RENCANA KERJA DAN ANGGARAN

SATUAN KERJA PERANGKAT DAERAH

KABUPATEN BANYUWANGI
TAHUN ANGGARAN 2015

Urusan Pemerintahan: 1.02 Kesehatan

Organisasi : 1.02.01 Dinas Kesehatan
Program : [Link] Program Pembiayaan kesehatan
Kegiatan : [Link].03 Jaminan Kesehatan Nasional Puskesmas Songgon
Sub Kegiatan : JKN Puskesmas Songgon
Lokasi Kegiatan : Kabupaten Banyuwangi
Jumlah Tahun 2013 : Rp -
Jumlah Tahun 2014 : Rp -
Jumlah Tahun 2015 Rp 1,683,840,000
Jumlah Tahun 2016 : Rp 1,714,780,000
Jumlah Tahun 2017 : Rp 2,597,097,627
Indikator Dan Tolok Ukur Kinerja Belanja Langsung Target Kinerja
Indikator Tolok Ukur Kinerja 100 %
- Menunjang peningkatan akses dan mutu pelayanan kesehatan 100 %
Capaian Program
- Menunjang Cakupan Rawat Jalan Peserta JKN 15% Rp 2,597,097,627
Masukan - Tersedianya dana 100 %
Keluaran - Terlaksananya pelayanan JKN di puskesmas 85%
Hasil - Meningkatnya cakupan kunjungan masyarakat ke puskesmas
Kelompok Sasaran Kegiatan: Masyarakat dalam cakupan pelayanan kesehatan dasar di puskesmas
Rincian Perubahan Anggaran Belanja Langsung Program dan Per Kegiatan Satuan Kerja Perangkat Daerah
Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5

5 2 BELANJA LANGSUNG
5 2 2 BELANJA BARANG DAN JASA
5 2 2 01 Belanja Barang Habis Pakai
5 2 2 01 01 Belanja Alat Tulis Kantor
Amplop no 10 20 Kotak 3,550
Amplop Coklat (F4) 10 Kotak 51,600
Amplop Putih 20 Dus 12,750
Ballpoint 500 Buah 3,350
Ballpoint bertempat 10 Buah 40,250
Binder Clip 155 20 Buah 9,600
Binder Clip 200 20 Dos 15,000
Binder Clip 260 20 Dos 21,000
Box File 50 Buah 18,600
Buku Folio Bergaris isi 200 Lembar 30 Buku 28,200
Buku tulis isi 50 100 Buah 4,900
Buku Folio Bergaris isi 100 Lembar 50 Buah 18,000
CDR ( isi 100 Pcs ) 2 Box 172,600
Correstion Pen (TIP-Ex) 100 Buah 10,800
Cutter 10 Buah 18,350
Hetmachine/Staples Kecil 20 Buah 21,000
Isi Staples Merk Etona no.10 20 Kotak 2,700
Isi Staples Merk Great Wall no 3 20 Kotak 4,800
Isolasi Jilid Hitam 5 cm 5 Buah 33,000
Isolasi Jilid Hitam 3 cm 5 Buah 24,000
Isolasi Bening 5 Buah 18,000
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
Isolasi Kecil 20 Roll 3,050
Kertas HVS F4 70 gr 250 Rim 39,000
Kertas Bufalo Folio 5 Rim 21,350
Lem Kertas 30 Buah 13,650
Map Jepit Plastik 500 Buah 7,450
Map Plastik Folio 500 Buah 3,550
Odner Folio 20 Buah 25,850
Paper Klip no.3 50 Kotak 3,250
Paper Klip no.3 50 Kotak 6,000
Penggaris Besi 30 cm 20 Buah 29,150
Pensil 2B 5 Lusin 59,400
Perforator/Pembolong no.30 10 Buah 13,400
Pita penghapus mesin ketik elektrik 2 Buah 17,950
Pita Mesin Ketik Manual 2 Buah 24,000
Spidol Snowman Permanen 10 Lusin 72,000
Stabilo 30 Buah 10,200
Stampad Kecil 15 Buah 12,600
Stip/ Penghapus 50 Buah 4,400
Stopmap bufalo 7,500 Buah 5,400
Tas 110 Buah 25,000
Tinta Printer 60 Botol 66,000
Tinta Printer Rainbow black 30 Buah 46,050
Tinta Printer Rainbow Colour 30 Buah 46,050
Kalkulator 5 Buah 124,350

5 2 2 01 03 Belanja Alat Listrik dan Elektronik ( Lampu pijar, Battery

Kering dll )
Baterai Kecil 50 2 bh/ pak 13,450
Baterai 9 Volt 25 Buah 26,500
Lampu Esensial 8 Watt 20 Pcs 40,100
Lampu Esensial 25 Watt 50 Pcs 41,500
Lampu Emergency 5 Buah 409,100
Kabel Roll 3 Buah 78,500
Senter LED 10 Pcs 27,700
Stavolt 3 Unit 242,750

5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya

Materai Rp 3000 150 Lembar 3,000
Materai Rp 6000 300 Lembar 6,000

5 2 2 01 06 Belanja Bahan bakar Minyak/Gas dan Pelumas Oli

BBM 1 Paket 10,000,000

5 2 2 01 08 Belanja Pengisian Tabung Gas

Oksigen 2,5 m³ 20 Tabung 75,000
Oksigen 6 m³ 68 Tabung 100,000

5 2 2 01 12 Belanja Spanduk Atau Alat Informasi

Baner 500 Meter ² 30,000

5 2 2 01 13 Belanja Baliho
Baliho 2 X 4 m 100 Meter 35,000

5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan

 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
Belanja Peralatan dan Bahan Kesehatan 1 Paket 76,984,150

5 2 2 02 BELANJA BAHAN/ MATERIAL

5 2 2 02 04 Belanja Bahan Obat - obatan
Belanja Bahan Obat - obatan 1 paket 149,893,427

5 2 2 02 17 Belanja bahan dan alat laboratorium

Belanja bahan dan alat laboratorium 1 Paket 144,926,800

5 2 2 03 Belanja Jasa Kantor

5 2 2 03 06 Belanja kawat/ faximile / internet
Biaya internet 12 bulan 500,000

5 2 2 03 09 Belanja Jasa Transaksi Keuangan

Biaya Kliring 12 bulan 20,000

5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan

Jasa Pelayanan Kesehatan 1 Paket 1,137,226,500

5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan

Kalibrasi Alat2 kesehatan 1 Paket 12,401,950

5 2 2 03 59 Belanja Jasa Instalasi Jaringan

Jasa Instalasi Jaringan Komputer Standar Network Area Kecil 1 Kali 2,750,000

5 2 2 05 Belanja Perawatan Kendaraan Bermotor

5 2 2 05 01 Belanja Jasa Servis
Servis 4 Paket 577,500

5 2 2 05 02 Belanja Penggantian Suku Cadang

Accu Mobil 1 Buah 648,300
Ban Mobil 2 Buah 713,650
Filter Oli 2 Buah 46,900
Busi 2 Buah 70,975

5 2 2 06 Belanja Cetak Dan Penggandaan

5 2 2 06 01 Belanja Cetak
Cetak HVS Double folio/ Double kwarto 4,400 lembar 650
Cetak HVS Folio 70 gram 2 muka 1,000 lembar 550
Cetak HVS Folio 70 gram 1 muka 31,500 lembar 250
Cetak NCR 1/2 Folio / Kwarto 1,500 lembar 220
Cetak Kohort 34 buku 35,500
Resep Dokter 100 Buku 6,400
Biaya Jilid 100 Buku 26,000
Kresek Kecil Berlogo 100 Ikat 26,000
Stiker P4K 1,000 Lembar 4,400
Laeflet 5,000 Lembar 4,600
Klip Plastik 800 set 19,200
Buku Pengelolaan Cold Chain Petugas Imunisasi 1 buku 80,000
Register Buku pencatatan hasil kegiatan Posbindu PTM 50 buku 71,000
KMS Faktos Resiko PTM 4,700 lembar 2,200
Lembar Balik 1,100 lembar 5,150

5 2 2 06 02 Belanja Penggandaan
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
Penggandaan/ Foto Copy 124,725 lembar 300

5 2 2 11 Belanja Makanan dan minuman

5 2 2 11 06 Belanja Makanan dan minuman harian peserta
Nasi 250 Kotak 25,000
Snack 250 Kotak 7,500

5 2 2 15 Belanja Perjalanan Dinas

5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah
Transport PHN
* Jarak 0 - 5 Km 51 OH 30,000
* Jarak 6 - 10 Km 186 OH 35,000
* Jarak 11 - 15 Km 49 OH 40,000

5 2 2 20 Belanja Pemeliharaan
5 2 2 20 04 Belanja Pemeliharaan Gedung
Pemasangan keramik 1 Paket 35,000,000
Partisikaca 1 Paket 7,000,000

5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor

pemeliharaan peralatn dan perlengkapan 12 Paket 100,000

5 2 3 BELANJA MODAL
5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor
5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi
Mesin Absensi 1 Unit 15,000,000

5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian

Mesin antrian 1 Unit 15,750,000

5 2 3 11 Belanja modal pengadaan perlengkapan kantor

5 2 3 11 02 Belanja modal pengadaan Almari
Almari 4 Buah 3,520,000

5 2 3 11 07 Belanja modal pengadaan rak arsip

Rak Arsip 3 Buah 2,470,600

5 2 3 11 14 Belanja Modal Pengadaan etalase

Lemari Etalase Tinggi 195x150x60 2 Unit 2,079,000

5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran

Pemadam kebakaran 2 Unit 5,203,450

5 2 3 12 Belanja Modal Pengadaan Komputer

5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC
Komputer / PC 1 Unit 8,700,000

5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book

Lap top 6 Unit 8,500,000

5 2 3 12 04 Belanja Modal Pengadaan Printer

Printer Laser Jet 5 Unit 5,200,800

5 2 3 13 Belanja modal pengadaan mebeulair

 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
5 2 3 13 02 Belanja modal pengadaan Meja Rapat
Meja rapat ruang khusus 2 buah 8,893,500
Meja rapat 9 Unit 6,142,600
Meja kerja staf 1/2 biro 5 Unit 1,188,000

5 2 3 13 04 Belanja modal pengadaan kursi kerja

Kursi Kerja 2 buah 1,660,000
Kursi Staf 65 buah 595,000

5 2 3 13 10 Belanja modal pengadaan kursi Tunggu

Kursi Tunggu Pasien 10 Buah 2,227,500

5 2 3 14 Belanja modal pengadaan Peralatan Dapur

5 2 3 14 04 Belanja modal pengadaan dispenser
Dispenser 3 Unit 810,000

5 2 3 14 05 Belanja modal pengadaan kulkas

kulkas 2 Unit 3,745,000

5 2 3 16 Belanja modal pengadaan alat-alat studio

5 2 3 16 01 Belanja modal pengadaan Kamera
Kamera 2 Unit 3,850,000

5 2 3 16 03 Belanja modal pengadaan proyektor/infokus

LCD Proyektor 2 Unit 12,927,750

5 2 3 16 06 Belanja Modal Pengadaan monitor LCD

Monitor LCD 2 Unit 11,484,000

5 2 3 16 19 Belanja modal pengadaan TV

TV 22" 8 Unit 2,714,250
TV 26" 1 Unit 3,180,100

5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran

5 2 3 19 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 1 Paket 128,254,200

5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi

Scaller UDS-K woodpacker 1 set 2,524,800
Mata bor high speed fisure 2 set 7,485,000

5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan

5 2 3 30 14 Belanja modal pengadaan CCTV
CCTV 1 Paket 17,000,000

5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor

5 2 3 38 02 Belanja Modal Pengadaan AC
Belanja Modal Pengadaan AC 2 PK 2 Set 8,195,000
Belanja Modal Pengadaan AC 1 PK 6 Set 4,246,000
Belanja Modal Pengadaan AC 1/2 PK 7 Set 4,125,000

5 2 3 38 03 Belanja Modal Pengadaan gorden

gorden 22 m² 404,250
gorden horisontal blind 10 m² 753,100
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
gorde plastik pitras 75 m² 275,000

5 2 3 38 04 Belanja Modal Pengadaan Awning

Pemasangan Awning (135 m2 x 495.000) 1 paket 66,825,000

5 2 3 38 05 Belanja Modal Pengadaan genset

genset 1 Unit 11,726,900

5 2 3 38 11 Belanja Modal Pengadaan Backdrop

Backdrop 1 Paket 20,000,000

Jumlah

Banyuwangi, Oktober 2016

Kepala Puskesmas Songgon

WAWAN PRAYITNO
Penata / III/c
NIP. 19691225 199203 1 008
Keterangan :
Tanggal Pembahasan :
Catatan Hasil Pembahasan:
1
2
Tim anggaran Pemerintah Daerah
No Nama / NIP Jabatan Tanda Tangan
1
2
3

O2 ###
BMHP ###
Lab ###
Obat ###
Alked ###
###
518,871,097.00
 DRAFT
RKA-SKPD 2.2.1

an kesehatan
Nasional Puskesmas Songgon

Target Kinerja 2,597,097,627

100 % -
100 %
Rp 2,597,097,627
100 %
85%

gkat Daerah
elum Perubahan
Jumlah
6=3x5

2,597,097,627 Rp (400,000,000)
1,840,877,527
203,018,000 400,000,000
79,485,600 - -
71,000 `
516,000
255,000
1,675,000
402,500
192,000
300,000
420,000
930,000
846,000
490,000
900,000
345,200
1,080,000
183,500
420,000
54,000
96,000
165,000
120,000
90,000
elum Perubahan
Jumlah
61,000
9,750,000
106,750
409,500
3,725,000
1,775,000
517,000
162,500
300,000
583,000
297,000
134,000
35,900
48,000
720,000
306,000
189,000
220,000
40,500,000
2,750,000
3,960,000
1,381,500
1,381,500 78,863,850
621,750

7,498,250

672,500
662,500
802,000
2,075,000
2,045,500
235,500
277,000
728,250

2,250,000
450,000
1,800,000

10,000,000
10,000,000

8,300,000
1,500,000
6,800,000

15,000,000
15,000,000

3,500,000
3,500,000

76,984,150
elum Perubahan
Jumlah
76,984,150

294,820,227
149,893,427
149,893,427 149,838,427

144,926,800
144,926,800

1,158,618,450
6,000,000
6,000,000

240,000
240,000

1,137,226,500
1,137,226,500

12,401,950
12,401,950

2,750,000
2,750,000

4,621,350
2,310,000
2,310,000

2,311,350
648,300
1,427,300
93,800
141,950

118,474,500
81,057,000
2,860,000
550,000
7,875,000
330,000
1,207,000
640,000
2,600,000
2,600,000
4,400,000
23,000,000
15,360,000
80,000
3,550,000
10,340,000
5,665,000

37,417,500
elum Perubahan
Jumlah
37,417,500 124,793

8,125,000
8,125,000
6,250,000
1,875,000

10,000,000
10,000,000

1,530,000
6,510,000
1,960,000

43,200,000 Grendel jendela Aluminium mutu baik Buah 34,788

42,000,000 Grendel jendela Aluminium biasa Buah 29,900
35,000,000 Grendel pintu Unit 40,250
7,000,000

1,200,000
1,200,000

756,220,100
30,750,000
15,000,000 2594177627
15,000,000 Rp 2,920,000
4.9075630252
15,750,000
15,750,000 16736720
Belanja Modal Pengadaan mesin Antrian
36,056,700 Mesin antrian
14,080,000
14,080,000

7,411,800
7,411,800

4,158,000
4,158,000

10,406,900
10,406,900

85,704,000
8,700,000
8,700,000

51,000,000
51,000,000
25500000
26,004,000
26,004,000 10401600

143,280,400
elum Perubahan
Jumlah
79,010,400
17,787,000
55,283,400 30,713,000 33784300
5,940,000 24,570,400

41,995,000
3,320,000
38,675,000

22,275,000
22,275,000 11,137,500

9,920,000
2,430,000
2,430,000

7,490,000
7,490,000

81,417,600
7,700,000
7,700,000

25,855,500
25,855,500

22,968,000
22,968,000

24,894,100
21,714,000 10,857,000
3,180,100 14,037,100

145,749,000
128,254,200 42,751,400

17,494,800
2,524,800
14,970,000

17,000,000
17,000,000
17,000,000

206,342,400
70,741,000
16,390,000 4246000
25,476,000 7,450,000 8195000
28,875,000 250,000 275,000

37,049,500
8,893,500 16,424,500
7,531,000
elum Perubahan
Jumlah
20,625,000

66,825,000
66,825,000

11,726,900
11,726,900

20,000,000
20,000,000

2,597,097,627

uwangi, Oktober 2016

ala Puskesmas Songgon

WAWAN PRAYITNO
Penata / III/c
19691225 199203 1 008

Tanda Tangan
 RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
KABUPATEN BANYUWANGI
TAHUN ANGGARAN 2015

Urusan Pemerintahan: 1.02 Kesehatan

Organisasi : 1.02.01 Dinas Kesehatan
Program : [Link] Program Pembiayaan kesehatan
Kegiatan : [Link].03 Jaminan Kesehatan Nasional Puskesmas Songgon
Sub Kegiatan : JKN Puskesmas Songgon
Lokasi Kegiatan : Kabupaten Banyuwangi
Jumlah Tahun 2013 : Rp -
Jumlah Tahun 2014 : Rp -
Jumlah Tahun 2015 Rp 1,683,840,000
Jumlah Tahun 2016 : Rp 1,714,780,000
Jumlah Tahun 2017 : Rp 2,597,097,627
Indikator Dan Tolok Ukur Kinerja Belanja Langsung Target Kinerja
Indikator Tolok Ukur Kinerja 100 %
- Menunjang peningkatan akses dan mutu pelayanan kesehatan 100 %
Capaian Program
- Menunjang Cakupan Rawat Jalan Peserta JKN 15% Rp 2,597,097,6
Masukan - Tersedianya dana 100 %
Keluaran - Terlaksananya pelayanan JKN di puskesmas 85%
Hasil - Meningkatnya cakupan kunjungan masyarakat ke puskesmas
Kelompok Sasaran Kegiatan: Masyarakat dalam cakupan pelayanan kesehatan dasar di puskesmas
Rincian Perubahan Anggaran Belanja Langsung Program dan Per Kegiatan Satuan Kerja Perangkat Daerah
Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5

5 2 BELANJA LANGSUNG
5 2 2 BELANJA BARANG DAN JASA
5 2 2 01 Belanja Barang Habis Pakai
5 2 2 01 01 Belanja Alat Tulis Kantor
Calkulator 5 Buah 124,350
Amplop no 10 20 Kotak 3,550
Buku Folio Bergaris isi 200 Lembar 30 Buku 28,200
Buku tulis isi 50 100 Buah 4,900
Buku Folio Bergaris isi 100 Lembar 50 Buah 18,000
CDR ( isi 100 Pcs ) 1 Box 172,600
Correstion Pen (TIP-Ex) 100 Buah 10,800
Cutter 10 Buah 18,350
Hetmachine/Staples Kecil 20 Buah 21,000
Isi Staples Merk Etona no.10 20 Kotak 2,700
Isi Staples Merk Great Wall no 3 20 Kotak 4,800
Isolasi Jilid Hitam 5 cm 5 Buah 33,000
 Amplop Coklat (F4) 10 Kotak 51,600
Isolasi Jilid Hitam 3 cm 5 Buah 24,000
Isolasi Bening 2 Buah 18,000
Isolasi Kecil 20 Roll 3,050
Kertas HVS F4 70 gr 250 Rim 39,000
Kertas Bufalo Folio 5 Rim 21,350
Lem Kertas 30 Buah 13,650
Map Jepit Plastik 500 Buah 7,450
Map Plastik Folio 500 Buah 3,550
Odner Folio 20 Buah 25,850
Paper Klip no.3 50 Kotak 3,250
Amplop Putih 20 Dus 12,750
Paper Klip no.3 50 Kotak 6,000
Penggaris Besi 30 cm 20 Buah 29,150
Perforator/Pembolong no.30 2 Buah 68,400
Pita Mesin Ketik Manual 2 Buah 24,000
Spidol Snowman Permanen 10 Lusin 72,000
Stabilo 30 Buah 10,200
Stampad Kecil 15 Buah 12,600
Stip/ Penghapus 50 Buah 4,400
Stopmap bufalo 7,500 Buah 5,400
Ballpoint 500 Buah 3,350
Tas 110 Buah 25,000
Tinta Printer 59 Botol 66,000
Tinta Printer Rainbow black 28 Buah 46,050
Tinta Printer Rainbow Colour 30 Buah 46,050
Ballpoint bertempat 10 Buah 40,250
Binder Clip 155 20 Buah 9,600
Binder Clip 200 20 Dos 15,000
Binder Clip 260 20 Dos 21,000
Box File 50 Buah 18,600

5 2 2 01 03 Belanja Alat Listrik dan Elektronik ( Lampu pijar, Battery

Kering dll )
Senter LED 10 Pcs 26,450
Baterai Kecil 52 2 bh/ pak 12,850
Baterai 9 Volt 24 Set 27,300
Lampu Esential (SL) Philip 18 W 62 Pcs 46,300
Lampu Emergency 250 L Rechargeable 9 Buah 224,450
Kabel Roll Presto 3 Roll 80,550

5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya

Materai Rp 3000 150 Lembar 3,000
Materai Rp 6000 300 Lembar 6,000
5 2 2 01 06 Belanja Bahan bakar Minyak/Gas dan Pelumas Oli
BBM 1 Paket 10,000,000

5 2 2 01 08 Belanja Pengisian Tabung Gas

Oksigen 2,5 m³ 20 Tabung 75,000
Oksigen 6 m³ 68 Tabung 100,000

5 2 2 01 09 Belanja Alat/ Kelengkapan Inventaris Ruang Pasien

Gorden 23 M² 385,850
Korden/Gorden Horisontal blind 10 M² 718,900
Gorden Plastik Pitrs 82.50 Meter 250,000

5 2 2 01 12 Belanja Spanduk Atau Alat Informasi

Baner 652 Meter ² 23,000

5 2 2 01 13 Belanja Baliho
Baliho 133 Meter 26,250

5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan

Belanja Peralatan dan Bahan Kesehatan 1 Paket 76,984,150

5 2 2 02 BELANJA BAHAN/ MATERIAL

5 2 2 02 04 Belanja Bahan Obat - obatan
Belanja Bahan Obat - obatan 1 paket 149,893,427

5 2 2 02 17 Belanja bahan dan alat laboratorium

Belanja bahan dan alat laboratorium 1 Paket 144,926,800

5 2 2 03 Belanja Jasa Kantor

5 2 2 03 06 Belanja kawat/ faximile / internet
Biaya internet 1 Tahun 6,000,000

5 2 2 03 09 Belanja Jasa Transaksi Keuangan

Biaya Kliring 1 Tahun 240,000

5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan

Jasa Pelayanan Kesehatan 1 Paket 1,137,226,500

5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan

Kalibrasi Alat2 kesehatan 1 Paket 12,401,950

5 2 2 03 59 Belanja Jasa Instalasi Jaringan

Jasa Instalasi Jaringan Komputer Standar Network Area Kecil 1 Kali 2,750,000

5 2 2 05 Belanja Perawatan Kendaraan Bermotor

5 2 2 05 01 Belanja Jasa Servis
Servis 4 Paket 525,000
5 2 2 05 02 Belanja Penggantian Suku Cadang
Accu Mobil Yuassa 1 Buah 988,750
Ban Mobil Bridgestone 2 Buah 714,050
Filter Oli 2 Buah 49,200
Busi 2 Buah 74,600

5 2 2 06 Belanja Cetak Dan Penggandaan

5 2 2 06 01 Belanja Cetak
Buku Regester 50 Buah 25,600
Cetak Sertifikat/Piagam Full Colour 900 Exemplar 3,500
Cetak HVS Folio 70 gram 1 muka 65 Rim 122,000
Cetak Laeflet 5,000 Lembar 4,400
Cetak Blangko Hasil Laboratorium 100 Bendel 16,200
Lembar Balik 1,100 5,150
Cetak Kohort 1,200 Lembar 11,850
Klip Plastik 5x 8 cm 791 Box 19,400
HVS Double Folio/Double Kwarto 60 Gr Warna Cetak Sheet 4,400 Lembar 600
Cetak Resep Dokter 51 Buku 12,400
Biaya Jilid 140 Buku 18,450
Kresek kecil berlogo 79 Ikat 32,600

5 2 2 06 02 Belanja Penggandaan
Penggandaan/ Foto Copy 136,175 lembar 300
Sisa Mati 1 lembar 200

5 2 2 11 Belanja Makanan dan minuman

5 2 2 11 06 Belanja Makanan dan minuman harian peserta
Nasi 235 Kotak 25,000
Snack 235 Kotak 10,000

5 2 2 15 Belanja Perjalanan Dinas

5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah
Transport PHN
* Jarak 0 - 5 Km 51 OH 30,000
* Jarak 6 - 10 Km 186 OH 35,000
* Jarak 11 - 15 Km 49 OH 40,000

5 2 2 20 Belanja Pemeliharaan
5 2 2 20 04 Belanja Pemeliharaan Gedung
Pemasangan keramik 1 Paket 35,000,000
Partisikaca 1 Paket 7,000,000

5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor

Servis Komputer, Laptop, Printer 12 Unit/Bulan 100,000

5 2 3 BELANJA MODAL
5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor
5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi
Mesin Absensi 1 Unit 15,750,000

5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian

Mesin antrian 1 Unit 15,000,000

5 2 3 11 Belanja modal pengadaan perlengkapan kantor

5 2 3 11 02 Belanja modal pengadaan Almari
Almari 4 Buah 3,520,000

5 2 3 11 07 Belanja modal pengadaan rak arsip

Rak Arsip 3 Buah 2,470,600

5 2 3 11 14 Belanja Modal Pengadaan etalase

Lemari Etalase Tinggi 195x150x60 2 Unit 2,079,000

5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran

Pemadam kebakaran 2 Unit 5,203,450

5 2 3 12 Belanja Modal Pengadaan Komputer

5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC
Komputer / PC 1 Unit 8,938,150

5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book

Lap top 6 Unit 8,509,600

5 2 3 12 04 Belanja Modal Pengadaan Printer

Printer Laser Jet 5 Unit 5,201,150

5 2 3 13 Belanja modal pengadaan mebeulair

5 2 3 13 02 Belanja modal pengadaan Meja Rapat
Meja rapat ruang khusus 2 buah 8,893,500
Meja rapat 9 Unit 6,142,600
Meja kerja staf 1/2 biro 5 Unit 1,188,000

5 2 3 13 04 Belanja modal pengadaan kursi kerja

Kursi Kerja 2 buah 1,660,000
Kursi Staf 65 buah 595,000

5 2 3 13 10 Belanja modal pengadaan kursi Tunggu

Kursi Tunggu Pasien 10 Buah 2,227,500

5 2 3 14 Belanja modal pengadaan Peralatan Dapur

5 2 3 14 04 Belanja modal pengadaan dispenser
Dispenser 3 Unit 850,500

5 2 3 14 05 Belanja modal pengadaan kulkas

Kulkas 2 Pintu Small 2 Unit 3,718,800
5 2 3 16 Belanja modal pengadaan alat-alat studio
5 2 3 16 01 Belanja modal pengadaan Kamera
Kamera 2 Unit 3,850,000

5 2 3 16 03 Belanja modal pengadaan proyektor/infokus

LCD Proyektor 2 Unit 12,927,750

5 2 3 16 06 Belanja Modal Pengadaan monitor LCD

Monitor LCD 2 Unit 11,484,000

5 2 3 16 19 Belanja modal pengadaan TV

TV 22" 8 Unit 2,714,250
TV 26" 1 Unit 3,180,100

5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran

5 2 3 19 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 1 Paket 128,254,200

5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi

Scaller UDS-K woodpacker 1 set 2,295,300
Mata bor high speed fisure 2 set 7,485,000

5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan

5 2 3 30 14 Belanja modal pengadaan CCTV
CCTV 1 Paket 17,000,000

5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor

5 2 3 38 02 Belanja Modal Pengadaan AC
Belanja Modal Pengadaan AC 2 PK 2 Set 8,195,000
Belanja Modal Pengadaan AC 1 PK 6 Set 4,246,000
Belanja Modal Pengadaan AC 1/2 PK 7 Set 4,125,000

5 2 3 38 04 Belanja Modal Pengadaan Awning

Pemasangan Awning (135 m2 x 495.000) 1 paket 66,825,000

5 2 3 38 05 Belanja Modal Pengadaan genset

genset 1 Unit 11,193,850

5 2 3 38 11 Belanja Modal Pengadaan Backdrop

Backdrop 1 Paket 20,000,000

Jumlah

Banyuwangi, Oktober 2016

Kepala Puskesmas Songgon
 WAWAN PRAYITNO
Penata / III/c
NIP. 19691225 199203 1 008
Keterangan :
Tanggal Pembahasan :
Catatan Hasil Pembahasan:
1
2
Tim anggaran Pemerintah Daerah
No Nama / NIP Jabatan Tanda Tangan
1
2
3

O2 ###
BMHP ###
Lab ###
Obat ###
Alked ###
###
518,871,097.00
 DRAFT
RKA-SKPD 2.2.1

kesehatan
sional Puskesmas Songgon

Target Kinerja
100 %
100 %
Rp 2,597,097,627
100 %
85%

um Perubahan
Jumlah
6=3x5

2,597,097,627
1,878,322,977
238,200,950
78,770,800
621,750
71,000
846,000
490,000
900,000
172,600
1,080,000
183,500
420,000
54,000
96,000
165,000
 516,000
120,000
36,000
61,000
9,750,000
106,750
409,500
3,725,000
1,775,000
517,000
162,500
255,000
300,000
583,000
136,800
48,000
720,000
306,000
189,000
220,000
40,500,000
1,675,000
2,750,000
3,894,000
1,289,400
1,381,500
402,500
192,000
300,000
420,000
930,000
-
-
-
-

6,720,200

264,500
668,200
655,200
2,870,600
2,020,050
241,650

2,250,000
450,000
1,800,000
 10,000,000
10,000,000

8,300,000
1,500,000
6,800,000

36,688,550
8,874,550
7,189,000
20,625,000

14,996,000
14,996,000

3,491,250
3,491,250

76,984,150
76,984,150

294,820,227
149,893,427
149,893,427

144,926,800
144,926,800

1,158,618,450
6,000,000
6,000,000

240,000
240,000

1,137,226,500
1,137,226,500

12,401,950
12,401,950

2,750,000
2,750,000

4,764,450
2,100,000
2,100,000
 2,664,450
988,750
1,428,100
98,400
149,200

120,493,900
79,641,200
1,280,000
3,150,000
7,930,000
22,000,000
1,620,000
5,665,000
14,220,000
15,345,400
2,640,000
632,400
2,583,000
2,575,400

40,852,700
40,852,500
200

8,225,000
8,225,000
5,875,000
2,350,000

10,000,000
10,000,000

1,530,000
6,510,000
1,960,000

43,200,000
42,000,000
35,000,000
7,000,000

1,200,000
1,200,000

718,774,650
30,750,000
 15,750,000
15,750,000

15,000,000
15,000,000

36,056,700
14,080,000
14,080,000

7,411,800
7,411,800

4,158,000
4,158,000

10,406,900
10,406,900

86,001,500
8,938,150
8,938,150

51,057,600
51,057,600 25528800

26,005,750
26,005,750 15,603,450
10,402,300
143,280,400
79,010,400
17,787,000
55,283,400
5,940,000

41,995,000
3,320,000
38,675,000

22,275,000
22,275,000

9,989,100
2,551,500
2,551,500

7,437,600
7,437,600
 81,417,600
7,700,000
7,700,000

25,855,500
25,855,500

22,968,000
22,968,000

24,894,100
21,714,000
3,180,100

145,519,500
128,254,200

17,265,300
2,295,300
14,970,000

17,000,000
17,000,000
17,000,000

168,759,850
70,741,000
16,390,000
25,476,000
28,875,000

66,825,000
66,825,000

11,193,850
11,193,850

20,000,000
20,000,000

2,597,097,627

wangi, Oktober 2016

a Puskesmas Songgon
WAWAN PRAYITNO
Penata / III/c
19691225 199203 1 008

Tanda Tangan
 RENCANA ANGGARAN BIAYA (RAB)
Kegiatan : JKN Puskesmas Songgon
Obyek Belanja : Belanja Alat Kedokteran Umum

Jumlah Harga
No Jenis Obat Satuan Volume Satuan
(Rp.)
1 Tabung Oksigen 6m3 10 Pcs 1,146,700 11,467,000
2 Alat untuk Mengeluarkan Benda Asing 2 pcs 1,916,475 3,832,950
3 Pinset telinga smic 2 buah 1,324,450 2,648,900
4 Incubator Bayi ex. Lokal 0 Unit1,558,425 -
5 Partus Set 0 set 6,546,500 -
6 Hecting set 0 pcs 404,250 -
7 Emergency Strecher 1 Unit
17,473,250 17,473,250
8 Halogen Examination Lamp 1 Unit7,753,800 7,753,800
9 Spygnomanometer 0 buah 2,319,900 -
10 Instrument trolly 1 buah 3,472,750 3,472,750
11 THT set 1 pcs 1,397,550 2,795,100
12 Almari instrument 2 buah 5,486,250 10,972,500
13 Oksigen Sentral 1 Set
65,000,000 65,000,000
14 Paket DDTK 1 Paket 286,750 286,750
15 BKB Kit 1 Paket2,551,200 2,551,200
JUMLAH 128,254,200
PEMBULATAN
TERBILANG : EMPAT PULUH ENAM JUTA SEMBILAN RATUS TIGA PULUH LIMA RIBU SERATUS
RUPIAH

Banyuwangi, 07 Oktober 2015

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Kepala Puskesmas Songgon

MUJITO,SKM WAWAN PRAYITNO,[Link]

Penata Penata
NIP. 19690524 199103 1 003 NIP.19691225 199203 1 008
MAK 31204
Gigante BRAUN-UK LED EXAMINATION LAMP.32.0082 : 990,61 Poundsterling

CAREWELL Ultrasonic Pocket Doppler CFD-22 3,127,000

undsterling PT Global Systech Medika

183,000 3,310,000 PT. Karya Pratama

 RENCANA ANGGARAN BIAYA (RAB) 2016
Kegiatan : JKN Puskesmas Songgon
Obyek Belanja : Belanja BMHP

No Jenis Obat Volume Satuan Harga

Alat Suntik sekali pakai 1 cc x 27G
1 Nipro 100
Pc
1,089
Alat Suntik sekali pakai 10 cc x 21G
2 Nipro 200
Pc
1,428
Alat Suntik sekali pakai 3 cc x 23G
3 Nipro 5000
Pc
871
Alat Suntik sekali pakai 5 cc x 23G
4 Nipro 1000
Pc
1,077
5 Alat Suntik Sekali Pakai 0,05 ml BD 12 box/100 182,105
6 Alat Suntik Sekali Pakai 0,5 ml BD 50 box/100 182,105
7 Alkohol 70 % 1 liter 10 Botol 23,650
8 Alkohol swab 20 box/100 11,000
9 Bioplacenton tulle 10 Box 114,400
10 Blade B Braun Aesculaps 11 10 box/100 330,000
11
12
13
14 Catgut Chromic 3/0 + jarum Bbraun 1 Roll 1,457,500
15 Catgut Plain 3/0 + jarum Bbraun 1 Roll 1,430,000
16 Folley Catheter 2 way no. 16 6 box/10 88,000
17 Folley Catheter 2 way no. 18 6 box/10 88,000
18 Folley Catheter 2 way no. 20 3 box/10 88,000
19 Folley Catheter 2 way no. 22 3 box/10 88,000
20 Folley Catheter 2 way no. 24 2 box/10 88,000
21 Handschoon Size L 20 box/100 35,750
22 Handschoon Size M 100 box/100 35,750
23 Handschoon Size S 5 box/100 35,750
24 I.V Catheter no. 18 Stera 200 buah 4,180
25 I.V Catheter no. 20 Stera 100 buah 4,180
26 I.V Catheter No. 22 Stera 100 buah 4,180
27 I.V Catheter No. 24 Stera 100 buah 4,180
28 I.V Catheter no. 26 Stera 50 buah 4,510
29 Infusion Set Dewasa Terumo type y 600 Unit 8,053
30 Infusion Set Pediatric Terumo 100 Unit 11,447
31 Jelly tube 82 g 10 tube 82 g 32,504
32 Kapas pembalut 250 g Ahmad Daris 20 1 Roll 26,400
33 Kapas pembalut 500 g 20 1 Roll 30,008
34 Kapas Pembalut Hidrofil 36x80 cm 30 1 Roll 143,000
35 Kasa Hidrofil 4 m x 5 cm 100 1 Roll 1,210
36 Kasa Hidrofil 4 m x 15 cm 300 1 Roll 4,180
37 Kasa Hidrofil 40 X 40 30 1 Roll 1,980

38 Lysol 1 liter 5 botol 45,100

39 Povidon Iodida larutan 10% 300 ml 20 cart/10 btl 19,800
40
41
42 Povidon Iodine 30 cc 50 Botol 3,190
43 Rivanol 300 cc 10 Botol 2,805
Silk Black 3/0 + jarum 1/2 35 mm
44 Bbraun 1
Roll
396,000
45 Leukoplast 7,5 cm X 4,5 m 100 Roll 39,085
46 Test Kehamilan OneMed UltraOne 200 2,133
47 Underpad 300 8,580
48 Sabun Cuci Tangan 5 L 20 Btl 23,100
49 Blood Lancet 28 G 10 16,023

ALKEDUM
Umbilical Cord Clam blue OGS 100 Pcs 1,050
Feeding Tube Terumo 100 cm no 5 0 Pcs 8,841
Selang penghisap lendir bayi 100 Pcs 20,550
Apron plastik 10 buah Rp 58,327.50
Cement Zinc 3 set Rp 274,952.70
CHKM 3 botol Rp 124,987.50
Devitalisasi pasta (non arsen) 6 botol Rp 549,945.00
Formokresol (TKF) 3 set Rp 124,988
Glass ionomer 6 set Rp 559,944
H2O2 3% 2 botol Rp 49,995
Handschoon panjang siku 50 psg Rp 34,997
Handschoon rumah tangga size L 10 psg Rp 24,998
Hansaplast 10 box/100 Rp 58,328
Jarum hecting kulit 10 buah Rp 23,331
Jarum hecting otot 10 buah Rp 23,331
Jarum/needle No. 23 G 10 box Rp 124,988
Kaca mata goggle 5 buah Rp 91,658
Pengait cerumen dan sendok serumen pcs Rp 21,665
10
Plesterin bulat 2 box Rp 45,829
Termometer klinis 10 buah Rp 24,998
Test buta warna ( isihara ) 10 buah Rp 141,653
Tounge spatel 10 buah Rp 12,499
Tricresul / Formalin 3 buah Rp 91,658
Tromol kasa kecil 4 buah Rp 258,308
Tromol kasa sedang 4 buah Rp 424,958
Tuorniquet 10 buah Rp 24,998
Urinal 10 buah Rp 7,500
Washlap kain 200 buah Rp 8,333
bahan tumpatan sementara 6 set Rp 256,641
kalsium hidroksida 3 botol Rp 601,607
Eugenol 3 botol Rp 91,658
Seluloid Kotak/ Strip 2 Pc 143,300
Tempat Alkohol ( Dappen Glass ) 2 Pc 9,200
Spongostan 3 Box 683,750
Ky Jelly 10 Tube 50,700
Sound Timer 4 Pc 63,100
2016

Jumlah Harga
(Rp.)

108,900.00 1,197.9 1,089 108,900.0

285,600.00 1,570.8 1,428 285,600.0

4,355,000.00 958.1 871 4,355,000.0

1,077,000.00 1,184.7 1,077 1,077,000.0

2,185,260.00 200,315.5 182,105 2,185,260.0
9,105,250.00 200,315.5 182,105 9,105,250.0
236,500.00 26,015.0 23,650 236,500.0
220,000.00 12,100.0 11,000 220,000.0
1,144,000.00 125,840.0 114,400 1,144,000.0
3,300,000.00 363,000.0 330,000 3,300,000.0

1,457,500.00 1,603,250.0 1,457,500 1,457,500.0

1,430,000.00 1,573,000.0 1,430,000 1,430,000.0
528,000.00 96,800.0 88,000 528,000.0
528,000.00 96,800.0 88,000 528,000.0
264,000.00 96,800.0 88,000 264,000.0
264,000.00 96,800.0 88,000 264,000.0
176,000.00 96,800.0 88,000 176,000.0
715,000.00 39,325.0 35,750 715,000.0
3,575,000.00 39,325.0 35,750 3,575,000.0
178,750.00 39,325.0 35,750 178,750.0
836,000.00 4,598.0 4,180 836,000.0
418,000.00 4,598.0 4,180 418,000.0
418,000.00 4,598.0 4,180 418,000.0
418,000.00 4,598.0 4,180 418,000.0
225,500.00 4,961.0 4,510 225,500.0
4,831,800.00 8,858.3 8,053 4,831,800.0
1,144,700.00 12,591.7 11,447 1,144,700.0
325,040.00 35,754.4 32,504 325,040.0
528,000.00 29,040.0 26,400 528,000.0
600,160.00 33,008.8 30,008 600,160.0
4,290,000.00 157,300.0 143,000 4,290,000.0
121,000.00 1,331.0 1,210 121,000.0
1,254,000.00 4,598.0 4,180 1,254,000.0
59,400.00 2,178.0 1,980 59,400.0

225,500.00 49,610.0 45,100 225,500.0

 396,000.00 21,780.0 19,800 396,000.0

159,500.00 3,509.0 3,190 159,500.0

28,050.00 3,085.5 2,805 28,050.0

396,000.00 435,600.0 396,000 396,000.0

3,908,500.00 42,993.5 39,085 3,908,500.0
426,600.00 2,346.3 2,133 426,600.0
2,574,000.00 9,438.0 8,580 2,574,000.0
462,000.00 25,410.0 23,100 462,000.0
160,230.00 17,625.3 16,023 160,230.0
- - -
- - -
105,000.00 1,155.0 1,155.0 115,500.0
- 9,725.1 9,725.0 -
2,055,000.00 22,605.0 22,605.0 2,260,500.0
583,275.00 ELITECH 64,160.3 64,160.0 641,600.0
824,858.10 GC 302,448.0 302,448.0 907,344.0
374,962.50 GHIMAS 137,486.3 137,486.0 412,458.0
3,299,670.00 D PULP 604,939.5 604,940.0 3,629,640.0
374,962.50 Camex 137,486.3 137,486.0 412,458.0
3,359,664.00 gc 615,938.4 615,938.0 3,695,628.0
99,990.00 ONEMED 54,994.5 54,995.0 109,990.0
1,749,825.00 GYNAEC MASTER 38,496.2 38,496.0 1,924,800.0
249,975.00 ONEMED 27,497.3 27,497.0 274,970.0
583,275.00 BSN 64,160.3 64,160.0 641,600.0
233,310.00 RRC 25,664.1 25,664.0 256,640.0
233,310.00 RRC 25,664.1 25,664.0 256,640.0
1,249,875.00 TERUMO 137,486.3 137,486.0 1,374,860.0
458,287.50 LOKAL 100,823.3 100,823.0 504,115.0
SS 23,831.0 23,831.0 238,310.0
216,645.00
91,658.60 ONEMED 50,412.2 50,412.0 100,824.0
249,975.00 SAFETY 27,497.3 27,497.0 274,970.0
1,416,525.00 ONEMED 155,817.8 155,817.0 1,558,170.0
124,993.00 SS 13,749.2 13,749.0 137,490.0
274,972.50 CAMEX 100,823.3 100,823.0 302,469.0
1,033,230.00 SS 284,138.3 284,138.0 1,136,552.0
1,699,830.00 SS 467,453.3 467,453.0 1,869,812.0
249,975.00 RRC 27,497.3 27,497.0 274,970.0
74,998.00 LOKAL 8,249.8 8,250.0 82,500.0
1,666,500.00 LOKAL 9,165.8 9,166.0 1,833,200.0
1,539,846.00 CAVITON 282,305.1 282,305.0 1,693,830.0
1,804,819.50 Hydcal/Calcidor 661,767.2 661,767.0 1,985,301.0
274,972.50 CAMEX 100,823.3 100,823.0 302,469.0
157,630.0 157,630.0 315,260.0
10,120.0 10,120.0 20,240.0
752,125.0 752,125.0 2,256,375.0
 507000 55,770.0 55,770.0 557,700.0
69,410.0 69,410.0 277,640.0

81,893,919.70 87,141,225.0
100100
 RENCANA ANGGARAN BIAYA

KEGIATAN : JAMINAN PELAYANAN KESEHATAN BANYUWANGI PUSKESMAS SONGG

OBYEK BELANJA : BELANJA OBAT

NO NAMA Formulasi dan Sediaan SATUAN KEBUTUH

AN

1 air untuk injeksi cairan inj botol 100

2 albendazol tab 400 mg tablet
3 albendazol sir 200 mg/5mL botol
4 alopurinol tab 100 mg tablet
5 alopurinol tab 300 mg tablet 10,000
6 aminofilin tab 200 mg tablet 2,000
7 aminofilin cairan inj 24 mg/mL ampul 30
8 amitriptilin tab salut 25 mg tab sal selaput 25 mg tablet 100
9 amlodipin tab 5 mg tablet 500
10 amlodipin tab 10 mg tablet 2,000
11 amoksisilin tab 500 mg tablet 40,000
12 amoksisilin sir kering 125 mg/5 mL botol 200
13 amoksisilin sir kering 250 mg/5 mL botol 100
14 ampisilin serb inj i.v. 1000 mg/vial vial
15 antasida syr sir botol 200
16 antasida tablet tab kunyah tablet 20,000
17 antifungi / salep 3-6 salep tube -
18 antihemoroid, kombinasi : suppositoria supp 30
19 antimigren kombinasi : ergotamin + kofein tab tablet 250
20 asam asetilsalisilat (asetosal) tab 80 mg tablet
21 asam askorbat (vitamin C) tab 50 mg tablet -
22 asam askorbat (vitamin C) tab 250 mg tablet 1,000
23 asam folat tab 1 mg tablet
24 asam mefenamat kaps 250 mg kapsul
25 asam mefenamat kapl 500 mg tablet 30,000
26 asam retinoat krim 0,1% tube
27 asiklovir tab 200 mg tablet
28 asiklovir tab 400 mg tablet 500
29 atapulgit tab tab tablet 3,000
30 atenolol tab 50 mg tablet
31 atropin cairan inj i.v./i.m./s.k. 0,25 mg/mL ampul
32 atropin tab 0,5 mg tablet
33 atropin cairan inj i.m. /i.v. /s.k. 0,25 mg/mL ampul
34 bedak salisil serb 2% pot
35 benzatin benzil penisilin cairan inj i.m. 1,2 juta UI/mL vial
36 benzatin benzil penisilin cairan inj i.m. 2,4 juta UI/mL vial
37 betametason krim 0,1% tube 150
38 betametason tts mata 1mg/ mL botol 100
39 bisakodil tab 5 mg tablet
40 bisakodil sup 5 mg supp 12
41 bisakodil sup 10 mg supp
42 captopril tab 12,5 mg tablet 1,000
43 captopril tab 25 mg tablet 8,000
44 coal tar lar 5% botol 5
45 dapson tab 100 mg tablet
46 deksametason cairan inj i.v./i.m. 5 mg/mL ampul 200
47 deksametason tab 0,5 mg tablet 20,000
48 deksametason cairan inj 5 mg/mL ampul
49 deksametason tab 0,5 mg tablet
50 diazepam cairan inj i.v. 5 mg/mL ampul
51 diazepam lar rektal 5 mg/2,5 mL botol 10
52 diazepam lar rektal 10 mg/2,5mL botol 10
53 diazepam tab 2 mg tablet
54 diazepam tab 5 mg tablet 100
55 dietilkarbamazin tab 100 mg tablet
56 difenhidramin cairan inj i.v./i.m. 10 mg/mL ampul 120
57 digoksin tab 0,25 mg tablet 100
58 diltiazem tab 30 mg (HCl) tablet
59 dimenhidrinat tab 50 mg tablet 1,000
60 doksisiklin kaps 100 mg kapsul 300
61 domperidon tab 10 mg tablet 500
62 domperidon sir 5 mg/5 mL botol 50
63 epinefrin (adrenalin) cairan inj i.v./i.m./s.k. 0,1% ampul 60
64 eritromisin tab 500 mg tablet 2,000
65 eritromisin sir kering 200 mg/5 mL botol 200
66 etil klorida spray 100 ml botol 50
67 fenitoin kaps 30 mg kapsul
68 fenitoin kaps 100 mg kapsul
69 fenitoin cairan inj 50 mg/mL ampul
70 fenobarbital tab 30 mg tablet
71 fenobarbital tab 100 mg tablet
72 fenoksimetil penisilin (penisilin V) tab 250 mg tablet
73 fenoksimetil penisilin (penisilin V) tab 500 mg tablet
74 fitomenadion (vitamin K1) tab salut 10 mg tablet
75 fitomenadion (vitamin K1) inj i.m. 2 mg/mL ampul
76 fitomenadion (vitamin K1) inj i.m. 10 mg/mL ampul
77 flufenazin cairan inj i.m. 25 mg/mL (dekanoat) ampul
78 fluoksetin tab 20 mg tablet
79 fluor kapl 1 mg tablet
80 furosemid tab 40 mg tablet 10,000
81 furosemid cairan inj i.v./i.m. 10 mg/mL ampul 50
82 garam oralit serb sachet 3,000
83 glibenklamid tab 5 mg tablet 5,000
84 glimepirid 1 mg tab 1 mg tablet
85 glimepirid 2 mg tab 2 mg tablet 10,000
86 glipizid tab 5 mg tablet
87 gliseril trinitrat tab 0,5 mg tablet
88 gliserin cairan obat luar 100 mg/mL botol
89 glukosa lar infus 5% botol 100
90 griseofulvin, micronized tab 125 mg tablet
91 griseofulvin, micronized tab 250 mg tablet 500
92 haloperidol 1,5 mg tablet 200
93 haloperidol 2 mg tablet
94 haloperidol 5 mg tablet
95 haloperidol tetes 2 mg/mL botol
96 haloperidol cairan inj i.m. 5 mg/mL (HCl) ampul
97 haloperidol cairan inj 50 mg/mL (dekanoat) ampul
98 hidrogen peroksida 800 ml cairan 3% botol
99 hidroklorotiazid tab 25 mg tablet 1,000
100 hidrokortison krim 2,5% tube 1,200
101 hiosin butilbromid tab 10 mg tablet 2,500
102 ibuprofen tab 200 mg tablet 10,000
103 ibuprofen tab 400 mg tablet 30,000
104 ibuprofen susp 100 mg/5 ml botol 200
105 ibuprofen susp 200 mg/5 ml botol
106 isoniazid tab 100 mg tablet
107 isoniazid tab 300 mg tablet
108 isosorbid dinitrat tab sublingual 5 mg tablet
109 isosorbid dinitrat tab sublingual 10 mg tablet
110 kalsium carbonat tab 500 mg tablet
111 kalsium laktat (kalk) tab 500 mg tablet 2,000
112 kaptopril tab 12,5 mg tablet
113 kaptopril tab 25 mg tablet
114 kaptopril tab 50 mg tablet
115 karbamazepin tab 200 mg tablet 200
116 karbogliserin tts telinga 10% botol
117 ketokonazol tab 200 mg tablet 500
118 ketokonazol krim 2% tube 200
119 klofazimin , micronized kaps dalam minyak 100 mg kapsul
120 kloramfenikol kaps 250 mg kapsul
121 kloramfenikol susp 125 mg/5 mL botol 100
122 kloramfenikol tts mata 0,5% botol 200
123 kloramfenikol salep mata 1% tube 50
124 kloramfenikol tts telinga 3% botol 300
125 klorfeniramin tab 4 mg tablet 10,000
126 klorpromazin 25 mg tab sal selaput 25 mg tablet
127 klorpromazin 25 mg tab sal selaput 100 mg tablet
128 klorpromazin 25 mg cairan inj i.m. 5 mg/mL ampul
129 kodein tab 10 mg tablet
130 kodein tab 20 mg tablet
131 kodein tab 10 mg tablet
132 kolkisin tab 500 mcg tablet
133 kotrimoksazol (dewasa) kombinasi tab 480 mg tablet
134 kotrimoksazol sirup susp 240 mg botol 100
135 laktulosa sir 3,335 g/5 mL botol
136 lidokain cairan inj 2% ampul
137 lidokain spray oral 10% botol
138 lidokain kombinasi epinefrin cairan inj 2 mL ampul 1,200
139 loratadin tab 10 mg tablet 500
140 magnesium sulfat cairan inj i.v. 20% ampul
141 magnesium sulfat cairan inj i.v. 40% ampul
142 mebendazol tab 100 mg tablet
143 mebendazol tab 500 mg tablet
144 mebendazol sir 50 mg/mL botol
145 metformin tab 500 mg tablet 3,000
146 metformin tab 850 mg tablet
147 metilergometrin tab sal selaput 0,125 mg tablet
148 metilergometrin cairan inj 0,2 mg/mL ampul
149 metilprednisolon tab 4 mg tablet 2,000
150 metoklopramid tab 10 mg tablet
151 metronidazol tab 250 mg tablet
152 metronidazol tab 500 mg tablet
153 metronidazol sir 125 mg/5 mL botol 50
154 metronidazol lar infus 5 mg/mL botol 10
155 mikonazol krim 2% tube 100
156 mometason furoat krim 0,1% 5 g tube 50
157 natrium bikarbonat tab 500 mg tablet 100
158 natrium diklofenak tab sal enterik 25 mg tablet 10,000
159 natrium diklofenak tab sal enterik 50 mg tablet 20,000
160 natrium tiosulfat cairan inj i.v 25% ampul
161 nifedipin tab 10 mg tablet 500
162 nistatin tab sal gula 500.000 UI/mL tablet
163 nistatin tab vaginal 100.000 IU tablet
164 oksitosin cairan inj 10 IU/mL ampul 150
165 omeprazol 20 mg kaps 20 mg kapsul 600
166 parasetamol tab 500 mg tablet 50,000
167 parasetamol sir 120 mg/5 ml botol 420
168 parasetamol drops 60 mg/0,6 ml botol 150
169 perak sulfadiazin krim 1% tube 100
170 permetrin krim 5% tube 50
171 pirantel pamoat tablet 125 mg tablet
172 pirantel pamoat tablet 250 mg tablet
173 pirantel pamoat susp 125 mg/5 mL botol
174 piridoksin (vitamin B6) tab 10 mg tablet 5,000
175 prazikuantel tab 600 mg tablet
176 prednison tab 5 mg tablet
177 prokain benzilpenisilin serb inj i.m. 3 juta UI/viaL vial
178 propanolol tab 10 mg tablet
179 propiltiourasil tab 100 mg tablet
180 ranitidin tab 150 mg tablet 10,000
181 ringer laktat lar infus botol 1,000
182 risperidon tab 2 mg tablet
183 salbutamol tab 2 mg tablet
184 salbutamol tab 4 mg tablet 2,000
185 salbutamol MDI/aerosol 100 mcg/dosis botol
186 salep 2-4 salep pot -
187 serum anti bisa ular A.B.U.I cairan inj i.m./i.v. vial
188 serum antitetanus (A.T.S) inj i.m. 1500 IU/mL vial
189 setirizin sir 5 mg/5 mL botol
190 sianokobalamin tab 50 mcg tablet 5,000
191 sianokobalamin inj 500 mcg/ mL ampul 200
192 simvastatin tab sal selaput 10 mg tablet
193 simvastatin tab sal selaput 20 mg tablet 1,000
194 siprofloksasin tab sal selaput 500 mg tablet
195 spironolakton tab 25 mg tablet 300
196 tetrakain tts mata 0,5% botol 50
197 tetrasiklin kaps 250 mg (HCl) kapsul
198 tetrasiklin kaps 500 mg (HCl) kapsul
199 thiamin (vitamin B1) tab 50 mg tablet 5,000
200 triheksifenidil tab 2 mg tablet
201 vitamin b kompleks tab kombinasi tablet
202 zinc tab dispersible 20 mg tablet

JUMLAH TOTAL
PAGU ANGGARAN
SISA MATI

Banyuwangi, 8 M
Mengetahui
Kuasa Pengguna Anggaran PenanggungJ
Kepala Bidang Bina PKF Kepala Puskesma

MUJITO,SKM WAWAN PRAYIT

Penata/ III C Penata/ III
NIP. 19690524 199103 1 003 NIP. 19691225 199

Atropin Sulfat Inj. box/100 amp

furosemid ( Lasix ) cairan inj i.v./i.m. 10 mg/mL 5 ampul/ Box 50
USKESMAS SONGGON

HARGA
HARGA TOTAL
SATUAN

Rp 3,025 Rp 302,500 3,327.50 332750

Rp 403 Rp - 0
Rp 5,718 Rp - 0
Rp 85 Rp - 991.1 0
Rp 220 Rp 2,200,000 0
Rp 88 Rp 176,000 0
Rp 4,204 Rp 126,126 4048 121440
Rp 123 Rp 12,320 172.7 17270
Rp 206 Rp 102,850 127.6 63800
Rp 363 Rp 726,000 176 352000
Rp 287 Rp 11,484,000 280.5 11220000
Rp 2,690 Rp 537,900 2528.9 505780
Rp 7,217 Rp 721,710 0
Rp 5,610 Rp - 0
Rp 2,376 Rp 475,200 2450.8 490160
Rp 79 Rp 1,584,000 74.8 1496000
Rp 1,984 Rp - 0
Rp 3,350 Rp 100,485 3685 110550
Rp 526 Rp 131,450 0
Rp 163 Rp - 0
Rp 105 Rp - 0
Rp 175 Rp 174,900 151.8 151800
Rp 53 Rp - 0
Rp 261 Rp - 0
Rp 123 Rp 3,696,000 128.7 3861000
Rp 10,725 Rp - 0
Rp 261 Rp - 0
Rp 370 Rp 184,800 422.4 211200
Rp 209 Rp 627,000 176 528000
Rp 770 Rp - 0
Rp 1,485 Rp - 0
Rp 89 Rp - 0
Rp 1,430 Rp - 0
Rp 1,375 Rp - 0
Rp 12,177 Rp - 0
Rp 14,740 Rp - 0
Rp 1,672 Rp 250,800 1669.8 250470
Rp 27,617 Rp 2,761,660 0
Rp 5,489 Rp - 0
Rp 6,650 Rp 79,794 0
Rp 6,650 Rp - 0
Rp 68 Rp 68,200 0
Rp 92 Rp 739,200 0
Rp 275,000 Rp 1,375,000 0
Rp 66 Rp - 0
Rp 1,738 Rp 347,600 1837 367400
Rp 68 Rp 1,364,000 52.8 1056000
Rp 1,738 Rp - 0
Rp 76 Rp - 0
Rp 4,598 Rp - 0
Rp 12,678 Rp 126,775 13935.9 139359
Rp 18,126 Rp 181,258 20257.6 202576
Rp 50 Rp - 0
Rp 34 Rp 3,410 0
Rp 110 Rp - 0
Rp 1,155 Rp 138,600 1422.3 170676
Rp 107 Rp 10,670 127.6 12760
Rp 226 Rp - 0
Rp 114 Rp 114,400 0
Rp 297 Rp 89,100 325.6 97680
Rp 184 Rp 91,850 143 71500
Rp 3,666 Rp 183,315 0
Rp 8,910 Rp 534,600 2666.4 159984
Rp 1,023 Rp 2,046,000 883.3 1766600
Rp 8,470 Rp 1,694,000 0
Rp 102,520 Rp 5,126,000 0
Rp 102 Rp - 0
Rp 169 Rp - 0
Rp 1,888 Rp - 0
Rp 68 Rp - 0
Rp 215 Rp - 0
Rp 319 Rp - 0
Rp 561 Rp - 0
Rp 693 Rp - 0
Rp 3,759 Rp - 0
Rp 3,759 Rp - 0
Rp 60,500 Rp - 0
Rp 1,283 Rp - 0
Rp 61 Rp - 0
Rp 94 Rp 935,000 94.6 946000
Rp 3,060 Rp 153,010 0
Rp 317 Rp 950,400 319 957000
Rp 62 Rp 308,000 0
Rp 292 Rp - 0
Rp 480 Rp 4,796,000 0
Rp 446 Rp - 0
Rp 1,650 Rp - 0
Rp 5,866 Rp - 0
Rp 6,325 Rp 632,500 8349 834900
Rp 230 Rp - 0
Rp 669 Rp 334,400 0
Rp 122 Rp 24,420 80.3 16060
Rp 142 Rp - 0
Rp 182 Rp - 0
Rp 18,150 Rp - 0
Rp 18,150 Rp - 0
Rp 91,666 Rp - 0
Rp 43,175 Rp - 0
Rp 164 Rp 163,900 180.4 180400
Rp 3,078 Rp 3,693,360 3206.5 3847800
Rp 446 Rp 1,113,750 0
Rp 121 Rp 1,210,000 127.6 1276000
Rp 165 Rp 4,950,000 154 4620000
Rp 3,849 Rp 769,780 2995.3 599060
Rp 6,683 Rp - 0
Rp 28 Rp - 0
Rp 73 Rp - 0
Rp 97 Rp - 0
Rp 101 Rp - 0
Rp 65 Rp - 0
Rp 77 Rp 154,000 75.9 151800
Rp 68 Rp - 0
Rp 97 Rp - 0
Rp 333 Rp - 0
Rp 270 Rp 53,900 326.7 65340
Rp 2,246 Rp - 0
Rp 330 Rp 165,000 0
Rp 3,135 Rp 627,000 3080 616000
Rp 3,088 Rp - 0
Rp 274 Rp - 0
Rp 4,048 Rp 404,800 4786.1 478610
Rp 5,170 Rp 1,034,000 0
Rp 1,760 Rp 88,000 2175.8 108790
Rp 2,376 Rp 712,800 0
Rp 56 Rp 561,000 50.6 506000
Rp 75 Rp - 0
Rp 158 Rp - 0
Rp 1,155 Rp - 0
Rp 550 Rp - 0
Rp 1,210 Rp - 0
Rp 699 Rp - 0
Rp 404 Rp - 0
Rp 152 Rp - 0
Rp 2,384 Rp 238,370 2589.4 258940
Rp 15,950 Rp - 0
Rp 923 Rp - 0
Rp 156,200 Rp - 0
Rp 1,499 Rp 1,799,160 2233 2679600
Rp 169 Rp 84,700 161.7 80850
Rp 1,694 Rp - 0
Rp 2,142 Rp - 0
Rp 322 Rp - 0
Rp 350 Rp - 0
Rp 5,049 Rp - 0
Rp 124 Rp 372,900 121 363000
Rp 491 Rp - 0
Rp 169 Rp - 0
Rp 3,025 Rp - 0
Rp 655 Rp 1,309,000 234.3 468600
Rp 114 Rp - 0
Rp 121 Rp - 0
Rp 176 Rp - 160.6 0
Rp 4,510 Rp 225,500 0
Rp 10,945 Rp 109,450 0
Rp 3,300 Rp 330,000 3932.5 393250
Rp 20,951 Rp 1,047,530 0
Rp 22 Rp 2,200 0
Rp 146 Rp 1,463,000 176 1760000
Rp 194 Rp 3,872,000 192.5 3850000
Rp 4,455 Rp - 0
Rp 121 Rp 60,500 125.4 62700
Rp 704 Rp - 0
Rp 528 Rp - 0
Rp 2,420 Rp 363,000 2299 344850
Rp 232 Rp 139,260 0
Rp 87 Rp 4,345,000 68.2 3410000
Rp 1,582 Rp 664,356 1299.1 545622
Rp 5,720 Rp 858,000 0
Rp 25,300 Rp 2,530,000 0
Rp 12,623 Rp 631,125 0
Rp 475 Rp - 0
Rp 950 Rp - 0
Rp 9,196 Rp - 0
Rp 130 Rp 649,000 143 715000
Rp 2,526 Rp - 0
Rp 125 Rp - 0
Rp 8,935 Rp - 0
Rp 72 Rp - 0
Rp 351 Rp - 0
Rp 132 Rp 1,320,000 127.6 1276000
Rp 5,720 Rp 5,720,000 8651.5 8651500
Rp 1,109 Rp - 0
Rp 65 Rp - 80.3 0
Rp 98 Rp 195,800 0
Rp 70,125 Rp - 0
Rp 2,200 Rp - 2939.2 0
Rp 520,300 Rp - 0
Rp 139,150 Rp - 0
Rp 15,519 Rp - 0
Rp 63 Rp 313,500 0
Rp 1,540 Rp 308,000 0
Rp 186 Rp - 0
Rp 430 Rp 430,100 158.4 158400
Rp 422 Rp - 0
Rp 990 Rp 297,000 0
Rp 12,650 Rp 632,500 0
 Rp 164 Rp - 0
Rp 330 Rp - 0
Rp 63 Rp 313,500 0
Rp 363 Rp - 0
Rp 118 Rp - 0
Rp 521 Rp - 0

Rp 95,148,944
Rp 106,950,000 165,706,482
Rp 11,801,056 70,557,538

Banyuwangi, 8 Maret 2016

PenanggungJawab
Kepala Puskesmas Songgon

WAWAN PRAYITNO,[Link]
Penata/ III C
NIP. 19691225 199203 1 008

277500
62700
zz
 RENCANA ANGGARAN BIAYA

KEGIATAN : JAMINAN PELAYANAN KESEHATAN BANYUWANGI PUSKESMAS SONGGON

OBYEK BELANJA : BELANJA OBAT

VOLUM
NO NAMA BARANG SATUAN HARGA (Rp)
E
1 Alat GCHb Easytouch 1 Unit 750,000
2 Alkohol 95% 2 botol 74,990
3 Asam cuka 6% 250 ml 2 botol 47,660
5 Blood lancet 20 Box 163,900
6 HCl 0,1 N 100 ml 16 Btl 27,500
7 HCl 0,1 N 100 ml 4 Btl 27,500
8 HIV Test Oncoprobe 800 tes 108,000
9 HIV Test Intec 40 tes 90,000
11 Pot Sputum 100 Pot 4,000
12 Reagen Golda 30 unit 899,000
13 Reagen Ziehl Nielsen 3 Set 294,500
14 Stik Asam Urat 40 Tube 145,000
15 Stik Gula 70 Tube 145,000
16 Stik Hb ET 20 Tube 180,000
17 Stik Kolesterol 10 Tube 230,000

JUMLAH
SISA MATI
TOTAL

Banyuwangi, 13 Agustus 2016

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Kepala Puskesmas Songgon

MUJITO,SKM WAWAN PRAYITNO,[Link]

Penata Penata
NIP. 19690524 199103 1 003 NIP.19691225 199203 1 008
NGI PUSKESMAS SONGGON
AT

JUMLAH ( Rp )

750,000
149,980
95,320
3,278,000
440,000
110,000 MOLEX AYUS
86,400,000 ONEMED
3,600,000
400,000 18
26,970,000
883,500
5,800,000
10,150,000
3,600,000
2,300,000

144,926,800
600
144,927,400
144,926,800
uwangi, 13 Agustus 2016

PenanggungJawab
ala Puskesmas Songgon

WAN PRAYITNO,[Link]
Penata
19691225 199203 1 008
 RENCANA ANGGARAN BIAYA

KEGIATAN : JAMINAN PELAYANAN KESEHATAN BANYUWANGI PUSKESM

OBYEK BELANJA : BELANJA OBAT

NO NAMA Formulasi dan Sediaan SATUAN KEBUTUHAN

air untuk injeksi cairan inj botol 100
aminofilin cairan inj 24 mg/mL ampul 30
amitriptilin tab salut 25 mg tab sal selaput 25 mg tablet 100
amlodipin tab 5 mg tablet 500
amlodipin tab 10 mg tablet 2,000
amoksisilin tab 500 mg tablet 50,000
amoksisilin sir kering 125 mg/5 mL botol 300
antasida syr sir botol 200
antasida tablet tab kunyah tablet 30,000
antihemoroid, kombinasi : suppositoria supp 30
asam askorbat (vitamin C) tab 250 mg tablet 1,000
asam mefenamat kapl 500 mg tablet 30,000
Asam traneksamat injeksi 100 mg/ml ampul 100
asiklovir tab 400 mg tablet 1,000
atapulgit tab tab tablet 3,000
atropin inj 0,25 mg/ml ampul 50
Betahistin Mesilat tablet 1,000
betametason krim 0,1% tube 250
deksametason cairan inj i.v./i.m. 5 mg/mL ampul 200
deksametason tab 0,5 mg tablet 30,000
diazepam lar rektal 5 mg/2,5 mL botol 10
diazepam lar rektal 10 mg/2,5mL botol 10
difenhidramin cairan inj i.v./i.m. 10 mg/mL ampul 200
digoksin tab 0,25 mg tablet 100
doksisiklin kaps 100 mg kapsul 300
domperidon tab 10 mg tablet 500
epinefrin (adrenalin) cairan inj i.v./i.m./s.k. 0,1% ampul 60
eritromisin tab 500 mg tablet 2,000
furosemid tab 40 mg tablet 2,000
garam oralit serb sachet 5,000
glukosa lar infus 5% botol 200
haloperidol 1,5 mg tablet 200
hidroklorotiazid tab 25 mg tablet 1,000
hidrokortison krim 2,5% tube 240
ibuprofen tab 200 mg tablet 10,000
ibuprofen tab 400 mg tablet 20,000
ibuprofen susp 100 mg/5 ml botol 200
kalsium laktat (kalk) tab 500 mg tablet 5,000
karbamazepin tab 200 mg tablet 200
ketokonazol krim 2% tube 200
kloramfenikol susp 125 mg/5 mL botol 100
kloramfenikol salep mata 1% tube 150
klorfeniramin tab 4 mg tablet 10,000
kotrimoksazol sirup susp 240 mg botol 300
lidokain kombinasi epinefrin cairan inj 2 mL ampul 1,200
loratadin tab 10 mg tablet 1,500
metformin tab 500 mg tablet 3,000
metilprednisolon tab 4 mg tablet 10,000
metronidazol tab 500 mg tablet 8,000
mikonazol krim 2% tube 100
natrium diklofenak tab sal enterik 25 mg tablet 10,000
natrium diklofenak tab sal enterik 50 mg tablet 20,000
nifedipin tab 10 mg tablet 500
oksitosin cairan inj 10 IU/mL ampul 150
parasetamol tab 500 mg tablet 80,000
parasetamol sir 120 mg/5 ml botol 420
piridoksin (vitamin B6) tab 10 mg tablet 15,000
ranitidin tab 150 mg tablet 10,000
ringer laktat lar infus botol 1,000
salbutamol tab 2 mg tablet 1,000
simvastatin tab sal selaput 20 mg tablet 1,000

alopurinol tab 300 mg tablet 1,000

amoksisilin sir kering 250 mg/5 mL botol 100
ampisilin serb inj i.v. 1000 mg/vial vial 100
antimigren kombinasi : ergotamin + kofein tab tablet 250
bedak salisil serb 2% pot 100
bisakodil sup 5 mg supp 12
captopril tab 12,5 mg tablet 1,000
captopril tab 25 mg tablet 8,000
diazepam tab 5 mg tablet 100
dimenhidrinat tab 50 mg tablet 1,000
domperidon sir 5 mg/5 mL botol 50
eritromisin sir kering 200 mg/5 mL botol 200
etil klorida spray 100 ml botol 50
furosemid cairan inj i.v./i.m. 10 mg/mL ampul 50
glibenklamid tab 5 mg tablet 5,000
glimepirid 2 mg tab 2 mg tablet 10,000
griseofulvin, micronized tab 250 mg tablet 500
hiosin butilbromid tab 10 mg tablet 2,500
ketokonazol tab 200 mg tablet 500
kloramfenikol tts mata 0,5% botol 200
kloramfenikol tts telinga 3% botol 300
metronidazol sir 125 mg/5 mL botol 50
metronidazol lar infus 5 mg/mL botol 30
mometason furoat krim 0,1% 5 g tube 50
natrium bikarbonat tab 500 mg tablet 100
omeprazol 20 mg kaps 20 mg kapsul 600
parasetamol drops 60 mg/0,6 ml botol 150
perak sulfadiazin krim 1% tube 100
permetrin krim 5% tube 50
salbutamol tab 4 mg tablet 5,000
sianokobalamin tab 50 mcg tablet 10,000
sianokobalamin inj 500 mcg/ mL ampul 200

Atropin Sulfat Inj Box/ 100 1

ATS inj i.m. 1500 IU/mL Ampul 10
cefotaxim Inj Inj 1 g vial 100
ceftriaxon Inj Inj 1 g Vial 100
Cimetidin Inj. 5 amp 30
Citicolin Inj Box 10
CPZ Inj 25 mg 5
D40% Larutan 1nfus ampul 25 ml 20
epinefrin (adrenalin) inj. 0,1% ampul 30
Gentamisin Injeksi 40 mg / ml ampul 100
Gentamisin Tetes mata botol 100
Lasix Inj 5 amp/ box 20
Metoklopramid Inj box/ 30 100
Meylon Inj Box/ 120 5
Neurotropic Inj Box/ 10 10
Novalgin Inj Box/ 5 50
Ondansetron Inj 4 mg Flas 200
Pirasetam Inj Inj 1 g box/ 10 3
Ranitidin Inj. box 30
SABU vial 5
Setirizin tablet tablet 1,000
thiamin (vitamin B1) tab 50 mg tablet 10,000
272 Triheksifenidil tab 2 mg tablet 200
273 Ventolin Nebulizer Box/ 5 20
274 vitamin B kompleks tablet 10,000
Hyosin injeksi / buscopan inj Ampul 50
Karbazokrom injeksi / adona Box/10 3
Metamizol injeksi / norages Ampul 200
Ringer Laktat Infus botol 400
glukosa lar infus 5% botol 100

Ambroxol tab 30 mg Tablet 2,000

aminofilin tab 200 mg Tablet 2,000
Antalgin tablet 500 mg tablet 10,000
BIAYA

YUWANGI PUSKESMAS SONGGON

JA OBAT

HARGA SATUAN HARGA SATUAN HARGA TOTAL

3,327.50 3,328 332,800
4048 4,048 121,440
172.7 173 17,300
127.6 128 64,000
176 176 352,000
280.5 281 14,050,000
2528.9 2,529 758,700
2450.8 2,451 490,200
74.8 75 2,250,000
3685 3,685 110,550
151.8 152 152,000
128.7 129 3,870,000
3011.8 3,012 301,180
422.4 422 422,000
176 176 528,000
2022.9 2,023 101,150
180.4 180 180,400
1669.8 1,670 417,500
1837 1,837 367,400
52.8 53 1,590,000
13935.9 13,936 139,360
20257.6 20,258 202,580
1422.3 1,422 284,400
127.6 128 12,800
325.6 326 97,800
143 143 71,500
2666.4 2,666 159,960
883.3 883 1,766,000
94.6 95 190,000
319 319 1,595,000
8349 8,349 1,669,800
80.3 80 16,000
180.4 180 180,000
3206.5 3,207 769,680
127.6 128 1,280,000
 154 154 3,080,000
2995.3 2,995 599,000
75.9 76 380,000
326.7 327 65,400
3080 3,080 616,000
4786.1 4,786 478,600
2175.8 2,176 326,400
50.6 51 510,000
2589.4 2,589 776,700
2233 2,233 2,679,600
161.7 162 243,000
121 121 363,000
234.3 343 3,430,000
160.6 161 1,288,000
3932.5 3,933 393,300
176 176 1,760,000
192.5 193 3,860,000
125.4 125 62,500
2299 2,299 344,850
68.2 68 5,440,000
1299.1 1,299 545,580
143 143 2,145,000
127.6 128 1,280,000
8651.5 8,652 8,652,000
80.3 80 80,000
158.4 158 158,000

Rp 220 242 242,000 242.0

Rp 7,217 7,939 793,900 7,938.8
Rp 5,610 12,267 1,226,700 6,171.0
Rp 526 578 144,500 578.4
Rp 1,375 1,513 151,300 1,512.5
Rp 6,650 7,315 87,780 7,314.5
Rp 68 75 75,000 75.0
Rp 75 83 664,000 82.5
Rp 34 38 3,800 37.5
Rp 114 126 126,000 125.8
Rp 3,666 4,033 201,650 4,032.9
Rp 8,470 9,317 1,863,400 9,317.0
Rp 102,520 112,772 5,638,600 112,772.0
Rp 3,060 3,366 168,300 3,366.2
Rp 62 68 340,000 67.8
Rp 480 528 5,280,000 527.6
Rp 669 736 368,000 735.7
Rp 446 490 1,225,000 490.1
Rp 330 363 181,500 363.0
Rp 5,170 5,687 1,137,400 5,687.0
Rp 2,376 2,614 784,200 2,613.6
Rp 4,510 4,961 248,050 4,961.0
Rp 10,945 12,040 361,200 12,039.5
Rp 20,951 23,046 1,152,300 23,045.7
Rp 22 24 2,420 24.2
Rp 232 255 153,000 255.3
Rp 5,720 6,292 943,800 6,292.0
Rp 25,300 27,830 2,783,000 27,830.0
Rp 12,623 13,885 694,250 13,884.8
Rp 98 108 538,450 107.7
Rp 44 49 490,000 48.4
Rp 1,540 1,694 338,800 1,694.0

277,500 305,250 305,250

187,000 1,870,000
5,388 5,927 592,700
26,000 28,600 2,860,000
33,050 36,355 1,090,650
163,800 180,180 1,801,800
26,100 28,710 143,550 5926.8
2,156 43,120
Rp 2,666 2,666 79,980
Rp 3,730 3,730 373,000 83,270.00
Rp 4,840 4,840 484,000
62,700 1,254,000 56925.00
14,900 16,390 1,639,000 28710.00
9,900 49,500 11050.00
51,750 56,925 569,250 2156.00
54,350 59,785 2,989,250 62700.00
6,600 7,260 1,452,000 187000.00
75,700 83,270 249,810 9900.00
85,150 93,665 2,809,950 162,930,562.2 3730.00
751,469 3,757,345 (19,982,219.2) 5.50
Rp 173 173 173,000 4840.00
105 1,050,000 173.00
 107 21,400 104.5
Rp 11,050 221,000 106.7
140 1,400,000 139.7
47,018 2,350,900 47018.4
161,286 483,858 3
13,978 2,795,600 220.00
8,652 3,460,800 440.00
8,349 834,900 8349

200 400,000 2,200.00

228 456,000 2,200.00
201 2,010,000 11,000.00

142,948,343
305,250.0
-
5,926.8
28,600.0
36,355.0
180,180.0
28,710.0
-
2,933.0
4,103.1
5,324.0
-
16,390.0
10,890.0
62,617.5
 RENCANA ANGGARAN BIAYA

KEGIATAN : JAMINAN PELAYANAN KESEHATAN BANYUWANGI PUSKESMASSUMBERBERAS

OBYEK BELANJA : BELANJA BAHAN OBAT-OBATAN 2017

Formulasi dan HARGA

NO NAMA SATUAN KEBUTUHA
Sediaan SATUAN
N

1 air untuk injeksi cairan inj botol 200 Rp 3,025

2 amoksisilin sir kering 125 mg/5 botol 500 Rp 2,299
3 antasida syr sir botol 300 Rp 2,228
4 antalgin tab 500mg tablet 20,000 Rp 183
5 asam mefenamat kapl 500 mg tablet 50,000 Rp 117
6 diazepam tab 5 mg tablet 3,000 Rp 1,730
7 dimenhidrinat tab 50 mg tablet 5,000 Rp 207
8 domperidon sir 5 mg/5 mL botol 100 Rp 3,666
9 etil klorida spray 100 ml botol 20 Rp 135,015
10 gentamisin injeksi 40 mg/ml injeksi 40 mg/ml ampul 100 Rp 3,391
11 gentamisin tetes mata botol 300 Rp 4,400
12 gentamisin salep kulit tube 500 Rp 3,178
13 haloperidol 5 mg tablet 5,000 Rp 83
14 hidrokortison krim 2,5% tube 500 Rp 2,915
15 kloramfenikol tts mata 0,5% botol 100 Rp 29,330
16 kloramfenikol tts telinga 3% botol 200 Rp 26,886
17 kotrimoksazol sirup susp 240 mg botol 200 Rp 2,354
18 lidokain compositum cairan inj 2 mL ampul 300 Rp 2,030
19 parasetamol sir 120 mg/5 ml botol 500 Rp 1,181
20 serum anti bisa ular A.B.U.I cairan inj i.m./i.v. vial 40 Rp 683,154
21 serum antitetanus (A.T.S) inj i.m. 1500 IU/mL vial 30 Rp 187,000
22 simvastatin tab sal selaput 20 m tablet 3,000 Rp 430
23 triheksifenidil tab 2 mg tablet 5,000 Rp 97
24 vitamin b kompleks tab kombinasi tablet 6,000 Rp 127

JUMLAH TOTAL
PAGU ANGGARAN
SISA MATI
ASSUMBERBERAS

HARGA TOTAL

Rp 605,000 3,328
Rp 1,149,500 2,529
Rp 668,400 2,451
Rp 3,660,000 201
Rp 5,850,000 129
Rp 5,190,000 1,903
Rp 1,035,000 228
Rp 366,630 4,033
Rp 2,700,300 148,517
Rp 339,100 3,730
Rp 1,320,000 4,840
Rp 1,589,000 3,496
Rp 415,000 91
Rp 1,457,500 3,207
Rp 2,933,000 32,263
Rp 5,377,200 29,575
Rp 470,800 2,589
Rp 609,000 2,233
Rp 590,500 1,299
Rp 27,326,160 751,469
Rp 5,610,000 205,700
Rp 1,290,300 473
Rp 485,000 107
Rp 762,000 140

Rp 71,799,390 66,398,900
5,400,490
Rp (71,799,390)
 RENCANA ANGGARAN BIAYA (RAB) 2016
Kegiatan : JKN Puskesmas Songgon
Obyek Belanja : Belanja BMHP

No Jenis Obat Volume Satuan Harga

1 Alat Suntik sekali pakai 1 cc x 27G Nipro 100 Pc 990

2 Alat Suntik sekali pakai 10 cc x 21G Nipro 100 Pc 1,298
3 Alat Suntik sekali pakai 3 cc x 23G Nipro 3000 Pc 792
4 Alat Suntik sekali pakai 5 cc x 23G Nipro 1000 Pc 979
5 Alat Suntik Sekali Pakai 0,05 ml BD 12 box/100 165,550
6 Alat Suntik Sekali Pakai 0,5 ml BD 50 box/100 165,550
7 Alkohol 70 % 1 liter 10 Botol 21,500
8 Alkohol swab 20 box/100 10,000
9 Bioplacenton tulle 10 Box 104,000
10 Blade B Braun Aesculaps 11 10 box/100 300,000
11 Blood Transfusion Set Terumo unit 13,976
12 Catgut Chromic 3/0 + jarum Onemed Roll 134,000
13 Catgut Plain 3/0 + jarum Roll 134,000
14 Catgut Chromic 3/0 + jarum Bbraun 0 Roll 1,325,000
15 Catgut Plain 3/0 + jarum Bbraun 0 Roll 1,300,000
16 Folley Catheter 2 way no. 16 4 box/10 80,000
17 Folley Catheter 2 way no. 18 4 box/10 80,000
18 Folley Catheter 2 way no. 20 2 box/10 80,000
19 Folley Catheter 2 way no. 22 2 box/10 80,000
20 Folley Catheter 2 way no. 24 2 box/10 80,000
21 Handschoon Size L 20 box/100 32,500
22 Handschoon Size M 20 box/100 32,500
23 Handschoon Size S 5 box/100 32,500
24 I.V Catheter no. 18 Stera 100 buah 3,800
25 I.V Catheter no. 20 Stera 100 buah 3,800
26 I.V Catheter No. 22 Stera 100 buah 3,800
27 I.V Catheter No. 24 Stera 100 buah 3,800
28 I.V Catheter no. 26 Stera 50 buah 4,100
29 Infusion Set Dewasa Terumo Type Y 400 Unit 7,321
30 Infusion Set Pediatric Terumo 100 Unit 10,406
31 Jelly tube 82 g 10 tube 82 g 29,549
32 Kapas pembalut 250 g Ahmad Daris 20 1 Roll 24,000
33 Kapas pembalut 500 g 20 1 Roll 27,280
34 Kapas Pembalut Hidrofil 36x80 cm 30 1 Roll 130,000
35 Kasa Hidrofil 4 m x 5 cm 100 1 Roll 1,100
36 Kasa Hidrofil 4 m x 15 cm 300 1 Roll 3,800
37 Kasa Hidrofil 40 X 40 30 1 Roll 1,800
38 Kasa steril 16 cm x 16 cm pad 7,900
39 Lysol 1 liter 5 botol 41,000
40 Surgical Mask3 ply earloop 0 box/50 22,000
41 Surgical Mask3 ply tie on box/50 16,500
42 Povidon Iodida larutan 10% 300 ml 10 cart/10 btl 18,000
43 Povidon Iodine 30 cc 50 Botol 2,900
44 Rivanol 300 cc 0 Botol 2,550
45 Silk Black 3/0 + jarum 1/2 35 mm Bbraun 0 Roll 360,000
46 Leukoplast 7,5 cm X 4,5 m 100 Roll 35,532
47 Test Kehamilan OneMed UltraOne 200 1,939
48 Underpad 100 7,800
49 Sabun Cuci Tangan 5 L 20 Btl 21,000
50 Blood Lancet 28 G 10 14,566

ALKEDUM
44 Umbilical Cord Clam blue OGS 100 Pcs 1,050
45 Feeding Tube Terumo 100 cm no 5 50 Pcs 8,841
Selang penghisap lendir bayi 100 Pcs 22,605
Apron plastik 10 buah 64,160
Cement Zinc 3 set 302,448
CHKM 3 botol 137,486
Devitalisasi pasta (non arsen) 6 botol 604,940
Formokresol (TKF) 3 set 137,486
Glass ionomer 6 set 615,938
H2O2 3% 2 botol 54,995
Handschoon panjang siku 50 psg 38,496
Handschoon rumah tangga size L 10 psg 27,497
Hansaplast 10 box/100 64,160
Jarum hecting kulit 10 buah 25,664
Jarum hecting otot 10 buah 25,664
Jarum/needle No. 23 G 10 box 137,486
Kaca mata goggle 5 buah 100,823
Pengait cerumen dan sendok serumen pcs 23,831
10
Plesterin bulat 2 box 50,412
Termometer klinis 10 buah 27,497
Test buta warna ( isihara ) 10 buah 155,817
Tounge spatel 10 buah 13,749
Tricresul / Formalin 3 buah 100,823
Tromol kasa kecil 4 buah 284,138
Tromol kasa sedang 4 buah 467,453
Tuorniquet 10 buah 27,497
Urinal 10 buah 8,250
Washlap kain 200 buah 9,166
bahan tumpatan sementara 6 set 282,305
kalsium hidroksida 3 botol 661,767
Eugenol 3 botol 100,823
Seluloid Kotak/ Strip 2 Pc 157,630
Tempat Alkohol ( Dappen Glass ) 2 Pc 10,120
Spongostan 3 Box 752,125
Sound Timer 5 Pc 69,410
YA (RAB) 2016

#REF!

Jumlah Harga
Ongkir
(Rp.)
79.20 1,069.20 106,920.00 1,176
103.84 1,401.84 140,184.00 1,542
63.36 855.36 2,566,080.00 941
78.32 1,057.32 1,057,320.00 1,163
165,550.00 1,986,600.00 182,105
165,550.00 8,277,500.00 182,105
1,075.00 22,575.00 225,750.00 24,833
300.00 10,300.00 206,000.00 11,330
3,500.00 107,500.00 1,075,000.00 118,250
6,000.00 306,000.00 3,060,000.00 336,600
13,976.00 - 15,374
4,020.00 138,020.00 - 151,822
4,020.00 138,020.00 - 151,822
26,500.00 1,351,500.00 - 1,486,650
26,000.00 1,326,000.00 - 1,458,600
2,400.00 82,400.00 329,600.00 90,640
2,400.00 82,400.00 329,600.00 90,640
2,400.00 82,400.00 164,800.00 90,640
2,400.00 82,400.00 164,800.00 90,640
2,400.00 82,400.00 164,800.00 90,640
975.00 33,475.00 669,500.00 36,823
975.00 33,475.00 669,500.00 36,823
975.00 33,475.00 167,375.00 36,823
114.00 3,914.00 391,400.00 4,305
114.00 3,914.00 391,400.00 4,305
114.00 3,914.00 391,400.00 4,305
114.00 3,914.00 391,400.00 4,305
123.00 4,223.00 211,150.00 4,645
7,321.00 2,928,400.00 8,053
10,406.00 1,040,600.00 11,447
886.00 30,435.00 304,350.00 33,479
330.00 24,330.00 486,600.00 26,763
818.00 28,098.00 561,960.00 30,908
19,800.00 149,800.00 4,494,000.00 164,780
210.00 1,310.00 131,000.00 1,441
580.00 4,380.00 1,314,000.00 4,818
95.00 1,895.00 56,850.00 2,085
800.00 8,700.00 - 9,570
2,050.00 43,050.00 215,250.00 47,355
660.00 22,660.00 - 24,926
495.00 16,995.00 - 18,695
900.00 18,900.00 189,000.00 20,790
 145.00 3,045.00 152,250.00 3,350
127.50 2,677.50 - 2,945
7,200.00 367,200.00 - 403,920
35,532.00 3,553,200.00 39,085
58.00 1,997.00 399,400.00 2,197
468.00 8,268.00 826,800.00 9,095
420.00 21,420.00 428,400.00 23,562
437.00 15,003.00 150,030.00 16,503
- - -
- - -
- - -
105.00 1,155.00 115,500.00 1,271
8,841.00 442,050.00 9,725
22,605.00 2,260,500.00
64,160.00 641,600.00 ELITECH
302,448.00 907,344.00 GC
137,486.00 412,458.00 GHIMAS
604,940.00 3,629,640.00 D PULP
137,486.00 412,458.00 Camex
615,938.00 3,695,628.00 gc
54,995.00 109,990.00 ONEMED
38,496.00 1,924,800.00 GYNAEC MASTER
27,497.00 274,970.00 ONEMED
64,160.00 641,600.00 BSN
25,664.00 256,640.00 RRC
25,664.00 256,640.00 RRC
137,486.00 1,374,860.00 TERUMO
100,823.00 504,115.00 LOKAL
SS
23,831.00 238,310.00
50,412.00 100,824.00 ONEMED
27,497.00 274,970.00 SAFETY
155,817.00 1,558,170.00 ONEMED
13,749.00 137,490.00 SS
100,823.00 302,469.00 CAMEX
284,138.00 1,136,552.00 SS
467,453.00 1,869,812.00 SS
27,497.00 274,970.00 RRC
8,250.00 82,500.00 LOKAL
9,166.00 1,833,200.00 LOKAL
282,305.00 1,693,830.00 CAVITON
661,767.00 1,985,301.00 Hydcal/Calcidor
100,823.00 302,469.00 CAMEX
157,630.00 315,260.00
10,120.00 20,240.00
752,125.00 2,256,375.00
69,410.00 347,050.00
 117,612 Sinar Roda Utama 1,176
154,202 Sinar Roda Utama
2,822,688 Sinar Roda Utama
1,163,052 Sinar Roda Utama
2,185,260 AAM
9,105,250 AAM
248,325 Jaya Mas Medika
226,600 Jaya Mas Medika
1,182,500Enseval Medica Prima
BBraun Medical Indonesia
3,366,000
- Terumo Indonesia
- Jaya Mas Medika
- Jaya Mas Medika
BBraun
- Medical Indonesia
BBraun
- Medical Indonesia
362,560 Jaya Mas Medika
362,560 Jaya Mas Medika
181,280 Jaya Mas Medika
181,280 Jaya Mas Medika
181,280 Jaya Mas Medika
736,450 Jaya Mas Medika
736,450 Jaya Mas Medika
184,113 Jaya Mas Medika
430,540 Jaya Mas Medika
430,540 Jaya Mas Medika
430,540 Jaya Mas Medika
430,540 Jaya Mas Medika
232,265 Jaya Mas Medika
3,221,240 Terumo Indonesia
1,144,660 Terumo Indonesia
334,785 Jaya Mas Medika
535,260 Ahmad daris
618,156 Jaya Mas Medika
4,943,400 Ahmad daris
144,100 Ahmad daris 149,800.00
1,445,400 Ahmad daris 8,988,000.00
62,535 Ahmad daris
- Ahmad daris
236,775 Jaya Mas Medika
- Jaya Mas Medika
- Jaya Mas Medika
207,900 Jaya Mas Medika
 167,475 Jaya Mas Medika
- Jaya Mas Medika
- Jaya Mas Medika
3,908,520BSN Medical Indonesia
439,340 Jaya Mas Medika
Global Pharma Indonesia
909,480
471,240 Jaya Mas Medika
165,033 Jaya Mas Medika
-
-
-
127,050
486,255
2,260,500 22,605.0
641,600 64,160.0
907,344 302,448.0
412,458 137,486.0
3,629,640 604,940.0
412,458 137,486.0
3,695,628 615,938.0
109,990 54,995.0
1,924,800 38,496.0
274,970 27,497.0
641,600 64,160.0
256,640 25,664.0
256,640 25,664.0
1,374,860 137,486.0
504,115 100,823.0
238,310 23,831.0
100,824 50,412.0
274,970 27,497.0
1,558,170 155,817.0
137,490 13,749.0
302,469 100,823.0
1,136,552 284,138.0
1,869,812 467,453.0
274,970 27,497.0
82,500 8,250.0
1,833,200 9,166.0
1,693,830 282,305.0
1,985,301 661,767.0
302,469 100,823.0
315,260 157,630.0
20,240 10,120.0
2,256,375 752,125.0
277,640 69,410.0

76,984,116
 RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
UPTD PUSKESMAS SONGGON 2017

Anggaran Tahun Tribulan I Tribulan II Tribulan III

Kode Rekening Uraian ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS SEP
1 2 3 4 5 6 7 8 9 10 11 12

5 2 BELANJA LANGSUNG 2,597,097,627

5 2 2 BELANJA BARANG DAN JASA 1,840,877,527

5 2 2 01 Belanja Barang Habis Pakai 203,018,000

5 2 2 01 01 Belanja Alat Tulis Kantor 79,485,600 20,750,500 16,592,475 20,454,950

5 2 2 01 03 Belanja Alat Listrik dan elektronik (Lampu pijar, Battery kering dll) 7,498,250 7,498,250
5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya 2,250,000 825,000 825,000
5 2 2 01 06 Belanja Bahan Bakar Minyak/Gas dan Pelumas Oli 10,000,000 2,000,000 2,000,000 2,000,000
5 2 2 01 08 Belanja Pengisian Tabung Gas 8,300,000 2,075,000 2,075,000 2,075,000
5 2 2 01 12 Belanja Spanduk Atau Alat Informasi 15,000,000 5,000,000 5,000,000
5 2 2 01 13 Belanja Baliho 3,500,000 3,500,000
5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan 76,984,150 39197425 37786725
5 2 2 02 BELANJA BAHAN/ MATERIAL 294,820,227

5 2 2 02 04 Belanja Bahan Obat - obatan 149,893,427 74,947,000 74,946,427

5 2 2 02 17 Belanja bahan dan alat laboratorium 144,926,800 32,638,302 33,570,150 39,380,425
5 2 2 03 Belanja Jasa Kantor 1,158,618,450

5 2 2 03 06 Belanja kawat/ faximile / internet 6,000,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000
5 2 2 03 09 Belanja Jasa Transaksi Keuangan 240,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000
 Anggaran Tahun Tribulan I Tribulan II Tribulan III
Kode Rekening Uraian ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS SEP
1 2 3 4 5 6 7 8 9 10 11 12
5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan 1,137,226,500 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875
5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan 12,401,950 12,401,950

5 2 2 03 59 Belanja Jasa Instalasi Jaringan Komputer 2,750,000 2,750,000

5 2 2 05 Belanja Perawatan Kendaraan Bermotor 4,621,350

5 2 2 05 01 Belanja Jasa Servis 2,310,000 577,500 577,500 577,500

5 2 2 05 02 Belanja Penggantian Suku Cadang 2,311,350 884,050

5 2 2 06 Belanja Cetak Dan Penggandaan 118,474,500

5 2 2 06 01 Belanja Cetak 81,057,000 23,789,975 16,738,525 12,358,298

5 2 2 06 02 Belanja Penggandaan 37,417,500 3,118,200 3,118,200 3,118,200 3,118,200 3,118,200 3,118,200 3,118,200 3,118,200 3,118,200
5 2 2 11 Belanja Makanan dan minuman 8,125,000

5 2 2 11 06 Belanja Makanan dan minuman harian peserta 8,125,000 2,031,250 2,031,250

5 2 2 15 Belanja Perjalanan Dinas 10,000,000

5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah 10,000,000 2,000,000 2,500,000 1,500,000

5 2 2 20 Belanja Pemeliharaan 43,200,000

5 2 2 20 04 Belanja Pemeliharaan Gedung 42,000,000 42,000,000

5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor 1,200,000 400,000 400,000

5 2 3 BELANJA MODAL 756,220,100

5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor 30,750,000

5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi 15,000,000 15,000,000

5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian 15,750,000 15,750,000

5 2 3 11 Belanja modal pengadaan perlengkapan kantor 36,056,700

5 2 3 11 02 Belanja modal pengadaan Almari 14,080,000

 Anggaran Tahun Tribulan I Tribulan II Tribulan III
Kode Rekening Uraian ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS SEP
1 2 3 4 5 6 7 8 9 10 11 12
5 2 3 11 07 Belanja modal pengadaan rak arsip 7,411,800 7,411,800
5 2 3 11 14 Belanja Modal Pengadaan etalase 4,158,000 4,158,000
5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran 10,406,900 10,406,900
5 2 3 12 Belanja Modal Pengadaan Komputer 85,704,000

5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC 8,700,000 8,700,000

5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book 51,000,000 25,500,000

5 2 3 12 04 Belanja Modal Pengadaan Printer 26,004,000 15,602,400
5 2 3 13 Belanja modal pengadaan mebeulair 143,280,400

5 2 3 13 02 Belanja modal pengadaan Meja Rapat 79,010,400 17,787,000 30,713,000

5 2 3 13 04 Belanja modal pengadaan kursi kerja 41,995,000 3,320,000 38,675,000
5 2 3 13 10 Belanja modal pengadaan kursi Tunggu 22,275,000

5 2 3 14 Belanja modal pengadaan Peralatan Dapur 9,920,000

5 2 3 14 04 Belanja modal pengadaan dispenser 2,430,000 2,430,000

5 2 3 14 05 Belanja modal pengadaan kulkas 7,490,000

5 2 3 16 Belanja modal pengadaan alat-alat studio 81,417,600

5 2 3 16 01 Belanja modal pengadaan Kamera 7,700,000

5 2 3 16 03 Belanja modal pengadaan proyektor/infokus 25,855,500 25,855,500

5 2 3 16 06 Belanja Modal Pengadaan monitor LCD 22,968,000

5 2 3 16 19 Belanja modal pengadaan TV 24,894,100

5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran 145,749,000

5 2 3 18 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 128,254,200 65,000,000 31,833,325

5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi 17,494,800 17,494,800
 Anggaran Tahun Tribulan I Tribulan II Tribulan III
Kode Rekening Uraian ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS SEP
1 2 3 4 5 6 7 8 9 10 11 12
5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan 17,000,000

5 2 3 30 14 Belanja modal pengadaan CCTV 17,000,000 17,000,000

5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor 206,342,400

5 2 3 38 02 Belanja Modal Pengadaan AC 70,741,000 16,390,000 28,875,000

5 2 3 38 03 Belanja Modal Pengadaan gorden 37,049,500 16,424,500 20,625,000
5 2 3 38 04 Belanja Modal Pengadaan Awning 66,825,000 66,825,000
5 2 3 38 05 Belanja Modal Pengadaan genset 11,726,900 11,726,900

5 2 3 38 11 Belanja Modal Pengadaan Backdrop 20,000,000

J U M LAH 2,597,097,627 216,424,800 216,424,800 216,424,827 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800
142,900,000 142,900,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000

Banyuwangi, Nopember 2016

Kepala UPTD Puskesmas Songgon

WAWAN PRAYITNO,[Link]
NIP. 19691225 199203 1 008
 Tribulan IV
(Rp.)
OKT NOP DES
13 14 15

19,871,400
21,687,675 79,485,600

600,000 2,250,000
2,000,000 2,000,000 10,000,000
2,075,000 8,300,000
5,000,000 15,000,000
3,500,000 38492075
76,984,150 38492075
0 74946427
149,893,427 0
39,337,923 144,926,800 144926800 0
0 39,337,923
500,000 500,000 500,000 6,000,000
20,000 20,000 20,000 240,000
 Tribulan IV
(Rp.)
OKT NOP DES
13 14 15
94,768,875 94,768,875 94,768,875 1,137,226,500
12,401,950
2,750,000
0
577,500 2,310,000
1,427,300 2,311,350
0
28,170,202 81,057,000 28,170,202
3,080,350 6,273,350 37,417,500 6,273,350
0
2,553,800 1,508,700 8,125,000
0
4,000,000 10,000,000
0
42,000,000
400,000 1,200,000
0
0
15,000,000
15,750,000
0
14,080,000 14,080,000
 Tribulan IV
(Rp.)
OKT NOP DES
13 14 15
7,411,800
4,158,000
10,406,900
0
8,700,000
25,500,000 51,000,000
10,401,600 26,004,000
0
24,570,400 5,940,000 79,010,400
41,995,000
22,275,000 22,275,000
0
2,430,000
7,490,000 7,490,000
0
7,700,000 7,700,000
25,855,500
22,968,000 22,968,000
24,894,100 24,894,100
0 31627100
31,420,875 128,254,200 63,254,200
17,494,800
 Tribulan IV
(Rp.)
OKT NOP DES
13 14 15
0
17,000,000
0
25,476,000 70,741,000
37,049,500
66,825,000
11,726,900
20,000,000 20,000,000

216,424,800 216,424,800 216,424,800

142,898,000 142,898,000 142,898,000 1,714,780,000

gon
 RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
UPTD PUSKESMAS SONGGON 2017

Anggaran Tribulan I Tribulan II Tribulan III

Kode Rekening Uraian Tahun ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS
1 2 3 4 5 6 7 8 9 10 11

5 2 BELANJA LANGSUNG 2,597,097,627

5 2 2 BELANJA BARANG DAN JASA 1,878,322,977

5 2 2 01 Belanja Barang Habis Pakai 238,200,950

5 2 2 01 01 Belanja Alat Tulis Kantor 78,770,800 20,201,650 19,126,450 20,756,575

5 2 2 01 03 Belanja Alat Listrik dan elektronik (Lampu pijar, Battery kering dll) 6,720,200 6,720,200
5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya 2,250,000 825,000 600,000
5 2 2 01 06 Belanja Bahan Bakar Minyak/Gas dan Pelumas Oli 10,000,000 2,000,000 2,000,000 2,000,000
5 2 2 01 08 Belanja Pengisian Tabung Gas 8,300,000 2,075,000 2,075,000 2,075,000
5 2 2 01 09 Belanja Alat/ Kelengkapan Inventaris Ruang Pasien 36,688,550 16,063,550
5 2 2 01 12 Belanja Spanduk Atau Alat Informasi 14,996,000 4,232,350 4,991,000
5 2 2 01 13 Belanja Baliho 3,491,250 3,491,250
5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan 76,984,150 39,197,425 37,786,725
5 2 2 02 BELANJA BAHAN/ MATERIAL 294,820,227

5 2 2 02 04 Belanja Bahan Obat - obatan 149,893,427 74,947,000 74,946,427

5 2 2 02 17 Belanja bahan dan alat laboratorium 144,926,800 34,413,902 33,824,925
5 2 2 03 Belanja Jasa Kantor 1,158,618,450

5 2 2 03 06 Belanja kawat/ faximile / internet 6,000,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000
5 2 2 03 09 Belanja Jasa Transaksi Keuangan 240,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000
5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan 1,137,226,500 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875
5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan 12,401,950 12,401,950
 Anggaran Tribulan I Tribulan II Tribulan III
Kode Rekening Uraian Tahun ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS
1 2 3 4 5 6 7 8 9 10 11
5 2 2 03 59 Belanja Jasa Instalasi Jaringan Komputer 2,750,000

5 2 2 05 Belanja Perawatan Kendaraan Bermotor 4,764,450

5 2 2 05 01 Belanja Jasa Servis 2,100,000 525,000 525,000

5 2 2 05 02 Belanja Penggantian Suku Cadang 2,664,450 1,236,350

5 2 2 06 Belanja Cetak Dan Penggandaan 120,493,900

5 2 2 06 01 Belanja Cetak 79,641,200 23,027,225 15,933,500 14,071,698

5 2 2 06 02 Belanja Penggandaan 40,852,700 3,775,050 3,033,150 3,337,750 3,437,275 2,404,100 3,404,100 4,437,275 3,407,400
5 2 2 11 Belanja Makanan dan minuman 8,225,000

5 2 2 11 06 Belanja Makanan dan minuman harian peserta 8,225,000 2,065,000 2,065,000 2,065,000
5 2 2 15 Belanja Perjalanan Dinas 10,000,000

5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah 10,000,000 2,000,000 1,500,000

5 2 2 20 Belanja Pemeliharaan 43,200,000

5 2 2 20 04 Belanja Pemeliharaan Gedung 42,000,000 42,000,000

5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor 1,200,000 400,000 400,000

5 2 3 BELANJA MODAL 718,774,650

5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor 30,750,000

5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi 15,750,000 15,750,000

5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian 15,000,000 15,000,000

5 2 3 11 Belanja modal pengadaan perlengkapan kantor 36,056,700

5 2 3 11 02 Belanja modal pengadaan Almari 14,080,000

5 2 3 11 07 Belanja modal pengadaan rak arsip 7,411,800 7,411,800

5 2 3 11 14 Belanja Modal Pengadaan etalase 4,158,000 4,158,000
5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran 10,406,900 10,406,900
5 2 3 12 Belanja Modal Pengadaan Komputer 86,001,500
 Anggaran Tribulan I Tribulan II Tribulan III
Kode Rekening Uraian Tahun ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS
1 2 3 4 5 6 7 8 9 10 11
5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC 8,938,150 8,938,150

5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book 51,057,600 25,528,800

5 2 3 12 04 Belanja Modal Pengadaan Printer 26,005,750

5 2 3 13 Belanja modal pengadaan mebeulair 143,280,400

5 2 3 13 02 Belanja modal pengadaan Meja Rapat 79,010,400 17,787,000 24,570,400

5 2 3 13 04 Belanja modal pengadaan kursi kerja 41,995,000 3,320,000 38,675,000
5 2 3 13 10 Belanja modal pengadaan kursi Tunggu 22,275,000

5 2 3 14 Belanja modal pengadaan Peralatan Dapur 9,989,100

5 2 3 14 04 Belanja modal pengadaan dispenser 2,551,500 2,551,500

5 2 3 14 05 Belanja modal pengadaan kulkas 7,437,600

5 2 3 16 Belanja modal pengadaan alat-alat studio 81,417,600

5 2 3 16 01 Belanja modal pengadaan Kamera 7,700,000

5 2 3 16 03 Belanja modal pengadaan proyektor/infokus 25,855,500

5 2 3 16 06 Belanja Modal Pengadaan monitor LCD 22,968,000

5 2 3 16 19 Belanja modal pengadaan TV 24,894,100

5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran 145,519,500

5 2 3 18 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 128,254,200 65,000,000 31,833,325

5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi 17,265,300 17,265,300
5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan 17,000,000

5 2 3 30 14 Belanja modal pengadaan CCTV 17,000,000 17,000,000

5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor 168,759,850

5 2 3 38 02 Belanja Modal Pengadaan AC 70,741,000 16,390,000 28,875,000

5 2 3 38 04 Belanja Modal Pengadaan Awning 66,825,000 66,825,000
5 2 3 38 05 Belanja Modal Pengadaan genset 11,193,850
 Anggaran Tribulan I Tribulan II Tribulan III
Kode Rekening Uraian Tahun ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS
1 2 3 4 5 6 7 8 9 10 11
5 2 3 38 11 Belanja Modal Pengadaan Backdrop 20,000,000

J U M LAH 2,597,097,627 216,424,800 216,424,800 216,424,827 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800
142,900,000 142,900,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000
Banyuwangi, Nopember 2016

Kepala UPTD Puskesmas Songgon

WAWAN PRAYITNO,[Link]
NIP. 19691225 199203 1 008
an III Tribulan IV
p.) (Rp.)
SEP OKT NOP DES
12 13 14 15

19,871,400
18,686,125 78,770,800 78,770,800
6,720,200 6,720,200
825,000 2,250,000 2,250,000
4,000,000 10,000,000 10,000,000

2,075,000 8,300,000 8,300,000

20,625,000
5,772,650 14,996,000
3,491,250 38492075
76,984,150 38492075
0 74946427
149,893,427 0
37,854,025 38,833,948 144,926,800 144926800 0
0 38,833,948
500,000 500,000 500,000 500,000 6,000,000
20,000 20,000 20,000 20,000 240,000
94,768,875 94,768,875 94,768,875 94,768,875 1,137,226,500
12,401,950
an III Tribulan IV
p.) (Rp.)
SEP OKT NOP DES
12 13 14 15
2,750,000 2,750,000
0
525,000 525,000 2,100,000
1,428,100 2,664,450
0
26,608,777 79,641,200 79,641,200 26,608,777
3,404,100 1,736,225 4,279,525 4,196,750 40,852,700 40,852,700 0
0 1,739,525
2,030,000 8,225,000 8225000
0
2,500,000 4,000,000 10,000,000
0
42,000,000
400,000 1,200,000
0
0
15,750,000
15,000,000
0
14,080,000 14,080,000
7,411,800
4,158,000
10,406,900
0
an III Tribulan IV
p.) (Rp.)
SEP OKT NOP DES
12 13 14 15
8,938,150
25,528,800 51,057,600
15,603,450 10,402,300 26,005,750
0
30,713,000 5,940,000 79,010,400
41,995,000
22,275,000 22,275,000
0
2,551,500
7,437,600 7,437,600
0
7,700,000 7,700,000
25,855,500 25,855,500
22,968,000 22,968,000
24,894,100 24,894,100
0 31627100
31,420,875 128,254,200 63,254,200
17,265,300
0
17,000,000
0
25,476,000 70,741,000
66,825,000
11,193,850 11,193,850
an III Tribulan IV
p.) (Rp.)
SEP OKT NOP DES
12 13 14 15
20,000,000 20,000,000

216,424,800 216,424,800 216,424,800 216,424,800

142,898,000 142,898,000 142,898,000 142,898,000 1,714,780,000
Nopember 2016

kesmas Songgon

YITNO,[Link]
199203 1 008
 RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
KABUPATEN BANYUWANGI
TAHUN ANGGARAN 2015

Urusan Pemerintahan: 1.02 Kesehatan

Organisasi : 1.02.01 Dinas Kesehatan
Program : [Link] Program Pembiayaan kesehatan
Kegiatan : [Link].03 Jaminan Kesehatan Nasional Puskesmas Songgon
Sub Kegiatan : JKN Puskesmas Songgon
Lokasi Kegiatan : Kabupaten Banyuwangi
Jumlah Tahun 2013 : Rp -
Jumlah Tahun 2014 : Rp -
Jumlah Tahun 2015 Rp 1,683,840,000
Jumlah Tahun 2016 : Rp 1,714,780,000
Jumlah Tahun 2017 : Rp 2,597,097,627
Indikator Dan Tolok Ukur Kinerja Belanja Langsung Target Kinerja
Indikator Tolok Ukur Kinerja 100 %
- Menunjang peningkatan akses dan mutu pelayanan kesehatan 100 %
Capaian Program
- Menunjang Cakupan Rawat Jalan Peserta JKN 15% Rp 2,597,097,62
Masukan - Tersedianya dana 100 %
Keluaran - Terlaksananya pelayanan JKN di puskesmas 85%
Hasil - Meningkatnya cakupan kunjungan masyarakat ke puskesmas
Kelompok Sasaran Kegiatan: Masyarakat dalam cakupan pelayanan kesehatan dasar di puskesmas
Rincian Perubahan Anggaran Belanja Langsung Program dan Per Kegiatan Satuan Kerja Perangkat Daerah
Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5

5 2 BELANJA LANGSUNG
5 2 2 BELANJA BARANG DAN JASA
5 2 2 01 Belanja Barang Habis Pakai
5 2 2 01 01 Belanja Alat Tulis Kantor
Amplop no 10 20 Kotak 3,550
Calkulator 5 Buah 113,050
Buku Folio Bergaris isi 200 Lembar 30 Buku 28,200
Buku tulis isi 50 100 Buah 4,900
Buku Folio Bergaris isi 100 Lembar 50 Buah 18,000
CDR ( isi 100 Pcs ) 1 Box 172,600
Correstion Pen (TIP-Ex) 100 Buah 10,800
Cutter 10 Buah 18,350
Hetmachine/Staples Kecil 20 Buah 21,000
Isi Staples Merk Etona no.10 20 Kotak 2,700
Isi Staples Merk Great Wall no 3 20 Kotak 4,800
Isolasi Jilid Hitam 5 cm 5 Buah 33,000
Amplop Coklat (F4) 10 Kotak 51,600
Isolasi Jilid Hitam 3 cm 5 Buah 24,000
Isolasi Bening 2 Buah 18,000
Isolasi Kecil 20 Roll 3,050
Kertas HVS F4 70 gr 250 Rim 39,000
Kertas Bufalo Folio 5 Rim 21,350
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5
Lem Kertas 30 Buah 13,650
Map Jepit Plastik 500 Buah 7,450
Map Plastik Folio 500 Buah 3,550
Odner Folio 20 Buah 25,850
Paper Klip no.3 50 Kotak 3,250
Amplop Putih 20 Dus 12,750
Paper Klip no.3 50 Kotak 6,000
Penggaris Besi 30 cm 20 Buah 29,150
Perforator/Pembolong no.30 2 Buah 68,400
Pita Mesin Ketik Manual 2 Buah 24,000
Spidol Snowman Permanen 10 Lusin 72,000
Stabilo 30 Buah 10,200
Stampad Kecil 15 Buah 12,600
Stip/ Penghapus 50 Buah 4,400
Stopmap bufalo 7,500 Buah 5,400
Ballpoint 500 Buah 3,350
Tas 110 Buah 25,000
Tinta Printer 59 Botol 66,000
Tinta Printer Rainbow black 28 Buah 46,050
Tinta Printer Rainbow Colour 30 Buah 46,050
Ballpoint bertempat 10 Buah 40,250
Binder Clip 155 20 Buah 9,600
Binder Clip 200 20 Dos 15,000
Binder Clip 260 20 Dos 21,000
Box File 50 Buah 18,600

5 2 2 01 03 Belanja Alat Listrik dan Elektronik ( Lampu pijar, Battery

Kering dll )
Senter LED 10 Pcs 26,450
Baterai Kecil 52 2 bh/ pak 12,850
Baterai 9 Volt 24 Set 27,300
Lampu Esential (SL) Philip 18 W 62 Pcs 46,300
Lampu Emergency 250 L Rechargeable 9 Buah 224,450
Kabel Roll Presto 3 Roll 80,550

5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya

Materai Rp 3000 150 Lembar 3,000
Materai Rp 6000 300 Lembar 6,000

5 2 2 01 06 Belanja Bahan bakar Minyak/Gas dan Pelumas Oli

BBM 1 LS 10,000,000

5 2 2 01 08 Belanja Pengisian Tabung Gas

Oksigen 2,5 m³ 20 Tabung 75,000
Oksigen 6 m³ 68 Tabung 100,000

5 2 2 01 09 Belanja Alat/ Kelengkapan Inventaris Ruang Pasien

Gorden 23 M² 385,850
Korden/Gorden Horisontal blind 10 M² 718,900
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5
Gorden Plastik Pitrs 82.50 Meter 250,000

5 2 2 01 12 Belanja Spanduk Atau Alat Informasi

Baner 460 Meter ² 30,000

5 2 2 01 13 Belanja Baliho
Baliho 100 Meter 35,000

5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan

Belanja Peralatan dan Bahan Kesehatan 1 Paket 91,954,150

5 2 2 02 BELANJA BAHAN/ MATERIAL

5 2 2 02 04 Belanja Bahan Obat - obatan
Belanja Bahan Obat - obatan 1 paket 150,321,727

5 2 2 02 17 Belanja bahan dan alat laboratorium

Belanja bahan dan alat laboratorium 1 Paket 144,926,800

5 2 2 03 Belanja Jasa Kantor

5 2 2 03 06 Belanja kawat/ faximile / internet
Biaya internet 1 Tahun 6,000,000

5 2 2 03 09 Belanja Jasa Transaksi Keuangan

Biaya Kliring 1 Tahun 240,000

5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan

Jasa Pelayanan Kesehatan 1 Paket 1,137,226,500

5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan

Kalibrasi Alat2 kesehatan 1 Paket 12,401,950

5 2 2 03 59 Belanja Jasa Instalasi Jaringan

Jasa Instalasi Jaringan Komputer Standar Network Area Kecil 1 Kali 2,750,000

5 2 2 05 Belanja Perawatan Kendaraan Bermotor

5 2 2 05 01 Belanja Jasa Servis
Servis 4 Paket 577,500

5 2 2 05 02 Belanja Penggantian Suku Cadang

Accu Mobil Yuassa 1 Buah 988,750
Ban Mobil Bridgestone 2 Buah 714,050
Filter Oli 2 Buah 49,200
Busi 2 Buah 74,600

5 2 2 06 Belanja Cetak Dan Penggandaan

5 2 2 06 01 Belanja Cetak
Buku Regester 50 Buah 25,600
Cetak Sertifikat/Piagam Full Colour 900 Exemplar 3,500
Cetak HVS Folio 70 gram 1 muka 65 Rim 122,000
Cetak Laeflet 5,000 Lembar 4,400
Cetak Blangko Hasil Laboratorium 100 Bendel 16,200
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5
Lembar Balik 1,205 Lembar 4,700
Cetak Kohort 1,200 Lembar 11,850
Klip Plastik 5x 8 cm 791 Box 19,400
HVS Double Folio/Double Kwarto 60 Gr Warna Cetak Sheet 4,400 Lembar 600
Cetak Resep Dokter 51 Buku 12,400
Biaya Jilid 140 Buku 18,450
Kresek kecil berlogo 79 Ikat 32,600

5 2 2 06 02 Belanja Penggandaan
Penggandaan/ Foto Copy 136,100 lembar 300

5 2 2 11 Belanja Makanan dan minuman

5 2 2 11 06 Belanja Makanan dan minuman harian peserta
Nasi 235 Kotak 25,000
Snack 235 Kotak 10,000

5 2 2 15 Belanja Perjalanan Dinas

5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah
Transport PHN
* Jarak 0 - 5 Km 51 OH 30,000
* Jarak 6 - 10 Km 186 OH 35,000
* Jarak 11 - 15 Km 49 OH 40,000

5 2 2 20 Belanja Pemeliharaan
5 2 2 20 04 Belanja Pemeliharaan Gedung
Pemasangan keramik 1 Paket 35,000,000
Partisikaca 1 Paket 7,000,000

5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor

Servis Komputer, Laptop, Printer 12 Unit/Bulan 100,000

5 2 3 BELANJA MODAL
5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor
5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi
Mesin Absensi 1 Unit 15,750,000

5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian

Mesin antrian 1 Unit 16,000,000

5 2 3 11 Belanja modal pengadaan perlengkapan kantor

5 2 3 11 02 Belanja modal pengadaan Almari
Almari 4 Buah 3,842,000

5 2 3 11 07 Belanja modal pengadaan rak arsip

Rak Arsip 2 Buah 3,222,100

5 2 3 11 14 Belanja Modal Pengadaan etalase

Lemari Etalase Tinggi 195x150x60 2 Unit 1,890,000

5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran

Pemadam kebakaran 2 Unit 4,730,450
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5
5 2 3 12 Belanja Modal Pengadaan Komputer
5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC
Komputer / PC 1 Unit 8,938,150

5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book

Lap top 6 Unit 8,509,600

5 2 3 12 04 Belanja Modal Pengadaan Printer

Printer Laser Jet 5 Unit 5,201,150

5 2 3 13 Belanja modal pengadaan mebeulair

5 2 3 13 01 Belanja modal pengadaan Meja Kerja
Meja kerja Staf 1/2 Biro 6 Unit 1,080,000

5 2 3 13 02 Belanja modal pengadaan Meja Rapat

Meja rapat ruang khusus 2 buah 8,085,000
Meja rapat 10 Unit 5,560,800

5 2 3 13 04 Belanja modal pengadaan kursi kerja

Kursi Kerja 2 buah 1,660,000
Kursi Staf 65 buah 595,000

5 2 3 13 10 Belanja modal pengadaan kursi Tunggu

Kursi Tunggu Pasien 10 Buah 2,216,650

5 2 3 14 Belanja modal pengadaan Peralatan Dapur

5 2 3 14 04 Belanja modal pengadaan dispenser
Dispenser 3 Unit 850,500

5 2 3 14 05 Belanja modal pengadaan kulkas

Kulkas 2 Pintu Small 2 Unit 3,718,800

5 2 3 16 Belanja modal pengadaan alat-alat studio

5 2 3 16 01 Belanja modal pengadaan Kamera
Kamera 4 Unit 3,300,000

5 2 3 16 03 Belanja modal pengadaan proyektor/infokus

LCD Proyektor 2 Unit 12,020,050

5 2 3 16 19 Belanja modal pengadaan TV

TV 22" 8 Unit 2,467,900
TV 26" 1 Unit 2,891,450
Televisi Full HD LED TV 2 Unit 12,804,000

5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran

5 2 3 19 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 1 Paket 128,254,200

5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi

Scaller UDS-K woodpacker 1 set 2,295,300

5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan

 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5
5 2 3 30 14 Belanja modal pengadaan CCTV
CCTV 1 Paket 17,000,000

5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor

5 2 3 38 02 Belanja Modal Pengadaan AC
Belanja Modal Pengadaan AC 2 PK 2 Set 7,450,000
Belanja Modal Pengadaan AC 1 PK 7 Set 3,860,000
Belanja Modal Pengadaan AC 1/2 PK 7 Set 3,750,000

5 2 3 38 04 Belanja Modal Pengadaan Awning

Pemasangan Awning (135 m2 x 495.000) 1 paket 66,825,000

5 2 3 38 05 Belanja Modal Pengadaan genset

genset 1 Unit 11,193,850

5 2 3 38 11 Belanja Modal Pengadaan Backdrop

Backdrop 1 Paket 20,000,000

Jumlah

Banyuwangi, Oktober 2016

Kepala Puskesmas Songgon

WAWAN PRAYITNO
Penata / III/c
NIP. 19691225 199203 1 008
Keterangan :
Tanggal Pembahasan :
Catatan Hasil Pembahasan:
1
2
Tim anggaran Pemerintah Daerah
No Nama / NIP Jabatan Tanda Tangan
1
2
3

O2 ###
BMHP ###
Lab ###
Obat ###
Alked ###
###
 Sebelum Perubahan
Kode Rekening Uraian Rincian Perhitungan
Volume Satuan Harga
1 2 3 4 5
518,871,097.00
 DRAFT
RKA-SKPD 2.2.1

n kesehatan
sional Puskesmas Songgon

Target Kinerja
100 %
100 %
Rp 2,597,097,627
100 %
85%

lum Perubahan
Jumlah
6=3x5

2,597,097,627
1,892,663,327
251,927,200
78,714,300
71,000
565,250
846,000
490,000
900,000
172,600
1,080,000
183,500
420,000
54,000
96,000
165,000
516,000
120,000
36,000
61,000
9,750,000
106,750
lum Perubahan
Jumlah
6=3x5
409,500
3,725,000
1,775,000
517,000
162,500
255,000
300,000
583,000
136,800
48,000
720,000
306,000
189,000
220,000
40,500,000
1,675,000
2,750,000
3,894,000
1,289,400
1,381,500
402,500
192,000
300,000
420,000
930,000

6,720,200

264,500
668,200
655,200
2,870,600
2,020,050
241,650

2,250,000
450,000 36,000 36000 96000
1,800,000 25 150000 90000
186000 186000
10,000,000
10,000,000

8,300,000
1,500,000 75,000 1.666667 150000
6,800,000 500,000 300000 5.666667 600000
575,000 400000 750000
36,688,550 700000
8,874,550 16,063,550
7,189,000
lum Perubahan
Jumlah
6=3x5
20,625,000

13,800,000
13,800,000

3,500,000
3,500,000

91,954,150
91,954,150

295,248,527
150,321,727
150,321,727

144,926,800
144,926,800

1,158,618,450
6,000,000
6,000,000

240,000
240,000

1,137,226,500
1,137,226,500

12,401,950
12,401,950

2,750,000
2,750,000

4,974,450
2,310,000
2,310,000

2,664,450
988,750
1,428,100
98,400
149,200

120,469,700
79,639,700
1,280,000
3,150,000
7,930,000
22,000,000
1,620,000
lum Perubahan
Jumlah
6=3x5
5,663,500
14,220,000
15,345,400
2,640,000
632,400
2,583,000
2,575,400

40,830,000
40,830,000 18007.66666667

8,225,000
8,225,000
5,875,000
2,350,000

10,000,000
10,000,000

1,530,000
6,510,000
1,960,000

43,200,000
42,000,000
35,000,000
7,000,000

1,200,000
1,200,000

704,434,300
31,750,000
15,750,000
15,750,000

16,000,000
16,000,000

35,053,100
15,368,000
15,368,000

6,444,200
6,444,200 6440000

3,780,000
3,780,000

9,460,900
9,460,900
lum Perubahan
Jumlah
6=3x5
86,001,500
8,938,150
8,938,150

51,057,600
51,057,600 25528800

26,005,750
26,005,750 15,603,450
10,402,300
142,419,500
6,480,000
6,480,000

71,778,000
16,170,000
55,608,000

41,995,000
3,320,000
38,675,000

22,166,500
22,166,500

9,989,100
2,551,500
2,551,500

7,437,600
7,437,600

85,482,750
13,200,000
13,200,000
1,650,000
24,040,100
24,040,100

48,242,650
19,743,200
2,891,450
25,608,000

130,549,500
128,254,200 64,127,100.00

2,295,300
2,295,300

17,000,000
lum Perubahan
Jumlah
6=3x5
17,000,000
17,000,000

166,188,850
68,170,000
14,900,000
27,020,000
26,250,000

66,825,000
66,825,000

11,193,850
11,193,850

20,000,000
20,000,000

2,597,097,627

uwangi, Oktober 2016

ala Puskesmas Songgon

WAWAN PRAYITNO
Penata / III/c
19691225 199203 1 008

Tanda Tangan
 RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
UPTD PUSKESMAS SONGGON 2016

Anggaran Tahun Tribulan I Tribulan II Tribulan III

Kode Rekening Uraian ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS SEP
1 2 3 4 5 6 7 8 9 10 11 12

5 2 BELANJA LANGSUNG 2,597,097,627

5 2 2 BELANJA BARANG DAN JASA 1,892,663,327
5 2 2 01 Belanja Barang Habis Pakai 251,927,200
5 2 2 01 01 Belanja Alat Tulis Kantor 78,714,300 18,124,225 25,981,977 17,913,223
5 2 2 01 03 Belanja Alat Listrik dan elektronik (Lampu pijar, Battery kering dll) 6,720,200 6,720,200
5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya 2,250,000 186,000 186,000 186,000 186,000 186,000 186,000 186,000 186,000 186,000
5 2 2 01 06 Belanja Bahan Bakar Minyak/Gas dan Pelumas Oli 10,000,000 1,200,000 600,000 800,000 800,000 800,000 600,000 800,000 1,000,000 800,000
5 2 2 01 08 Belanja Pengisian Tabung Gas 8,300,000 750,000 750,000 750,000 750,000 750,000 750,000 750,000 750,000 575,000
5 2 2 01 09 Belanja Alat/ Kelengkapan Inventaris Ruang Pasien 36,688,550 20,625,000 16,063,550
5 2 2 01 12 Belanja Spanduk Atau Alat Informasi 13,800,000 3,450,000 3,450,000 3,450,000
5 2 2 01 13 Belanja Baliho 3,500,000
5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan 91,954,150 68,965,600
5 2 2 02 BELANJA BAHAN/ MATERIAL 295,248,527
5 2 2 02 04 Belanja Bahan Obat - obatan 150,321,727 112,741,300
5 2 2 02 17 Belanja bahan dan alat laboratorium 144,926,800 26,094,725 37,215,625 45,186,700
5 2 2 03 Belanja Jasa Kantor 1,158,618,450
5 2 2 03 06 Belanja kawat/ faximile / internet 6,000,000 1,500,000 1,500,000 1,500,000
5 2 2 03 09 Belanja Jasa Transaksi Keuangan 240,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000
5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan 1,137,226,500 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875
5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan 12,401,950 12,401,950
5 2 2 03 59 Belanja Jasa Instalasi Jaringan Komputer 2,750,000
5 2 2 05 Belanja Perawatan Kendaraan Bermotor 4,974,450
5 2 2 05 01 Belanja Jasa Servis 2,310,000 577,500 577,500 577,500
5 2 2 05 02 Belanja Penggantian Suku Cadang 2,664,450
5 2 2 06 Belanja Cetak Dan Penggandaan 120,469,700
5 2 2 06 01 Belanja Cetak 79,639,700 18,686,800 19,701,225 14,194,725
5 2 2 06 02 Belanja Penggandaan 40,830,000 5,402,300 4,402,300 2,102,400 3,402,300 2,987,000 3,402,600 4,402,600 2,118,100 3,009,800
5 2 2 11 Belanja Makanan dan minuman 8,225,000
5 2 2 11 06 Belanja Makanan dan minuman harian peserta 8,225,000 2,065,000 2,065,000 2,030,000
5 2 2 15 Belanja Perjalanan Dinas 10,000,000
5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah 10,000,000 2,480,000 2,490,000 2,515,000
5 2 2 20 Belanja Pemeliharaan 43,200,000
5 2 2 20 04 Belanja Pemeliharaan Gedung 42,000,000 42,000,000
5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor 1,200,000 400,000 400,000
5 2 3 BELANJA MODAL 704,434,300
5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor 31,750,000
5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi 15,750,000 15,750,000
5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian 16,000,000 16,000,000
5 2 3 11 Belanja modal pengadaan perlengkapan kantor 35,053,100
5 2 3 11 02 Belanja modal pengadaan Almari 15,368,000 15,368,000
5 2 3 11 07 Belanja modal pengadaan rak arsip 6,444,200 6,444,200
5 2 3 11 14 Belanja Modal Pengadaan etalase 3,780,000 3,780,000
5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran 9,460,900 9,460,900
5 2 3 12 Belanja Modal Pengadaan Komputer 86,001,500
5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC 8,938,150 8,938,150
5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book 51,057,600 51,057,600
5 2 3 12 04 Belanja Modal Pengadaan Printer 26,005,750 26,005,750
5 2 3 13 Belanja modal pengadaan mebeulair 142,419,500
5 2 3 13 02 Belanja modal pengadaan Meja Rapat 78,258,000 55,608,000 16,170,000 6,480,000
5 2 3 13 04 Belanja modal pengadaan kursi kerja 41,995,000 3,320,000 38,675,000
5 2 3 13 10 Belanja modal pengadaan kursi Tunggu 22,166,500 22,166,500
5 2 3 14 Belanja modal pengadaan Peralatan Dapur 9,989,100
5 2 3 14 04 Belanja modal pengadaan dispenser 2,551,500 2,551,500
5 2 3 14 05 Belanja modal pengadaan kulkas 7,437,600 7,437,600
5 2 3 16 Belanja modal pengadaan alat-alat studio 85,482,750
5 2 3 16 01 Belanja modal pengadaan Kamera 13,200,000 13,200,000
5 2 3 16 03 Belanja modal pengadaan proyektor/infokus 24,040,100 24,040,100
5 2 3 16 19 Belanja modal pengadaan TV 48,242,650 25,608,000 19,743,200 2,891,450
5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran 130,549,500
5 2 3 18 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 128,254,200 65,000,000 63,254,200
5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi 2,295,300 2,295,300
5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan 17,000,000
5 2 3 30 14 Belanja modal pengadaan CCTV 17,000,000 17,000,000
5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor 166,188,850
5 2 3 38 02 Belanja Modal Pengadaan AC 68,170,000 26,250,000 27,020,000
5 2 3 38 04 Belanja Modal Pengadaan Awning 66,825,000 66,825,000
5 2 3 38 05 Belanja Modal Pengadaan genset 11,193,850 11,193,850
5 2 3 38 11 Belanja Modal Pengadaan Backdrop 20,000,000 20,000,000

J U M LAH 2,597,097,627 163,656,750 210,960,250 259,182,275 281,606,552 283,890,425 229,065,125 243,030,325 290,444,200 161,320,998
216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800
52,768,050 5,464,550 -42,757,475 -65,181,752 -67,465,625 -12,640,325 -26,605,525 -74,019,400 55,103,802
Banyuwangi, Desember 2016

Kepala UPTD Puskesmas Songgon

WAWAN PRAYITNO,[Link]
NIP. 19691225 199203 1 008
 Tribulan IV
(Rp.)
OKT NOP DES
13 14 15

16,694,875 78,714,300 20756575 #REF!

6,720,200
186,000 195,000 195,000 2,250,000
800,000 800,000 1,000,000 10,000,000
575,000 575,000 575,000 8,300,000
36,688,550
3,450,000 13,800,000
3,500,000 3,500,000
22,988,550 91,954,150 91,954,150 22,988,550
0
37,580,427 150,321,727 150,321,727
36,429,750 144,926,800 37,580,427
0
1,500,000 6,000,000
20,000 20,000 20,000 240,000
94,768,875 94,768,875 94,768,875 1,137,226,500
12,401,950
2,750,000 2,750,000
0
577,500 2,310,000
2,664,450 2,664,450
0
 27,056,950 79,639,700 79,639,700 0
4,646,625 1,667,650 3,286,325 40,830,000 40,830,000 1,167,650
0 0
2,065,000 8,225,000
0 7,686,325
2,515,000 10,000,000
0
42,000,000
400,000 1,200,000
0
0
15,750,000
16,000,000
0
15,368,000
6,444,200
3,780,000
9,460,900
0
8,938,150
51,057,600
26,005,750
0
78,258,000
41,995,000
22,166,500
0
2,551,500
7,437,600
0
13,200,000
24,040,100
48,242,650
0
128,254,200
 2,295,300
0
17,000,000
0
14,900,000 68,170,000
66,825,000
11,193,850
20,000,000

158,291,927 157,844,825 157,803,975 2,123,156,900

216,424,800 216,424,800 216,424,827 2,597,097,627
58,132,873 58,579,975 58,620,852
16

ggon

8
 RENCANA KERJA DAN ANGGARAN
SATUAN KERJA PERANGKAT DAERAH
UPTD PUSKESMAS SONGGON 2016

Anggaran Tahun Tribulan I Tribulan II Tribulan III

Kode Rekening Uraian ini (Rp.) (Rp.) (Rp.)
(Rp.) JAN PEB MARET APRIL MEI JUNI JULI AGTS SEP
1 2 3 4 5 6 7 8 9 10 11 12

5 2 BELANJA LANGSUNG 2,597,097,627

5 2 2 BELANJA BARANG DAN JASA 1,892,663,327
5 2 2 01 Belanja Barang Habis Pakai 251,927,200
5 2 2 01 01 Belanja Alat Tulis Kantor 78,714,300 18,124,225 16,694,675 15,497,081
5 2 2 01 03 Belanja Alat Listrik dan elektronik (Lampu pijar, Battery kering dll) 6,720,200 6,720,200
5 2 2 01 04 Belanja Perangko, Materai dan Benda Pos Lainnya 2,250,000 186,000 186,000 186,000 186,000 186,000 186,000 186,000 186,000 186,000
5 2 2 01 06 Belanja Bahan Bakar Minyak/Gas dan Pelumas Oli 10,000,000 600,000 600,000 800,000 800,000 800,000 1,200,000 800,000 1,000,000 800,000
5 2 2 01 08 Belanja Pengisian Tabung Gas 8,300,000 750,000 750,000 750,000 750,000 750,000 750,000 750,000 750,000 575,000
5 2 2 01 09 Belanja Alat/ Kelengkapan Inventaris Ruang Pasien 36,688,550 20,625,000 16,063,550
5 2 2 01 12 Belanja Spanduk Atau Alat Informasi 13,800,000 3,450,000 3,450,000 3,450,000
5 2 2 01 13 Belanja Baliho 3,500,000 3,500,000
5 2 2 01 16 Belanja Peralatan Dan Bahan Kesehatan 91,954,150 45,873,450 46,080,700
5 2 2 02 BELANJA BAHAN/ MATERIAL 295,248,527
5 2 2 02 04 Belanja Bahan Obat - obatan 150,321,727 73,410,825 76,910,902
5 2 2 02 17 Belanja bahan dan alat laboratorium 144,926,800 26,094,625 34,986,675 36,429,750
5 2 2 03 Belanja Jasa Kantor 1,158,618,450
5 2 2 03 06 Belanja kawat/ faximile / internet 6,000,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000 500,000
5 2 2 03 09 Belanja Jasa Transaksi Keuangan 240,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000 20,000
5 2 2 03 28 Belanja Jasa Pelayanan Kesehatan 1,137,226,500 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875 94,768,875
5 2 2 03 38 Belanja jasa kalibrasi alat-alat kesehatan 12,401,950 12,401,950
5 2 2 03 59 Belanja Jasa Instalasi Jaringan Komputer 2,750,000
5 2 2 05 Belanja Perawatan Kendaraan Bermotor 4,974,450
5 2 2 05 01 Belanja Jasa Servis 2,310,000 577,500 577,500 577,500
5 2 2 05 02 Belanja Penggantian Suku Cadang 2,664,450
5 2 2 06 Belanja Cetak Dan Penggandaan 120,469,700
5 2 2 06 01 Belanja Cetak 79,639,700 19,701,000 20,285,725 12,118,492
5 2 2 06 02 Belanja Penggandaan 40,830,000 3,416,900 3,388,100 2,102,500 3,402,500 3,402,500 3,402,500 4,456,025 2,271,500 2,009,800
5 2 2 11 Belanja Makanan dan minuman 8,225,000
5 2 2 11 06 Belanja Makanan dan minuman harian peserta 8,225,000 2,065,000 2,065,000 2,030,000
5 2 2 15 Belanja Perjalanan Dinas 10,000,000
5 2 2 15 01 Belanja Perjalanan Dinas Dalam Daerah 10,000,000 2,480,000 2,490,000 2,515,000
5 2 2 20 Belanja Pemeliharaan 43,200,000
5 2 2 20 04 Belanja Pemeliharaan Gedung 42,000,000 42,000,000
5 2 2 20 06 Belanja Pemeliharaan peralatan dan perlengkapan kantor 1,200,000 400,000 400,000
5 2 3 BELANJA MODAL 704,434,300
5 2 3 10 Belanja Modal Pengadaan Peralatan Kantor 31,750,000
5 2 3 10 13 Belanja Modal Pengadaan mesin Absensi 15,750,000 15,750,000
5 2 3 10 18 Belanja Modal Pengadaan mesin Antrian 16,000,000 16,000,000
5 2 3 11 Belanja modal pengadaan perlengkapan kantor 35,053,100
5 2 3 11 02 Belanja modal pengadaan Almari 15,368,000 15,368,000
5 2 3 11 07 Belanja modal pengadaan rak arsip 6,444,200 6,444,200
5 2 3 11 14 Belanja Modal Pengadaan etalase 3,780,000 3,780,000
5 2 3 11 15 Belanja Modal Pengadaan Pemadam Kebakaran 9,460,900 9,460,900
5 2 3 12 Belanja Modal Pengadaan Komputer 86,001,500
5 2 3 12 02 Belanja Modal Pengadaan Komputer/ PC 8,938,150 8,938,150
5 2 3 12 03 Belanja Modal Pengadaan Komputer Note Book 51,057,600 17,019,200
5 2 3 12 04 Belanja Modal Pengadaan Printer 26,005,750
5 2 3 13 Belanja modal pengadaan mebeulair 142,419,500
5 2 3 13 02 Belanja modal pengadaan Meja Rapat 78,258,000 6,480,000 16,170,000 27,804,000
5 2 3 13 04 Belanja modal pengadaan kursi kerja 41,995,000 3,320,000 38,675,000
5 2 3 13 10 Belanja modal pengadaan kursi Tunggu 22,166,500 22,166,500
5 2 3 14 Belanja modal pengadaan Peralatan Dapur 9,989,100
5 2 3 14 04 Belanja modal pengadaan dispenser 2,551,500 2,551,500
5 2 3 14 05 Belanja modal pengadaan kulkas 7,437,600
5 2 3 16 Belanja modal pengadaan alat-alat studio 85,482,750
5 2 3 16 01 Belanja modal pengadaan Kamera 13,200,000
5 2 3 16 03 Belanja modal pengadaan proyektor/infokus 24,040,100
5 2 3 16 19 Belanja modal pengadaan TV 48,242,650 19,743,200
5 2 3 19 Belanja Modal Pengadaan Alat-alat Kedokteran 130,549,500
5 2 3 18 01 Belanja Modal Pengadaan Ala-alat Kedokteran Umum 128,254,200 65,000,000 31,420,875
5 2 3 19 02 Belanja Modal Pengadaan Ala-alat Kedokteran Gigi 2,295,300 2,295,300
5 2 3 30 Belanja modal pengadaan alat-alat persenjataan/ keamanan 17,000,000
5 2 3 30 14 Belanja modal pengadaan CCTV 17,000,000 17,000,000
5 2 3 38 Belanja Modal Pengadaan Perlengkapan Gedung Kantor 166,188,850
5 2 3 38 02 Belanja Modal Pengadaan AC 68,170,000 26,250,000 27,020,000
5 2 3 38 04 Belanja Modal Pengadaan Awning 66,825,000 66,825,000
5 2 3 38 05 Belanja Modal Pengadaan genset 11,193,850 11,193,850
5 2 3 38 11 Belanja Modal Pengadaan Backdrop 20,000,000

J U M LAH 2,597,097,627 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800
142,900,000 142,900,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000 142,898,000
216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800 216,424,800
Banyuwangi, Desember 2016

Kepala UPTD Puskesmas Songgon

WAWAN PRAYITNO,[Link]
NIP. 19691225 199203 1 008
 Tribulan IV
(Rp.)
OKT NOP DES
13 14 15

28,398,319 78,714,300 78,714,300 56,500

6,720,200 28,398,319
186,000 195,000 195,000 2,250,000
800,000 800,000 1,000,000 10,000,000
575,000 575,000 575,000 8,300,000
36,688,550
3,450,000 13,800,000
3,500,000
91,954,150 91,954,150 45,977,075
0
150,321,727
47,415,750 144,926,800
0
500,000 500,000 500,000 6,000,000
20,000 20,000 20,000 240,000
94,768,875 94,768,875 94,768,875 1,137,226,500
12,401,950
2,750,000 2,750,000
0
577,500 2,310,000
2,664,450 2,664,450
0
 27,534,483 79,639,700 79,639,700 0
5,446,625 990,117 6,540,933 40,830,000 40,830,000
0 5,449,925
2,065,000 8,225,000
0
2,515,000 10,000,000
0
42,000,000
400,000 1,200,000
0
0
15,750,000
16,000,000
0
15,368,000
6,444,200
3,780,000
9,460,900
0
8,938,150
34,038,400 51,057,600
26,005,750 26,005,750
0
27,804,000 78,258,000
41,995,000
22,166,500
0
2,551,500
7,437,600 7,437,600
0
13,200,000 13,200,000
24,040,100 24,040,100
2,891,450 25,608,000 48,242,650
0
31,833,325 128,254,200 63,254,200
 2,295,300 -65,000,000
0 31,833,325
17,000,000
0
14,900,000 68,170,000
66,825,000
11,193,850
20,000,000 20,000,000

216,424,800 216,424,800 216,424,827

142,898,000 142,898,000 142,898,000 1,714,780,000
216,424,800 216,424,800 216,424,827 2,597,097,627
6
#REF!
gon
NO URAIAN JUMLAH
Calkulator 5 Buah 124,350 621,750 124,350
Amplop no 10 20 Kotak 3,550 71,000 10 3,500
Buku Folio Bergaris isi 200 Lembar 30 Buku 28,200 846,000 10 28,200
Buku tulis isi 50 100 Buah 4,900 490,000 50 4,900
Buku Folio Bergaris isi 100 Lembar 50 Buah 18,000 900,000 18,000
CDR ( isi 100 Pcs ) 1 Box 172,600 172,600 1 172,600
Correstion Pen (TIP-Ex) 100 Buah 10,800 1,080,000 25 10,800
Cutter 10 Buah 18,350 183,500 5 18,300
Hetmachine/Staples Kecil 20 Buah 21,000 420,000 5 21,000
Isi Staples Merk Etona no.10 20 Kotak 2,700 54,000 10 2,700
Isi Staples Merk Great Wall no 3 20 Kotak 4,800 96,000 4,800
Isolasi Jilid Hitam 5 cm 5 Buah 33,000 165,000 33,000
Amplop Coklat (F4) 10 Kotak 51,600 516,000 5 51,600
Isolasi Jilid Hitam 3 cm 5 Buah 24,000 120,000 5 24,000
Isolasi Bening 2 Buah 18,000 36,000 2 18,000
Isolasi Kecil 20 Roll 3,050 61,000 10 3,000
Kertas HVS F4 70 gr 250 Rim 39,000 9,750,000 50 39,000
Kertas Bufalo Folio 5 Rim 21,350 106,750 3 21,300
Lem Kertas 30 Buah 13,650 409,500 20 13,650
Map Jepit Plastik 500 Buah 7,450 3,725,000 150 7,400
Map Plastik Folio 500 Buah 3,550 1,775,000 150 3,500
Odner Folio 20 Buah 25,850 517,000 25,850
Paper Klip no.3 50 Kotak 3,250 162,500 3,250
Amplop Putih 20 Dus 12,750 255,000 12,750
Paper Klip no.3 50 Kotak 6,000 300,000 15 6,000
Penggaris Besi 30 cm 20 Buah 29,150 583,000 7 29,100
Perforator/Pembolong no.30 2 Buah 68,400 136,800 68,400
Pita Mesin Ketik Manual 2 Buah 24,000 48,000 24,000
Spidol Snowman Permanen 10 Lusin 72,000 720,000 5 72,000
Stabilo 30 Buah 10,200 306,000 17 10,200
Stampad Kecil 15 Buah 12,600 189,000 12,600
Stip/ Penghapus 50 Buah 4,400 220,000 4,400
Stopmap bufalo 7,500 Buah 5,400 40,500,000 1,500 5,400
Ballpoint 500 Buah 3,350 1,675,000 125 3,300
Tas 110 Buah 25,000 2,750,000 30 25,000
Tinta Printer 59 Botol 66,000 3,894,000 14 66,000
Tinta Printer Rainbow black 28 Buah 46,050 1,289,400 7 46,000
Tinta Printer Rainbow Colour 30 Buah 46,050 1,381,500 5 46,000
Ballpoint bertempat 10 Buah 40,250 402,500 10 40,200
Binder Clip 155 20 Buah 9,600 192,000 20 9,600
Binder Clip 200 20 Dos 15,000 300,000 5 15,000
Binder Clip 260 20 Dos 21,000 420,000 5 21,000
Box File 50 Buah 18,600 930,000 10 18,600

11347.917

Benner 460 Meter ² 30,000 13,800,000 115 30,000

Baliho 100 Meter 35,000 3,500,000 100 35,000

Buku Regester 50 Buah 25,600 1,280,000 25,600

Cetak Sertifikat/Piagam Full Colour 900 Exemplar 3,500 3,150,000 10 3,500
Cetak HVS Folio 70 gram 1 muka 65 Rim 122,000 7,930,000 34 122,000
Cetak Laeflet 5,000 Lembar 4,400 22,000,000 3000 4,400
Cetak Blangko Hasil Laboratorium 100 Bendel 16,200 1,620,000 16,200
Lembar Balik 1,205 Lembar 4,700 5,663,500 4,700
Cetak Kohort 1,200 Lembar 11,850 14,220,000 11,800
Klip Plastik 5x 8 cm 791 Box 19,400 15,345,400 19,400
HVS Double Folio/Double Kwarto 60 Gr 4,400 Lembar 600 2,640,000 600
Cetak Resep Dokter 51 Buku 12,400 632,400 43 12,000
Biaya Jilid 140 Buku 18,450 2,583,000 43 18,000
Kresek kecil berlogo 79 Ikat 32,600 2,575,400 32,600
79,639,700

Penggandaan/ Foto Copy 136,100 lembar 300 40,830,000 11,347 300

lembar 200 -
Nasi 235 Kotak 25,000 5,875,000 58 25,000
Snack 235 Kotak 10,000 2,350,000 58 10,000

59
* Jarak 0 - 5 Km 51 OH 30,000 1,530,000 11 30,000
* Jarak 6 - 10 Km 186 OH 35,000 6,510,000 46 35,000
* Jarak 11 - 15 Km 49 OH 40,000 1,960,000 12 40,000

Oksogien
Oksigen 2,5 m³ 20 Tabung 75,000 Tabung 75,000
Oksigen 6 m³ 68 Tabung 100,000 Tabung 100,000

2
2
2
 - 5 124,350 621,750 124,350 -
35,000 3,500 - 10 3,500 35,000
282,000 28,200 - 10 28,200 282,000 10
245,000 50 4,900 245,000 4,900 -
- 25 18,000 450,000 25 18,000 450,000
172,600 172,600 - 172,600 -
270,000 25 10,800 270,000 25 10,800 270,000 25
91,500 5 18,300 91,500 18,300 -
105,000 10 21,000 210,000 5 21,000 105,000
27,000 10 2,700 27,000 2,700 -
- 20 4,800 96,000 4,800 -
- 5 33,000 165,000 33,000 -
258,000 5 51,600 258,000 51,600 -
120,000 24,000 - 24,000 -
36,000 18,000 - 18,000 -
30,000 10 3,000 30,000 3,000 -
1,950,000 85 39,000 3,315,000 65 39,000 2,535,000 50
63,900 21,300 - 2 21,300 42,600
273,000 13,650 - 5 13,650 68,250 5
1,110,000 155 7,400 1,147,000 95 7,400 703,000 100
525,000 155 3,500 542,500 100 3,500 350,000 95
- 20 25,800 516,000 25,800 -
- 19 3,250 61,750 30 3,250 97,500 1
- 20 12,500 250,000 12,500 -
90,000 6,000 - 1 6,000 6,000 34
203,700 29,100 - 7 29,100 203,700 6
- 2 68,400 136,800 68,400 -
- 2 24,000 48,000 24,000 -
360,000 72,000 - 72,000 - 5
173,400 13 10,200 132,600 10,200 -
- 7 12,500 87,500 12,500 - 8
- 30 4,400 132,000 10 4,400 44,000 10
8,100,000 2,400 5,400 12,960,000 1,725 5,400 9,315,000 1,875
412,500 125 3,300 412,500 100 3,300 330,000 150
750,000 30 25,000 750,000 20 25,000 500,000 30
924,000 19 66,000 1,254,000 5 66,000 330,000 21
322,000 14 46,000 644,000 46,000 - 7
230,000 12 46,000 552,000 4 46,000 184,000 9
402,000 40,200 - 40,200 - -
192,000 9,600 - 9,600 - -
75,000 5 15,000 75,000 5 15,000 75,000 5
105,000 5 21,000 105,000 21,000 - 10
186,000 20 18,600 372,000 10 18,600 186,000 10
18,119,600 25,957,900 16,112,050
16112050
136164 -

3,450,000 115 30,000 3,450,000 115 30,000 3,450,000 115

3,500,000 - -

- 50 25,500 1,275,000 25,600 -

35,000 275 3,500 962,500 615 3,500 2,152,500
4,148,000 17 122,000 2,074,000 14 122,000 1,708,000
13,200,000 1000 4,400 4,400,000 1000 4,400 4,400,000
- 100 16,000 1,600,000 16,200 -
- 1205 4,700 5,663,500 4,700 -
- 11,850 - 11,850 - 1,200
 - 19,400 - 185 19,300 3,570,500 661
- 600 - 4400 500 2,200,000
516,000 8 12,000 96,000 12,400 -
774,000 59 18,000 1,062,000 18,450 - 38
- 79 32,500 2,567,500 32,600 -
18,673,000 19,700,500 14,031,000

3,404,100 11,347 300 3,404,100 11,347 300 3,404,100 11,347

- - -
1,450,000 59 25,000 1,475,000 59 25,000 1,475,000 59
580,000 59 10,000 590,000 59 10,000 590,000 59
2,030,000 2,065,000 2,065,000

330,000 15 30,000 450,000 13 30,000 390,000 12

1,610,000 46 35,000 1,610,000 47 35,000 1,645,000 47
480,000 12 40,000 480,000 12 40,000 480,000 13
2,420,000 2,540,000 2,515,000

1,500,000 4 75,000 300,000 2 75,000 150,000 3

6,800,000 4 100,000 400,000 6 100,000 600,000 5
8,300,000 700,000 750,000

2.5
2
2
2
124,350 - - -
3,500 - - 1,000
28,200 282,000 - -
4,900 - - -
18,000 - - -
172,600 - - - 889350
10,800 270,000 - - 270000
18,300 - - 500 619350
21,000 - - -
2,700 - - -
4,800 - - -
33,000 - - -
51,600 - - -
24,000 - - -
18,000 - - -
3,000 - - 1,000
39,000 1,950,000 - -
21,300 - - 250
13,650 68,250 - -
7,400 740,000 - 25,000
3,500 332,500 - 25,000
25,800 - - 1,000
3,250 3,250 - -
12,500 - - 5,000
6,000 204,000 - -
29,100 174,600 - 1,000
68,400 - - -
24,000 - - -
72,000 360,000 - -
10,200 - - -
12,500 100,000 - 1,500
4,400 44,000 - -
5,400 10,125,000 - - 2250
3,300 495,000 - 25,000
25,000 750,000 - -
66,000 1,386,000 - - 552600
46,000 322,000 - 1,400
46,000 414,000 - 1,500
40,200 - - 500
9,600 - - -
15,000 75,000 - -
21,000 210,000 - -
18,600 186,000 - -
18,491,600 20,224,925
(5,732,975)
1,098,475

30,000 3,450,000 -
- -

25,600 - - 6
3,500 - - 113
122,000 - - 8
4,400 - - 625
16,200 - - 13
4,700 - - 151
11,850 14,220,000 - 150
 19,400 12,823,400 (55) 99
600 - - 550
12,400 - - 6
18,450 701,100 - 18
32,600 - - 10
27,744,500 17,698,075
3,667,075
300 3,404,100 90,712 19,235,350
- - 1,537,275
25,000 1,475,000 -
10,000 590,000 -
2,065,000 8,225,000 39300

30,000 360,000 - 4,150

35,000 1,645,000 -
40,000 520,000 -
2,525,000

75,000 225,000
100,000 500,000
725,000