DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME

Berdasarkan Berita Acara Pusban / Polindes

Nomor : B-513/DINKES/PUSK-KB/400.7.18.2/10/2024
Tanggal : 25 Oktober 2024

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg mar 28 A 02901 CB Tablet 340
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg mei 26 E24062 Tablet 90
5 Amlodipin tablet 5 mg des 25 2310233 Tablet 200
6 Amlodipin tablet 10 mg jul 25 23TG055 Tablet 200
7 Amoksisilin kaplet 500 mg nop 26 2311-26-115 Kaplet 100
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
sep 26 1209114 Tablet 230

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 0

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg agt 27 23TH061 Tablet 80
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0
Asam Mefenamat kaplet 500 mg
19 jan 26 A40061 Tablet 160
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 60
22 Asiklovir tablet 200 mg Tablet 70
23 Betahistin Mesilat tablet 6 mg sep 25 54K0090 Tablet 90
24 Betametason krim 0.1% (sebagai valerat) jul-25 G32628W Tube 6
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 3
26 Cetirizine tablet 10 mg okt 25 2310119 Tablet 190
27 Cetirizine syrup 03-28 40323/17300 Botol 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg sep 26 22i004 Tablet 40
30 Desoximetasone 0,25 % Crem nov 25 5131928 Tube 5
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg sep 26 2309123 Tablet 180
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Sachet 82

43 Gentamycin Sulfat Injeksi Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% 11/20/25 Lcm50052 Tube 10
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg jul 26 54H4187 Tablet 270
50 Glimepiride tablet 2 mg jul 27 54G0504 Tablet 210
51 Gliseril Gualakolat tablet 100 mg agt 25 2208-06-155 Tablet 120
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 0
56 Ibuprofen suspensi 100 mg/5 ml Botol 0
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 0
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 150
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 6
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 100
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 5
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml 28 jun 25 B97F53A Vial 2
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 2
82 Meloksikam tablet 15 mg 12-2025 LS23022 Tablet 30
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg aug-25 tsj83651 Tablet 200
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 0
86 Metilprednisolon tablet 4 mg Tablet 0
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Aug 26 33966 Tablet 0
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 60
92 Natrium Klorida larutan infus 0.9 % Botol 5
93 Nifedipin tablet 10 mg Tablet 40
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg Tablet 10
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% Tube 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0
100 Omeprazol kapsul 20 mg okt25 2310-01-280 Kapsul 180
101 Ondansentron tablet 4 mg Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml aug 25 A21567 Botol 9
105 Parasetamol tablet 500 mg sep 25 T. 2223099 Tablet 300
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) aug-25 23601308 Tablet 0
108 Piroksikam tablet 20 mg Tablet 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 0
111 Ranitidin tablet 150 mg Tablet 10
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 6
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 0
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0
120 Salisil Bedak 2% Kotak 0
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg april-2026 D40071N Tablet 190
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg nop-25 2311-05-335 Tablet 100
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 22TD1045 Tablet 250
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 0
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc Tablet 0
133 Stimuno Sachet 0
134 Zinc tablet 20 mg Tablet 40
OBAT GENERIK BERMEREK 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 120
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
Botol 5

149 Sucralfate Suspensi 500mg/5ml Syr Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 15
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 75
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Piece 15
163 Alkohol Swab Piece 70
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S Pasang 35
174 Handscoon No. 7 M Pasang 48
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 2
182 Infusion Set Dewasa Piece 2
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 4
185 IV Catheter No. 24 G 18-25 200503 Piece 4
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 11
191 Kasa Steril 16 x 16 cm Kotak 9
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 41
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 2
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 1
204 Urine bag Piece 0
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor : B-380/DINKES/PUSK-KB/400.7.18.2/09/2024
Tanggal : 25 September 2024

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg mar 28 A 02901 CB Tablet 300
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg mei 26 E24062 Tablet 30
5 Amlodipin tablet 5 mg des 25 2310233 Tablet 30
6 Amlodipin tablet 10 mg jul 25 23TG055 Tablet 250
7 Amoksisilin kaplet 500 mg nop 26 2311-26-115 Kaplet 100
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
sep 26 1209114 Tablet 110

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 0

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg agt 27 23TH061 Tablet 80
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0
Asam Mefenamat kaplet 500 mg
19 jan 26 A40061 Tablet 250
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 80
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg sep 25 54K0090 Tablet 160
24 Betametason krim 0.1% (sebagai valerat) jul-25 G32628W Tube 6
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 3
26 Cetirizine tablet 10 mg okt 25 2310119 Tablet 160
27 Cetirizine syrup 03-28 40323/17300 Botol 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg sep 26 22i004 Tablet 70
30 Desoximetasone 0,25 % Crem nov 25 5131928 Tube 5
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg sep 26 2309123 Tablet 100
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Sachet 82

43 Gentamycin Sulfat Injeksi Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% 11/20/25 Lcm50052 Tube 10
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg jul 26 54H4187 Tablet 390
50 Glimepiride tablet 2 mg jul 27 54G0504 Tablet 300
51 Gliseril Gualakolat tablet 100 mg agt 25 2208-06-155 Tablet 190
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 0
56 Ibuprofen suspensi 100 mg/5 ml Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 0
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 180
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 6
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 100
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 7
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml 28 jun 25 B97F53A Vial 2
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 2
82 Meloksikam tablet 15 mg 12-2025 LS23022 Tablet 40
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg aug-25 tsj83651 Tablet 290
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 20
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Aug 26 33966 Tablet 0
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 60
92 Natrium Klorida larutan infus 0.9 % Botol 5
93 Nifedipin tablet 10 mg Tablet 40
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg Tablet 10
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% Tube 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0
100 Omeprazol kapsul 20 mg okt25 2310-01-280 Kapsul 240
101 Ondansentron tablet 4 mg Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml aug 25 A21567 Botol 16
105 Parasetamol tablet 500 mg sep 25 T. 2223099 Tablet 220
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) aug-25 23601308 Tablet 0
108 Piroksikam tablet 20 mg Tablet 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 10
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 6
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 20
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0
120 Salisil Bedak 2% Kotak 0
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg april-2026 D40071N Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg nop-25 2311-05-335 Tablet 0
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 22TD1045 Tablet 310
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 0
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc Tablet 0
133 Stimuno Sachet 0
134 Zinc tablet 20 mg Tablet 40
OBAT GENERIK BERMEREK 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 120
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 15
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 75
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 100
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S Pasang 35
174 Handscoon No. 7 M Pasang 78
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 2
182 Infusion Set Dewasa Piece 2
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 7
185 IV Catheter No. 24 G 18-25 200503 Piece 5
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 11
191 Kasa Steril 16 x 16 cm Kotak 9
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 41
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 2
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 1
204 Urine bag Piece 0
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor : B-337/DINKES/PUSK-KB/400.7.18.2/8/2024
Tanggal : 25 Agustus 2024

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg mar 28 A 02901 CB Tablet 290
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg mei 26 E24062 Tablet 180
5 Amlodipin tablet 5 mg des 25 2310233 Tablet 210
6 Amlodipin tablet 10 mg jul 25 23TG055 Tablet 550
7 Amoksisilin kaplet 500 mg nop 26 2311-26-115 Kaplet 100
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
sep 26 1209114 Tablet 370

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 4

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg agt 27 23TH061 Tablet 300
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0
Asam Mefenamat kaplet 500 mg
19 jan 26 A40061 Tablet 300
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 80
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg sep 25 54K0090 Tablet 80
24 Betametason krim 0.1% (sebagai valerat) jul-25 G32628W Tube 6
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 3
26 Cetirizine tablet 10 mg okt 25 2310119 Tablet 60
27 Cetirizine syrup 03-28 40323/17300 Botol 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg sep 26 22i004 Tablet 70
30 Desoximetasone 0,25 % Crem nov 25 5131928 Tube 5
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg sep 26 2309123 Tablet 220
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Sachet 82

43 Gentamycin Sulfat Injeksi Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% 11/20/25 Lcm50052 Tube 10
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg jul 26 54H4187 Tablet 390
50 Glimepiride tablet 2 mg jul 27 54G0504 Tablet 520
51 Gliseril Gualakolat tablet 100 mg agt 25 2208-06-155 Tablet 240
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 0
56 Ibuprofen suspensi 100 mg/5 ml Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 0
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 80
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 6
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 0
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 2
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml 28 jun 25 B97F53A Vial 2
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 2
82 Meloksikam tablet 15 mg 12-2025 LS23022 Tablet 200
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg aug-25 tsj83651 Tablet 340
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 40
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Aug 26 33966 Tablet 0
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 60
92 Natrium Klorida larutan infus 0.9 % Botol 5
93 Nifedipin tablet 10 mg Tablet 40
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg Tablet 30
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% Tube 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0
100 Omeprazol kapsul 20 mg okt25 2310-01-280 Kapsul 300
101 Ondansentron tablet 4 mg Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml aug 25 A21567 Botol 29
105 Parasetamol tablet 500 mg sep 25 T. 2223099 Tablet 450
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) aug-25 23601308 Tablet 0
108 Piroksikam tablet 20 mg Tablet 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 10
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 6
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0
120 Salisil Bedak 2% Kotak 0
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg april-2026 D40071N Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg nop-25 2311-05-335 Tablet 50
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 22TD1045 Tablet 320
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 0
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc Tablet 0
133 Stimuno Sachet 0
134 Zinc tablet 20 mg Tablet 40
OBAT GENERIK BERMEREK 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 120
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 15
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 75
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 0
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S Pasang 35
174 Handscoon No. 7 M Pasang 8
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 2
182 Infusion Set Dewasa Piece 2
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 7
185 IV Catheter No. 24 G 18-25 200503 Piece 5
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 11
191 Kasa Steril 16 x 16 cm Kotak 6
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 46
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 0
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 1
204 Urine bag Piece 0
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor : B-307/DINKES/PUSK-KB/400.7.18.2/5/2024
Tanggal : Jul-24

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg mar 28 A 02901 CB Tablet 240
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg mei 26 E24062 Tablet 300
5 Amlodipin tablet 5 mg 08-26 I11515BJ Tablet 90
6 Amlodipin tablet 10 mg jul 25 23TG055 Tablet 350
7 Amoksisilin kaplet 500 mg nop 26 2311-26-115 Kaplet 100
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
sep 26 1209114 Tablet 420

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 4

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 40
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0
Asam Mefenamat kaplet 500 mg
19 jan 26 A40061 Tablet 300
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 80
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg sep 25 54K0090 Tablet 240
24 Betametason krim 0.1% (sebagai valerat) jul-25 G32628W Tube 6
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 2
26 Cetirizine tablet 10 mg okt 25 2310119 Tablet 190
27 Cetirizine syrup 03-28 40323/17300 Botol 6
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg sep 26 22i004 Tablet 200
30 Desoximetasone 0,25 % Crem Tube 0
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg sep 26 2309123 Tablet 240
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Sachet 82

43 Gentamycin Sulfat Injeksi Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% 11/20/25 Lcm50052 Tube 16
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg jul 27 54H4166 Tablet 270
50 Glimepiride tablet 2 mg sep 25 TPk16251 Tablet 380
51 Gliseril Gualakolat tablet 100 mg agt 25 2208-06-155 Tablet 320
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 5
56 Ibuprofen suspensi 100 mg/5 ml Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 0
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 120
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 6
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 30
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0
82 Meloksikam tablet 15 mg 12-2025 LS23022 Tablet 200
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg aug-25 tsj83651 Tablet 490
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 60
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Aug 26 33966 Tablet -50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 70
92 Natrium Klorida larutan infus 0.9 % Botol 5
93 Nifedipin tablet 10 mg Tablet 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg Tablet 30
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% Tube 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0
100 Omeprazol kapsul 20 mg sep 25 2309-25-280 Kapsul 260
101 Ondansentron tablet 4 mg Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml aug 25 A21567 Botol 17
105 Parasetamol tablet 500 mg sep 25 1309305 Tablet 270
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) aug-25 23601308 Tablet 130
108 Piroksikam tablet 20 mg Tablet 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 90
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 6
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0
120 Salisil Bedak 2% Kotak 3
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg nop-25 2311-05-335 Tablet 0
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 22TD1045 Tablet 440
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 0
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc Tablet 0
133 Stimuno Sachet 0
134 Zinc tablet 20 mg Tablet 40
OBAT GENERIK BERMEREK 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 120
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) 1-2024 4110080 Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 15
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 75
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 100
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S Pasang 35
174 Handscoon No. 7 M Pasang 28
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 2
182 Infusion Set Dewasa Piece 2
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 7
185 IV Catheter No. 24 G 18-25 200503 Piece 5
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 11
191 Kasa Steril 16 x 16 cm Kotak 10
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 46
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) 9-2024 19090063 Piece 0
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 1
204 Urine bag Piece 0
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor : B-193/DINKES/PUSK-KB/400.7.18.2/5/2024
Tanggal : Jun-24

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN)

1 2 3
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg
2 Alopurinol tablet 100 mg
3 Ambroxol sirup 15 mg/ml
4 Ambroxol tablet 30 mg
5 Amlodipin tablet 5 mg
6 Amlodipin tablet 10 mg
7 Amoksisilin kaplet 500 mg
8 Amoksisilin sirup kering 125 mg/5 ml
9 Amoksisilin sirup kering 250 mg/5 ml
10 Amoksisilin sirup kering Drop 100mg/1 ml

Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan

11
Magnesium Hidroksida 200 mg

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 %
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg
17 Asam Askorbat (Vitamin C ) tablet 50mg
18 Asam Asetilsalisilat 80 mg (MINIASPI'80)
Asam Mefenamat kaplet 500 mg
19
20 Asiklovir krim 5%
21 Asiklovir tablet 400 mg
22 Asiklovir tablet 200 mg
23 Betahistin Mesilat tablet 6 mg
24 Betametason krim 0.1% (sebagai valerat)
25 Calsium Gluconas 100 mg/ml Injeksi
26 Cetirizine tablet 10 mg
27 Cetirizine syrup
28 Deksametason injeksi i.v. 5 mg/ml
29 Deksametason tablet 0.5 mg
30 Desoximetasone 0,25 % Crem
31 Digoksin tablet 0.25 mg
32 Dimenhidrinat tablet 50 mg
33 Domperidon tablet 10 mg
34 Eritromisin kapsul 500 mg
35 Eritromisin sirup 200 mg/5 ml
36 Etakridin larutan 0.1%
37 Fenol Gliserol tetes telinga 10%
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg
40 Furosemid injeksi i.v./i.m. 10 mg/ml
41 Furosemid tablet 40 mg
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
43 Gentamycin Sulfat Injeksi
44 Gentamisin injeksi 40 mg/ml
45 Gentamisin salep kulit 0.1%
46 Gentamisin salep Mata 0,3%
47 Gentian Violet larutan 1 %
48 Glibenklamida tablet 5 mg
49 Glimepiride tablet 1 mg
50 Glimepiride tablet 2 mg
51 Gliseril Gualakolat tablet 100 mg
52 Glukosa larutan infus 5 % steril D5
53 Griseofulvin Micronized tablet 125 mg
54 Hidroklorotiazida tablet 25 mg (HCT)
55 Hidrokortison krim 2.5%
56 Ibuprofen suspensi 100 mg/5 ml
57 Ibuprofen suspensi 200 mg/5 ml
58 Ibuprofen tablet 200 mg
59 Ibuprofen tablet 400 mg
60 Isosorbid Dinitrat tablet Sublingual 5 mg
61 Kalsium Laktat (Kalk) tablet 500 mg
62 Kaptopril tablet 12.5 mg
63 Kaptopril tablet 25 mg
64 Kaptopril tablet 50 mg
65 Kandesartan tablet 8 mg
66 Ketokonazol krim 2%
67 Ketokonazol tablet 200 mg
68 Klindamisin kapsul 150 mg
69 Kloramfenikol kapsul 250 mg
70 Kloramfenikol salep mata 1%
71 Kloramfenikol salep kulit 1%
72 Kloramfenikol suspensi 125 mg/ 5ml
73 Kloramfenikol tetes telinga 3%
74 Klorfeniramina Maleat (CTM) tablet 4 mg
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
77 Lanzoprazol kapsul 30 mg
78 Loratadine 10 mg/tablet
79 Lidokain injeksi 2%
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml
82 Meloksikam tablet 15 mg
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml
84 Metformin Hci tablet 500 mg
85 Metildopa tablet 250 mg Dopamet 250 mg
86 Metilprednisolon tablet 4 mg
87 Metoklopramide tablet 10 mg
88 Metronidazol tablet 250 mg
89 Metronidazol tablet 500 mg
90 Mikonazol krim/salep 2% (Nitrat)
91 Natrium Diklofenak tablet 50 mg
92 Natrium Klorida larutan infus 0.9 %
93 Nifedipin tablet 10 mg
94 Nystatin Vaginal tab 100.000 IU/g
95 N- Acetylcysteine 200 mg
96 Obat Batuk Hitam (O.B.H) @ 100 ml
97 Oksitetrasiklin salep kulit 3%
98 Oksitetrasiklin HCl Salep Mata 1%
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj)
100 Omeprazol kapsul 20 mg
101 Ondansentron tablet 4 mg
102 Ondansentron Injeksi 4mg/2ml
103 Papaverin tablet 40 mg
104 Parasetamol sirup 120 mg/5 ml
105 Parasetamol tablet 500 mg
106 Pirantel tablet score (Base) 125 mg
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI)
108 Piroksikam tablet 20 mg
109 Povidon Iodida larutan 10 % 300 ml BETADINE
110 Ranitidin injeksi 25 mg/2 ml
111 Ranitidin tablet 150 mg
112 Retinol (Vitamin A) 100.000 IU kapsul lunak
113 Retinol (Vitamin A) 200.000 IU kapsul lunak
114 Ringer Laktat larutan infus RL
115 Salbutamol tablet 2 mg (sebagai Sulfat)
116 Salbutamol tablet 4 mg (sebagai Sulfat)
117 Salbutamol sirup 2 mg/5 ml
118 SALEP WHITFIELD CREM
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4%
120 Salisil Bedak 2%
121 Sefadroksil sirup kering 125 mg/5 ml
122 Sefadroksil sirup kering 250 mg/5 ml
123 Sefadroksil kapsul 500 mg
124 Sianokobalamin (Vit. B12) tablet 50 mg
125 Simetidin tablet 200 mg
126 Simvastatin tablet 10 mg
127 Simvastatin tablet 20 mg
128 Siprofloksasin tablet 500 mg (sebagai HCI)
129 Tablet tambah darah kombinasi
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat)
131 Vitamin B Kompleks tablet
132 Sivit-Zinc
133 Stimuno
134 Zinc tablet 20 mg
OBAT GENERIK BERMEREK

135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect)

Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN

136
COMPRESITUM

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml)

139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS

140 Antihipermotilitas (Kand.LOPERAMID 2 mg)
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj )
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr)
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES)

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar)
Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
149 Sucralfate Suspensi 500mg/5ml Syr
150 Herbalkof syrup obat batuk herbal
VAKSIN (BMHP Medis)
151 ADS 0,05 ML
152 ADS 0,5 ML
153 ADS 5 ML
154 ADS 2 ML
155 SAFETY BOX 5 ML
156 SAFETY BOX 2,5 ML
BAHAN HABIS PAKAI
158 Alat suntik sekali pakai 1 ml
159 Alat suntik sekali pakai 2,5 ml
160 Alat suntik sekali pakai 3 ml
161 Alat suntik sekali pakai 5 ml
162 Alat suntik sekali pakai 10 ml
163 Alkohol Swab
164 Aquadest steril (Aqua Pro Injection)
165 Blood lancet
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic)
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain)
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic)
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain)
170 Folley Catheter 16 G
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL)
172 Handscoen Gynecology ( Powdered Letex Steril L)
173 Handscoon No. 6 S
174 Handscoon No. 7 M
175 Handscoon No. 7,5 L
176 Handscoon Steril 6
177 Handscoon Steril 6,5
178 Handscoon Steril 7
179 Hidrogen Peroksida 3 / H2O2
180 Hypavix atau Polyvix 10 cm x 5 m
181 Infusion Set Anak
182 Infusion Set Dewasa
183 IV Catheter No. 20 G
184 IV Catheter No. 22 G
185 IV Catheter No. 24 G
186 IV Catheter No. 26 G
187 Kaca Slide
188 Kapas 500
189 Kapas 250 gram
190 Kasa Pembalut Hydrofil 4m x 15cm
191 Kasa Steril 16 x 16 cm
192 Etanol 70 % 1 Liter
193 Masker plus 2 Ply TALI (Biasa)
194 Masker plus 3 Ply (Hijab)
195 Masker Sungkup Oksigen Anak
196 Masker Sungkup Oksigen Dewasa
197 Oxygen Nasal Cannula (Oxyflow Bayi)
198 Oxygen Nasal Cannula (Oxyflow Anak)
199 Oxygen Nasal Cannula (Oxyflow Dewasa)
200 Perban Elastis
201 Plesterin (Bulat Soft)
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR)
203 Underped
204 Urine bag
205 Wing Needle 27 G x 3/4
206 Povidon Iodida larutan 10 % 300 ml BETADINE
Tgl Exp.Date No.Batch Satuan Jumlah

4 5 6 7

Tablet 0
nov-27 A 02904 KA Tablet 240
Botol 0
Tablet 300
08-26 I11515BJ Tablet 90
6-25 23TG055 Tablet 350
Kaplet 100
Botol 0
Botol 0
Botol 0

11-26 1211017 Tablet 420

Botol 4

Tube 0
Pot 0
Supp 10
Tablet 0
Tablet 40
Tablet 0
oct 26 A31548 Tablet 300
06-2026 2AC3020 Tube 8
02-2027 B30241J Tablet 80
sep-24 a0130912 Tablet 100
aug-25 54k0588 Tablet 240
jul-25 G32628W Tube 6
Ampul 2
09-2024 2209-05-332 Tablet 190
Botol 6
Ampul 0
Januari 25 800049B Tablet 200
Tube 0
Tablet 0
Tablet 0
sep-26 2309123 Tablet 240
Kapsul 0
Botol 0
Botol 0
Botol 5
Ampul 0
Tablet 0
Ampul 0
Tablet 0

Sachet 82

Ampul 0
Ampul 0
11/20/25 LCM50052 Tube 16
Tube 0
Botol 0
Tablet 0
sep 25 TPK 16251 Tablet 270
jul-27 5460504 Tablet 380
Sep-25 2209-01-155 Tablet 320
Botol 0
Tablet 0
Tablet 0
Tube 5
Botol 5
Botol 0
Tablet 0
Tablet 0

Tablet 0

06-2025 AZ1237 Tablet 120

Tablet 0
Tablet 0
Tablet 0
Tablet 0
Tube 2
Tablet 0
Kapsul 0
Kapsul 0
Tube 0
Tube 0
Botol 0
 Botol 6
Tablet 30

Tablet 0

Botol 0

Kapsul 0

Tablet 0
Ampul 4
Vial 0
Vial 0
12-2025 LS23022 Tablet 200
Ampul 0
aug-25 tsj83651 Tablet 490
Tablet 30
Tablet 60
Tablet 0
Tablet 0
Tablet -50
Tablet 5
Tablet 70
Botol 5
Tablet 100
Tablet 20
Tablet 30
Botol 0
Tube 5
Tube 0
Ampul 0
aug-25 2308072 Kapsul 260
Tablet 0
Ampul 0
Tablet 0
Botol 17
08-2024 PJ03651 Tablet 270
Tablet 0
aug-25 23601308 Tablet 130
Tablet 0
Botol 0
Ampul 5
Tablet 90
Kapsul 0
 Kapsul 0
Botol 6
Tablet 40
2-25 C1020BJ Tablet 0
Botol 0
Pot 0
Pot 0
Kotak 3
3-25 18130400406 Botol 0
Botol 0
Kapsul 0
Tablet 0
Tablet 0
04-2025 2304-11-335 Tablet 0
nop-25 2311-05-335 Tablet 0
Tablet 0
22TD1045 Tablet 440
Tablet 0
Januari 2025 B90311B Tablet 0
Tablet 0
Sachet 0
Tablet 40
0
Supp 0

Ampul 0

Tablet 0
Ampul 0
Tablet 0
Tablet 120
Tube 2
Ampul 0
Botol 2
Tablet 20

Botol 8

Blister 0

1-2024 4110080 Tube 0

Botol 2

Botol 8
 Botol 0
0
Piece 0
Piece 0
Piece 0
Piece 0
Piece 1
Piece 1
0
Januari 2025 20B1704J Piece 15
Piece 0
Januari 2025 20B0205J Piece 75
Februari 2025 20C2309J Piece 8
Nopember 2024 19L0907J Piece 15
Piece 100
Vial 2
Box 0
Piece 1
Piece 1
Piece 0
Piece 0
Piece 2
Piece 0
Pasang 0
Pasang 35
Pasang 28
Pasang 0
Pasang 0
Pasang 0
Pasang 0
Botol 0
Roll 0
Piece 2
Piece 2
1-25 200121 Piece 3
5-25 200511 Piece 7
18-25 200503 Piece 5
Piece 0
Kotak 0
Bungkus 1
 Bungkus 0
Aug-25 23092088 Roll 11
Kotak 10
Botol 0
Box 0
3-2026 03032103 Piece 46
Piece 0
Piece 0
Piece 0
Piece 2
9-2024 19090063 Piece 0
Roll 0
Kotak 0
Botol 0
Piece 1
Piece 0
Piece 0
Botol 0
0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor :
Tanggal : May-24

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg 03-25 1303284 Tablet 160
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg Tablet 0
5 Amlodipin tablet 5 mg 08-26 I11515BJ Tablet 170
6 Amlodipin tablet 10 mg 6-25 23TG055 Tablet 250
7 Amoksisilin kaplet 500 mg Kaplet 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
11-26 1211017 Tablet 270

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 4

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 40
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0
Asam Mefenamat kaplet 500 mg
19 Tablet 100
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 80
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg aug-25 54k0588 Tablet 160
24 Betametason krim 0.1% (sebagai valerat) jul-25 G32628W Tube 6
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 2
26 Cetirizine tablet 10 mg 09-2024 2209-05-332 Tablet 10
27 Cetirizine syrup Botol 1
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg Januari 25 800049B Tablet 0
30 Desoximetasone 0,25 % Crem Tube 0
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg sep-26 2309123 Tablet 160
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Sachet 82

43 Gentamycin Sulfat Injeksi Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% 11/20/25 LCM50052 Tube 7
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg 01-2025 TPK16351 Tablet 130
50 Glimepiride tablet 2 mg Tablet 270
51 Gliseril Gualakolat tablet 100 mg Sep-25 2209-01-155 Tablet 140
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 5
56 Ibuprofen suspensi 100 mg/5 ml Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 20
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 180
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 6
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 60
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0
82 Meloksikam tablet 15 mg Tablet 200
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg aug-25 tsj83651 Tablet 140
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 60
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Tablet 0
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 70
92 Natrium Klorida larutan infus 0.9 % Botol 5
93 Nifedipin tablet 10 mg Tablet 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg Tablet 60
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% Tube 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0
100 Omeprazol kapsul 20 mg aug-25 2308072 Kapsul 80
101 Ondansentron tablet 4 mg Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml Botol 8
105 Parasetamol tablet 500 mg 08-2024 PJ03651 Tablet 130
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) aug-25 23601308 Tablet 130
108 Piroksikam tablet 20 mg Tablet 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 170
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 6
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0
120 Salisil Bedak 2% Kotak 3
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg nop-25 2311-05-335 Tablet 0
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 22TD1045 Tablet 560
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 60
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet -200
132 Sivit-Zinc Tablet 0
133 Stimuno Sachet 0
134 Zinc tablet 20 mg Tablet 40
OBAT GENERIK BERMEREK 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 120
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) 1-2024 4110080 Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 15
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 75
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 100
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S Pasang 35
174 Handscoon No. 7 M Pasang 28
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 2
182 Infusion Set Dewasa Piece 2
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 7
185 IV Catheter No. 24 G 18-25 200503 Piece 5
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 11
191 Kasa Steril 16 x 16 cm Kotak 10
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 46
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) 9-2024 19090063 Piece 0
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 1
204 Urine bag Piece 0
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor :
Tanggal : Apr-24

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 80
2 Alopurinol tablet 100 mg 03-25 1303284 Tablet 0
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg 09-2024 2209.01-146 Tablet 20
5 Amlodipin tablet 5 mg Tablet 40
6 Amlodipin tablet 10 mg Tablet 0
7 Amoksisilin kaplet 500 mg Kaplet 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 150
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
04-2024 1204104 Tablet 7

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 0

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 10
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 0
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 440
17 Asam Askorbat (Vitamin C ) tablet 50mg 11-2023 31307111 Tablet 0
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) 51J0317 Tablet 0
Asam Mefenamat kaplet 500 mg
19 03-2023 AZ1237 Tablet 8
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 80
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 100
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 20
23 Betahistin Mesilat tablet 6 mg Tablet 2
24 Betametason krim 0.1% (sebagai valerat) Tube 2
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 70
26 Cetirizine tablet 10 mg 09-2024 2209-05-332 Tablet 5
27 Cetirizine syrup Botol 0
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg Januari 25 800049B Tablet 0
30 Desoximetasone 0,25 % Crem Tube 0
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg Tablet 0
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 5
37 Fenol Gliserol tetes telinga 10% Botol 0
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 82
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Desember 2023 A00032BJ Sachet 0

43 Gentamycin Sulfat Injeksi Juli 2022 C90721B Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 3
45 Gentamisin salep kulit 0.1% Tube 0
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 100
49 Glimepiride tablet 1 mg 01-2025 TPK16351 Tablet 150
50 Glimepiride tablet 2 mg Tablet 140
51 Gliseril Gualakolat tablet 100 mg Sep-25 2209-01-155 Tablet 0
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 5
55 Hidrokortison krim 2.5% Tube 5
56 Ibuprofen suspensi 100 mg/5 ml Juli 2023 F9087IT Botol 0
57 Ibuprofen suspensi 200 mg/5 ml Botol 80
58 Ibuprofen tablet 200 mg Tablet 0
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 300
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 0
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 2
66 Ketokonazol krim 2% Tube 0
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 6
73 Kloramfenikol tetes telinga 3% Botol 20
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 0
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 4
79 Lidokain injeksi 2% Ampul 0
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 80
82 Meloksikam tablet 15 mg Tablet 0
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg Tablet 30
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 190
86 Metilprednisolon tablet 4 mg Tablet 0
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 50
89 Metronidazol tablet 500 mg Tablet 5
90 Mikonazol krim/salep 2% (Nitrat) Tablet 70
91 Natrium Diklofenak tablet 50 mg Tablet 5
92 Natrium Klorida larutan infus 0.9 % Botol 100
93 Nifedipin tablet 10 mg Tablet 20
94 Nystatin Vaginal tab 100.000 IU/g Tablet 90
95 N- Acetylcysteine 200 mg 10-2023 21AS1096 Tablet 0
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 5
97 Oksitetrasiklin salep kulit 3% 9-2022 119925 Tube 0
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Oktober 2021 J82865W Ampul 20
100 Omeprazol kapsul 20 mg Kapsul 0
101 Ondansentron tablet 4 mg 5-2023 C1906EX Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 15
104 Parasetamol sirup 120 mg/5 ml 04-2024 A10616 Botol 320
105 Parasetamol tablet 500 mg 08-2024 PJ03651 Tablet 0
106 Pirantel tablet score (Base) 125 mg Tablet 30
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) 02-2024 10108B Tablet 0
108 Piroksikam tablet 20 mg Tablet 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 5
110 Ranitidin injeksi 25 mg/2 ml Ampul 170
111 Ranitidin tablet 150 mg Tablet 0
112 Retinol (Vitamin A) 100.000 IU kapsul lunak 5-24 A10529 Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 6
114 Ringer Laktat larutan infus RL Botol 40
115 Salbutamol tablet 2 mg (sebagai Sulfat) April 2024 390506 Tablet 0
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% 8-22 185H001A Pot 3
120 Salisil Bedak 2% Kotak 0
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg Tablet 0
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 620
129 Tablet tambah darah kombinasi 04-2024 22TD1045 Tablet 60
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 0
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc MEI 2022 E90610T Tablet 0
133 Stimuno 12-22 A02479 Sachet 40
134 Zinc tablet 20 mg 7-23 4811589A Tablet 0
OBAT GENERIK BERMEREK 6-2022 FO1612J 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 120
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) JUNI 22 00526 Tablet 2
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 0
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 2
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 20
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) 3-2022 GKL1134010233A1 Tablet 8

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 0

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) 1-2024 4110080 Tube 2

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
11-2022 184400 Botol 8

149 Sucralfate Suspensi 500mg/5ml Syr 2-2023 00B80 Botol 0

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 1
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 0
BAHAN HABIS PAKAI 15
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 0
159 Alat suntik sekali pakai 2,5 ml Piece 75
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 8
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 15
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 0
163 Alkohol Swab Piece 2
164 Aquadest steril (Aqua Pro Injection) Vial 0
165 Blood lancet Box 1
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) ApriL2023 180501 Piece 0
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 2
170 Folley Catheter 16 G Piece 0
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 35
173 Handscoon No. 6 S APRIL2024 1905580306 Pasang 8
174 Handscoon No. 7 M Pasang 0
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 0
182 Infusion Set Dewasa Piece 3
183 IV Catheter No. 20 G 1-25 200121 Piece 2
184 IV Catheter No. 22 G 5-25 200511 Piece 0
185 IV Catheter No. 24 G 18-25 200503 Piece 0
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 1
188 Kapas 500 Bungkus 0
189 Kapas 250 gram Bungkus 11
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 10
191 Kasa Steril 16 x 16 cm Kotak 0
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 46
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 0
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 2
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) 9-2024 19090063 Piece 0
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 1
203 Underped Piece 0
204 Urine bag 4-2024 20190522 Piece 0
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor :
Tanggal : Mar-24

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO 0
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg 03-25 1303284 Tablet 60
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg 09-2024 2209.01-146 Tablet 50
5 Amlodipin tablet 5 mg Tablet 170
6 Amlodipin tablet 10 mg Tablet 90
7 Amoksisilin kaplet 500 mg Kaplet 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
04-2024 1204104 Tablet 90

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 9

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg 11-2023 31307111 Tablet 240
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) 51J0317 Tablet 0
Asam Mefenamat kaplet 500 mg
19 03-2023 AZ1237 Tablet 120
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 80
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg Tablet 60
24 Betametason krim 0.1% (sebagai valerat) Tube 1
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 2
26 Cetirizine tablet 10 mg 09-2024 2209-05-332 Tablet 70
27 Cetirizine syrup Botol 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg Januari 25 800049B Tablet 0
30 Desoximetasone 0,25 % Crem Tube 0
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg Tablet 100
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Desember 2023 A00032BJ Sachet 82

43 Gentamycin Sulfat Injeksi Juli 2022 C90721B Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% Tube 5
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg 01-2025 TPK16351 Tablet 150
50 Glimepiride tablet 2 mg Tablet 50
51 Gliseril Gualakolat tablet 100 mg Sep-25 2209-01-155 Tablet 140
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 5
56 Ibuprofen suspensi 100 mg/5 ml Juli 2023 F9087IT Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 80
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 280
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 1
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 100
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0
82 Meloksikam tablet 15 mg Tablet 80
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg Tablet 200
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 70
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Tablet 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 70
92 Natrium Klorida larutan infus 0.9 % Botol 0
93 Nifedipin tablet 10 mg Tablet 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg 10-2023 21AS1096 Tablet 90
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% 9-2022 119925 Tube 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Oktober 2021 J82865W Ampul 0
100 Omeprazol kapsul 20 mg Kapsul 0
101 Ondansentron tablet 4 mg 5-2023 C1906EX Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml 04-2024 A10616 Botol 15
105 Parasetamol tablet 500 mg 08-2024 PJ03651 Tablet 390
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) 02-2024 10108B Tablet 100
108 Piroksikam tablet 20 mg Tablet 70
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 70
112 Retinol (Vitamin A) 100.000 IU kapsul lunak 5-24 A10529 Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 1
115 Salbutamol tablet 2 mg (sebagai Sulfat) April 2024 390506 Tablet 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% 8-22 185H001A Pot 0
120 Salisil Bedak 2% Kotak 3
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg Tablet 80
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 04-2024 22TD1045 Tablet 140
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 60
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc MEI 2022 E90610T Tablet 0
133 Stimuno 12-22 A02479 Sachet 0
134 Zinc tablet 20 mg 7-23 4811589A Tablet 50
OBAT GENERIK BERMEREK 6-2022 FO1612J 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) JUNI 22 00526 Tablet 40
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) 3-2022 GKL1134010233A1 Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) 1-2024 4110080 Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
11-2022 184400 Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr 2-2023 00B80 Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 15
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 45
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 0
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) ApriL2023 180501 Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S APRIL2024 1905580306 Pasang 35
174 Handscoon No. 7 M Pasang 20
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 0
182 Infusion Set Dewasa Piece 0
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 5
185 IV Catheter No. 24 G 18-25 200503 Piece 0
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 10
191 Kasa Steril 16 x 16 cm Kotak 10
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 0
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) 9-2024 19090063 Piece 2
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 0
204 Urine bag 4-2024 20190522 Piece 1
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor :
Tanggal :

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO 0
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg 03-25 1303284 Tablet 30
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg 09-2024 2209.01-146 Tablet 50
5 Amlodipin tablet 5 mg Tablet 90
6 Amlodipin tablet 10 mg Tablet 0
7 Amoksisilin kaplet 500 mg Kaplet 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
04-2024 1204104 Tablet 40

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 4

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg 11-2023 31307111 Tablet 100
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) 51J0317 Tablet 0
Asam Mefenamat kaplet 500 mg
19 03-2023 AZ1237 Tablet 170
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 8
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 80
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg Tablet 20
24 Betametason krim 0.1% (sebagai valerat) Tube 1
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 1
26 Cetirizine tablet 10 mg 09-2024 2209-05-332 Tablet 120
27 Cetirizine syrup Botol 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg Januari 25 800049B Tablet 0
30 Desoximetasone 0,25 % Crem Tube 0
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg Tablet 100
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 0
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Desember 2023 A00032BJ Sachet 82

43 Gentamycin Sulfat Injeksi Juli 2022 C90721B Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% Tube 5
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg 01-2025 TPK16351 Tablet 160
50 Glimepiride tablet 2 mg Tablet 50
51 Gliseril Gualakolat tablet 100 mg Sep-25 2209-01-155 Tablet 60
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 0
56 Ibuprofen suspensi 100 mg/5 ml Juli 2023 F9087IT Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 80
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 100
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 1
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 150
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0
82 Meloksikam tablet 15 mg Tablet 80
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg Tablet 110
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 110
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Tablet 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 30
92 Natrium Klorida larutan infus 0.9 % Botol 0
93 Nifedipin tablet 10 mg Tablet 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg 10-2023 21AS1096 Tablet 90
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% 9-2022 119925 Tube 0
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Oktober 2021 J82865W Ampul 0
100 Omeprazol kapsul 20 mg Kapsul 0
101 Ondansentron tablet 4 mg 5-2023 C1906EX Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml 04-2024 A10616 Botol 7
105 Parasetamol tablet 500 mg 08-2024 PJ03651 Tablet 210
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) 02-2024 10108B Tablet 0
108 Piroksikam tablet 20 mg Tablet 160
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 0
112 Retinol (Vitamin A) 100.000 IU kapsul lunak 5-24 A10529 Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 1
115 Salbutamol tablet 2 mg (sebagai Sulfat) April 2024 390506 Tablet 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% 8-22 185H001A Pot 0
120 Salisil Bedak 2% Kotak 1
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg Tablet 160
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 04-2024 22TD1045 Tablet 300
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 130
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc MEI 2022 E90610T Tablet 0
133 Stimuno 12-22 A02479 Sachet 0
134 Zinc tablet 20 mg 7-23 4811589A Tablet 50
OBAT GENERIK BERMEREK 6-2022 FO1612J 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) JUNI 22 00526 Tablet 40
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) 3-2022 GKL1134010233A1 Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 3

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) 1-2024 4110080 Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
11-2022 184400 Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr 2-2023 00B80 Botol 8

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 0
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 0
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 0
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) ApriL2023 180501 Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S APRIL2024 1905580306 Pasang 35
174 Handscoon No. 7 M Pasang 20
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 0
182 Infusion Set Dewasa Piece 0
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 5
185 IV Catheter No. 24 G 18-25 200503 Piece 0
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 10
191 Kasa Steril 16 x 16 cm Kotak 10
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece -4
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) 9-2024 19090063 Piece 2
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 0
204 Urine bag 4-2024 20190522 Piece 1
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
0
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME
Berdasarkan Berita Acara Pusban / Polindes
Nomor :
Tanggal :

NO KODE NAMA OBAT / BMHP MEDIS (ALAT KESEHATAN) Tgl Exp.Date No.Batch Satuan Jumlah

1 2 3 4 5 6 7
OBAT GENERIK BERLOGO 0
1 Albendazol tablet 400 mg Tablet 0
2 Alopurinol tablet 100 mg 03-25 1303284 Tablet 70
3 Ambroxol sirup 15 mg/ml Botol 0
4 Ambroxol tablet 30 mg 09-2024 2209.01-146 Tablet 70
5 Amlodipin tablet 5 mg Tablet 230
6 Amlodipin tablet 10 mg Tablet 0
7 Amoksisilin kaplet 500 mg Kaplet 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0
10 Amoksisilin sirup kering Drop 100mg/1 ml Botol 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan
11
Magnesium Hidroksida 200 mg
04-2024 1204104 Tablet 100

Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan

12
Magnesium Hidroksida 200 mg/5 ml
Botol 10

13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5
15
mg
Supp 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0
17 Asam Askorbat (Vitamin C ) tablet 50mg 11-2023 31307111 Tablet 160
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) 51J0317 Tablet 0
Asam Mefenamat kaplet 500 mg
19 03-2023 AZ1237 Tablet 220
20 Asiklovir krim 5% 06-2026 2AC3020 Tube 10
21 Asiklovir tablet 400 mg 02-2027 B30241J Tablet 100
22 Asiklovir tablet 200 mg sep-24 a0130912 Tablet 100
23 Betahistin Mesilat tablet 6 mg Tablet 60
24 Betametason krim 0.1% (sebagai valerat) Tube 2
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 1
26 Cetirizine tablet 10 mg 09-2024 2209-05-332 Tablet 170
27 Cetirizine syrup Botol 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0
29 Deksametason tablet 0.5 mg Januari 25 800049B Tablet 0
30 Desoximetasone 0,25 % Crem Tube 0
31 Digoksin tablet 0.25 mg Tablet 0
32 Dimenhidrinat tablet 50 mg Tablet 0
33 Domperidon tablet 10 mg Tablet 120
34 Eritromisin kapsul 500 mg Kapsul 0
35 Eritromisin sirup 200 mg/5 ml Botol 0
36 Etakridin larutan 0.1% Botol 0
37 Fenol Gliserol tetes telinga 10% Botol 3
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0
41 Furosemid tablet 40 mg Tablet 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr,
42
Trinatrium Sitrat Dihidrat 0.58 gr, Glukosa Anhidrat 4 gr
Desember 2023 A00032BJ Sachet 102

43 Gentamycin Sulfat Injeksi Juli 2022 C90721B Ampul 0

44 Gentamisin injeksi 40 mg/ml Ampul 0
45 Gentamisin salep kulit 0.1% Tube 6
46 Gentamisin salep Mata 0,3% Tube 0
47 Gentian Violet larutan 1 % Botol 0
48 Glibenklamida tablet 5 mg Tablet 0
49 Glimepiride tablet 1 mg 01-2025 TPK16351 Tablet 220
50 Glimepiride tablet 2 mg Tablet 130
51 Gliseril Gualakolat tablet 100 mg Sep-25 2209-01-155 Tablet 120
52 Glukosa larutan infus 5 % steril D5 Botol 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0
55 Hidrokortison krim 2.5% Tube 1
56 Ibuprofen suspensi 100 mg/5 ml Juli 2023 F9087IT Botol 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0
58 Ibuprofen tablet 200 mg Tablet 100
59 Ibuprofen tablet 400 mg Tablet 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0
61 Kalsium Laktat (Kalk) tablet 500 mg 06-2025 AZ1237 Tablet 150
62 Kaptopril tablet 12.5 mg Tablet 0
63 Kaptopril tablet 25 mg Tablet 0
64 Kaptopril tablet 50 mg Tablet 0
65 Kandesartan tablet 8 mg Tablet 0
66 Ketokonazol krim 2% Tube 2
67 Ketokonazol tablet 200 mg Tablet 0
68 Klindamisin kapsul 150 mg Kapsul 0
69 Kloramfenikol kapsul 250 mg Kapsul 0
70 Kloramfenikol salep mata 1% Tube 0
71 Kloramfenikol salep kulit 1% Tube 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0
73 Kloramfenikol tetes telinga 3% Botol 1
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 220
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg +
75
Trimetoprin 80 mg
Tablet 0
Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40
76
mg/5 ml
Botol 0
77 Lanzoprazol kapsul 30 mg Kapsul 0
78 Loratadine 10 mg/tablet Tablet 0
79 Lidokain injeksi 2% Ampul 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0
82 Meloksikam tablet 15 mg Tablet 100
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0
84 Metformin Hci tablet 500 mg Tablet 200
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30
86 Metilprednisolon tablet 4 mg Tablet 180
87 Metoklopramide tablet 10 mg Tablet 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Tablet 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5
91 Natrium Diklofenak tablet 50 mg Tablet 50
92 Natrium Klorida larutan infus 0.9 % Botol 0
93 Nifedipin tablet 10 mg Tablet 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20
95 N- Acetylcysteine 200 mg 10-2023 21AS1096 Tablet 120
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0
97 Oksitetrasiklin salep kulit 3% 9-2022 119925 Tube 0
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Oktober 2021 J82865W Ampul 0
100 Omeprazol kapsul 20 mg Kapsul 0
101 Ondansentron tablet 4 mg 5-2023 C1906EX Tablet 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0
103 Papaverin tablet 40 mg Tablet 0
104 Parasetamol sirup 120 mg/5 ml 04-2024 A10616 Botol 13
105 Parasetamol tablet 500 mg 08-2024 PJ03651 Tablet 390
106 Pirantel tablet score (Base) 125 mg Tablet 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) 02-2024 10108B Tablet 20
108 Piroksikam tablet 20 mg Tablet 200
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5
111 Ranitidin tablet 150 mg Tablet 0
112 Retinol (Vitamin A) 100.000 IU kapsul lunak 5-24 A10529 Kapsul 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0
114 Ringer Laktat larutan infus RL Botol 5
115 Salbutamol tablet 2 mg (sebagai Sulfat) April 2024 390506 Tablet 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) 2-25 C1020BJ Tablet 0
117 Salbutamol sirup 2 mg/5 ml Botol 0
118 SALEP WHITFIELD CREM Pot 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% 8-22 185H001A Pot 0
120 Salisil Bedak 2% Kotak 4
121 Sefadroksil sirup kering 125 mg/5 ml 3-25 18130400406 Botol 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0
123 Sefadroksil kapsul 500 mg Kapsul 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0
125 Simetidin tablet 200 mg Tablet 0
126 Simvastatin tablet 10 mg 04-2025 2304-11-335 Tablet 0
127 Simvastatin tablet 20 mg Tablet 230
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0
129 Tablet tambah darah kombinasi 04-2024 22TD1045 Tablet 440
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 200
131 Vitamin B Kompleks tablet Januari 2025 B90311B Tablet 0
132 Sivit-Zinc MEI 2022 E90610T Tablet 0
133 Stimuno 12-22 A02479 Sachet 0
134 Zinc tablet 20 mg 7-23 4811589A Tablet 50
OBAT GENERIK BERMEREK 6-2022 FO1612J 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0
Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN
136
COMPRESITUM
Ampul 0

137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0

138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) JUNI 22 00526 Tablet 40
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 3
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) 3-2022 GKL1134010233A1 Tablet 20

145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 5

Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials
146
(COMBIVENT)
Blister 0

147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) 1-2024 4110080 Tube 0

Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK
148
KID syr 20 mg/5ml
11-2022 184400 Botol 2

149 Sucralfate Suspensi 500mg/5ml Syr 2-2023 00B80 Botol 10

150 Herbalkof syrup obat batuk herbal Botol 0
VAKSIN (BMHP Medis) 0
151 ADS 0,05 ML Piece 0
152 ADS 0,5 ML Piece 0
153 ADS 5 ML Piece 0
154 ADS 2 ML Piece 0
155 SAFETY BOX 5 ML Piece 1
156 SAFETY BOX 2,5 ML Piece 1
BAHAN HABIS PAKAI 0
158 Alat suntik sekali pakai 1 ml Januari 2025 20B1704J Piece 0
159 Alat suntik sekali pakai 2,5 ml Piece 0
160 Alat suntik sekali pakai 3 ml Januari 2025 20B0205J Piece 2
161 Alat suntik sekali pakai 5 ml Februari 2025 20C2309J Piece 8
162 Alat suntik sekali pakai 10 ml Nopember 2024 19L0907J Piece 15
163 Alkohol Swab Piece 0
164 Aquadest steril (Aqua Pro Injection) Vial 2
165 Blood lancet Box 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) ApriL2023 180501 Piece 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0
170 Folley Catheter 16 G Piece 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0
173 Handscoon No. 6 S APRIL2024 1905580306 Pasang 45
174 Handscoon No. 7 M Pasang 30
175 Handscoon No. 7,5 L Pasang 0
176 Handscoon Steril 6 Pasang 0
177 Handscoon Steril 6,5 Pasang 0
178 Handscoon Steril 7 Pasang 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0
181 Infusion Set Anak Piece 0
182 Infusion Set Dewasa Piece 0
183 IV Catheter No. 20 G 1-25 200121 Piece 3
184 IV Catheter No. 22 G 5-25 200511 Piece 5
185 IV Catheter No. 24 G 18-25 200503 Piece 0
186 IV Catheter No. 26 G Piece 0
187 Kaca Slide Kotak 0
188 Kapas 500 Bungkus 1
189 Kapas 250 gram Bungkus 0
190 Kasa Pembalut Hydrofil 4m x 15cm Aug-25 23092088 Roll 10
191 Kasa Steril 16 x 16 cm Kotak 10
192 Etanol 70 % 1 Liter Botol 0
193 Masker plus 2 Ply TALI (Biasa) Box 0
194 Masker plus 3 Ply (Hijab) 3-2026 03032103 Piece 16
195 Masker Sungkup Oksigen Anak Piece 0
196 Masker Sungkup Oksigen Dewasa Piece 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) 9-2024 19090063 Piece 2
200 Perban Elastis Roll 0
201 Plesterin (Bulat Soft) Kotak 0
202 SOFTA-MAN @ B-BRAUN 500 ml (ASEPTIC CAIR) Botol 0
203 Underped Piece 0
204 Urine bag 4-2024 20190522 Piece 1
205 Wing Needle 27 G x 3/4 Piece 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0
0