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PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMBUAN
SERUYAN
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN SERUYAN
SURAT PERMINTAAN BARANG (SPB)
Nomor : .........................................

Unit Pemakai Barang


Tanggal
CEPAT : Instalasi Farmasi Rawat Jalan
: 01 Februari 2015

No
1 Aclam dry sirup
Nama Barang
TEPAT Satuan
Btl 60ml
Volume Keterangan
5
2 Acyclovir 200mg Tablet 910
3
4
5
Acyclovir 400 mg
Albendazol tab 400 mg
Alinamin F tablet
SEMBUH Tablet
Tablet
Tablet
46
289
175
6 Allopurinol 100mg tablet Tablet 945
7 Allopurinol 300mg tablet Tablet 1325
8 Alpara tab Tablet 60
9 Ambeven Kapsul 190
10 Ambroxol sirup Botol 4
11 Ambroxol tablet 30mg Tablet 226
12 Amitripilin Tablet Salut 25 mg (HCI) Tablet 940
13 Amlodipin Tablet 10 mg Tablet 180
14 Amlodipin Tablet 5 mg Tablet 45
15 Amoxicilin Sirup Botol 7
16 Amoxicillin 250mg Tablet 181
17 Amoxicillin tablet 500mg Tablet 2660
18 Ampicilin tab 500mg Tablet 447
Analog Insulin Long Acting Inj Disposibele/ Solostar 10
19 Penfill Catridge
20 Antalgin 500mg Tablet 260
21 Antasida Doen Tablet Tablet 480
22 Apyalis syr Botol 18
23 Asam Asetil Salisilat Tablet 410
24 Asam Askorbat (Vitamin C) Tablet 50 mg Tablet 930
25 Asam Mefenamat 500mg Tablet 510
26 Asam Traneksamat 500mg Tablet 44
27 Asedas sirup Btl 60ml 4
28 Aspar-K Tablet 565
29 Asthin Force Tablet 84
30 Azitromicyn 500 mg Tablet 151
31 Besi (II) Sulfat 7 H2O tablet salut Kombinasi Tablet 3000
32 Betadine 30ml Botol 30ml 3
33 Bisoprolol Tablet 5 mg Tablet 18
34 Bralin 500 mg Tablet 85
35 Bronkris tablet Tablet 100
36 Budisonid respules ( Pulmicort ) Respule 20
37 Buscopan Tablet 190
38 Captopril 25mg Tablet 726
39 Captopril tab 12,5mg Tablet 731
40 Cavilex tab Tablet 75
41 Cefadroxyl kaps 500mg Kapsul 249
42 Cimetidine Tablet 100
43 Ciprofloxacin 500mg Tablet 628
44 Clabat tablet Tablet 6
45 Clindamicin 150 Tablet 200
46 Clindamicin 300mg Tablet 85
47 Clonidin Tablet 200
48 Cloramphenicol TT Btl 7
49 Clorfeniramine maleat tab 4mg Tablet 1000
50 Cobazim 1000 Tablet 88
51 Colfin Tablet 500
52 Cotrimoksazole pediatrik Tablet 160
53 Cotrimoxazole Sirup Botol 7
54 Cotrimoxsazole 480mg Tablet 265
55 Curcuma Plus DHA sy Btl 60ml 5
56 Curcuma Plus Imuns Syr Btl 60 ml 3
57 Curcuma tablet Tablet 165
58 Deprezac 20mg kapl Kapsul 150
59 Dexamethasone 0,5mg talet Tablet 230
60 Dexanta tablet Tablet 130
61 Dexclosan tablet Tablet 440
62 Diazepam tablet 2mg Tablet 100
63 Diazepam tablet 5mg Tablet 250
64 Digoxin tablet Tablet 250
65 Dimenhidrinat 50mg Tablet 193
66 Dionicol Tablet 280
67 Domperidon tab 10 mg Tablet 500
68 Domperidone Drop Botol 19
69 Domperidone Sirup Botol 4
70 Dopamet tab 250mg Tablet 178
71 Dulcolax Tab Tablet 376
72 Duvadilan Tablet 99
73 Erlaquin tab 250mg Tablet 180
74 Eryra 500 mg ** Tablet 61
75 Erytromicin 250mg caps 95
76 Erytromicin Sirup Botol 11
77 Etadexta Tablet 170
78 Etambuthol tab 500mg Tablet 370
79 Ethil Klorida spray Botol 3
80 Faryzol sy 60 ml 7
81 Fenitoin kapsul 100 mg tablet 86
82 Fladystin ovule Ovules 20
83 Flagyl ( metronidazole Supp ) Supp 20
84 Flamar Tablet 437
85 Folavit tabl 400 mg Tablet 180
86 Forbetes 500mg Tablet 500
87 Forten 25mg Tablet 40
88 Forumen tetes telinga Btl 1
89 Fudan 100mg tablet Tablet 28
90 Fudan 50 mg Tablet 222
91 Fudan sirup Botol 60ml 5
92 Furosemide 40mg Tablet 3330
93 Galfluk Tablet 100
94 Garam Oralit Serbuk Sachet 75
95 Gemfibrozil Kaps 300 mg Kapsul 885
96 Gentamisin Salep Mata 0,3% ( Genoint ) Tube 48
97 Glibenclamide tab 5mg Tablet 784
98 Glicab Tablet 600
99 Glimepirid 1 Mg Tablet 250
100 Glimepirid 3 mg Tablet 238
101 Glucosamin tab Tablet 230
102 Glukolos ( Glikasit) Tablet 420
103 Gravinon Tablet 225
104 Haloperidol Tablet 5 mg Tablet 500
105 Hydrocortisone cream tube 48
106 Ibuprofen 200 mg Tablet 354
107 Ibuprofen suspensi 100mg/5ml Botol/ 60 ml 32
108 Ibuprofen tab 400mg Tablet 554
109 Imudator syrup Btl 60ml 2
110 Irbesartan Tab 300 mg Tablet 250
111 Isiprinol syr Botol 60ml 4
112 Isoniazide Tablet 486
113 Isosobrid Dinitrat Tab 5 mg Tablet 25
114 Kalbion Tablet 1024
115 Kalium Aspartat Tab 300 mg (kalipar) Tablet 450
116 Kalium Diklofenak 50mg Tablet 228
117 Kalnex 250 mg Tablet 89
118 Kalsium Laktat Tablet 734
119 Karbamazepine 200 mg Tablet 426
120 Ketocid kaplet Tablet 120
121 Ketokonazole Tablet 200 mg Tablet 400
122 Kidimun sirup Botol 1
123 Klorokuin tablet Tablet 184
124 Kodein Tablet 10 mg Tablet 100
125 Kodein Tablet 20 mg Tablet 100
126 Kombinasi Salmeterol 25 ml flutikason / seretide Flash 3
127 Kompolax Sirup Botol 3
128 Lapifed Tablet 150
129 Lasal syrup Btl 100ml 13
130 Lerzin ( Cetirizine ) Tablet 295
131 Lerzin sirup Botol 5
132 Letonal 25 mg ( Spinorolactone ) Tablet 140
133 Libronil tablet Tablet 400
134 Lisinopril Tablet 10 mg Tablet 1168
135 Lisinopril Tablet 5 mg Tablet 310
136 Loperamid 2mg Tablet 9
137 Mediamer B6 Tablet 120
138 Megabal ( mecobalamin ) Tablet 165
139 Meloxicam 15mg Tablet 445
140 Meloxicam 7,5mg Tablet 10
141 Metformin 500 mg Tablet 335
142 Methicol Tablet 335
143 Methylergometrin Tablet Tablet 240
144 Methylprednisolon 4mg Tablet 44
145 Metolon tab Tablet 500
146 Metronidazole 250mg Tablet 379
147 Metronidazole 500mg Tablet 200
148 Mikonazol Krim/Salep 2% Tube 8
149 Motilex 2mg Tablet 222
150 Mucos drop Botol 1
151 Mucotein 3mg tab Tablet 60
152 Mucotein syrup Botol 4
153 Musin Tablet Tablet 160
154 Nairet Tablet Tablet 600
155 Natrium diklofenak 25mg Tablet 91
156 Natrium diklofenak 50 mg Tablet 519
157 Nephrolit Tablet 10
158 Neuraxon 5000 tab Tablet 330
159 Neuroviron V Kapsul 110
160 Nexa tablet Tablet 436
161 Nifedipin Tablet 12
162 Norit Tablet 400
163 Nystatin Supp 34
164 Obimin Tablet 30
165 Ofloxacin 200 mg Tablet 140
166 Ofloxacin 400mg Tablet 90
167 Olanzapin Tab Tablet 71
168 Omeprazole Kapsul 103
169 Opiclam Tablet 156
170 Opilax sirup Botol 10
171 Otsu WI 25ml (aquadest steril) ampul 6
172 Oxycobal Tablet 410
173 Paracetamol Sirup 120 mg/5 Botol 71
174 Paracetamol tab 500mg Tablet 895
175 Piracetam 400mg Tablet 140
176 Piracetam 800mg Tablet 334
177 Piralen Sirup Botol 1
178 Pirantel Suspensi 125 mg/ 5 ml Botol 5
179 Piroxicam tab 10mg Tablet 1230
180 Postinor Tablet 16
181 Prednison Tablet 454
182 Premaston tab Tablet 15
183 Primadex Sirup (Cotri sirup) Botol 1
184 Primaquin Tablet 1000
185 Primolut N Tablet 124
186 Profertil Tablet 20
187 Propanolol 10mg Tablet 692
188 Propanolol 40 mg Tablet 50
189 Provomer Tablet 480
190 Pularex Tablet 70
191 Pyrazinamide 500mg Tablet 150
192 Quinne Tablet 60
193 Ramoxyl 500mg Tablet 815
194 Ranitidin Tablet 150 mg Tablet 610
195 Renadinac 25mg Tablet 179
196 Rifampicin 600mg tablet Tablet 100
197 Salbutamol 2 mg Tablet 220
198 Salisil Bedak 2 % Pcs 3
199 Scopma tablet Tablet 445
200 Scopma plus Tablet 20
201 Sefiksim Kapsul 100mg Tablet 3184
202 Sefixime Sirup Botol 42
203 Setirizin Tablet 10 mg Tablet 390
204 Simvastatin 10 mg Tablet 120
205 Simvastatin 20mg Tablet 465
206 Sofero Tablet 10
207 Spasminal Tablet 203
208 Spuit 3 cc ( stera 3 cc ) Pcs 100
209 Sukrakfat Susp 500 mg/ 5 ml Botol 1
210 Takana sirup Boto 4
211 Teosal Tablet 125
212 Thiamphenicol Kapsul 475
213 Tramadol Tablet 140
214 Tremenza sirup Botol 60ml 6
215 Valproat Sirup Botol 12
216 Vectrin sirup Botol 60ml 4
217 Vit K tablet Tablet 200
218 Vitamin B 6 Tablet 1026
219 Vitamin B Kompleks Tablet Tablet 970
220 Vitamin B1 Tablet 3966
221 Vitazim Tablet 1002
222 Zibramax sirup Botol 2
223 Zinc drop 20 mg/ 5 MI Botol 5
224 Zinc Tablet Dispersible 20 mg Tablet 650
225 Zircum kid Sirup Botol 6

Kuala Pembuang, 31 Januari 2015


Mengetahui, Yang Mengajukan
Pengguna Barang Permintaan,

dr. Riza Syahputra Rini Yeni Susanti, S.Farm., Apt


NIP. 19760903 200802 1 002 NIP. 19790610 201001 2 006
EMBUANG
UYAN
SERUYAN
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN SERU
SURAT PERINTAH PENGELUARAN/ PENYALURAN BARANG
Nomor : ........................................................

Dari
Kepada
: Pengguna Barang CEPAT
: Koordiantor Instalasi Farmasi Rawat Inap

TEPAT
Harap dikeluarkan dari tempat penyimpanan dan disalurkan barang yang tersebut dalam daftar
di bawah ini untuk instalasi Farmasi Rawat Jalan.

Berdasarkan Surat Permintaan Barang:

No Volume Satuan Nama Barang


SEMBUH Harga satuan Jumlah Keterangan
1 5 Btl 60ml Aclam dry sirup Rp 64,020 Rp 320,100
2 910 Tablet Acyclovir 200mg Rp 245 Rp 222,950
3 46 Tablet Acyclovir 400 mg Rp 340 Rp 15,640
4 289 Tablet Albendazol tab 400 mg Rp 425 Rp 122,825
5 175 Tablet Alinamin F tablet Rp 551 Rp 96,422
6 945 Tablet Allopurinol 100mg tablet Rp 145 Rp 137,214
7 1325 Tablet Allopurinol 300mg tablet Rp 74 Rp 97,480
8 60 Tablet Alpara tab Rp 619 Rp 37,125
9 190 Kapsul Ambeven Rp 1,467 Rp 278,751
10 4 Botol Ambroxol sirup Rp 3,630 Rp 14,520
11 226 Tablet Ambroxol tablet 30mg Rp 138 Rp 31,093
12 940 Tablet Amitripilin Tablet Salut 25 mg (HCI) Rp 123 Rp 115,620
13 180 Tablet Amlodipin Tablet 10 mg Rp 352 Rp 63,360
14 45 Tablet Amlodipin Tablet 5 mg Rp 197 Rp 8,865
15 7 Botol Amoxicilin Sirup Rp 4,070 Rp 28,490
16 181 Tablet Amoxicillin 250mg Rp 301 Rp 54,494
17 2660 Tablet Amoxicillin tablet 500mg Rp 407 Rp 1,082,620
18 447 Tablet Ampicilin tab 500mg Rp 407 Rp 181,929
Solostar Analog Insulin Long Acting Inj
19 10 Disposibele/ Penfill Catridge Rp 85,000 Rp 850,000
20 260 Tablet Antalgin 500mg Rp 193 Rp 50,180
21 480 Tablet Antasida Doen Tablet Rp 78 Rp 37,440
22 18 Botol Apyalis syr Rp 32,010 Rp 576,180
23 410 Tablet Asam Asetil Salisilat Rp 110 Rp 45,100
24 930 Tablet Asam Askorbat (Vitamin C) Tablet 50 mg Rp 105 Rp 97,650
25 510 Tablet Asam Mefenamat 500mg Rp 171 Rp 86,955
26 44 Tablet Asam Traneksamat 500mg Rp 1,306 Rp 57,475
27 4 Btl 60ml Asedas sirup Rp 37,345 Rp 149,380
28 565 Tablet Aspar-K Rp 3,000 Rp 1,695,000
29 84 Tablet Asthin Force Rp 9,625 Rp 808,500
30 151 Tablet Azitromicyn 500 mg Rp 4,613 Rp 696,563
Tablet Besi (II) Sulfat 7 H2O tablet salut
31 3000 Kombinasi Rp 45 Rp 135,000
32 3 Botol 30ml Betadine 30ml Rp 15,738 Rp 47,214
33 18 Tablet Bisoprolol Tablet 5 mg Rp 695 Rp 12,510
34 85 Tablet Bralin 500 mg Rp 12,004 Rp 1,020,317
35 100 Tablet Bronkris tablet Rp 116 Rp 11,625
36 20 Respule Budisonid respules ( Pulmicort ) Rp 8,900 Rp 178,000
37 190 Tablet Buscopan Rp 2,057 Rp 390,862
38 726 Tablet Captopril 25mg Rp 152 Rp 110,011
39 731 Tablet Captopril tab 12,5mg Rp 99 Rp 72,369
40 75 Tablet Cavilex tab Rp 464 Rp 34,811
41 249 Kapsul Cefadroxyl kaps 500mg Rp 770 Rp 191,730
42 100 Tablet Cimetidine Rp 79 Rp 7,949
43 628 Tablet Ciprofloxacin 500mg Rp 312 Rp 196,187
44 6 Tablet Clabat tablet Rp 2,730 Rp 16,380
45 200 Tablet Clindamicin 150 Rp 405 Rp 81,000
46 85 Tablet Clindamicin 300mg Rp 579 Rp 49,215
47 200 Tablet Clonidin Rp 224 Rp 44,800
48 7 Btl Cloramphenicol TT Rp 1,759 Rp 12,313
49 1000 Tablet Clorfeniramine maleat tab 4mg Rp 26 Rp 26,400
50 88 Tablet Cobazim 1000 Rp 2,860 Rp 251,680
51 500 Tablet Colfin Rp 450 Rp 225,000
52 160 Tablet Cotrimoksazole pediatrik Rp 92 Rp 14,720
53 7 Botol Cotrimoxazole Sirup Rp 2,213 Rp 15,491
54 265 Tablet Cotrimoxsazole 480mg Rp 152 Rp 40,333
55 5 Btl 60ml Curcuma Plus DHA sy Rp 13,337 Rp 66,685
56 3 Btl 60 ml Curcuma Plus Imuns Syr Rp 13,337 Rp 40,011
57 165 Tablet Curcuma tablet Rp 880 Rp 145,245
58 150 Kapsul Deprezac 20mg kapl Rp 5,113 Rp 766,905
59 230 Tablet Dexamethasone 0,5mg talet Rp 81 Rp 18,630
60 130 Tablet Dexanta tablet Rp 242 Rp 31,493
61 440 Tablet Dexclosan tablet Rp 143 Rp 63,083
62 100 Tablet Diazepam tablet 2mg Rp 39 Rp 3,900
63 250 Tablet Diazepam tablet 5mg Rp 65 Rp 16,250
64 250 Tablet Digoxin tablet Rp 92 Rp 22,883
65 193 Tablet Dimenhidrinat 50mg Rp 107 Rp 20,651
66 280 Tablet Dionicol Rp 450 Rp 126,000
67 500 Tablet Domperidon tab 10 mg Rp 174 Rp 87,000
68 19 Botol Domperidone Drop Rp 17,100 Rp 324,900
69 4 Botol Domperidone Sirup Rp 3,490 Rp 13,960
70 178 Tablet Dopamet tab 250mg Rp 2,134 Rp 379,852
71 376 Tablet Dulcolax Tab Rp 1,067 Rp 401,030
72 99 Tablet Duvadilan Rp 6,669 Rp 660,205
73 180 Tablet Erlaquin tab 250mg Rp 260 Rp 46,827
74 61 Tablet Eryra 500 mg ** Rp 690 Rp 42,090
75 95 caps Erytromicin 250mg Rp 509 Rp 48,355
76 11 Botol Erytromicin Sirup Rp 8,090 Rp 88,990
77 170 Tablet Etadexta Rp 450 Rp 76,500
78 370 Tablet Etambuthol tab 500mg Rp 386 Rp 142,761
79 3 Botol Ethil Klorida spray Rp 111,550 Rp 334,650
80 7 60 ml Faryzol sy Rp 6,000 Rp 42,000
81 86 tablet Fenitoin kapsul 100 mg Rp 134 Rp 11,524
82 20 Ovules Fladystin ovule Rp 18,546 Rp 370,928
83 20 Supp Flagyl ( metronidazole Supp ) Rp 3,655 Rp 73,100
84 437 Tablet Flamar Rp 200 Rp 87,400
85 180 Tablet Folavit tabl 400 mg Rp 880 Rp 158,449
86 500 Tablet Forbetes 500mg Rp 105 Rp 52,500
87 40 Tablet Forten 25mg Rp 5,981 Rp 239,240
88 1 Btl Forumen tetes telinga Rp 28,509 Rp 28,509
89 28 Tablet Fudan 100mg tablet Rp 10,003 Rp 280,087
90 222 Tablet Fudan 50 mg Rp 16,312 Rp 3,621,264
91 5 Botol 60ml Fudan sirup Rp 86,693 Rp 433,465
92 3330 Tablet Furosemide 40mg Rp 36 Rp 119,813
93 100 Tablet Galfluk Rp 8,440 Rp 844,000
94 75 Sachet Garam Oralit Serbuk Rp 317 Rp 23,775
95 885 Kapsul Gemfibrozil Kaps 300 mg Rp 306 Rp 270,810
96 48 Tube Gentamisin Salep Mata 0,3% ( Genoint ) Rp 2,786 Rp 133,728
97 784 Tablet Glibenclamide tab 5mg Rp 66 Rp 51,744
98 600 Tablet Glicab Rp 284 Rp 170,400
99 250 Tablet Glimepirid 1 Mg Rp 272 Rp 68,000
100 238 Tablet Glimepirid 3 mg Rp 414 Rp 98,532
101 230 Tablet Glucosamin tab Rp 2,134 Rp 490,820
102 420 Tablet Glukolos ( Glikasit) Rp 284 Rp 119,280
103 225 Tablet Gravinon Rp 4,744 Rp 1,067,400
104 500 Tablet Haloperidol Tablet 5 mg Rp 105 Rp 52,500
105 48 tube Hydrocortisone cream Rp 2,868 Rp 137,664
106 354 Tablet Ibuprofen 200 mg Rp 121 Rp 42,834
107 32 Botol/ 60 ml Ibuprofen suspensi 100mg/5ml Rp 3,811 Rp 121,952
108 554 Tablet Ibuprofen tab 400mg Rp 198 Rp 109,692
109 2 Btl 60ml Imudator syrup Rp 65,353 Rp 130,706
110 250 Tablet Irbesartan Tab 300 mg Rp 2,717 Rp 679,250
111 4 Botol 60ml Isiprinol syr Rp 86,693 Rp 346,772
112 486 Tablet Isoniazide Rp 49 Rp 23,814
113 25 Tablet Isosobrid Dinitrat Tab 5 mg Rp 98 Rp 2,450
114 1024 Tablet Kalbion Rp 440 Rp 450,693
115 450 Tablet Kalium Aspartat Tab 300 mg (kalipar) Rp 739 Rp 332,550
116 228 Tablet Kalium Diklofenak 50mg Rp 425 Rp 96,900
117 89 Tablet Kalnex 250 mg Rp 11,040 Rp 982,560
118 734 Tablet Kalsium Laktat Rp 56 Rp 40,939
119 426 Tablet Karbamazepine 200 mg Rp 267 Rp 113,742
120 120 Tablet Ketocid kaplet Rp 8,269 Rp 992,310
121 400 Tablet Ketokonazole Tablet 200 mg Rp 320 Rp 128,000
122 1 Botol Kidimun sirup Rp 38,678 Rp 38,678
123 184 Tablet Klorokuin tablet Rp 44 Rp 8,128
124 100 Tablet Kodein Tablet 10 mg Rp 550 Rp 55,000
125 100 Tablet Kodein Tablet 20 mg Rp 1,210 Rp 121,000
126 3 Flash Kombinasi Salmeterol 25 ml flutikason / s Rp 99,733 Rp 299,199
127 3 Botol Kompolax Sirup Rp 7,563 Rp 22,689
128 150 Tablet Lapifed Rp 2,001 Rp 300,093
129 13 Btl 100ml Lasal syrup Rp 24,674 Rp 320,762
130 295 Tablet Lerzin ( Cetirizine ) Rp 190 Rp 56,050
131 5 Botol Lerzin sirup Rp 11,495 Rp 57,475
132 140 Tablet Letonal 25 mg ( Spinorolactone ) Rp 1,716 Rp 240,240
133 400 Tablet Libronil tablet Rp 66 Rp 26,400
134 1168 Tablet Lisinopril Tablet 10 mg Rp 660 Rp 770,880
135 310 Tablet Lisinopril Tablet 5 mg Rp 385 Rp 119,350
136 9 Tablet Loperamid 2mg Rp 99 Rp 891
137 120 Tablet Mediamer B6 Rp 3,218 Rp 386,100
138 165 Tablet Megabal ( mecobalamin ) Rp 31,460 Rp 5,190,900
139 445 Tablet Meloxicam 15mg Rp 1,319 Rp 586,911
140 10 Tablet Meloxicam 7,5mg Rp 761 Rp 7,611
141 335 Tablet Metformin 500 mg Rp 182 Rp 60,803
142 335 Tablet Methicol Rp 1,238 Rp 414,563
143 240 Tablet Methylergometrin Tablet Rp 169 Rp 40,560
144 44 Tablet Methylprednisolon 4mg Rp 538 Rp 23,692
145 500 Tablet Metolon tab Rp 342 Rp 170,885
146 379 Tablet Metronidazole 250mg Rp 129 Rp 48,891
147 200 Tablet Metronidazole 500mg Rp 169 Rp 33,800
148 8 Tube Mikonazol Krim/Salep 2% Rp 3,075 Rp 24,600
149 222 Tablet Motilex 2mg Rp 99 Rp 21,978
150 1 Botol Mucos drop Rp 40,012 Rp 40,012
151 60 Tablet Mucotein 3mg tab Rp 6,235 Rp 374,115
152 4 Botol Mucotein syrup Rp 41,079 Rp 164,316
153 160 Tablet Musin Tablet Rp 834 Rp 133,374
154 600 Tablet Nairet Tablet Rp 1,134 Rp 680,208
155 91 Tablet Natrium diklofenak 25mg Rp 152 Rp 13,832
156 519 Tablet Natrium diklofenak 50 mg Rp 239 Rp 124,269
157 10 Tablet Nephrolit Rp 798 Rp 7,975
158 330 Tablet Neuraxon 5000 tab Rp 2,534 Rp 836,260
159 110 Kapsul Neuroviron V Rp 599 Rp 65,852
160 436 Tablet Nexa tablet Rp 1,471 Rp 641,465
161 12 Tablet Nifedipin Rp 115 Rp 1,380
162 400 Tablet Norit € 286.00 Rp 114,400
163 34 Supp Nystatin Rp 448 Rp 15,232
164 30 Tablet Obimin Rp 1,444 Rp 43,333
165 140 Tablet Ofloxacin 200 mg Rp 519 Rp 72,660
166 90 Tablet Ofloxacin 400mg Rp 720 Rp 64,800
167 71 Tablet Olanzapin Tab Rp 12,320 Rp 874,720
168 103 Kapsul Omeprazole Rp 221 Rp 22,763
169 156 Tablet Opiclam Rp 2,145 Rp 334,620
170 10 Botol Opilax sirup Rp 44,013 Rp 440,130
171 6 ampul Otsu WI 25ml (aquadest steril) Rp 2,668 Rp 16,008
172 410 Tablet Oxycobal Rp 550 Rp 225,500
173 71 Botol Paracetamol Sirup 120 mg/5 Rp 2,530 Rp 179,630
174 895 Tablet Paracetamol tab 500mg Rp 116 Rp 103,373
175 140 Tablet Piracetam 400mg Rp 194 Rp 27,160
176 334 Tablet Piracetam 800mg Rp 321 Rp 107,214
177 1 Botol Piralen Sirup Rp 2,310 Rp 2,310
178 5 Botol Pirantel Suspensi 125 mg/ 5 ml Rp 9,100 Rp 45,500
179 1230 Tablet Piroxicam tab 10mg Rp 72 Rp 89,138
180 16 Tablet Postinor Rp 17,188 Rp 275,008
181 454 Tablet Prednison Rp 143 Rp 64,791
182 15 Tablet Premaston tab Rp 4,757 Rp 71,355
183 1 Botol Primadex Sirup (Cotri sirup) Rp 5,500 Rp 5,500
184 1000 Tablet Primaquin Rp 147 Rp 147,000
185 124 Tablet Primolut N Rp 2,618 Rp 324,632
186 20 Tablet Profertil Rp 18,838 Rp 376,760
187 692 Tablet Propanolol 10mg Rp 85 Rp 58,820
188 50 Tablet Propanolol 40 mg Rp 133 Rp 6,655
189 480 Tablet Provomer Rp 2,338 Rp 1,122,000
190 70 Tablet Pularex Rp 220 Rp 15,400
191 150 Tablet Pyrazinamide 500mg Rp 242 Rp 36,300
192 60 Tablet Quinne Rp 160 Rp 9,600
193 815 Tablet Ramoxyl 500mg Rp 450 Rp 366,750
194 610 Tablet Ranitidin Tablet 150 mg Rp 128 Rp 78,080
195 179 Tablet Renadinac 25mg Rp 476 Rp 85,254
196 100 Tablet Rifampicin 600mg tablet Rp 830 Rp 83,000
197 220 Tablet Salbutamol 2 mg Rp 92 Rp 20,335
198 3 Pcs Salisil Bedak 2 % Rp 1,180 Rp 3,540
199 445 Tablet Scopma tablet Rp 330 Rp 146,850
200 20 Tablet Scopma plus Rp 651 Rp 13,020
201 3184 Tablet Sefiksim Kapsul 100mg Rp 899 Rp 2,862,416
202 42 Botol Sefixime Sirup Rp 9,400 Rp 394,800
203 390 Tablet Setirizin Tablet 10 mg Rp 190 Rp 74,100
204 120 Tablet Simvastatin 10 mg Rp 180 Rp 21,600
205 465 Tablet Simvastatin 20mg Rp 480 Rp 223,200
206 10 Tablet Sofero Rp 534 Rp 5,335
207 203 Tablet Spasminal Rp 743 Rp 150,728
208 100 Pcs Spuit 3 cc ( stera 3 cc ) Rp 650 Rp 65,000
209 1 Botol Sukrakfat Susp 500 mg/ 5 ml Rp 14,450 Rp 14,450
210 4 Boto Takana sirup Rp 25,341 Rp 101,364
211 125 Tablet Teosal Rp 270 Rp 33,768
212 475 Kapsul Thiamphenicol Rp 440 Rp 209,000
213 140 Tablet Tramadol Rp 354 Rp 49,588
214 6 Botol 60ml Tremenza sirup Rp 16,638 Rp 99,828
215 12 Botol Valproat Sirup Rp 41,800 Rp 501,600
216 4 Botol 60ml Vectrin sirup Rp 42,680 Rp 170,720
217 200 Tablet Vit K tablet Rp 697 Rp 139,400
218 1026 Tablet Vitamin B 6 Rp 19 Rp 19,638
219 970 Tablet Vitamin B Kompleks Tablet Rp 24 Rp 23,687
220 3966 Tablet Vitamin B1 Rp 26 Rp 104,179
221 1002 Tablet Vitazim Rp 694 Rp 694,937
222 2 Botol Zibramax sirup Rp 121,550 Rp 243,100
223 5 Botol Zinc drop 20 mg/ 5 MI Rp 14,160 Rp 70,800
224 650 Tablet Zinc Tablet Dispersible 20 mg Rp 521 Rp 338,650
225 6 Botol Zircum kid Sirup Rp 8,140 Rp 48,840

Kuala Pembuang, 31 Januari 2015


Pengguna Barang,

dr. Riza Syahputra


NIP. 19760903 200802 1 002
EMBUANG
UYAN
AH
H
SERUYAN
T
T
UH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMBU
SERUYAN
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN
BERITA ACARA SERAH TERIMA
SERUY
Nomor : ......................................

Kami yang bertanda tangan di bawah ini:


1. Nama : Rica Hajianti, S.Far., Apt
CEPAT
TEPAT
NIP : 19801105 201001 2 010
Jabatan : Koordinator Instalasi Farmasi Rawat Inap

SEMBUH
2. Nama : Rini yeni Susanti, S.Farm.,Apt
NIP : 19790610 201001 2 006
Jabatan : Koordinator Instalasi Farmasi Rawat Jalan

Telah melaksanakan serah terima barang sebagaimana tersebut dalam daftar di bawah ini:

No Nama Barang Satuan Volume Harga satuan Jumlah Harga


1 Aclam dry sirup Btl 60ml 5 Rp 64,020 Rp 320,100
2 Acyclovir 200mg Tablet 910 Rp 245 Rp 222,950
3 Acyclovir 400 mg Tablet 46 Rp 340 Rp 15,640
4 Albendazol tab 400 mg Tablet 289 Rp 425 Rp 122,825
5 Alinamin F tablet Tablet 175 Rp 551 Rp 96,422
6 Allopurinol 100mg tablet Tablet 945 Rp 145 Rp 137,214
7 Allopurinol 300mg tablet Tablet 1325 Rp 74 Rp 97,480
8 Alpara tab Tablet 60 Rp 619 Rp 37,125
9 Ambeven Kapsul 190 Rp 1,467 Rp 278,751
10 Ambroxol sirup Botol 4 Rp 3,630 Rp 14,520
11 Ambroxol tablet 30mg Tablet 226 Rp 138 Rp 31,093
Amitripilin Tablet Salut 25 mg Tablet 940 Rp 123
12 (HCI) Rp 115,620
13 Amlodipin Tablet 10 mg Tablet 180 Rp 352 Rp 63,360
14 Amlodipin Tablet 5 mg Tablet 45 Rp 197 Rp 8,865
15 Amoxicilin Sirup Botol 7 Rp 4,070 Rp 28,490
16 Amoxicillin 250mg Tablet 181 Rp 301 Rp 54,494
17 Amoxicillin tablet 500mg Tablet 2660 Rp 407 Rp 1,082,620
18 Ampicilin tab 500mg Tablet 447 Rp 407 Rp 181,929
Analog Insulin Long Acting Inj
Solostar 10 Rp 85,000
19 Disposibele/ Penfill Catridge Rp 850,000
20 Antalgin 500mg Tablet 260 Rp 193 Rp 50,180
21 Antasida Doen Tablet Tablet 480 Rp 78 Rp 37,440
22 Apyalis syr Botol 18 Rp 32,010 Rp 576,180
23 Asam Asetil Salisilat Tablet 410 Rp 110 Rp 45,100
Asam Askorbat (Vitamin C) Tablet Tablet 930 Rp 105
24 50 mg Rp 97,650
25 Asam Mefenamat 500mg Tablet 510 Rp 171 Rp 86,955
26 Asam Traneksamat 500mg Tablet 44 Rp 1,306 Rp 57,475
27 Asedas sirup Btl 60ml 4 Rp 37,345 Rp 149,380
28 Aspar-K Tablet 565 Rp 3,000 Rp 1,695,000
29 Asthin Force Tablet 84 Rp 9,625 Rp 808,500
30 Azitromicyn 500 mg Tablet 151 Rp 4,613 Rp 696,563
Besi (II) Sulfat 7 H2O tablet salut
Tablet 3000 Rp 45
31 Kombinasi Rp 135,000
Betadine 30ml Botol 30ml 3 Rp 15,738
32 Rp 47,214
33 Bisoprolol Tablet 5 mg Tablet 18 Rp 695 Rp 12,510
34 Bralin 500 mg Tablet 85 Rp 12,004 Rp 1,020,317
35 Bronkris tablet Tablet 100 Rp 116 Rp 11,625
36 Budisonid respules ( Pulmicort ) Respule 20 Rp 8,900 Rp 178,000
37 Buscopan Tablet 190 Rp 2,057 Rp 390,862
38 Captopril 25mg Tablet 726 Rp 152 Rp 110,011
39 Captopril tab 12,5mg Tablet 731 Rp 99 Rp 72,369
40 Cavilex tab Tablet 75 Rp 464 Rp 34,811
41 Cefadroxyl kaps 500mg Kapsul 249 Rp 770 Rp 191,730
42 Cimetidine Tablet 100 Rp 79 Rp 7,949
43 Ciprofloxacin 500mg Tablet 628 Rp 312 Rp 196,187
44 Clabat tablet Tablet 6 Rp 2,730 Rp 16,380
45 Clindamicin 150 Tablet 200 Rp 405 Rp 81,000
46 Clindamicin 300mg Tablet 85 Rp 579 Rp 49,215
47 Clonidin Tablet 200 Rp 224 Rp 44,800
48 Cloramphenicol TT Btl 7 Rp 1,759 Rp 12,313
49 Clorfeniramine maleat tab 4mg Tablet 1000 Rp 26 Rp 26,400
50 Cobazim 1000 Tablet 88 Rp 2,860 Rp 251,680
51 Colfin Tablet 500 Rp 450 Rp 225,000
52 Cotrimoksazole pediatrik Tablet 160 Rp 92 Rp 14,720
53 Cotrimoxazole Sirup Botol 7 Rp 2,213 Rp 15,491
54 Cotrimoxsazole 480mg Tablet 265 Rp 152 Rp 40,333
55 Curcuma Plus DHA sy Btl 60ml 5 Rp 13,337 Rp 66,685
56 Curcuma Plus Imuns Syr Btl 60 ml 3 Rp 13,337 Rp 40,011
57 Curcuma tablet Tablet 165 Rp 880 Rp 145,245
58 Deprezac 20mg kapl Kapsul 150 Rp 5,113 Rp 766,905
59 Dexamethasone 0,5mg talet Tablet 230 Rp 81 Rp 18,630
60 Dexanta tablet Tablet 130 Rp 242 Rp 31,493
61 Dexclosan tablet Tablet 440 Rp 143 Rp 63,083
62 Diazepam tablet 2mg Tablet 100 Rp 39 Rp 3,900
63 Diazepam tablet 5mg Tablet 250 Rp 65 Rp 16,250
64 Digoxin tablet Tablet 250 Rp 92 Rp 22,883
65 Dimenhidrinat 50mg Tablet 193 Rp 107 Rp 20,651
66 Dionicol Tablet 280 Rp 450 Rp 126,000
67 Domperidon tab 10 mg Tablet 500 Rp 174 Rp 87,000
68 Domperidone Drop Botol 19 Rp 17,100 Rp 324,900
69 Domperidone Sirup Botol 4 Rp 3,490 Rp 13,960
70 Dopamet tab 250mg Tablet 178 Rp 2,134 Rp 379,852
71 Dulcolax Tab Tablet 376 Rp 1,067 Rp 401,030
72 Duvadilan Tablet 99 Rp 6,669 Rp 660,205
73 Erlaquin tab 250mg Tablet 180 Rp 260 Rp 46,827
74 Eryra 500 mg ** Tablet 61 Rp 690 Rp 42,090
75 Erytromicin 250mg caps 95 Rp 509 Rp 48,355
76 Erytromicin Sirup Botol 11 Rp 8,090 Rp 88,990
77 Etadexta Tablet 170 Rp 450 Rp 76,500
78 Etambuthol tab 500mg Tablet 370 Rp 386 Rp 142,761
79 Ethil Klorida spray Botol 3 Rp 111,550 Rp 334,650
80 Faryzol sy 60 ml 7 Rp 6,000 Rp 42,000
81 Fenitoin kapsul 100 mg tablet 86 Rp 134 Rp 11,524
82 Fladystin ovule Ovules 20 Rp 18,546 Rp 370,928
83 Flagyl ( metronidazole Supp ) Supp 20 Rp 3,655 Rp 73,100
84 Flamar Tablet 437 Rp 200 Rp 87,400
85 Folavit tabl 400 mg Tablet 180 Rp 880 Rp 158,449
86 Forbetes 500mg Tablet 500 Rp 105 Rp 52,500
87 Forten 25mg Tablet 40 Rp 5,981 Rp 239,240
88 Forumen tetes telinga Btl 1 Rp 28,509 Rp 28,509
89 Fudan 100mg tablet Tablet 28 Rp 10,003 Rp 280,087
90 Fudan 50 mg Tablet 222 Rp 16,312 Rp 3,621,264
Fudan sirup Botol 60ml 5 Rp 86,693
91 Rp 433,465
92 Furosemide 40mg Tablet 3330 Rp 36 Rp 119,813
93 Galfluk Tablet 100 Rp 8,440 Rp 844,000
94 Garam Oralit Serbuk Sachet 75 Rp 317 Rp 23,775
95 Gemfibrozil Kaps 300 mg Kapsul 885 Rp 306 Rp 270,810
Gentamisin Salep Mata 0,3% Tube 48 Rp 2,786
96 ( Genoint ) Rp 133,728
97 Glibenclamide tab 5mg Tablet 784 Rp 66 Rp 51,744
98 Glicab Tablet 600 Rp 284 Rp 170,400
99 Glimepirid 1 Mg Tablet 250 Rp 272 Rp 68,000
100 Glimepirid 3 mg Tablet 238 Rp 414 Rp 98,532
101 Glucosamin tab Tablet 230 Rp 2,134 Rp 490,820
102 Glukolos ( Glikasit) Tablet 420 Rp 284 Rp 119,280
103 Gravinon Tablet 225 Rp 4,744 Rp 1,067,400
104 Haloperidol Tablet 5 mg Tablet 500 Rp 105 Rp 52,500
105 Hydrocortisone cream tube 48 Rp 2,868 Rp 137,664
106 Ibuprofen 200 mg Tablet 354 Rp 121 Rp 42,834
107 Ibuprofen suspensi 100mg/5ml Botol/ 60 ml 32 Rp 3,811 Rp 121,952
108 Ibuprofen tab 400mg Tablet 554 Rp 198 Rp 109,692
109 Imudator syrup Btl 60ml 2 Rp 65,353 Rp 130,706
110 Irbesartan Tab 300 mg Tablet 250 Rp 2,717 Rp 679,250
Isiprinol syr Botol 60ml 4 Rp 86,693
111 Rp 346,772
112 Isoniazide Tablet 486 Rp 49 Rp 23,814
113 Isosobrid Dinitrat Tab 5 mg Tablet 25 Rp 98 Rp 2,450
114 Kalbion Tablet 1024 Rp 440 Rp 450,693
Kalium Aspartat Tab 300 mg
Tablet 450 Rp 739
115 (kalipar) Rp 332,550
116 Kalium Diklofenak 50mg Tablet 228 Rp 425 Rp 96,900
117 Kalnex 250 mg Tablet 89 Rp 11,040 Rp 982,560
118 Kalsium Laktat Tablet 734 Rp 56 Rp 40,939
119 Karbamazepine 200 mg Tablet 426 Rp 267 Rp 113,742
120 Ketocid kaplet Tablet 120 Rp 8,269 Rp 992,310
121 Ketokonazole Tablet 200 mg Tablet 400 Rp 320 Rp 128,000
122 Kidimun sirup Botol 1 Rp 38,678 Rp 38,678
123 Klorokuin tablet Tablet 184 Rp 44 Rp 8,128
124 Kodein Tablet 10 mg Tablet 100 Rp 550 Rp 55,000
125 Kodein Tablet 20 mg Tablet 100 Rp 1,210 Rp 121,000
126 Kombinasi Salmeterol 25 ml flutikas Flash 3 Rp 99,733 Rp 299,199
127 Kompolax Sirup Botol 3 Rp 7,563 Rp 22,689
128 Lapifed Tablet 150 Rp 2,001 Rp 300,093
129 Lasal syrup Btl 100ml 13 Rp 24,674 Rp 320,762
130 Lerzin ( Cetirizine ) Tablet 295 Rp 190 Rp 56,050
131 Lerzin sirup Botol 5 Rp 11,495 Rp 57,475
Letonal 25 mg ( Spinorolactone ) Tablet 140 Rp 1,716
132 Rp 240,240
133 Libronil tablet Tablet 400 Rp 66 Rp 26,400
134 Lisinopril Tablet 10 mg Tablet 1168 Rp 660 Rp 770,880
135 Lisinopril Tablet 5 mg Tablet 310 Rp 385 Rp 119,350
136 Loperamid 2mg Tablet 9 Rp 99 Rp 891
137 Mediamer B6 Tablet 120 Rp 3,218 Rp 386,100
138 Megabal ( mecobalamin ) Tablet 165 Rp 31,460 Rp 5,190,900
139 Meloxicam 15mg Tablet 445 Rp 1,319 Rp 586,911
140 Meloxicam 7,5mg Tablet 10 Rp 761 Rp 7,611
141 Metformin 500 mg Tablet 335 Rp 182 Rp 60,803
142 Methicol Tablet 335 Rp 1,238 Rp 414,563
143 Methylergometrin Tablet Tablet 240 Rp 169 Rp 40,560
144 Methylprednisolon 4mg Tablet 44 Rp 538 Rp 23,692
145 Metolon tab Tablet 500 Rp 342 Rp 170,885
146 Metronidazole 250mg Tablet 379 Rp 129 Rp 48,891
147 Metronidazole 500mg Tablet 200 Rp 169 Rp 33,800
148 Mikonazol Krim/Salep 2% Tube 8 Rp 3,075 Rp 24,600
149 Motilex 2mg Tablet 222 Rp 99 Rp 21,978
150 Mucos drop Botol 1 Rp 40,012 Rp 40,012
151 Mucotein 3mg tab Tablet 60 Rp 6,235 Rp 374,115
152 Mucotein syrup Botol 4 Rp 41,079 Rp 164,316
153 Musin Tablet Tablet 160 Rp 834 Rp 133,374
154 Nairet Tablet Tablet 600 Rp 1,134 Rp 680,208
155 Natrium diklofenak 25mg Tablet 91 Rp 152 Rp 13,832
156 Natrium diklofenak 50 mg Tablet 519 Rp 239 Rp 124,269
157 Nephrolit Tablet 10 Rp 798 Rp 7,975
158 Neuraxon 5000 tab Tablet 330 Rp 2,534 Rp 836,260
159 Neuroviron V Kapsul 110 Rp 599 Rp 65,852
160 Nexa tablet Tablet 436 Rp 1,471 Rp 641,465
161 Nifedipin Tablet 12 Rp 115 Rp 1,380
162 Norit Tablet 400 € 286.00 Rp 114,400
163 Nystatin Supp 34 Rp 448 Rp 15,232
164 Obimin Tablet 30 Rp 1,444 Rp 43,333
165 Ofloxacin 200 mg Tablet 140 Rp 519 Rp 72,660
166 Ofloxacin 400mg Tablet 90 Rp 720 Rp 64,800
167 Olanzapin Tab Tablet 71 Rp 12,320 Rp 874,720
168 Omeprazole Kapsul 103 Rp 221 Rp 22,763
169 Opiclam Tablet 156 Rp 2,145 Rp 334,620
170 Opilax sirup Botol 10 Rp 44,013 Rp 440,130
Otsu WI 25ml (aquadest steril) ampul 6 Rp 2,668
171 Rp 16,008
172 Oxycobal Tablet 410 Rp 550 Rp 225,500
173 Paracetamol Sirup 120 mg/5 Botol 71 Rp 2,530 Rp 179,630
174 Paracetamol tab 500mg Tablet 895 Rp 116 Rp 103,373
175 Piracetam 400mg Tablet 140 Rp 194 Rp 27,160
176 Piracetam 800mg Tablet 334 Rp 321 Rp 107,214
177 Piralen Sirup Botol 1 Rp 2,310 Rp 2,310
Pirantel Suspensi 125 mg/ 5 ml Botol 5 Rp 9,100
178 Rp 45,500
179 Piroxicam tab 10mg Tablet 1230 Rp 72 Rp 89,138
180 Postinor Tablet 16 Rp 17,188 Rp 275,008
181 Prednison Tablet 454 Rp 143 Rp 64,791
182 Premaston tab Tablet 15 Rp 4,757 Rp 71,355
183 Primadex Sirup (Cotri sirup) Botol 1 Rp 5,500 Rp 5,500
184 Primaquin Tablet 1000 Rp 147 Rp 147,000
185 Primolut N Tablet 124 Rp 2,618 Rp 324,632
186 Profertil Tablet 20 Rp 18,838 Rp 376,760
187 Propanolol 10mg Tablet 692 Rp 85 Rp 58,820
188 Propanolol 40 mg Tablet 50 Rp 133 Rp 6,655
189 Provomer Tablet 480 Rp 2,338 Rp 1,122,000
190 Pularex Tablet 70 Rp 220 Rp 15,400
191 Pyrazinamide 500mg Tablet 150 Rp 242 Rp 36,300
192 Quinne Tablet 60 Rp 160 Rp 9,600
193 Ramoxyl 500mg Tablet 815 Rp 450 Rp 366,750
194 Ranitidin Tablet 150 mg Tablet 610 Rp 128 Rp 78,080
195 Renadinac 25mg Tablet 179 Rp 476 Rp 85,254
196 Rifampicin 600mg tablet Tablet 100 Rp 830 Rp 83,000
197 Salbutamol 2 mg Tablet 220 Rp 92 Rp 20,335
198 Salisil Bedak 2 % Pcs 3 Rp 1,180 Rp 3,540
199 Scopma tablet Tablet 445 Rp 330 Rp 146,850
200 Scopma plus Tablet 20 Rp 651 Rp 13,020
201 Sefiksim Kapsul 100mg Tablet 3184 Rp 899 Rp 2,862,416
202 Sefixime Sirup Botol 42 Rp 9,400 Rp 394,800
203 Setirizin Tablet 10 mg Tablet 390 Rp 190 Rp 74,100
204 Simvastatin 10 mg Tablet 120 Rp 180 Rp 21,600
205 Simvastatin 20mg Tablet 465 Rp 480 Rp 223,200
206 Sofero Tablet 10 Rp 534 Rp 5,335
207 Spasminal Tablet 203 Rp 743 Rp 150,728
208 Spuit 3 cc ( stera 3 cc ) Pcs 100 Rp 650 Rp 65,000
209 Sukrakfat Susp 500 mg/ 5 ml Botol 1 Rp 14,450 Rp 14,450
210 Takana sirup Boto 4 Rp 25,341 Rp 101,364
211 Teosal Tablet 125 Rp 270 Rp 33,768
212 Thiamphenicol Kapsul 475 Rp 440 Rp 209,000
213 Tramadol Tablet 140 Rp 354 Rp 49,588
Tremenza sirup Botol 60ml 6 Rp 16,638
214 Rp 99,828
215 Valproat Sirup Botol 12 Rp 41,800 Rp 501,600
Vectrin sirup Botol 60ml 4 Rp 42,680
216 Rp 170,720
217 Vit K tablet Tablet 200 Rp 697 Rp 139,400
218 Vitamin B 6 Tablet 1026 Rp 19 Rp 19,638
219 Vitamin B Kompleks Tablet Tablet 970 Rp 24 Rp 23,687
220 Vitamin B1 Tablet 3966 Rp 26 Rp 104,179
221 Vitazim Tablet 1002 Rp 694 Rp 694,937
222 Zibramax sirup Botol 2 Rp 121,550 Rp 243,100
223 Zinc drop 20 mg/ 5 MI Botol 5 Rp 14,160 Rp 70,800
224 Zinc Tablet Dispersible 20 mg Tablet 650 Rp 521 Rp 338,650
225 Zircum kid Sirup Botol 6 Rp 8,140 Rp 48,840

Yang Menerima Yang Mengeluarkan

Rini Yeni Susanti, S.Farm.,Apt Rica Hajianti, S.Far., Apt


NIP. 19790610 201001 2 006 NIP. 19801105 201001 2 010

Mengetahui,
Pengguna Barang

dr. Riza Syahputra


NIP. 19760903 200802 1 002
PEMBUANG
ERUYAN
MAH
N SERUYAN
PAT
PAT
BUH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN
ABSENSI PESERTA DIKLAT BTCLS
SERU
CEPAT
DI RSUD KUALA PEMBUANG 23 NOPEMBER 2015

TEPAT
NO NAMA PESERTA NIP TANDATANGAN

1 JUAIRIAH 19850405 201001 2 009 1

SEMBUH
2 RINDU RUSHANO - 2

3 FAHRUL ILMI - 3

4 M. NUR AKMAL HIDAYAT 19871111 201001 1 001 4

5 ENDANG LESTARI 19840216 200903 2 003 5

6 SRI NORMAWATI 19841007 201001 2 001 6

7 RENY SELYWARTIE 19890903 201001 2 001 7

8 KUSNAWATI 19830409 200903 2 005 8

9 ERNI 19850421 201001 2 001 9

10 ALI ALATAS - 10

11 RATU SRI RAHAYU 19811218 201001 2 010 11

12 NOR JENNAH HZ, AMK 19800808 200604 2 040 12

13 ROSLINA 19601209 199503 2 001 13

14 TITIK LESTARI - 14

15 SERLI MANURUNG - 15

16 SRI WARDANI M. - 16

17 FITRIAH - 17

18 SITI ROHMANIAH 19880408 201001 2 003 18

19 ANA DEVIA JANIARTI 19850913 200903 2 001 19

20 RINA SUSANA 19791108 200903 2 001 20

21 MAHHETYANI - 21

22 ADNAN MEIYANTO 19830529 200903 1 004 22


CEPAT
TEPAT
NO NAMA PESERTA NIP TANDATANGAN

23 RIA SAFITRI 19860613 201001 2 007 23

SEMBUH
24 HETY MEILIANY 19820519 200604 2 013 24

25 YETI SULIANTI 19760426 200501 2 015 25

26 RIKA FITRIANI 19790922 200604 2 029 26

27 LATIFAH AZIZAH 19890725 2011012 010 27

28 DEWI RAMAYANTI 19850325 201101 2 017 28

29 ENI TRANI 19810517 200501 2 021 29

30 LASINRANG 19890508 201101 1 002 30

31 ERNAWATI 19770902 200604 2 021 31

32 ARPINAH 19830310 200903 2 004 32

33 SRI WARTINI 19801201 200501 2 015 33

34 FERIDA PUJI LESTARI 19830209 200903 2 007 34

35 ALI RAHMAN 19780505 199803 1 007 35

36 36

37 37

38 38

39 39

40 40
AERUYAN
PEMBUANG
MAH
N SERUYAN
PAT
PAT
BUH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN
DAFTAR PESERTA DIKLAT BTCLS
SERU
CEPAT
DI RSUD KUALA PEMBUANG TAHUN 2015

TEPAT
NO NAMA PESERTA BIO DATA IJAZAH FOTO KETERANGAN

SEMBUH
2

10

11

12

13

14

15

16

17

18

19

20

21

22
CEPAT
TEPAT
NO NAMA PESERTA BIO DATA IJAZAH FOTO KETERANGAN

23

SEMBUH
24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40
A PEMBUANG
SERUYAN
MAH
EN SERUYAN
EPAT
PAT
PAT
MBUH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN
ABSENSI PESERTA DIKLAT BTCLS
SERU
CEPAT
DI RSUD KUALA PEMBUANG 26 NOPEMBER 2015

TEPAT
NO NAMA PESERTA NIP TANDATANGAN

1 JUAIRIYAH 19850405 201001 2 009 1

SEMBUH
2 RINDU RUSHANO - 2

3 FAHRUL ILMI - 3

4 M. NUR AKMAL HIDAYAT 19871111 201001 1 001 4

5 ENDANG LESTARI 19840216 200903 2 003 5

6 SRI NORMAWATI 19841007 201001 2 001 6

7 RENY SELYWARTIE 19890903 201001 2 001 7

8 KUSNAWATI 19830409 200903 2 005 8

9 ERNI 19850421 201001 2 001 9

10 ALI ALATAS - 10

11 RATU SRI RAHAYU 19811218 201001 2 010 11

12 NOR JENNAH HZ, AMK 19800808 200604 2 040 12

13 ROSLINA 19601209 199503 2 001 13

14 TITIK LESTARI - 14

15 SERLI MANURUNG - 15

16 SRI WARDHANI M. - 16

17 FITRIAH - 17

18 SITI ROHMANIAH 19880408 201001 2 003 18

19 ANA DEVIA JANIARTI 19850913 200903 2 001 19

20 RINA SUSANA 19791108 200903 2 001 20

21 MAHHETYANI - 21

22 ADNAN MEIYANTO 19830529 200903 1 004 22


CEPAT
TEPAT
NO NAMA PESERTA NIP TANDATANGAN

23 RIA SAFITRI 19860613 201001 2 007 23

SEMBUH
24 HETY MEILIANY 19820519 200604 2 013 24

25 YETI SULIANTI 19760426 200501 2 015 25

26 RIKA FITRIANI 19790922 200604 2 029 26

27 LATIFAH AZIZAH 19890725 2011012 010 27

28 DEWI RAMAYANTI 19850325 201101 2 017 28

29 ENI TRANI 19810517 200501 2 021 29

30 LASINRANG 19890508 201101 1 002 30

31 ERNAWATI 19770902 200604 2 021 31

32 ARPINAH 19830310 200903 2 004 32

33 SRI WARTINI 19801201 200501 2 015 33

34 FERIDA PUJI LESTARI 19830209 200903 2 007 34

35 ALI RAHMAN 19780505 199803 1 007 35

36 36

37 37

38 38

39 39

40 40
AERUYAN
PEMBUANG
MAH
N SERUYAN
PAT
PAT
BUH
ABSENSI NARASUMBER DIKLAT BTCLS
DI RSUD KUALA PEMBUANG 22 S/D 26 NOPEMBER 201

TANGGAL
NO NAMA
22 NOP 2015 23 NOP 2015

1 IPW AGUNG SUSILA, S.Kep

2 AHMAD SATORI, S.Kep

3 HASRIL D, S.Kep, M.Kes

4 ANDI SUBANDI, S.Kep


DIKLAT BTCLS
S/D 26 NOPEMBER 2015

TANGGAL

24 NOP 2015 25 NOP 2015 26 NOP 2015


PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN
DAFTAR PENERIMA KAOS DIKLAT BTCLS
SERU
CEPAT
DI RSUD KUALA PEMBUANG 22 S/D 26 NOPEMBER 2015

TEPAT
NO NAMA PESERTA NIP TANDATANGAN

1 JUAIRIAH 19850405 201001 2 009 1

SEMBUH
2 RINDU RUSHANO - 2

3 FAHRUL ILMI - 3

4 M. NUR AKMAL HIDAYAT 19871111 201001 1 001 4

5 ENDANG LESTARI 19840216 200903 2 003 5

6 SRI NORMAWATI 19841007 201001 2 001 6

7 RENY SELYWARTIE 19890903 201001 2 001 7

8 KUSNAWATI 19830409 200903 2 005 8

9 ERNI 19850421 201001 2 001 9

10 ALI ALATAS - 10

11 RATU SRI RAHAYU 19811218 201001 2 010 11

12 NOR JENNAH HZ, AMK 19800808 200604 2 040 12

13 ROSLINA 19601209 199503 2 001 13

14 TITIK LESTARI - 14

15 SERLI MANURUNG - 15

16 SRI WARDANI M. - 16

17 FITRIAH - 17

18 SITI ROHMANIAH 19880408 201001 2 003 18

19 ANA DEVIA JANIARTI 19850913 200903 2 001 19

20 RINA SUSANA 19791108 200903 2 001 20

21 MAHHETYANI - 21

22 ADNAN MEIYANTO 19830529 200903 1 004 22


CEPAT
TEPAT
NO NAMA PESERTA NIP TANDATANGAN

23 RIA SAFITRI 19860613 201001 2 007 23

SEMBUH
24 HETY MEILIANY 19820519 200604 2 013 24

25 YETI SULIANTI 19760426 200501 2 015 25

26 RIKA FITRIANI 19790922 200604 2 029 26

27 LATIFAH AZIZAH 19890725 2011012 010 27

28 DEWI RAMAYANTI 19850325 201101 2 017 28

29 ENI TRANI 19810517 200501 2 021 29

30 LASINRANG 19890508 201101 1 002 30

31 ERNAWATI 19770902 200604 2 021 31

32 ARPINAH 19830310 200903 2 004 32

33 SRI WARTINI 19801201 200501 2 015 33

34 FERIDA PUJI LESTARI 19830209 200903 2 007 34

35 ALI RAHMAN 19780505 199803 1 007 35

36 dr RIZA SYAHPUTRA 36

37 ABDUS SUHADI 37

38 SRI SUPADMI 38

39 RAHMADI GURUH S 39

40 ISKANDAR ZULKARNAIN 40

41 RIFAI RAHMAN 41

42 ERWAN PUDJIADI 42

43 RAUDAH 43

44 UNI 44

45 AMELLYA A 45
AERUYAN
PEMBUANG
MAH
N SERUYAN
PAT
PAT
BUH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN SERU
DAFTAR HADIR RAPAT PEMBAHASAN PERUBAHAN STATUS BARU REKAM MEDIS
DI RSUD KUALA PEMBUANG 30 NOPEMBER 2015

CEPAT
TEPAT
NO NAMA PESERTA JABATAN TANDATANGAN

1 1

SEMBUH
2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21 21

22 22
CEPAT
TEPAT
NO NAMA PESERTA JABATAN TANDATANGAN

23 23

SEMBUH
24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 35

36 36

37 37

38 38

39 39

40 40

41 41

42 42

43 43

44 44

45 45
AERUYAN
PEMBUANG
MAH
N SERUYAN
PAT223

PAT
BUH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PEMB
SERUYA
RSUD KUALA PEMBUANG
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN SERU
DAFTAR HADIR RAPAT INSTALASI FARMASI

CEPAT
DI RSUD KUALA PEMBUANG 4 APRIL 2016

TEPAT
NO NAMA JABATAN TANDATANGAN

1 1

SEMBUH
2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21 21

22 22
CEPAT
TEPAT
NO NAMA JABATAN TANDATANGAN

23 23

SEMBUH
24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34
AERUYAN
PEMBUANG
MAH
N SERUYAN
PAT
PAT
BUH
PEMERINTAH KABUPATEN SERUYAN

RSUDRSUD
KUALA PE
SERU
RSUD KUALA PEMBUANG

RAMAH
Alamat : Jl. A. Yani No.30 Kuala Pembuang 74211 Kalimantan Tengah

RAMAH
Telpon. (0538) 21017 Faximile. (0538) 21566

KABUPATEN SE
N0 NAMA PESERTA BIO DATA IJAZAH FOTO CEPAT
CEPAT
KETERANGAN

TEPAT
TEPAT
SEMBUH
SEMBUH
LA PEMBUANG
SERUYAN
MAH
AMAH
EN SERUYAN
EPAT
EPAT
EPAT
EPAT
MBUH
MBUH

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