USULAN OBAT TAHUN 2018

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL. BANTAYA KEC. PARIGI
No. Telp/Fax :

SUB KELAS ERAPI, NAMA

PERESEPAN
No. GENERIK,SEDIAAN/KEKUATAN DAN Satuan Volume Harga Satuan (Rp) Jumlah Harga (Rp) PEMESAN METODE PEMESANAN
MAKSIMAL
RESTRIKSI PENGGUNAAN
ANTIPIRAI
1 Allopurinol 100 mg Box, 10 strip @10 tab 10000 Rp 117.00 Rp 1,170,000.00
2 Allopurinol 300 mg Box, 10 strp @ 10 tab 5000 Rp 220.00 Rp 1,100,000.00
ANALGESIK NON NARKOTIKA, ANTIPIRETIK

3 Asam Mefenamat tab 500 mg Box, 10 strip @10 tab 10000 Rp 113.00 Rp 1,130,000.00
4 Paracetamol tab 500 mg Box, 10 strip @10 tab 20000 Rp 58.00 Rp 1,160,000.00
5 Paracetamol Syrup 120 mg/5 ml botol 60 ml 1000 Rp 1,119.00 Rp 1,119,000.00
6 Paracetamol Drops 100 mg/ml botol 15 ml 300 Rp 5,000.00 Rp 1,500,000.00
7 Ibuprofen sirup 100mg/5 ml botol 60 ml 500 Rp 2,560.00 Rp 1,280,000.00
8 Ibuprofen tablet 200 Mg Box, 10 strip @10 tab 1000 Rp 95.00 Rp 95,000.00
ANTIINFLAMASI NON STEROID
9 Natrium Diclovenac 25 mg Box, 5 strip @ 10 tab 5000 Rp 121.00 Rp 605,000.00
10 Natrium Diclovenac 50 mg Box, 5 strip @ 10 tab 3000 Rp 322.00 Rp 966,000.00
11 Ketoprofen 50 mg Box, 5 strip @ 10 tab 5000 Rp 640.00 Rp 3,200,000.00
12 Ketoprofen 100 Mg Box, 5 strip @ 10 tab 5000 Rp 1,277.28 Rp 6,386,400.00
13 Melosikam 7,5 mg Box, 5 strip @ 10 tab 5000 Rp 400.00 Rp 2,000,000.00
14 Melosikam 15 Mg Box, 5 strip @ 10 tab 3000 Rp 500.00 Rp 1,500,000.00
15 Kolkisin tablet 500 mcg Box, 10 strip @10 tab 2000 Rp 421.94 Rp 843,880.00
16 Kalium Diklofenak tablet 25 mg Box, 10 strip @10 tab 1000 Rp 303.39 Rp 303,390.00
17 Kalium Diklofenak tablet 50 mg Box, 10 strip @10 tab 1000 Rp 549.60 Rp 549,600.00
ANTIBAKTERI (BETALAKTAM)
18 Amoxcillin 500 mg Box, 10 strip @10 tab 10000 Rp 233.00 Rp 2,330,000.00
19 Amoxcillin Sirup 125 mg/5ml botol 60 ml 1000 Rp 2,200.00 Rp 2,200,000.00
SEFALOSFORIN
20 Sefadroxil 500 mg Kapsul Box, 10 strip @10 kap 3000 Rp 557.00 Rp 1,671,000.00
21 Sefadroxil Sirup/kering 125 mg/5 ml botol 60 ml 500 Rp 5,286.00 Rp 2,643,000.00
22 Sefixim Kapsul 100 mg Box, 5 strip @ 10 kap 3000 Rp 649.00 Rp 1,947,000.00
23 Sefiksim syrup botol 60 ml 500 Rp 9,700.00 Rp 4,850,000.00
ANTI VIRUS (ANTI HERPES)
24 Asiklovir 200 Mg Box, 10 strip @ 10 tab 5000 Rp 250.00 Rp 1,250,000.00
25 Asiklovir 400 Mg Box, 10 strip @ 10 tab 5000 Rp 340.00 Rp 1,700,000.00
OBAT SALURAN CERNA
ANTASIDA DAN ANTIULKUS
26 Antasida DOEN tablet Box, 10 strip @ 10 tab 30000 Rp 64.00 Rp 1,920,000.00
27 Antasida Susp. 60 Ml botol 60 ml 500 Rp 2,106.00 Rp 1,053,000.00
28 Ranitidin tablet 150 mg Box, 10 strip @ 10 tab 20000 Rp 150.00 Rp 3,000,000.00
29 Omeprazole kapsul 20 mg Box, 3 strip @ 10 Kap 30000 Rp 164.00 Rp 4,920,000.00
30 Sukralfat syrup botol 100 ml 300 Rp 24,500.00 Rp 7,350,000.00
31 Farmacrol tablet Box, 10 strip @ 10 tab 5000 Rp 600.00 Rp 3,000,000.00
32 Farmacrol Susp. 100 Ml botol 100 ml 200 Rp 49,000.00 Rp 9,800,000.00
 ANTIEMETIK
33 Ondansentron tab 4 Mg Box 2 strip @ 6 tablet 2000 Rp 1,200.00 Rp 2,400,000.00
34 Domperidon Tablet Box, 10 strip @ 10 tab 5000 Rp 185.00 Rp 925,000.00
35 Domperidon Sirup 5 Mg/Ml botol 60 ml 200 Rp 9,000.00 Rp 1,800,000.00
ANTIHISTAMIN
36 Loratadin tab 10 mg Box, 10 strip @ 10 tab 20000 Rp 134.00 Rp 2,680,000.00
37 Cetirizine Kaps 10 Mg Box, 10 strip 10 kaps 10000 Rp 200.00 Rp 2,000,000.00
38 Cetirizine Syrup % Mg/5 Ml Botol 60 ml 200 Rp 4,500.00 Rp 900,000.00
39 CTM 4 Mg Box, 10 strip @ 10 tab 30000 Rp 45.00 Rp 1,350,000.00
ANTIHIPERTENSI
ACE INHIBITOR
40 Lisinopril 5 Mg Box, 3 strps @ 10 tab 5000 Rp 385.00 Rp 1,925,000.00
41 Lisinopril 10 Mg Box, 3 strps @ 10 tab 5000 Rp 660.00 Rp 3,300,000.00
KALSIUM ANTAGONIS
42 Amlodipine Besylat Tab 5 Mg Box, 3 strps @ 10 tab 50000 Rp 105.00 Rp 5,250,000.00
43 Amlodipine Besylat Tab 10 Mg Box, 3 strps @ 10 tab 50000 Rp 163.00 Rp 8,150,000.00
ANGIOTENSIN II ANTAGONIS
44 Valsartan Tab 80 mg Box, 1 strip @ 6 tab 100 Rp 4,000.00 Rp 400,000.00
ANTIHIPERLIPIDEMIA
45 Simvastatin 10 mg Box, 3 strip @ 10 tab 40000 Rp 135.00 Rp 5,400,000.00
46 Simvastatin 20 mg Box, 3 strip @ 10 tab 2000 Rp 500.00 Rp 1,000,000.00
47 Pravastatin tablet 10 mg Box, 3 strip @ 10 tab 1000 Rp 600.00 Rp 600,000.00
48 Pravastatin tablet 20 mg Box, 3 strip @ 10 tab 1000 Rp 1,500.00 Rp 1,500,000.00
KORTIKOSTEROID
49 Dexametasone Tablet 0,5 Mg Box, 10 strip @ 10 tab 5000 Rp 70.00 Rp 350,000.00
50 Metil Prdnisolon 4 Mg Box, 10 strip @ 10 tab 5000 Rp 165.00 Rp 825,000.00
51 Metil Prdnisolon 8 Mg Box, 3 strip @ 10 tab 5000 Rp 450.00 Rp 2,250,000.00
 HORMON, OBAT ENDOKRIN LAIN,
ANTIDIABETIK PARENTERAL DAN
KONTRASEPTIK
ANTIDIABETIK ORAL
SULFONIL UREA
52 Glimepiride 1 Mg Box, 10 strip @ 10 tab 5000 Rp 278.00 Rp 1,390,000.00
53 Glimepiride 2 Mg Box, 10 strip @ 10 tab 10000 Rp 148.50 Rp 1,485,000.00
54 Glikuidon Tab 30 Mg Box, 10 strip @ 10 tab 3000 Rp 110.00 Rp 330,000.00
BIGUANID
55 Metformin 500 mg Box, 10 strip @ 10 tab 30000 Rp 119.00 Rp 3,570,000.00
MUKOLITIK
56 Bromheksin Hcl Box, 10 strip @ 10 tab 5000 Rp 15.00 Rp 75,000.00
57 Ambroxol tablet Box, 10 strip @ 10 tab 15000 Rp 16.50 Rp 247,500.00
58 Ambroxol Syrup botol 60 ml 300 Rp 5,000.00 Rp 1,500,000.00

ANTI ASMA/OBAT SALURAN NAFAS

59 Salbutamol Tablet 2 Mg Box, 10 strip @ 10 tab 3000 Rp 65.00 Rp 195,000.00

60 Tremenza Tablet (pseudoephedrin) Box, 10 strip @ 10 tab 5000 Rp 275.00 Rp 1,375,000.00
OBAT DIARE
61 Atapulgit Tab (Molagit) Box, 15 strip @ 10 tab 5000 Rp 602.00 Rp 3,010,000.00
62 Loperamid tablet Box, 10 strip @ 10 tab 2000 Rp 900.00 Rp 1,800,000.00
 LARUTAN ELEKTROLIT DAN NUTRISI

63 L-BIO Box, @ 30 sachet 300 Rp 7,866.00 Rp 2,359,800.00

64 Garam Oralit Box, @ 100 sachet 3002 Rp 400.00 Rp 1,200,800.00
65 Zinc syrup Btl, @ 60 ml 301 Rp 9,000.00 Rp 2,709,000.00
KATARTIK
66 Bisakodil Supp 5 Mg Box, @ 6 Suppos 50 Rp 5,670.00 Rp 283,500.00
67 Bisakodil Supp 10 Mg Box, @ 50 Suppos 50 Rp 5,800.00 Rp 290,000.00
EKSPEKTORAN
68 Inadryl Sirup 60 Ml Btol, 60 Ml 200 Rp 3,500.00 Rp 700,000.00
OBAT TETES MATA
69 Gentamycin tetes mata 0,3% Botol @ 5 Ml 300 Rp 4,150.00 Rp 1,245,000.00
70 Kloramfenikol tetes mata 0,5 % Botol @ 5 Ml 200 Rp 4,000.00 Rp 800,000.00
71 Cendo Lyteers - Cendo Lyteers 15 ml Botol @ 15 Ml 30 Rp 30,497.00 Rp 914,910.00
72 Cendo Xitrol 5 Ml Botol @ 5 Ml 30 Rp 34,000.00 Rp 1,020,000.00
73 Oxytetrasiklin Zalf Mata Tube, @ 3,5 g 300 Rp 2,000.00 Rp 600,000.00
OBAT TETES TELINGA
74 Karbogliserin 10%, 5 Ml Botol, @ 5 Ml 50 Rp 5,000.00 Rp 250,000.00
75 Vorumen Tetes telinga Botol, @ 15 Ml 30 Rp 45,000.00 Rp 1,350,000.00
76 Kloramfenikol tetes telinga 3 % Botol. @ 5 Ml 300 Rp 2,500.00 Rp 750,000.00
KAUSTIK
77 Albothyl 10 Ml Botol, @ 10 Ml 30 Rp 36,000.00 Rp 1,080,000.00
OBAT TOPIKAL UNTUK KULIT
78 ketokonazole krim 2% (ANTIFUNGI) Tube, @ 10 g 300 Rp 2,800.00 Rp 840,000.00

(ANTI INFLAMASI DAN ANTIPRURITIK)

79 Betametasone krim 0,1 % 5 gr Tube, @ 5 gr 300 Rp 1,435.00 Rp 430,500.00

80 Gentamisin salep kulit 0,1 % Tube, @ 5 gr 500 Rp 4,469.00 Rp 2,234,500.00
81 Desoksimetasone krim 0,25 % 10 gr Tube, @ 10 gr 200 Rp 10,800.00 Rp 2,160,000.00
82 Hidrocortison Asetat krim 1 % 5 gr Tube, @ 5 gr 300 Rp 2,700.00 Rp 810,000.00
HORMON TIROID
83 Propiltiourasil tab 100 Mg Box, 10 strip @ 10 tab 5000 Rp 291.00 Rp 1,455,000.00
ANTIVERTIGO
84 Betahistine mesilat Tab 6 Mg Box, 10 strip @ 10 tab 5000 Rp 380.00 Rp 1,900,000.00
VITAMIN DAN MINERAL
85 Asam Askorbat (Vitamin C Tab 50 Mg) Box, 10 strip @ 10 tab 20000 Rp 120.00 Rp 2,400,000.00
86 Vit.B.Complex Tab Box, 10 strip @ 10 tab 20000 Rp 132.00 Rp 2,640,000.00
87 Neurodex FC (B1,B6,B12) Box, 10 strip @ 10 tab 5000 Rp 240.00 Rp 1,200,000.00
88 Sulfas Ferosus (Fe) Ktk, @ 100 tablet 3000 Rp 495.00 Rp 1,485,000.00
89 Multivitamin Anak Syrup Botol, @ 60 Ml 508 Rp 16,000.00 Rp 8,128,000.00
90 Hemafort Box, 10 strip @ 10 tab 5000 Rp 450.00 Rp 2,250,000.00
91 Kandistatin Drops (ANTIFUNGI) Botol, @ 12 Ml 50 Rp 19,300.00 Rp 965,000.00
JUMLAH Rp 176,975,780.00
Rp 176,975,794.00

KEPALA PUSKESMAS PARIGI

 YUNITA TAGUNU, SKM
NIP. 19830624 200312 2 005
 USULAN BHP TAHUN 2018

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL. BANTAYA KEC. PARIGI
No. Telp/Fax :

No Nama Alkes, Bentuk, Sediaan, Kekuatan Kemasan Jumlah Harga Satuan (Rp) Total Harga (Rp) Pemesan Metode Pemesanan
1 Strip Nesco Cholesterol/Dus dus 304 Rp 200,000.00 Rp 60,800,000
2 Strip Nesco Glucosa/Dus dus 151 Rp 120,000.00 Rp 18,120,000
3 Strip Nesco Uric Acid/Dus dus 120 Rp 125,000.00 Rp 15,000,000
4 Alkohol swab Box/100 lbr 100 Rp 20,680.00 Rp 2,068,000
5 Terumo Dental @ 100 Needle box 20 Rp 134,091.00 Rp 2,681,820
6 Septocain @ 50 box 6 Rp 429,091.00 Rp 2,574,546
7 Kasa Hydrophil steril uk 16 x 16 box / 16 101 Rp 7,569.00 Rp 764,469
8 Benang Hekting untuk wajah 3/0 dos 10 Rp 87,500.00 Rp 875,000
9 H2O2 botol 12 Rp 29,800.00 Rp 357,600
10 Regulator set 2 Rp 135,000.00 Rp 270,000
11 Aseptik Gell btl 10 Rp 50,000.00 Rp 500,000
12 Plastik Klip Sedang pak 101 Rp 6,014.00 Rp 607,414
13 Plastik Klip Kecil pak 101 Rp 5,000.00 Rp 505,000
14 Kantongan Kresek pak 102 Rp 30,000.00 Rp 3,060,000
15 Kertas Perkamen rim 20 Rp 40,000.00 Rp 800,000
16 Cito Ject (Alat Gigi) set 1 Rp 7,000,000.00 Rp 7,000,000
BLENDER / PULVERIZER OBAT MEREK SCI
set 1 Rp 2,000,000.00
17 TYPE MU - 5300 Rp 2,000,000
JUMLAH Rp 117,983,849.00
Rp 117,983,863.00

KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN OBAT / TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No NAMA OBAT, BENTUK, SEDIAAN, KEKUATAN KEMASAN JUMLAH HARGA SATUAN (Rp) TOTAL HARGA (Rp) PEMESANAN METODE PEMESANAN
1. Alloporinol 100 mg Dus, 10 blis @ 10 tab 5002 Rp 90.00 Rp 450,180.00
2. Ambroxol 30 mg Dus, 10 strip @ 10 tab 3000 Rp 300.00 Rp 900,000.00
3. Amlodipin 10 mg Box, 3 strip @ 10 tab 5000 Rp 352.00 Rp 1,760,000.00
4. Amlodipin 5 mg Box, 3 strip @ 10 tab 15000 Rp 197.00 Rp 2,955,000.00
5. Amoxicillin 500 mg tab Ktk @ 10 x 10 tab 5000 Rp 279.00 Rp 1,395,000.00
6. Amoxicillin syrup kering Forte 250 mg Dus, botol 60 ml 200 Rp 4,730.00 Rp 946,000.00
7. Amoxicillin Syrup kering 125 mg Botol 60 ml 300 Rp 2,560.00 Rp 768,000.00
8. Antasida DOEN tablet Kunyah Dus, 10 Strip @ 10 tab 15000 Rp 78.00 Rp 1,170,000.00
9. Asam Askorbat (Vit. C) 50 mg Dus, 10 strip x 10 tab 20000 Rp 105.00 Rp 2,100,000.00
10. Asam Folat tab 1 mg Botol @ 100 tab 1000 Rp 52.00 Rp 52,000.00
11. Asam Mefenamat 500 mg Dus, 10 Strip @ 10 tab 5000 Rp 127.00 Rp 635,000.00
12. Antasida DOEN Syrup BTL @ 60 ml 300 Rp 2,300.00 Rp 690,000.00
13. Aciklovir tablet/kapsul/kaplet 200 mg Ktk @ 10 x 10 tab 5000 Rp 251.00 Rp 1,255,000.00
14. Bisakodil Suppositoria 10 mg Supp 300 Rp 6,045.00 Rp 1,813,500.00
15. Bisakodil Suppositoria 5 mg 1 Box @ 6's 200 Rp 4,990.00 Rp 998,000.00
16 Multivitamin Syrup Anak BTL @ 60 ml 100 Rp 31,900.00 Rp 3,190,000.00
17 Bromhexin Tablet Ktk 10 strip @ 10 tab 3000 Rp 1,000.00 Rp 3,000,000.00
18 Betametasone zalf kulit Tube 5 gr 200 Rp 1,596.00 Rp 319,200.00
19 Dexametasone 0,5 mg Dus, 10 Strip @ 10 tab 3000 Rp 68.00 Rp 204,000.00
20 Donperidon tab 10 mg Dus 10 strip x 10 tab 2000 Rp 174.00 Rp 348,000.00
21 Donperidon Syrup Botol 60 ml 200 Rp 2,000.00 Rp 400,000.00
22 Diphenhidramin Inj Ampul @ 1 ml 300 Rp 1,160.00 Rp 348,000.00
23 Gentamycin Zalf Kulit tube 5 gram 100 Rp 2,873 Rp 287,300.00
24 Gentamycin Tetes mata Dus,botol plastik 5 ml 100 Rp 3,513.00 Rp 351,300.00
25 Glimepirid tab 1 mg Ktk 5 x 10 tab 3000 Rp 278.00 Rp 834,000.00
26 Glimepirid tab 2 mg Ktk 5 x 10 tab 2000 Rp 458.00 Rp 916,000.00
27 Glimepirid tab 3 mg Ktk 5 x 10 tab 2000 Rp 424.00 Rp 848,000.00
28 Lidocain Inj Dus, 100 amp @ 2 ml 500 Rp 929.00 Rp 464,500.00
29 Loratadine 10 mg Dus, 5 strip @ 10 tab 3000 Rp 170.00 Rp 510,000.00
30 Lisinopril 10 mg Box, 3 strip @ 10 tab 500 Rp 660.00 Rp 330,000.00
31 Lisinopril 5 mg Box, 3 strip @ 10 tab 500 Rp 385.00 Rp 192,500.00
32 Omeprazole kapsul 20 mg Dus, 10 x 3's 5000 Rp 221.00 Rp 1,105,000.00
33 Prednison tab 5 mg Dus, 10 Strip @ 10 tab 4000 Rp 125.00 Rp 500,000.00
34 Paracetamol 500 mg Dus, 10 Strip @ 10 tab 9997 Rp 88.00 Rp 879,736.00
35 paracetamol Syrup Btl @ 60 ml 407 Rp 1,875.00 Rp 763,125.00
36 Sefadroxil Kaps 500 mg Dus, 10 Strip @ 10 kap 2000 Rp 548.00 Rp 1,096,000.00
37 Sefixim Kaps 100 mg Dus, 5 Strip @ 10 kap 1000 Rp 1,000.00 Rp 1,000,000.00
38 Simvastatin 10 mg Dus, 3 strip @ 10 tab 5000 Rp 177.00 Rp 885,000.00
39 Sukralfat Syrup Botol 100 ml 50 Rp 14,450.00 Rp 722,500.00
40 Sefiksim syrup Dus, botol 30 ml 50 Rp 9,377.00 Rp 468,850.00
41 Vit B Complex Dus, 10 strip @ 10 tab 2000 Rp 1,000.00 Rp 2,000,000.00
42 Setirizine kapsul 10 mg Box 10 strip@10 caps 4000 Rp 190.00 Rp 760,000.00
43 Methyl Prednisolon 4 mg Dus, 10 strip @ 10 tab 2000 Rp 230.00 Rp 460,000.00
44 Novabion kapsul Dus, 10 strip @ 10 kap 30 Rp 27,300.00 Rp 819,000.00
45 Natrium Diclovenac 25 mg Dus, 5 x 10's 2003 Rp 146.00 Rp 292,438.00
JUMLAH Rp 42,182,129.00 Rp. 42. 182. 130

KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN OBAT / TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No NAMA OBAT, BENTUK, SEDIAAN, KEKUATAN KEMASAN JUMLAH HARGA SATUAN (Rp) TOTAL HARGA (Rp) PEMESANAN METODE PEMESANAN
1. Alloporinol 100 mg Dus, 10 blis @ 10 tab 5001 Rp 90.00 Rp 450,090.00
2. Ambroxol 30 mg Dus, 10 strip @ 10 tab 3000 Rp 300.00 Rp 900,000.00
3. Amlodipin 10 mg Box, 3 strip @ 10 tab 5000 Rp 352.00 Rp 1,760,000.00
4. Amlodipin 5 mg Box, 3 strip @ 10 tab 15000 Rp 197.00 Rp 2,955,000.00
5. Amoxicillin 500 mg tab Ktk @ 10 x 10 tab 5000 Rp 279.00 Rp 1,395,000.00
6. Amoxicillin syrup kering Forte 250 mg Dus, botol 60 ml 200 Rp 4,730.00 Rp 946,000.00
7. Amoxicillin Syrup kering 125 mg Botol 60 ml 300 Rp 2,560.00 Rp 768,000.00
8. Antasida DOEN tablet Kunyah Dus, 10 Strip @ 10 tab 14999 Rp 78.00 Rp 1,169,922.00
9. Asam Askorbat (Vit. C) 50 mg Dus, 10 strip x 10 tab 18000 Rp 105.00 Rp 1,890,000.00
10. Asam Folat tab 1 mg Botol @ 100 tab 1001 Rp 52.00 Rp 52,052.00
11. Asam Mefenamat 500 mg Dus, 10 Strip @ 10 tab 5001 Rp 127.00 Rp 635,127.00
12. Antasida DOEN Syrup BTL @ 60 ml 300 Rp 2,300.00 Rp 690,000.00
13. Aciklovir tablet/kapsul/kaplet 200 mg Ktk @ 10 x 10 tab 3000 Rp 251.00 Rp 753,000.00
14. Bisoprolol 5 mg Strip 1500 Rp 800.00 Rp 1,200,000.00
15. Betahistin Mesylate 6 mg ktk 10 x 10 tablet 100 Rp 43,035 Rp 998,000.00
16 Multivitamin Syrup Anak BTL @ 60 ml 31 Rp 31,900.00 Rp 988,900.00
17 Bromhexin Tablet Ktk 10 strip @ 10 tab 1000 Rp 1,000.00 Rp 1,000,000.00
18 Betametasone zalf kulit Tube 5 gr 200 Rp 1,596.00 Rp 319,200.00
19 Dexametasone 0,5 mg Dus, 10 Strip @ 10 tab 3000 Rp 68.00 Rp 204,000.00
20 Cendo Lyteers - Cendo Lyteers 15 ml btl 15 ml 50 Rp 19,125 Rp 956,250.00
21 Donperidon Syrup Botol 60 ml 200 Rp 2,000.00 Rp 400,000.00
22 Diphenhidramin Inj Ampul @ 1 ml 300 Rp 1,160.00 Rp 348,000.00
23 Gentamycin Zalf Kulit tube 5 gram 100 Rp 2,873 Rp 287,300.00
24 Gentamycin Tetes mata Dus,botol plastik 5 ml 100 Rp 3,513.00 Rp 351,300.00
25 Glimepirid tab 1 mg Ktk 5 x 10 tab 3000 Rp 278.00 Rp 834,000.00
26 Glimepirid tab 2 mg Ktk 5 x 10 tab 2000 Rp 458.00 Rp 916,000.00
27 Glimepirid tab 3 mg Ktk 5 x 10 tab 2000 Rp 424.00 Rp 848,000.00
28 Lidocain Inj Dus, 100 amp @ 2 ml 500 Rp 929.00 Rp 464,500.00
29 Loratadine 10 mg Dus, 5 strip @ 10 tab 3000 Rp 170.00 Rp 510,000.00
30 Kloramfenikol tetes mata 0,5 % btl 5 ml 200 Rp 3,881 Rp 776,200.00
31 Kloramfenikol tetes telinga 3 % btl 5 ml 300 Rp 2,484 Rp 745,200.00
32 Omeprazole kapsul 20 mg Dus, 10 x 3's 4000 Rp 221.00 Rp 884,000.00
33 Tetrasiklin kapsul 500 mg dus,10 strip@10 caps 3000 Rp 325.00 Rp 975,000.00
34 Paracetamol 500 mg Dus, 10 Strip @ 10 tab 9991 Rp 88.00 Rp 879,208.00
35 paracetamol Syrup Btl @ 60 ml 411 Rp 1,875.00 Rp 770,625.00
36 Sefadroxil Kaps 500 mg Dus, 10 Strip @ 10 kap 1000 Rp 548.00 Rp 548,000.00
37 Sulfas Ferosus (Fe) tab 10999 Rp 45.00 Rp 494,955.00
38 Simvastatin 10 mg Dus, 3 strip @ 10 tab 5000 Rp 177.00 Rp 885,000.00
39 Sukralfat Syrup Botol 100 ml 51 Rp 14,450.00 Rp 736,950.00
40 Metformin 500 mg Tab 13,000 119.00 Rp 1,547,000.00
41 Vit B Complex Dus, 10 strip @ 10 tab 1000 Rp 1,000.00 Rp 1,000,000.00
42 Neurodex (Vit B1, B6 B12) Box @ 10 strip 15 Rp 89,350.00 Rp 1,340,250.00
43 Setirizine kapsul 10 mg Box 10 strip@10 caps 3000 Rp 190.00 Rp 570,000.00
44 Meloxicam 7,5 mg ktk 50 @10 tablet 300 Rp 7,609 Rp 2,282,700.00
45 Hydrochlortiazid (HCT) Tab 5,000 171.00 Rp 855,000.00
46 Vorumen Tetes telinga Btl, @ 15 ml 15 Rp 40,000.00 Rp 600,000.00
47 Zinc syrup Dus, botol 60 ml 160 Rp 8,140.00 Rp 1,302,400.00
JUMLAH Rp 42,182,129.00 Rp. 42. 182. 130

KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN BHP/ TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No Nama Alkes, Bentuk, Sediaan, Kekuatan Kemasan Jumlah Harga Satuan (Rp) Total Harga (Rp) Pemesan Metode
Pemesanan
1 Strip Nesco Cholesterol/Dus dus 30 Rp 209,091.00 Rp 6,272,730.00
2 Strip Nesco Glucosa/Dus dus 15 Rp 152,273.00 Rp 2,284,095.00
3 Strip Nesco Uric Acid/Dus dus 15 Rp 162,273.00 Rp 2,434,095.00
4 Alkohol swab Box/100 lbr 40 20,680.00 Rp 827,200.00
5 Terumo Dental @ 100 Needle box 8 Rp 134,091.00 Rp 1,072,728.00
6 Septocain @ 50 box 3 Rp 429,091.00 Rp 1,287,273.00
7 Blood Lancets box 5 Rp 50,000.00 Rp 250,000.00
8 Kasa Kompres steril 40 x 40 bh 203 Rp 2,088.00 Rp 423,864.00
9 Kasa Hydrophil steril uk 16 x 16 box / 16 103 Rp 7,569.00 Rp 779,607.00
10 Bisturi Gea No. 11 dos 9 Rp 87,500.00 Rp 787,500.00
11 ST. Handscund Steril No. 7 psg 101 Rp 10,500.00 Rp 1,060,500.00
12 Gloves surgical no. 7,5 Pasang 100 14,863.62 Rp 1,486,362.00
13 Masker One Med Kait dos 20 Rp 45,000.00 Rp 900,000.00
14 Masker One Med Tali dos 15 Rp 55,200.00 Rp 828,000.00
15 Plester BSN 5 x 2 Cm roll 10 Rp 52,000.00 Rp 520,000.00
16 Aseptik Gell btl 10 Rp 50,000.00 Rp 500,000.00
17 Syringe disposable 3 cc X 23G X 1 1/4" box / 100 4 Rp 84,825.00 Rp 339,300.00
18 Alkohol 70 % 1 liter btl 10 Rp 28,058.00 Rp 280,580.00
19 Plastik Klip Sedang 100 Rp 6,000.00 Rp 600,000.00
20 Plastik Klip Kecil 100 Rp 5,000.00 Rp 500,000.00
21 Kantongan Kresek 40 Rp 30,000.00 Rp 1,200,000.00
22 Hunds Crub Btl 500 ml 15 90,986.00 Rp 1,364,790.00
23 Kertas Perkamen 20 Rp 40,000.00 Rp 800,000.00
24 Lidocain Inj Dus, 100 Amp @ 2 ml 186 Rp 929.00 Rp 172,794.00
25 Umbilical Cord Klem Steril Nylon Box 20 57,500.00 Rp 1,150,000.00
Rp 28,121,418.00 Rp. 28. 121, 420
KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN BHP/ TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No Nama Alkes, Bentuk, Sediaan, Kekuatan Kemasan Jumlah Harga Satuan (Rp) Total Harga (Rp) Pemesan Metode Pemesanan

1 Strip Nesco Cholesterol/Dus dus 36 Rp 209,091.00 Rp 7,527,276.00

2 Strip Nesco Glucosa/Dus dus 13 Rp 152,273.00 Rp 1,979,549.00
3 Strip Nesco Uric Acid/Dus dus 13 Rp 162,273.00 Rp 2,109,549.00
4 Alkohol swab Box/100 lbr 40 20,680.00 Rp 827,200.00
5 Terumo Dental @ 100 Needle box 10 Rp 134,091.00 Rp 1,340,910.00
6 Septocain @ 50 box 6 Rp 429,091.00 Rp 2,574,546.00
7 Blood Lancets box 5 Rp 50,000.00 Rp 250,000.00
8 Kasa Kompres steril 40 x 40 bh 200 Rp 2,088.00 Rp 417,600.00
9 Kasa Hydrophil steril uk 16 x 16 box / 16 200 Rp 7,569.00 Rp 1,513,800.00
10 Bisturi Gea No. 11 dos 8 Rp 87,500.00 Rp 700,000.00
11 ST. Handscund Non Steril size M box 5 Rp 40,000.00 Rp 200,000.00
12 Gloves surgical Non Steril Size S box 5 40,000.00 Rp 200,000.00
13 Masker One Med Kait dos 20 Rp 45,000.00 Rp 900,000.00
14 Masker One Med Tali dos 16 Rp 55,200.00 Rp 883,200.00
15 Plester BSN 5 x 2 Cm roll 9 Rp 52,000.00 Rp 468,000.00
16 Aseptik Gell btl 10 Rp 50,000.00 Rp 500,000.00
17 Syringe disposable 3 cc X 23G X 1 1/4" box / 100 4 Rp 84,825.00 Rp 339,300.00
18 Alkohol 70 % 1 liter btl 6 Rp 28,058.00 Rp 168,348.00
19 Plastik Klip Sedang 102 Rp 6,000.00 Rp 612,000.00
20 Plastik Klip Kecil 102 Rp 5,000.00 Rp 510,000.00
21 Kantongan Kresek 42 Rp 30,000.00 Rp 1,260,000.00
22 Hunds Crub Btl 500 ml 15 90,986.00 Rp 1,364,790.00
23 Kertas Perkamen 20 Rp 40,000.00 Rp 800,000.00
24 Lidocain Inj Dus, 100 Amp @ 2 ml 108 Rp 929.00 Rp 100,332.00
25 Umbilical Cord Klem Steril Nylon Box 10 57,500.00 Rp 575,000.00
Rp 28,121,400.00 Rp. 28. 121, 420
KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN OBAT / TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No NAMA OBAT, BENTUK, SEDIAAN, KEKUATAN KEMASAN JUMLAH HARGA SATUAN (Rp) TOTAL HARGA (Rp) PEMESANAN METODE PEMESANAN
1. Alloporinol 100 mg Dus, 10 blis @ 10 tab 5001 Rp 90.00 Rp 450,090.00
2. Ambroxol 30 mg Dus, 10 strip @ 10 tab 3000 Rp 300.00 Rp 900,000.00
3. Amlodipin 10 mg Box, 3 strip @ 10 tab 5000 Rp 352.00 Rp 1,760,000.00
4. Amlodipin 5 mg Box, 3 strip @ 10 tab 15000 Rp 197.00 Rp 2,955,000.00
5. Amoxicillin 500 mg tab Ktk @ 10 x 10 tab 5000 Rp 279.00 Rp 1,395,000.00
6. Amoxicillin syrup kering Forte 250 mg Dus, botol 60 ml 200 Rp 4,730.00 Rp 946,000.00
7. Amoxicillin Syrup kering 125 mg Botol 60 ml 300 Rp 2,560.00 Rp 768,000.00
8. Antasida DOEN tablet Kunyah Dus, 10 Strip @ 10 tab 14999 Rp 78.00 Rp 1,169,922.00
9. Asam Askorbat (Vit. C) 50 mg Dus, 10 strip x 10 tab 18000 Rp 105.00 Rp 1,890,000.00
10. Asam Folat tab 1 mg Botol @ 100 tab 1001 Rp 52.00 Rp 52,052.00
11. Asam Mefenamat 500 mg Dus, 10 Strip @ 10 tab 5001 Rp 127.00 Rp 635,127.00
12. Antasida DOEN Syrup BTL @ 60 ml 300 Rp 2,300.00 Rp 690,000.00
13. Aciklovir tablet/kapsul/kaplet 200 mg Ktk @ 10 x 10 tab 3000 Rp 251.00 Rp 753,000.00
14. Bisoprolol 5 mg Strip 1500 Rp 800.00 Rp 1,200,000.00
15. Betahistin Mesylate 6 mg ktk 10 x 10 tablet 100 Rp 43,035 Rp 998,000.00
16 Multivitamin Syrup Anak BTL @ 60 ml 31 Rp 31,900.00 Rp 988,900.00
17 Bromhexin Tablet Ktk 10 strip @ 10 tab 1000 Rp 1,000.00 Rp 1,000,000.00
18 Betametasone zalf kulit Tube 5 gr 200 Rp 1,596.00 Rp 319,200.00
19 Dexametasone 0,5 mg Dus, 10 Strip @ 10 tab 3000 Rp 68.00 Rp 204,000.00
20 Cendo Lyteers - Cendo Lyteers 15 ml btl 15 ml 50 Rp 19,125 Rp 956,250.00
21 Donperidon Syrup Botol 60 ml 200 Rp 2,000.00 Rp 400,000.00
22 Diphenhidramin Inj Ampul @ 1 ml 300 Rp 1,160.00 Rp 348,000.00
23 Gentamycin Zalf Kulit tube 5 gram 100 Rp 2,873 Rp 287,300.00
24 Gentamycin Tetes mata Dus,botol plastik 5 ml 100 Rp 3,513.00 Rp 351,300.00
25 Glimepirid tab 1 mg Ktk 5 x 10 tab 3000 Rp 278.00 Rp 834,000.00
26 Glimepirid tab 2 mg Ktk 5 x 10 tab 2000 Rp 458.00 Rp 916,000.00
27 Glimepirid tab 3 mg Ktk 5 x 10 tab 2000 Rp 424.00 Rp 848,000.00
28 Lidocain Inj Dus, 100 amp @ 2 ml 500 Rp 929.00 Rp 464,500.00
29 Loratadine 10 mg Dus, 5 strip @ 10 tab 3000 Rp 170.00 Rp 510,000.00
30 Kloramfenikol tetes mata 0,5 % btl 5 ml 200 Rp 3,881 Rp 776,200.00
31 Kloramfenikol tetes telinga 3 % btl 5 ml 300 Rp 2,484 Rp 745,200.00
32 Omeprazole kapsul 20 mg Dus, 10 x 3's 4000 Rp 221.00 Rp 884,000.00
33 Tetrasiklin kapsul 500 mg dus,10 strip@10 caps 3000 Rp 325.00 Rp 975,000.00
34 Paracetamol 500 mg Dus, 10 Strip @ 10 tab 9991 Rp 88.00 Rp 879,208.00
35 paracetamol Syrup Btl @ 60 ml 411 Rp 1,875.00 Rp 770,625.00
36 Sefadroxil Kaps 500 mg Dus, 10 Strip @ 10 kap 1000 Rp 548.00 Rp 548,000.00
37 Sulfas Ferosus (Fe) tab 10999 Rp 45.00 Rp 494,955.00
38 Simvastatin 10 mg Dus, 3 strip @ 10 tab 5000 Rp 177.00 Rp 885,000.00
39 Sukralfat Syrup Botol 100 ml 51 Rp 14,450.00 Rp 736,950.00
40 Metformin 500 mg Tab 13,000 119.00 Rp 1,547,000.00
41 Vit B Complex Dus, 10 strip @ 10 tab 1000 Rp 1,000.00 Rp 1,000,000.00
42 Neurodex (Vit B1, B6 B12) Box @ 10 strip 15 Rp 89,350.00 Rp 1,340,250.00
43 Setirizine kapsul 10 mg Box 10 strip@10 caps 3000 Rp 190.00 Rp 570,000.00
44 Meloxicam 7,5 mg ktk 50 @10 tablet 300 Rp 7,609 Rp 2,282,700.00
45 Hydrochlortiazid (HCT) Tab 5,000 171.00 Rp 855,000.00
46 Vorumen Tetes telinga Btl, @ 15 ml 15 Rp 40,000.00 Rp 600,000.00
47 Zinc syrup Dus, botol 60 ml 160 Rp 8,140.00 Rp 1,302,400.00
JUMLAH Rp 42,182,129.00 Rp. 42. 182. 130

KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN OBAT / TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No NAMA OBAT, BENTUK, SEDIAAN, KEKUATAN KEMASAN JUMLAH HARGA SATUAN (Rp) TOTAL HARGA (Rp) PEMESANAN METODE PEMESANAN
1. Alloporinol 100 mg Dus, 10 blis @ 10 tab 5002 Rp 90.00 Rp 450,180.00
2. Ambroxol 30 mg Dus, 10 strip @ 10 tab 3000 Rp 300.00 Rp 900,000.00
3. Amlodipin 10 mg Box, 3 strip @ 10 tab 5000 Rp 352.00 Rp 1,760,000.00
4. Amlodipin 5 mg Box, 3 strip @ 10 tab 15000 Rp 197.00 Rp 2,955,000.00
5. Amoxicillin 500 mg tab Ktk @ 10 x 10 tab 5000 Rp 279.00 Rp 1,395,000.00
6. Amoxicillin syrup kering Forte 250 mg Dus, botol 60 ml 200 Rp 4,730.00 Rp 946,000.00
7. Amoxicillin Syrup kering 125 mg Botol 60 ml 300 Rp 2,560.00 Rp 768,000.00
8. Antasida DOEN tablet Kunyah Dus, 10 Strip @ 10 tab 15000 Rp 78.00 Rp 1,170,000.00
9. Asam Askorbat (Vit. C) 50 mg Dus, 10 strip x 10 tab 20000 Rp 105.00 Rp 2,100,000.00
10. Asam Folat tab 1 mg Botol @ 100 tab 1000 Rp 52.00 Rp 52,000.00
11. Asam Mefenamat 500 mg Dus, 10 Strip @ 10 tab 5000 Rp 127.00 Rp 635,000.00
12. Antasida DOEN Syrup BTL @ 60 ml 300 Rp 2,300.00 Rp 690,000.00
13. Aciklovir tablet/kapsul/kaplet 200 mg Ktk @ 10 x 10 tab 5000 Rp 251.00 Rp 1,255,000.00
14. Bisakodil Suppositoria 10 mg Supp 300 Rp 6,045.00 Rp 1,813,500.00
15. Bisakodil Suppositoria 5 mg 1 Box @ 6's 200 Rp 4,990.00 Rp 998,000.00
16 Multivitamin Syrup Anak BTL @ 60 ml 100 Rp 31,900.00 Rp 3,190,000.00
17 Bromhexin Tablet Ktk 10 strip @ 10 tab 3000 Rp 1,000.00 Rp 3,000,000.00
18 Betametasone zalf kulit Tube 5 gr 200 Rp 1,596.00 Rp 319,200.00
19 Dexametasone 0,5 mg Dus, 10 Strip @ 10 tab 3000 Rp 68.00 Rp 204,000.00
20 Donperidon tab 10 mg Dus 10 strip x 10 tab 2000 Rp 174.00 Rp 348,000.00
21 Donperidon Syrup Botol 60 ml 200 Rp 2,000.00 Rp 400,000.00
22 Diphenhidramin Inj Ampul @ 1 ml 300 Rp 1,160.00 Rp 348,000.00
23 Gentamycin Zalf Kulit tube 5 gram 100 Rp 2,873 Rp 287,300.00
24 Gentamycin Tetes mata Dus,botol plastik 5 ml 100 Rp 3,513.00 Rp 351,300.00
25 Glimepirid tab 1 mg Ktk 5 x 10 tab 3000 Rp 278.00 Rp 834,000.00
26 Glimepirid tab 2 mg Ktk 5 x 10 tab 2000 Rp 458.00 Rp 916,000.00
27 Glimepirid tab 3 mg Ktk 5 x 10 tab 2000 Rp 424.00 Rp 848,000.00
28 Lidocain Inj Dus, 100 amp @ 2 ml 500 Rp 929.00 Rp 464,500.00
29 Loratadine 10 mg Dus, 5 strip @ 10 tab 3000 Rp 170.00 Rp 510,000.00
30 Lisinopril 10 mg Box, 3 strip @ 10 tab 500 Rp 660.00 Rp 330,000.00
31 Lisinopril 5 mg Box, 3 strip @ 10 tab 500 Rp 385.00 Rp 192,500.00
32 Omeprazole kapsul 20 mg Dus, 10 x 3's 5000 Rp 221.00 Rp 1,105,000.00
33 Prednison tab 5 mg Dus, 10 Strip @ 10 tab 4000 Rp 125.00 Rp 500,000.00
34 Paracetamol 500 mg Dus, 10 Strip @ 10 tab 9997 Rp 88.00 Rp 879,736.00
35 paracetamol Syrup Btl @ 60 ml 407 Rp 1,875.00 Rp 763,125.00
36 Sefadroxil Kaps 500 mg Dus, 10 Strip @ 10 kap 2000 Rp 548.00 Rp 1,096,000.00
37 Sefixim Kaps 100 mg Dus, 5 Strip @ 10 kap 1000 Rp 1,000.00 Rp 1,000,000.00
38 Simvastatin 10 mg Dus, 3 strip @ 10 tab 5000 Rp 177.00 Rp 885,000.00
39 Sukralfat Syrup Botol 100 ml 50 Rp 14,450.00 Rp 722,500.00
40 Sefiksim syrup Dus, botol 30 ml 50 Rp 9,377.00 Rp 468,850.00
41 Vit B Complex Dus, 10 strip @ 10 tab 2000 Rp 1,000.00 Rp 2,000,000.00
42 Setirizine kapsul 10 mg Box 10 strip@10 caps 4000 Rp 190.00 Rp 760,000.00
43 Methyl Prednisolon 4 mg Dus, 10 strip @ 10 tab 2000 Rp 230.00 Rp 460,000.00
44 Novabion kapsul Dus, 10 strip @ 10 kap 30 Rp 27,300.00 Rp 819,000.00
45 Natrium Diclovenac 25 mg Dus, 5 x 10's 2003 Rp 146.00 Rp 292,438.00
JUMLAH Rp 42,182,129.00 Rp. 42. 182. 130

KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN BHP/ TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No Nama Alkes, Bentuk, Sediaan, Kekuatan Kemasan Jumlah Harga Satuan (Rp) Total Harga (Rp) Pemesan Metode Pemesanan

1 Strip Nesco Cholesterol/Dus dus 36 Rp 209,091.00 Rp 7,527,276.00

2 Strip Nesco Glucosa/Dus dus 13 Rp 152,273.00 Rp 1,979,549.00
3 Strip Nesco Uric Acid/Dus dus 13 Rp 162,273.00 Rp 2,109,549.00
4 Alkohol swab Box/100 lbr 40 20,680.00 Rp 827,200.00
5 Terumo Dental @ 100 Needle box 10 Rp 134,091.00 Rp 1,340,910.00
6 Septocain @ 50 box 6 Rp 429,091.00 Rp 2,574,546.00
7 Blood Lancets box 5 Rp 50,000.00 Rp 250,000.00
8 Kasa Kompres steril 40 x 40 bh 200 Rp 2,088.00 Rp 417,600.00
9 Kasa Hydrophil steril uk 16 x 16 box / 16 200 Rp 7,569.00 Rp 1,513,800.00
10 Bisturi Gea No. 11 dos 8 Rp 87,500.00 Rp 700,000.00
11 ST. Handscund Non Steril size M box 5 Rp 40,000.00 Rp 200,000.00
12 Gloves surgical Non Steril Size S box 5 40,000.00 Rp 200,000.00
13 Masker One Med Kait dos 20 Rp 45,000.00 Rp 900,000.00
14 Masker One Med Tali dos 16 Rp 55,200.00 Rp 883,200.00
15 Plester BSN 5 x 2 Cm roll 9 Rp 52,000.00 Rp 468,000.00
16 Aseptik Gell btl 10 Rp 50,000.00 Rp 500,000.00
17 Syringe disposable 3 cc X 23G X 1 1/4" box / 100 4 Rp 84,825.00 Rp 339,300.00
18 Alkohol 70 % 1 liter btl 6 Rp 28,058.00 Rp 168,348.00
19 Plastik Klip Sedang 102 Rp 6,000.00 Rp 612,000.00
20 Plastik Klip Kecil 102 Rp 5,000.00 Rp 510,000.00
21 Kantongan Kresek 42 Rp 30,000.00 Rp 1,260,000.00
22 Hunds Crub Btl 500 ml 15 90,986.00 Rp 1,364,790.00
23 Kertas Perkamen 20 Rp 40,000.00 Rp 800,000.00
24 Lidocain Inj Dus, 100 Amp @ 2 ml 108 Rp 929.00 Rp 100,332.00
25 Umbilical Cord Klem Steril Nylon Box 10 57,500.00 Rp 575,000.00
Rp 28,121,400.00 Rp. 28. 121, 420
KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005
 SURAT PESANAN BHP/ TW 2017

USULAN DARI
UNIT KERJA : PUSKESMAS PARIGI
ALAMAT LENGKAP : JL. PACUAN KUDA No. 305 KEL BANTAYA KEC. PARIGI
No. Telp/Fax :

No Nama Alkes, Bentuk, Sediaan, Kekuatan Kemasan Jumlah Harga Satuan (Rp) Total Harga (Rp) Pemesan Metode Pemesanan

1 Strip Nesco Cholesterol/Dus dus 30 Rp 209,091.00 Rp 6,272,730.00

2 Strip Nesco Glucosa/Dus dus 15 Rp 152,273.00 Rp 2,284,095.00
3 Strip Nesco Uric Acid/Dus dus 15 Rp 162,273.00 Rp 2,434,095.00
4 Alkohol swab Box/100 lbr 40 20,680.00 Rp 827,200.00
5 Terumo Dental @ 100 Needle box 8 Rp 134,091.00 Rp 1,072,728.00
6 Septocain @ 50 box 3 Rp 429,091.00 Rp 1,287,273.00
7 Blood Lancets box 5 Rp 50,000.00 Rp 250,000.00
8 Kasa Kompres steril 40 x 40 bh 203 Rp 2,088.00 Rp 423,864.00
9 Kasa Hydrophil steril uk 16 x 16 box / 16 103 Rp 7,569.00 Rp 779,607.00
10 Bisturi Gea No. 11 dos 9 Rp 87,500.00 Rp 787,500.00
11 ST. Handscund Steril No. 7 psg 101 Rp 10,500.00 Rp 1,060,500.00
12 Gloves surgical no. 7,5 Pasang 100 14,863.62 Rp 1,486,362.00
13 Masker One Med Kait dos 20 Rp 45,000.00 Rp 900,000.00
14 Masker One Med Tali dos 15 Rp 55,200.00 Rp 828,000.00
15 Plester BSN 5 x 2 Cm roll 10 Rp 52,000.00 Rp 520,000.00
16 Aseptik Gell btl 10 Rp 50,000.00 Rp 500,000.00
17 Syringe disposable 3 cc X 23G X 1 1/4" box / 100 4 Rp 84,825.00 Rp 339,300.00
18 Alkohol 70 % 1 liter btl 10 Rp 28,058.00 Rp 280,580.00
19 Plastik Klip Sedang 100 Rp 6,000.00 Rp 600,000.00
20 Plastik Klip Kecil 100 Rp 5,000.00 Rp 500,000.00
21 Kantongan Kresek 40 Rp 30,000.00 Rp 1,200,000.00
22 Hunds Crub Btl 500 ml 15 90,986.00 Rp 1,364,790.00
23 Kertas Perkamen 20 Rp 40,000.00 Rp 800,000.00
24 Lidocain Inj Dus, 100 Amp @ 2 ml 186 Rp 929.00 Rp 172,794.00
25 Umbilical Cord Klem Steril Nylon Box 20 57,500.00 Rp 1,150,000.00
Rp 28,121,418.00 Rp. 28. 121, 420
KEPALA PUSKESMAS PARIGI

YUNITA TAGUNU, SKM

NIP. 19830624 200312 2 005