DETASEMEN KESEHATAN WILAYAH 02.04.

04
RUMAH SAKIT Tk. IV 02.07.05 dr. NOESMIR

LAPORAN TAGIHAN BEKKES INSTALASI FARMASI RUMAH S

BULAN APRIL 2022

TGL NOMOR PENERI

NO NAMA BARANG PBF SATUAN
FAKTUR FAKTUR MAAN

1 2 3 4 5 6 7

A OBAT
1 SEVODEX INF 18/3/22 PRIMKOPAD 30 BTL 3

JUMLAH
TOTAL TAGIHAN
S INSTALASI FARMASI RUMAH SAKIT TK IV 02.04.05
BULAN APRIL 2022

HARGA HARGA HARGA TOTAL

% DISKON
SATUAN (A) SATUAN (-D) SATUAN + PPN HARGA

8 9 10 11 12 13

3,306,729.00 Rp 9,920,187

JUMLAH
TOTAL TAGIHAN
 KLASIFIKASI OBAT dan JUMLAH TAGIHAN KOTOR

OBAT OBAT OBAT OBAT

OBAT CAIR PADAT GAS SERBUK/TEPUNG GEL/SALEP OBAT LAINNYA

9,920,187

9,920,187
Rp 9,920,187
DETASEMEN KESEHATAN WILAYAH 02.04.04
RUMAH SAKIT Tk. IV 02.07.05 dr. NOESMIR

LAPORAN TAGIHAN BEKKES INSTALASI FARMASI RUMA

BULAN APRIL 2022

TGL NOMOR
NO NAMA BARANG PBF SATUAN
FAKTUR FAKTUR

1 2 3 4 5 6

A OBAT
Silex Syrup 4/1/2022 PRIMKOPAD 3 botol
Spironolacton 100mg tablet
Sporetik-200 caps capsul
Suprafenid Suppos suppositoria
Tera-f caps tablet
Tetagam inj vial
Thyrozol tab tablet
Tofedex tab tablet
Tremenza syrup botol
Tremenza tab tablet
Trijec inj vial
Trovensis 8mg inj ampul
Trovensis 8mg tab tablet
Ultrafoct salep tube
Umkalin Syrup botol
Unalium 5mg tab tablet
Urdafalk capsul
Valsartan 8mg tablet
Ventolin nebu ampul
Viccilin SX inj vial
Vitamin bcomp tablet
Vometa drop botol
Wida D10% kolf botol
Zincpro drop botol
JUMLAH
TOTAL TAGIHAN
LASI FARMASI RUMAH SAKIT TK IV 02.04.05
N APRIL 2022

HARGA HARGA
PENERI HARGA SATUAN KLASIFIKASI
% DISKON SATUAN SATUAN TOTAL HARGA
MAAN (A)
(-D) + PPN

7 8 9 10 11 12 13 OBAT CAIR

1 Rp 100,000 100,000 100,000

10 Rp 600 6,000
10 Rp 47,500 475,000
10 Rp 19,200 192,000
200 Rp 699 139,800
1 Rp 318,000 318,000
100 Rp 4,080 408,000
10 Rp 11,500 115,000
1 Rp 40,000 40,000 40,000
10 Rp 3,000 30,000
20 Rp 339,110 6,782,200
21 Rp 112,962 2,372,200
10 Rp 28,500 285,000
1 Rp 144,000 144,000
2 Rp 80,000 160,000 160,000
10 Rp 12,000 120,000
10 Rp 16,200 162,000
10 Rp 7,440 74,400
25 Rp 14,880 372,000
6 Rp 130,067 780,400
160 Rp 263 42,000
1 72,000.00 72,000 72,000
22 9,272.73 204,000 204,000
2 51,000.00 102,000 102,000
JUMLAH 678,000
OTAL TAGIHAN 13,496,000
KLASIFIKASI OBAT dan JUMLAH TAGIHAN KOTOR

OBAT OBAT OBAT OBAT

OBAT PADAT GEL/SALE
GAS SERBUK/TEPUNG LAINNYA
P

6,000
475,000
192,000
139,800
318,000
408,000
115,000

30,000
6,782,200
2,372,200
285,000
144,000

120,000
162,000
74,400
372,000
780,400
42,000

1,857,200 Rp 10,624,800 336,000

DETASEMEN KESEHATAN WILAYAH 02.04.04
RUMAH SAKIT Tk. IV 02.07.05 dr. NOESMIR

LAPORAN TAGIHAN BEKKES INSTALASI FARMASI RU

BULAN APRIL 2022

NOMOR
NO NAMA BARANG TGL FAKTUR PBF SATUAN
FAKTUR

1 2 3 4 5 6

A OBAT
Alganax 0,25 mg Tab 4/1/2022 PRIMKOPAD 3 tablet
Antasida DOEN tablet
Aminofillin inj ampul
Ambroxol tablet tablet
Ambroxol Syrup botol
Aminefron Tab tablet
Amlodipine 10mg tab tablet
As. Fusidat cream tube
Asam Folat tablet
Analsik tab tablet
Apetic syr botol
Betadine slf tube
Bfluid softbag softbag
Bionect cream tube
Ca Glukonas Inj ampul
Cernevit inj vial
Calsivas 10mg tab tablet
Channa caps capsul
Cefxon inj ampul
Cephaflox inj vial
CTM botol (100 tab) botol
Cetirizin tab tablet
Cinolon-n slf tube
Diazepam inj ampul
suppositori
Dulcolax supp a
Dopamine inj ampul
Esola inj vial
Elpicef inj vial
Eperisone tablet
Furosemide inj ampul
Flutias inhaler botol
Fleet Enama fls
Folavit tab tablet
Gastrinal Syrup botol
Gentamisin inj ampul
Gentamisin sk tube
Glimepiride tab tablet
Hepagusan inj vial
ISDN tab tablet
Ketosteril Tab capsul
Kloderma cream tube
Kliran 4mg inj ampul
Kliran 8mg Inj ampul
Keterolac tab tablet
L-Bio Caps capsul
L-zink syr botol
Lameson tab tablet
Lopamid tab tablet
Lasix Inj ampul
Mefinal tab tablet
Metronidazole inf botol
Maxprinol syr botol
Manitol inf botol
Mederma Cream tube
Nifedipine Tab tablet
Nymiko drop botol
Nucral syr botol
Norsec inj vial
Neurosanbe tab tablet
Neurodex Tab tablet
Oseltamivir tab tablet
Omeprazole inj vial
Oxytocin Inj ampul
ODR inj ampul
Osfit Platinum botol
OTSU Manitol kolf
Proxium inj vial
Provelyn 75 tab capsul
Phytomenadion tab tablet
Paracetamol syr botol
Plasminex Inj ampul
Ranitidine inj ampul
Sanmol tab tablet
Sanmol syr botol
Sanmol Forte syr botol
Sanadryl DMP syrup botol
Sanadryl Expectoran botol
Spuit 50cc Pcs
Sporetik syr botol
Sagestam inj ampul
Simarc Tab tablet
Tetagam Inj box
Topedex inj ampul
Tracetate Tab tablet
Tricodazole Inf softfles
Trovensis 8mg Inj ampul
Valisanbe Inj ampul
Ventolin Nebu ampul
Veltrom 10mg Tab tablet
Vildi Tab tablet
Xylocain Gel fls
JUMLAH
TOTAL TAGIHAN
EKKES INSTALASI FARMASI RUMAH SAKIT TK IV 02.04.05
BULAN APRIL 2022

HARGA
HARGA HARGA SATUAN +
PENERI MAAN % DISKON SATUAN
SATUAN (A) PPN
(-D)

7 8 9 10 11 12

10 Rp 7,000
500 Rp 720
10 Rp 19,200
300 Rp 384
5 Rp 9,000
10 Rp 12,300
100 Rp 1,200
2 Rp 30,000
50 Rp 840
20 Rp 3,600
1 Rp 51,600
1 Rp 18,000
4 Rp 316,000
1 Rp 196,000
1 Rp 48,000
5 Rp 345,360
20 Rp 13,800
10 Rp 9,600
4 Rp 346,750
10 Rp 339,500
1 Rp 12,000
200 Rp 600
1 Rp 30,000
1 Rp 42,000
1 Rp 54,000
2 Rp 48,000
3 Rp 262,000
8 Rp 322,500
100 Rp 2,880
21 Rp 9,429
1 Rp 240,000
2 Rp 162,000
20 Rp 2,000
1 Rp 48,000
50 Rp 15,000
10 Rp 10,000
100 Rp 700
30 Rp 103,400
100 Rp 300
20 Rp 11,300
1 Rp 60,000
19 Rp 53,337
4 Rp 90,000
30 Rp 4,800
5 Rp 14,400
2 Rp 55,000
10 Rp 6,600
10 Rp 800
2 Rp 51,000
10 Rp 2,500
7 Rp 49,714
1 Rp 124,000
2 Rp 151,200
1 Rp 186,000
10 Rp 800
1 Rp 54,000
4 Rp 93,000
18 Rp 245,333
10 Rp 2,500
10 Rp 1,200
140 Rp 20,071
3 Rp 41,667
50 Rp 12,000
12 Rp 44,500
30 Rp 8,000
 22 Rp 120,909
14 Rp 258,000
10 Rp 20,400
10 Rp 4,800
15 Rp 10,000
10 Rp 27,000
152 Rp 7,696
12 Rp 625
1 Rp 20,000
2 Rp 45,000
1 Rp 24,000
1 Rp 24,000
2 Rp 42,000
1 Rp 138,000
150 Rp 13,360
10 Rp 4,800
15 Rp 348,000
8 Rp 85,000
20 Rp 36,000
6 Rp 150,000
2 Rp 120,000
3 Rp 42,000
20 Rp 18,000
30 Rp 2,500
10 Rp 9,300
1 Rp 120,000
JUMLAH
TOTAL TAGIHAN
TOTAL HARGA KLASIFIKASI OBAT dan JUMLAH TAGIHAN KOTOR

OBAT
13 OBAT CAIR OBAT PADAT OBAT GAS
SERBUK/TEPUNG

70,000 70,000
360,000 360,000
192,000 192,000
115,200 115,200
45,000 45,000
123,000 123,000
120,000 120,000
60,000
42,000 42,000
72,000 72,000
51,600 51,600
18,000
1,264,000 1,264,000
196,000
48,000 48,000
1,726,800 1,726,800
276,000 276,000
96,000 96,000
1,387,000 1,387,000
3,395,000 3,395,000
12,000 12,000
120,000 120,000
30,000
42,000 42,000
54,000
96,000 96,000
 786,000 786,000
2,580,000 2,580,000
288,000 288,000
198,009 198,009
240,000 240,000
324,000 324,000
40,000 40,000
48,000 48,000
750,000 750,000
100,000
70,000 70,000
3,102,000 3,102,000
30,000 30,000
226,000 226,000
60,000
1,013,403 1,013,403
360,000 360,000
144,000 144,000
72,000 72,000
110,000 110,000
66,000 66,000
8,000 8,000
102,000 102,000
25,000 25,000
347,998 347,998
124,000 124,000
302,400 302,400
186,000
8,000 8,000
54,000 54,000
372,000 372,000
4,415,994 4,415,994
25,000 25,000
12,000 12,000
2,809,940 2,809,940
125,001 125,001
600,000 600,000
534,000 534,000
240,000 240,000
2,659,998 2,659,998
3,612,000 3,612,000
204,000 204,000
48,000 48,000
150,000 150,000
270,000 270,000
1,169,792 1,169,792
7,500 7,500
20,000 20,000
90,000 90,000
24,000 24,000
24,000 24,000
84,000 84,000
138,000 138,000
2,004,000 2,004,000
48,000 48,000
5,220,000 5,220,000
680,000 680,000
720,000 720,000
900,000 900,000
240,000 240,000
126,000 126,000
360,000 360,000
75,000 75,000
93,000 93,000
120,000 120,000
7,660,996 6,497,640 Rp 35,134,999
49,997,635
AGIHAN KOTOR

OBAT GEL/SALEP OBAT LAINNYA

60,000

18,000

196,000

30,000

54,000
100,000

60,000

186,000
704,000
DETASEMEN KESEHATAN WILAYAH 02.04.04
RUMAH SAKIT Tk. IV 02.07.05 dr. NOESMIR

LAPORAN TAGIHAN BEKKES INSTALASI FARMASI RUMAH SAKIT TK IV 02.04.0

BULAN APRIL 2022

TGL NOMOR PENERI HARGA

NO NAMA BARANG FAKTUR PBF FAKTUR SATUAN MAAN SATUAN (A) %

1 2 3 4 5 6 7 8 9
A OBAT
Albendazole Tab 4/1/2022PRIMKOPAD 3 Tablet 2 Rp 10,000
Alganax 0.5mg Tablet 10 Rp 18,000
Ambroxol Tab Tablet 500 Rp 568
Aminefron Tab Tablet 20 Rp 12,600
Aminophyllin Inj
Amoxicillin 500mg Ampul 3 Rp 37,000
Tab Tablet 100 Rp 615
Antasida
Asam Syrup Fls 3 Rp 8,667
Asam Folat
Traneksamat
Asam Tablet 100 Rp 720
250mg/Ml
Traneksamat Ampul 7 Rp 13,000
500mg/Ml
Asam Ampul 10 Rp 14,300
Traneksamat Tab Tablet 30 Rp 3,100
Aspilets Atramat
Benang Chewable Tablet 100 Rp 615
Plain 4-0 Pcs 2 Rp 114,000
Betadine Salep Tube 1 Rp 25,000
Biofos Syrup
Calsium Gluconas Fls 1 Rp 96,000
Inj Ampul 1 Rp 37,000
Catflam Fast Sachet 10 Rp 15,000
Cefspan Syrup Fls 1 Rp 180,000
Cefxon Inj Vial 6 Rp 347,500
Celodime Inj Vial 6 Rp 342,000
Cephaflox Inj Vial 6 Rp 344,500
Cernevit Inj Vial 1 Rp 345,000
Cetrizine Tab Tablet 200 Rp 680
Curcuma ER
Depakote Tablet 110 Rp 2,478
250mg
Depakote ER Tablet 6 Rp 22,674
500mg Tablet 10 Rp 30,800
Domperidon Syr Fls 3 Rp 18,668
Durogesic Patch Patch 1 Rp 246,000
Elpicef Inj Vial 4 Rp 369,000
Esola Inj Vial 12 Rp 270,000
Fibramed 300 Tablet 30 Rp 19,700
Folaplus Tab Tablet 30 Rp 2,300
Frego 5mg Tablet 10 Rp 10,500
Fuco Tab Tablet 3 Rp 24,000
Furosemide Inj Ampul 2 Rp 20,000
Futrolit Inf Softbag 24 Rp 80,000
GastrinalSalep
Genoint Syrup Fls 1 Rp 54,000
Mata Tube 1 Rp 14,000
Gentalex Cream Tube 10 Rp 12,300
Gentamisin Sk Tube 10 Rp 10,000
Gluvas 2mg Tablet 10 Rp 9,600
Graphace Syr Fls 1 Rp 93,000
Imunos Tab Tablet 10 Rp 12,300
ISDN Tab Tablet 200 Rp 915
Jarum Insulin Pcs 1 Rp 37,000
Kaen 1B Inf Kolf 4 Rp 42,000
Kalxetin Caps Capsul 10 Rp 13,000
Kliran Inj 4mg/Ml Ampul 10 Rp 56,000
Kliran Inj 8mg/Ml Ampul 18 Rp 90,278
Lametic 4mg Inj Ampul 14 Rp 60,000
Lametic 8mg Inj Ampul 7 Rp 100,000
Lancolin 500mg Inj Ampul 3 Rp 124,000
Lantidex Inj Ampul 6 Rp 79,667
Lantus Flexpen Flexpen 1 Rp 320,000
Lasix Inj Ampul 3 Rp 55,000
Leshicol 300mg Tablet 20 Rp 21,600
Lipepsa Syrup Fls 1 Rp 21,000
Liprolac Sachet Sachet 5 Rp 18,500
Loratadine Tab Tablet 100 Rp 870
L-Zinc Syrup Fls 1 Rp 55,500
Mertigo Sr Tablet 10 Rp 10,500
Metronidazole Tab Tablet 100 Rp 615
Metronidazole Inf Fls 14 Rp 61,180
Neurodex Tab Tablet 10 Rp 1,900
Ngt 3.5 Pcs 1 Rp 71,000
Norelut Tab Tablet 10 Rp 8,200
Norsec Inj Vial 4 Rp 252,000
Nucral Syrup Fls 3 Rp 93,000
Omeprazole Caps Capsul 200 Rp 739
Otsu Kaen 1 B Kolf 4 Rp 39,000
Oxytocin Inj Ampul 100 Rp 3,900
Panloc Inj Vial 12 Rp 260,400
Parasetamol Inf Fls 6 Rp 46,500
Periflux Syr Fls 1 Rp 60,000
Proanes Inj Ampul 25 Rp 110,800
Proxium Inj Vial 14 Rp 269,290
Ranitidine Inj Ampul 8 Rp 11,000
Salicyl Vedak Fls 1 Rp 8,000
Tabur
Sanadryl Botol 1 Rp 24,000
Expectoran
Sanmol Syr Syrup Botol 1 Rp 21,000
Sanmol Tab Tablet 20 Rp 1,500
Scabimite Cream Tube 2 Rp 78,500
Spuit 50cc Pcs 1 Rp 44,000
Threeway Pcs 5 Rp 39,400
Stopcock
Tofedex Inj Ampul 3 Rp 77,000
Tracetate Syrup Fls 1 Rp 660,000
Tracetate Tab Tablet 15 Rp 37,539
Triject Inj Vial 4 Rp 360,000
Trombo Aspilets Tablet 20 Rp 1,650
Trovensis 4mg Tablet 10 Rp 20,700
Tab
Trovensis Inj Ampul 1 Rp 120,000
Urotractin Caps Capsul 10 Rp 8,000
Viccilin Sx Vial 1 Rp 128,400
Yusimox Caps Capsul 100 Rp 880
JUMLAH
TOTAL TAGIHAN
H SAKIT TK IV 02.04.05

HARGA HARGA
SATUAN SATUAN TOTAL
DISKON (-D) + PPN HARGA KLASIFIKASI OBAT dan JUMLAH TAGIHAN KOTOR

OBAT OBAT
10 11 12 13 OBAT CAIR OBAT PADAT GAS SERBUK/TEPUNG

20,000 20,000
180,000 180,000
284,000 284,000
252,000 252,000
111,000 111,000
61,500 61,500
26,001 26,001
72,000 72,000
91,000 91,000
143,000 143,000
93,000 93,000
61,500 61,500
228,000 228,000
25,000
96,000 96,000
37,000 37,000
150,000 150,000
180,000 180,000
2,085,000 2,085,000
2,052,000 2,052,000
2,067,000 2,067,000
345,000 345,000
136,000 136,000
272,580 272,580
136,044 136,044
308,000 308,000
56,004 56,004
246,000 246,000
1,476,000 1,476,000
3,240,000 3,240,000
591,000 591,000
69,000 69,000
105,000 105,000
 72,000 72,000
40,000 40,000
1,920,000 1,920,000
54,000 54,000
14,000
123,000
100,000
96,000 96,000
93,000 93,000
123,000 123,000
183,000 183,000
37,000 37,000
168,000 168,000
130,000 130,000
560,000 560,000
1,625,004 1,625,004
840,000 840,000
700,000 700,000
372,000 372,000
478,002 478,002
320,000 320,000
165,000 165,000
432,000 432,000
21,000 21,000
92,500 92,500
87,000 87,000
55,500 55,000
105,000 105,000
61,500 61,500
856,520 856,520
19,000 19,000
71,000 71,000
82,000 82,000
1,008,000 1,008,000
279,000 279,000
147,800 147,800
156,000 156,000
390,000 390,000
3,124,800 3,124,800
279,000 279,000
60,000 60,000
2,770,000 2,770,000
3,770,060 3,770,060
88,000 88,000
8,000 8,000
24,000 24,000
21,000 21,000
30,000 30,000
157,000
44,000 44,000
 197,000 197,000
231,000 231,000
660,000 660,000
563,085 563,085
1,440,000 1,440,000
33,000 33,000
207,000 207,000
120,000 120,000
80,000 80,000
128,400 128,400
88,000 88,000
5,012,525 6,714,009 Rp 29,349,766
41,495,300
TAGIHAN KOTOR

OBAT
GEL/SALE OBAT
P LAINNYA

25,000
 14,000
123,000
100,000

157,000
419,000