No. Nama Perusahaan No.

Faktur Tanggal Faktur Nama Obat Jumlah Satuan

1 PT. TEMPO 1422064294 27.12.2016 Berotec 0,1 Mg MDI HFA AS 100
Spiriva 18 MCG REF.30 AS-ARN 20
Spiriva 18 MCG + HH 10'S-ASR 20
Combivent 2.5 ML UDV-AS 10

2 PT. TEMPO 1422042857 31.03.2016 MICARDIS 80MG TAB. 20'S-AS 335

3 PT. TEMPO 1422064295 27.12.2016 PRADAXA 75 MF CAP 30'S-ASK 5

PRADAXA 75 MF CAP 30'S-ASK 5

4 PT. TEMPO 1422064296 27.12.2016 Combivent 2,5ML UDV-AS 10

DLCLAX 5MG SUP INF. 6'S -AS 5

5 PT. TEMPO 1422064301 27.12.2016 Berotec 0,1 MG MDI HFA AS 100

400
50
20
Jumlah Satuan Harga Satuan Total TOTAL HARGA
Box Rp 80,000.00 Rp 8,000,000.00
Box Rp 442,500.00 Rp 8,850,000.00
Box Rp 162,000.00 Rp 3,240,000.00
Box Rp 99,900.00 Rp 999,000.00
Rp 21,089,000.00
Box Rp 130,000.00 Rp 43,550,000.00
Rp 43,550,000.00
Box Rp 427,500.00 Rp 2,137,500.00
Box Rp 427,500.00 Rp 2,137,500.00
Rp 4,275,000.00
Box Rp 99,900.00 Rp 999,000.00
Box Rp 34,020.00 Rp 170,100.00
Rp 1,169,100.00
Box Rp 80,000.00 Rp 8,000,000.00
Box Rp 130,000.00 Rp 52,000,000.00
Box Rp 442,500.00 Rp 22,125,000.00
Box Rp 162,000.00 Rp 3,240,000.00
Rp 85,365,000.00
No. Nama Perusahaan No. Faktur Tanggal Faktur Nama Obat Jumlah Satuan
1 PT. ANTAR MITRA SEMBADA A18W020 30.06.2016 Climdamycin 300mg 100
Climdamycin 150mg 50
Ursodeoxycholic ACID 250mg 10

2 PT. ANTAR MITRA SEMBADA A19E672 11.08.2016 Lansoprazole 30MG 200

Climdamycin 300mg 150
Jumlah Satuan Harga Satuan Total TOTAL HARGA Diskon Setelah Potongan
Box Rp 62,520.00 Rp 6,252,000.00
Box Rp 36,200.00 Rp 1,810,000.00
Box Rp 126,000.00 Rp 1,260,000.00
Rp 9,322,000.00 Rp 390,550.00 Rp 8,931,450.00
Box Rp 24,570.00 Rp 4,914,000.00
Box Rp 62,520.00 Rp 9,378,000.00
Rp 14,292,000.00 Rp 2,937,150.00 Rp 11,354,850.00
 PPN Jumlah yang dibayarkan

Rp 893,145.00 Rp 9,824,595.00

Rp 1,135,485.00 Rp 12,490,335.00
 No NAMA PERUSAHAAN NO FAKTUR TANGGAL FAKTUR
1 PT. Rajawali Nusindo RN 3164824 10/03/2016
2 PT. Rajawali Nusindo RN 3164449 21-9-2016
3 PT. Rajawali Nusindo RN 3164008 09/08/2016
4 PT. Rajawali Nusindo RN 3164034 09/09/2016
5 PT. Rajawali Nusindo RN 3167627 26-08-2016
6 PT. Rajawali Nusindo RN 3167627 26-08-2016

7 PT. Rajawali Nusindo RN 3167466 23-08-2016

8 PT. Rajawali Nusindo RN 2727826 09/08/2016
9 PT. Rajawali Nusindo RN3164211 14.09.2016

10 PT. Rajawali Nusindo RN316632 19.10.2016

11 PT. Rajawali Nusindo RN3164142 13.09.2016

12 PT. Rajawali Nusindo RN3166950 08.11.2016

13 PT. Rajawali Nusindo RN3167628 26/08/2016

14 PT. Rajawali Nusindo RN3164904 05/10/2016

15 PT. Rajawali Nusindo RN3163314 07/12/2016

 NAMA OBAT JUMLAH SATUAN HARGA SATUAN
E-SOME 1,500.00 VIA 37,044.00
SPICA SPINAL 0,5% HEVY 200.00 DOS 60,114.00
SPICA SPINAL 0,5% HEVY 200.00 DOS 60,113.60
SPICA SPINAL 0,5% HEVY 10.00 DOS 60,114.00
IBUPROFEN SUSPENSI 100 MG/ 5 M 100.00 BTL 2,318.18
ANTASIDA DOEN SUSPENSI 60 ML 1,800.00 BTL 1,877.27

PROKAIN BENZIL PEN.3JTIU/30VL 6.00 DOS 246,708.83

E-SOME 105.00 VIA 37,043.63
Diphenhydramine HCL10MG/30 AMP 1.00 Dos Rp 33,655.00

Prokain Benzil PEN. 3 JTIU/30 VIAL 3 Dos Rp 246,708.67

Prokain Benzil PEN. 3 JTIU/30 VIAL 27 Dos Rp 246,708.67

E-Some 600 Via Rp 37,043.63

Tetracycline 250MGKAPS/10 15 Dos Rp 15,272.67

Afolat 0,4 MG (Asam Folat) 100 50 Dos Rp 6,000.00

Methylpredinisolone 125mg 300 Dos Rp 13,181.81

E-SOME 870 Via Rp 37,043.63

25 VIA Rp 37,043.63
Gemfibrozil 300 MG Kaps/1 50 Dos Rp 36,181.80
Keterolac 30 MG/12 AMP X 1ML 232 Dos 14269.09
Lidocaine 2% INJ/100 Amp x 2 ML 4 Dos Rp 79,090.75
NA. Diklofenak 25MGTE/5STRX10 10.00 Dos Rp 7,136.30
SPICA SPINAL 0,5% HEVY 100.00 Dos Rp 60,113.63
 TOTAL TOTAL HARGA PPN JUMLAH BAYAR Harga Faktur
55,566,000.00 55,566,000.00 5,556,600 61,122,600.00 61,122,600 10%
12,022,800.00 12,022,800.00 1,202,280 13,225,080.00 13,225,080
12,022,720.00 12,022,720.00 1,202,272 13,224,992.00 13,224,992
601,140.00 601,140.00 60,114 661,254.00 661,254
231,818.00 231,818.00
3,379,086.00 3,379,086.00
3,610,904.00 361,090 3,971,994.40 3,971,994
1,480,252.98 1,480,252.98 148,025 1,628,278.28 1,628,278
3,889,581.15 3,889,581.15 388,958 4,278,539.27 4,278,639
Rp 33,655.00
Rp 33,655.00 3,366 37,020.50 37,021
Rp 740,126.01
Rp 6,661,134.09
Rp 7,401,260.10 740,126 8,141,386.11 8,141,386
Rp 22,226,178.00
Rp 22,226,178.00 2,222,618 24,448,795.80 24,448,796
Rp 229,090.05
Rp 229,090.05 22,909 251,999.06 251,999
Rp 300,000.00
Rp 300,000.00 30,000 330,000.00 330,000
Rp 3,954,543.00
Rp 3,954,543.00 395,454 4,349,997.30 4,349,997
Rp 32,227,958.10
Rp 926,090.75
Rp 1,809,090.00
Rp 3,310,428.88
Rp 316,363.00
Rp 71,363.00
Rp 6,011,363.00
Rp 44,672,656.73 4,467,266 49,139,922.40 49,139,920