Rp - 1500 Rp 907,500.00 590 Rp 356,950.00 910 Rp 550,550.00 910
71 Fenobarbital 30 mg 1030 Rp 247,200.00 Rp - 530 Rp 139,920.00 500 Rp 107,280.00 500
Ferro Fumarat 60mg + Asam Folat 0,4mg / TTD 7266
5950 Rp 2,106,300.00 23000 Rp 8,142,000.00 21684 Rp 7,676,136.00 7266 Rp 2,572,164.00
72 untuk ibu hamil
73 Fitomenadion 10 mg (Vitamin K) 319 Rp 241,802.00 0 Rp - 319 Rp 241,802.00 0 Rp - 0
74 Fitomenadion 10 mg (Vitamin K) 0 Rp - 1200 Rp 897,600.00 1100 Rp 822,800.00 100 Rp 74,800.00 100
75 Fitomenadion injeksi 10mg/ml (i.m.) 0 Rp - 30 Rp 103,500.00 7 Rp 24,150.00 23 Rp 79,350.00 23
76 Fitomenadion injeksi 2mg/ml (i.m.) / INFANT 20 Rp 73,640.00 0 Rp - 20 Rp 73,640.00 0 Rp - 0
77 Fitomenadion injeksi 2mg/ml (i.m.) / INFANT 0 Rp - 90 Rp 124,740.00 10 Rp 13,860.00 80 Rp 110,880.00 80
78 Flufenazin injeksi 25mg/ml (i.m.)/SIKZONOATE 6 Rp 375,958.00 0 Rp - 6 Rp 375,958.00 0 Rp - 0
79 Flufenazin injeksi 25mg/ml (i.m.)/SIKZONOATE 0 Rp - 35 Rp 2,795,100.00 30 Rp 2,395,800.00 5 Rp 399,300.00 5
80 Furosemid 40 mg 2408 Rp 194,706.00 0 Rp - 2238 Rp 180,960.14 170 Rp 13,745.86 170
81 Furosemid 40 mg 0 Rp - 1000 Rp 82,000.00 0 Rp - 1000 Rp 82,000.00 1000
82 Garam Oralit Kombinasi Serbuk (200 ml air) 1717 Rp 476,702.00 Rp - 1423 Rp 365,711.00 294 Rp 110,991.00 294
83 Gentamisin Sulfate tetes mata 0,3% 78 Rp 330,072.60 72 Rp 304,632.00 110 Rp 465,487.00 40 Rp 169,217.60 40
84 Glibenklamid 5 mg 945 Rp 112,455.00 0 Rp - 930 Rp 110,670.00 15 Rp 1,785.00 15
85 Glimepiride 1 mg 0 Rp - 5000 Rp 465,000.00 492 Rp 45,756.00 4508 Rp 419,244.00 4508
86 Glimepiride 3 mg 5155 Rp 896,970.00 0 Rp - 5155 Rp 896,970.00 0 Rp - 0
87 Glimepiride 3 mg 11000 Rp 2,695,000.00 6780 Rp 1,661,100.00 4220 Rp 1,033,900.00 4220
88 Glimepiride 2 mg 5000 Rp 1,035,000.00 0 Rp - 5000 Rp 1,035,000.00 0 Rp - 0
89 Gliseril Guaiyakolat 100 mg 3199 Rp 321,554.97 0 Rp - 3199 Rp 321,554.97 0 Rp - 0
90 Gliseril Guaiyakolat 100 mg 0 Rp - 4500 Rp 445,500.00 1366 Rp 135,234.00 3134 Rp 310,266.00 3134
91 Glukose larutan infus 10% 37 Rp 296,111.00 0 Rp - 37 Rp 296,111.00 0 Rp - 0
92 Griseofulvin (micronized) 125 mg 700 Rp 156,800.00 900 Rp 201,600.00 410 Rp 91,840.00 1190 Rp 266,560.00 1190
93 Haloperidol 0,5 mg 390 Rp 35,628.00 0 Rp - 390 Rp 35,628.00 0 Rp - 0
94 Haloperidol 0,5 mg 0 Rp - 300 Rp 15,000.00 0 Rp - 300 Rp 15,000.00 300
95 Haloperidol 1,5 mg 2470 Rp 146,930.00 Rp - 2470 Rp 146,930.00 0 Rp - 0
96 Haloperidol 1,5 mg 0 Rp - 10000 Rp 590,000.00 7020 Rp 414,180.00 2980 Rp 175,820.00 2980
Haloperidol injeksi 50mg/ml / HALDOL DECANOAS Rp - Rp - Rp - 0 Rp - 0
97 0
98 Hidrokortison Krim 2,5% 123 Rp 304,425.00 48 Rp 118,800.00 80 Rp 198,000.00 91 Rp 225,225.00 91
Human Tetanus imunoglobulin (i.m.) 250 IU injeksi / Rp 1,886,630.00 Rp - Rp 1,886,630.00 0 Rp - 0
99 TETAGAM 10 0 10
Human Tetanus imunoglobulin (i.m.) 250 IU injeksi / Rp - Rp 2,642,400.00 11 Rp 1,614,800.00 7 Rp 1,027,600.00 7
100 TETAGAM 0 18
101 Ibuprofen 400 mg 0 Rp - 2000 Rp 620,000.00 10 Rp 3,100.00 1990 Rp 616,900.00 1990
102 Infus Ringer Asetat / ASERING 149 Rp 1,429,358.76 0 Rp - 21 Rp 184,800.00 128 Rp 1,244,558.76 128
Ipatropium Bromida serbuk inhalasi 20mcg/semprot / Rp 86,600.00 Rp - Rp 86,600.00 0 Rp - 0
103 ATROVENT 1 0 1
104 Isoniazid 100 mg 800 Rp 225,600.00 0 Rp - 800 Rp 225,600.00 0 Rp - 0
105 Isosorbid DiNitrat 5 mg (ISDN) (BLUD) 0 Rp - 2000 Rp 242,000.00 10 Rp 1,210.00 1990 Rp 240,790.00 1990
106 Isosorbid DiNitrat 5 mg (ISDN) 1573 Rp 224,939.00 0 Rp - 1573 Rp 224,939.00 0 Rp - 0
107 Kalsium Glukonat 10% injeksi 0 Rp - 10 Rp 57,230.00 10 Rp 57,230.00 0 Rp - 0
108 Kalsium Laktat 500 mg (KALK) 5860 Rp 385,740.00 0 Rp - 5860 Rp 385,740.00 0 Rp - 0
109 Kalsium Laktat 500 mg (KALK) 0 Rp - 8000 Rp 480,000.00 500 Rp 30,000.00 7500 Rp 450,000.00 7500
110 KAPTOPRIL 25MG 0 Rp - 2000 Rp 150,000.00 1020 Rp 76,500.00 980 Rp 73,500.00 980
111 Kaptopril 12,5 mg 2474 Rp 163,284.00 0 Rp - 2474 Rp 163,284.00 0 Rp - 0
112 Kaptopril 12,5 mg 0 Rp - 3500 Rp 308,000.00 2400 Rp 211,200.00 1100 Rp 96,800.00 1100
113 Karbamazepin 200 mg 170 Rp 40,515.60 0 Rp - 170 Rp 40,515.60 0 Rp - 0
114 Karbamazepin 200 mg 0 Rp - 700 Rp 132,300.00 370 Rp 69,930.00 330 Rp 62,370.00 330
0
Karbogliserin tetes telinga 10% / FENOL GLISEROL 42 Rp 116,268.00 0 Rp - 42 Rp 116,268.00 0 Rp -
115
Rp - 59
Karbogliserin tetes telinga 10% / FENOL GLISEROL 0 72 Rp 237,600.00 13 Rp 42,900.00 59 Rp 194,700.00
116
117 KDT/FDC KATEGORI II 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
118 KDT/FDC KOMBIPAK KATEGORI I 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
119 KDT/FDC untuk ANAK 2 Rp 496,240.00 0 Rp - 2 Rp 496,240.00 0 Rp - 0
120 KDT/FDC untuk DEWASA (KATEGORI I) 10 Rp 4,154,690.00 20 Rp 8,309,380.00 30 Rp 12,464,070.00 0 Rp - 0
121 Ketokonazole 200 mg 754 Rp 224,182.98 0 Rp - 754 Rp 224,182.98 0 Rp - 0
122 Ketokonazole Krim 2% 44 Rp 110,792.00 50 Rp 125,900.00 54 Rp 135,972.00 40 Rp 100,720.00 40
123 Ketorolac 30mg/ml injeksi 264 Rp 287,496.00 0 Rp - 264 Rp 287,496.00 0 Rp - 0
124 Ketorolac 30mg/ml injeksi (BLUD) 0 Rp - 50 Rp 110,000.00 50 Rp 110,000.00 0 Rp - 0
125 Ketorolac 30mg/ml injeksi (BLUD) 0 Rp - 50 Rp 87,500.00 0 Rp - 50 Rp 87,500.00 50
126 Kloramfenikol 250 mg 540 Rp 261,779.97 0 Rp - 300 Rp 181,500.00 240 Rp 80,279.97 240
127 Kloramfenikol salep kulit 2% 15 g (Bufacetin) 85 Rp 287,562.80 0 Rp - 85 Rp 287,562.80 0 Rp - 0
128 Kloramfenikol salep kulit 2% 15 g (Bufacetin) 0 Rp - 72 Rp 233,424.00 22 Rp 71,324.00 50 Rp 162,100.00 50
129 Kloramfenikol salep mata 1% 111 Rp 213,204.37 0 Rp - 111 Rp 213,204.37 0 Rp - 0
Kloramfenikol salep mata 1% / Erlamycetin SM 43
0 Rp - 48 Rp 491,040.00 5 Rp 51,150.00 43 Rp 439,890.00
130 (BLUD)
131 Klorfeniramin Maleat 4 mg (CTM) 9253 Rp 150,057.07 0 Rp - 9253 Rp 150,057.07 0 Rp - 0
132 Klorfeniramin Maleat 4 mg (CTM) 0 Rp - 12000 Rp 288,000.00 4150 Rp 99,600.00 7850 Rp 188,400.00 7850
133 Klorpromazin 100 mg 5870 Rp 862,890.00 0 Rp - 5870 Rp 862,890.00 0 Rp - 0
134 Klorpromazin 100 mg (CEPEZET) (BLUD) 0 Rp - 3000 Rp 1,815,000.00 1090 Rp 659,450.00 1910 Rp 1,155,550.00 1910
135 Klorpromazin 25 mg 200 Rp 36,200.00 800 Rp 144,800.00 870 Rp 157,470.00 130 Rp 23,530.00 130
136 Klorpromazin injeksi 25mg/ml (i.m.) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
137 Kodein 10 mg 410 Rp 234,110.00 0 Rp - 185 Rp 105,635.00 225 Rp 128,475.00 225
138 Kotrimoksazol Kombinasi 480 mg (dewasa) 2065 Rp 278,125.00 0 Rp - 1255 Rp 169,029.96 810 Rp 109,095.04 810
139 Kotrimoksazol Kombinasi 480 mg (dewasa) 0 Rp - 500 Rp 63,000.00 0 Rp - 500 Rp 63,000.00 500
140 Kotrimoksazol Kombinasi Suspensi 240 mg 104 Rp 229,000.00 0 Rp - 104 Rp 229,000.00 0 Rp - 0
25
Lidokain 2%+Epinefrin 1:80.000 Injeksi 2ml (COMP.) 180 Rp 219,960.00 0 Rp - 155 Rp 189,410.00 25 Rp 30,550.00
141
142 Lidokain 2% injeksi 300 Rp 344,700.00 0 Rp - 31 Rp 35,619.00 269 Rp 309,081.00 269
143 Lidokain 2% injeksi 0 Rp - 400 Rp 338,800.00 0 Rp - 400 Rp 338,800.00 400
144 linfus KA_EN 3A 30 Rp 320,880.00 0 Rp - 3 Rp 32,088.00 27 Rp 288,792.00 27
145 Loratadin 10 mg 783 Rp 102,573.00 0 Rp - 783 Rp 102,573.00 0 Rp - 0
146 Loratadin 10 mg 0 Rp - 1000 Rp 109,000.00 17 Rp 1,853.00 983 Rp 107,147.00 983
147 Metformin 500 mg 7180 Rp 793,725.00 0 Rp - 7180 Rp 793,725.00 0 Rp - 0
148 Metformin 500 mg 0 Rp - 30000 Rp 2,310,000.00 21092 Rp 1,624,084.00 8908 Rp 685,916.00 8908
149 Metil Ergometrin 0,125 mg 170 Rp 38,080.00 100 Rp 22,400.00 180 Rp 40,320.00 90 Rp 20,160.00 90
150 Metil Ergometrin injeksi 0,2mg/ml / MYOMERGIN 20 Rp 59,180.00 0 Rp - 20 Rp 59,180.00 0 Rp - 0
151 Metil Prednisolon 4 mg 0 Rp - 1000 Rp 102,000.00 770 Rp 78,540.00 230 Rp 23,460.00 230
152 Metoklopramid 10 mg 0 Rp - 500 Rp 45,000.00 500 Rp 45,000.00 0 Rp - 0
153 Metronidazole 500 mg 1160 Rp 263,590.00 0 Rp - 760 Rp 101,080.00 400 Rp 162,510.00 400
154 Mikonazole Krim 2% (Nitrat) 73 Rp 253,032.40 0 Rp - 31 Rp 58,900.00 42 Rp 194,132.40 42
155 Natrium Diklofenak 25 mg 3335 Rp 426,880.00 0 Rp - 3015 Rp 385,920.00 320 Rp 40,960.00 320
156 Natrium Diklofenak 25 mg 0 Rp - 2800 Rp 322,000.00 0 Rp - 2800 Rp 322,000.00 2800
157 Natrium Diklofenak 50 mg 2540 Rp 316,100.00 0 Rp - 2540 Rp 316,100.00 0 Rp - 0
158 Natrium Diklofenak 50 mg 0 Rp - 8400 Rp 1,033,200.00 3630 Rp 446,490.00 4770 Rp 586,710.00 4770
159 Natrium Klorida infus 0,9% (NaCl) 60 Rp 470,600.00 0 Rp - 60 Rp 470,600.00 0 Rp - 0
160 Natrium Klorida infus 0,9% (NaCl) 0 Rp - 313 Rp 1,026,640.00 237 Rp 777,360.00 76 Rp 249,280.00 76
161 Nistatin 100.000 IU (tablet vaginal) 80 Rp 44,080.00 0 Rp - 80 Rp 44,080.00 0 Rp - 0
162 Obat Batuk Hitam ( OBH ) 175 Rp 781,830.73 0 Rp - 175 Rp 781,830.73 0 Rp - 0
163 Obat Batuk Hitam ( OBH ) 0 Rp - 240 Rp 1,287,000.00 62 Rp 332,475.00 178 Rp 954,525.00 178
164 ONDANSETRON 4mg/2ml injeksi 195 Rp 219,180.00 0 Rp - 195 Rp 219,180.00 0 Rp - 0
165 ONDANSETRON 4mg/2ml injeksi 0 Rp - 25 Rp 21,825.00 25 Rp 21,825.00 0 Rp - 0
166 ONDANSETRON HCL 4mg/2ml (BLUD) 0 Rp - 50 Rp 369,600.00 46 Rp 340,032.00 4 Rp 29,568.00 4
167 OSELTAMIVIR PHOSPHATE TABLET 75 MG 0 Rp - 100 Rp 700,000.00 66 Rp 462,000.00 34 Rp 238,000.00 34
168 ORALIT (RAMOLIT) (BLUD) 0 Rp - 1000 Rp 570,000.00 0 Rp - 1000 Rp 570,000.00 1000
169 OXYTETRACYCLINE SALEP MATA 1 % (HCL) 0 Rp - 35 Rp 87,500.00 35 Rp 87,500.00 0 Rp - 0
170 Parasetamol 500 mg 20961 Rp 2,242,617.39 Rp - 20961 Rp 2,242,617.39 0 Rp - 0
171 Parasetamol 500 mg 0 Rp - 40000 Rp 7,840,000.00 24449 Rp 4,792,004.00 15551 Rp 3,047,996.00 15551
172 Parasetamol Syrup 120mg/5ml 320 Rp 377,920.00 600 Rp 708,600.00 782 Rp 923,542.00 138 Rp 162,978.00 138
173 Perak Sulfadiazin Krim 1% / BURNAZIN 0 Rp - 12 Rp 248,397.60 12 Rp 248,397.60 0 Rp - 0
174 Permetrin Krim 5% / SCABIMITE 16 Rp 189,200.00 16 Rp 189,200.00 31 Rp 366,575.00 1 Rp 11,825.00 1
175 Piridoksin 10 mg (Vitamin B6) 4718 Rp 618,058.00 5000 Rp 655,000.00 4066 Rp 532,646.00 5652 Rp 740,412.00 5652
176 Prednison 5 mg 2958 Rp 215,934.00 Rp - 1948 Rp 142,204.00 1010 Rp 73,730.00 1010
177 Prednison 5 mg 0 Rp - 2000 Rp 136,000.00 0 Rp - 2000 Rp 136,000.00 2000
178 PropilTioUrasil 100 mg (PTU) 500 Rp 293,000.00 0 Rp - 500 Rp 293,000.00 0 Rp - 0
179 Propranolol 10 mg 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
180 Propranolol 10 mg 280 Rp 16,240.00 0 Rp - 150 Rp 8,700.00 130 Rp 7,540.00 130
181 Ranitidin 150 mg 0 Rp - 2000 Rp 440,000.00 406 Rp 89,320.00 1594 Rp 350,680.00 1594
182 RANITIDIN 150MG (BLUD) 0 Rp - 1000 Rp 165,000.00 1000 Rp 165,000.00 0 Rp - 0
183 Ranitidin injeksi 25mg/ml 126 Rp 149,688.00 700 Rp 831,600.00 826 Rp 981,288.00 0 Rp - 0
184 Retinol kapsul lunak 100.000 IU (Vitamin A Biru) 0 Rp - 500 Rp 148,500.00 500 Rp 148,500.00 0 Rp - 0
Retinol kapsul lunak 200.000 IU (Vitamin A Merah) Rp 52,200.00 Rp - Rp 52,200.00 0 Rp - 0
185 100 100
Retinol kapsul lunak 200.000 IU (Vitamin A Merah) Rp - Rp 3,367,200.00 6058 Rp 3,344,016.00 42 Rp 23,184.00 42
186 0 6100
187 Ringer Laktat larutan infus (RL) 200 Rp 1,526,000.00 0 Rp - 180 Rp 1,373,400.00 20 Rp 152,600.00 20
188 risperidon 1mg 330 Rp 79,200.00 0 Rp - 310 Rp 74,400.00 20 Rp 4,800.00 20
190 risperidon 2mg 0 Rp - 1000 Rp 123,000.00 0 Rp - 1000 Rp 123,000.00 1000
191 Salbutamol 2 mg 400 Rp 11,352.00 0 Rp - 400 Rp 11,352.00 0 Rp - 0
192 Salbutamol 2 mg 4000 Rp 268,000.00 2000 Rp 134,000.00 2966 Rp 198,722.00 3034 Rp 203,278.00 3034
193 Salep 2 - 4 Kombinasi 44 Rp 123,024.00 0 Rp - 44 Rp 123,024.00 0 Rp - 0
194 Salep 2 - 4 Kombinasi 0 Rp - 120 Rp 169,200.00 38 Rp 53,580.00 82 Rp 115,620.00 82
195 Sefadroksil 500 mg 0 Rp - 1000 Rp 388,000.00 420 Rp 162,960.00 580 Rp 225,040.00 580
196 Sefadroksil sirup kering 125mg/5ml 41 Rp 171,585.00 0 Rp - 11 Rp 46,035.00 30 Rp 125,550.00 30
197 Sianokobalamin injeksi 500mcg/ml 426 Rp 463,062.00 0 Rp - 426 Rp 463,062.00 0 Rp - 0
198 Sianokobalamin injeksi 500mcg/ml 0 Rp - 200 Rp 220,800.00 141 Rp 155,664.00 59 Rp 65,136.00 59
199 Sianokobalamin tablet 50 mcg (Vitamin B12) 3196 Rp 156,604.00 Rp - 2106 Rp 103,194.00 1090 Rp 53,410.00 1090
Sianokobalamin tablet 50 mcg (Vitamin B12) (BLUD) Rp - Rp 70,000.00 120 Rp 8,400.00 880 Rp 61,600.00 880
200 0 1000
201 Simvastatin 20 mg (salut selaput) 5290 Rp 1,147,930.00 0 Rp - 5290 Rp 1,147,930.00 0 Rp - 0
202 Simvastatin 20 mg (salut selaput) 0 Rp - 18000 Rp 2,700,000.00 4150 Rp 622,500.00 13850 Rp 2,077,500.00 13850
35
TERBUTALIN SULFAT 2.5 MG NEBUL / BRICASMA 0 Rp - 60 Rp 460,500.00 25 Rp 191,875.00 35 Rp 268,625.00
203
204 Thiamin 50 mg (Vitamin B1) 4328 Rp 393,848.00 0 Rp - 4328 Rp 393,848.00 0 Rp - 0
205 Thiamin 50 mg (Vitamin B1) (BLUD) 0 Rp - 1000 Rp 253,000.00 1000 Rp 253,000.00 0 Rp - 0
206 Thiamin 50 mg (Vitamin B1) (BLUD) 0 Rp - 5000 Rp 1,419,330.00 140 Rp 39,741.80 4860 Rp 1,379,588.20 4860
207 Trifluoperazine 5 mg (salut selaput) 340 Rp 97,580.00 500 Rp 143,500.00 550 Rp 157,850.00 290 Rp 83,230.00 290
208 Triheksifenidil 2 mg 1470 Rp 458,640.00 0 Rp - 1470 Rp 458,640.00 0 Rp - 0
209 Triheksifenidil 2 mg 0 Rp - 9000 Rp 567,000.00 5605 Rp 353,115.00 3395 Rp 213,885.00 3395
210 Vitamin B Kompleks 9433 Rp 839,537.00 0 Rp - 9433 Rp 839,537.00 0 Rp - 0
211 Vitamin B Kompleks 0 Rp - 13000 Rp 741,000.00 8996 Rp 512,772.00 4004 Rp 228,228.00 4004
212 Zinc 20 mg (dispersible) 1515 Rp 793,860.00 0 Rp - 1515 Rp 793,860.00 0 Rp - 0
213 Zinc 20 mg (dispersible) 0 Rp - 2000 Rp 416,000.00 515 Rp 107,120.00 1485 Rp 308,880.00 1485
214 Zinc sirup (Sulfate) 20mg/5ml 0 Rp - 144 Rp 456,624.00 98 Rp 310,758.00 46 Rp 145,866.00 46
215 Eugenol 1 Rp 154,000.00 0 Rp - 1 Rp 154,000.00 0 Rp - 0
216 Chkm 1 Rp 264,000.00 0 Rp - 1 Rp 264,000.00 0 Rp - 0
217 Calplus 1 Rp 379,500.00 0 Rp - 1 Rp 379,500.00 0 Rp - 0
218 GIC Besar 1 Rp 1,958,660.00 0 Rp - 1 Rp 1,958,660.00 0 Rp - 0
219 GIC kecil 1 Rp 422,840.00 0 Rp - 1 Rp 422,840.00 0 Rp - 0
220 Chlorethyl 1 Rp 528,000.00 0 Rp - 1 Rp 528,000.00 0 Rp - 0
221 TKF 1 Rp 132,300.00 0 Rp - 1 Rp 132,300.00 0 Rp - 0
222 Amlodipin 10 mg (BLUD) 0 Rp - 800 Rp 325,600.00 800 Rp 325,600.00 0 Rp - 0
223 Aminofilin 200 mg (BLUD) 0 Rp - 500 Rp 117,500.00 0 Rp - 500 Rp 117,500.00 500
224 Ceftriaxone Inj (BLUD) 30 Rp 181,500.00 0 Rp - 30 Rp 181,500.00 0 Rp - 0
225 Citicolin Inj (BLUD) 15 Rp 156,750.00 0 Rp - 0 Rp - 15 Rp 156,750.00 15
226 Asam Mefenamat 500 mg (BLUD) 3980 Rp 1,138,280.00 3980 Rp 1,138,280.00 0 Rp - 0
227 Asam Mefenamat 500 mg (BLUD) 0 Rp - 1000 Rp 297,000.00 940 Rp 279,180.00 60 Rp 17,820.00 60
228 Bisoprolol 5 mg (BLUD) 900 Rp 133,650.00 0 Rp - 900 Rp 133,650.00 0 Rp - 0
229 Ibuprofen 400 mg (BLUD) 1900 Rp 606,100.00 2000 Rp 638,000.00 3560 Rp 1,135,640.00 340 Rp 108,460.00 340
230 SIPROFLOXACIN HCL 500MG jkn -gantrung- 1970 Rp 758,450.00 Rp - 580 Rp 223,300.00 1390 Rp 535,150.00 1390
231 SIPROFLOXACIN HCL 500MG jkn -gantrung- 0 Rp - 1000 Rp 660,000.00 0 Rp - 1000 Rp 660,000.00 1000
232 Ciprofloxaxin 500 mg (BLUD) 2000 Rp 913,000.00 0 Rp - 2000 Rp 913,000.00 0 Rp - 0
233 Etaflox (BLUD) 2000 Rp 913,000.00 0 Rp - 2000 Rp 913,000.00 0 Rp - 0
234 Grathazone (BLUD) 2000 Rp 627,000.00 0 Rp - 2000 Rp 627,000.00 0 Rp - 0
235 Facidol Drop (BLUD) 100 Rp 990,000.00 0 Rp - 100 Rp 990,000.00 0 Rp - 0
236 Yusimox Syrup (BLUD) 100 Rp 440,000.00 0 Rp - 84 Rp 369,600.00 16 Rp 70,400.00 16
237 MgSo4 (BLUD) 5 Rp 60,500.00 0 Rp - 3 Rp 36,300.00 2 Rp 24,200.00 2
238 Methil Ergometrin Inj (BLUD) 20 Rp 81,400.00 0 Rp - 5 Rp - 15 Rp 81,400.00 15
239 Protocin Inj (BLUD) 50 Rp 330,000.00 0 Rp - 12 Rp 79,200.00 38 Rp 250,800.00 38
240 Chlorethyl (BLUD) 8 Rp 960,000.00 0 Rp - 8 Rp 960,000.00 0 Rp - 0
241 Scandonest (BLUD) 0 Rp - 1 Rp 1,400,000.00 1 Rp 1,400,000.00 0 Rp - 0
242 Caviton White (BLUD) 0 Rp - 2 Rp 547,470.00 2 Rp 547,470.00 0 Rp - 0
243 Caviton Pink (BLUD) 0 Rp - 1 Rp 273,735.00 1 Rp 273,735.00 0 Rp - 0
244 TKF (BLUD) 0 Rp - 1 Rp 114,180.00 1 Rp 114,180.00 0 Rp - 0
245 CHKM(BLUD) 0 Rp - 1 Rp 328,790.00 1 Rp 328,790.00 0 Rp - 0
246 Hyposol (BLUD) 0 Rp - 1 Rp 449,900.00 1 Rp 449,900.00 0 Rp - 0
247 Elite Cement Mini Pack (BLUD) 0 Rp - 1 Rp 354,695.00 1 Rp 354,695.00 0 Rp - 0
248 Master Bond (BLUD) 0 Rp - 1 Rp 1,429,230.00 1 Rp 1,429,230.00 0 Rp - 0
249 Clorexoral (BLUD) 0 Rp - 1 Rp 198,990.00 1 Rp 198,990.00 0 Rp - 0
250 Fuji 1x Gp Gold Label (BLUD) 0 Rp - 1 Rp 313,170.00 1 Rp 313,170.00 0 Rp - 0
251 Aroma Fine Normal (BLUD) 0 Rp - 1 Rp 103,840.00 1 Rp 103,840.00 0 Rp - 0
252 Etsa Composit Gel Biru (BLUD) 0 Rp - 1 Rp 138,435.00 1 Rp 138,435.00 0 Rp - 0
Jumlah 675,997 57,933,836.24 399,522 104,183,441.34 388,058 107,978,643.46 687,461 54,138,634.12 687,461
MENGETAHUI
KEPALA PUSKESMAS GANTRUNG
drg. DYAH ARIANA DARMAYANI

NIP. 19781021 201001 2 008
Rincian Mutasi Persediaan Alat dan Bahan Habis Pakai TA. 2021 pada Puskesmas Gantrung
Saldo per 1 Januari 2021 Penambahan Pengurangan Saldo Per 31 Desember 2021 HASIL STOCK OPNAME
( Rp )
1 2 3 4 5 6 7 8 9 ( 3+5-7) 10 (4+6-8) 11

1 Alat Suntik Sekali pakai 0,05 ml 0 Rp - 700 Rp 1,022,000.00 700 Rp 1,022,000.00 0 Rp - 0
3 Alat Suntik Sekali pakai 0,5 ml oneject (BLUD) 0 Rp - 4800 Rp 7,920,000.00 3200 Rp 5,280,000.00 1600 Rp 2,640,000.00 1600
4 Alat Suntik Sekali pakai 1 ml 98 Rp 140,140.00 0 Rp - 98 Rp 140,140.00 0 Rp - 0
5 Alat Suntik Sekali pakai 1 ml 0 Rp - 200 Rp 286,000.00 73 Rp 104,390.00 127 Rp 181,610.00 127
7 Alat Suntik Sekali pakai 3 ml 0 Rp - 2595 Rp 1,476,555.00 1995 Rp 1,135,155.00 600 Rp 341,400.00 600
10 APD Lengkap 2 Rp 600,000.00 0 Rp - 2 Rp 600,000.00 0 Rp - 0
11 Alkohol 70% 1 Liter 0 Rp - 159 Rp 5,565,000.00 67 Rp 2,345,000.00 92 Rp 3,220,000.00 92
12 Alkohol 70% 1000ml (BLUD) 20 Rp 550,000.00 0 Rp - 20 Rp 550,000.00 0 Rp - 0
13 Alkohol swabs 0 Rp - 24500 Rp 1,935,500.00 21500 Rp 1,698,500.00 3000 Rp 237,000.00 3000
14 Alkohol Swab (BLUD) 700 Rp 140,000.00 0 Rp - 700 Rp 140,000.00 0 Rp - 0
15 Alkohol Swab (BLUD) 0 Rp - 4800 Rp 1,161,600.00 4800 Rp 1,161,600.00 0 Rp - 0
16 Aseptic Gel (Ethyl Alkohol 70%) + Dispenser / cairan 22 Rp 3,938,000.00 0 Rp - 0 Rp - 22 Rp 3,938,000.00 22
17 Aseptic Gel (Ethyl Alkohol 70%) + Dispenser / cairan 0 Rp - 50 Rp 1,325,000.00 16 Rp 424,000.00 34 Rp 901,000.00 34
18 ASEPTIK GEL 5LT 0 Rp - 62 Rp 14,136,000.00 17 Rp 3,876,000.00 45 Rp 10,260,000.00 45
19 Auto disable syringe 0.3 ml piece 0 Rp - 560 Rp 702,800.00 560 Rp 702,800.00 0 Rp - 0
20 Baju APD (disposable protective cover all)/hazmat 0 Rp - 1073 Rp 96,570,000.00 418 Rp 37,620,000.00 655 Rp 58,950,000.00 655
21 ECG Gell 1000 ML 3 Rp 85,500.00 0 Rp - 0 Rp - 3 Rp 85,500.00 3
22 ECG Paper (BLUD) 7 Rp 962,500.00 0 Rp - 7 Rp 962,500.00 0 Rp - 0
23 Bioanallitika H2O2 3% 100ml (Bok Gantrung) 10 Rp 682,000.00 0 Rp - 0 Rp - 10 Rp 682,000.00 10
24 Chromic catgut with needle surgical sutures 2/0 0 Rp - 24 Rp 2,880,000.00 0 Rp - 24 Rp 2,880,000.00 24
25 Face Shield Helm 0 Rp - 17 Rp 2,550,000.00 0 Rp - 17 Rp 2,550,000.00 17
26 Face Shield Mika 0 Rp - 16 Rp 320,000.00 0 Rp - 16 Rp 320,000.00 16
27 Folley Catether No. 16 33 Rp 263,973.60 0 Rp - 33 Rp 263,973.60 0 Rp - 0
29 Hand Sanitizer 0 Rp - 34 Rp 2,221,560.00 1 Rp 65,340.00 33 Rp 2,156,220.00 33
30 Hand schoen non steril free powder Uk. S 1200 Rp 1,254,000.00 0 Rp - 1200 Rp 1,254,000.00 0 Rp - 0
31 Hand schoen non steril free powder Uk. S 0 Rp - 4500 Rp 5,580,000.00 3600 Rp 4,464,000.00 900 Rp 1,116,000.00 900
32 Hand schoen non steril free powder Uk. M 2000 Rp 2,090,000.00 0 Rp - 2000 Rp 2,090,000.00 0 Rp - 0
33 Hand schoen non steril free powder Uk. M 0 Rp - 7100 Rp 8,804,000.00 5100 Rp 6,324,000.00 2000 Rp 2,480,000.00 2000
34 Hand schoen non steril free powder Uk. L 0 Rp - 1500 Rp 1,860,000.00 600 Rp 744,000.00 900 Rp 1,116,000.00 900
35 Hand schoen steril ukuran 6,5 0 Rp - 3025 Rp 16,123,250.00 975 Rp 5,196,750.00 2050 Rp 10,926,500.00 2050
36 Hand schoen steril ukuran 7 100 Rp 418,000.00 0 Rp - 100 Rp 418,000.00 0 Rp - 0
37 Hand Schoen steril ukuran 7,5 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
38 Hand Schoen steril ukuran 7,5 100 Rp 393,800.00 0 Rp - 50 Rp 196,900.00 50 Rp 196,900.00 50
39 Handsrub 500ml 1 Rp 91,666.70 0 Rp - 1 Rp 91,666.70 0 Rp - 0
40 ST. Gynecolog 9 Rp 720,000.00 0 Rp - 9 Rp 720,000.00 0 Rp - 0
41 Sarung tangan obgin 0 Rp - 20 Rp 380,000.00 0 Rp - 20 Rp 380,000.00 20
42 I.V Catether No.18 0 Rp - 50 Rp 313,450.00 24 Rp 150,456.00 26 Rp 162,994.00 26
43 I.V Catether No.20 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
44 I.V Catether No.20 129 Rp 808,787.43 0 Rp - 51 Rp 319,753.17 78 Rp 489,034.26 78
45 I.V Catether No.22 112 Rp 616,000.00 0 Rp - 112 Rp 616,000.00 0 Rp - 0
46 I.V Catether No.24 18 Rp 112,854.06 50 Rp 313,450.00 23 Rp 144,187.00 45 Rp 282,117.06 45
47 Infusion Set Dewasa (NIPRO / OTSUKA) 98 Rp 607,600.00 200 Rp 1,240,000.00 146 Rp 905,200.00 152 Rp 942,400.00 152
48 Kacamata Google 0 Rp - 50 Rp 1,380,000.00 11 Rp 303,600.00 39 Rp 1,076,400.00 39
49 Kapas Pembalut 250 gram 10 Rp 125,000.00 25 Rp 312,500.00 17 Rp 212,500.00 18 Rp 225,000.00 18
50 Karbol liquid 0 Rp - 5 Rp 62,500.00 0 Rp - 5 Rp 62,500.00 5
51 Kasa Hidrofil 16x16cm 100 Rp 800,000.00 200 Rp 1,600,000.00 205 Rp 1,640,000.00 95 Rp 760,000.00 95
52 Kasa Kompres 40x40 Steril 50 Rp 80,000.00 0 Rp - 10 Rp 16,000.00 40 Rp 64,000.00 40
53 Kasa Pembalut 40yardx80cm (potong) 10 Rp 1,350,000.00 10 Rp 1,350,000.00 20 Rp 2,700,000.00 0 Rp - 0
54 Kasa Pembalut Hidrofil 2mx80cm 76 Rp 585,200.00 0 Rp - 6 Rp 58,440.00 70 Rp 526,760.00 70
55 Kasa Pembalut Hidrofil 4mx15cm 100 Rp 210,000.00 0 Rp - 100 Rp 210,000.00 0 Rp - 0
56 Larutan Desinfektan Literan 8 Rp 960,000.00 0 Rp - 8 Rp 960,000.00 0 Rp - 0
57 Larutan Desinfektan Literan 0 Rp - 200 Rp 8,000,000.00 200 Rp 8,000,000.00 0 Rp - 0
58 Lokal Apron Palstik Lengan Panjang (BOK) 72 Rp 3,009,600.00 0 Rp - 72 Rp 3,009,600.00 0 Rp - 0
59 Lokal Apron Palstik Lengan Panjang (BLUD) 0 Rp - 250 Rp 1,925,000.00 250 Rp 1,925,000.00 0 Rp - 0
60 Lokal Hazmat (BOK) 53 Rp 9,911,000.00 0 Rp - 53 Rp 9,911,000.00 0 Rp - 0
61 Masker Hijab earloop @50 1700 Rp 4,420,000.00 0 Rp - 1700 Rp 4,420,000.00 0 Rp - 0
62 Masker Hijab earloop @50 0 Rp - 13400 Rp 13,132,000.00 6050 Rp 5,929,000.00 7350 Rp 7,203,000.00 7350
63 Masker Tali (face mask ties on) 2150 Rp 5,590,000.00 2250 Rp 5,850,000.00 2300 Rp 5,980,000.00 2100 Rp 5,460,000.00 2100
64 Masker Karet (face mask ear loop) 4200 Rp 7,560,000.00 Rp - 4200 Rp 7,560,000.00 0 Rp - 0
65 Masker Karet (face mask ear loop) 0 Rp - 20350 Rp 12,210,000.00 7950 Rp 4,770,000.00 12400 Rp 7,440,000.00 12400
66 Gidcare Maker Bedah (BOK) 1350 Rp 7,425,000.00 0 Rp - 1350 Rp 7,425,000.00 0 Rp - 0
67 Freemad Masker N95 (BOK) 160 Rp 11,880,000.00 0 Rp - 160 Rp 11,880,000.00 0 Rp - 0
68 Masker N95 1860 7 Rp 138,845.00 0 Rp - 7 Rp 138,845.00 0 Rp - 0
69 Masker N95 3M (BLUD) 10 Rp 750,000.00 0 Rp - 10 Rp 750,000.00 0 Rp - 0
71 Masker N95 0 Rp - 1100 Rp 21,890,000.00 110 Rp 2,786,000.00 990 Rp 19,104,000.00 990
72 Masker N-95 0 Rp - 360 Rp 37,800,000.00 360 Rp 37,800,000.00 0 Rp - 0
73 Masker KN95 0 Rp - 150 Rp 750,000.00 70 Rp 350,000.00 80 Rp 400,000.00 80
74 Nasal Oksigen Kanula dewasa 45 Rp 229,090.95 0 Rp - 10 Rp 50,909.10 35 Rp 178,181.85 35
75 Nasal Oksigen Kanula anak 20 Rp 101,640.00 0 Rp - 20 Rp 101,640.00 0 Rp - 0
76 Nurse Cap 0 Rp - 700 Rp 210,000.00 500 Rp 150,000.00 200 Rp 60,000.00 200
77 Onescrub 500cc (clhorhexidine gluconate 4%) + dis 1 Rp 62,500.00 0 Rp - 1 Rp 62,500.00 0 Rp - 0
78 Plain catgut with needle surgical sutures 2/0 0 Rp - 72 Rp 360,000.00 60 Rp 300,000.00 12 Rp 60,000.00 12
80 plester non woven 10cm x 5m 10 Rp 413,600.00 25 Rp 1,034,000.00 25 Rp 1,034,000.00 10 Rp 413,600.00 10
81 plester non woven 5cm x 5m 0 Rp - 10 Rp 237,600.00 3 Rp 71,280.00 7 Rp 166,320.00 7
82 Pot Sputum 350 Rp 749,350.00 0 Rp - 350 Rp 749,350.00 0 Rp - 0
83 Pot Sputum 0 Rp - 300 Rp 682,500.00 90 Rp 204,750.00 210 Rp 477,750.00 210
84 Povidon Iodine larutan 100mg/ml kemasan 300ml 0 Rp - 15 Rp 315,000.00 15 Rp 315,000.00 0 Rp - 0
85 Povidon Iodine larutan 100mg/ml kemasan 30ml 19 Rp 60,800.00 30 Rp 96,000.00 17 Rp 54,400.00 32 Rp 102,400.00 32
86 Powdered examination size M 0 Rp - 4000 Rp 4,920,000.00 4000 Rp 4,920,000.00 0 Rp - 0
87 SAFETY BOX 5 LITER 0 Rp - 205 Rp 2,896,445.00 205 Rp 2,896,445.00 0 Rp - 0
88 Sofra-Tulle (BLUD) 11 Rp 3,388,000.00 0 Rp - 8 Rp 2,464,000.00 3 Rp 924,000.00 3
89 Underpad 60 Rp 277,200.00 0 Rp - 60 Rp 277,200.00 0 Rp - 0
90 Underpad 0 Rp - 50 Rp 2,475,000.00 0 Rp - 50 Rp 2,475,000.00 50
91 USG Paper (BLUD) 3 Rp 940,500.00 0 Rp - 0 Rp - 3 Rp 940,500.00 3
92 Kantong Jenazah 25 Rp 3,125,000.00 0 Rp - 0 Rp - 25 Rp 3,125,000.00 25
93 Alginat Zetalgin (BLUD) 10 Rp 1,250,000.00 0 Rp - 10 Rp 1,250,000.00 0 Rp - 0
94 Gips Pro Model Super 11 (BLUD) 8 Rp 500,000.00 0 Rp - 8 Rp 500,000.00 0 Rp - 0
95 Dermafix 6X7 (BLUD) 6 Rp 574,200.00 0 Rp - 6 Rp 574,200.00 0 Rp - 0
96 Mess no 11 (BLUD) 3 Rp 297,000.00 0 Rp - 3 Rp 297,000.00 0 Rp - 0
97 VIRY 6.0 Benang OK (BLUD) 4 Rp 814,000.00 0 Rp - 4 Rp 814,000.00 0 Rp - 0
98 Poliaid 1 liter (BLUD) 6 Rp 776,400.00 0 Rp - 6 Rp 776,400.00 0 Rp - 0
99 Poliwash 500 ml (BLUD) 45 Rp 2,623,500.00 0 Rp - 44 Rp 2,565,200.00 1 Rp 58,300.00 1
100 Sarung Tangan Uk. L Handscoon Latex (BLUD) 1500 Rp 1,909,095.00 0 Rp - 1500 Rp 1,909,095.00 0 Rp - 0
101 Sarung Tangan Uk. M Handscoon Latex (BLUD) 300 Rp 381,819.00 0 Rp - 300 Rp 381,819.00 0 Rp - 0
102 Sarung Tangan Uk. S Handscoon Latex (BLUD) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
103 Shamrock Handscoon (BOK) 3200 Rp 7,040,000.00 0 Rp - 3200 Rp 7,040,000.00 0 Rp - 0
104 APD Hazmat (BLUD) 0 Rp - 10 Rp 1,550,000.00 10 Rp 1,550,000.00 0 Rp - 0
105 Jarum Mani No 18 (BLUD) 0 Rp - 5 Rp 1,017,500.00 5 Rp 1,017,500.00 0 Rp - 0
107 Needle uk. 23 (BLUD) 0 Rp - 1 Rp 104,500.00 1 Rp 104,500.00 0 Rp - 0
108 Umbilical Cord Klem (BLUD) 0 Rp - 1 Rp 198,000.00 1 Rp 198,000.00 0 Rp - 0
109 Mucus Ekstractor (BLUD) 0 Rp - 50 Rp 687,500.00 8 Rp 110,000.00 42 Rp 577,500.00 42
110 Sarung Tangan Obgyn Steril (BLUD) 0 Rp - 20 Rp 1,364,000.00 15 Rp 1,023,000.00 5 Rp 341,000.00 5
111 Delee Besar (BLUD) 0 Rp - 5 Rp 110,000.00 1 Rp 22,000.00 4 Rp 88,000.00 4
112 Benang Silk 3/0 (BLUD) 0 Rp - 1 Rp 1,430,000.00 1 Rp 1,430,000.00 0 Rp - 0
113 Apron Plastik(BLUD) 0 Rp - 7 Rp 485,100.00 7 Rp 485,100.00 0 Rp - 0
114 Kantong Limbah Medis 60cm X 100cm (BLUD) 0 Rp - 10 Rp 300,000.00 10 Rp 300,000.00 0 Rp - 0
115 Apron Plastik Tanpa Lengan (BLUD) 0 Rp - 300 Rp 507,000.00 300 Rp 507,000.00 0 Rp - 0
116 Apron Lengan Panjang (BLUD) 0 Rp - 250 Rp 1,925,000.00 250 Rp 1,925,000.00 0 Rp - 0
117 GC HS Posterior (BLUD) 0 Rp - 1 Rp 1,200,000.00 1 Rp 1,200,000.00 0 Rp - 0
118 Bayzime Detergent Alkali Enzimatic 1 L (BLUD) 0 Rp - 3 Rp 1,935,789.00 3 Rp 1,935,789.00 0 Rp - 0
119 Bayzime Detergent Alkali Enzimatic 1 L (BLUD) 0 Rp - 7 Rp 4,516,796.00 0 Rp - 7 Rp 4,516,796.00 7
120 Baymed Handscrub 4% 500 ml (BLUD) 0 Rp - 20 Rp 1,700,006.00 0 Rp - 20 Rp 1,700,006.00 20
121 IV Catheter with Injection No. 22, Cosmomed (BLUD) 0 Rp - 50 Rp 400,000.00 18 Rp 144,000.00 32 Rp 256,000.00 32
122 Dermafix 5X7 cm, Onemed (BLUD) 0 Rp - 5 Rp 325,000.00 1 Rp 65,000.00 4 Rp 260,000.00 4
123 Dermafix 10X25 cm, Onemed (BLUD) 0 Rp - 1 Rp 215,000.00 1 Rp 215,000.00 0 Rp - 0
Jumlah 20,836 96,291,146.64 120,192 338,389,901.00 104,416 267,790,358.47 36,612 166,890,689.17 36,612
MENGETAHUI

NIP. 19781021 201001 2 008
Rincian Mutasi Persediaan Bahan Laborat Pakai TA. 2021 pada Puskesmas Gantrung
( Rp )
1 2 3 4 5 6 7 8 9 ( 3+5-7) 10 (4+6-8) 11

1 Asam Klorida 0,1 N 100ml / HCL 9 Rp 95,040.00 0 Rp - 9 Rp 95,040.00 0 Rp - 0
2 Blood lancet 0 Rp - 500 Rp 79,250.00 300 Rp 47,550.00 200 Rp 31,700.00 200
3 Blue Tip (BLUD) 2 Rp 286,000.00 0 Rp - 0 Rp - 2 Rp 286,000.00 2
4 Cholesterol Test (Benecheck) 5 Rp 126,762.50 0 Rp - 5 Rp 126,762.50 0 Rp - 0
5 Cholesterol Test (Benecheck) 0 Rp - 20 Rp 5,000,000.00 17 Rp 4,250,000.00 3 Rp 750,000.00 3
6 Glucose Test (Benecheck) 5 Rp 801,085.00 0 Rp - 5 Rp 801,085.00 0 Rp - 0
7 Glucose Test (Benecheck) 0 Rp - 21 Rp 3,360,000.00 16 Rp 2,560,000.00 5 Rp 800,000.00 5
8 HBSAG strip 250 Rp 2,025,000.00 0 Rp - 250 Rp 2,025,000.00 0 Rp - 0
9 HBSAG strip 0 Rp - 150 Rp 1,112,850.00 100 Rp 741,900.00 50 Rp 370,950.00 50
10 Perhidrol 3% 100ml/Hidrogen Peroksida (H2O2) 1 Rp 5,500.00 0 Rp - 1 Rp 5,500.00 0 Rp - 0
11 RAPID sd bio syphilis (syphylis Ab Test) @25 25 Rp 181,250.00 0 Rp - 25 Rp 181,250.00 0 Rp - 0
12 Rapid diagnostic syphilis test (sd bioline) 500 Rp 4,435,000.00 300 Rp 2,661,000.00 200 Rp 1,774,000.00 200
13 rdt covid19 600 Rp 49,170,000.00 0 Rp - 600 Rp 49,170,000.00 0 Rp - 0
14 COVID-19 Ag TEST 1510 Rp 64,930,000.00 1160 Rp 49,880,000.00 350 Rp 15,050,000.00 350
15 Reagent (I) TEST HIV1/2 3.0_SD BIOLINE 170 Rp 2,052,333.00 0 Rp - 170 Rp 2,052,333.00 0 Rp - 0
16 Reagent HIV (I) RAPID 500 Rp 5,987,500.00 0 Rp - 500 Rp 5,987,500.00 0 Rp - 0
17 Reagent HIV (I) RAPID 0 Rp - 370 Rp 2,968,880.00 340 Rp 2,728,160.00 30 Rp 240,720.00 30
18 Reagent II HIV (FOCUS) 22 Rp 277,935.00 0 Rp - 22 Rp 277,935.00 0 Rp - 0
19 Reagent TRIGLYCERIDES 2 Rp 1,964,220.00 0 Rp - 2 Rp 1,964,220.00 0 Rp - 0
20 Reagent Uji Asam Urat 2 Rp 1,472,300.00 0 Rp - 2 Rp 1,472,300.00 0 Rp - 0
21 Reagent UREA / BUN 1 Rp 539,360.00 0 Rp - 1 Rp 539,360.00 0 Rp - 0
22 REAGENT KIMIA KLINIK UREA 0 Rp - 1 Rp 539,360.00 1 Rp 539,360.00 0 Rp - 0
23 REAGENT WIDAL H TYPHI 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
24 REAGENT WIDAL O-A 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
25 REAGENT WIDAL O-B 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
26 REAGENT WIDAL O-D 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
27 Reagent Ziehl Nielson / ZN 0 Rp - 2 Rp 353,520.00 2 Rp 353,520.00 0 Rp - 0
28 SHYPILIS AB TEST 27 Rp - 0 Rp - 27 Rp - 0 Rp - 0
29 Test GOLONGAN DARAH A 1 Rp 68,250.00 0 Rp - 1 Rp 68,250.00 0 Rp - 0
30 Test GOLONGAN DARAH A,B 2 Rp 180,500.00 0 Rp - 2 Rp 180,500.00 0 Rp - 0
31 Test GOLONGAN DARAH B 1 Rp 68,250.00 0 Rp - 1 Rp 68,250.00 0 Rp - 0
32 Test GOLONGAN DARAH D 2 Rp 220,500.00 0 Rp - 2 Rp 220,500.00 0 Rp - 0
33 REAGEN GOL DARAH 3 Rp 1,000,000.00 0 Rp - 3 Rp 1,000,000.00 0 Rp - 0
34 Test URINE 10 Parameter / CYBOW 3 Rp 407,760.00 0 Rp - 3 Rp 407,760.00 0 Rp - 0
35 Test URINE 10 Parameter Verify (BLUD) 8 Rp 2,737,777.77 0 Rp - 8 Rp 2,737,777.77 0 Rp - 0
36 Test Urine 3 parameter 1 Rp 55,926.00 0 Rp - 1 Rp 55,926.00 0 Rp - 0
37 TRULAB N (KONTROL NORMAL) PROLINE E Rp 4,343,740.00 Rp - Rp 4,343,740.00 Rp -
6BTL/KTK 2 0 2 0 0
38 Uric Acid Test (Benecheck) 6 Rp 919,650.00 0 Rp - 6 Rp 919,650.00 0 Rp - 0
39 Uric Acid Test (Benecheck) 0 Rp - 13 Rp 1,950,000.00 8 Rp 1,200,000.00 5 Rp 750,000.00 5
40 VACUUM TUBE STERILE K3 EDTA 3ML soft needle Rp 25,578,000.00 Rp - Rp 25,578,000.00 Rp -
tendre 98 0 98 0 0
41 Tabung EDTA (Tutup Ungu) Endo (BLUD) 6 Rp 1,452,000.00 0 Rp - 6 Rp 1,452,000.00 0 Rp - 0
42 Sysmex Cellpack diluent 20 liter (BLUD) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
43 Sysmex Stromatolyser WH 500 ml (BLUD) 1 Rp 1,265,000.00 0 Rp - 1 Rp 1,265,000.00 0 Rp - 0
44 Sysmex Cellclean 50 ml (BLUD) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
45 GBLAB Centrifuge Tube 15 ml +tutup (BLUD) 8 Rp 29,040.00 0 Rp - 8 Rp 29,040.00 0 Rp - 0
46 GP Vacullab Plain 3 ml (BLUD) 1 Rp 268,950.00 0 Rp - 1 Rp 268,950.00 0 Rp - 0
47 IR Ziehl Nelsen 100 ml (BLUD) 2 Rp 412,500.00 0 Rp - 2 Rp 412,500.00 0 Rp - 0
48 Sysmex Cellpack diluent 20 liter (BLUD) 0 Rp - 3 Rp 6,305,310.00 3 Rp 6,305,310.00 0 Rp - 0
49 Sysmex Cellclean 50 ml (BLUD) 0 Rp - 2 Rp 2,768,480.00 2 Rp 2,768,480.00 0 Rp - 0
50 Intec Tes Kehamilan (BLUD) 0 Rp - 50 Rp 275,000.00 50 Rp 275,000.00 0 Rp - 0
51 GP Yellow Tip 200 UL (BLUD) 0 Rp - 2000 Rp 453,200.00 2000 Rp 453,200.00 0 Rp - 0
52 Parafilm (BLUD) 0 Rp - 1 Rp 625,000.00 1 Rp 625,000.00 0 Rp - 0
53 Sysmex Stromatolyser WH 500 ml (BLUD) 0 Rp - 3 Rp 4,174,500.00 3 Rp 4,174,500.00 0 Rp - 0
54 AMA Golongan Darah A, 10 ml (BLUD) 0 Rp - 1 Rp 77,000.00 1 Rp 77,000.00 0 Rp - 0
55 AMA Golongan Darah B, 10 ml (BLUD) 0 Rp - 2 Rp 77,000.00 2 Rp 77,000.00 0 Rp - 0
56 AMA Golongan Darah AB, 10 ml (BLUD) 0 Rp - 3 Rp 77,000.00 3 Rp 77,000.00 0 Rp - 0
57 AMA Golongan Darah O, 10 ml (BLUD) 0 Rp - 4 Rp 165,000.00 4 Rp 165,000.00 0 Rp - 0
58 Family DR HB. Strip (25T) (BLUD) 0 Rp - 2 Rp 1,100,000.00 2 Rp 1,100,000.00 0 Rp - 0
59 GBLAB K3 EDTA 3 ml (100PCS) (BLUD) 0 Rp - 1 Rp 237,600.00 1 Rp 237,600.00 0 Rp - 0
60 Object Glas (BLUD) 0 Rp - 5 Rp 250,000.00 5 Rp 250,000.00 0 Rp - 0
61 Cover Glas (BLUD) 0 Rp - 2 Rp 130,000.00 2 Rp 130,000.00 0 Rp - 0
62 Slide Widal (BLUD) 0 Rp - 2 Rp 90,000.00 2 Rp 90,000.00 0 Rp - 0
63 Test URINE 10 Parameter Verify (BLUD) 0 Rp - 2 Rp 390,000.00 2 Rp 390,000.00 0 Rp - 0
64 Widal O (BLUD) 0 Rp - 1 Rp 150,000.00 1 Rp 150,000.00 0 Rp - 0
65 Widal OA (BLUD) 0 Rp - 2 Rp 150,000.00 2 Rp 150,000.00 0 Rp - 0
66 Widal OB (BLUD) 0 Rp - 3 Rp 150,000.00 3 Rp 150,000.00 0 Rp - 0
67 Widal H (BLUD) 0 Rp - 4 Rp 150,000.00 4 Rp 150,000.00 0 Rp - 0
Jumlah 1,770 104,167,029.27 5,180 102,523,950.00 6,105 186,637,609.27 845 20,053,370.00 845
MENGETAHUI

NIP. 19781021 201001 2 008
HASIL STOCK OPNAME SELISIH
Nilai KETERAN
Nilai Persediaan ( Rp ) *Kondisi Jumlah Persediaa GAN
n ( Rp )
12 13 14 (9-11) 15 ( 10-12 ) 16
Rp - - -
Rp - - -
Rp - - -
Rp 826,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 251,001.00 - -
Rp - - -
Rp 139,300.00 - -
Rp - - -
Rp - - -
Rp 125,875.00 - -
Rp - - -
Rp 170,780.00 - -
Rp - - -
Rp 1,677,144.00 - -
Rp 137,678.00 - -
Rp - - -
Rp 289,980.00 - -
Rp - - -
Rp 55,660.00 - -
Rp - - -
Rp 23,990.00 - -
Rp 115,152.00 - -
Rp 123,513.00 - -
Rp - - -
Rp 344,500.00 - -
Rp 780,255.00 - -
Rp 917,334.00 - -
Rp - - -
Rp 117,900.00 - -
Rp 791,700.00 - -
Rp 9,198,553.00 - -
Rp 380,295.00 - -
Rp 280,350.00 - -
Rp - - -
Rp 232,470.00 - -
Rp 17,045.25 - -
Rp 463,654.40 - -
Rp - - -
Rp 349,360.00 - -
Rp 803,660.00 - -
Rp 35,640.00 - -
Rp 496,000.00 - -
Rp - - -
Rp 250,690.00 - -
Rp - - -
Rp 220,424.65 - -
Rp - - -
Rp 15,450.00 - -
Rp 15,394.00 - -
Rp 255,906.00 - -
Rp - - -
Rp 25,773.00 - -
Rp - - -
Rp - - -
Rp 94,752.00 - -
Rp 145,600.00 - -
Rp 142,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp 66,600.00 - -
Rp - - -
Rp 439,890.00 - -
Rp 2,400,000.00 - -
Rp - - -
Rp 550,550.00 - -
Rp 107,280.00 - -
Rp 2,572,164.00 - -
Rp - - -
Rp 74,800.00 - -
Rp 79,350.00 - -
Rp - - -
Rp 110,880.00 - -
Rp - - -
Rp 399,300.00 - -
Rp 13,745.86 - -
Rp 82,000.00 - -
Rp 110,991.00 - -
Rp 169,217.60 - -
Rp 1,785.00 - -
Rp 419,244.00 - -
Rp - - -
Rp 1,033,900.00 - -
Rp - - -
Rp - - -
Rp 310,266.00 - -
Rp - - -
Rp 266,560.00 - -
Rp - - -
Rp 15,000.00 - -
Rp - - -
Rp 175,820.00 - -
Rp - - -
Rp 225,225.00 - -
Rp - - -
Rp 1,027,600.00 - -
Rp 616,900.00 - -
Rp 1,244,558.76 - -
Rp - - -
Rp - - -
Rp 240,790.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp 450,000.00 - -
Rp 73,500.00 - -
Rp - - -
Rp 96,800.00 - -
Rp - - -
Rp 62,370.00 - -
Rp - - -
Rp 194,700.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 100,720.00 - -
Rp - - -
Rp - - -
Rp 87,500.00 - -
Rp 80,279.97 - -
Rp - - -
Rp 162,100.00 - -
Rp - - -
Rp 439,890.00 - -
Rp - - -
Rp 188,400.00 - -
Rp - - -
Rp 1,155,550.00 - -
Rp 23,530.00 - -
Rp - - -
Rp 128,475.00 - -
Rp 109,095.04 - -
Rp 63,000.00 - -
Rp - - -
Rp 30,550.00 - -
Rp 309,081.00 - -
Rp 338,800.00 - -
Rp 288,792.00 - -
Rp - - -
Rp 107,147.00 - -
Rp - - -
Rp 685,916.00 - -
Rp 20,160.00 - -
Rp - - -
Rp 23,460.00 - -
Rp - - -
Rp 162,510.00 - -
Rp 194,132.40 - -
Rp 40,960.00 - -
Rp 322,000.00 - -
Rp - - -
Rp 586,710.00 - -
Rp - - -
Rp 249,280.00 - -
Rp - - -
Rp - - -
Rp 954,525.00 - -
Rp - - -
Rp - - -
Rp 29,568.00 - -
Rp 238,000.00 - -
Rp 570,000.00 - -
Rp - - -
Rp - - -
Rp 3,047,996.00 - -
Rp 162,978.00 - -
Rp - - -
Rp 11,825.00 - -
Rp 740,412.00 - -
Rp 73,730.00 - -
Rp 136,000.00 - -
Rp - - -
Rp - - -
Rp 7,540.00 - -
Rp 350,680.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 23,184.00 - -
Rp 152,600.00 - -
Rp 4,800.00 - -
Rp 93,275.00 - -
Rp 123,000.00 - -
Rp - - -
Rp 203,278.00 - -
Rp - - -
Rp 115,620.00 - -
Rp 225,040.00 - -
Rp 125,550.00 - -
Rp - - -
Rp 65,136.00 - -
Rp 53,410.00 - -
Rp 61,600.00 - -
Rp - - -
Rp 2,077,500.00 - -
Rp 268,625.00 - -
Rp - - -
Rp - - -
Rp 1,379,588.20 - -
Rp 83,230.00 - -
Rp - - -
Rp 213,885.00 - -
Rp - - -
Rp 228,228.00 - -
Rp - - -
Rp 308,880.00 - -
Rp 145,866.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 117,500.00 - -
Rp - - -
Rp 156,750.00 - -
Rp - - -
Rp 17,820.00 - -
Rp - - -
Rp 108,460.00 - -
Rp 535,150.00 - -
Rp 660,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 70,400.00 - -
Rp 24,200.00 - -
Rp 81,400.00 - -
Rp 250,800.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
54,138,634.12 - - - -
Pejabat Penyimpan Barang
GALUH MARISTA, S.Farm., Apt.

NIP. 19940312 202012 2 009

Nilai KETERAN
n ( Rp )
12 13 14 (9-11) 15 ( 10-12 ) 16
Rp - - -
Rp - - -
Rp 2,640,000.00 - -
Rp - - -
Rp 181,610.00 - -
Rp - - -
Rp 341,400.00 - -
Rp - - -
Rp 294,000.00 - -
Rp - - -
Rp 3,220,000.00 - -
Rp - - -
Rp 237,000.00 - -
Rp - - -
Rp - - -
Rp 3,938,000.00 - -
Rp 901,000.00 - -
Rp 10,260,000.00 - -
Rp - - -
Rp 58,950,000.00 - -
Rp 85,500.00 - -
Rp - - -
Rp 682,000.00 - -
Rp 2,880,000.00 - -
Rp 2,550,000.00 - -
Rp 320,000.00 - -
Rp - - -
Rp - - -
Rp 2,156,220.00 - -
Rp - - -
Rp 1,116,000.00 - -
Rp - - -
Rp 2,480,000.00 - -
Rp 1,116,000.00 - -
Rp 10,926,500.00 - -
Rp - - -
Rp - - -
Rp 196,900.00 - -
Rp - - -
Rp - - -
Rp 380,000.00 - -
Rp 162,994.00 - -
Rp - - -
Rp 489,034.26 - -
Rp - - -
Rp 282,117.06 - -
Rp 942,400.00 - -
Rp 1,076,400.00 - -
Rp 225,000.00 - -
Rp 62,500.00 - -
Rp 760,000.00 - -
Rp 64,000.00 - -
Rp - - -
Rp 526,760.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 7,203,000.00 - -
Rp 5,460,000.00 - -
Rp - - -
Rp 7,440,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 19,104,000.00 - -
Rp - - -
Rp 400,000.00 - -
Rp 178,181.85 - -
Rp - - -
Rp 60,000.00 - -
Rp - - -
Rp 60,000.00 - -
Rp 120,000.00 - -
Rp 413,600.00 - -
Rp 166,320.00 - -
Rp - - -
Rp 477,750.00 - -
Rp - - -
Rp 102,400.00 - -
Rp - - -
Rp - - -
Rp 924,000.00 - -
Rp - - -
Rp 2,475,000.00 - -
Rp 940,500.00 - -
Rp 3,125,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 58,300.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 577,500.00 - -
Rp 341,000.00 - -
Rp 88,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 4,516,796.00 - -
Rp 1,700,006.00 - -
Rp 256,000.00 - -
Rp 260,000.00 - -
Rp - - -
166,890,689.17 - - - -

NIP. 19940312 202012 2 009

Nilai KETERAN
n ( Rp )
12 13 14 (9-11) 15 ( 10-12 ) 16
Rp - - -
Rp 31,700.00 - -
Rp 286,000.00 - -
Rp - - -
Rp 750,000.00 - -
Rp - - -
Rp 800,000.00 - -
Rp - - -
Rp 370,950.00 - -
Rp - - -
Rp - - -
Rp 1,774,000.00 - -
Rp - - -
Rp 15,050,000.00 - -
Rp - - -
Rp - - -
Rp 240,720.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 750,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
20,053,370.00 - - - -

NIP. 19940312 202012 2 009
Rincian Penambahan Persediaan OBAT BLUD TA. 2022
ASPIRIN (MINIASPI) TABLET 80 MG 500 Tab
RANITIDINE INJEKSI 25 MG/ML 50 Amp
ONDANSETRON HCL 4mg/2ml 6 Amp
ASPIRIN (ASPILET) TABLET 80 MG 500 Tab
Bisoprolol 5 mg 270 Tab
DEXAMETHASONE 0,5MG 2,000 Tab
ASPIRIN (ASPILET) TABLET 80 MG 1,000 Tab
Gentamisin salep kulit 0,1% 24 Tube
RANITIDINE INJEKSI 50 MG/2ML 100 Amp
Ethyl Chloride (Etil Klorida) 8 Botol
AMOXYCILLIN SIRUP 125 MG/5 ML 30 Botol
PEHACAIN (LIDOCAIN+EPHINEPRINE) 200 Amp
CEFADROXIL 500MG 500 Cap
ASPIRIN (ASPILET) TABLET 80 MG 1000 Tab
Bisoprolol 5 mg- 180 Tab
AMOXYCILLIN SIRUP 125 MG/5 ML 40 Botol
ERLAMYCETIN SM (CHLORAMPHENICOL SM) 24 TUBE
RANITIDINE INJEKSI 50 MG/2ML 50 Amp
Bisoprolol 5 mg 90 Tab
DEXAMETHASONE 0,5MG 1,000 Tab
ASPIRIN (MINIASPI) TABLET 80 MG 1,000
Gentamisin salep kulit 0,1% 24
BETAMETHASONE CR 0.1% 14
ONDANSETRON HCL 4mg/2ml 50
DEXAMETHASONE 5mg/ml 20
Bisoprolol 5 mg 180
METHYLPREDNISOLONE TABLET 4 MG 500
LORATADINE TABLET 10 MG 500
Bisoprolol 5 mg- 420
METFORMIN HCL 500mg 5,000
ERLAMYCETIN SM (CHLORAMPHENICOL SM) 48
GUAIFENESIN TABLET 100 MG (Gliseril Guaiakolat 100 mg) 4,000
SEPTANEST INJEKSI 1
GUAIFENESIN TABLET 100 MG (Gliseril Guaiakolat 100 mg) 3000
AMBROXOL TABLET 30 MG 2000
JUMLAH
Rincian Penambahan Persediaan BMHP BLUD TA. 2022

DERMAFIX S IV 6X7 CM ONEMED 4
DERMAFIX SS SILICONE FOAM DRESSING ADHESIVE 10X10 CM ONEMED 4
HCg TEST KEHAMILAN ONEMED 4
DARYANTULLE STERIL 3
PLESTERIN BULAT NON WOVEN 4
IV CATHETER wing No22G Cosmomed 100
DENTAL NEEDLE 30G ONEMED 2
OXYFLOW BUBBLE BAYI 20
BOTOL STERIL TUTUP PUTIH (POT URIN) 200
KERTAS PUYER PRESS 2400
ALAT TINDIK TELINGA SEKALI PAKAI 30
BAYMED 500 ML SABUN CUCI 15
MASKER NEBULIZER SET ANAK 10
MASKER NEBULIZER SET DEWASA 20
Sarung Tangan Maxter S 3000
KASA STERIL 16 X 16 CM 50
JUMLAH
Rincian Penambahan Persediaan BAHAN LAB BLUD TA. 2021

GBLAB K3 EDTA 3 ml 300 PCS
KERTAS LAKMUS MERAH 1 PACK
KERTAS LAKMUS BIRU 1 PACK
Cholesterol (total) test system 3 PACK
OBJECT GLASS ONE LAB 5 PACK
URIT REAGEN 11G 3 PACK
POT URIN 300 POT
JUMLAH
T BLUD TA. 2022
Rp 450.00 Rp 225,000.00
Rp 3,200.00 Rp 160,000.00
Rp 5,000.00 Rp 30,000.00
Rp 847.00 Rp 423,500.00
Rp 444.00 Rp 119,880.00
Rp 165.00 Rp 330,000.00
Rp 6,727.38 Rp 672,737.70
Rp 1,065.60 Rp 1,065,600.00
Rp 5,919.63 Rp 142,071.12
Rp 9,620.04 Rp 962,004.00
Rp 225,000.00 Rp 1,800,000.00
Rp 6,516.81 Rp 195,504.30
Rp 4,188.47 Rp 837,694.80
Rp 671.55 Rp 335,775.00
Rp 616.05 Rp 616,050.00
Rp 515.54 Rp 92,797.20
Rp 6,189.92 Rp 247,596.80
Rp 8,624.67 Rp 431,233.50
Rp 10,594.95 Rp 254,278.80
Rp 1,786.60 Rp 89,330.00
Rp 616.10 Rp 55,449.00
Rp 197.16 Rp 197,160.00
Rp 522.81 Rp 522,810.00
Rp 3,996.00 Rp 95,904.00
Rp 3,330.00 Rp 46,620.00
Rp 7,992.00 Rp 399,600.00
Rp 2,355.86 Rp 47,117.20
Rp 386.65 Rp 69,597.00
Rp 190.00 Rp 95,000.00
Rp 166.00 Rp 83,000.00
Rp 386.65 Rp 162,393.00
Rp 216.45 Rp 1,082,250.00
Rp 9,546.00 Rp 458,208.00
Rp 132.09 Rp 528,360.00
Rp 898,700.00 Rp 898,700.00
Rp 135.42 Rp 406,260.00
Rp 170.68 Rp 341,360.00
Rp 14,520,841.42
P BLUD TA. 2022 Rincian Penambahan Persediaan BMHP BO
Rp 110,000.00 Rp 440,000.00 Masker Hijab Baymed

Rp 37,000.00 Rp 148,000.00 Sarung Tangan Maxter S
Rp 95,000.00 Rp 380,000.00 Sarung Tangan Maxter M
Rp 218,670.00 Rp 656,010.00
Rp 46,953.00 Rp 187,812.00
Rp 8,000.00 Rp 800,000.00
Rp 131,000.00 Rp 262,000.00
Rp 11,300.00 Rp 226,000.00
Rp 3,800.00 Rp 760,000.00
Rp 95.83 Rp 229,999.20
Rp 10,139.00 Rp 304,170.00
Rp 37,932.03 Rp 568,980.45
Rp 19,470.00 Rp 194,700.00
Rp 19,470.00 Rp 389,400.00
Rp 410.70 Rp 1,232,100.00
Rp 8,000.00 Rp 400,000.00
Rp 7,179,171.65
Rp 1,900.00 Rp 570,000.00
Rp 10,647.00 Rp 10,647.00
Rp 10,647.00 Rp 10,647.00
Rp 250,000.00 Rp 750,000.00
Rp 14,080.00 Rp 70,400.00
Rp 115,159.00 Rp 345,477.00
Rp 990.00 Rp 297,000.00
Rp 2,054,171.00
bahan Persediaan BMHP BOK TA. 2022
2,000 Rp 660.01 Rp 1,320,012.00

3,300 Rp 790.00 Rp 2,606,997.39
1,000 Rp 790.00 Rp 790,000.00
Nomor : 900 / 1331 / 402.102.26 / 2021

PERSEDIAAN
PER 31 DESEMBER 2021

KABUPATEN : MADIUN
Rincian Mutasi Persediaan OBAT Pakai TA. 2020 pada Puskesmas Gantrung
( Rp )
1 2 3 4 5 6 7 8 9 ( 3+5-7) 10 (4+6-8) 11

1 Albendazole 400 mg 15 Rp 6,060.00 0 Rp - 15 Rp 6,060.00 0 Rp - 0
2 Allopurinol 100mg 801 Rp 146,262.60 0 Rp - 801 Rp 146,262.60 0 Rp - 0
3 Allopurinol 100 mg (BLUD) 0 Rp - 1000 Rp 272,250.00 1000 Rp 272,250.00 0 Rp - 0
4 Allopurinol 300 mg 0 Rp - 4500 Rp 900,000.00 370 Rp 74,000.00 4130 Rp 826,000.00 4130
5 Ambroksol 30 mg 3759 Rp 762,997.00 0 Rp - 3759 Rp 762,997.00 0 Rp - 0
6 Aminofilin 200 mg 1010 Rp 89,890.00 0 Rp - 1010 Rp 89,890.00 0 Rp - 0
7 Aminofilin 200 mg 0 Rp - 2000 Rp 190,000.00 2000 Rp 190,000.00 0 Rp - 0
8 Aminofilin Injeksi 24 mg/ml 0 Rp - 90 Rp 267,840.00 90 Rp 267,840.00 0 Rp - 0
9 Amitriptilin 25 mg 800 Rp 133,600.00 3500 Rp 584,500.00 2797 Rp 467,099.00 1503 Rp 251,001.00 1503
11 Amlodipin 10 mg 0 Rp - 10000 Rp 700,000.00 8010 Rp 560,700.00 1990 Rp 139,300.00 1990
12 Amlodipin 10 mg (ZEVASK) (BLUD) 0 Rp - 800 Rp 325,600.00 800 Rp 325,600.00 0 Rp - 0
14 Amlodipin 5 mg 15300 Rp 810,900.00 12925 Rp 685,025.00 2375 Rp 125,875.00 2375
15 Ampisilin serbuk injeksi 1000mg (i.v.) 20 Rp 164,740.00 0 Rp - 20 Rp 164,740.00 0 Rp - 0
16 Ampisilin serbuk injeksi 1000mg (i.v.) 0 Rp - 20 Rp 170,780.00 0 Rp - 20 Rp 170,780.00 20
17 Amoksisillin 500 mg 7661 Rp 1,907,589.00 0 Rp - 7661 Rp 1,907,589.00 0 Rp - 0
18 Amoksisillin 500 mg 0 Rp - 13000 Rp 2,613,000.00 4656 Rp 935,856.00 8344 Rp 1,677,144.00 8344
19 Antasida kombinasi suspensi 0 Rp - 100 Rp 167,900.00 18 Rp 30,222.00 82 Rp 137,678.00 82
20 Antacida Tablet 400 Mg 5234 Rp 303,572.00 Rp - 5234 Rp 303,572.00 0 Rp - 0
21 Antacida Tablet 400 Mg 0 Rp - 17000 Rp 918,000.00 11630 Rp 628,020.00 5370 Rp 289,980.00 5370
22 Anti Bakteri komb. Polymixin+Bacitracin salep 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
23 Anti Bakteri Komb. Polymixin+Bacitracin Salep 56 Rp 283,360.00 0 Rp - 45 Rp 227,700.00 11 Rp 55,660.00 11
24 Anti Flu / DEMACOLIN / Paraflu 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
25 Anti Fungi kombinasi salep 63 Rp 302,274.00 0 Rp - 58 Rp 278,284.00 5 Rp 23,990.00 5
26 Anti Fungi kombinasi salep 0 Rp - 24 Rp 115,152.00 0 Rp - 24 Rp 115,152.00 24
27 Anti Hemoroid kombinasi suppositoria 50 Rp 158,350.00 20 Rp 63,340.00 31 Rp 98,177.00 39 Rp 123,513.00 39
28 Aqua Pro Injeksi 24 Rp 68,640.00 0 Rp - 24 Rp 68,640.00 0 Rp - 0
29 Aqua Pro Injeksi 0 Rp - 200 Rp 530,000.00 70 Rp 185,500.00 130 Rp 344,500.00 130
30 Asam Askorbat 50 mg (Vitamin C) 7341 Rp 770,805.00 8000 Rp 840,000.00 7910 Rp 830,550.00 7431 Rp 780,255.00 7431
31 Asam Askorbat 500 mg (Vitamin C) 0 Rp - 9300 Rp 1,841,400.00 4667 Rp 924,066.00 4633 Rp 917,334.00 4633
32 Asam Folat 1 mg 570 Rp 39,900.00 0 Rp - 570 Rp 39,900.00 0 Rp - 0
33 Asam Folat 400 mcg 500 Rp 65,500.00 1500 Rp 196,500.00 1100 Rp 144,100.00 900 Rp 117,900.00 900
34 Asam Mefenamat 500 mg 0 Rp - 4000 Rp 910,000.00 520 Rp 118,300.00 3480 Rp 791,700.00 3480
35 Asetyl Sistein 200 mg 1170 Rp 436,410.00 27700 Rp 10,332,100.00 4209 Rp 1,569,957.00 24661 Rp 9,198,553.00 24661
36 Asiklovir 400 mg 1510 Rp 611,550.00 0 Rp - 571 Rp 231,255.00 939 Rp 380,295.00 939
37 ASPIRIN (ASETOSAL) TABLET 80 MG 1166 Rp 122,430.00 7000 Rp 735,000.00 5496 Rp 577,080.00 2670 Rp 280,350.00 2670
38 Atapulgit 600 mg / NEW ANTIDES 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
39 ATTAPULGITE 630 MG / PULAREX 2149 Rp 348,138.00 1000 Rp 162,000.00 1714 Rp 277,668.00 1435 Rp 232,470.00 1435
40 Azithromycin 500 mg 0 Rp - 25 Rp 28,408.75 10 Rp 11,363.50 15 Rp 17,045.25 15
41 Bedak Salicyl Serbuk 2% 0 Rp - 100 Rp 626,560.00 26 Rp 162,905.60 74 Rp 463,654.40 74
42 Betahistine 6 mg 1210 Rp 133,100.00 0 Rp - 1210 Rp 133,100.00 0 Rp - 0
43 Betahistine 6 mg 0 Rp - 6100 Rp 536,800.00 2130 Rp 187,440.00 3970 Rp 349,360.00 3970
44 Betamethasone krim 0,1% 114 Rp 163,020.00 650 Rp 929,500.00 202 Rp 288,860.00 562 Rp 803,660.00 562
45 Bisakodyl 5mg 0 Rp - 210 Rp 45,360.00 45 Rp 9,720.00 165 Rp 35,640.00 165
46 Ciprofloxaxin 500 mg 0 Rp - 2000 Rp 496,000.00 0 Rp - 2000 Rp 496,000.00 2000
47 Clozapin 25 mg 590 Rp 661,390.00 Rp - 590 Rp 661,390.00 0 Rp - 0
48 Clozapin 25 mg 0 Rp - 1000 Rp 473,000.00 470 Rp 222,310.00 530 Rp 250,690.00 530
49 Deksamethasone 0,5 mg (BLUD) 4223 Rp 257,603.00 Rp - 4223 Rp 257,603.00 0 Rp - 0
50 Deksamethasone 0,5 mg (BLUD) 0 Rp - 3000 Rp 412,000.00 1395 Rp 191,575.35 1605 Rp 220,424.65 1605
51 Deksamethasone 5mg/ml (BLUD) 200 Rp 528,000.00 0 Rp - 200 Rp 528,000.00 0 Rp - 0
52 Diazepam injeksi 5mg/ml (i.v./i.m.) 0 Rp - 10 Rp 15,450.00 0 Rp - 10 Rp 15,450.00 10
53 Diazepam 2 mg 373 Rp 32,078.00 0 Rp - 194 Rp 16,684.00 179 Rp 15,394.00 179
54 DIAZEPAM RECTAL 10MG / STESOLID (5/BOX) 9 Rp 164,511.00 5 Rp 91,395.00 0 Rp - 14 Rp 255,906.00 14
55 Difenhidramin injeksi 10mg/ml (i.v./i.m.) 50 Rp 58,400.00 0 Rp - 50 Rp 58,400.00 0 Rp - 0
56 Difenhidramin injeksi 10mg/ml (i.v./i.m.) 0 Rp - 150 Rp 117,150.00 117 Rp 91,377.00 33 Rp 25,773.00 33
57 Digoksin 0,25 mg 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
58 Dimenhidrinat 50 mg 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
59 Dimenhidrinat 50 mg 902 Rp 101,024.00 1000 Rp 112,000.00 1056 Rp 118,272.00 846 Rp 94,752.00 846
60 Domperidon 10 mg 4232 Rp 385,112.00 0 Rp - 2632 Rp 239,512.00 1600 Rp 145,600.00 1600
61 Domperidon 10 mg 0 Rp - 2000 Rp 142,000.00 0 Rp - 2000 Rp 142,000.00 2000
62 Domperidon suspensi 5mg/5ml 31 Rp 83,700.00 0 Rp - 31 Rp 83,700.00 0 Rp - 0
63 Epinefrin (adrenalin) injeksi 0,1% (i.v./s.k./i.m.) 40 Rp 56,320.00 0 Rp - 40 Rp 56,320.00 0 Rp - 0
64 Epinefrin (adrenalin) injeksi 0,1% (i.v./s.k./i.m.) 0 Rp - 17 Rp 94,017.99 17 Rp 94,017.99 0 Rp - 0
ERGOTAMINE TARTRATE|CAFFEINE TABLET Rp - 465590
200 Rp 74,000.00 20 Rp 7,400.00 465590 Rp 66,600.00
65 (ANTI MIGRAIN) 465410
66 Eritromisin 250 mg 280 Rp 163,240.00 Rp - 280 Rp 163,240.00 0 Rp - 0
ERLAMYCETIN SM (CHLORAMPHENICOL SM)- 43
0 Rp - 48 Rp 491,040.00 5 Rp 51,150.00 43 Rp 439,890.00
67 JKN GANTRUNG
68 Favipiravir 200 mg 0 Rp - 160 Rp 2,400,000.00 0 Rp - 160 Rp 2,400,000.00 160
69 Fenitoin 100 mg 290 Rp 45,820.00 Rp - 290 Rp 45,820.00 0 Rp - 0
70 Fenitoin 100 mg 0 Rp - 1500 Rp 907,500.00 590 Rp 356,950.00 910 Rp 550,550.00 910
71 Fenobarbital 30 mg 1030 Rp 247,200.00 Rp - 530 Rp 139,920.00 500 Rp 107,280.00 500
Ferro Fumarat 60mg + Asam Folat 0,4mg / TTD 7266
5950 Rp 2,106,300.00 23000 Rp 8,142,000.00 21684 Rp 7,676,136.00 7266 Rp 2,572,164.00
72 untuk ibu hamil
73 Fitomenadion 10 mg (Vitamin K) 319 Rp 241,802.00 0 Rp - 319 Rp 241,802.00 0 Rp - 0
74 Fitomenadion 10 mg (Vitamin K) 0 Rp - 1200 Rp 897,600.00 1100 Rp 822,800.00 100 Rp 74,800.00 100
75 Fitomenadion injeksi 10mg/ml (i.m.) 0 Rp - 30 Rp 103,500.00 7 Rp 24,150.00 23 Rp 79,350.00 23
76 Fitomenadion injeksi 2mg/ml (i.m.) / INFANT 20 Rp 73,640.00 0 Rp - 20 Rp 73,640.00 0 Rp - 0
77 Fitomenadion injeksi 2mg/ml (i.m.) / INFANT 0 Rp - 90 Rp 124,740.00 10 Rp 13,860.00 80 Rp 110,880.00 80
78 Flufenazin injeksi 25mg/ml (i.m.)/SIKZONOATE 6 Rp 375,958.00 0 Rp - 6 Rp 375,958.00 0 Rp - 0
79 Flufenazin injeksi 25mg/ml (i.m.)/SIKZONOATE 0 Rp - 35 Rp 2,795,100.00 30 Rp 2,395,800.00 5 Rp 399,300.00 5
80 Furosemid 40 mg 2408 Rp 194,706.00 0 Rp - 2238 Rp 180,960.14 170 Rp 13,745.86 170
81 Furosemid 40 mg 0 Rp - 1000 Rp 82,000.00 0 Rp - 1000 Rp 82,000.00 1000
82 Garam Oralit Kombinasi Serbuk (200 ml air) 1717 Rp 476,702.00 Rp - 1423 Rp 365,711.00 294 Rp 110,991.00 294
83 Gentamisin Sulfate tetes mata 0,3% 78 Rp 330,072.60 72 Rp 304,632.00 110 Rp 465,487.00 40 Rp 169,217.60 40
84 Glibenklamid 5 mg 945 Rp 112,455.00 0 Rp - 930 Rp 110,670.00 15 Rp 1,785.00 15
85 Glimepiride 1 mg 0 Rp - 5000 Rp 465,000.00 492 Rp 45,756.00 4508 Rp 419,244.00 4508
86 Glimepiride 3 mg 5155 Rp 896,970.00 0 Rp - 5155 Rp 896,970.00 0 Rp - 0
87 Glimepiride 3 mg 11000 Rp 2,695,000.00 6780 Rp 1,661,100.00 4220 Rp 1,033,900.00 4220
88 Glimepiride 2 mg 5000 Rp 1,035,000.00 0 Rp - 5000 Rp 1,035,000.00 0 Rp - 0
89 Gliseril Guaiyakolat 100 mg 3199 Rp 321,554.97 0 Rp - 3199 Rp 321,554.97 0 Rp - 0
90 Gliseril Guaiyakolat 100 mg 0 Rp - 4500 Rp 445,500.00 1366 Rp 135,234.00 3134 Rp 310,266.00 3134
91 Glukose larutan infus 10% 37 Rp 296,111.00 0 Rp - 37 Rp 296,111.00 0 Rp - 0
92 Griseofulvin (micronized) 125 mg 700 Rp 156,800.00 900 Rp 201,600.00 410 Rp 91,840.00 1190 Rp 266,560.00 1190
93 Haloperidol 0,5 mg 390 Rp 35,628.00 0 Rp - 390 Rp 35,628.00 0 Rp - 0
94 Haloperidol 0,5 mg 0 Rp - 300 Rp 15,000.00 0 Rp - 300 Rp 15,000.00 300
95 Haloperidol 1,5 mg 2470 Rp 146,930.00 Rp - 2470 Rp 146,930.00 0 Rp - 0
96 Haloperidol 1,5 mg 0 Rp - 10000 Rp 590,000.00 7020 Rp 414,180.00 2980 Rp 175,820.00 2980
Haloperidol injeksi 50mg/ml / HALDOL DECANOAS Rp - Rp - Rp - 0 Rp - 0
97 0
98 Hidrokortison Krim 2,5% 123 Rp 304,425.00 48 Rp 118,800.00 80 Rp 198,000.00 91 Rp 225,225.00 91
Human Tetanus imunoglobulin (i.m.) 250 IU injeksi / Rp 1,886,630.00 Rp - Rp 1,886,630.00 0 Rp - 0
99 TETAGAM 10 0 10
Human Tetanus imunoglobulin (i.m.) 250 IU injeksi / Rp - Rp 2,642,400.00 11 Rp 1,614,800.00 7 Rp 1,027,600.00 7
100 TETAGAM 0 18
101 Ibuprofen 400 mg 0 Rp - 2000 Rp 620,000.00 10 Rp 3,100.00 1990 Rp 616,900.00 1990
102 Infus Ringer Asetat / ASERING 149 Rp 1,429,358.76 0 Rp - 21 Rp 184,800.00 128 Rp 1,244,558.76 128
Ipatropium Bromida serbuk inhalasi 20mcg/semprot / Rp 86,600.00 Rp - Rp 86,600.00 0 Rp - 0
103 ATROVENT 1 0 1
104 Isoniazid 100 mg 800 Rp 225,600.00 0 Rp - 800 Rp 225,600.00 0 Rp - 0
105 Isosorbid DiNitrat 5 mg (ISDN) (BLUD) 0 Rp - 2000 Rp 242,000.00 10 Rp 1,210.00 1990 Rp 240,790.00 1990
106 Isosorbid DiNitrat 5 mg (ISDN) 1573 Rp 224,939.00 0 Rp - 1573 Rp 224,939.00 0 Rp - 0
107 Kalsium Glukonat 10% injeksi 0 Rp - 10 Rp 57,230.00 10 Rp 57,230.00 0 Rp - 0
108 Kalsium Laktat 500 mg (KALK) 5860 Rp 385,740.00 0 Rp - 5860 Rp 385,740.00 0 Rp - 0
109 Kalsium Laktat 500 mg (KALK) 0 Rp - 8000 Rp 480,000.00 500 Rp 30,000.00 7500 Rp 450,000.00 7500
110 KAPTOPRIL 25MG 0 Rp - 2000 Rp 150,000.00 1020 Rp 76,500.00 980 Rp 73,500.00 980
111 Kaptopril 12,5 mg 2474 Rp 163,284.00 0 Rp - 2474 Rp 163,284.00 0 Rp - 0
112 Kaptopril 12,5 mg 0 Rp - 3500 Rp 308,000.00 2400 Rp 211,200.00 1100 Rp 96,800.00 1100
113 Karbamazepin 200 mg 170 Rp 40,515.60 0 Rp - 170 Rp 40,515.60 0 Rp - 0
114 Karbamazepin 200 mg 0 Rp - 700 Rp 132,300.00 370 Rp 69,930.00 330 Rp 62,370.00 330
0
Karbogliserin tetes telinga 10% / FENOL GLISEROL 42 Rp 116,268.00 0 Rp - 42 Rp 116,268.00 0 Rp -
115
Rp - 59
Karbogliserin tetes telinga 10% / FENOL GLISEROL 0 72 Rp 237,600.00 13 Rp 42,900.00 59 Rp 194,700.00
116
117 KDT/FDC KATEGORI II 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
118 KDT/FDC KOMBIPAK KATEGORI I 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
119 KDT/FDC untuk ANAK 2 Rp 496,240.00 0 Rp - 2 Rp 496,240.00 0 Rp - 0
120 KDT/FDC untuk DEWASA (KATEGORI I) 10 Rp 4,154,690.00 20 Rp 8,309,380.00 30 Rp 12,464,070.00 0 Rp - 0
121 Ketokonazole 200 mg 754 Rp 224,182.98 0 Rp - 754 Rp 224,182.98 0 Rp - 0
122 Ketokonazole Krim 2% 44 Rp 110,792.00 50 Rp 125,900.00 54 Rp 135,972.00 40 Rp 100,720.00 40
123 Ketorolac 30mg/ml injeksi 264 Rp 287,496.00 0 Rp - 264 Rp 287,496.00 0 Rp - 0
124 Ketorolac 30mg/ml injeksi (BLUD) 0 Rp - 50 Rp 110,000.00 50 Rp 110,000.00 0 Rp - 0
125 Ketorolac 30mg/ml injeksi (BLUD) 0 Rp - 50 Rp 87,500.00 0 Rp - 50 Rp 87,500.00 50
126 Kloramfenikol 250 mg 540 Rp 261,779.97 0 Rp - 300 Rp 181,500.00 240 Rp 80,279.97 240
127 Kloramfenikol salep kulit 2% 15 g (Bufacetin) 85 Rp 287,562.80 0 Rp - 85 Rp 287,562.80 0 Rp - 0
128 Kloramfenikol salep kulit 2% 15 g (Bufacetin) 0 Rp - 72 Rp 233,424.00 22 Rp 71,324.00 50 Rp 162,100.00 50
129 Kloramfenikol salep mata 1% 111 Rp 213,204.37 0 Rp - 111 Rp 213,204.37 0 Rp - 0
Kloramfenikol salep mata 1% / Erlamycetin SM 43
0 Rp - 48 Rp 491,040.00 5 Rp 51,150.00 43 Rp 439,890.00
130 (BLUD)
131 Klorfeniramin Maleat 4 mg (CTM) 9253 Rp 150,057.07 0 Rp - 9253 Rp 150,057.07 0 Rp - 0
132 Klorfeniramin Maleat 4 mg (CTM) 0 Rp - 12000 Rp 288,000.00 4150 Rp 99,600.00 7850 Rp 188,400.00 7850
133 Klorpromazin 100 mg 5870 Rp 862,890.00 0 Rp - 5870 Rp 862,890.00 0 Rp - 0
134 Klorpromazin 100 mg (CEPEZET) (BLUD) 0 Rp - 3000 Rp 1,815,000.00 1090 Rp 659,450.00 1910 Rp 1,155,550.00 1910
135 Klorpromazin 25 mg 200 Rp 36,200.00 800 Rp 144,800.00 870 Rp 157,470.00 130 Rp 23,530.00 130
136 Klorpromazin injeksi 25mg/ml (i.m.) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
137 Kodein 10 mg 410 Rp 234,110.00 0 Rp - 185 Rp 105,635.00 225 Rp 128,475.00 225
138 Kotrimoksazol Kombinasi 480 mg (dewasa) 2065 Rp 278,125.00 0 Rp - 1255 Rp 169,029.96 810 Rp 109,095.04 810
139 Kotrimoksazol Kombinasi 480 mg (dewasa) 0 Rp - 500 Rp 63,000.00 0 Rp - 500 Rp 63,000.00 500
140 Kotrimoksazol Kombinasi Suspensi 240 mg 104 Rp 229,000.00 0 Rp - 104 Rp 229,000.00 0 Rp - 0
25
Lidokain 2%+Epinefrin 1:80.000 Injeksi 2ml (COMP.) 180 Rp 219,960.00 0 Rp - 155 Rp 189,410.00 25 Rp 30,550.00
141
142 Lidokain 2% injeksi 300 Rp 344,700.00 0 Rp - 31 Rp 35,619.00 269 Rp 309,081.00 269
143 Lidokain 2% injeksi 0 Rp - 400 Rp 338,800.00 0 Rp - 400 Rp 338,800.00 400
144 linfus KA_EN 3A 30 Rp 320,880.00 0 Rp - 3 Rp 32,088.00 27 Rp 288,792.00 27
145 Loratadin 10 mg 783 Rp 102,573.00 0 Rp - 783 Rp 102,573.00 0 Rp - 0
146 Loratadin 10 mg 0 Rp - 1000 Rp 109,000.00 17 Rp 1,853.00 983 Rp 107,147.00 983
147 Metformin 500 mg 7180 Rp 793,725.00 0 Rp - 7180 Rp 793,725.00 0 Rp - 0
148 Metformin 500 mg 0 Rp - 30000 Rp 2,310,000.00 21092 Rp 1,624,084.00 8908 Rp 685,916.00 8908
149 Metil Ergometrin 0,125 mg 170 Rp 38,080.00 100 Rp 22,400.00 180 Rp 40,320.00 90 Rp 20,160.00 90
150 Metil Ergometrin injeksi 0,2mg/ml / MYOMERGIN 20 Rp 59,180.00 0 Rp - 20 Rp 59,180.00 0 Rp - 0
151 Metil Prednisolon 4 mg 0 Rp - 1000 Rp 102,000.00 770 Rp 78,540.00 230 Rp 23,460.00 230
152 Metoklopramid 10 mg 0 Rp - 500 Rp 45,000.00 500 Rp 45,000.00 0 Rp - 0
153 Metronidazole 500 mg 1160 Rp 263,590.00 0 Rp - 760 Rp 101,080.00 400 Rp 162,510.00 400
154 Mikonazole Krim 2% (Nitrat) 73 Rp 253,032.40 0 Rp - 31 Rp 58,900.00 42 Rp 194,132.40 42
155 Natrium Diklofenak 25 mg 3335 Rp 426,880.00 0 Rp - 3015 Rp 385,920.00 320 Rp 40,960.00 320
156 Natrium Diklofenak 25 mg 0 Rp - 2800 Rp 322,000.00 0 Rp - 2800 Rp 322,000.00 2800
157 Natrium Diklofenak 50 mg 2540 Rp 316,100.00 0 Rp - 2540 Rp 316,100.00 0 Rp - 0
158 Natrium Diklofenak 50 mg 0 Rp - 8400 Rp 1,033,200.00 3630 Rp 446,490.00 4770 Rp 586,710.00 4770
159 Natrium Klorida infus 0,9% (NaCl) 60 Rp 470,600.00 0 Rp - 60 Rp 470,600.00 0 Rp - 0
160 Natrium Klorida infus 0,9% (NaCl) 0 Rp - 313 Rp 1,026,640.00 237 Rp 777,360.00 76 Rp 249,280.00 76
161 Nistatin 100.000 IU (tablet vaginal) 80 Rp 44,080.00 0 Rp - 80 Rp 44,080.00 0 Rp - 0
162 Obat Batuk Hitam ( OBH ) 175 Rp 781,830.73 0 Rp - 175 Rp 781,830.73 0 Rp - 0
163 Obat Batuk Hitam ( OBH ) 0 Rp - 240 Rp 1,287,000.00 62 Rp 332,475.00 178 Rp 954,525.00 178
164 ONDANSETRON 4mg/2ml injeksi 195 Rp 219,180.00 0 Rp - 195 Rp 219,180.00 0 Rp - 0
165 ONDANSETRON 4mg/2ml injeksi 0 Rp - 25 Rp 21,825.00 25 Rp 21,825.00 0 Rp - 0
166 ONDANSETRON HCL 4mg/2ml (BLUD) 0 Rp - 50 Rp 369,600.00 46 Rp 340,032.00 4 Rp 29,568.00 4
167 OSELTAMIVIR PHOSPHATE TABLET 75 MG 0 Rp - 100 Rp 700,000.00 66 Rp 462,000.00 34 Rp 238,000.00 34
168 ORALIT (RAMOLIT) (BLUD) 0 Rp - 1000 Rp 570,000.00 0 Rp - 1000 Rp 570,000.00 1000
169 OXYTETRACYCLINE SALEP MATA 1 % (HCL) 0 Rp - 35 Rp 87,500.00 35 Rp 87,500.00 0 Rp - 0
170 Parasetamol 500 mg 20961 Rp 2,242,617.39 Rp - 20961 Rp 2,242,617.39 0 Rp - 0
171 Parasetamol 500 mg 0 Rp - 40000 Rp 7,840,000.00 24449 Rp 4,792,004.00 15551 Rp 3,047,996.00 15551
172 Parasetamol Syrup 120mg/5ml 320 Rp 377,920.00 600 Rp 708,600.00 782 Rp 923,542.00 138 Rp 162,978.00 138
173 Perak Sulfadiazin Krim 1% / BURNAZIN 0 Rp - 12 Rp 248,397.60 12 Rp 248,397.60 0 Rp - 0
174 Permetrin Krim 5% / SCABIMITE 16 Rp 189,200.00 16 Rp 189,200.00 31 Rp 366,575.00 1 Rp 11,825.00 1
175 Piridoksin 10 mg (Vitamin B6) 4718 Rp 618,058.00 5000 Rp 655,000.00 4066 Rp 532,646.00 5652 Rp 740,412.00 5652
176 Prednison 5 mg 2958 Rp 215,934.00 Rp - 1948 Rp 142,204.00 1010 Rp 73,730.00 1010
177 Prednison 5 mg 0 Rp - 2000 Rp 136,000.00 0 Rp - 2000 Rp 136,000.00 2000
178 PropilTioUrasil 100 mg (PTU) 500 Rp 293,000.00 0 Rp - 500 Rp 293,000.00 0 Rp - 0
179 Propranolol 10 mg 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
180 Propranolol 10 mg 280 Rp 16,240.00 0 Rp - 150 Rp 8,700.00 130 Rp 7,540.00 130
181 Ranitidin 150 mg 0 Rp - 2000 Rp 440,000.00 406 Rp 89,320.00 1594 Rp 350,680.00 1594
182 RANITIDIN 150MG (BLUD) 0 Rp - 1000 Rp 165,000.00 1000 Rp 165,000.00 0 Rp - 0
183 Ranitidin injeksi 25mg/ml 126 Rp 149,688.00 700 Rp 831,600.00 826 Rp 981,288.00 0 Rp - 0
184 Retinol kapsul lunak 100.000 IU (Vitamin A Biru) 0 Rp - 500 Rp 148,500.00 500 Rp 148,500.00 0 Rp - 0
Retinol kapsul lunak 200.000 IU (Vitamin A Merah) Rp 52,200.00 Rp - Rp 52,200.00 0 Rp - 0
185 100 100
Retinol kapsul lunak 200.000 IU (Vitamin A Merah) Rp - Rp 3,367,200.00 6058 Rp 3,344,016.00 42 Rp 23,184.00 42
186 0 6100
187 Ringer Laktat larutan infus (RL) 200 Rp 1,526,000.00 0 Rp - 180 Rp 1,373,400.00 20 Rp 152,600.00 20
190 risperidon 2mg 0 Rp - 1000 Rp 123,000.00 0 Rp - 1000 Rp 123,000.00 1000
191 Salbutamol 2 mg 400 Rp 11,352.00 0 Rp - 400 Rp 11,352.00 0 Rp - 0
192 Salbutamol 2 mg 4000 Rp 268,000.00 2000 Rp 134,000.00 2966 Rp 198,722.00 3034 Rp 203,278.00 3034
193 Salep 2 - 4 Kombinasi 44 Rp 123,024.00 0 Rp - 44 Rp 123,024.00 0 Rp - 0
194 Salep 2 - 4 Kombinasi 0 Rp - 120 Rp 169,200.00 38 Rp 53,580.00 82 Rp 115,620.00 82
195 Sefadroksil 500 mg 0 Rp - 1000 Rp 388,000.00 420 Rp 162,960.00 580 Rp 225,040.00 580
196 Sefadroksil sirup kering 125mg/5ml 41 Rp 171,585.00 0 Rp - 11 Rp 46,035.00 30 Rp 125,550.00 30
197 Sianokobalamin injeksi 500mcg/ml 426 Rp 463,062.00 0 Rp - 426 Rp 463,062.00 0 Rp - 0
198 Sianokobalamin injeksi 500mcg/ml 0 Rp - 200 Rp 220,800.00 141 Rp 155,664.00 59 Rp 65,136.00 59
199 Sianokobalamin tablet 50 mcg (Vitamin B12) 3196 Rp 156,604.00 Rp - 2106 Rp 103,194.00 1090 Rp 53,410.00 1090
Sianokobalamin tablet 50 mcg (Vitamin B12) (BLUD) Rp - Rp 70,000.00 120 Rp 8,400.00 880 Rp 61,600.00 880
200 0 1000
201 Simvastatin 20 mg (salut selaput) 5290 Rp 1,147,930.00 0 Rp - 5290 Rp 1,147,930.00 0 Rp - 0
202 Simvastatin 20 mg (salut selaput) 0 Rp - 18000 Rp 2,700,000.00 4150 Rp 622,500.00 13850 Rp 2,077,500.00 13850
35
TERBUTALIN SULFAT 2.5 MG NEBUL / BRICASMA 0 Rp - 60 Rp 460,500.00 25 Rp 191,875.00 35 Rp 268,625.00
203
204 Thiamin 50 mg (Vitamin B1) 4328 Rp 393,848.00 0 Rp - 4328 Rp 393,848.00 0 Rp - 0
205 Thiamin 50 mg (Vitamin B1) (BLUD) 0 Rp - 1000 Rp 253,000.00 1000 Rp 253,000.00 0 Rp - 0
206 Thiamin 50 mg (Vitamin B1) (BLUD) 0 Rp - 5000 Rp 1,419,330.00 140 Rp 39,741.80 4860 Rp 1,379,588.20 4860
207 Trifluoperazine 5 mg (salut selaput) 340 Rp 97,580.00 500 Rp 143,500.00 550 Rp 157,850.00 290 Rp 83,230.00 290
208 Triheksifenidil 2 mg 1470 Rp 458,640.00 0 Rp - 1470 Rp 458,640.00 0 Rp - 0
209 Triheksifenidil 2 mg 0 Rp - 9000 Rp 567,000.00 5605 Rp 353,115.00 3395 Rp 213,885.00 3395
210 Vitamin B Kompleks 9433 Rp 839,537.00 0 Rp - 9433 Rp 839,537.00 0 Rp - 0
211 Vitamin B Kompleks 0 Rp - 13000 Rp 741,000.00 8996 Rp 512,772.00 4004 Rp 228,228.00 4004
212 Zinc 20 mg (dispersible) 1515 Rp 793,860.00 0 Rp - 1515 Rp 793,860.00 0 Rp - 0
213 Zinc 20 mg (dispersible) 0 Rp - 2000 Rp 416,000.00 515 Rp 107,120.00 1485 Rp 308,880.00 1485
214 Zinc sirup (Sulfate) 20mg/5ml 0 Rp - 144 Rp 456,624.00 98 Rp 310,758.00 46 Rp 145,866.00 46
215 Eugenol 1 Rp 154,000.00 0 Rp - 1 Rp 154,000.00 0 Rp - 0
216 Chkm 1 Rp 264,000.00 0 Rp - 1 Rp 264,000.00 0 Rp - 0
217 Calplus 1 Rp 379,500.00 0 Rp - 1 Rp 379,500.00 0 Rp - 0
218 GIC Besar 1 Rp 1,958,660.00 0 Rp - 1 Rp 1,958,660.00 0 Rp - 0
219 GIC kecil 1 Rp 422,840.00 0 Rp - 1 Rp 422,840.00 0 Rp - 0
220 Chlorethyl 1 Rp 528,000.00 0 Rp - 1 Rp 528,000.00 0 Rp - 0
221 TKF 1 Rp 132,300.00 0 Rp - 1 Rp 132,300.00 0 Rp - 0
222 Amlodipin 10 mg (BLUD) 0 Rp - 800 Rp 325,600.00 800 Rp 325,600.00 0 Rp - 0
223 Aminofilin 200 mg (BLUD) 0 Rp - 500 Rp 117,500.00 0 Rp - 500 Rp 117,500.00 500
224 Ceftriaxone Inj (BLUD) 30 Rp 181,500.00 0 Rp - 30 Rp 181,500.00 0 Rp - 0
225 Citicolin Inj (BLUD) 15 Rp 156,750.00 0 Rp - 0 Rp - 15 Rp 156,750.00 15
226 Asam Mefenamat 500 mg (BLUD) 3980 Rp 1,138,280.00 3980 Rp 1,138,280.00 0 Rp - 0
227 Asam Mefenamat 500 mg (BLUD) 0 Rp - 1000 Rp 297,000.00 940 Rp 279,180.00 60 Rp 17,820.00 60
228 Bisoprolol 5 mg (BLUD) 900 Rp 133,650.00 0 Rp - 900 Rp 133,650.00 0 Rp - 0
229 Ibuprofen 400 mg (BLUD) 1900 Rp 606,100.00 2000 Rp 638,000.00 3560 Rp 1,135,640.00 340 Rp 108,460.00 340
230 SIPROFLOXACIN HCL 500MG jkn -gantrung- 1970 Rp 758,450.00 Rp - 580 Rp 223,300.00 1390 Rp 535,150.00 1390
231 SIPROFLOXACIN HCL 500MG jkn -gantrung- 0 Rp - 1000 Rp 660,000.00 0 Rp - 1000 Rp 660,000.00 1000
232 Ciprofloxaxin 500 mg (BLUD) 2000 Rp 913,000.00 0 Rp - 2000 Rp 913,000.00 0 Rp - 0
233 Etaflox (BLUD) 2000 Rp 913,000.00 0 Rp - 2000 Rp 913,000.00 0 Rp - 0
234 Grathazone (BLUD) 2000 Rp 627,000.00 0 Rp - 2000 Rp 627,000.00 0 Rp - 0
235 Facidol Drop (BLUD) 100 Rp 990,000.00 0 Rp - 100 Rp 990,000.00 0 Rp - 0
236 Yusimox Syrup (BLUD) 100 Rp 440,000.00 0 Rp - 84 Rp 369,600.00 16 Rp 70,400.00 16
237 MgSo4 (BLUD) 5 Rp 60,500.00 0 Rp - 3 Rp 36,300.00 2 Rp 24,200.00 2
238 Methil Ergometrin Inj (BLUD) 20 Rp 81,400.00 0 Rp - 5 Rp - 15 Rp 81,400.00 15
239 Protocin Inj (BLUD) 50 Rp 330,000.00 0 Rp - 12 Rp 79,200.00 38 Rp 250,800.00 38
240 Chlorethyl (BLUD) 8 Rp 960,000.00 0 Rp - 8 Rp 960,000.00 0 Rp - 0
241 Scandonest (BLUD) 0 Rp - 1 Rp 1,400,000.00 1 Rp 1,400,000.00 0 Rp - 0
242 Caviton White (BLUD) 0 Rp - 2 Rp 547,470.00 2 Rp 547,470.00 0 Rp - 0
243 Caviton Pink (BLUD) 0 Rp - 1 Rp 273,735.00 1 Rp 273,735.00 0 Rp - 0
244 TKF (BLUD) 0 Rp - 1 Rp 114,180.00 1 Rp 114,180.00 0 Rp - 0
245 CHKM(BLUD) 0 Rp - 1 Rp 328,790.00 1 Rp 328,790.00 0 Rp - 0
246 Hyposol (BLUD) 0 Rp - 1 Rp 449,900.00 1 Rp 449,900.00 0 Rp - 0
247 Elite Cement Mini Pack (BLUD) 0 Rp - 1 Rp 354,695.00 1 Rp 354,695.00 0 Rp - 0
248 Master Bond (BLUD) 0 Rp - 1 Rp 1,429,230.00 1 Rp 1,429,230.00 0 Rp - 0
249 Clorexoral (BLUD) 0 Rp - 1 Rp 198,990.00 1 Rp 198,990.00 0 Rp - 0
250 Fuji 1x Gp Gold Label (BLUD) 0 Rp - 1 Rp 313,170.00 1 Rp 313,170.00 0 Rp - 0
251 Aroma Fine Normal (BLUD) 0 Rp - 1 Rp 103,840.00 1 Rp 103,840.00 0 Rp - 0
252 Etsa Composit Gel Biru (BLUD) 0 Rp - 1 Rp 138,435.00 1 Rp 138,435.00 0 Rp - 0
Jumlah 675,997 57,933,836.24 399,522 104,183,441.34 388,058 107,978,643.46 687,461 54,138,634.12 687,461
MENGETAHUI

NIP. 19781021 201001 2 008
Rincian Mutasi Persediaan Alat dan Bahan Habis Pakai TA. 2021 pada Puskesmas Gantrung
( Rp )
1 2 3 4 5 6 7 8 9 ( 3+5-7) 10 (4+6-8) 11

3 Alat Suntik Sekali pakai 0,5 ml oneject (BLUD) 0 Rp - 4800 Rp 7,920,000.00 3200 Rp 5,280,000.00 1600 Rp 2,640,000.00 1600
7 Alat Suntik Sekali pakai 3 ml 0 Rp - 2595 Rp 1,476,555.00 1995 Rp 1,135,155.00 600 Rp 341,400.00 600
10 APD Lengkap 2 Rp 600,000.00 0 Rp - 2 Rp 600,000.00 0 Rp - 0
11 Alkohol 70% 1 Liter 0 Rp - 159 Rp 5,565,000.00 67 Rp 2,345,000.00 92 Rp 3,220,000.00 92
12 Alkohol 70% 1000ml (BLUD) 20 Rp 550,000.00 0 Rp - 20 Rp 550,000.00 0 Rp - 0
13 Alkohol swabs 0 Rp - 24500 Rp 1,935,500.00 21500 Rp 1,698,500.00 3000 Rp 237,000.00 3000
14 Alkohol Swab (BLUD) 700 Rp 140,000.00 0 Rp - 700 Rp 140,000.00 0 Rp - 0
15 Alkohol Swab (BLUD) 0 Rp - 4800 Rp 1,161,600.00 4800 Rp 1,161,600.00 0 Rp - 0
16 Aseptic Gel (Ethyl Alkohol 70%) + Dispenser / cairan 22 Rp 3,938,000.00 0 Rp - 0 Rp - 22 Rp 3,938,000.00 22
17 Aseptic Gel (Ethyl Alkohol 70%) + Dispenser / cairan 0 Rp - 50 Rp 1,325,000.00 16 Rp 424,000.00 34 Rp 901,000.00 34
18 ASEPTIK GEL 5LT 0 Rp - 62 Rp 14,136,000.00 17 Rp 3,876,000.00 45 Rp 10,260,000.00 45
19 Auto disable syringe 0.3 ml piece 0 Rp - 560 Rp 702,800.00 560 Rp 702,800.00 0 Rp - 0
20 Baju APD (disposable protective cover all)/hazmat 0 Rp - 1073 Rp 96,570,000.00 418 Rp 37,620,000.00 655 Rp 58,950,000.00 655
21 ECG Gell 1000 ML 3 Rp 85,500.00 0 Rp - 0 Rp - 3 Rp 85,500.00 3
22 ECG Paper (BLUD) 7 Rp 962,500.00 0 Rp - 7 Rp 962,500.00 0 Rp - 0
23 Bioanallitika H2O2 3% 100ml (Bok Gantrung) 10 Rp 682,000.00 0 Rp - 0 Rp - 10 Rp 682,000.00 10
24 Chromic catgut with needle surgical sutures 2/0 0 Rp - 24 Rp 2,880,000.00 0 Rp - 24 Rp 2,880,000.00 24
25 Face Shield Helm 0 Rp - 17 Rp 2,550,000.00 0 Rp - 17 Rp 2,550,000.00 17
26 Face Shield Mika 0 Rp - 16 Rp 320,000.00 0 Rp - 16 Rp 320,000.00 16
29 Hand Sanitizer 0 Rp - 34 Rp 2,221,560.00 1 Rp 65,340.00 33 Rp 2,156,220.00 33
30 Hand schoen non steril free powder Uk. S 1200 Rp 1,254,000.00 0 Rp - 1200 Rp 1,254,000.00 0 Rp - 0
31 Hand schoen non steril free powder Uk. S 0 Rp - 4500 Rp 5,580,000.00 3600 Rp 4,464,000.00 900 Rp 1,116,000.00 900
32 Hand schoen non steril free powder Uk. M 2000 Rp 2,090,000.00 0 Rp - 2000 Rp 2,090,000.00 0 Rp - 0
33 Hand schoen non steril free powder Uk. M 0 Rp - 7100 Rp 8,804,000.00 5100 Rp 6,324,000.00 2000 Rp 2,480,000.00 2000
34 Hand schoen non steril free powder Uk. L 0 Rp - 1500 Rp 1,860,000.00 600 Rp 744,000.00 900 Rp 1,116,000.00 900
35 Hand schoen steril ukuran 6,5 0 Rp - 3025 Rp 16,123,250.00 975 Rp 5,196,750.00 2050 Rp 10,926,500.00 2050
36 Hand schoen steril ukuran 7 100 Rp 418,000.00 0 Rp - 100 Rp 418,000.00 0 Rp - 0
37 Hand Schoen steril ukuran 7,5 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
38 Hand Schoen steril ukuran 7,5 100 Rp 393,800.00 0 Rp - 50 Rp 196,900.00 50 Rp 196,900.00 50
39 Handsrub 500ml 1 Rp 91,666.70 0 Rp - 1 Rp 91,666.70 0 Rp - 0
40 ST. Gynecolog 9 Rp 720,000.00 0 Rp - 9 Rp 720,000.00 0 Rp - 0
41 Sarung tangan obgin 0 Rp - 20 Rp 380,000.00 0 Rp - 20 Rp 380,000.00 20
42 I.V Catether No.18 0 Rp - 50 Rp 313,450.00 24 Rp 150,456.00 26 Rp 162,994.00 26
43 I.V Catether No.20 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
44 I.V Catether No.20 129 Rp 808,787.43 0 Rp - 51 Rp 319,753.17 78 Rp 489,034.26 78
45 I.V Catether No.22 112 Rp 616,000.00 0 Rp - 112 Rp 616,000.00 0 Rp - 0
46 I.V Catether No.24 18 Rp 112,854.06 50 Rp 313,450.00 23 Rp 144,187.00 45 Rp 282,117.06 45
47 Infusion Set Dewasa (NIPRO / OTSUKA) 98 Rp 607,600.00 200 Rp 1,240,000.00 146 Rp 905,200.00 152 Rp 942,400.00 152
48 Kacamata Google 0 Rp - 50 Rp 1,380,000.00 11 Rp 303,600.00 39 Rp 1,076,400.00 39
49 Kapas Pembalut 250 gram 10 Rp 125,000.00 25 Rp 312,500.00 17 Rp 212,500.00 18 Rp 225,000.00 18
50 Karbol liquid 0 Rp - 5 Rp 62,500.00 0 Rp - 5 Rp 62,500.00 5
51 Kasa Hidrofil 16x16cm 100 Rp 800,000.00 200 Rp 1,600,000.00 205 Rp 1,640,000.00 95 Rp 760,000.00 95
52 Kasa Kompres 40x40 Steril 50 Rp 80,000.00 0 Rp - 10 Rp 16,000.00 40 Rp 64,000.00 40
53 Kasa Pembalut 40yardx80cm (potong) 10 Rp 1,350,000.00 10 Rp 1,350,000.00 20 Rp 2,700,000.00 0 Rp - 0
54 Kasa Pembalut Hidrofil 2mx80cm 76 Rp 585,200.00 0 Rp - 6 Rp 58,440.00 70 Rp 526,760.00 70
55 Kasa Pembalut Hidrofil 4mx15cm 100 Rp 210,000.00 0 Rp - 100 Rp 210,000.00 0 Rp - 0
56 Larutan Desinfektan Literan 8 Rp 960,000.00 0 Rp - 8 Rp 960,000.00 0 Rp - 0
57 Larutan Desinfektan Literan 0 Rp - 200 Rp 8,000,000.00 200 Rp 8,000,000.00 0 Rp - 0
58 Lokal Apron Palstik Lengan Panjang (BOK) 72 Rp 3,009,600.00 0 Rp - 72 Rp 3,009,600.00 0 Rp - 0
59 Lokal Apron Palstik Lengan Panjang (BLUD) 0 Rp - 250 Rp 1,925,000.00 250 Rp 1,925,000.00 0 Rp - 0
60 Lokal Hazmat (BOK) 53 Rp 9,911,000.00 0 Rp - 53 Rp 9,911,000.00 0 Rp - 0
61 Masker Hijab earloop @50 1700 Rp 4,420,000.00 0 Rp - 1700 Rp 4,420,000.00 0 Rp - 0
62 Masker Hijab earloop @50 0 Rp - 13400 Rp 13,132,000.00 6050 Rp 5,929,000.00 7350 Rp 7,203,000.00 7350
63 Masker Tali (face mask ties on) 2150 Rp 5,590,000.00 2250 Rp 5,850,000.00 2300 Rp 5,980,000.00 2100 Rp 5,460,000.00 2100
64 Masker Karet (face mask ear loop) 4200 Rp 7,560,000.00 Rp - 4200 Rp 7,560,000.00 0 Rp - 0
65 Masker Karet (face mask ear loop) 0 Rp - 20350 Rp 12,210,000.00 7950 Rp 4,770,000.00 12400 Rp 7,440,000.00 12400
66 Gidcare Maker Bedah (BOK) 1350 Rp 7,425,000.00 0 Rp - 1350 Rp 7,425,000.00 0 Rp - 0
67 Freemad Masker N95 (BOK) 160 Rp 11,880,000.00 0 Rp - 160 Rp 11,880,000.00 0 Rp - 0
68 Masker N95 1860 7 Rp 138,845.00 0 Rp - 7 Rp 138,845.00 0 Rp - 0
71 Masker N95 0 Rp - 1100 Rp 21,890,000.00 110 Rp 2,786,000.00 990 Rp 19,104,000.00 990
72 Masker N-95 0 Rp - 360 Rp 37,800,000.00 360 Rp 37,800,000.00 0 Rp - 0
73 Masker KN95 0 Rp - 150 Rp 750,000.00 70 Rp 350,000.00 80 Rp 400,000.00 80
74 Nasal Oksigen Kanula dewasa 45 Rp 229,090.95 0 Rp - 10 Rp 50,909.10 35 Rp 178,181.85 35
75 Nasal Oksigen Kanula anak 20 Rp 101,640.00 0 Rp - 20 Rp 101,640.00 0 Rp - 0
76 Nurse Cap 0 Rp - 700 Rp 210,000.00 500 Rp 150,000.00 200 Rp 60,000.00 200
77 Onescrub 500cc (clhorhexidine gluconate 4%) + dis 1 Rp 62,500.00 0 Rp - 1 Rp 62,500.00 0 Rp - 0
80 plester non woven 10cm x 5m 10 Rp 413,600.00 25 Rp 1,034,000.00 25 Rp 1,034,000.00 10 Rp 413,600.00 10
81 plester non woven 5cm x 5m 0 Rp - 10 Rp 237,600.00 3 Rp 71,280.00 7 Rp 166,320.00 7
82 Pot Sputum 350 Rp 749,350.00 0 Rp - 350 Rp 749,350.00 0 Rp - 0
83 Pot Sputum 0 Rp - 300 Rp 682,500.00 90 Rp 204,750.00 210 Rp 477,750.00 210
84 Povidon Iodine larutan 100mg/ml kemasan 300ml 0 Rp - 15 Rp 315,000.00 15 Rp 315,000.00 0 Rp - 0
85 Povidon Iodine larutan 100mg/ml kemasan 30ml 19 Rp 60,800.00 30 Rp 96,000.00 17 Rp 54,400.00 32 Rp 102,400.00 32
86 Powdered examination size M 0 Rp - 4000 Rp 4,920,000.00 4000 Rp 4,920,000.00 0 Rp - 0
87 SAFETY BOX 5 LITER 0 Rp - 205 Rp 2,896,445.00 205 Rp 2,896,445.00 0 Rp - 0
88 Sofra-Tulle (BLUD) 11 Rp 3,388,000.00 0 Rp - 8 Rp 2,464,000.00 3 Rp 924,000.00 3
89 Underpad 60 Rp 277,200.00 0 Rp - 60 Rp 277,200.00 0 Rp - 0
90 Underpad 0 Rp - 50 Rp 2,475,000.00 0 Rp - 50 Rp 2,475,000.00 50
91 USG Paper (BLUD) 3 Rp 940,500.00 0 Rp - 0 Rp - 3 Rp 940,500.00 3
92 Kantong Jenazah 25 Rp 3,125,000.00 0 Rp - 0 Rp - 25 Rp 3,125,000.00 25
93 Alginat Zetalgin (BLUD) 10 Rp 1,250,000.00 0 Rp - 10 Rp 1,250,000.00 0 Rp - 0
94 Gips Pro Model Super 11 (BLUD) 8 Rp 500,000.00 0 Rp - 8 Rp 500,000.00 0 Rp - 0
95 Dermafix 6X7 (BLUD) 6 Rp 574,200.00 0 Rp - 6 Rp 574,200.00 0 Rp - 0
96 Mess no 11 (BLUD) 3 Rp 297,000.00 0 Rp - 3 Rp 297,000.00 0 Rp - 0
97 VIRY 6.0 Benang OK (BLUD) 4 Rp 814,000.00 0 Rp - 4 Rp 814,000.00 0 Rp - 0
98 Poliaid 1 liter (BLUD) 6 Rp 776,400.00 0 Rp - 6 Rp 776,400.00 0 Rp - 0
99 Poliwash 500 ml (BLUD) 45 Rp 2,623,500.00 0 Rp - 44 Rp 2,565,200.00 1 Rp 58,300.00 1
100 Sarung Tangan Uk. L Handscoon Latex (BLUD) 1500 Rp 1,909,095.00 0 Rp - 1500 Rp 1,909,095.00 0 Rp - 0
101 Sarung Tangan Uk. M Handscoon Latex (BLUD) 300 Rp 381,819.00 0 Rp - 300 Rp 381,819.00 0 Rp - 0
102 Sarung Tangan Uk. S Handscoon Latex (BLUD) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
103 Shamrock Handscoon (BOK) 3200 Rp 7,040,000.00 0 Rp - 3200 Rp 7,040,000.00 0 Rp - 0
104 APD Hazmat (BLUD) 0 Rp - 10 Rp 1,550,000.00 10 Rp 1,550,000.00 0 Rp - 0
107 Needle uk. 23 (BLUD) 0 Rp - 1 Rp 104,500.00 1 Rp 104,500.00 0 Rp - 0
108 Umbilical Cord Klem (BLUD) 0 Rp - 1 Rp 198,000.00 1 Rp 198,000.00 0 Rp - 0
109 Mucus Ekstractor (BLUD) 0 Rp - 50 Rp 687,500.00 8 Rp 110,000.00 42 Rp 577,500.00 42
110 Sarung Tangan Obgyn Steril (BLUD) 0 Rp - 20 Rp 1,364,000.00 15 Rp 1,023,000.00 5 Rp 341,000.00 5
111 Delee Besar (BLUD) 0 Rp - 5 Rp 110,000.00 1 Rp 22,000.00 4 Rp 88,000.00 4
112 Benang Silk 3/0 (BLUD) 0 Rp - 1 Rp 1,430,000.00 1 Rp 1,430,000.00 0 Rp - 0
113 Apron Plastik(BLUD) 0 Rp - 7 Rp 485,100.00 7 Rp 485,100.00 0 Rp - 0
114 Kantong Limbah Medis 60cm X 100cm (BLUD) 0 Rp - 10 Rp 300,000.00 10 Rp 300,000.00 0 Rp - 0
115 Apron Plastik Tanpa Lengan (BLUD) 0 Rp - 300 Rp 507,000.00 300 Rp 507,000.00 0 Rp - 0
116 Apron Lengan Panjang (BLUD) 0 Rp - 250 Rp 1,925,000.00 250 Rp 1,925,000.00 0 Rp - 0
117 GC HS Posterior (BLUD) 0 Rp - 1 Rp 1,200,000.00 1 Rp 1,200,000.00 0 Rp - 0
118 Bayzime Detergent Alkali Enzimatic 1 L (BLUD) 0 Rp - 3 Rp 1,935,789.00 3 Rp 1,935,789.00 0 Rp - 0
119 Bayzime Detergent Alkali Enzimatic 1 L (BLUD) 0 Rp - 7 Rp 4,516,796.00 0 Rp - 7 Rp 4,516,796.00 7
120 Baymed Handscrub 4% 500 ml (BLUD) 0 Rp - 20 Rp 1,700,006.00 0 Rp - 20 Rp 1,700,006.00 20
121 IV Catheter with Injection No. 22, Cosmomed (BLUD) 0 Rp - 50 Rp 400,000.00 18 Rp 144,000.00 32 Rp 256,000.00 32
122 Dermafix 5X7 cm, Onemed (BLUD) 0 Rp - 5 Rp 325,000.00 1 Rp 65,000.00 4 Rp 260,000.00 4
123 Dermafix 10X25 cm, Onemed (BLUD) 0 Rp - 1 Rp 215,000.00 1 Rp 215,000.00 0 Rp - 0
Jumlah 20,836 96,291,146.64 120,192 338,389,901.00 104,416 267,790,358.47 36,612 166,890,689.17 36,612
MENGETAHUI

NIP. 19781021 201001 2 008
Rincian Mutasi Persediaan Bahan Laborat Pakai TA. 2021 pada Puskesmas Gantrung
( Rp )
1 2 3 4 5 6 7 8 9 ( 3+5-7) 10 (4+6-8) 11

1 Asam Klorida 0,1 N 100ml / HCL 9 Rp 95,040.00 0 Rp - 9 Rp 95,040.00 0 Rp - 0
2 Blood lancet 0 Rp - 500 Rp 79,250.00 300 Rp 47,550.00 200 Rp 31,700.00 200
3 Blue Tip (BLUD) 2 Rp 286,000.00 0 Rp - 0 Rp - 2 Rp 286,000.00 2
4 Cholesterol Test (Benecheck) 5 Rp 126,762.50 0 Rp - 5 Rp 126,762.50 0 Rp - 0
5 Cholesterol Test (Benecheck) 0 Rp - 20 Rp 5,000,000.00 17 Rp 4,250,000.00 3 Rp 750,000.00 3
6 Glucose Test (Benecheck) 5 Rp 801,085.00 0 Rp - 5 Rp 801,085.00 0 Rp - 0
7 Glucose Test (Benecheck) 0 Rp - 21 Rp 3,360,000.00 16 Rp 2,560,000.00 5 Rp 800,000.00 5
8 HBSAG strip 250 Rp 2,025,000.00 0 Rp - 250 Rp 2,025,000.00 0 Rp - 0
9 HBSAG strip 0 Rp - 150 Rp 1,112,850.00 100 Rp 741,900.00 50 Rp 370,950.00 50
10 Perhidrol 3% 100ml/Hidrogen Peroksida (H2O2) 1 Rp 5,500.00 0 Rp - 1 Rp 5,500.00 0 Rp - 0
11 RAPID sd bio syphilis (syphylis Ab Test) @25 25 Rp 181,250.00 0 Rp - 25 Rp 181,250.00 0 Rp - 0
12 Rapid diagnostic syphilis test (sd bioline) 500 Rp 4,435,000.00 300 Rp 2,661,000.00 200 Rp 1,774,000.00 200
13 rdt covid19 600 Rp 49,170,000.00 0 Rp - 600 Rp 49,170,000.00 0 Rp - 0
14 COVID-19 Ag TEST 1510 Rp 64,930,000.00 1160 Rp 49,880,000.00 350 Rp 15,050,000.00 350
15 Reagent (I) TEST HIV1/2 3.0_SD BIOLINE 170 Rp 2,052,333.00 0 Rp - 170 Rp 2,052,333.00 0 Rp - 0
16 Reagent HIV (I) RAPID 500 Rp 5,987,500.00 0 Rp - 500 Rp 5,987,500.00 0 Rp - 0
17 Reagent HIV (I) RAPID 0 Rp - 370 Rp 2,968,880.00 340 Rp 2,728,160.00 30 Rp 240,720.00 30
18 Reagent II HIV (FOCUS) 22 Rp 277,935.00 0 Rp - 22 Rp 277,935.00 0 Rp - 0
19 Reagent TRIGLYCERIDES 2 Rp 1,964,220.00 0 Rp - 2 Rp 1,964,220.00 0 Rp - 0
20 Reagent Uji Asam Urat 2 Rp 1,472,300.00 0 Rp - 2 Rp 1,472,300.00 0 Rp - 0
21 Reagent UREA / BUN 1 Rp 539,360.00 0 Rp - 1 Rp 539,360.00 0 Rp - 0
22 REAGENT KIMIA KLINIK UREA 0 Rp - 1 Rp 539,360.00 1 Rp 539,360.00 0 Rp - 0
23 REAGENT WIDAL H TYPHI 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
24 REAGENT WIDAL O-A 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
25 REAGENT WIDAL O-B 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
26 REAGENT WIDAL O-D 1 Rp 43,725.00 0 Rp - 1 Rp 43,725.00 0 Rp - 0
27 Reagent Ziehl Nielson / ZN 0 Rp - 2 Rp 353,520.00 2 Rp 353,520.00 0 Rp - 0
28 SHYPILIS AB TEST 27 Rp - 0 Rp - 27 Rp - 0 Rp - 0
29 Test GOLONGAN DARAH A 1 Rp 68,250.00 0 Rp - 1 Rp 68,250.00 0 Rp - 0
30 Test GOLONGAN DARAH A,B 2 Rp 180,500.00 0 Rp - 2 Rp 180,500.00 0 Rp - 0
31 Test GOLONGAN DARAH B 1 Rp 68,250.00 0 Rp - 1 Rp 68,250.00 0 Rp - 0
32 Test GOLONGAN DARAH D 2 Rp 220,500.00 0 Rp - 2 Rp 220,500.00 0 Rp - 0
33 REAGEN GOL DARAH 3 Rp 1,000,000.00 0 Rp - 3 Rp 1,000,000.00 0 Rp - 0
34 Test URINE 10 Parameter / CYBOW 3 Rp 407,760.00 0 Rp - 3 Rp 407,760.00 0 Rp - 0
35 Test URINE 10 Parameter Verify (BLUD) 8 Rp 2,737,777.77 0 Rp - 8 Rp 2,737,777.77 0 Rp - 0
36 Test Urine 3 parameter 1 Rp 55,926.00 0 Rp - 1 Rp 55,926.00 0 Rp - 0
37 TRULAB N (KONTROL NORMAL) PROLINE E Rp 4,343,740.00 Rp - Rp 4,343,740.00 Rp -
6BTL/KTK 2 0 2 0 0
38 Uric Acid Test (Benecheck) 6 Rp 919,650.00 0 Rp - 6 Rp 919,650.00 0 Rp - 0
39 Uric Acid Test (Benecheck) 0 Rp - 13 Rp 1,950,000.00 8 Rp 1,200,000.00 5 Rp 750,000.00 5
40 VACUUM TUBE STERILE K3 EDTA 3ML soft needle Rp 25,578,000.00 Rp - Rp 25,578,000.00 Rp -
tendre 98 0 98 0 0
41 Tabung EDTA (Tutup Ungu) Endo (BLUD) 6 Rp 1,452,000.00 0 Rp - 6 Rp 1,452,000.00 0 Rp - 0
42 Sysmex Cellpack diluent 20 liter (BLUD) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
43 Sysmex Stromatolyser WH 500 ml (BLUD) 1 Rp 1,265,000.00 0 Rp - 1 Rp 1,265,000.00 0 Rp - 0
44 Sysmex Cellclean 50 ml (BLUD) 0 Rp - 0 Rp - 0 Rp - 0 Rp - 0
45 GBLAB Centrifuge Tube 15 ml +tutup (BLUD) 8 Rp 29,040.00 0 Rp - 8 Rp 29,040.00 0 Rp - 0
46 GP Vacullab Plain 3 ml (BLUD) 1 Rp 268,950.00 0 Rp - 1 Rp 268,950.00 0 Rp - 0
47 IR Ziehl Nelsen 100 ml (BLUD) 2 Rp 412,500.00 0 Rp - 2 Rp 412,500.00 0 Rp - 0
48 Sysmex Cellpack diluent 20 liter (BLUD) 0 Rp - 3 Rp 6,305,310.00 3 Rp 6,305,310.00 0 Rp - 0
49 Sysmex Cellclean 50 ml (BLUD) 0 Rp - 2 Rp 2,768,480.00 2 Rp 2,768,480.00 0 Rp - 0
50 Intec Tes Kehamilan (BLUD) 0 Rp - 50 Rp 275,000.00 50 Rp 275,000.00 0 Rp - 0
51 GP Yellow Tip 200 UL (BLUD) 0 Rp - 2000 Rp 453,200.00 2000 Rp 453,200.00 0 Rp - 0
52 Parafilm (BLUD) 0 Rp - 1 Rp 625,000.00 1 Rp 625,000.00 0 Rp - 0
53 Sysmex Stromatolyser WH 500 ml (BLUD) 0 Rp - 3 Rp 4,174,500.00 3 Rp 4,174,500.00 0 Rp - 0
54 AMA Golongan Darah A, 10 ml (BLUD) 0 Rp - 1 Rp 77,000.00 1 Rp 77,000.00 0 Rp - 0
55 AMA Golongan Darah B, 10 ml (BLUD) 0 Rp - 2 Rp 77,000.00 2 Rp 77,000.00 0 Rp - 0
56 AMA Golongan Darah AB, 10 ml (BLUD) 0 Rp - 3 Rp 77,000.00 3 Rp 77,000.00 0 Rp - 0
57 AMA Golongan Darah O, 10 ml (BLUD) 0 Rp - 4 Rp 165,000.00 4 Rp 165,000.00 0 Rp - 0
58 Family DR HB. Strip (25T) (BLUD) 0 Rp - 2 Rp 1,100,000.00 2 Rp 1,100,000.00 0 Rp - 0
59 GBLAB K3 EDTA 3 ml (100PCS) (BLUD) 0 Rp - 1 Rp 237,600.00 1 Rp 237,600.00 0 Rp - 0
60 Object Glas (BLUD) 0 Rp - 5 Rp 250,000.00 5 Rp 250,000.00 0 Rp - 0
61 Cover Glas (BLUD) 0 Rp - 2 Rp 130,000.00 2 Rp 130,000.00 0 Rp - 0
62 Slide Widal (BLUD) 0 Rp - 2 Rp 90,000.00 2 Rp 90,000.00 0 Rp - 0
63 Test URINE 10 Parameter Verify (BLUD) 0 Rp - 2 Rp 390,000.00 2 Rp 390,000.00 0 Rp - 0
64 Widal O (BLUD) 0 Rp - 1 Rp 150,000.00 1 Rp 150,000.00 0 Rp - 0
65 Widal OA (BLUD) 0 Rp - 2 Rp 150,000.00 2 Rp 150,000.00 0 Rp - 0
66 Widal OB (BLUD) 0 Rp - 3 Rp 150,000.00 3 Rp 150,000.00 0 Rp - 0
67 Widal H (BLUD) 0 Rp - 4 Rp 150,000.00 4 Rp 150,000.00 0 Rp - 0
Jumlah 1,770 104,167,029.27 5,180 102,523,950.00 6,105 186,637,609.27 845 20,053,370.00 845
MENGETAHUI

NIP. 19781021 201001 2 008
Nilai KETERAN
n ( Rp )
12 13 14 (9-11) 15 ( 10-12 ) 16
Rp - - -
Rp - - -
Rp - - -
Rp 826,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 251,001.00 - -
Rp - - -
Rp 139,300.00 - -
Rp - - -
Rp - - -
Rp 125,875.00 - -
Rp - - -
Rp 170,780.00 - -
Rp - - -
Rp 1,677,144.00 - -
Rp 137,678.00 - -
Rp - - -
Rp 289,980.00 - -
Rp - - -
Rp 55,660.00 - -
Rp - - -
Rp 23,990.00 - -
Rp 115,152.00 - -
Rp 123,513.00 - -
Rp - - -
Rp 344,500.00 - -
Rp 780,255.00 - -
Rp 917,334.00 - -
Rp - - -
Rp 117,900.00 - -
Rp 791,700.00 - -
Rp 9,198,553.00 - -
Rp 380,295.00 - -
Rp 280,350.00 - -
Rp - - -
Rp 232,470.00 - -
Rp 17,045.25 - -
Rp 463,654.40 - -
Rp - - -
Rp 349,360.00 - -
Rp 803,660.00 - -
Rp 35,640.00 - -
Rp 496,000.00 - -
Rp - - -
Rp 250,690.00 - -
Rp - - -
Rp 220,424.65 - -
Rp - - -
Rp 15,450.00 - -
Rp 15,394.00 - -
Rp 255,906.00 - -
Rp - - -
Rp 25,773.00 - -
Rp - - -
Rp - - -
Rp 94,752.00 - -
Rp 145,600.00 - -
Rp 142,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp 66,600.00 - -
Rp - - -
Rp 439,890.00 - -
Rp 2,400,000.00 - -
Rp - - -
Rp 550,550.00 - -
Rp 107,280.00 - -
Rp 2,572,164.00 - -
Rp - - -
Rp 74,800.00 - -
Rp 79,350.00 - -
Rp - - -
Rp 110,880.00 - -
Rp - - -
Rp 399,300.00 - -
Rp 13,745.86 - -
Rp 82,000.00 - -
Rp 110,991.00 - -
Rp 169,217.60 - -
Rp 1,785.00 - -
Rp 419,244.00 - -
Rp - - -
Rp 1,033,900.00 - -
Rp - - -
Rp - - -
Rp 310,266.00 - -
Rp - - -
Rp 266,560.00 - -
Rp - - -
Rp 15,000.00 - -
Rp - - -
Rp 175,820.00 - -
Rp - - -
Rp 225,225.00 - -
Rp - - -
Rp 1,027,600.00 - -
Rp 616,900.00 - -
Rp 1,244,558.76 - -
Rp - - -
Rp - - -
Rp 240,790.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp 450,000.00 - -
Rp 73,500.00 - -
Rp - - -
Rp 96,800.00 - -
Rp - - -
Rp 62,370.00 - -
Rp - - -
Rp 194,700.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 100,720.00 - -
Rp - - -
Rp - - -
Rp 87,500.00 - -
Rp 80,279.97 - -
Rp - - -
Rp 162,100.00 - -
Rp - - -
Rp 439,890.00 - -
Rp - - -
Rp 188,400.00 - -
Rp - - -
Rp 1,155,550.00 - -
Rp 23,530.00 - -
Rp - - -
Rp 128,475.00 - -
Rp 109,095.04 - -
Rp 63,000.00 - -
Rp - - -
Rp 30,550.00 - -
Rp 309,081.00 - -
Rp 338,800.00 - -
Rp 288,792.00 - -
Rp - - -
Rp 107,147.00 - -
Rp - - -
Rp 685,916.00 - -
Rp 20,160.00 - -
Rp - - -
Rp 23,460.00 - -
Rp - - -
Rp 162,510.00 - -
Rp 194,132.40 - -
Rp 40,960.00 - -
Rp 322,000.00 - -
Rp - - -
Rp 586,710.00 - -
Rp - - -
Rp 249,280.00 - -
Rp - - -
Rp - - -
Rp 954,525.00 - -
Rp - - -
Rp - - -
Rp 29,568.00 - -
Rp 238,000.00 - -
Rp 570,000.00 - -
Rp - - -
Rp - - -
Rp 3,047,996.00 - -
Rp 162,978.00 - -
Rp - - -
Rp 11,825.00 - -
Rp 740,412.00 - -
Rp 73,730.00 - -
Rp 136,000.00 - -
Rp - - -
Rp - - -
Rp 7,540.00 - -
Rp 350,680.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 23,184.00 - -
Rp 152,600.00 - -
Rp 4,800.00 - -
Rp 93,275.00 - -
Rp 123,000.00 - -
Rp - - -
Rp 203,278.00 - -
Rp - - -
Rp 115,620.00 - -
Rp 225,040.00 - -
Rp 125,550.00 - -
Rp - - -
Rp 65,136.00 - -
Rp 53,410.00 - -
Rp 61,600.00 - -
Rp - - -
Rp 2,077,500.00 - -
Rp 268,625.00 - -
Rp - - -
Rp - - -
Rp 1,379,588.20 - -
Rp 83,230.00 - -
Rp - - -
Rp 213,885.00 - -
Rp - - -
Rp 228,228.00 - -
Rp - - -
Rp 308,880.00 - -
Rp 145,866.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 117,500.00 - -
Rp - - -
Rp 156,750.00 - -
Rp - - -
Rp 17,820.00 - -
Rp - - -
Rp 108,460.00 - -
Rp 535,150.00 - -
Rp 660,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 70,400.00 - -
Rp 24,200.00 - -
Rp 81,400.00 - -
Rp 250,800.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
54,138,634.12 - - - -

NIP. 19940312 202012 2 009

Nilai KETERAN
n ( Rp )
12 13 14 (9-11) 15 ( 10-12 ) 16
Rp - - -
Rp - - -
Rp 2,640,000.00 - -
Rp - - -
Rp 181,610.00 - -
Rp - - -
Rp 341,400.00 - -
Rp - - -
Rp 294,000.00 - -
Rp - - -
Rp 3,220,000.00 - -
Rp - - -
Rp 237,000.00 - -
Rp - - -
Rp - - -
Rp 3,938,000.00 - -
Rp 901,000.00 - -
Rp 10,260,000.00 - -
Rp - - -
Rp 58,950,000.00 - -
Rp 85,500.00 - -
Rp - - -
Rp 682,000.00 - -
Rp 2,880,000.00 - -
Rp 2,550,000.00 - -
Rp 320,000.00 - -
Rp - - -
Rp - - -
Rp 2,156,220.00 - -
Rp - - -
Rp 1,116,000.00 - -
Rp - - -
Rp 2,480,000.00 - -
Rp 1,116,000.00 - -
Rp 10,926,500.00 - -
Rp - - -
Rp - - -
Rp 196,900.00 - -
Rp - - -
Rp - - -
Rp 380,000.00 - -
Rp 162,994.00 - -
Rp - - -
Rp 489,034.26 - -
Rp - - -
Rp 282,117.06 - -
Rp 942,400.00 - -
Rp 1,076,400.00 - -
Rp 225,000.00 - -
Rp 62,500.00 - -
Rp 760,000.00 - -
Rp 64,000.00 - -
Rp - - -
Rp 526,760.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 7,203,000.00 - -
Rp 5,460,000.00 - -
Rp - - -
Rp 7,440,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 19,104,000.00 - -
Rp - - -
Rp 400,000.00 - -
Rp 178,181.85 - -
Rp - - -
Rp 60,000.00 - -
Rp - - -
Rp 60,000.00 - -
Rp 120,000.00 - -
Rp 413,600.00 - -
Rp 166,320.00 - -
Rp - - -
Rp 477,750.00 - -
Rp - - -
Rp 102,400.00 - -
Rp - - -
Rp - - -
Rp 924,000.00 - -
Rp - - -
Rp 2,475,000.00 - -
Rp 940,500.00 - -
Rp 3,125,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 58,300.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 577,500.00 - -
Rp 341,000.00 - -
Rp 88,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 4,516,796.00 - -
Rp 1,700,006.00 - -
Rp 256,000.00 - -
Rp 260,000.00 - -
Rp - - -
166,890,689.17 - - - -

NIP. 19940312 202012 2 009

Nilai KETERAN
n ( Rp )
12 13 14 (9-11) 15 ( 10-12 ) 16
Rp - - -
Rp 31,700.00 - -
Rp 286,000.00 - -
Rp - - -
Rp 750,000.00 - -
Rp - - -
Rp 800,000.00 - -
Rp - - -
Rp 370,950.00 - -
Rp - - -
Rp - - -
Rp 1,774,000.00 - -
Rp - - -
Rp 15,050,000.00 - -
Rp - - -
Rp - - -
Rp 240,720.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp 750,000.00 - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
Rp - - -
20,053,370.00 - - - -

NIP. 19940312 202012 2 009

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Lampiran : Berita Acara Stock Opname

Nomor : 900 / 1331 / 402.102.26 / 2021

LAPORAN PENGECEKAN FISIK (STOCK OPNAME)

OPD / UNIT KERJA : PUSKESMAS GANTRUNG

1.1.7.1.12 Persediaan Alat Kesehatan Habis Pakai

1.1.7.2.5 Persediaan Bahan Laborat

Madiun, 31 Desember 2021

drg. DYAH ARIANA DARMAYANI GALUH MARISTA, S.Farm., Apt.

LAPORAN PENGECEKAN FISIK (STOCK OPNAME)

OPD / UNIT KERJA : PUSKESMAS GANTRUNG

1.1.7.2.4 Persediaan Obat-Obatan

drg. DYAH ARIANA DARMAYANI

1.1.7.1.12 Persediaan Alat Kesehatan Habis Pakai

drg. DYAH ARIANA DARMAYANI

1.1.7.2.5 Persediaan Bahan Laborat

drg. DYAH ARIANA DARMAYANI

Madiun, 31 Desember 2021

Pejabat Penyimpan Barang

GALUH MARISTA, S.Farm., Apt.

HASIL STOCK OPNAME SELISIH

Madiun, 31 Desember 2021

Pejabat Penyimpan Barang

GALUH MARISTA, S.Farm., Apt.

HASIL STOCK OPNAME SELISIH

Madiun, 31 Desember 2021

Pejabat Penyimpan Barang

GALUH MARISTA, S.Farm., Apt.

Rincian Penambahan Persediaan BMHP BLUD TA. 2022

Rincian Penambahan Persediaan BAHAN LAB BLUD TA. 2021

P BLUD TA. 2022 Rincian Penambahan Persediaan BMHP BO

Rp 110,000.00 Rp 440,000.00 Masker Hijab Baymed

2,000 Rp 660.01 Rp 1,320,012.00

LAPORAN PENGECEKAN FISIK (STOCK OPNAME)

OPD / UNIT KERJA : PUSKESMAS GANTRUNG

1.1.7.2.4 Persediaan Obat-Obatan

drg. DYAH ARIANA DARMAYANI

1.1.7.1.12 Persediaan Alat Kesehatan Habis Pakai

drg. DYAH ARIANA DARMAYANI

1.1.7.2.5 Persediaan Bahan Laborat

drg. DYAH ARIANA DARMAYANI

Madiun, 31 Desember 2021

Pejabat Penyimpan Barang

GALUH MARISTA, S.Farm., Apt.

HASIL STOCK OPNAME SELISIH

Madiun, 31 Desember 2021

Pejabat Penyimpan Barang

GALUH MARISTA, S.Farm., Apt.

HASIL STOCK OPNAME SELISIH

Madiun, 31 Desember 2021

Pejabat Penyimpan Barang

GALUH MARISTA, S.Farm., Apt.

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