PEMERINTAH KABUPATEN KONAWE UTARA

DINAS KESEHATAN
Jl. Kompleks Perkantoran Pemda Kel.Wanggudu Kec.Asera. E-mail : konutkessos
WANGGUDU

SURAT BUKTI BARANG KELUAR

No. 02.037 / IF-KU / IV / 2016

DIKIRIM KEPADA : Puskesmas Matandahi

BULAN : April
BARANG BERUPA : Obat dan Alat Kesehatan

HARGA TOTAL
No. NAMA OBAT KEMASAN QUANTUM
SATUAN HARGA
1 Albendazol suspensi 200 mg/5 ml Dus, @ 10 btl 4,234.00 20 84,680.00
2 alopurinol tablet 100 mg Ktk, 10 strip @ 10 tab 90.00 700 63,000.00
3 Aminofilin tablet 200 mg Btl 100 tablet 86.00 300 25,800.00
4 Amoksisilin kaplet 500 mg Ktk, 10 strip @ 10 tab 279.00 1,500 418,500.00
5 Amoksisilin sirup kering 125 mg/ 5 ml Dus, 60 btl @ 60ml 2,560.00 60 153,600.00
6 Antasida DOEN I tablet kunyah, kombinasi Ktk, 10 strip @ 10 tab 78.00 1,900 148,200.00
7 Antasida DOEN II suspensi, kombi : Dus, 50 btl @ 60ml 2,213.00 50 110,650.00
8 Antimigren tablet : Ergotamin Tartat 1 mg + Kofein 50 mg Btl 100 tablet 149.00 500 74,500.00
9 Asam Asetilsalisilat tablet 100 mg (Asetosal) Ktk, 10 strip @ 10 tab 127.00 100 12,700.00
10 Asam Askorbat (Vit C) tablet 250 mg Ktk, 10 strip @ 10 tab 167.00 200 33,400.00
11 Asam Folat tablet 1 mg Btl 100 tablet 52.00 500 26,000.00
12 Asam Mefenamat kaplet 500 mg Ktk, 10 strip @ 10 tab 127.00 2,000 254,000.00
13 Aseptan 500 ml + Dispenser Btl 500 ml 39,150 2 78,300.00
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet (tablet
14 1 sase @ 30 tab 45.00 300 13,500.00
tambah darah kombinasi )
15 Betametason krim 0.1 % (sebagai Valerat) ktk, 24 tube @ 5 g 1,669.00 72 120,168.00
16 Cetirizine tablet 10 mg ktk 10 x 10 tablet 190.00 200 38,000.00
17 Deksametason tablet 0,5 mg Ktk, 10 strip @ 10 tab 68.00 1,000 68,000.00
18 Dekstrometorfan sirup 10 mg/5 ml (HBr) Btl 60 ml 1,467.40 20 29,348.00
19 Domperidon suspensi 5 mg/5 ml Dus, 50 btl @ 60 ml 3,490.00 50 174,500.00
20 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 174.00 1,000 174,000.00
21 Efedrin tablet 25 mg (HCL) Btl 250 tablet 51.26 250 12,815.00
22 Furosemid injeksi i.v./i.m. 10 mg/ml Ktk, 25 amp @ 2 ml 2,012.00 50 100,600.00
23 Furosemid tablet 40 mg Ktk, 10 strip @ 10 tab 89.63 200 17,926.00
24 Ibuprofen tablet 200 mg Btl @100 tablet 121.00 500 60,500.00
25 Ibuprofen tablet 400 mg ktk 10 str x 10 tablet 157.00 1,000 157,000.00
26 Kaptopril tablet 12,5 mg ktk 10 x 10 tablet 69.00 500 34,500.00
27 Kaptopril tablet 25 mg Dus, 10 Strip @ 10 tab 97.00 500 48,500.00
28 natrium diklo 25 mg ktk 5 x 10 tablet 146.00 500 73,000.00
29 natrium diklo 50 mg ktk 5 x 10 tablet 193.00 500 96,500.00
30 Natrium Klorida larutan infus 0,9 % Botol 500 ml 5,170.00 40 206,800.00
31 ofloxacin tablet 200 mg dus 50 tab 440.00 100 44,000.00
32 Omeprazol kapsul 20 mg ktk 3 x 10 kapsul 221.00 300 66,300.00
33 Parasetamol drops Botol 15 ml 5,720.00 20 114,400.00
34 Parasetamol Sirup 120 mg / 5 ml Btl 60 ml 1,535.00 100 153,500.00
35 Parasetamol tablet 500 mg Strip 10 x 10 tablet 88.00 2,000 176,000.00
36 Prednison tablet 5 mg ktk 10 str x 10 tablet 125.00 500 62,500.00
37 povidon iodine 10% (kokodin) Btl 300 ml 15,386.00 5 76,930.00
 HARGA TOTAL
No. NAMA OBAT KEMASAN QUANTUM
SATUAN HARGA
38 Ranitidin tablet 150 mg ktk 10 x 10 tablet 128.00 1,000 128,000.00
39 Retinol (Vitamin A) 100.000 IU kapsul lunak Btl 50 kapsul lunak 286.00 150 42,900.00
40 Rivanol Botol 300 ml 3,327.75 5 16,638.75
41 Sianokobalamin (vit B 12) tablet 50 mg Ktk 10 x 10 tablet 63.00 1,000 63,000.00
42 Tetrasiklin kapsul/kaplet 250 mg Ktk 10 x 10 kapsul 162.00 500 81,000.00
43 Tetrasiklin kapsul 500 mg ktk 10 str x 10 kapsul 325.00 500 162,500.00
44 Vitamin B Kompleks tablet ktk 10 x 10 tab 112.00 500 56,000.00
45 Zinc tablet 20 mg Dus, 10 Stip @ 10 tab 521.00 700 364,700.00
Alat Kesehatan -
1 Hansd Schun No 7,5 pcs 9,350.00 50 467,500.00
2 Infusion set anak Set /kantong 4,567.50 25 114,187.50
3 Infusion set dewasa (Stera) Set /kantong 4,176.00 50 208,800.00
4 Kasa Hydrofil 40 x 80 cm (Onemed) Roll 137,025.00 1 137,025.00
TOTAL 5,444,868.25

Wanggudu, 05 April 2016

Yang Menerima Yang Menyerahkan,
Kepala Puskesmas Matandahi Petugas Instalasi farmasi
Kabupaten Konawe Utara Kabupaten Konawe Utara

Irsan, SKM Rita Sandi, S.Farm, Apt

NIP. 19800208 200701 1 011 NIP. 19840410 201101 2 025
TEN KONAWE UTARA
SEHATAN
ggudu Kec.Asera. E-mail : konutkessos
GUDU

RANG KELUAR
KU / IV / 2016

KET
KET