BATAS BUFFER STOCK REAGEN DAN BAHAN HABIS PAKAI UNTUK MELAKUKAN ORDER / PENGAJUAN BARANG

UKURAN/J RATA2 JMLH BATAS TOTAL TOTAL

JENIS JMLH HARGA
NO NAMA REAGEN SATUAN UMLAH PASIEN BUFFER PASIEN 1 KEBUTUHAN 1
PEMERIKSAAN (pieces)
TEST
PERBULAN STOCK TAHUN TAHUN
SATUAN

1 Diatro Dyluent Darah Rutin Derigen 20 L 200 Test 200 pasien 1 1482 8 Derigen Rp 1,760,000

2 Diatro Lyse Darah Rutin Botol 1L 200 test 200 pasien 1 1482 8 Botol Rp 1,633,500

3 Diatro Cleaner Darah Rutin Botol 1L 200 test 200 pasien 1 1482 8 Botol Rp 302,500

Hematology Control
4 Darah Rutin Vial 2 ml 4 Test 2xcontrol 1 50 12 Vial Rp 440,000
Normal
Hematology Control
5 Darah Rutin Vial 2 ml 4 Test 2xcontrol 1 50 12 Vial Rp 440,000
Low
Hematology Control
6 Darah Rutin Vial 2 ml 4 Test 2xcontrol 1 50 12 Vial Rp 440,000
High
Microhaematocrit
7 LED Tube 100 pcs 100 Test 129 pasien 2 1082 11 Tube Rp 50,000
Sodium Heparin

8 Quick Check Hb Hemoglobin (Hb) Tube 25 stik 25 stik 19 pasien 1 188 8 Tube Rp 190,000

± 1000
9 Giemsa Diff Count Botol 100 ml 7 pasien 0 70 1 Botol Rp 650,000
Test

10 Salmonella Typhi O Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol

Salmonella
11 Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol
Paratyphi AO
Salmonella
12 Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol
Paratyphi BO
Salmonella
13 Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol
Paratyphi CO
Rp 750,000
 Rp 750,000
14 Salmonella Typhi H Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol

Salmonella
15 Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol
Paratyphi AH
Salmonella
16 Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol
Paratyphi BH
Salmonella
17 Widal Botol 5 ml 200 Test 121 test 1 812 6 Botol
Paratyphi CH

18 Antigen A Golongan Darah Vial 5 ml 250 Test 23 test 1 276 3 Vial

19 Antigen B Golongan Darah Vial 5 ml 250 Test 23 test 1 276 3 Vial

Rp 400,000
20 Antigen AB Golongan Darah Vial 5 ml 250 Test 23 test 1 276 3 Vial

21 Antigen D (Rhesus) Golongan Darah Vial 5 ml 250 Test 23 test 1 276 3 Vial

22 Bilirubin T/D Bilirubin Botol 100 ml 90 test 0 0 0 0 Rp -

23 Cholesterol Kolesterol Botol 100 ml 90 test 47 pasien 1 516 6 Botol Rp 1,760,000

Cholesterol Stik
24 Kolesterol Stik Tube 10 stik 10 test 10 pasien 2 120 10 Tube Rp 150,000
(nesco)

25 Creatinin Kreatinin Botol 100 ml 90 test 3 pasien 1 22 2 Botol Rp 617,100

26 Glucose Gula Darah Botol 100 ml 90 test 135 pasien 2 1620 20 Botol Rp 748,000

27 Glucose Stik (nesco) Gula Darah Stik Tube 25 stik 25 test 20 pasien 2 240 10 Tube Rp 90,000

28 GOT (ASAT) SGOT / Fungsi Hati Botol 50 ml 32 test 3 pasien 1 36 2 Botol Rp 1,161,600
29 GPT (ASAT) SGPT / Fungsi Hati Botol 50 ml 32 test 3 pasien 1 36 2 Botol Rp 1,161,600

HDL Cholesterol
30 Kolesterol HDL Botol 100 ml 180 test 3 pasien 1 84 2 Botol Rp 895,400
(Precipitant)
LDL Cholesterol
31 Kolesterol LDL Botol 100 ml 180 test 3 pasien 1 84 2 Botol Rp 4,345,000
(Direct)

32 Total Protein Protein Botol 100 ml 90 test 0 0 0 0 Rp -

33 Triglycerides Trigliserid Botol 100 ml 90 test 15 pasien 1 174 3 Botol Rp 2,541,000

34 Urea Ureum Botol 100 ml 90 test 3 pasien 1 22 2 Botol Rp 580,800

35 Uric Acid Asam Urat Botol 100 ml 90 test 40 pasien 1 480 6 Botol Rp 1,573,000

Uric Acid Stik

36 Asam Urat Stik Tube 25 stik 25 test 20 pasien 1 240 11 Botol Rp 90,000
(nesco)
Urine Lengkap
37 Cybow 10 Strip Botol 100 pcs 100 test 10 pasien 1 120 2 Botol Rp 279,000
Makroskopis

38 Dengue IgG/IgM DBD Box 25 pcs 25 test 10 pasien 1 120 6 Box Rp -

39 Anti HIV SD ½ HIV Box 100 pcs 100 test 70-100 pasien 2 658 7 Box Rp -

40 Anti HIV Oncoprobe HIV Box 50 pcs 50 test 1 pasien 1 12 1 Box Rp -

Anti HIV Advanced

41 HIV Box 100 pcs 100 test 1 pasien 1 12 1 Box Rp -
Intec

42 HBsAG Rapid Hepatitis B Box 100 pcs 100 test 20 pasien 1 1525 16 Box Rp -

43 Ziehl Neelsen BTA Box 100 ml 50 Slide 253 slide 3 780 48 Box Rp -
44 Pewarnaan Gram Gram Box 100 ml 50 Slide 6 slide 1 32 2 Box Rp -

45 KOH Jamur Botol 100 ml 50 Slide 6 slide 1 28 2 Botol Rp -

46 PPTest Test Kehamilan Box 50 pcs 50 test 10 pasien 1 120 3 Box Rp 40,000

47 RPR Kit TPHA / Sifilis Box 100 pcs 100 test 0 0 0 0 Rp -

48 Tabung EDTA - Pak 100 pcs - 200 pcs 1 1670 17 Pak Rp 175,000

Tabung Vacutube
49 - Pak 100 pcs - 168 pcs 1 2020 21 Pak Rp 175,000
Plain

50 Tip Kuning - Pak 1000 pcs - 168 pcs 1 2020 2 Pak Rp 85,000

51 Tip Biru - Pak 500 pcs - 168 pcs 1 2020 5 Pak Rp 85,000

52 Alkohol 70 % - Botol 100 ml - 300 ml 2 0 36 Botol Rp -

53 Tissue - Rol 1 Rol - 5 Rol 2 0 60 Rol Rp -

54 Hypoclorit - Botol 1L - 500 ml 1 0 7 Botol Rp -

55 Plester - Rol 1 Rol - 3 Rol 1 0 37 Rol Rp -

56 Spiut 3 cc - Box 100 pcs - 185 pcs 1 2214 23 Box Rp 65,000

57 Spiut 1 cc - Box 100 pcs - 123 pcs 1 1476 15 Box Rp 65,000

58 Blood Lancet - Box 100 pcs - 30 pcs 1 360 4 Box Rp 25,000

59 Object Glass - Box 72 pcs - 273 slide 1 2500 35 Box Rp -

60 Deck Glass - Pak 100 pcs - 10 slide 1 130 2 Pak Rp 85,000

61 Pot Dahak Sputum Buah 500 pcs - 273 pot 100 2340 2500 pcs Rp -

62 Pot Urine Urine Buah - - 20 pot - 332 350 pcs Rp 500

63 Handscoond APD Box 100 pcs - 90 pcs 1 0 13 Box Rp 48,000

64 Masker APD Box 50 pcs - 30 pcs 1 0 8 Box Rp 25,000

65 Kapas - Gulung 1 Rol - ¼ rol 1 0 2 Rol Rp -

66 Spirtus Botol 1L - 300 ml 1 0 5 Botol Rp -

JUMLAH

Mengetahui, Ciruas, 18 Juni 2016

Kepala UPTD Puskesmas DTP Ciruas Petugas Laboratorium

dr. Hendi Fitriyadi Z. Risawati, Amd. AK

NIP 198307232010011008 NIP 198204012006042010
PENGAJUAN BARANG

TOTAL HARGA KET

Rp 14,080,000 sdh PPN

Rp 13,680,000 sdh PPN

Rp 2,420,000 sdh PPN

Rp 5,280,000

Setiap hari, apabila

Rp 5,280,000 jumlah pasien ≥30
pasien perhari

Rp 5,280,000

Rp 550,000

Rp 1,520,000

Rp 650,000

Rp 4,500,000
Rp 4,500,000

Rp 1,200,000

Rp -

Rp 3,520,000 4x100 ml (1 box)

Rp 1,500,000

Rp 617,100 200 ml

Rp 3,740,000 4x100 ml (1 box)

Rp 900,000

Rp 1,161,600 20x5 ml (1 box)

Rp 1,161,600 20x5 ml (1 box)

Rp 895,400 4x80 ml (1 box)

Rp 4,345,000 80 ml

Rp -

Rp 2,541,000 4x100 ml (1 box)

Rp 580,800 2x100 ml (1 box)

Rp 3,146,000 4x100 ml (1 box)

Rp 990,000

Rp 558,000

P2PL Dinkes Kab.

Rp -
Serang

P2PL Dinkes Kab.

Rp -
Serang

P2PL Dinkes Kab.

Rp -
Serang

P2PL Dinkes Kab.

Rp -
Serang
P2PL Dinkes
Rp - Kab.Serang(untuk
ibu hamil)
P2TB Dinkes Kab.
Rp -
Serang
 P2PL Dinkes Kab.
Rp -
Serang

P2PL Dinkes Kab.

Rp -
Serang

Rp 120,000

P2PL Dinkes Kab.

Rp -
Serang

Rp 2,975,000

Rp 3,675,000

Rp 170,000

Rp 425,000

Gudang Farmasi
Rp -
Puskesmas

Gudang Barang
Rp -
Puskesmas

P2TB Dinkes Kab.

Rp -
Serang

Gudang Farmasi
Rp -
Puskesmas

Rp 1,495,000

Rp 975,000

Rp 100,000
 P2TB Dinkes Kab.
Rp -
Serang

Rp 170,000

P2TB Dinkes Kab.

Rp -
Serang

Rp 175,000

Rp 624,000

Rp 200,000

Gudang Farmasi
Rp -
Puskesmas

P2TB Dinkes Kab.

Rp -
Serang
Rp 91,200,500
 UKURAN/J
JENIS JMLH
NO NAMA REAGEN SATUAN UMLAH HARGA
PEMERIKSAAN (pieces)
TEST

1 Diatro Dyluent Darah Rutin Derigen 20 L Rp 1,760,000 200 Test

2 Diatro Lyse Darah Rutin Botol 1L Rp 1,633,500 200 test
3 Diatro Cleaner Darah Rutin Botol 1L Rp 302,500 200 test
Hematology Control
4 Darah Rutin Vial 2 ml Rp 440,000 4 Test
Normal
Hematology Control
5 Darah Rutin Vial 2 ml Rp 440,000 4 Test
Low
Hematology Control
6 Darah Rutin Vial 2 ml Rp 440,000 4 Test
High

7 Tabung Westergreen LED Tabung 100 pcs Rp 2,500,000 100 Test

8 Natrium Sitrat LED Botol 100 ml 125 Test

9 Quick Check Hb Hemoglobin (Hb) Tube 25 stik Rp 190,000 25 stik
± 1000
10 Giemsa Diff Count Botol 100 ml Rp 650,000
Test
11 Salmonella Typhi O Widal Botol 5 ml 200 Test
Salmonella Paratyphi
12 Widal Botol 5 ml 200 Test
AO
Salmonella Paratyphi
13 Widal Botol 5 ml 200 Test
BO
Salmonella Paratyphi
14 Widal Botol 5 ml 200 Test
CO
Rp 750,000
15 Salmonella Typhi H Widal Botol 5 ml 200 Test
Salmonella Paratyphi
16 Widal Botol 5 ml 200 Test
AH
Salmonella Paratyphi
17 Widal Botol 5 ml 200 Test
BH
Salmonella Paratyphi
18 Widal Botol 5 ml 200 Test
CH
19 Antigen A Golongan Darah Vial 5 ml 250 Test
20 Antigen B Golongan Darah Vial 5 ml 250 Test
Rp 400,000
21 Antigen AB Golongan Darah Vial 5 ml 250 Test
22 Antigen D (Rhesus) Golongan Darah Vial 5 ml 250 Test
300 kali
23 Kontrol Kimia Kimia Klinik Vial 12x5 ml Rp 3,850,000
Test
24 Bilirubin T/D Bilirubin Botol 2x100 ml Rp 850,300 200 test
25 Cholesterol Kolesterol Botol 4x100 ml Rp 2,093,300 400 Test
 Cholesterol Stik
26 Kolesterol Stik Tube 10 stik Rp 150,000 10 test
(nesco)
27 Creatinin Kreatinin Botol 200 ml Rp 733,920 200 Test
28 Glucose Gula Darah Botol 4x100 ml Rp 889,570 400 Test

29 Glucose Stik (nesco) Gula Darah Stik Tube 25 stik Rp 90,000 25 test
30 GOT (ASAT) SGOT / Fungsi Hati Botol 20x5 ml Rp 1,381,380 100 Test
31 GPT (ASAT) SGPT / Fungsi Hati Botol 20x5 ml Rp 1,381,380 100 Test
HDL Cholesterol
32 Kolesterol HDL Botol 4x80 ml Rp 1,064,800 100 Test
(Precipitant)
LDL Cholesterol
33 Kolesterol LDL Botol 80 ml Rp 5,167,030 80 Test
(Direct)
1000
34 Total Protein Protein Botol 1000 ml Rp 915,750
Test
35 Triglycerides Trigliserid Botol 4x100 ml Rp 3,021,810 400 Test
36 Urea Ureum Botol 2x100 ml Rp 690,690 200 Test
37 Uric Acid Asam Urat Botol 4x100 ml Rp 1,870,660 400 Test
Uric Acid Stik
38 Asam Urat Stik Tube 25 stik Rp 90,000 25 test
(nesco)
Urine Lengkap
39 Cybow 10 Strip Botol 100 pcs Rp 279,000 100 test
Makroskopis

40 Dengue IgG/IgM DBD Box 25 pcs Rp - 25 test

41 Anti HIV SD ½ HIV Box 100 pcs Rp - 100 test

42 Anti HIV Oncoprobe HIV Box 50 pcs Rp - 50 test

Anti HIV Advanced

43 HIV Box 100 pcs Rp - 100 test
Intec

44 HBsAG Rapid Hepatitis B Box 100 pcs Rp - 100 test

45 Ziehl Neelsen BTA Box 100 ml Rp - 50 Slide

46 Pewarnaan Gram Gram Box 100 ml Rp - 50 Slide

47 KOH Jamur Botol 100 ml Rp - 50 Slide

48 PPTest Test Kehamilan Box 50 pcs Rp 40,000 50 test

49 RPR Kit TPHA / Sifilis Box 100 pcs Rp - 100 test

50 Tabung EDTA - Pak 100 pcs Rp 200,000 -

Tabung Vacutube
51 - Pak 100 pcs Rp 200,000 -
Plain
52 Tip Kuning - Pak 1000 pcs Rp - -
53 Tip Biru - Pak 500 pcs Rp - -
54 Alkohol 70 % - Botol 100 ml Rp - -

55 Tissue - Rol 1 Rol Rp - -

56 Hypoclorit - Botol 1L Rp - -

57 Plester - Rol 1 Rol Rp - -

58 Spiut 3 cc - Box 100 pcs Rp 65,000 -
59 Spiut 1 cc - Box 100 pcs Rp 65,000 -
60 Blood Lancet - Box 100 pcs Rp 25,000 -
61 Object Glass - Box 72 pcs Rp - -
62 Deck Glass - Pak 100 pcs Rp 85,000 -
63 Pot Dahak Sputum Buah 500 pcs Rp - -
64 Pot Urine Urine Buah - Rp 500 -
65 Handscoond APD Box 100 pcs Rp 48,000 -
66 Masker APD Box 50 pcs Rp 25,000 -
67 Kapas - Gulung 1 Rol Rp - -

68 Spirtus Botol 1L Rp - -

Mengetahui,
Kepala UPTD Puskesmas DTP Ciruas

dr. Hendi Fitriyadi Z.

NIP 198307232010011008
 PENGEMBALIAN
Cost /Test KET RETRIBUSI
KE PUSKESMAS

Rp 8,800
Rp 8,167
Rp 1,512

Rp 2,200
Rp 25,079 Rp 40,000

Rp 2,200

Rp 2,200

Rp 25,000 Alat
Rp 6,000

Rp 7,600 Rp 18,000

Rp 650 Rp -

Rp 3,750 Rp 39,000

Rp 1,600 Rp 15,000

Rp 12,900 Rp -

Rp 4,251 Rp 16,000
Rp 5,235 Rp 21,000
Rp 15,000 Rp 21,000

Rp 3,670 Rp 16,000
Rp 2,224 Rp 20,000

Rp 3,600 Rp 20,000

Rp 13,814 Rp 16,000
Rp 13,814 Rp 16,000

Rp 10,648 Rp 25,000

Rp 64,588 Rp 25,000

Rp 916 Rp 16,000

Rp 7,555 Rp 24,000
Rp 3,454 Rp 16,000
Rp 4,677 Rp 19,000

Rp 3,600 Rp 19,000

Rp 2,790 Rp 18,000

P2PL Dinkes Kab. Rp 120,000

Serang
P2PL Dinkes Kab. Rp -
Serang
P2PL Dinkes Kab. Rp -
Serang
P2PL Dinkes Kab. Rp -
Serang
P2PL Dinkes
Kab.Serang(untuk Rp 35,000
ibu hamil)
P2TB Dinkes Kab. Rp 25,000
Serang
P2PL Dinkes Kab. Rp -
Serang
P2PL Dinkes Kab. Rp -
Serang
Rp 800 Rp 10,000
P2PL Dinkes Kab.
Serang
Rp 2,000 Rp -

Rp 2,000 Rp -
 Rp -
Rp -
Gudang Farmasi Rp -
Puskesmas
Gudang Barang Rp -
Puskesmas
P2TB Dinkes Kab. Rp -
Serang
Gudang Farmasi Rp -
Puskesmas
Rp -
Rp -
Rp -
P2TB Dinkes Kab. Rp -
Serang
Rp -
P2TB Dinkes Kab. Rp -
Serang
Rp -
Rp -
Rp -
Gudang Farmasi Rp -
Puskesmas
P2TB Dinkes Kab. Rp -
Serang