Nomor Dokumen

Unit Penerima

No Kode
1 DRG000000082
2 DRG000000385
3 DRG000001172
4 DRG000001718
5 DRG000001941
6 DRG000003002
7 DRG000003565
8 DRG000003572
9 DRG000046953
10 DRG000004623
11 MDVx042122
12 MDVx042124
13 MDVx042121
14 DRG000005108
15 MDVx002305
16 DRG000006906
17 MDVx042177
18 DRG000007279
19 DRG000047196
20 DRG000008343
21 DRG000008819
22 DRG000011633
23 DRG000046969
24 MDVx042136
25 DRG000016618
26 MDVx042788
27 DRG000018110
28 MDVx042392
29 DRG000019258
30 DRG000019432
31 SBx148
32 DRG000047300
33 MDVx002021
34 DRG000021931
35 DRG000025979
36 MDVx039006
37 DRG000027447
38 DRG000028512
39 DRG000029465
40 MDVx018682
41 DRG000030693
42 DRG000031925
43 DRG000047107
44 DRG000046916
 45 MDVx042835
46 MDVx042053
47 DRG000046770
48 DRG000047397
49 DRG000046944
50 MDVx042268
51 DRG000047173
52 DRG000047182
53 MDVx010642
54 DRG000044426
55 DRG000046912
56 DRG000045684
57 MDVx042244
58 MDVx042336
59 DRG000046225

Total Berat:
Total Koli:

Yang menerima

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 SURAT BUKTI
INSTALASI FARMASI DINAS K

: 422 / DROPING SEP 2018

: WONOKERTO II

Nama Obat/Perbekkes
2-4 KOMBINASI SALEP (POT 30 GRAM)
ACETYLCYSTEINE CAPSUL 200 MG(DUS, 10 STRIP @ 10 KAPSUL)
ALKOHOL CAIRAN OBAT LUAR 70 %(BOTOL 1000 ML)
AMINOPHYLLINE TABLET 200 MG(BOTOL @ 100 TABLET SALUT SELAPUT)
AMOXICILLIN CAPTABS 500 MG(DUS, 10 STRIP @ 10 KAPLET)
ANTIHEMOROID SUPPOSITORIA SUPPOSITORIA 2 GRAM(STRIP a 10 SUPPOSITORIA)
ASAM ASKORBAT Tablet 50 Mg(ASAM ASKORBAT (VIT C) 50 MG)
ASAM MAFENAMAT Tablet 500 Mg(ASAM MAFENAMAT TABLET 4 MG)
ATTAPULGITE TABLET 600 MG()
BEDAK SALICYL SERBUK OBAT LUAR 2 %(BOTOL PLASTIK 100 GRAM)
BENECHECK BLOOD GLUCOSE STRIP -()
BENECHECK TOTAL CHOLESTEROL STRIP -()
BENECHECK URIC ACID STRIP -()
BETAMETASON CREAM 0,1 %(DUS, 25 TUBE @ 5 GRAM)
BLOOD LANCET()
CAPTOPRIL TABLET 12,5 MG(DUS, 10 STRIP @ 10 TABLET)
CAVITON PASTA\n 30 GR()
CEFADROXIL CAPSUL 500 MG(DUS, 10 STRIP @ 10 CAPSUL)
CHLORAMPHENICOL BUFACETIN 2% SALEP KULIT 15 GR(BOX, 12 TUBE)
CHLORAMPHENICOL SALEP MATA 1%(TUBE 5 GRAM)
CIPROFLOXACIN TABLET SALUT SELAPUT 500 MG(DUS, 10 BLISTER @ 10 TABLET SALUT SELAPUT)
DEXAMETHASON TABLET 0.5 MG(DUS, 10 STRIP @ 10 TABLET)
EUGENOL LARUTAN \/ CAIRAN\n 10 ML(BOTOL 10 ML)
FOKUS HBsAg STRIP -()
FUJI IX ART LAIN-LAIN UNIT(FUJI IX ART)
GOLD LABEL 2 GLASS IONOMER POWDER 15 GR + LIQUID 10 GR (8.0 ML)(BOX, 1-1 PKG UNIVERSAL RESTORATIVE)
GRISEOFULVIN 125 TABLET 125 MG(BOX 10 STRIP @ 10 TAB)
HUMAN HEXAGON RDT SYPHILIS KIT -(20 TESTS)
HYDROCORTISON CREAM 2.5 %(TUBE 5 GRAM)
IBUPROFEN TABLET 200 MG(DUS, 10 STRIP @ 10 TABLET)
Kalsium Hidroksida Pasta()
KALSIUM LAKTAT TABLET 500 MG(KOTAK 100 TABLET)
KERTAS PUYER()
KLORFENIRAMINE MALEAT TABLET 4 MG(DUS,10 STRIP A 10 TABLET)
MICONAZOLE CREAM 2 %(DUS, 24 TUBE @ 10 G)
MISSION Plus Hb Hemoglobin Test Stips()
NATRIUM DIKLOFENAK TABLET SALUT ENTERIK 50 MG(5 STRIP a 10 TABLET)
NIFEDIPIN TABLET SALUT SELAPUT 10 MG(DUS, 10 STRIP @ 10 TABLET SALUT SELAPUT)
NYSTATIN TABLET SALUT SELAPUT 500.000 IU(DUS, 10 STRIP @ 10 TABLET SALUT SELAPUT)
ONEMED Plesterin Bulat()
ORALIT 200 SERBUK (SACHET A 5.5 GRAM)
PARASETAMOL SIRUP 120 MG/5 ML(BOTOL A 60 ML)
PARASETAMOL TABLET 500 MG(BOX, 10 STRIP @10 TABLET)
PIRIDOKSIN HCL (VIT. B6) TABLET 10 MG()
PLASTIK OBAT LAIN-LAIN 8,7 X 13(100 PIECES)
POT SPUTUM LAIN-LAIN\n -()
PULP-X \/ PULP DEVITALIZER PASTA 6 GR(POT)
ROEKO ENDO-FROST SPRAY 200 ML()
SD HIV-1\/2 3.0 (MULTI) KIT -()
SURGICAL MASK-3 PLY PLUS EARLOOP LAIN-LAIN -(BOX, 50 LEMBAR)
TABLET TAMBAH DARAH NEO TABLET -(10 STRIPS @10 FILM COATED TABLETS)
THIAMIN TABLET 50 MG(BOX, 10 STRIPS @10 TABLET)
VACUTAINER K3 EDTA 3 ML UNGU GRAINER()
VITAMIN B COMPLEX TABLET (DUS, 10 STRIP @ 10 TABLET)
VITAMIN B12 (SIANOKOBALAMIN) TABLET 50 MCG(BOX, 10 STRIP @10 TABLET)
XYLOCAINE GEL 2 %(DUS, 10 SYRINGE PLASTIK @ 10 G)
YELLOW TIP MIKROLIT LAIN-LAIN 200 MUI(PACK, 1000 PIECES)
ZIEHL NEELSEN LARUTAN \/ CAIRAN 100 ML()
ZINK TABLET DISPERSIBLE 20 MG(DUS, 10 STRIP @ 10 TABLET DISPERSIBEL)

Yang menerima

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 KELUAR (SBBK)
AN KABUPATEN PEKALONGAN

Satuan Jumlah Distribusi No. Batch Expired Harga (Rp)

POT 72 4802001--A13--2620 2020-02-28 2620
TABLET 5000 A21--EBE212E--350 2020-06-01 350
BOTTLE 2 21111688-2--25000 2020-10-01 25000
TABLET 400 17CG045--A1--89 2020-02-01 89
TABLET 10000 A30--270579--233 2021-12-01 233
SUPPOSITORY 60 A20--I72122W--3167 2021-09-01 3167
TABLET 10000 A20--72593B--105 2020-09-01 105
TABLET 5000 161854--106 2018-12-01 106
TABLET 1500 AK1131--145 2020-11-01 145
SACHET 100 AB0KFP0800--1025 2019-11-01 1025
STRIP 50 G17058056--2992 2019-05-01 2992
STRIP 50 B33--C18096069--23100 2019-10-01 23100
STRIP 50 B33--U18078065--5060 2019-12-01 5060
TUBE 100 A20--L719267--1340 2020-12-01 1340
PIECES 600 15051788--B18--145 2022-04-01 145.66
TABLET 1000 1511056--59 2019-12-01 59
PIECES 1 1702271--154000 2019-02-26 154000
TABLET 200 8B6581--A11--478 2020-02-01 478
TUBE 144 A24--10204805--3038 2021-04-01 3038
TUBE 100 A20--I72759W--1881 2020-10-01 1881
TABLET 1000 160997108--281 2020-09-01 281
TABLET 10000 00716L0120--41 2019-12-30 41
BOTTLE 1 L60574W--18100 2020-12-01 18100
STRIP 100 1720108--B7--10692 2019-10-31 10692
BOTTLE 1 1511051--521224 2018-12-01 521224
1 FUJI-GL2--335500 2020-08-01 335500
TABLET 300 A19--180204176--210 2020-02-01 210
TEST 200 17010-PROP-MAR18 2019-05-01 26635.5
TUBE 50 A20--L71823T--2475 2021-12-01 2475
TABLET 10000 A39--1807-14-177--105 2020-07-01 105
TUBE 1 17010--159500 2020-07-12 159500
TABLET 2000 172119--A2--59 2019-09-30 59
PIECES 50 K-PUYER--1000 2020-01-01 1000
TABLET 10000 T1153AF--37 2021-02-01 37
TUBE 50 A20--I7250800--3414 2021-09-01 3414
TEST 500 B25--HB8030032--8000 2020-02-01 8000
TABLET 10000 A26--16365050--115 2021-06-01 115
TABLET 1000 NIFEDIPIN--TAB--104 2020-05-01 104
TABLET 100 A8--16371004--790 2021-04-01 790
BOX 2 12071788--30800 2022-06-01 30800
SACHET 300 ORALIT-SACH--288 2020-12-01 288
BOTTLE 300 171109--1010 2019-06-01 1010
TABLET 25000 PARASET-TAB--49 2020-05-01 49
TABLET 3000 A20--1702024B--123 2020-08-01 123
PIECES 3000 AGS18--FILARIASIS--98 2024-03-01 98
PIECES 500 STERIL-PROP--5890 2020-03-01 5890
POT 1 1881601--246600 2018-12-01 246400
1 EF200ML--352000 2020-09-01 352000
TEST 100 03AMC005A-PROP-MAR18 2019-05-01 14340
200 6382018P12--B4--396 2023-02-01 396
TABLET 4980 TTD-DAK--352 2020-06-01 352
TABLET 10000 A39--1806-08-158--85 2022-06-01 85
PIECES 100 WITH-EDTA-PROG--1500 2023-03-01 1500
TABLET 4000 1856515--115 2020-09-01 115
TABLET 2000 17TH071--A1--46 2022-08-01 46
SYRINGE 1 T12812--A18--41600 2019-08-31 41600
PIECES 200 B16--YELLOW-TIP--175 2020-01-01 175.7
KIT 1 R-ZN--276500 2020-08-01 276500
TABLET 500 A22--K73351J--524 2019-11-01 524

PEKALONGAN, 2018-09-06
Yang menyerahkan/memeriksa

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Mengetahui,

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Jumlah (Rp) Keterangan
188640 DAK 2018
1750000 DAK 2018
50000 DAK 2017
35600 DAK 2018
2330000 DAK 2018
190020 DAK 2018
1050000 DAK 2018
530000 DAK 2017
217500 DAK 2017
102500 DAK 2017
149600 DAK 2017
1155000 DAK 2018
253000 DAK 2018
134000 DAK 2018
87396 DAK 2018
59000 DAK 2017
154000 DAK 2017
95600 DAK 2018
437472 DAK 2018
188100 DAK 2018
281000 DAK 2017
410000 DAK 2017
18100 DAK 2017
1069200 DAK 2018
521224 DAK 2017
335500 DAK 2017
63000 DAK 2018
5327100 APBN 2018
123750 DAK 2018
1050000 DAK 2018
159500 DAK 2017
118000 DAK 2018
50000 DAK 2017
370000 DAK 2017
170700 DAK 2018
4000000 DAK 2018
1150000 DAK 2018
104000 DAK 2017
79000 DAK 2018
61600 DAK 2017
86400 DAK 2017
303000 DAK 2017
1225000 DAK 2017
369000 DAK 2018
 294000 APBN 2018
2945000 APBN 2017
246400 DAK 2017
352000 DAK 2017
1434000 APBN 2018
79200 DAK 2018
1752960 DAK 2017
850000 DAK 2018
150000 Lain-lain 2018
460000 DAK 2017
92000 DAK 2018
41600 DAK 2018
35140 DAK 2018
276500 APBN 2017
262000 DAK 2018
35873302

PEKALONGAN, 2018-09-06
Yang menyerahkan/memeriksa

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