rko pkm 2015 ciledug

8/18/2019 RKO PKM 2015 Ciledug

1/52

1. Daftar Obat E- Katalog yang diadakan dari Dana JKN UPT Puskesmas Ciledu

NO Nama Obat atuan !arga atuan Kebutu"an1 2 3 4 5

J U # $ % !

Cirebopn,………………………

Kepala UPT Puskesma

drg. N&$% O


2/52

N


3/52

g

!arga6

……………2015

s Ciledug

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4/52


5/52

/. Daftar Obat Non E - Katalog (ang diadakan dari Dana JKN UPT Puskesma

NO Nama Obat atuan !arga atuan Kebutu"an1 2 3 4 5

J U # $ % !

Cirebopn,………

Kepala UP


6/52


7/52

Ciledug

!arga6

…………………………2015

Puskesmas Ciledug


8/52

N&$% O'(%N

+ 1**/0 /


9/52

0. Daftar Obat E - Katalog (ang diadakan dari Dana JKN UP

NO Nama Obat atuan !arga atuan1 2 3 4

J U # $ % !


10/52


11/52

Puskesmas Ciledug

Kebutu"an !arga5 6

Cirebopn,……………………………………2015

Kepala UPT Puskesmas Ciledug


12/52

drg. N&$% O'(%N

N&P) 1*+,+ 1**/0 /


13/52

. Daftar Obat Non E - Katalog (ang diadakan dari Dana

NO Nama Obat atuan !arga atuan1 2 3 4

J U # $ % !


14/52


15/52

JKN UPT Puskesmas Ciledug

Kebutu"an !arga5 6

Cirebopn,……………………………………2015



16/52

drg. N&$% O'(%N

N&P) 1*+,+ 1**/0 /


17/52

DINAS KESEHATAN

UPT PUSKESMAS CI

Jalan Alun-alun no. 20 Ciledug Phone (0231) 661

Cirebon, 8 gus!us 2

"omor # K e p

$ampiran # 1 %erkas &!'( Kepala )i

Peri'al # Pengadaan *ba!a dan %+P -K" Kabupa!en Ci

di .um

%ersama ini kami memo'on pengadaan oba! dan perbekalan kese'a!an /an

berasal dai dana *perasional -K" !a'un 2015 /ang ada pada Puskesmas kami un!u

pengadaann/a di )inas Kese'a!an dengan da!ar pengadaan oba! dan %+P !erlampir

demikian sura! permo'onan ini disampaikan a!as perkenaann/a kami uapkan !erima

Kepala UPT Pus

drg. N&$

N&P) 1*+,+


18/52

EDUG

91 kotak pos 451

015

a d a

as Kese'a!an

rebon

ber

g danan/a

di proses

di sura! ini

asi'(

kesmas Ciledug

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1**/0 /


19/52

0. Daftar 2#!P E - Katalog (ang diadakan dari Dana JKN

"* "+ *%T .TU"

1 la! .un!ik .ekali Pakai 1 Tuberulin 2 127 nipro9

2 la! .un!ik .ekali Pakai 1 Tuberulin 2 127s!era9

3 la! .un!ik .ekali Pakai 1 Tuberulin 2 127Terumo9

4 la! .un!ik .ekali Pakai 10 21 1 127nipro9

5 la! .un!ik .ekali Pakai 10 21 1 127s!era9

6 la! .un!ik .ekali Pakai 10 21 1 127!erumo9

la! .un!ik .ekali Pakai 2(5 23 1 147s!era9

8 la! .un!ik .ekali Pakai 3 23 1 147nipro9

: la! .un!ik .ekali Pakai 3 23 1 147s!era9



12 la! .un!ik .ekali Pakai 5 22 1 147s!era9

13 la! .un!ik .ekali Pakai 5 22 1 147";Pa/ "o( 16 *nemed uroare olle/ Ca!'e!er 2 >a/ "o 18

44 Aolle/ Ca!'e!er 2 >a/ "o( 18 *nemed uroare olle/ Ca!'e!er 2 >a/ "o 18





4: Aolle/ Ca!'e!er ped "o 6 *nemed uroare olle/ Ca!'e!er ped "o 6

50 Aolle/ Ca!'e!er ped "o 8 *nemed uroare olle/ Ca!'e!er ped "o 8

51 Aolle/ Ca!'e!er ped "o 10 *nemed uroare olle/ Ca!'e!er ped "o 10

52 ;nus .e!, ;B, ing needle ;(B Ca!'e!er "o( 22 17.!era ;(B Ca!'e!er "o( 22 179

53 ;nus .e!, ;B, ing needle ;(B Ca!'e!er "o( 24 347.!era ;(B Ca!'e!er "o( 24 3479

54 ;nus .e!, ;B, ing needle ;nusion .e! Pedia!ri 60 dropsml9.!era ;nusion .e! Pedia!ri 60 dropsml99

55 ;B Ca!'e!er ";P


20/52

5 ;B Ca!'e!er ";P


21/52

PT Puskesmas Ciledug


22/52

,018(00 600 4,210,800

,018(00

,018(00

,018(00

,018(00

,334(00 200 1,466,800

,334(00

,334(00

,334(00

14,18(00

14,18(00

14,18(00

130,000(00

105,000(00

104,500(00

800(00 50 40,000

5:0(00

,:00(00 601 4,4,:00

24,000(00

6,:30(00

6,:30(00

6,:30(00

6,:30(00 651 4,511,430

6,:30(00

6,:30(00

33,000(00

41,:10(00

2,830(00

::(00 6000 5,84,000

6,5:5(00

6,5:5(00

15,500(00 60 :30,000

38,125,350

Cirebopn, 8 gus!us 2015


drg. N&$% O'(%N

N&P) 1*+,+ 1**/0 /


23/52

1. Daftar Obat Non E- Katalog yang diadakan dari Dana JKN

"* "+ *%T .TU"

1 moksisilin kapsulkaple!!able! sored 500 mg )us, 10 s!rip H 10 kap!ab

-U+$


24/52

UPT Puskesmas Ciledug


25/52

1. Daftar Obat E- Katalog yang diadakan dari Dana JKN UP

"* "+ *%T .TU"

1 CT r!esuna!e !able! 50 mg ? modiaIuine an'/drida !able! 200 mg9 1 blis!erH24 !able!

2 deoJir )ipiJoksil !able!kaple! 10 mg )us, 3 %lis!er H 10 kapsul

3 ir un!uk in=eksi Iua pro ;n=eks9 20 ml Bial 20 ml

4 ir un!uk ;n=eksi 25 ml )us, 120 ampul PF H 25+$

5 ir un!uk irigasi lar inus 1000 ml %!l H 1000 ml

6 karbose !able!kaple! 100 mg )us, 10 s!rip H10!able!

karbose !able!kaple! 50 mg )us, 10 s!rip H10!able!

8 lbendaol suspensi 200 mg5 ml )us, 10 dus H 1 bo!ol H 10 ml

: lbendaol !able!kapsulkaple! 400 mg )us, 5 s!rip H 6 !able!

10 lbumin serum normal 'uman albumin9 in=eksi 20L, 100 ml Bial 100 ml

11 lbumin serum normal 'uman albumin9 in=eksi 20L, 50 ml Bial 50 ml

12 lbumin serum normal 'uman albumin9 in=eksi 25L, 100 ml )us, bo!ol H 100 ml

13 lbumin serum normal 'uman albumin9 in=eksi 25L, 20 ml bo!ol H 20 ml

14 lbumin serum normal 'uman albumin9 in=eksi 25L, 50 ml bo!ol H 50 ml

15 lbumin serum normal 'uman albumin9 in=eksi 5L 250 ml bo!ol H 250 ml

16 lbumin serum normal 'uman albumin9 in=eksi 5L 50 ml bo!ol H 50 ml

1 lopurinol !able!kapsulkaple! 100 mg %o, 10 s!rips H 10 !able!s

18 lopurinol !able!kapsulkaple! 300 mg )us, 10 blis!er H 10 !able!

1: lpraolam !able!kapsulkaple! 0,25 mg )us, 10 .!rip H 10 !able!

20 lpraolam !able!kapsulkaple! 0,5 mg 1 bo 10 .!rip D 10 !able!

21 lpraolam !able!kapsulkaple! 1 mg K!k 1010 !able!

22 l!eplase in=eksi 50 mgJial )us, 1 JialH50mg ? 1 Jial pelaru!

23 mo!erisin % salep ma!a 1L !ube 3(5 gr

24 mikasin in=eksi 250 mgml Bial 2 ml

25 minoElin in=eksi 24 mgml dus 30 ampul H10 ml

26 minoElin !able! sored 200 mg %o!ol H 100 !able! salu! selapu!

2 minoElin !able!kapsulkaple! 150 mg %!l H 100 !able!

28 miodaron in=eksi 150 mg3 ml )us, 6 ampul H 3 ml

2: miodaron !able!kaple! 200 mg s!rip

30 mi!rip!ilin !able! salu! 25 mg Cl9 )us, 10 s!rip H 10 !ss

31 mlodipin !able! 10 mg %o, 3 s!rips H 10 !able!s

32 mlodipin !able! 5 mg %o, 3 s!rips H 10 !able!s

33 moksisilin kapsulkaple! 250 mg dus 10 D 10M.34 moksisilin kapsulkaple!!able! sored 500 mg )us, 10 s!rip H 10 kap!ab

35 moksisilin sirup kering or!e 250 mg5 ml )us, %o!ol 60 ml

36 moksisilin sirup kering 125 mg 5 ml b!l H 60 ml

3 mpisilin serbuk in=eksi i(J( 1000 mgJial )us, 10 Jial H 1 g

38 nalog insulin long a!ing in= 100 U;ml, Jialar!ridge disposiblepenEll ar!ri dus, 5 solos!ar pen H 3ml

3: nalog insulin mi a!ing in= 100 U;ml, nalog insulin mi a!ing in= 100 U; ;n=eksi 100 ;Uml, Alepen disposibl

40 nalog ;nsulin +i ;nsulin ;n= 100 U;ml )us, 5 PreElled pen H 3 ml

41 nalog insulin mi insulinin= 100 U;ml, Jialar!ridge disposiblepenEll ar!ri PenEll ar!ridge

42 nalog ;nsulin


26/52

56 r!esuna!e in=eksi i(J(i(m( 60 mgml )us, 1 Bial H 60 mg ? 1 mpul Pel

5 sam se!ilsalisila! ase!osal9 !able! 100 mg )us H 10 D 10 Ms

58 sam se!ilsalisila! ase!osal9 !able!kaple!kapsul 80 mg K*TK H 10 10 T%

5: sam skorba! Bi!amin C9 !able! 250 mg k!k 1010 !able!

60 sam skorba! Bi!amin C9 !able! 50 mg )us 10 s!rip 10 !ab

61 sam Aola! !able!kapsulkaple! 0,4 mg )us, 10 s!rip H10 !able!

62 sam Aola! !able!kapsulkaple! 1 mg %o!ol H 100 !able!

63 sam ;bandrona! in=eksi 6mg6ml %oks, 1 ampul

64 sam +eenama! kapsulkaple! 250 mg dus, 10 blis!er H 10 kapsul

65 sam +eenama! kapsulkaple! 500 mg )us, 10 blis!er H 10 kap!ab ss

66 sam pipemida! kapsul 400 mg .!rip

6 sam !raneksama! in=eksi 50 mgml )us, 10 ampul H 5 ml

68 sam oledrona! in=eksi 4mg5m$ )us, 1 Jial plas!ik H 5ml

6: sikloJir salep ma!a 3L Tube 3,5 gram

0 sikloJir !able!kapsulkaple! 200 mg )us, 10 blis!er H 10 !able!

1 sikloJir !able!kapsulkaple! 400 mg k!k 1010 !able!

2 sparaginase serbuk in=eksi 10(000 U;Jial 10(000 U;Bial

3 !apulgi! !able! 600 mg )us 5 s!rip H 10 !able!

4 !enolol !able!kapsulkaple! 100 mg s!rip

5 !enolol !able!kapsulkaple! 50 mg %o H 10 s!rip 10 !ab

6 !rakurium in=eksi 25 mg2,5 ml )us, 5 ampul H 2(5 ml

!ropin in=eksi i(J(i(m(s(k( 0,25 mgml 100 +PU$ H 1 +$

8 !ropin .ula! !able! 0,5 mg )us, 10 s!rip H 10 !able!

: !ropin .ula! !e!es ma!a 0,5L %o!ol 5ml

80 !ropin .ula! !e!es ma!a 1L %o!ol 5ml

81 i!romisin sir kering 200 mg 5 m$ bo!ol H 60 ml

82 i!romisin !able! 500 mg k!k 210 !able!

83 i!romisin !able! 250 mg .!rip

84 %edak salisil serbuk 2L )us H 50 gram

85 %ena!in %enil Penisilin 1,2 =u!a ;U Jial )s 10 Jial 1,2 -! ;U

86 %ena!in %enil Penisilin 2,4 =u!a ;UJial 10 Jial H 2(400(000 ;U

8 %era!an! in=eksi suspensi 25 mgm$ Bial

88 %erapros! sodium !able! 20 mg %o 3 blis!er H 10 Table!

8: %e!ame!ason krim 0,1L sebagai Balera!9 Tube 5 gr

:0 %e!ame!ason !e!es ma!a 1 mgml bo!ol H 5 ml

:1 %eJasiumab in=eksi 25 mgml .kema


27/52

116 )eksame!ason in=eksi i(J(i(m( 5 mgml )us, 100 ampul H 1 ml

11 )eksame!ason !able! 0,5 mg )us, 10 blis!er H 10 !able!

118 )esoges!rel !able! 5 mg )us, 1 %lis!er H 28 !able!

11: )esoksime!ason krim 0,25L )us, !ube H 5 g

120 )esoksime!ason krim 0,25L Ko!ak, !ube H 15 gram

121 )esoksime!ason salep 0,25L )us Tube 10 gram

122 )iaepam laru!an rek!al 5 mg2,5 m$ )us, 5 alubag H 1 !ube H 2,5ml

123 )iaepam in=eksi i(J(i(m 5 mgml )us, 30 ampul H 2 ml

124 )iaepam laru!an rek!al 10 mg2,5 m$ )us, 5 alubag H 1 !ube H 2,5ml

125 )iaepam !able!kapsulkaple! 2 mg %o!ol Plas!ik H 100 !able!

126 )ie!ilkarbamain !able! sored 100 mg )us, 10 blis!er H10 !able!

12 )ien'idramin in=eksi i(J(i(m( 10 mgml Cl9 ampul H 1 ml

128 )igoksin in=eksi 0,25 mgml %o H 5 ampul 2 m$

12: )igoksin !able! 0,25 mg %o 10 D 10 Tab

130 )il!iaem Cl !able! 30 mg )us, 10 s!rip H 10 !able!

131 )il!iaem inus in=eksi 50 mg 10 Jial H 50mg

132 )il!iaem in=eksi 25 mg5 m$ Bial 5 m$

133 )il!iaem Kapsul .< 100 mg 3 blis!er H 10 kapsul

134 )il!iaem Kapsul .< 200 mg 3 blis!er H 10 kapsul

135 )imen'idrina! !able! 50 mg %!l 100 !able!

136 )ina!rium ede!a! !e!es ma!a 0,35L bo!ol 15 ml

13 )ina!rium klodrona! inus kons 60 mgm$ ampul

138 )obu!amin in=eksi 50 mgm$ ampul H 5 ml

13: )oksaosin mesila! !able! 1 mg )us, 5 blis!er H10Ms !ab

140 )oksaosin mesila! !able! 2 mg )us, 5 blis!er H10Ms !ab

141 )oksisiklin !able!kapsulkaple! 100 mg %o H 10 s!rip 10 kapsul

142 )oksorubisin serbuk in=eksi i(J( 10 mgJial )us, 1 Jial H 10 mg

143 )oksorubisin serbuk in=eksi i(J( 50 mgJial )us, 1 Jial H 50 mg

144 )omperidon suspensisirup 5 mg5 ml b!l H 60 ml

145 )omperidon !able! 10 mg dus 10 D 10M.

146 )omperidon !e!es 5 mgm$ )us, bo!ol H 10 ml

14 )opamin in=eksi 40 mgml ampul H 5 ml

148 )ose!aksel in=eksi 20 mg0,5 ml )us, 1 Jial H0,5 ml? 1 Jial pelaru!

14: )TP die!'/lene !riamine pen!aae!i aid9 2,062,5 mg pen!e!a!e alium ! )us H 5 Jial

150 )u!as!erid kaps lunak 0,5 mg )us, %o!ol Plas!ik H 30 Table!

151 FaJirens !able! salu! 600 mg %o!ol 30 !ab

152 Fedrin ;n= 50 mgml mpul H 1 ml

153 Fksemes!an !able! 25 mg )us, 2 blis!er H 15 !able!

154 Fnoksaparin sodium in= 20 mg0,2 m$ dus, 2 preElled s/ringe H 0,2 ml



15 Fpinerin drenalin9 in=eksi i(Js(k(i(m 1 mgml )us H 30 mpul

158 Fpirubisin serb in=eksi 50 mg25ml Bial H 25 ml

15: Fpirubisin serb in=eksi 10 mg5 ml )us, 1 Jial H5 ml

160 Frgokalsierol Ji!amin )3)29 kapsul 50(000 U; )us 3 s!rip H 10 Alas' !able!

161 Frgokalsierol Ji!amin )3)29 suspensi 10(000 U;ml )us, %o!ol Plas!ik H 100 m$

162 Fri!romisin kapsulkaple! 250 mg k!k 10 10 kapsul

163 Fri!romisin kapsulkaple! 500 mg )us, 10 blis!er H 10 kss

164 Fri!romisin sirup kering 200 mg 5 ml %o!ol H60 ml

165 Fri!ropoe!inala in= 10000 U;m$ Jialampul PreElled ./ringe9

166 Fri!ropoe!inala in= 2000 U;m$ )us, 6 preElled s/renge H 0(5 ml

16 Fri!ropoe!inala in= 3000 U;m$ PreElled ./ringe H 1ml

168 Fri!ropoe!inbe!a in= 2000 U;0,3 m$ %oks, 6 ampul

16: F!ambu!ol !able! 250 mg Cl9 k!k 20 10 !able!

10 F!ambu!ol !able! salu! 500 mg Cl9 )us, 10 s!rip H 10 !ss

11 F!anol 0L airan b!l H 100 ml

12 F!iniles!radiol !able! 0,05 mg )us, bo!ol H 100 !able!

13 F!onoges!rel implan 68 mg )us, 1 blis!er H 1 subdermal impla

14 F!oposid in=eksi 20 mgml Bial 100mg5ml

15 Fugenol airan %o!ol 10 ml


28/52

16 FJerolimus !ab 0,25 mg )us, 6 blis!er H 10 !able!

1 FJerolimus !ab 0,5 mg )us, 6 blis!er H 10 !able!

18 Aak!or ;D kompleks serbuk in=eksi 1(000 U;Jial ? pelaru! 10 ml )us, 1 Jial H 1000 ;U? 1 Jial pelar

1: Aak!or ;D kompleks serbuk in=eksi 500 U;Jial ? pelaru! 5 ml )us, 1 Jial H 500 ;U? 1 Jial pelaru

180 Aak!or koagulasi ;; 1435 U;, ak!or koagulasi B;; 20 U;, ak!or koagulasi ;D 2 )ual, Jial 500 ;U

181 Aak!or Koagulasi ;; 1435 U;, Aak!or Koagulasi B;;; 20 U;, Aak!or Koagulasi ;D )us, Jial H 250 ;U? 1 Jial pelaru

182 Aak!or B;;a rekombinan9 serb in= 1 mgJial ? pelaru! un!uk in=eksi K*TK H 1 B;$ .F


29/52

236 en!amisin salep ma!a 0,3L Tube H 3,5 gr

23 en!amisin !e!es ma!a 0,3L )us, bo!ol plas!ik 5 ml

238 libenklamid !able! 5 mg )us, 10 blis!er H 10 kap!ab

23: liklaid !ab 80 mg .!rip

240 liklaid !ab 30 mg )us, 6 s!rip H 10 !able! lepas lam

241 liklaid !able! lepas lamba! 60 +g %o, 30 Table!

242 likuidon !ab 30 mg )us, 10 .!rip H 10 !able!

243 limepiride !able! 1 mg k!k 510 !able!




24 lipiid !able!kaple!kapsul 10 mg )us, bo!olHT% 10+ 30

248 lipiid !able!kaple!kapsul 5 mg )us, bo!olHT% 10+ 31

24: liseril !rini!ra! in= 50 mg10 m$ 1 bo isi 5 ampul 10 ml

250 liseril !rini!ra! kaps .< 2,5 mg )us 1010

251 liseril !rini!ra! kaps .< 5 mg )us 1010

252 liseril !rini!ra! !ab sublingual 0,5 mg %!l H 30 !able!

253 liserin lar 50L l/erin 100 ml

254 lukosa laru!an inus 10 L s!eril bo!ol H 500 ml

255 lukosa laru!an inus 5 L s!eril bo!ol H 500 ml

256 oserelin ase!a! in= 10,8 mgJial )us, 1 s/ringe H 10(8 mg

25 oserelin ase!a! in= 3,6 mg )us, 1 s/ringe H 3(6 mg

258 riseoulJin !able! 125 mg )us, 10 blis!er H 10 !able!

25: aloperidol in= 50 mgm$ )us 5 mpulH1m$

260 aloperidol in=eksi i(m 5 mgml K*TK H 12 ampul

261 aloperidol !able! 0,5 mg )us, 10 blis!er H 10 !able!

262 aloperidol !able! 5 mg )us, 10 blis!er H 10 !able!

263 aloperidol !able! 1,5 mg )us, 10 blis!er H 10 !able!

264 aloperidol !able! 2 mg K*TK H 10 10 T%

265 aloperidol !!s 2 mgm$ %*T*$ H 15 +$

266 alo!an ;n'alasi %o!ol

26 eparin in=eksi i(J(s(k( 5000 U;ml Jial

268 epa!i!is % imunoglobulin 'uman9 )us, 1 s/ringe H 0(5 m$

26: idrokor!ison krim 1L !ube H 5 ml

20 idrokor!ison krim 2,5 L Tube 5 gr

21 idroksi Urea !able!kaple!kapsul 500 mg Jial

22 iosin bu!ilbromid in=eksi 20 mgml bo 5ampul H1 ml

23 oma!ropin !e!es ma!a 2L %o!ol 5ml

24 uman ;nsulin ;n!ermedia!e !ing ;n= 100 U;ml )us, 5 PreElled pen H 3 ml

25 uman insulin in!ermedia!e a!ing in= 100 U;ml, Jial uman ;nsulin ;n!erme )us, Jial 10 ml

26 uman insulin in!ermedia!e a!ing in= 100 U;ml, Jial ;nsulin 'uman %asal9 )us, Jial 10 ml

2 uman insulin in!ermedia!e a!ing in= 100 U;ml,penEll ar!ridge uman ;nsu ;n=eksi 100 ;Uml, penEll disposible

28 uman insulin in!ermedia!e a!ing in= 100 U;ml,penEll ar!ridge ;nsulin 'um )us ;si 5 penEllar!ridge H 3ml

2: uman insulin in!ermedia!e a!ing in= 100 U;ml,penEll ar!ridge ;nsulin 'um penEllar!ridge H 3ml

280 uman insulin in!ermedia!e a!ing in= 100iuml, Jial ;nsulin uman %asal9 )us, 1 Bial H 5 ml

281 uman insulin mi in= 100iuml, Jial ;nsulin uman Comb 259 )us, 1 Bial H 5 ml

282 uman ;nsulin +i ;nsulin ;n= 100 U;ml )us, 5 PreElled pen H 3 ml

283 uman insulin mi insulin in= 100 U;ml, penEll ar!ridge uman ;nsulin Pre ;n=eksi 100 ;Uml, penEll disposible

284 uman insulin mi insulin in= 100 U;ml, penEll ar!ridge ;nsulin 'uman Com )us ;si 5 penEllar!ridge H 3ml

285 uman insulin mi insulin in= 100 U;ml, Jial uman ;nsulin Premi# 30L .ol )us, Jial 10 ml

286 uman insulin mi insulin in= 100 U;ml, Jial ;nsulin 'uman Comb9 )us, Jial 10 ml

28 uman ;nsulin .'or! !ing ;n= 100 U;ml )us, 5 PreElled pen H 3 ml

288 uman insulin s'or! a!ing in= 100 U;ml, penEll ar!ridge uman ;nsulin .' ;n=eksi 100 ;Uml, penEll disposible

28: uman insulin s'or! a!ing in= 100 U;ml, penEll ar!ridge ;nsulin 'uman


30/52

2:6 ;buproen suspensi 200 mg5 ml )us, bo!ol 60 ml

2: ;buproen !able! 200 mg bo!ol H 100 !able!

2:8 ;buproen !able! 400 mg )us, 10 s!rip H 10 !able!

2:: ;osamid serbuk in=eksi 1000 mgJial )us, 1 Jial H 1 g

300 ;mani!ib +esila! !able! salu! selapu! 100 mg .kema


31/52

356 Klobaam !ab 10 mg )us, 10 .!rip H 10 !able!

35 Klonidin in=eksi i(J 0,15 mgml C$9 1509 %o, 10 ampoules H 1m$

358 Klonidin !able! 0,15 mg K!k 10D10 T%

35: Klopidogrel !ab 5 mg )us, 3 s!rip H 10 !ab

360 Kloramenikol salep kuli! 2L %o isi 24 !ube H 15 gram

361 Kloramenikol salep ma!a 1 L Tube H 5 gram

362 Kloramenikol serb in= 1000 mgm$ Jial

363 Kloramenikol suspensi 125 mg 5 ml %o!ol H 60 ml

364 Kloreniramina +alea! CT+9 !able!kapsulkaple! 4 mg ko!ak,10s!ripH10 !able!

365 Klorpromain in=eksi i(m( 25 mgml Cl9 )us H 30 mpul

366 Klorpromain in=eksi i(m 5 mgml 2 ml Cl9 )us H 30 mpul

36 Klorpromain !able! salu! 100 mg Cl9 Ko!ak H 10 10 !ab

368 Klorpromain !able! salu! 25 mg Cl9 10 D 10

36: Kloapin 100 mg K*TK H 5 10 T%

30 Kloapin 25 mg K*TK H 5 10 T%

31 Kodein !able! 10 mg k!k 1010 !able!



34 Kolekalsierol Ji!amin )39 kapsul lunak 0,25 mg %!l H 30 kapsul

35 Kolkisin !able!kaple!kapsul 500 mg %o H 3 s!rip 10 !ab

36 Koloid F. %+ 130 000 lar in 6L %o!ol Plas!ik H 500 ml

3 Kombinasi # ;pra!ropium bromida in'alasi 0,5 mg .albu!amol 2,5 mg 1 dus H 20 Jial

38 Kombinasi in=eksi depo! # +edroksi proges!eron ase!a! 25 mg Fs!radiol sipion Bial

3: Kombinasi suspensi # ParaEn ? gliserin ? enol!alein %o!ol H 60 ml

380 Kombinasi !able! salu! # %esi ;;9 sula! 2* 200 mg sam ola! 0,25 mg 1 sase H30 !able!

381 Kombinasi !able! salu! # %esi ;;9 sula! 2* 200 mg sam ola! 0,25 mg )us, 100 .a'e! H 30 Table!

382 Kombinasi !e!es ma!a 2,5 mgm$# "a!rium klorida 8,664 mgQ Kalium klorida 1 bo!ol 15 ml

383 Kombinasi# r!eme!'er 20 mgQ $umean!rin 120 mg )us, 4 blis!er H 6 !able!

384 Kombinasi# $eJodopa 100 mgQ Karbidopa 25 mgQ Fn!ekapon 200 mg )us, bo!ol plas!ik H 30 !able! salu!

385 Kombinasi# $opinaJir 200 mgQ


32/52

416 $aru!an mengandung sam mino Kombinasi sam mino# 34gr, lukosa# : %ag 3 C'amber9 1440 ml

41 $aru!an mengandung sam mino Kombinasi sam mino# 45gr, lukosa# 1 %ag 3 C'amber9 1:20 ml

418 $aru!an mengandung sam mino Kombinasi lukosa dan elek!roli! 150 gr %ag )ouble 'amber )ua ompar

41: $aru!an mengandung sam mino Kombinasi lukosa dan elek!roli! 80 gr ? %ag )ouble 'amber )ua ompar

420 $aru!an mengandung Flek!roli! Kalium Klorida9 mpoel 25 +$

421 $aru!an mengandung Flek!roli! $aru!an )ensi!/ Pol/ F!'ilene9,

426 $aru!an mengandung Karbo'idra! Aru!ose 120 g, gluose 66 g, D/li!ol 60 g bo!ol 500 m$

42 $aru!an mengandung Karbo'idra! Aru!ose 60 g, gluose 33 g, D/li!ol 30 g $ Ale/ bag 500 m$

428 $aru!an mengandung Karbo'idra! +al!ose 100 gr9 Plas!i %o!!le 500 +$

42: $aru!an mengandung Karbo'idra! ? Flek!roli! 25(00g mal!ose, 3(00 g sodiu Plas!i %o!!le 500 +$

430 $aru!an mengandung Karbo'idra! ? Flek!roli! e!a!e, "a, K, Cl, Ca, +g, .or bo!ol 500 m$

431 $aru!an mengandung Karbo'idra! ? Flek!roli! sam amino 28 gr$, lukosa %o!ol Plas!ik 1000 m$

432 $aru!an mengandung Karbo'idra! ? Flek!roli! sam amino 28 gr$, lukosa %o!ol Plas!ik 1000 m$

433 $aru!an mengandung Karbo'idra! ? Flek!roli! Aru!ose 60 g, gluose 33 g, D bo!ol 500 m$

434 $aru!an mengandung Karbo'idra! ? Flek!roli! lukosa 25 g, "aCl 2,0 g, KCl 1 %o!ol 500 ml

435 $aru!an mengandung Karbo'idra! ? Flek!roli! lukosa 55 g Q "a!rium C'lorid %o!ol 500 ml

436 $aru!an mengandung Karbo'idra! ? Flek!roli! lukosa# 25,0 gQ "aCl# 4,5 g9 %o!ol 500 ml

43 $aru!an mengandung Karbo'idra! ? Flek!roli! lukosa# 55(0 gQ "aCl# 2(25 g9 %o!ol 500 ml

438 $aru!an mengandung Karbo'idra! ? Flek!roli! lukosa# 55(0 gQ "aCl# 4(5 g9 %o!ol 500 ml

43: $aru!an mengandung Karbo'idra! ? Flek!roli! $aru!an nu!risi kombinasi in so!bag 500ml

440 $aru!an mengandung Karbo'idra! ? Flek!roli! $aru!an moleule eri surose in= amp 100 mg5 m$ ampul

45 +agnesium sula! in=eksi 20L )us, 120 ampul plas!ik H 25 ml


33/52

46 +agnesium sula! in=eksi 40L )us, 120 ampul plas!ik H 25 ml

4 +ani!ol bo!ol 500 ml

48 +apro!ilin Cl !ab 25 mg .!rip

4: +apro!ilin Cl !ab 50 mg K*TK H 5 10 T%

480 +)P me!'/lene dip'osp'ona!e9 1 mg me!'/lene dip'osp'oni aidm$ )us H 5 Jial

481 +ebendaol !able! 500 mg )us,24 Ca!' H 1 !able!

482 +edroksi Proges!eron se!a! !able!kaple!kapsul 100 mg )us, 10 blis!er H10 !able!

483 +elalan !able! 2 mg %o, Table! 2 mg25Ms

484 +eropenem in= 1 g )us, 1 Jial H 1 g

485 +eropenem serb in= 500 mgJial )us, 1 Jial H 0,5 g

486 +esna in= 100 mgm$ )us, 15 mpul

48 +e!adon sir 50mg5ml %o!ol 1000 ml

488 +e!ormin Cl !able! 500 mg )us, 10 blis!er H 10 !able!

48: +e!ormin Cl !able! 850 mg )us, 10 blis!er H 10 kap!ab

4:0 +e!ildopa !able! salu! 250 mg )us, 10 .!rip H 10 !able! salu! sel

4:1 +e!ilergome!rin +alea! +e!ilergome!rin9 !able! salu! 0,125 mg k!k 10 10 !able! salu!

4:2 +e!ilergome!rin +alea! in=eksi 0,200 mg1 ml ampul H 1 ml

4:3 +e!ilenida! kapsul $ 20 mg )us, bo!ol plas!ik H 30 kapsul pel

4:4 +e!ilenida! !able! .< 10 mg )us, 2 blis!er H 15 !able!

4:5 +e!ilprednisolon in= 125 mg2 m$ )us, 1 Bial H125mg ? 1 ampul pel

4:6 +e!ilprednisolon in= 500 mg8 m$ )us, 1 Jial H 500 mg

4: +e!ilprednisolon !able! 16 mg .!rip

4:8 +e!ilprednisolon !able! 4 mg )us, 10 %lis!er H 10 Table!

4:: +e!ilprednisolon !able! 8 mg )us, 10 %lis!er H 10 !able!

500 +e!oklopramid drop bo!ol 10 m$ )us, %o!ol 10 ml

501 +e!oklopramide sirup 5 mg 5 ml %*T*$ 60 +$

502 +e!oklopramide !able! 5 mg k!k 10 10 !able!

503 +e!o!reksa! serb in= 50 mg2 m$ Jial H 2 ml

504 +e!o!reksa! serbuk in=eksi i(Ji(m(i(!( 5 mg %o 10 ampul H 1 ml

505 +e!o!reksa! !able!kaple!kapsul 2,5 mg %o, bo!!le H 50 !ab

506 +e!ronidaol inus 500 mg100 ml )us, 1 %o!ol H 100 ml

50 +e!ronidaol oJula 500 mg dus 1 Ms H 5 oJula

508 +e!ronidaol sirup 125 mg5 +l )us, bo!ol 60ml

50: +e!ronidaol suposi!oria 500 mg )us, 2 blis!er H 5 supposi!oria

510 +e!ronidaol !able! 250 mg 10 s!rip H 10 !ab

511 +e!ronidaol !able! 500 mg 10 s!rip H 10 !ab

512 +;% me!aiodoben/lguanidine9 Jial

513 +;%; me!o/ iso bu!/l iso ni!ril9 5m$ rea!ion Jial )us H 5 Jial

514 +idaolam in=eksi i(J( 1 mgml %oks 10 amp

515 +idaolam in=eksi i(J( 5 mgml %oks 5 amp

516 +ikaungin "a serb in= 50 mg )us,1 JialH50mg

51 +ikoenola! +oe!il 500 mg %oks, 50 !able!

518 +ikonaol krimsalep 2 L "i!ra!9 Tube 10 gram

51: +i!omisin C r/s!allin9 serbuk in= 10 mgJial 10 mg Bial

520 +odiEed uid gela!ine %+ 30 000 lar in 4L %!l H 500 ml

521 +oksioksasin !e!es ma!a 0,5L bo!ol, !e!es ma!a 3 ml

522 +ome!ason uroa! krim 0,1L !ube 10 gram

523 +orEn C$ in= 10 mgml )us 10 amp H 1 ml

524 +orEn C$ !able! .< 10 mg )us, 6 s!rip H 10 !able!

525 +orEn C$ !able! .< 15 mg )us, 6 s!rip H 10 !able!

526 +orEn !able! 10 mg %o!ol 30 !able!

52 "ase!il sis!ein in=( nebules 100 mg %o H 5 ampul

528 "al 0,:L %o!ol 500 ml

52: "adroparin in= :500 am$ s/ringe 0,3 m$ )us, 5 blis!er H 2 ps 0(3 ml

530 "adroparin in= :500 am$, s/ringe 0,4 m$ )us, 5 blis!er H 2 ps 0(4 ml

531 "adroparin in= :500 am$, s/ringe 0,6 m$ )us, 5 blis!er H 2 ps 0(6 ml

532 "alokson in=eksi 0,4 mgml )us, 5 mpul H 2ml

533 "a!rium %ikarbona! in=eksi i(J 8,4L mpoel 25 +$

534 "a!rium )ikloenak !able! 50 mg %o ,5 %lis!er H 10 !able!

535 "a!rium osa! lar oral 45 m$ %o!ol, 45 ml


34/52

536 "a!rium usida! salep 20 mgg Tube 5 gr

53 "eos!igmin in=eksi 0,5 mgml %o, isi 5 ampul H 1 ml

538 "eJirapin !able! 200 mg b!l 60 !able!

53: "iedipin !ab 20 mg, slo> releaseQ oros blis!er

540 "iedipin !ab 30 mg, oros blis!er

541 "iedipin !able!kapsul 10 mg )us, 10 .!rip H 10 !able! salu! sel

542 "ikardipin in= 10 mgJial %o H 1 Jial

543 "ilo!inib kapsul 200 mg .kema


35/52

5:6 Piridoksin Ji!amin %69 in= 100 mgm$ mpul 1 ml

5: Polikresulen airan )us, %o!ol H 10ml

5:8 PoJidon ;odida laru!an 10L 1000 ml bo!ol H 1000 ml

5:: PoJidon ;odida laru!an 10L 30 ml bo!ol H 30 ml

600 PoJidon ;odida laru!an 10L 300 ml bo!ol H 300 ml

601 PoJidon ;odida laru!an 10L 60 ml b!l 60 ml

602 Pramipeksol !ab F< 0,35 mg )us, 3 alu blis!er H 10 !able!

603 Pramipeksol !ab F< 0,50 mg )us, 3 alu blis!er H 10 !able!

604 PraJas!a!in !able! 20 mg %o ,5 .!rip H 10 !able!

605 Primakuin !able! 15 mg )us,10 blis!er H10 !able!

606 Probenesid !able!kapsulkaple! 500 mg )us, 10 s!rip H 10 !able!

60 Prokain %enilpenisilin serbuk in=eksi 3 =u!a ;UJial Bial H 3 =u!a ;U

608 Propanolol !able! 10 mg Cl 9 )us, 10 .!rip H 10 !able!

60: Propil!iourasil !able!kapsulkaple! 100 mg %o!ol H 100 Table!

610 Propool in=eksi i(J(, bolus 1L mpul

611 Propranolol !able! 40 mg Cl9 )us, 10 s!rip H 10 !able!

612 Sue!iapin !ab 200 mg )us, 1 blis!er H 10 !able!



615


36/52

656 .e!aidim in=eksi 1 g )us, 2 Bial H 1 gram

65 .e!riakson serbuk in=eksi 1 gJial )us, 10 Bial H 1 g

658 .euroksim !able!kapsulkaple! 250 mg )us, 1 %lis!er H 10 Table! salu! sel

65: .euroksim serbuk in=eksi 50 mgJial %o H 2 Jial

660 .euroksim !ab 500 mg )us, 1 %lis!er H 10 Table! salu! sel

661 .er!ralin !ab 50 mg s!rip H 10 !ab

662 .e!iriin sirup 5 mg5 ml %o!ol H 60 ml

663 .e!iriin !able! 10 mg %o, 10 s!rips H 10 apsules

664 .e!uksimab inus 5 mgml .kema


37/52

16 Tio!ropium 18 mg reEll %o, 3 blis!ers H10 apsules

1 Tio!ropium kaps 18 mg ? 'andi'aller )us, 1 blis!er H10 kapsul ? 'andi

18 Tramadol in=eksi 50 mgml )us, 10 mpul H 2 ml

1: Tras!uumab serbuk in=eksi 440 mgJial .kema


38/52


39/52

Puskesmas Ciledug


40/52

38,:::

116

148

15:

:5 :6000 :,120,000

84

35 2,20:,000

158

112 12000 1,344,000

1,815

2,:50

:00,000

24,50

23

345 3600 1,242,000

1,03:,500 1:0

00

352

20,000

1,350

4

13,500

13,500

34,400

4,500

3,333

1,250 1500 1,85,000

:,800

13,400

3,200,000

3,600

1,520 :00 1,368,000

25,106

4,803,6:

2,400

45,000

6,045

4,::0

46 500 33,000

645

304,000

24,08:

:3,000

106,000

8,:00

11,600

110,500

25,600

30,800

12,:36

12,:36

305,000

25,000

6,000

150,000

2,600,000 25,300

112,000


41/52

1,580

68 40000 2,20,000

0,000

5,00

:,:83

:,818

11,525 4,180

16,48

45 3500 15,500

136

1,054

22,000

: 1200 116,400

134

12,66

46,66 3,66

4,015

104

3,500

124,:55

26,00

3,480

5,480

20

55,500

24,125

3,333

16 1200 200,400

15,600

:,840

:0,200

455,000

,100

6,35

12,::0

42,600

40,40

1,85

100,000

8,100

500,000

128,000

650

8,000

4:

:30 6000 5,580,000

,00

25,000

133,85

128,000

13:,500

314

451

2,500

1,360

128,: 100,000

16,66 5 83,335


42/52

11,813

23,250

8,500,000

4,423,500

4,400,000

2,0:5,000

:,200,000 1,133,000

::0,000

2,150,000

20,250

133

20,250

1,800

220

1,05

1,35 235

510

2:0

2,:00

11,500

128,000

33,:14

80,000

153,000

285,000

35,000

2,:50

634 3000 1,:02,000

3,41

1,248,31:

25,000

55,000

38,000

4,862

22,000

41:

410

30,4:3

24,500

33,000

2,400

:3,333

12,:1

241,66

:2,000

1,82:

85

25,000

412,500

2,50,000

3::,500

285

2:5,000

28:

6:

1,0:8,:00 330,000

3,3::


43/52

2,600

3,1:4

56 8200 45:,200

235

638

5,500

:50 265

436 1000 436,000

404

430

3,20

3,000

11:,:00

1,4:3

2,11

1,500 5,333

5,00

5,200

2,300,000

840,000

21: 3600 88,400

83,333

6,250

5:

:6

6: 2400 165,600

126 1000 126,000

16,500

641,500

42,:00

1,328,000

2,50

2,:8 00 1,:58,600

5,400

4,500

18,000

6,125

138,000

138,000

6,125

6,125

5,000

2,000

2,000

6,125

6,125

6,125

138,000

138,000

6,125

6,125

5,000

6,125

138,000

138,000

2,000 10,000

3,4::


44/52

4,4::

110 18000 1,:80,000

14: 18000 2,682,000

1,32:,163

211,000

3,:08

2,120 350,000

122,000

166,000

36:,000

14,000

1::,000

245,000

123,200

2::,000

150,300 80,000

:0,000

1,425

2,40

510,000

20,000

65

158

33,000

88 1200 105,600

18:

6:4

1,580

82,000

,800

0 25000 1,50,000

,00

5,000

4,:00

3,100

2,500

140

80 12000 :60,000

62

44,0

245 1500 36,500

85

2,042

1:0,000

408,000

1,360

110,000

60,300

2,56:

2,850

4,00

28,000

300 3000 :00,000

2,22

2,300

3,200 361

553 3000 1,65:,000


45/52

:00

30,600

184

3,400

3,524

1,600 56 :21,600

,260 3,680

51 60000 3,060,000

1,100

1,050

144 5000 20,000

68

5,000

1,550

500

850 1,100

2,500

3,:50

33,000

5,::0

5,350

12,450

50

42

15,50

3,220

8,:00

6,100

:0,66

100,833

113,333

2,08:

14: 200 1,02,800

2,145 1200 2,54,000

60

6,200

540

14,500

2,000

1,400

82,042

43

6,200

56,300

56,300

3,500

115,500

61,600

5,350

36,66

50,820

46,000

65,000

8,20

51,260

64,:00 42,000

46,000


46/52

2:5,240

343,842

322,000

218,00

2,050

8,000

:,000 :,000

8,000

12,650

50,500

42,350

2:,16

55,500

3,500

210,000

1::,000 56,000

:,500

6,800

6,:1

,00

,00

35,50

6,:30

:,16

10,000

10,000

105,500

60,500

210,000

5:1,000

511,000

358,000

2,000

12,000

550,000

1,500

00,000

2,00,000

500,000

40,000

528

13,068

850

638

83:

1,363

40,000

142,000

600

350

1,050

1,850

8:

154

685

1,341 52,000

2,800


47/52

3,500 40 140,000

62,000

1,200

3,26

43,000

,140

6,125 12,210

54,000

44,:60

4,::8

254,100

113 3000 33,500

1:8

800 3600 2,880,000

154 1200 184,800

2,50 200 550,0006,53

1,:50

1:,500

8:,::0

635 200 12,000

205

300

5,280

2,600

108

35,50

21,120

1,680

:,:50

3,850

4,100

3,220

110

160 4000 640,000

1,:25,000

1,23,500

6,11:

12,060

260,000

16,000

3,000

6:,000

2,000

,000

1,820

8,400

15,620

22,::0

1,300

13,200

4,00

54,144

66,640

:4,:62

61,600

6,200 200

33,:00


48/52

6,4:0

:,500

2,800

2,:::

3,500

100 3600 360,000

66,000 380,85

640

480

52,000

2,618

35:,:00

1,1::,::0

214,:00

160,000

288,1:: 11,1:5

80,000

48,500

400

650

1,100,000

550,000

2,550

2:,000

2,200

2,:50,000

120,000

68,000

36,000

211 1500 316,500

2,400

16

1,18:

1,:02,240

21:,540

5,522,580

:84,000

3,000,000

24,560

5,200

1,438 4010 5,66,380

8: 80000 ,120,000

6,450

1,0,815

1,248,220

:3,500

1,135,000

:15,000

:15,810

23,000

2,420

11,45

14,500

3,120

4,525

8,360 2:6

206


49/52

1,000

1,3:3

3,10:

2,163

14,203

5,::8

,200 11,268

2,300

205

1,650

,1:0

65 560 36,400

31:

15,642

106

1,3:1 1:,500

23,185

::5

580

1,013

1,140

120 4000 480,000

260

45:

610

:0

1,100

5,200

1,400

1,008

2,000

3,164,805

23,500

23,500

23,500

46,53:

5,248

6,25

,383

6,600

63,50

431

5,86

5: 4000 236,000

2,000

4,46

513

50: 2400 1,221,600

5,8:5

1,000

16,500

48,060

85:

8,800

38,500

4,800 2,:50

3,00


50/52

16,000

3,300

4,52

52,800

,200

3,300

,::: 181 2400 434,400

3,650,000

1,320,000

1,08

5

256,000

82,000

120,000

43,000

12,000 ,000

16:

3:1 3600 1,40,600

13,000

255

22,000

:3,000

55,000

1,4::

:00

315

:30

3,2:0,000

3,650

12,000

13,425

424

11,16

21,500

5,800

5,800

6,800

28,500

3,:00

6,500

1,120,000

223,000

8,100

1,050

250

1,66:

2,:4:

6,250

::

1,100

6,200

11,500

148 1200 1,600

300

1,135

563 :,128

:,22


51/52

13,86

152,543

2,3:5

1:,608,034

115,000

:0,000

65,500 405

36,500

6,400

5:,:50

5:,:50

5:,:50

0,521

0,521

0,521

5:,:50 0,521

28,204

33,16

6,285

8:,38

20,:00

24,585

1,:8

20,:33

16,500

1:,404

30,400

285,000

1:,:54

23,44

8,000

8,500

14,4:8

1,050

5,3:0

10,000

40,000

2,:3

5,450

1,680

3,:00

6,500

122,000

6,200

234

210,000

8,000

46,000

1,22:,::8

10 16000 1,12,000

1,55

3,42:

12,840

14,:80

,400

43 105,30:,815


52/52

Cirebopn, 8 gus!us 2015


drg. N&$% O'(%NN&P) 1*+,+ 1**/0 /

rko pkm 2015 ciledug

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