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8/19/2019 Berita Acara Pemusnahan Obat
1/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
TAHUN 2014
NO Nama Obat Kemasan Harga Satuan Jumlah
1 Diazepam 2 mg Tablet Kaleng/1000 tablet 355 Jan-12
2 Diazepam 2 mg Tablet Kaleng/1000 tablet !3 "ar-11
3 Diazepam 2 mg Tablet Kaleng/1000 tablet 202 N#$-11
% Diazepam 2 mg Tablet Kaleng/1000 tablet 1! N#$-11
5 Diazepam in&e'si (mpul K#ta'/30 ampul 1) Sep-11
* Diazepam in&e'si (mpul K#ta'/30 ampul 2* Sep-13
) (mitriptilin 25 mg Tablet K#ta'/100 tablet %3 Jun-12
Kl#rpr#mazin Tablet Kaleng/1000 tablet 21*5 (ug-11
! Hal#peri+#l 0,5 mg Tablet K#ta'/100 tablet 120 Jun-1310 en#barbital in&e'si (mpul K#ta'/30 ampul *0 Sep-12
11 en#barbital Tablet Tablet Kaleng/1000 tablet 1%2!) eb-12
12 en#barbital Tablet Tablet Kaleng/1000 tablet 2!5 eb-12
13 en#barbital Tablet Tablet Kaleng/1000 tablet 3)11 Jun-12
Kepala .us'esmas "#+#
T(H (,"+,Kep
1!*)0)15 1!03 1 011
en u angga 4p re
8/19/2019 Berita Acara Pemusnahan Obat
2/50
8/19/2019 Berita Acara Pemusnahan Obat
3/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
1 .eha7aian (mpul *1 Jul-112 etametas#n 'rim Tube K#ta'/2% tube 12 De7-10
3 Kl#ram8eni7#l tetes telinga #t#l K#ta'/2% b#t#l 2 Jan-10
% 9in7 Tablet K#ta'/100 tablet 2* De7-10
5 Obat Tambah Darah Tablet * Jun-11
* Obat lu Tablet * "ar-11
) (ntalgin n&e'si (mpul K#ta'/30 ampul 1) O7t-11
.it#gin (mpul K#ta'/10 ampul !1 (ug-11
! ":#mergin (mpul K#ta'/10 ampul %2 (ug-11
10 pine8rin in&e'si (mpul K#ta'/30 ampul O7t-11
11 Tiamin in&e'si (mpul K#ta'/30 ampul * (pr-11
12 De'sametas#n in&e'si (mpul K#ta'/100 ampul ! Sep-11
13 pine8rin in&e'si (mpul K#ta'/30 ampul 5! eb-11
1% ;i7illin in&e'si ;ial K#ta'/10 $ial 30 Jul-12
15 ;i7illin in&e'si ;ial K#ta'/10 $ial 15 (ug-12
1* De'sametas#n in&e'si (mpul K#ta'/100 ampul 50 Jun-11
1)
8/19/2019 Berita Acara Pemusnahan Obat
4/50
2) (7et#sal Tablet K#ta'/100 tablet 20) O7t-11
2 "etilerg#metrin Tablet K#ta'/100 tablet *5! N#$-11
2! K#trim#'saz#le .e+iatri' Tablet K#ta'/100 tablet 335 N#$-11
30 K#trim#'saz#le .e+iatri' Tablet K#ta'/100 tablet 135 Jul-12
31 (m#'sisilin 250 mg Kapsul K#ta'/120 'apsul 120 De7-10
8/19/2019 Berita Acara Pemusnahan Obat
5/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
32 (spilet Tablet 0 De7-1133 Kl#ram8eni'#l 250 mg Kapsul Kaleng/250 'apsul 3* Sep-11
3% Kl#ram8eni'#l 250 mg Kapsul Kaleng/250 'apsul 152 N#$-11
35 Kalsium =a'tat Tablet Kaleng/1000 tablet 01
3* =i+#7ain in&e'si (mpul K#ta'/30 ampul 1* Jun-11
3) it#mena+i#n in&e'si (mpul K#ta'/30 ampul %3 (pr-11
3 it#mena+i#n in&e'si (mpul K#ta'/30 ampul 203 (ug-11
3! De'sametas#n in&e'si (mpul K#ta'/100 ampul 1 Sep-11
%0 (min#>lin in&e'si (mpul K#ta'/30 ampul 5 Jul-10
%1 .it#gin (mpul K#ta'/ 10 ampul 1* Jul-11
%2 .it#gin (mpul K#ta'/10 ampul 2% (ug-10
%3 ":#mergin (mpul K#ta'/10 ampul 1 Sep-10
%% Diphenhi+ramin in&e'si (mpul K#ta'/30 ampul 1 (ug-10
%5 (?ua .r# n&e'si steril ;ial K#ta'/10 $ial %0 Sep-11
%* Thiame4 Kapsul K#ta'/100 'apsul 0 (ug-11
%) (ll#purin#l Tablet K#ta'/100 tablet 2%0 Sep-11
% "et#'l#prami+ Tablet K#ta'/100 tablet %%* N#$-11
%! N#$ar#n Tablet Kaleng/1000 tablet 3)0 Jul-1150 Hibi7et H#spital 7#n7entrat #t#l 1 "a:-0!
51 Kl#r#?uin Tablet Kaleng/1000 tablet 11%% O7t-11
52 Hi+r#7l#rtiazi+ Tablet Kaleng/1000 tablet %10 Jan-11
53 .iri+#'sin Tablet Kaleng/1000 tablet 1)1 Sep-11
5% s#s#rbi+ Dinitrat Tablet K#ta'/100 tablet *)0 eb-11
55
8/19/2019 Berita Acara Pemusnahan Obat
6/50
5 De'str#met#r8an Tablet Kaleng/1000 tablet 2000 Jun-11
5! St#ma7h Tube Tube 1 (pr-0!
*0 Kalsium =a'tat Tablet Kaleng/1000 tablet 1%53 N#$-11
*1
8/19/2019 Berita Acara Pemusnahan Obat
7/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
*3
8/19/2019 Berita Acara Pemusnahan Obat
8/50
!
8/19/2019 Berita Acara Pemusnahan Obat
9/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
!% Obat (sma Tablet %2 Jun-10!5 Obat Ba7ing "eben+az#le Tablet 1 Sep-12
!* 9in' Dispersibel Tablet K#ta'/100 tablet 15 (ug-11
!) Otsu "gSO% %0A ;ial * 13-01-201
! Otsu "gSO% %0A ;ial 1 )/!/2012
!! Otsu-D %0 ;ial 1 )/1/2012
100 Thiam8eni7#l Kapsul K#ta'/100 'apsul 1%0 "a:-10
101 O4:tetrasi'lin in&e'si ;ial K#ta'/10 $ial 10 (ug-0!
102 O4:tetrasi'lin Salep mata 1 A Tube K#ta'/25%tube 2% "a:-10
103 .apa$erin HBl in&e'si (mpul K#ta'/30 ampul %0 O7t-0!
10% Kl#ram8eni7#l Salep mata 1 A Tube K#ta'/2% tube ) "a:-10
105 Tiamin in&e'si (mpul K#ta'/30 ampul 1 Jul-10
10* N#$ar#n ;ial 2 "a:-10
10) Terram:7in in&e'si ;ial % (pr-10
10 Hi+r#7hl#rtiazi+a Tablet Kaleng/1000 tablet !35 Sep-11
10! (sam (s7#rbat 50 mg Tablet Kaleng/1000 tablet 1535 "ar-10
110 (sam (s7#rbat 50 mg Tablet Kaleng/1000 tablet 3*5 "a:-10
111 Tiamin tablet Tablet Kaleng/1000 tablet 2000 Sep-11112 N#$a+#4in Tablet Kaleng/1000 tablet 2*%% Jun-11
113 Salbutam#l 2 mg Tablet K#ta'/100 tablet !0 Jun-10
11% Sian#'#balamin in&e'si (mpul K#ta'/100 ampul ) Sep-11
115 Dig#4in Tablet K#ta'/100 tablet 1)00 Jun-12
11* Dig#4in Tablet K#ta'/100 tablet ! Jun-12
11) Hi+r#7hl#rtiazi+ Tablet Kaleng/1000 tablet !%3 "a:-12
11 Osetalmi$ir 'apsul )5 mg Kapsul K#ta'/100 'apsul 0 Jun-12
11! (7:7l#$ir 200 mg Tablet K#ta'/100 tablet 10 "ar-11
entu'Se+iaan
Tanggal 4pireD6/Ka+alua
8/19/2019 Berita Acara Pemusnahan Obat
10/50
120 .r#pilti#urasil Tablet Kaleng/100 tablet 100 Sep-12
121 .r#pilti#urasil Tablet Kaleng/100 tablet 100 Sep-12
122 .r#pilti#urasil Tablet Kaleng/100 tablet 200 Jun-12
123 .r#pilti#urasil Tablet Kaleng/100 tablet 12 De7-11
12% Sul8a+#4ine .:rimethamine Tablet K#ta'/100 tablet 100 Sep-11
8/19/2019 Berita Acara Pemusnahan Obat
11/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
125 Sul8a+#4ine .:rimethamine Tablet K#ta'/100 tablet !51 N#$-1112* Sul8a+#4ine .:rimethamine Tablet K#ta'/100 tablet 15! Jun-12
12) 8e+rin Tablet Kaleng/1000 tablet 35* Jan-12
12 .r#pan#l#l Tablet K#ta'/100 tablet 100 Jun-12
12! .r#pan#l#l Tablet K#ta'/100 tablet 50 Jul-11
130 De4tr#se %0 A 25 ml ;ial 2% )/1/2012
131 Otsu- "gSO% 20 A 25 ml ;ial * 2%-12-201
132 D#4:7:7line Kapsul K#ta'/100 'apsul 1%1 1/1/2012
133 D#4:7:7line Kapsul K#ta'/100 'apsul 200 De7-11
13% S7#pma Tablet K#ta'/100 tablet 50 "a:-12
135 K#trim#'saz#le .e+iatri' Tablet K#ta'/100 tablet 20 "ar-12
13* Dermazin Bream Tube 1 Jul-10
13) etin#l 200000 @/'apsul Kapsul #t#l/ 50 'apsul 50 eb-12
13 (ll#purin#l Tube K#ta'/100 tablet )0 Jul-11
13! .it#gin (mpul K#ta'/10 ampul 10 O7t-0!
1%0 it#mena+i#n Tablet #t#l/100 tablet 20 (ug-11
1%1 =i+#7ain in&e'si (mpul K#ta'/30 ampul 23 Jun-11
1%2 Salbutam#l 2 mg Tablet K#ta'/100 tablet 15 N#$-111%3
8/19/2019 Berita Acara Pemusnahan Obat
12/50
151 ur#semi+e Tablet K#ta'/100 tablet 20 "a:-13
152 Dig#4in Tablet K#ta'/100 tablet 100 Sep-12
153 uinin Tablet K#ta'/*0 tablet 3* (pr-03
15% 9in' Tablet K#ta'/100 tablet 500 N#$-12
155 "etr#ni+az#le 500 mg Tablet K#ta'/100 tablet 2)* N#$-12
8/19/2019 Berita Acara Pemusnahan Obat
13/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
15* (ll#purin#l Tablet K#ta'/100 tablet %0 (pr-1315) Dermazin Bream Tube 1 Jul-10
15 etin#l 200000 @/'apsul Kapsul #t#l/ 50 'apsul 50 eb-12
15! (ll#purin#l Tube K#ta'/100 tablet )0 Jul-11
1*0 .it#gin (mpul K#ta'/10 ampul 10 O7t-0!
1*1 it#mena+i#n Tablet #t#l/100 tablet 20 (ug-11
1*2 =i+#7ain in&e'si (mpul K#ta'/30 ampul 23 Jun-11
1*3 Salbutam#l 2 mg Tablet K#ta'/100 tablet 15 N#$-11
1*%
8/19/2019 Berita Acara Pemusnahan Obat
14/50
12 (sam (s7#rbat 50 mg Tablet Kaleng/1000 tablet 30 (ug-12
13 N#ristal sirup #t#l #4/50 b#t#l 1 De7-12
1% Diphenhi+ramin in&e'si (mpul K#ta'/30 ampul 30 (ug-10
15 Diphenhi+ramin in&e'si (mpul K#ta'/30 ampul 3 eb-13
1* "etr#ni+az#le 250 mg Tablet K#ta'/100 tablet 0 Jun-0!
8/19/2019 Berita Acara Pemusnahan Obat
15/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
1) Bipr#C#4a7in Tablet K#ta'/100 tablet 20) (ug-111 Bapt#pril 25 mg Tablet K#ta'/100 tablet 1%0 (ug-10
1! .it#gin in&e'si (mpul K#ta'/10 ampul 1) Sep-13
1!0 Bami+e4#n (mpul ! Jun-0*
1!1 =i+#7ain in&e'si (mpul K#ta'/30 ampul 21 Jun-11
1!2 it#mena+i#n in&e'si (mpul K#ta'/30 ampul 2! (pr-10
1!3 it#mena+i#n in&e'si (mpul K#ta'/30 ampul ! O7t-10
1!% pine8rin in&e'si (mpul K#ta'/30 ampul 5 eb-11
1!5 De'sametas#n in&e'si (mpul K#ta'/100 ampul 10 De7-10
1!* Diphenhi+ramin in&e'si (mpul K#ta'/30 ampul 2 eb-12
1!) Kl#ram8eni7#l 250 mg Kapsul Kaleng/250 'apsul !00 N#$-10
1! Kalsium =a'tat Tablet Kaleng/1000 tablet 52! Jun-0!
1!! .arasetam#l 500 mg Tablet Kaleng/1000 tablet 23 O7t-10
200 (ntasi+ Tablet Kaleng/1000 tablet 1000 (pr-11
201 ;it, '#mple's Tablet Kaleng/1000 tablet 1000 Jul-11
202 .re+nis#n Tablet Kaleng/1000 tablet 1!00 Sep-0)
203 .re+nis#n Tablet Kaleng/1000 tablet )50 De7-0!
20% 8e+rin Tablet Kaleng/1000 tablet %00 De7-0!205 .iri+#'sin Tablet Kaleng/1000 tablet !00 Sep-10
20* 4tra' ella+#na Tablet Kaleng/1000 tablet 00 De7-10
20) Sian#'#balamin Tablet Kaleng/1000 tablet 1000 Jul-11
20 (min#>lin 200 mg Tablet #t#l/100 tablet 1000 Jun-10
20! it#mena+i#n Tablet #t#l/100 tablet % (ug-12
210 ta'ri+in #t#l #t#l/300 ml 1 Sep-10
211 (nti8ungi Salep .#t K#ta'/2% p#t 5 Jan-11
212 E#+i#l Kapsul #t#l/100 'apsul 100 Jul-0!
entu'Se+iaan
Tanggal 4pireD6/Ka+alua
8/19/2019 Berita Acara Pemusnahan Obat
16/50
213 Kapt#pril12,5 mg Tablet K#ta'/100 tablet *0 Jun-0
21% .:rantel pam#at Tablet K#ta'/2% tablet %0 Jul-10
215 Kl#ram8eni'#l tetes telinga #t#l K#ta'/2% b#t#l % "ar-10
21* .hen#l
8/19/2019 Berita Acara Pemusnahan Obat
17/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
21 .rima?uin Tablet Kaleng/1000 tablet 50 Jun-0
21! Be8#ta4ime serbu' in&e'si ;ial K#ta'/2 $ial 10 De7-11
220 Otsutran- )0 #t#l 12 11/10/201
221 lin 200 mg Tablet #t#l/100 tablet 300 Sep-0
entu'Se+iaan
Tanggal 4pireD6/Ka+alua
8/19/2019 Berita Acara Pemusnahan Obat
18/50
2%5 Kl#ram8eni'#l Tetes Telinga #t#l K#ta'/2% #t#l 11 De7-0!
2%* O4:tetra7:7line salep 'ulit Tube K#ta'/2% tube 31 "ar-10
2%) it#mena+i#n n&e'si (mpul K#ta'/30 ampul 2* "a:-10
2% Bal7ianta 10 Tablet !0 Jun-11
8/19/2019 Berita Acara Pemusnahan Obat
19/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
2%!
8/19/2019 Berita Acara Pemusnahan Obat
20/50
2)5 (lben+az#le Tablet K#ta'/30 tablet "a:-12
2)* Ni8e+ipin Tablet K#ta'/100 tablet 0 !/)/2012
2)) Hi+r#'l#rtiazi+ Tablet Kaleng/1000 tablet 1%)1 "a:-12
2) (ntalgin Tablet K#ta'/100 tablet 300 "ar-12
2)! Seles B 50 mg Tablet Kaleng/1000 tablet 500 O7t-13
8/19/2019 Berita Acara Pemusnahan Obat
21/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
20 Be8a+r#'sil Kapsul 'a#ta'/100 'apsul 5 De7-13
21 OH Sirup #t#l #t#l/*0 ml 3 O7t-11
22 De4tr#met#r8an sirup #t#l #t#l/*0 ml 23 O7t-11
23 N#$a7hl#r suspensi #t#l #t#l/*0 ml 5 (ug-12
2% it#mena+i#n Tablet #t#l/100 tablet 0 N#$-13
25 rg#tamin BaFein Tablet #t#l/100 tablet 100 "ar-12
2*
8/19/2019 Berita Acara Pemusnahan Obat
22/50
8/19/2019 Berita Acara Pemusnahan Obat
23/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
1 ;, Bhateter N#, 2% .7s K#ta'/50 p7s ) Jul-12
2 ;, Bhateter N#, 2% .7s K#ta'/50 p7s 1 "a:-13
3 ;, Bhateter N#, 22 .7s K#ta'/50 p7s 1 (pr-11
% ;, Bhateter N#, 22 .7s K#ta'/50 p7s 1 Sep-13
5 ;, Bhateter N#, 21 .7s K#ta'/50 p7s 3 Sep-0!
* n8us set ana' .7s K#ta'/25 p7s 1 2-0-201
) n8us set ana' .7s K#ta'/25 p7s 2 )/*/2013
;, Bhateter N#, 20 .7s K#ta'/50 p7s 1!1 21-12-201
! ugen#l #t#l 2 N#$-13
10 =is#l #t#l 3 Jun-1311 Sil' la7' .7s K#ta'/3* p7s 33 De7-10
12 .lain Batgut N#, 3/0 .7s K#ta'/2% p7s ! De7-10
13 .lain Batgut N#, 3/0 .7s K#ta'/2% p7s 32 Sep-10
1% ;, Bhateter N#, 22 .7s K#ta'/50 p7s 1 Jul-12
15 ;, Bhateter N#, 20 .7s K#ta'/50 p7s 1 De7-11
1* isturi .7s K#ta'/100 p7s 1 De7-11
1) (lat Sunti' Se'ali .a'ai 3 ml .7s K#ta'/100 p7s 3 eb-13
1 (lat Sunti' Se'ali .a'ai 5 ml .7s K#ta'/100 p7s ** 10/!/200!
1! (lat Sunti' Se'ali .a'ai 3 ml .7s K#ta'/100 p7s 3%% O7t-13
20 n8us set ana' .7s K#ta'/25 p7s !% O7t-13
21 n8us set +eGasa .7s K#ta'/25 p7s % O7t-13
22 Oni#ne4 N#, 25 < .7s K#ta'/100 p7s 100 2!-0)-201
23 ;, Bhateter N#,2% .7s K#ta'/50 p7s 100 5/11/2013
2% @rin ag .7s 15 O7t-12
25 =:#>l Batgut Br#me .7s 1 De7-0
2* ing Nee+le N#, 23 < 4 3/% .7s K#ta'/50 p7s !% Jun-11
entu'Se+iaan
Tanggal 4pireD6/Ka+alua
8/19/2019 Berita Acara Pemusnahan Obat
24/50
2) ing Nee+le N#, 25 < 4 3/% .7s K#ta'/50 p7s )) Sep-11
2 ing Nee+le N#, 2) < 4 3/% .7s K#ta'/50 p7s % De7-11
2! (lat Sunti' Se'ali .a'ai 25 ml .7s K#ta'/100 p7s 25 "ar-10
30 ing Nee+le N#, 21 < 4 3/% .7s K#ta'/50 p7s 2) (ug-12
31 (lat Sunti' Se'ali .a'ai 3 ml .7s K#ta'/100 p7s )0 Jul-11
8/19/2019 Berita Acara Pemusnahan Obat
25/50
BERITA ACARA PENGHAPUSAN/PEMUSNAHAN OBAT
PUSKESMAS MODO
NO Nama Obat Kemasan Harga Satuan Jumlah
32 n8us set ana' .7s K#ta'/25 p7s 1 1-10-2010
33 (bb#7ath N#, 1 .7s K#ta'/50 p7s %5 Jan-10
3% Sil' la7' N#, 3/0 .7s K#ta'/3* p7s 1 Sep-11
35 ; Bhateter N#, 1 .7s K#ta'/50 p7s 5 15-11-2002
3* ; Bhateter N#, 2% .7s K#ta'/50 p7s 1 Jan-10
3) ;, Bhateter N#, 20 .7s K#ta'/50 p7s 1 eb-12
3 til Bhl#ri+a #t#l 3 De7-11
3! (lat Sunti' Se'ali .a'ai 5 ml .7s K#ta'/100 p7s 13 (ug-11
%0 (lat Sunti' Se'ali .a'ai 5 ml .7s K#ta'/100 p7s 11) Sep-11
%1 (lat Sunti' Se'ali .a'ai 25 ml .7s K#ta'/100 p7s 5 %/1/2012
"N
8/19/2019 Berita Acara Pemusnahan Obat
26/50
N#, at7h Nama .erusahan Ket
=H 3**% J .T,Kimia arma
N< 3133 J .T,Kimia arma
H 3031 J .T,Kimia arma
H 3030 J .T,Kimia arma
0*0)01% .T, n+#8arma
0000* .T, n+#8arma
00*00* .T, n+#8arma
H *11** .T, Kimia arma
0!0%003 .T, n+#8arma
153)!00%-2 .T, .hapr#s Tb',
)025* .T, Kimia arma
)0331 .T, Kimia arma
0)0*00! .T, n+#8arma
III,,IIIIIIIIIIIIIIIII201%
.engel#lah Obat .us'esmas "#+#
K(S"((T S,arm
Nip, 1!*0%21 201101 2 01!
8/19/2019 Berita Acara Pemusnahan Obat
27/50
8/19/2019 Berita Acara Pemusnahan Obat
28/50
N#, at7h Nama .erusahan Ket
150520%-1 .T, .hapr#s
15%55123 .T, .hapr#s
D,0%%30) .T, rla
010003 .T, n+#8arma
0)0500 .T, n+#8arma
0)1202! .T, n+#8arma
15313011-1 .T, .hapr#s
0*31 .T, thi7a
0*22 .T, thi7a
153%%003-2 .T, .hapr#s15%02005-2 .T, .hapr#s
1533)025-1 .T, .hapr#s
021%) .T, thi7a
0!*51 .T, "ei&i n+#
0!*53 .T, "ei&i n+#
0)0503) .T, n+#8arma
J*1)!% .T, Kimia arma
)-1232 .T, N#$apharin
*1%0 .T, Kimia arma
)!-123! .T, N#$apharin
053500% .T, .hapr#s
J *1%0 .T, Kimia arma
)%-0)3) .T, N#$apharin
K *2013 .T, Kimia arma
< 1!3) J .T, Kimia arma
K< 215) J .T, Kimia arma
8/19/2019 Berita Acara Pemusnahan Obat
29/50
1530100*-1 .T, .hapr#s
< 1)51 J .T, Kimia arma
!%33*020 .T, .hapr#s
533*00% .T, .hapr#s
*110%* .T, n+#8arma
8/19/2019 Berita Acara Pemusnahan Obat
30/50
N#, at7h Nama .erusahan Ket
!!%5501 .T, "e+i8arma
)!-0%%2 .T, N#$apharin
*0*02 .T, N#$apharin
.T, N#$apharin
00505) .T, n+#8arma
153200*-3 .T, .hapr#s
1532015-1 .T, .hapr#s
1533)022-2 .T, .hapr#s
)10%231 .T, =u7as
0)5)0 .T, thi7a)05*2 .T, thi7a
)05)% .T, thi7a
!%3%202!-2 .T, .hapr#s
)!01*5 .T, N#$apharin
)0!% .T, N#$apharin
*13* .T, Kimia arma
K *1!)* .T, Kimia arma
))020 .T, N#$apharin
. *2*!
J *1)*% .T, Kimia arma
( *001% .T, Kimia arma
10!0) .T, (> arma
( 230) HJ .T, Earin+# armatama
0*0*033 .T, n+#8arma
J *132 .T, Kimia arma
12)210 .T, Kimia arma
8/19/2019 Berita Acara Pemusnahan Obat
31/50
0*0*03 .T, n+#8arma
0%050%
K *1!*1 .T, Kimia arma
1)051% .T, i+atra
B )0533 .T, Kimia arma
8/19/2019 Berita Acara Pemusnahan Obat
32/50
N#, at7h Nama .erusahan Ket
J *1 )2% .T, Kimia arma
K *15 .T, Kimia arma
053200)-2 .T, .hapr#s
)102032 .T, =u7as D&a&a
=( 0!100 .T,
8/19/2019 Berita Acara Pemusnahan Obat
33/50
BB )10%% .T, n+#8arma
0*11131 .T, n+#8arma
0*0300) .T, n+#8arma
D 0!10 .T, n+#8arma
0)0*021 .T, n+#8arma
8/19/2019 Berita Acara Pemusnahan Obat
34/50
N#, at7h Nama .erusahan Ket
0)05010 .T, n+#8arma
0)0*002 .T, n+#8arma
K 2*)) J"D .T, Kimia arma
2 ( 3) .T, Otsu'a
)*13* .T, Otsu'a
)* ( 30 .T, Otsu'a
B 001 zer
J *1%*2 .T, Ja:a "as
12502011 .T, "arin =iza
)125 .T, Kimia arma
)!-*003 .T, N#$apharin
)*-0*31 .T, N#$apharin
050%00! .T, n+#8arma
0*0031 .T, n+#8arma
0050!) .T, n+#8arma
0050!% .T, n+#8arma
)0!!0 .T, Kimia arma
00*002 .T, n+#8arma
05303002 .T, .hapr#s
8/19/2019 Berita Acara Pemusnahan Obat
35/50
0*0035 .T, n+#8arma
0*0*023 .T, n+#8arma
0*0*022 .T, n+#8arma
0*1203! .T, n+#8arma
0)0)00) .T, n+#8arma
8/19/2019 Berita Acara Pemusnahan Obat
36/50
N#, at7h Nama .erusahan Ket
K *1!1% .T, Kimia arma
)1211 .T, Kimia arma
! = 0!1! .T, Kimia arma
0*050 .T, n+#8arma
D 11*0) J .T, Kimia arma
)* ( 30 .T, Otsu'a
!3 = 3* .T, Otsu'a
=< 25% J .T, Kimia arma
B 0303 1 .T, Earin+#
!01105 .T, 8ars .harma7euti7al0)01001 .T, n+#8arma
0550*013 .T, .hapr#s
02!1** .T, Kimia arma
0)10* .T, N#$apharin
0))% .T, thi7a
0531005 .T, .hapr#s
005052 .T, n+#8arma
K *1!12 .T, Kimia arma
0!11022 .T, n+#8arma
N %3)1 .T, (+itama a:a
KK 31*3 J .T, Kimia arma
0)1100) .T, n+#8arma
0!20* .T, Kimia arma
)10202 .T, =u7as .harma7euti7al
010123 .T, Ba$e4 H#llan+
0)100 .T, n+#8arma
8/19/2019 Berita Acara Pemusnahan Obat
37/50
0*% .T, Kimia arma
00*102 .T, n+#8arma
D 21003 .T, Kimia arma
3%)! .T, Kimia arma
TD" 1*53! .T, ern#8arm
8/19/2019 Berita Acara Pemusnahan Obat
38/50
N#, at7h Nama .erusahan Ket
D 0531 .T, Kimia arma
0550*013 .T, .hapr#s
02!1** .T, Kimia arma
0)10* .T, N#$apharin
0))% .T, thi7a
0531005 .T, .hapr#s
005052 .T, n+#8arma
K *1!12 .T, Kimia arma
0!11022 .T, n+#8arma
N %3)1 .T, (+itama a:aKK 31*3 J .T, Kimia arma
0)1100) .T, n+#8arma
0!20* .T, Kimia arma
)10202 .T, =u7as .harma7euti7al
010123 .T, Ba$e4 H#llan+
0)100 .T, n+#8arma
0*% .T, Kimia arma
00*102 .T, n+#8arma
D 21003 .T, Kimia arma
3%)! .T, Kimia arma
TD" 1*53! .T, ern#8arm
D 0531 .T, Kimia arma
< 1!3) J .T, Kimia arma
* K 1003 .T, Duta Kaisar
0)05011 .T, n+#8arma
153*012 .T, .hapr#s
8/19/2019 Berita Acara Pemusnahan Obat
39/50
H !1%* .T, Kimia arma
1)121) .T, "e7#sin n+#
!%3%203% .T, .hapr#s
253%200%-1 .T, .hapr#s
%3*3002 .T, .hapr#s
8/19/2019 Berita Acara Pemusnahan Obat
40/50
N#, at7h Nama .erusahan Ket
)1!10 .T, N#$apharin
30015 .T, De4a "e+i7a
100033 .T, thi7a
210*0)1 .T, =u7as
0050*2 .T, n+#8arma
0532002-3 .T, .hapr#s
2532011-3 .T, .hapr#s
021%) .T, thi7a
0*110*1 .T, n+#8arma
)102032 .T, =u7as"< 0!%) T .T, Kimia arma
%0!%2 .T, Kimia arma
3)30100** .T, "arin =iza armasi
10)11* .T, rrita .harma
))-0305 .T, N#$apharin
)!-123! .T, N#$apharin
= *320* .T, Kimia arma
%0!0*3 .T, n+#8arma
0*0*030 .T, n+#8arma
12)0* T .T, Kimia arma
))-032% .T, N#$apharin
) ( 0%2 .T, B#r#net Br#G
153100) .T, .hapr#s
200!0) .T, (> arma
200!01010 .T, "arin
**00 .T, Kimia arma
212!) .T Ki i
8/19/2019 Berita Acara Pemusnahan Obat
41/50
212!) .T, Kimia arma
( 2%11 KJ .T, Earin+#
12*13 .T, Kimia arma
= 111)% .T, =u7as D&a&a
5123 .T, n8ar (ris .harma
8/19/2019 Berita Acara Pemusnahan Obat
42/50
N#, at7h Nama .erusahan Ket
)%30*00! .T, .hapr#s
.SN 2%)3) .T, ern#8arm
3* J )* B .T, Otsu'a n+#
0!12032 .T, n+# arma
%*2)1010) .T, "arin =iza
253*01% .T, .hapr#s
01100) .T, n+# arma
K 101103 .T, Kimia arma
J 1010%0 .T, Kimia arma
00)002 .T, n+# arma00*31 .T, Kimia arma
32)3 .T, (+i Tama a:a
10 ( 0*2 .T, thi7a
15%010 .T, He4pharm Ja:a
3532011-3 .T, .hapr#s
353201!-1 .T, .hapr#s
10 B 01! .T, =u7as D&a&a
253%2002-2 .T, .hapr#s
253%200%-1 .T, .hapr#s
1553!5 .T, He4pharm Ja:a
15%50 .T, He4pharm Ja:a
1)0)03 .T, i+atra ha'ti
!%3302! .T, .hapr#s
B 0525 .T, Kimia arma
15153! .T, Kimia arma
10 .T, Der
8/19/2019 Berita Acara Pemusnahan Obat
43/50
D 0%%22 .T, rla
11*25 .T, Kimia arma
)1031%1 .T, =u7as D&a&a
)0)00*2 .T (rm#4in+# arma
8/19/2019 Berita Acara Pemusnahan Obat
44/50
N#, at7h Nama .erusahan Ket
053)3115 .T, .hapr#s
05*0101 .T, .hapr#s!%*01001% .T, .hapr#s
01000 .T, He4pharm Ja:a
3533)02)-1 .T, .hapr#s
B030* T 0*% .T, n+# arma
B 030% T 0*! .T, n+# arma
.N 23%35 .T, ern#8arm
)2!-53020 .T, .>zer
0)0503) .T, n+# arma
)10%231 .T, =u7as D&a&a
3*03* .T, ern#8arm
*12!3) .T, thi7a
123120*10 .T, "arin
1)132 G .T, Kimia arma
%*2511101 .T, "arin
10 J 033 .T, thi7a
1010*% .T, thi7a
K 101103 .T, Kimia arma3533)02)-1 .T, .hapr#s
J 20)%0% .T, (7ta$is
" 15** J .T, Kimia arma
031*02 .T, Kimia arma
0*% .T, Kimia arma
(1 03*3 J .T, Kimia arma
!33%* .T, Se&ahtera =estari
0530*01%-3 .T, .hapr#s
8/19/2019 Berita Acara Pemusnahan Obat
45/50
0530*01% 3 .T, .hapr#s
< !132 .T, Kimia arma
)0!!0 .T, Kimia arma
3- 3)0* .T, N#$apharin
!%%%% .T, Se&ahtera =estari
8/19/2019 Berita Acara Pemusnahan Obat
46/50
N#, at7h Nama .erusahan Ket
= 23) J .T, Kimia arma
J 10-0!0 .T, (> arma.T, N#$apharin
-151 .T, N#$apharin
%*2)1010) .T, "arin =iza
B !035! .T, Kimia arma
1)051% .T, i+atra ha'ti
153%20 .T, .hapr#s
1!0110 .T, .hapr#s
51** J .T, Kimia arma
*0!*! .T, Kimia arma
30015 .T, De4a "e+i7a
(*0051 .T, Kimia arma
1%1 .T, .hit# arma
0)001* .T, n+# arma
%%501 .T, rla
0!0*2% .T, n+# arma
3-0%%1 .T, N#$apharin
8/19/2019 Berita Acara Pemusnahan Obat
47/50
8/19/2019 Berita Acara Pemusnahan Obat
48/50
N#, at7h Nama .erusahan Ket
)21) .T, Ja:amas "e+i7
005%10 .T, "e+e4 "e+i'a0*0501 .T, D (+s:te .r#
101252%3 .T, raun
.T, raun
0)02 .T, .rima (l'esin+#
2000*0 .T, n+#8arma
20101222 .T, raun
11!01010 .T, Kimia arma
!*0221% .T, N#$apharin
1501200* .T, One "e+
20012005 .T, One "e+
15102005 .T, One "e+
*2!0 .T, Ja:amas "e+i7
*2!0 .T, Ja:amas "e+i7
( 052*5% .T, raun
0300% .T, One Je7t
.T, .rima (l'esin+#
101012 .T, O7ean "e+i7a
101012 .T, O7ean "e+i7a
101012 .T, O7ean "e+i7a
2000)30 .T, .rima (l'esin+#
2010110*
21/)2),01 .T, Truge "e+i7al
003*31 .T, ;#mel
200*0) .T, Ja:amas "e+i7
200*10 .T, Ja:amas "e+i7
8/19/2019 Berita Acara Pemusnahan Obat
49/50
200)01 .T, Ja:amas "e+i7
050322 .T, raun
310!200) .T, Ja:amas "e+i7
200*0 .T, Ja:amas "e+i7
8/19/2019 Berita Acara Pemusnahan Obat
50/50
N#, at7h Nama .erusahan Ket
2005101 .T, Ja:amas "e+i7
1!015 .T, Otsu'a n+#0*0!03 .T, .rima (l'esin+#
!11001 .T, n+#8arma
20015 .T, Otsu'a n+#
) 1001521 .T, =ab#rat#ri#us
! = 0!1! .T, Duta Kaisar arm
*2322)! .T,
200*10 .T, Ja:amas "e+i7
200)0105 .T, .r#> S:ringe
"#+#III,,IIIIIIIIIIIIIIIII201%
.engel#lah Obat .us'esmas "#+#
K(S"((T S,arm
Nip, 1!*0%21 201101 2 01!