01-12-

1 APT010000I62004354 160643 ny. SITTI MATMANI 

CAIRAN RL 7,300.00 3 8,030.00
2018 
2 APT010000I62004354 160643 ny. SITTI MATMANI 
DIMENHIDR 121.00 2 133.10
3 APT010000I62004354 160643 ny. SITTI MATMANI 
RANITIDIN 629.99 2 692.99
4 APT010000I62004354 160643 ny. SITTI MATMANI 
MECOBALAM6,600.00 1 7,260.00
5 APT010000I62004354 160643 ny. SITTI MATMANI 
AMLODIPIN 475.19 1 522.71
6 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 3 7,260.00
7 APT010000I32000262 160440 tn. ABDUL WAHID
CAIRAN WALANGADI 
NAC6,409.70 1 7,050.67
8 APT010000I32000262 160440 tn. ABDUL WAHID
CAPTOPRIL
WALANGADI 
199.99 1 219.99
9 APT010000I32000262 160440 tn. ABDUL WAHID
ATORVASTA6,435.00
WALANGADI  2 7,078.50
10 APT010000I32000262 160440 tn. ABDUL WAHID
CONCORWALANGADI 
2. 597.00 1 656.70
11 APT010000I32000262 160440 tn. ABDUL WAHID
ISOSORBID
WALANGADI 
102.85 3 113.14
12 APT010000I32000262 160440 tn. ABDUL WAHID
HANDSCOEN
WALANGADI 
478.00 30 525.80
13 APT010000I32000262 160440 tn. ABDUL WAHID
MASKERWALANGADI 
DI 700.00 5 770.00
14 APT010000I32000262 160440 tn. ABDUL WAHID
KAPAS ALWALANGADI 
300.00 5 330.00
15 APT010000I32000262 160440 tn. ABDUL WAHID
SPOIT 10WALANGADI 
C 2,310.00 1 2,541.00
16 APT010000I32000262 160440 tn. ABDUL WAHID
SPOIT 3 WALANGADI 
CC 1,485.00 1 1,633.50
17 APT010000I32000262 160440 tn. ABDUL WAHID
IV CATHETE
WALANGADI 
7,750.00 2 8,525.00
18 APT010000I32000263 160653 tn. M NIPPIRANITIDIN
T  3,000.00 1 3,300.00
19 APT010000I32000263 160653 tn. M NIPPIKETOROLAC
T  7,350.75 1 8,085.82

20 APT010000I32000263 160653 tn. M NIPPIINFUS

T  SET 17,000.00 10 18,700.00

21 APT010000I32000263 160653 tn. M NIPPICAIRAN

T  RL 7,300.00 1 8,030.00
22 APT010000I32000263 160653 tn. M NIPPIIVT CATHETE 7,750.00 1 8,525.00
23 APT010000I32000263 160653 tn. M NIPPIIVT DRESSI 4,850.00 1 5,335.00
24 APT010000I32000263 160653 tn. M NIPPIALKOHOL
T  S 300.00 1 330.00
25 APT010000I32000263 160653 tn. M NIPPISPOIT
T  3 CC 1,485.00 1 1,633.50
26 APT010000I32000263 160653 tn. M NIPPIHANDSCOEN
T  478.00 4 525.80
27 APT010000I32000263 160653 tn. M NIPPINEUROSANB5,324.00
T  1 5,856.40
28 APT010000I32000263 160653 tn. M NIPPINATRIUM
T  D 195.91 2 215.50
29 APT010000I32000263 160653 tn. M NIPPIRECOLFAR
T  4,950.00 3 5,445.00
30 APT010000I32000263 160653 tn. M NIPPIAMLODIPIN
T  475.19 1 522.71
31 APT010000I62004345 160563 ny. FITRIANI
RANITIDIN
RIDWAN P  629.99 6 692.99
32 APT010000I62004345 160563 ny. FITRIANI
SANPRIMA
RIDWAN P  902.00 12 992.20
33 APT010000I62004275 159982 tn. SULHAM HALOPERID 65.45 1 72.00
34 APT010000I62004325 160471 ny. SYARIFAH
CEFOTAXIM
ALWIAH 15,004.00 2 16,504.40
35 APT010000I62004325 160471 ny. SYARIFAH
KETOROLAC
ALWIAH  7,350.75 2 8,085.82
36 APT010000I62004325 160471 ny. SYARIFAH
RANITIDIN
ALWIAH  3,000.00 2 3,300.00
37 APT010000I62004325 160471 ny. SYARIFAH
ONDANSETR2,002.00
ALWIAH  3 2,202.20
38 APT010000I62004325 160471 ny. SYARIFAH
CAIRAN
ALWIAH 
RL 7,300.00 3 8,030.00
39 APT010000I62004325 160471 ny. SYARIFAH
CONECTA
ALWIAH 10,325.00 1 11,357.50
40 APT010000I62004325 160471 ny. SYARIFAH
HANDSCOEN
ALWIAH  478.00 2 525.80
41 APT010000I62004325 160471 ny. SYARIFAH
HANDSCOON
ALWIAH 13,613.00 2 14,974.30
42 APT010000I62004325 160471 ny. SYARIFAH
MASKER
ALWIAH 
DI 700.00 1 770.00
43 APT010000I62004346 160565 tn. MOH PADANG
CAIRANRAHANAR 
RL 7,300.00 3 8,030.00
44 APT010000I62004346 160565 tn. MOH PADANG
NEUROSANB5,324.00
RAHANAR  1 5,856.40
45 APT010000I62004346 160565 tn. MOH PADANG
RANITIDINRAHANAR 
3,000.00 1 3,300.00
46 APT010000I62004346 160565 tn. MOH PADANG
PARACETA RAHANAR 
220.72 2 242.79
47 APT010000I62004346 160565 tn. MOH PADANG
HANDSCOENRAHANAR 
478.00 4 525.80
48 APT010000I62004346 160565 tn. MOH PADANG
MASKERRAHANAR 
DI 700.00 2 770.00
49 APT010000I62004346 160565 tn. MOH PADANG
IV CATHETE
RAHANAR 
7,750.00 1 8,525.00
50 APT010000I62004346 160565 tn. MOH PADANG
NASAL CAN11,550.00
RAHANAR  1 12,705.00
51 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  3,000.00 2 3,300.00
52 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 2 8,085.82
53 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA  RL 7,300.00 4 8,030.00
54 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
3 CC 1,485.00 1 1,633.50
55 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
5 CC 1,595.00 1 1,754.50
56 APT010000I62004353 160635 tn. DARWISCONECTA
LAEDDA  10,325.00 1 11,357.50
57 APT010000I62004353 160635 tn. DARWISINFUS
LAEDDA 
SET 17,000.00 1 18,700.00
58 APT010000I62004343 160548 ny. SUGIARTICAIRAN
  AM70,188.80 1 77,207.68
59 APT010000I62004343 160548 ny. SUGIARTIMETIL
  PRE 702.00 2 772.20
60 APT010000I62004343 160548 ny. SUGIARTICAIRAN
  RL 7,300.00 3 8,030.00
61 APT010000I62004343 160548 ny. SUGIARTICONECTA
  10,325.00 1 11,357.50
62 APT010000I62004343 160548 ny. SUGIARTIHANDSCOEN
  478.00 2 525.80
63 APT010000I62004343 160548 ny. SUGIARTIHANDSCOON
  12,100.00 2 13,310.00
64 APT010000I62004343 160548 ny. SUGIARTIMASKER
  DI 700.00 2 770.00
65 APT010000I62004335 160511 tn. SUPRIADICEFOTAXIM
PAISAL  15,004.00 2 16,504.40
66 APT010000I62004335 160511 tn. SUPRIADIMETRONIDA8,250.00
PAISAL  3 9,075.00
67 APT010000I62004335 160511 tn. SUPRIADIRANITIDIN
PAISAL  3,000.00 2 3,300.00
68 APT010000I62004335 160511 tn. SUPRIADIKETOROLAC
PAISAL  7,350.75 3 8,085.82
69 APT010000I62004335 160511 tn. SUPRIADICAIRAN
PAISAL RL 7,300.00 3 8,030.00
70 APT010000I62004335 160511 tn. SUPRIADIMASKER
PAISAL DI 700.00 2 770.00
71 APT010000I62004335 160511 tn. SUPRIADIHANDSCOEN
PAISAL  478.00 4 525.80
72 APT010000I62004335 160511 tn. SUPRIADIHANDSCOON
PAISAL  12,100.00 1 13,310.00
73 APT010000I62004335 160511 tn. SUPRIADIIV DRESSI
PAISAL  4,850.00 1 5,335.00
74 APT010000I62004335 160511 tn. SUPRIADISPOIT
PAISAL 
3 CC 1,485.00 2 1,633.50
75 APT010000I62004340 155102 tn. DRS. H. ADONA
ISHAK ABDIR 
INJ22,880.00 3 25,168.00
76 APT010000I62004340 155102 tn. DRS. H. PARACETA
ISHAK ABDIR  220.72 3 242.79
77 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
NAC6,409.70 2 7,050.67
78 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 2 770.00
79 APT010000I62004340 155102 tn. DRS. H. HANDSCOEN
ISHAK ABDIR  478.00 4 525.80
80 APT010000I62004340 155102 tn. DRS. H. INFUS
ISHAK SET
ABDIR 17,000.00 1 18,700.00
81 APT010000I62004340 155102 tn. DRS. H. CONECTA
ISHAK ABDIR 10,325.00 1 11,357.50
82 APT010000I62004340 155102 tn. DRS. H. SPOIT
ISHAK3ABDIR 
CC 1,485.00 1 1,633.50
83 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  946.00 1 1,040.60
84 APT010000I62004338 155611 ny. ANDI ALWIAH
METRONIDA8,250.00
  3 9,075.00
85 APT010000I62004338 155611 ny. ANDI ALWIAH
AMLODIPIN
  838.19 1 922.01
86 APT010000I62004338 155611 ny. ANDI ALWIAH
CAIRAN  RL 7,300.00 4 8,030.00
87 APT010000I62004338 155611 ny. ANDI ALWIAH
HANDSCOEN
  478.00 4 525.80
88 APT010000I62004338 155611 ny. ANDI ALWIAH
MASKER  DI 700.00 2 770.00
 89 APT010000I62004331 160496 tn. H. RIDWAN
NEFROSTER
KADIR 49,599.00
  1 54,558.90
90 APT010000I62004331 160496 tn. H. RIDWAN
FUROSEMID2,920.50
KADIR   4 3,212.55
91 APT010000I62004331 160496 tn. H. RIDWAN
CEFTRIAXO19,999.10
KADIR   2 21,999.01
92 APT010000I62004331 160496 tn. H. RIDWAN
CAIRAN
KADIR
NA15,180.00
  2 16,698.00
93 APT010000I62004331 160496 tn. H. RIDWAN
SPOIT
KADIR
3 CC   1,485.00 2 1,633.50
94 APT010000I62004331 160496 tn. H. RIDWAN
SPOIT
KADIR
10 C   2,310.00 2 2,541.00
95 APT010000I62004331 160496 tn. H. RIDWAN
MASKER
KADIRDI   700.00 2 770.00
96 APT010000I62004331 160496 tn. H. RIDWAN
HANDSCOEN
KADIR   478.00 4 525.80
97 APT010000I62004339 160516 ny. HUSNAWATI 
METIL PRE 44,999.90 1 49,499.89
98 APT010000I62004339 160516 ny. HUSNAWATI 
SANMOL I 24,202.60 2 26,622.86
99 APT010000I62004352 160636 nn. REYSHADOMPERID
NUR SEPTIANI  508.20 6 559.02
100 APT010000I62004352 160636 nn. REYSHADIMENHIDR
NUR SEPTIANI  121.00 6 133.10
101 APT010000I62004352 160636 nn. REYSHARANITIDIN
NUR SEPTIANI  629.99 6 692.99
102 APT010000I62004352 160636 nn. REYSHAZINK
NUROKSI
SEPTIANI  604.00 3 664.40
103 APT010000I62004352 160636 nn. REYSHASANPRIMA
NUR SEPTIANI  902.00 10 992.20
104 APT010000I62004331 160496 tn. H. RIDWAN
ALPRAZOLA
KADIR   585.00 1 643.50
105 APT010000I62004349 160605 nn. SARTIKA 
VALISANBE 236.50 3 260.15
106 APT010000I62004349 160605 nn. SARTIKA 
BETAHISTI 733.33 3 806.67
107 APT010000I62004349 160605 nn. SARTIKA 
PARACETA 220.72 6 242.79
108 APT010000I62004349 160605 nn. SARTIKA 
METIL PRE 702.00 3 772.20
109 APT010000I62004349 160605 nn. SARTIKA 
CANGKANG 75.00 6 82.50
110 APT010000I62004349 160605 nn. SARTIKA 
CAIRAN RL 7,300.00 4 8,030.00
111 APT010000I62004349 160605 nn. SARTIKA 
MASKER DI 700.00 2 770.00
112 APT010000I62004349 160605 nn. SARTIKA 
HANDSCOEN 478.00 2 525.80
113 APT010000I62004349 160605 nn. SARTIKA 
CONECTA 10,325.00 1 11,357.50
114 APT010000I62004349 160605 nn. SARTIKA 
IV CATHETE 7,750.00 1 8,525.00
115 APT010000I62004349 160605 nn. SARTIKA 
CONECTA 10,325.00 1 11,357.50
116 APT010000I62004349 160605 nn. SARTIKA 
NEUROSAN 1,168.50 1 1,285.35
117 APT010000I66000402 160520 ny. YUYUNCONCOR
YUNINGSIH 
2. 597.00 3 656.70
118 APT010000I66000402 160520 ny. YUYUNISOSORBID
YUNINGSIH  102.85 6 113.14
119 APT010000I32000263 160653 tn. M NIPPINEUROSANB5,324.00
T  1 5,856.40
120 APT010000I32000263 160653 tn. M NIPPINATRIUM
T  D 195.91 2 215.50
121 APT010000I32000263 160653 tn. M NIPPIRECOLFAR
T  4,950.00 3 5,445.00
122 APT010000I32000263 160653 tn. M NIPPIAMLODIPIN
T  475.19 1 522.71
123 APT010000I62004354 160643 ny. SITTI MATMANI 
DIMENHIDR 121.00 2 133.10
124 APT010000I62004354 160643 ny. SITTI MATMANI 
RANITIDIN 629.99 2 692.99
125 APT010000I62004354 160643 ny. SITTI MATMANI 
MECOBALAM6,600.00 1 7,260.00
126 APT010000I62004354 160643 ny. SITTI MATMANI 
AMLODIPIN 475.19 1 522.71
127 APT010000I62004354 160643 ny. SITTI MATMANI 
CAIRAN RL 7,300.00 3 8,030.00
128 APT010000I62004354 160643 ny. SITTI MATMANI 
SPOIT 3 CC 1,485.00 3 1,633.50
129 APT010000I62004354 160643 ny. SITTI MATMANI 
ALKOHOL S 300.00 1 330.00
130 APT010000I62004355 160644 nn. A. HASRY
ZINK
AINUN
OKSI HAISYAR 
604.00 1 664.40
131 APT010000I62004355 160644 nn. A. HASRY
DOMPERID
AINUN HAISYAR 
508.20 2 559.02
132 APT010000I62004355 160644 nn. A. HASRY
CAIRAN
AINUNRLHAISYAR 
7,300.00 2 8,030.00
133 APT010000I62004355 160644 nn. A. HASRY
MASKER
AINUNDIHAISYAR 
700.00 2 770.00
134 APT010000I62004355 160644 nn. A. HASRY
HANDSCOEN
AINUN HAISYAR 
478.00 4 525.80
135 APT010000I62004319 160456 ny. MANTASIA
PIRACETAM
DG KEBO 
10,670.00 1 11,737.00
136 APT010000I62004319 160456 ny. MANTASIA
RANITIDIN
DG KEBO  629.99 2 692.99
137 APT010000I62004319 160456 ny. MANTASIA
MECOBALA
DG KEBO  616.00 1 677.60
138 APT010000I62004319 160456 ny. MANTASIA
ASPILETS
DG KEBO  110.00 1 121.00
139 APT010000I62004319 160456 ny. MANTASIA
CEFTRIAXO19,999.10
DG KEBO  2 21,999.01
140 APT010000I62004319 160456 ny. MANTASIA
SIMUCIL
DG KEBO 
2 1,760.00 3 1,936.00
141 APT010000I62004319 160456 ny. MANTASIA
CAIRAN
DG KEBO 
NAC6,409.70 2 7,050.67
142 APT010000I62004319 160456 ny. MANTASIA
MASKER
DG KEBO 
DI 700.00 2 770.00
143 APT010000I62004319 160456 ny. MANTASIA
HANDSCOEN
DG KEBO  478.00 4 525.80
144 APT010000I62004319 160456 ny. MANTASIA
SPOIT
DG10KEBO 
C 2,310.00 2 2,541.00
145 APT010000I62004319 160456 ny. MANTASIA
IV DRESSI
DG KEBO 4,850.00 1 5,335.00
146 APT010000I62004321 160462 ny. RABI  CEFTRIAXO19,999.10 2 21,999.01
147 APT010000I62004321 160462 ny. RABI  SANPRIMA 902.00 4 992.20
148 APT010000I62004321 160462 ny. RABI  SANMOL T 297.00 3 326.70
149 APT010000I62004321 160462 ny. RABI  CAIRAN RL 7,300.00 3 8,030.00
150 APT010000I62004321 160462 ny. RABI  HANDSCOEN 478.00 4 525.80
151 APT010000I62004321 160462 ny. RABI  SPOIT 5 CC 1,595.00 2 1,754.50
152 APT010000I62004337 84165 tn. WILLAYANTO 
CEFTRIAXO19,999.10 3 21,999.01
153 APT010000I62004337 84165 tn. WILLAYANTO 
CAIRAN NA15,180.00 1 16,698.00
154 APT010000I62004337 84165 tn. WILLAYANTO 
SANMOL T 297.00 3 326.70
155 APT010000I62004337 84165 tn. WILLAYANTO 
CAIRAN NAC6,409.70 3 7,050.67
156 APT010000I62004337 84165 tn. WILLAYANTO 
MASKER DI 700.00 2 770.00
157 APT010000I62004337 84165 tn. WILLAYANTO 
SPOIT 3 CC 1,485.00 2 1,633.50
158 APT010000I62004326 160484 nn. JIHAN MAGFIRAH
LEVOFLOXAGAFFAR 
449.00 3 493.90
159 APT010000I62004326 160484 nn. JIHAN MAGFIRAH
RANITIDIN GAFFAR 
629.99 6 692.99
160 APT010000I62004326 160484 nn. JIHAN MAGFIRAH
SANMOL T GAFFAR 
297.00 9 326.70
161 APT010000I62004350 160629 tn. ARIFUDDIN 
RANITIDIN 3,000.00 2 3,300.00
162 APT010000I62004350 160629 tn. ARIFUDDIN 
SANMOL T 297.00 3 326.70
163 APT010000I62004350 160629 tn. ARIFUDDIN 
CAIRAN RL 7,300.00 3 8,030.00
164 APT010000I62004350 160629 tn. ARIFUDDIN 
CAIRAN NA15,180.00 2 16,698.00
165 APT010000I62004350 160629 tn. ARIFUDDIN 
MASKER DI 700.00 1 770.00
166 APT010000I62004350 160629 tn. ARIFUDDIN 
HANDSCOEN 478.00 2 525.80
167 APT010000I62004351 118751 nn. DWI ANDIKA
CEFTRIAXO19,999.10
AM NUR  2 21,999.01
168 APT010000I62004351 118751 nn. DWI ANDIKA
RANITIDIN
AM NUR 
3,000.00 2 3,300.00
169 APT010000I62004351 118751 nn. DWI ANDIKA
CAIRANAMRLNUR 
7,300.00 2 8,030.00
170 APT010000I62004351 118751 nn. DWI ANDIKA
CAIRANAMNA15,180.00
NUR  2 16,698.00
171 APT010000I62004351 118751 nn. DWI ANDIKA
SPOIT AM
5 CCNUR 
1,595.00 1 1,754.50
172 APT010000I62004351 118751 nn. DWI ANDIKA
IV CATHETE
AM NUR 
7,750.00 1 8,525.00
173 APT010000I62004351 118751 nn. DWI ANDIKA
INFUS AM
SET NUR 
17,000.00 1 18,700.00
174 APT010000I62004347 160593 ny. KENNIACAIRAN
RATRI MULYA 
RL 7,300.00 3 8,030.00
175 APT010000I62004347 160593 ny. KENNIARANITIDIN
RATRI MULYA 
3,000.00 2 3,300.00
176 APT010000I62004347 160593 ny. KENNIADOMPERID
RATRI MULYA  508.20 3 559.02
177 APT010000I62004347 160593 ny. KENNIANEUROSANB5,324.00
RATRI MULYA  1 5,856.40
178 APT010000I62004347 160593 ny. KENNIAMASKER
RATRI MULYA 
DI 700.00 2 770.00
179 APT010000I62004347 160593 ny. KENNIAALKOHOL
RATRI MULYA 
S 300.00 2 330.00
180 APT010000I62004347 160593 ny. KENNIAHANDSCOON
RATRI MULYA 
12,100.00 1 13,310.00
181 APT010000I62004347 160593 ny. KENNIASPOIT
RATRI1MULYA 
CC 1,920.00 1 2,112.00
182 APT010000I62004347 160593 ny. KENNIAIVRATRI
CATHETE
MULYA 7,750.00 1 8,525.00
183 APT010000I62004344 160557 tn. AWALUDIN
CEFTRIAXO19,999.10
SYAM   3 21,999.01
184 APT010000I62004344 160557 tn. AWALUDIN
RANITIDIN
SYAM   3,000.00 2 3,300.00
185 APT010000I62004344 160557 tn. AWALUDIN
DOMPERID
SYAM   508.20 3 559.02
186 APT010000I62004344 160557 tn. AWALUDIN
SANMOL
SYAMI  24,202.60 2 26,622.86
187 APT010000I62004344 160557 tn. AWALUDIN
CAIRAN
SYAMRL   7,300.00 3 8,030.00
188 APT010000I62004344 160557 tn. AWALUDIN
MASKER
SYAM DI  700.00 2 770.00
189 APT010000I62004344 160557 tn. AWALUDIN
SPOITSYAM
10 C   2,310.00 1 2,541.00
190 APT010000I62004344 160557 tn. AWALUDIN
HANDSCOON
SYAM  12,100.00 1 13,310.00
191 APT010000I62004344 160557 tn. AWALUDIN
TRANSFUSI28,050.00
SYAM   1 30,855.00
192 APT010000I62004344 160557 tn. AWALUDIN
ALKOHOL
SYAMS  300.00 1 330.00
193 APT010000I62004314 123536 tn. MUHAMMAD
CEFTRIAXO19,999.10
ALWI MUIN SHI  2 21,999.01
194 APT010000I62004314 123536 tn. MUHAMMAD
LANSOPRAZ
ALWI MUIN
946.00
SHI  1 1,040.60
195 APT010000I62004314 123536 tn. MUHAMMAD
DOMPERIDALWI MUIN
508.20
SHI  3 559.02
196 APT010000I62004314 123536 tn. MUHAMMAD
- ALWI MUIN SHI 
0 0 0
197 APT010000I62004314 123536 tn. MUHAMMAD
METRONIDA8,250.00
ALWI MUIN SHI  3 9,075.00
198 APT010000I62004314 123536 tn. MUHAMMAD
CAIRANALWI
NAC6,409.70
MUIN SHI  3 7,050.67
199 APT010000I62004314 123536 tn. MUHAMMAD
MASKER ALWI
DI MUIN
700.00
SHI  1 770.00
200 APT010000I62004314 123536 tn. MUHAMMAD
HANDSCOEN
ALWI MUIN
478.00
SHI  4 525.80
201 APT010000I62004314 123536 tn. MUHAMMAD
IV CATHETE
ALWI 7,750.00
MUIN SHI  2 8,525.00
202 APT010000I62004348 97174 nn. MULIATI
RANITIDIN
MUSTIKA  3,000.00 2 3,300.00
203 APT010000I62004348 97174 nn. MULIATI
ONDANSETR2,002.00
MUSTIKA  2 2,202.20
204 APT010000I62004348 97174 nn. MULIATI
KETOROLAC
MUSTIKA  7,350.75 2 8,085.82
205 APT010000I62004348 97174 nn. MULIATI
SANMOL
MUSTIKA 
T 297.00 3 326.70
206 APT010000I62004348 97174 nn. MULIATI
DOMPERID
MUSTIKA  508.20 2 559.02
207 APT010000I62004348 97174 nn. MULIATI
SPORETIK
MUSTIKA  5,720.50 2 6,292.55
208 APT010000I62004348 97174 nn. MULIATI
CAIRAN
MUSTIKA 
FU41,388.90 2 45,527.79
209 APT010000I62004348 97174 nn. MULIATI
MASKER
MUSTIKA 
DI 700.00 2 770.00
210 APT010000I62004348 97174 nn. MULIATI
HANDSCOEN
MUSTIKA  478.00 4 525.80
211 APT010000I62004348 97174 nn. MULIATI
SPOIT
MUSTIKA 
5 CC 1,595.00 2 1,754.50
212 APT010000I62004348 97174 nn. MULIATI
ALKOHOL
MUSTIKA S 300.00 1 330.00
213 APT010000I62004330 131115 ny. TALLASA
SIMUCIL
DG JINNE 
2 1,760.00 3 1,936.00
214 APT010000I62004330 131115 ny. TALLASA
CEFTRIAXO19,999.10
DG JINNE  2 21,999.01
215 APT010000I62004330 131115 ny. TALLASA
CURCUMA
DG JINNE  1,098.90 3 1,208.79
216 APT010000I62004330 131115 ny. TALLASA
VITAMIN
DG JINNE 
B 76.33 1 83.96
217 APT010000I62004330 131115 ny. TALLASA
VITAMIN
DG JINNE 
B 135.00 1 148.50
218 APT010000I62004330 131115 ny. TALLASA
VITAMIN
DG JINNE 
B 76.33 1 83.96
219 APT010000I62004330 131115 ny. TALLASA
LANSOPRAZ
DG JINNE  946.00 1 1,040.60
220 APT010000I62004330 131115 ny. TALLASA
CAIRAN
DG JINNE 
RL 7,300.00 3 8,030.00
221 APT010000I62004330 131115 ny. TALLASA
MASKER
DG JINNE 
DI 700.00 1 770.00
222 APT010000I62004330 131115 ny. TALLASA
HANDSCOEN
DG JINNE  478.00 2 525.80
223 APT010000I62004330 131115 ny. TALLASA
ALKOHOL
DG JINNE 
S 300.00 1 330.00
224 APT010000I62004309 160384 tn. ARINOLSA
ZINK
SAPUTRA 
OKSI 604.00 1 664.40
225 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
B 76.33 2 83.96
226 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 71.91 2 79.10
227 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 1 79.10
228 APT010000I62004309 160384 tn. ARINOLSA
- SAPUTRA  0 0 0
229 APT010000I62004309 160384 tn. ARINOLSA
CEFTAZIDIM
SAPUTRA 23,166.00 3 25,482.60
230 APT010000I62004309 160384 tn. ARINOLSA
RIFASTAR
SAPUTRA 5,115.00 1 5,626.50
231 APT010000I62004309 160384 tn. ARINOLSA
SANMOL
SAPUTRA 
I 24,202.60 3 26,622.86
232 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 9 7,260.00
233 APT010000I62004328 160495 ny. BASSE DG.
ZINKKENNA
OKSI   604.00 1 664.40
234 APT010000I62004328 160495 ny. BASSE DG.
VITAMIN
KENNAC   71.91 4 79.10
235 APT010000I62004328 160495 ny. BASSE DG.
OMEPRAZOL
KENNA 24,999.70
  2 27,499.67
236 APT010000I62004328 160495 ny. BASSE DG.
ONDANSETR2,002.00
KENNA   3 2,202.20
237 APT010000I62004328 160495 ny. BASSE DG.
NEWKENNA
DIAT   557.15 6 612.87
238 APT010000I62004328 160495 ny. BASSE DG.
SANMOL
KENNAI 24,202.60
  1 26,622.86
239 APT010000I62004328 160495 ny. BASSE DG.
CAIRAN
KENNA
RL   7,300.00 1 8,030.00
240 APT010000I62004328 160495 ny. BASSE DG.
MASKER
KENNADI   700.00 1 770.00
241 APT010000I62004328 160495 ny. BASSE DG.
HANDSCOEN
KENNA   478.00 2 525.80
242 APT010000I62004328 160495 ny. BASSE DG.
INFUS
KENNA
SET 17,000.00
  1 18,700.00
243 APT010000I62004332 160501 tn. DRS. ANDI
MELOXICAM
SUKMA   250.00 2 275.00
244 APT010000I62004332 160501 tn. DRS. ANDI
MECOBALA
SUKMA   616.00 1 677.60
245 APT010000I62004332 160501 tn. DRS. ANDI
RANITIDIN
SUKMA   3,000.00 2 3,300.00
246 APT010000I62004332 160501 tn. DRS. ANDI
METIL
SUKMA
PRE 44,999.90
  1 49,499.89
247 APT010000I62004332 160501 tn. DRS. ANDI
ALPENTIN
SUKMA   2,425.50 1 2,668.05
248 APT010000I62004332 160501 tn. DRS. ANDI
CANGKANG
SUKMA   75.00 3 82.50
249 APT010000I62004332 160501 tn. DRS. ANDI
CAIRAN
SUKMA
RL   7,300.00 3 8,030.00
250 APT010000I62004332 160501 tn. DRS. ANDI
MASKER
SUKMA DI   700.00 2 770.00
251 APT010000I62004332 160501 tn. DRS. ANDI
HANDSCOEN
SUKMA   478.00 4 525.80
252 APT010000I62004332 160501 tn. DRS. ANDI
INFUS
SUKMA
SET 17,000.00
  1 18,700.00
253 APT010000I62004332 160501 tn. DRS. ANDI
AMITRIPTY
SUKMA   177.65 1 195.41
254 APT010000I32000259 160246 tn. MULYADI 
FUROSEMID 190.99 3 210.09
255 APT010000I32000259 160246 tn. MULYADI 
SPIRONOLA 366.30 3 402.93
256 APT010000I32000259 160246 tn. MULYADI 
ASPILETS 110.00 3 121.00
257 APT010000I32000259 160246 tn. MULYADI 
FARSORBID 306.00 3 336.60
258 APT010000I32000259 160246 tn. MULYADI 
CAPTOPRIL 199.99 3 219.99
259 APT010000I32000259 160246 tn. MULYADI 
ATORVASTA6,435.00 6 7,078.50
260 APT010000I32000259 160246 tn. MULYADI 
AZITROMYC 1,777.99 3 1,955.79
261 APT010000I32000259 160246 tn. MULYADI 
SPORETIK 5,720.50 6 6,292.55

262 APT010000I62004333 159705 ny. SITTI MAEMUNAH

CAIRAN AM70,188.80
BASO  2 77,207.68

263 APT010000I62004333 159705 ny. SITTI MAEMUNAH

ONDANSETR2,002.00
BASO  3 2,202.20
264 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN NA15,180.00
BASO  2 16,698.00
265 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 
700.00 2 770.00
266 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 5 CC BASO 
1,595.00 2 1,754.50
267 APT010000I62004333 159705 ny. SITTI MAEMUNAH
TRANSFUSI28,050.00
BASO  1 30,855.00
268 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOON 12,100.00
BASO  1 13,310.00
269 APT010000I62004357 129453 ny. NURBAENAH 
AMLODIPIN 475.19 1 522.71
270 APT010000I62004357 129453 ny. NURBAENAH 
ONDANSETR2,002.00 1 2,202.20
271 APT010000I62004357 129453 ny. NURBAENAH 
INFUS SET 17,000.00 1 18,700.00
272 APT010000I62004357 129453 ny. NURBAENAH 
IV CATHETE 7,750.00 1 8,525.00
273 APT010000I62004357 129453 ny. NURBAENAH 
SPOIT 3 CC 1,485.00 1 1,633.50
274 APT010000I62004330 131115 ny. TALLASASIMUCIL
DG JINNE 
2 1,760.00 9 1,936.00
275 APT010000I62004309 160384 tn. ARINOLSA
CAIRAN
SAPUTRA 
SAL27,830.00 2 30,613.00
276 APT010000I62004330 131115 ny. TALLASALANSOPRAZ
DG JINNE  946.00 3 1,040.60
277 APT010000I62004330 131115 ny. TALLASADOMPERID
DG JINNE  508.20 3 559.02
278 APT010000I62004330 131115 ny. TALLASAEPISAN
DG JINNE 
SU 51,150.00 1 56,265.00
279 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 9 1,208.79
280 APT010000I32000262 160440 tn. ABDUL WAHID
RECOLFARWALANGADI 
4,950.00 2 5,445.00
281 APT010000I32000262 160440 tn. ABDUL WAHID
SANMOLWALANGADI 
T 297.00 3 326.70
282 APT010000I32000262 160440 tn. ABDUL WAHID
FARSORBID
WALANGADI 
306.00 2 336.60
283 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  2 27,499.67
284 APT010000I62004350 160629 tn. ARIFUDDIN 
LANSOPRAZ 946.00 2 1,040.60
285 APT010000I62004350 160629 tn. ARIFUDDIN 
SPASMAL T 500.26 3 550.28
286 APT010000I62004350 160629 tn. ARIFUDDIN 
KETOROLAC 7,350.75 3 8,085.82
287 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG 838.19 1 922.01
288 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
289 APT010000I62004357 129453 ny. NURBAENAH 
RAMIPRIL 675.22 1 742.74
290 APT010000I62004357 129453 ny. NURBAENAH 
HCT 25 MG 128.00 1 140.80
291 APT010000I64002863 160668 tn. HARIS DG
OMEPRAZOL
SE'RE  24,999.70 1 27,499.67
292 APT010000I64002863 160668 tn. HARIS DG
CEFTRIAXO19,999.10
SE'RE  2 21,999.01
293 APT010000I64002863 160668 tn. HARIS DG
PLASMINEX
SE'RE  2,832.50 3 3,115.75
294 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE RL 7,300.00 1 8,030.00
295 APT010000I64002863 160668 tn. HARIS DG
COMBO
SE'RE PAC60,500.00 1 66,550.00
296 APT010000I64002863 160668 tn. HARIS DG
SPOIT
SE'RE 
3 CC 1,485.00 1 1,633.50
297 APT010000I64002863 160668 tn. HARIS DG
SPOIT
SE'RE 
10 C 2,310.00 2 2,541.00
298 APT010000I64002863 160668 tn. HARIS DG
SPOIT
SE'RE 
1 CC 1,920.00 1 2,112.00
299 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE NA15,180.00 1 16,698.00
1,100,000 1,210,000
300 APT010000I62004331 160496 tn. H. RIDWAN
CERTOFIX
KADIR   .00 1 .00
301 APT010000I62004331 160496 tn. H. RIDWAN
LIDOCAINE
KADIR   1,287.00 4 1,415.70
302 APT010000I62004331 160496 tn. H. RIDWAN
BENANG
KADIRSIL5  5,000.00 1 60,500.00
303 APT010000I62004331 160496 tn. H. RIDWAN
SPOIT
KADIR
3 CC   1,485.00 2 1,633.50
304 APT010000I62004331 160496 tn. H. RIDWAN
SPOIT
KADIR
10 C   2,310.00 2 2,541.00
305 APT010000I62004331 160496 tn. H. RIDWAN
HANDSCOEN
KADIR   478.00 8 525.80
306 APT010000I62004331 160496 tn. H. RIDWAN
HANDSCOON
KADIR 13,613.00
  3 14,974.30
307 APT010000I62004321 160462 ny. RABI  SPORETIK 5,720.50 2 6,292.55
308 APT010000I62004321 160462 ny. RABI  RANITIDIN 629.99 3 692.99
309 APT010000I62004321 160462 ny. RABI  MEFINAL 5 1,391.50 3 1,530.65
310 APT010000I62004350 160629 tn. ARIFUDDIN 
SANMOL T 297.00 6 326.70
311 APT010000I62004350 160629 tn. ARIFUDDIN 
LANSOGRA 1,000.00 4 1,100.00
312 APT010000I62004350 160629 tn. ARIFUDDIN 
SPASMAL T 500.26 6 550.28
313 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
CAIRAN RL 7,300.00 1 8,030.00
314 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
COMBO PAC 60,500.00 1 66,550.00
315 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
RANITIDIN 3,000.00 1 3,300.00
316 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
ONDANSETR2,002.00 1 2,202.20
317 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
BETAHISTI 733.33 2 806.67
318 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
IV CATHETE 7,750.00 1 8,525.00
319 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
SIMUCIL 2 1,760.00 3 1,936.00
320 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
CAIRAN RL 7,300.00 1 8,030.00
321 APT010000I66000405 160570 nn. ROHANI 
RANITIDIN 3,000.00 2 3,300.00

322 APT010000I66000405 160570 nn. ROHANI 

N-ACE INJ 38,500.00 3 42,350.00

323 APT010000I32000262 160440 tn. ABDUL WAHID

SANMOLWALANGADI 
T 297.00 3 326.70
324 APT010000I32000262 160440 tn. ABDUL WAHID
ASPILETSWALANGADI 
110.00 1 121.00
325 APT010000I32000262 160440 tn. ABDUL WAHID
CAPTOPRIL
WALANGADI 
199.99 1 219.99
326 APT010000I32000262 160440 tn. ABDUL WAHID
ATORVASTA6,435.00
WALANGADI  1 7,078.50
327 APT010000I32000262 160440 tn. ABDUL WAHID
CONCORWALANGADI 
2. 597.00 1 656.70
328 APT010000I32000262 160440 tn. ABDUL WAHID
FARSORBID
WALANGADI 
306.00 3 336.60
329 APT010000I32000262 160440 tn. ABDUL WAHID
L-CISIN WALANGADI 
2,890.80 2 3,179.88
330 APT010000I32000262 160440 tn. ABDUL WAHID
INFUSAN WALANGADI 
N 6,570.00 1 7,227.00
331 APT010000I32000262 160440 tn. ABDUL WAHID
HANDSCOEN
WALANGADI 
478.00 30 525.80
332 APT010000I32000262 160440 tn. ABDUL WAHID
MASKERWALANGADI 
DI 700.00 5 770.00
333 APT010000I32000262 160440 tn. ABDUL WAHID
KAPAS ALWALANGADI 
300.00 5 330.00
334 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
SANTAGESIK4,949.40 1 5,444.34
335 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
EPISAN SU 51,150.00 1 56,265.00
336 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
SPOIT 3 CC 1,485.00 1 1,633.50
337 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR2,002.00 2 2,202.20
338 APT010000I66000404 159099 ny. SITTI MULIYANA 
OMEPRAZOL 24,999.70 2 27,499.67
339 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
340 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
341 APT010000I66000404 159099 ny. SITTI MULIYANA 
HANDSCOEN 478.00 20 525.80
342 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 10,011.38 4 11,012.51
343 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALAM6,600.00 1 7,260.00
344 APT010000I66000404 159099 ny. SITTI MULIYANA 
SANMOL T 297.00 3 326.70
345 APT010000I66000405 160570 nn. ROHANI CAPTOPRIL 199.99 3 219.99
346 APT010000I66000405 160570 nn. ROHANI ATORVASTA6,435.00 2 7,078.50
347 APT010000I66000405 160570 nn. ROHANI FARSORBID 306.00 3 336.60
348 APT010000I66000405 160570 nn. ROHANI METIL PRE 44,999.90 1 49,499.89
349 APT010000I66000405 160570 nn. ROHANI ONDANSETR2,002.00 2 2,202.20
350 APT010000I66000405 160570 nn. ROHANI ZINK OKSI 604.00 1 664.40
351 APT010000I66000405 160570 nn. ROHANI VITAMIN C 125.84 1 138.42
352 APT010000I66000405 160570 nn. ROHANI CAIRAN NAC6,409.70 2 7,050.67
353 APT010000I66000405 160570 nn. ROHANI HUMI FLO 56,018.00 1 61,619.80
354 APT010000I66000405 160570 nn. ROHANI SPOIT 3 CC 1,485.00 1 1,633.50
355 APT010000I66000405 160570 nn. ROHANI SPOIT 50 C 10,000.09 1 11,000.10
PCS 24,090.00

PCS 266.20
PCS 1,385.98
PCS 7,260.00
PCS 522.71
PCS 21,780.00
PCS 7,050.67
PCS 219.99
PCS 14,157.00
PCS 656.70
PCS 339.42
PCS 15,774.00
PCS 3,850.00
PCS 1,650.00
PCS 2,541.00
PCS 1,633.50
PCS 17,050.00
PCS 3,300.00
PCS 8,085.82
187,000.0
PCS 0
PCS 8,030.00
PCS 8,525.00
PCS 5,335.00
PCS 330.00
PCS 1,633.50
PCS 2,103.20
PCS 5,856.40
PCS 431.00
PCS 16,335.00
PCS 522.71
PCS 4,157.94
PCS 11,906.40
PCS 72.00
PCS 33,008.80
PCS 16,171.64
PCS 6,600.00
PCS 6,606.60
PCS 24,090.00
PCS 11,357.50
PCS 1,051.60
PCS 29,948.60
PCS 770.00
PCS 24,090.00
PCS 5,856.40
PCS 3,300.00
PCS 485.58
PCS 2,103.20
PCS 1,540.00
PCS 8,525.00
PCS 12,705.00
PCS 6,600.00
PCS 16,171.64
PCS 32,120.00
PCS 1,633.50
PCS 1,754.50
PCS 11,357.50
PCS 18,700.00
PCS 77,207.68
PCS 1,544.40
PCS 24,090.00
PCS 11,357.50
PCS 1,051.60
PCS 26,620.00
PCS 1,540.00
PCS 33,008.80
PCS 27,225.00
PCS 6,600.00
PCS 24,257.46
PCS 24,090.00
PCS 1,540.00
PCS 2,103.20
PCS 13,310.00
PCS 5,335.00
PCS 3,267.00
PCS 75,504.00
PCS 728.37
PCS 14,101.34
PCS 1,540.00
PCS 2,103.20
PCS 18,700.00
PCS 11,357.50
PCS 1,633.50
PCS 1,040.60
PCS 27,225.00
PCS 922.01
PCS 32,120.00
PCS 2,103.20
PCS 1,540.00
PCS 54,558.90
PCS 12,850.20
PCS 43,998.02
PCS 33,396.00
PCS 3,267.00
PCS 5,082.00
PCS 1,540.00
PCS 2,103.20
PCS 49,499.89
PCS 53,245.72
PCS 3,354.12
PCS 798.60
PCS 4,157.94
PCS 1,993.20
PCS 9,922.00
PCS 643.50
PCS 780.45
PCS 2,420.01
PCS 1,456.74
PCS 2,316.60
PCS 495.00
PCS 32,120.00
PCS 1,540.00
PCS 1,051.60
PCS 11,357.50
PCS 8,525.00
PCS 11,357.50
PCS 1,285.35
PCS 1,970.10
PCS 678.84
PCS 5,856.40
PCS 431.00
PCS 16,335.00
PCS 522.71
PCS 266.20
PCS 1,385.98
PCS 7,260.00
PCS 522.71
PCS 24,090.00
PCS 4,900.50
PCS 330.00
PCS 664.40
PCS 1,118.04
PCS 16,060.00
PCS 1,540.00
PCS 2,103.20
PCS 11,737.00
PCS 1,385.98
PCS 677.60
PCS 121.00
PCS 43,998.02
PCS 5,808.00
PCS 14,101.34
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 5,335.00
PCS 43,998.02
PCS 3,968.80
PCS 980.10
PCS 24,090.00
PCS 2,103.20
PCS 3,509.00
PCS 65,997.03
PCS 16,698.00
PCS 980.10
PCS 21,152.01
PCS 1,540.00
PCS 3,267.00
PCS 1,481.70
PCS 4,157.94
PCS 2,940.30
PCS 6,600.00
PCS 980.10
PCS 24,090.00
PCS 33,396.00
PCS 770.00
PCS 1,051.60
PCS 43,998.02
PCS 6,600.00
PCS 16,060.00
PCS 33,396.00
PCS 1,754.50
PCS 8,525.00
PCS 18,700.00
PCS 24,090.00
PCS 6,600.00
PCS 1,677.06
PCS 5,856.40
PCS 1,540.00
PCS 660.00
PCS 13,310.00
PCS 2,112.00
PCS 8,525.00
PCS 65,997.03
PCS 6,600.00
PCS 1,677.06
PCS 53,245.72
PCS 24,090.00
PCS 1,540.00
PCS 2,541.00
PCS 13,310.00
PCS 30,855.00
PCS 330.00
PCS 43,998.02
PCS 1,040.60
PCS 1,677.06
- 0
PCS 27,225.00
PCS 21,152.01
PCS 770.00
PCS 2,103.20
PCS 17,050.00
PCS 6,600.00
PCS 4,404.40
PCS 16,171.64
PCS 980.10
PCS 1,118.04
PCS 12,585.10
PCS 91,055.58
PCS 1,540.00
PCS 2,103.20
PCS 3,509.00
PCS 330.00
PCS 5,808.00
PCS 43,998.02
PCS 3,626.37
PCS 83.96
PCS 148.50
PCS 83.96
PCS 1,040.60
PCS 24,090.00
PCS 770.00
PCS 1,051.60
PCS 330.00
PCS 664.40
PCS 167.92
PCS 158.20
PCS 79.10
- 0
PCS 76,447.80
PCS 5,626.50
PCS 79,868.58
PCS 65,340.00
PCS 664.40
PCS 316.40
PCS 54,999.34
PCS 6,606.60
PCS 3,677.22
PCS 26,622.86
PCS 8,030.00
PCS 770.00
PCS 1,051.60
PCS 18,700.00
PCS 550.00
PCS 677.60
PCS 6,600.00
PCS 49,499.89
PCS 2,668.05
PCS 247.50
PCS 24,090.00
PCS 1,540.00
PCS 2,103.20
PCS 18,700.00
PCS 195.41
PCS 630.27
PCS 1,208.79
PCS 363.00
PCS 1,009.80
PCS 659.97
PCS 42,471.00
PCS 5,867.37
PCS 37,755.30
154,415.3
PCS 6
PCS 6,606.60
PCS 33,396.00
PCS 1,540.00
PCS 3,509.00
PCS 30,855.00
PCS 13,310.00
PCS 522.71
PCS 2,202.20
PCS 18,700.00
PCS 8,525.00
PCS 1,633.50
PCS 17,424.00
PCS 61,226.00
PCS 3,121.80
PCS 1,677.06
PCS 56,265.00
PCS 10,879.11
PCS 10,890.00
PCS 980.10
PCS 673.20
PCS 54,999.34
PCS 2,081.20
PCS 1,650.84
PCS 24,257.46
PCS 922.01
PCS 7,078.50
PCS 742.74
PCS 140.80
PCS 27,499.67
PCS 43,998.02
PCS 9,347.25
PCS 8,030.00
PCS 66,550.00
PCS 1,633.50
PCS 5,082.00
PCS 2,112.00
PCS 16,698.00
1,210,000
PCS .00
PCS 5,662.80
PCS 60,500.00
PCS 3,267.00
PCS 5,082.00
PCS 4,206.40
PCS 44,922.90
PCS 12,585.10
PCS 2,078.97
PCS 4,591.95
PCS 1,960.20
PCS 4,400.00
PCS 3,301.68
PCS 8,030.00
PCS 66,550.00
PCS 3,300.00
PCS 2,202.20
PCS 1,613.34
PCS 8,525.00
PCS 5,808.00
PCS 8,030.00
PCS 6,600.00
127,050.0
PCS
0
PCS 980.10
PCS 121.00
PCS 219.99
PCS 7,078.50
PCS 656.70
PCS 1,009.80
PCS 6,359.76
PCS 7,227.00
PCS 15,774.00
PCS 3,850.00
PCS 1,650.00
PCS 5,444.34
PCS 56,265.00
PCS 1,633.50
PCS 4,404.40
PCS 54,999.34
PCS 43,998.02
PCS 54,558.90
PCS 10,516.00
PCS 44,050.04
PCS 7,260.00
PCS 980.10
PCS 659.97
PCS 14,157.00
PCS 1,009.80
PCS 49,499.89
PCS 4,404.40
PCS 664.40
PCS 138.42
PCS 14,101.34
PCS 61,619.80
PCS 1,633.50
PCS 11,000.10
02-12-
1 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 8 525.80
2018 
2 APT010000I62004360 151249 nn. WULANCEFIXIME
PURNAMASARI1,337.60
  2 1,471.36
3 APT010000I62004359 160674 ny. NURSIAH INFUSAN N 6,570.00 1 7,227.00
4 APT010000I62004359 160674 ny. NURSIAH SANMOL I 24,202.60 3 26,622.86
5 APT010000I62004359 160674 ny. NURSIAH NEUROSANB5,324.00 1 5,856.40
6 APT010000I62004349 160605 nn. SARTIKA BETAHISTI 733.33 3 806.67
7 APT010000I62004349 160605 nn. SARTIKA OMEPRAZOL 24,999.70 2 27,499.67
8 APT010000I62004349 160605 nn. SARTIKA PARACETA 220.72 6 242.79
9 APT010000I62004349 160605 nn. SARTIKA SOTATIC T 394.90 6 434.39
10 APT010000I62004349 160605 nn. SARTIKA CANGKANG 75.00 6 82.50
11 APT010000I62004349 160605 nn. SARTIKA NEUROSAN 1,168.50 1 1,285.35
12 APT010000I62004349 160605 nn. SARTIKA VALISANBE 236.50 3 260.15
13 APT010000I62004335 160511 tn. SUPRIADICEFOTAXIM
PAISAL  15,004.00 2 16,504.40
14 APT010000I62004335 160511 tn. SUPRIADIKETOROLAC
PAISAL  7,350.75 3 8,085.82
15 APT010000I62004335 160511 tn. SUPRIADIRANITIDIN
PAISAL  3,000.00 2 3,300.00
16 APT010000I62004335 160511 tn. SUPRIADIMETRONIDA8,250.00
PAISAL  3 9,075.00
17 APT010000I62004359 160674 ny. NURSIAH CEFTRIAXO19,999.10 3 21,999.01
18 APT010000I62004359 160674 ny. NURSIAH SANMOL I 24,202.60 3 26,622.86
19 APT010000I62004346 160565 tn. MOH PADANG
NEUROSANB5,324.00
RAHANAR  1 5,856.40
20 APT010000I62004346 160565 tn. MOH PADANG
RANITIDIN
RAHANAR 
3,000.00 2 3,300.00
21 APT010000I62004346 160565 tn. MOH PADANG
SANMOL RAHANAR 
T 297.00 3 326.70
22 APT010000I62004343 160548 ny. SUGIARTIOMEPRAZOL
  24,999.70 2 27,499.67
23 APT010000I62004343 160548 ny. SUGIARTIMETIL
  PRE 702.00 2 772.20
24 APT010000I62004275 159982 tn. SULHAM  SANMOL T 297.00 3 326.70
25 APT010000I62004275 159982 tn. SULHAM  NEUROSAN 1,168.50 1 1,285.35
26 APT010000I62004339 160516 ny. HUSNAWATI 
OMEPRAZOL 24,999.70 2 27,499.67
27 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  946.00 2 1,040.60
28 APT010000I62004340 155102 tn. DRS. H. SANMOL
ISHAK ABDIR 
T 297.00 3 326.70
29 APT010000I62004340 155102 tn. DRS. H. ADONA
ISHAK ABDIR 
INJ22,880.00 3 25,168.00
30 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 2 8,085.82
31 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  3,000.00 2 3,300.00
32 APT010000I62004363 160685 ny. NANI .T. 
KALITAKE 5,498.95 3 6,048.85
33 APT010000I62004363 160685 ny. NANI .T. 
SPOIT 50 12,367.00 2 13,603.70
34 APT010000I62004363 160685 ny. NANI .T. 
FUROSEMID2,920.50 2 3,212.55
35 APT010000I62004363 160685 ny. NANI .T. 
CAIRAN DE10,010.00 2 11,011.00
36 APT010000I62004363 160685 ny. NANI .T. 
PERFUSSOR21,000.00 1 23,100.00
37 APT010000I62004363 160685 ny. NANI .T. 
CALCII GLU10,351.00 2 11,386.10
38 APT010000I62004338 155611 ny. ANDI ALWIAH
METRONIDA8,250.00
  3 9,075.00
39 APT010000I62004338 155611 ny. ANDI ALWIAH
AMLODIPIN
  838.19 1 922.01
40 APT010000I66000404 159099 ny. SITTI MULIYANA 
BECLOV INJ13,418.20 4 14,760.02
41 APT010000I66000404 159099 ny. SITTI MULIYANA 
MEGABAL 1,730.00 1 1,903.00
42 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR2,002.00 3 2,202.20
43 APT010000I66000404 159099 ny. SITTI MULIYANA 
OMEPRAZOL 24,999.70 1 27,499.67
44 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
45 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
46 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
47 APT010000I62004331 160496 tn. H. RIDWAN
NEFROSTER
KADIR 49,599.00
  1 54,558.90
48 APT010000I62004331 160496 tn. H. RIDWAN
OMEPRAZOL
KADIR 24,999.70
  2 27,499.67
49 APT010000I62004331 160496 tn. H. RIDWAN
FUROSEMID2,920.50
KADIR   1 3,212.55
50 APT010000I62004331 160496 tn. H. RIDWAN
CEFTRIAXO19,999.10
KADIR   2 21,999.01
51 APT010000I62004331 160496 tn. H. RIDWAN
AMLODIPIN
KADIR   838.19 1 922.01
52 APT010000I62004331 160496 tn. H. RIDWAN
PLASMINEX
KADIR 13,002.00
  2 14,302.20
53 APT010000I62004331 160496 tn. H. RIDWAN
KETOROLAC
KADIR   7,350.75 2 8,085.82
54 APT010000I62004331 160496 tn. H. RIDWAN
ALPRAZOLA
KADIR   585.00 1 643.50
55 APT010000I62004352 160636 nn. REYSHASANMOL
NUR SEPTIANI 
I 24,202.60 3 26,622.86
56 APT010000I62004352 160636 nn. REYSHASANPRIMA
NUR SEPTIANI  902.00 2 992.20
57 APT010000I62004357 129453 ny. NURBAENAH 
RANITIDIN 3,000.00 3 3,300.00
58 APT010000I62004357 129453 ny. NURBAENAH 
AMLODIPIN 838.19 1 922.01
59 APT010000I62004357 129453 ny. NURBAENAH 
RAMIPRIL 675.22 1 742.74
60 APT010000I62004325 160471 ny. SYARIFAH
CEFOTAXIM
ALWIAH 15,004.00 2 16,504.40
61 APT010000I62004325 160471 ny. SYARIFAH
KETOROLAC
ALWIAH  7,350.75 2 8,085.82
62 APT010000I62004325 160471 ny. SYARIFAH
RANITIDIN
ALWIAH  3,000.00 2 3,300.00
63 APT010000I62004325 160471 ny. SYARIFAH
ONDANSETR2,002.00
ALWIAH  2 2,202.20
64 APT010000I66000405 160570 nn. ROHANI CAPTOPRIL 199.99 1 219.99
65 APT010000I66000405 160570 nn. ROHANI SIMVASTAT 359.10 1 395.01
66 APT010000I66000405 160570 nn. ROHANI FARSORBID 263.00 3 289.30
67 APT010000I66000405 160570 nn. ROHANI ZINKID TAB 2,750.00 1 3,025.00
68 APT010000I66000405 160570 nn. ROHANI B COMPLEK 76.34 5 83.97
69 APT010000I66000405 160570 nn. ROHANI VITAMIN C 6,413.00 1 7,054.30
70 APT010000I66000405 160570 nn. ROHANI CAIRAN NAC6,409.70 1 7,050.67
71 APT010000I66000405 160570 nn. ROHANI HANDSCOEN 478.00 10 525.80
72 APT010000I66000405 160570 nn. ROHANI CEFTRIAXO19,999.10 2 21,999.01
73 APT010000I66000405 160570 nn. ROHANI RANITIDIN 3,000.00 2 3,300.00
74 APT010000I66000405 160570 nn. ROHANI N-ACE INJ 38,500.00 2 42,350.00
75 APT010000I66000405 160570 nn. ROHANI METIL PRE 44,999.90 2 49,499.89
76 APT010000I66000405 160570 nn. ROHANI ONDANSETR2,002.00 2 2,202.20
77 APT010000I66000405 160570 nn. ROHANI HANDSCOEN 478.00 10 525.80
78 APT010000I62004314 123536 tn. MUHAMMAD
CEFTRIAXO19,999.10
ALWI MUIN SHI  2 21,999.01
79 APT010000I62004314 123536 tn. MUHAMMAD
METRONIDA8,250.00
ALWI MUIN SHI  3 9,075.00
80 APT010000I62004314 123536 tn. MUHAMMAD
CIPROFLOX
ALWI MUIN770.00
SHI  2 847.00
81 APT010000I62004314 123536 tn. MUHAMMAD
LANSOPRAZ
ALWI MUIN946.00
SHI  1 1,040.60
82 APT010000I62004314 123536 tn. MUHAMMAD
CAIRANALWI
NAC6,409.70
MUIN SHI  2 7,050.67
83 APT010000I62004314 123536 tn. MUHAMMAD
MASKERALWI
DI MUIN700.00
SHI  2 770.00
84 APT010000I62004360 151249 nn. WULANRANITIDIN
PURNAMASARI 3,000.00
  2 3,300.00
85 APT010000I62004360 151249 nn. WULANONDANSETR2,002.00
PURNAMASARI   2 2,202.20
86 APT010000I62004360 151249 nn. WULANSANMOL
PURNAMASARI
I 24,202.60
  2 26,622.86
87 APT010000I62004360 151249 nn. WULANCEFIXIME
PURNAMASARI 1,337.60
  2 1,471.36
88 APT010000I62004360 151249 nn. WULANHANDSCOEN
PURNAMASARI 478.00
  4 525.80
89 APT010000I62004332 160501 tn. DRS. ANDI
METIL
SUKMA
PRE 44,999.90
  1 49,499.89
 90 APT010000I62004332 160501 tn. DRS. ANDI
RANITIDIN
SUKMA   3,000.00 2 3,300.00
91 APT010000I62004332 160501 tn. DRS. ANDI
MEGABAL
SUKMA   1,730.00 1 1,903.00
92 APT010000I62004332 160501 tn. DRS. ANDI
MELOXICAM
SUKMA   250.00 2 275.00
93 APT010000I62004332 160501 tn. DRS. ANDI
HANDSCOEN
SUKMA   478.00 4 525.80
94 APT010000I62004332 160501 tn. DRS. ANDI
MASKER
SUKMADI   700.00 2 770.00
95 APT010000I62004348 97174 nn. MULIATIRANITIDIN
MUSTIKA  3,000.00 2 3,300.00
96 APT010000I62004348 97174 nn. MULIATIDOMPERID
MUSTIKA  508.20 2 559.02
97 APT010000I62004348 97174 nn. MULIATIKETOROLAC
MUSTIKA  7,350.75 2 8,085.82
98 APT010000I62004348 97174 nn. MULIATISANMOL
MUSTIKA T 297.00 3 326.70
99 APT010000I62004348 97174 nn. MULIATIONDANSETR2,002.00
MUSTIKA  2 2,202.20
100 APT010000I62004348 97174 nn. MULIATISPORETIK
MUSTIKA  5,720.50 2 6,292.55
101 APT010000I62004348 97174 nn. MULIATICAIRAN
MUSTIKA 
FU41,388.90 2 45,527.79
102 APT010000I62004348 97174 nn. MULIATIMASKER
MUSTIKA 
DI 700.00 2 770.00
103 APT010000I62004354 160643 ny. SITTI MATMANI 
DIMENHIDR 121.00 2 133.10
104 APT010000I62004354 160643 ny. SITTI MATMANI 
RANITIDIN 629.99 2 692.99
105 APT010000I62004354 160643 ny. SITTI MATMANI 
MEGABAL 1,730.00 1 1,903.00
106 APT010000I62004354 160643 ny. SITTI MATMANI 
AMLODIPIN 475.19 1 522.71
107 APT010000I62004354 160643 ny. SITTI MATMANI 
CAIRAN RL 7,300.00 1 8,030.00
108 APT010000I62004354 160643 ny. SITTI MATMANI 
MASKER DI 700.00 2 770.00
109 APT010000I62004309 160384 tn. ARINOLSA
ZINK SAPUTRA 
OKSI 604.00 1 664.40
110 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
B 76.33 2 83.96
111 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 9 7,260.00
112 APT010000I62004309 160384 tn. ARINOLSA
HANDSCOEN
SAPUTRA  478.00 4 525.80
113 APT010000I62004309 160384 tn. ARINOLSA
MASKER
SAPUTRA 
DI 700.00 2 770.00
114 APT010000I62004321 160462 ny. RABI  SPORETIK 5,720.50 2 6,292.55
115 APT010000I62004321 160462 ny. RABI  MEFINAL 5 1,391.50 3 1,530.65
116 APT010000I62004321 160462 ny. RABI  RANITIDIN 629.99 3 692.99
117 APT010000I62004321 160462 ny. RABI  SANMOL T 297.00 3 326.70
118 APT010000I62004321 160462 ny. RABI  CAIRAN NAC6,409.70 2 7,050.67
119 APT010000I62004321 160462 ny. RABI  MASKER DI 700.00 2 770.00
120 APT010000I62004321 160462 ny. RABI  SPOIT 3 CC 1,485.00 1 1,633.50
121 APT010000I62004355 160644 nn. A. HASRY
ZINKAINUN
OKSI HAISYAR 
604.00 1 664.40
122 APT010000I62004355 160644 nn. A. HASRY
DOMPERID
AINUN HAISYAR 
508.20 2 559.02
123 APT010000I62004355 160644 nn. A. HASRY
CAIRAN
AINUNRLHAISYAR 
7,300.00 3 8,030.00
124 APT010000I62004355 160644 nn. A. HASRY
MASKER
AINUNDIHAISYAR 
700.00 2 770.00
125 APT010000I62004355 160644 nn. A. HASRY
SPOIT
AINUN
10 CHAISYAR 
2,310.00 2 2,541.00
126 APT010000I32000263 160653 tn. M NIPPINEUROSANB5,324.00
T  1 5,856.40
127 APT010000I32000263 160653 tn. M NIPPINATRIUM
T  D 195.91 2 215.50
128 APT010000I32000263 160653 tn. M NIPPIRECOLFAR
T  4,950.00 3 5,445.00
129 APT010000I32000263 160653 tn. M NIPPIAMLODIPIN
T  475.19 1 522.71
130 APT010000I32000263 160653 tn. M NIPPICAIRAN
T  RL 7,300.00 3 8,030.00
131 APT010000I32000263 160653 tn. M NIPPIMASKER
T  DI 700.00 2 770.00
132 APT010000I32000263 160653 tn. M NIPPIIVT CATHETE 7,750.00 1 8,525.00
133 APT010000I62004344 160557 tn. AWALUDIN
CEFTRIAXO19,999.10
SYAM   3 21,999.01
134 APT010000I62004344 160557 tn. AWALUDIN
DOMPERID
SYAM   508.20 3 559.02
135 APT010000I62004344 160557 tn. AWALUDIN
RANITIDIN
SYAM   3,000.00 2 3,300.00
136 APT010000I62004344 160557 tn. AWALUDIN
SANMOL
SYAMI  24,202.60 2 26,622.86
137 APT010000I62004344 160557 tn. AWALUDIN
CAIRAN
SYAMRL   7,300.00 3 8,030.00
138 APT010000I62004344 160557 tn. AWALUDIN
MASKER
SYAM DI  700.00 2 770.00
139 APT010000I62004344 160557 tn. AWALUDIN
SPOITSYAM
5 CC   1,595.00 1 1,754.50
140 APT010000I62004337 84165 tn. WILLAYANTO 
SANMOL I 24,202.60 3 26,622.86
141 APT010000I62004337 84165 tn. WILLAYANTO 
CAIRAN RL 7,300.00 3 8,030.00
142 APT010000I62004337 84165 tn. WILLAYANTO 
MASKER DI 700.00 2 770.00
143 APT010000I62004337 84165 tn. WILLAYANTO 
IV CATHETE 7,750.00 1 8,525.00
144 APT010000I62004337 84165 tn. WILLAYANTO 
CAIRAN NA15,180.00 1 16,698.00
145 APT010000I62004330 131115 ny. TALLASACEFTRIAXO19,999.10
DG JINNE  2 21,999.01
146 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 3 1,208.79
147 APT010000I62004330 131115 ny. TALLASANEUROSAN
DG JINNE  1,168.50 1 1,285.35
148 APT010000I62004330 131115 ny. TALLASACAIRAN
DG JINNE 
NA15,180.00 2 16,698.00
149 APT010000I62004330 131115 ny. TALLASAALKOHOL
DG JINNE 
S 300.00 1 330.00
150 APT010000I62004330 131115 ny. TALLASAIVDG
CATHETE
JINNE  7,750.00 1 8,525.00
151 APT010000I62004319 160456 ny. MANTASIA
CEFTRIAXO19,999.10
DG KEBO  2 21,999.01
152 APT010000I62004319 160456 ny. MANTASIA
SIMUCIL
DG KEBO 
2 1,760.00 3 1,936.00
153 APT010000I62004319 160456 ny. MANTASIA
RANITIDIN
DG KEBO  3,000.00 2 3,300.00
154 APT010000I62004319 160456 ny. MANTASIA
MEGABAL
DG KEBO  1,730.00 1 1,903.00
155 APT010000I62004319 160456 ny. MANTASIA
ASPILETS
DG KEBO  110.00 1 121.00
156 APT010000I62004319 160456 ny. MANTASIA
PIRACETAM
DG KEBO 10,670.00 1 11,737.00
157 APT010000I62004319 160456 ny. MANTASIA
CAIRAN
DG KEBO 
NAC6,409.70 3 7,050.67
158 APT010000I62004347 160593 ny. KENNIARANITIDIN
RATRI MULYA  629.99 2 692.99
159 APT010000I62004347 160593 ny. KENNIADOMPERID
RATRI MULYA  508.20 3 559.02
160 APT010000I62004347 160593 ny. KENNIANEUROSAN
RATRI MULYA  1,168.50 1 1,285.35
161 APT010000I62004347 160593 ny. KENNIACAIRAN
RATRI MULYA 
RL 7,300.00 2 8,030.00
162 APT010000I62004347 160593 ny. KENNIAMASKER
RATRI MULYA 
DI 700.00 2 770.00
163 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
RANITIDIN 3,000.00 2 3,300.00
164 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
SANTAGESIK4,949.40 2 5,444.34
165 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
MASKER DI 700.00 2 770.00
166 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
HANDSCOEN 478.00 4 525.80
167 APT010000I62004363 160685 ny. NANI .T. 
FUROSEMID2,920.50 2 3,212.55
168 APT010000I62004363 160685 ny. NANI .T. 
CAIRAN RL 7,300.00 2 8,030.00
169 APT010000I62004363 160685 ny. NANI .T. 
MASKER DI 700.00 3 770.00
170 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  2 27,499.67
171 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ONDANSETR2,002.00
BASO  3 2,202.20

172 APT010000I62004333 159705 ny. SITTI MAEMUNAH

CAIRAN AM70,188.80
BASO  2 77,207.68

173 APT010000I62004333 159705 ny. SITTI MAEMUNAH

CAIRAN NAC6,409.70
BASO  2 7,050.67
174 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 
700.00 2 770.00
175 APT010000I62004333 159705 ny. SITTI MAEMUNAH
IV CATHETEBASO 
7,750.00 2 8,525.00
176 APT010000I62004328 160495 ny. BASSE DG.
ZINKKENNA
OKSI   604.00 1 664.40
177 APT010000I62004328 160495 ny. BASSE DG.
NEUROSAN
KENNA   1,168.50 3 1,285.35
178 APT010000I62004328 160495 ny. BASSE DG.
VITAMIN
KENNA
C   71.91 4 79.10
179 APT010000I62004328 160495 ny. BASSE DG.
OMEPRAZOL
KENNA 24,999.70
  2 27,499.67
180 APT010000I62004328 160495 ny. BASSE DG.
ONDANSETR2,002.00
KENNA   3 2,202.20
181 APT010000I62004328 160495 ny. BASSE DG.
CAIRAN
KENNARL   7,300.00 3 8,030.00
182 APT010000I62004328 160495 ny. BASSE DG.
IV CATHETE
KENNA 12,416.00
  1 13,657.60
183 APT010000I62004328 160495 ny. BASSE DG.
ALKOHOL
KENNAS   300.00 2 330.00
184 APT010000I62004328 160495 ny. BASSE DG.
CAIRAN
KENNANA15,180.00
  2 16,698.00
185 APT010000I62004351 118751 nn. DWI ANDIKA
CEFTRIAXO19,999.10
AM NUR  2 21,999.01
186 APT010000I62004351 118751 nn. DWI ANDIKA
RANITIDIN
AM NUR  3,000.00 2 3,300.00
187 APT010000I62004351 118751 nn. DWI ANDIKA
LANSOPRAZ
AM NUR  946.00 2 1,040.60
188 APT010000I62004351 118751 nn. DWI ANDIKA
DOMPERID
AM NUR  508.20 2 559.02
189 APT010000I62004351 118751 nn. DWI ANDIKA
CAIRAN AM RLNUR 
7,300.00 3 8,030.00
190 APT010000I62004351 118751 nn. DWI ANDIKA
CAIRAN AM NA15,180.00
NUR  1 16,698.00
191 APT010000I62004351 118751 nn. DWI ANDIKA
MASKER AMDINUR  700.00 2 770.00
192 APT010000I64002863 160668 tn. HARIS DG
OMEPRAZOL
SE'RE  24,999.70 1 27,499.67
193 APT010000I64002863 160668 tn. HARIS DG
CEFTRIAXO19,999.10
SE'RE  2 21,999.01
194 APT010000I64002863 160668 tn. HARIS DG
PLASMINEX
SE'RE  13,002.00 3 14,302.20
195 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE RL 7,300.00 3 8,030.00
196 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE NA15,180.00 2 16,698.00
197 APT010000I64002863 160668 tn. HARIS DG
MASKER
SE'RE  DI 700.00 2 770.00
198 APT010000I64002863 160668 tn. HARIS DG
INFUS
SE'RE 
SET 17,000.00 1 18,700.00
199 APT010000I62004338 155611 ny. ANDI ALWIAH
INFUSAN   N 6,570.00 3 7,227.00
200 APT010000I62004338 155611 ny. ANDI ALWIAH
MASKER  DI 700.00 1 770.00
201 APT010000I62004338 155611 ny. ANDI ALWIAH
HANDSCOEN
  478.00 2 525.80
202 APT010000I62004338 155611 ny. ANDI ALWIAH
IV CATHETE
  7,750.00 1 8,525.00
203 APT010000I62004338 155611 ny. ANDI ALWIAH
SPOIT 3  CC 1,485.00 1 1,633.50
204 APT010000I62004343 160548 ny. SUGIARTI
INFUSAN
  N 6,570.00 2 7,227.00
205 APT010000I62004343 160548 ny. SUGIARTI
MASKER
  DI 700.00 1 770.00
206 APT010000I62004343 160548 ny. SUGIARTI
HANDSCOEN
  478.00 2 525.80
207 APT010000I62004343 160548 ny. SUGIARTI
IV CATHETE
  7,750.00 1 8,525.00
208 APT010000I62004343 160548 ny. SUGIARTI
IV DRESSI
  4,850.00 1 5,335.00
209 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA  RL 7,300.00 2 8,030.00
210 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 1 770.00
211 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 2 525.80
212 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA  NA15,180.00 1 16,698.00
213 APT010000I62004353 160635 tn. DARWISCONECTA
LAEDDA  25,000.00 1 27,500.00
214 APT010000I62004353 160635 tn. DARWISSUNGKUP
LAEDDA  44,750.00 1 49,225.00
215 APT010000I62004325 160471 ny. SYARIFAH
CAIRAN
ALWIAH 
RL 7,300.00 3 8,030.00
216 APT010000I62004325 160471 ny. SYARIFAH
MASKER
ALWIAH DI 700.00 1 770.00
217 APT010000I62004325 160471 ny. SYARIFAH
HANDSCOEN
ALWIAH  478.00 2 525.80
218 APT010000I62004325 160471 ny. SYARIFAH
IV DRESSI
ALWIAH  4,850.00 1 5,335.00
219 APT010000I62004325 160471 ny. SYARIFAH
IV CATHETE
ALWIAH  7,750.00 1 8,525.00
220 APT010000I62004353 160635 tn. DARWISINFUSAN
LAEDDA N 6,570.00 2 7,227.00
221 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 1 770.00
222 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 2 525.80
223 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA  NA15,180.00 1 16,698.00
224 APT010000I62004353 160635 tn. DARWISIVLAEDDA 
CATHETE 7,750.00 1 8,525.00
225 APT010000I66000405 160570 nn. ROHANI  NEBULIZE 40,535.00 1 44,588.50
226 APT010000I62004346 160565 tn. MOH PADANG
CAIRANRAHANAR 
RL 7,300.00 2 8,030.00
227 APT010000I62004346 160565 tn. MOH PADANG
MASKERRAHANAR 
DI 700.00 1 770.00
228 APT010000I62004346 160565 tn. MOH PADANG
HANDSCOEN
RAHANAR 
478.00 2 525.80
229 APT010000I62004346 160565 tn. MOH PADANG
CONECTA RAHANAR 
25,000.00 1 27,500.00
230 APT010000I62004346 160565 tn. MOH PADANG
IV DRESSI
RAHANAR 
4,850.00 1 5,335.00
231 APT010000I62004346 160565 tn. MOH PADANG
TRANSFUSI28,050.00
RAHANAR  1 30,855.00
232 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 1 770.00
233 APT010000I62004340 155102 tn. DRS. H. IV
ISHAK
CATHETE
ABDIR 7,750.00 1 8,525.00
234 APT010000I62004340 155102 tn. DRS. H. NASAL
ISHAK ABDIR 
CA 11,550.07 1 12,705.07
235 APT010000I62004349 160605 nn. SARTIKA CAIRAN RL 7,300.00 3 8,030.00
236 APT010000I62004349 160605 nn. SARTIKA MASKER DI 700.00 1 770.00
237 APT010000I62004349 160605 nn. SARTIKA HANDSCOEN 478.00 2 525.80
238 APT010000I62004349 160605 nn. SARTIKA SPOIT 10 C 2,310.00 1 2,541.00
239 APT010000I62004349 160605 nn. SARTIKA SPOIT 1 CC 1,920.00 1 2,112.00
240 APT010000I62004335 160511 tn. SUPRIADICAIRAN
PAISAL 
RL 7,300.00 2 8,030.00
241 APT010000I62004335 160511 tn. SUPRIADIMASKER
PAISAL DI 700.00 1 770.00
242 APT010000I62004335 160511 tn. SUPRIADIHANDSCOEN
PAISAL  478.00 2 525.80
243 APT010000I62004335 160511 tn. SUPRIADIIV DRESSI
PAISAL  4,850.00 1 5,335.00
244 APT010000I62004335 160511 tn. SUPRIADICONECTA
PAISAL  25,000.00 1 27,500.00
245 APT010000I62004352 160636 nn. REYSHACAIRAN
NUR SEPTIANI 
RL 7,300.00 2 8,030.00
246 APT010000I62004352 160636 nn. REYSHAMASKER
NUR SEPTIANI 
DI 700.00 1 770.00
247 APT010000I62004352 160636 nn. REYSHASPOIT
NUR 3SEPTIANI 
CC 1,485.00 1 1,633.50
248 APT010000I62004352 160636 nn. REYSHACAIRAN
NUR SEPTIANI 
NA15,180.00 1 16,698.00
249 APT010000I62004352 160636 nn. REYSHAIVNURCATHETE
SEPTIANI 
7,750.00 1 8,525.00
250 APT010000I62004357 129453 ny. NURBAENAH 
CAIRAN RL 7,300.00 3 8,030.00
251 APT010000I62004357 129453 ny. NURBAENAH 
MASKER DI 700.00 1 770.00
252 APT010000I62004357 129453 ny. NURBAENAH 
HANDSCOEN 478.00 2 525.80
253 APT010000I62004357 129453 ny. NURBAENAH 
NASAL CA 11,550.07 1 12,705.07
254 APT010000I62004357 129453 ny. NURBAENAH 
NEBULIZE 40,535.00 1 44,588.50
255 APT010000I62004359 160674 ny. NURSIAH INFUSAN N 6,570.00 2 7,227.00
256 APT010000I62004359 160674 ny. NURSIAH MASKER DI 700.00 1 770.00
257 APT010000I62004359 160674 ny. NURSIAH HANDSCOEN 478.00 2 525.80
258 APT010000I62004359 160674 ny. NURSIAH SPOIT 5 CC 1,595.00 1 1,754.50
259 APT010000I62004359 160674 ny. NURSIAH SPOIT 3 CC 1,485.00 1 1,633.50
260 APT010000I62004339 160516 ny. HUSNAWATI 
INFUSAN N 6,570.00 2 7,227.00
261 APT010000I62004339 160516 ny. HUSNAWATI 
MASKER DI 700.00 1 770.00
262 APT010000I62004339 160516 ny. HUSNAWATI 
HANDSCOEN 478.00 2 525.80
263 APT010000I62004339 160516 ny. HUSNAWATI 
IV DRESSI 4,850.00 1 5,335.00
264 APT010000I62004339 160516 ny. HUSNAWATI 
CONECTA 25,000.00 1 27,500.00
265 APT010000I62004358 160665 ny. MURNIATICEFTRIAXO19,999.10
REMPE  1 21,999.01
266 APT010000I62004358 160665 ny. MURNIATIARMREMPE 
SLIM 68,750.00 1 75,625.00
267 APT010000I62004358 160665 ny. MURNIATICAIRAN
REMPE 
RL 7,300.00 2 8,030.00
268 APT010000I62004358 160665 ny. MURNIATIMASKER
REMPE DI 700.00 1 770.00
 269 APT010000I62004358 160665 ny. MURNIATI
IV DRESSI
REMPE  4,850.00 1 5,335.00
270 APT010000I62004358 160665 ny. MURNIATI
CAIRAN
REMPE 
AQ 2,860.00 2 3,146.00
271 APT010000I62004309 160384 tn. ARINOLSA
CAIRAN
SAPUTRA 
SAL27,830.00 1 30,613.00
272 APT010000I62004309 160384 tn. ARINOLSA
RIFASTAR
SAPUTRA 5,115.00 3 5,626.50
273 APT010000I62004365 160707 ny. FITRIANI 
CAIRAN RL 7,300.00 1 8,030.00
274 APT010000I62004365 160707 ny. FITRIANI 
COMBO PAC 60,500.00 1 66,550.00
275 APT010000I62004365 160707 ny. FITRIANI 
SPOIT 3 CC 1,485.00 3 1,633.50
276 APT010000I62004365 160707 ny. FITRIANI 
HANDSCOEN 478.00 2 525.80
277 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 3,000.00 1 3,300.00
278 APT010000I62004365 160707 ny. FITRIANI 
KETOROLAC 7,350.75 1 8,085.82
279 APT010000I62004365 160707 ny. FITRIANI 
ONDANSETR2,002.00 1 2,202.20
280 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 3,000.00 2 3,300.00
281 APT010000I62004365 160707 ny. FITRIANI 
ONDANSETR2,002.00 2 2,202.20
282 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 629.99 1 692.99
283 APT010000I62004365 160707 ny. FITRIANI 
DOMPERID 508.20 3 559.02
284 APT010000I62004328 160495 ny. BASSE DG.
SOTATIC
KENNAI   3,032.00 1 3,335.20
Sub Total   570
PCS 4,206.40

PCS 2,942.72
PCS 7,227.00
PCS 79,868.58
PCS 5,856.40
PCS 2,420.01
PCS 54,999.34
PCS 1,456.74
PCS 2,606.34
PCS 495.00
PCS 1,285.35
PCS 780.45
PCS 33,008.80
PCS 24,257.46
PCS 6,600.00
PCS 27,225.00
PCS 65,997.03
PCS 79,868.58
PCS 5,856.40
PCS 6,600.00
PCS 980.10
PCS 54,999.34
PCS 1,544.40
PCS 980.10
PCS 1,285.35
PCS 54,999.34
PCS 2,081.20
PCS 980.10
PCS 75,504.00
PCS 16,171.64
PCS 6,600.00
PCS 18,146.55
PCS 27,207.40
PCS 6,425.10
PCS 22,022.00
PCS 23,100.00
PCS 22,772.20
PCS 27,225.00
PCS 922.01
PCS 59,040.08
PCS 1,903.00
PCS 6,606.60
PCS 27,499.67
PCS 43,998.02
PCS 6,425.10
PCS 54,558.90
PCS 54,558.90
PCS 54,999.34
PCS 3,212.55
PCS 43,998.02
PCS 922.01
PCS 28,604.40
PCS 16,171.64
PCS 643.50
PCS 79,868.58
PCS 1,984.40
PCS 9,900.00
PCS 922.01
PCS 742.74
PCS 33,008.80
PCS 16,171.64
PCS 6,600.00
PCS 4,404.40
PCS 219.99
PCS 395.01
PCS 867.90
PCS 3,025.00
PCS 419.85
PCS 7,054.30
PCS 7,050.67
PCS 5,258.00
PCS 43,998.02
PCS 6,600.00
PCS 84,700.00
PCS 98,999.78
PCS 4,404.40
PCS 5,258.00
PCS 43,998.02
PCS 27,225.00
PCS 1,694.00
PCS 1,040.60
PCS 14,101.34
PCS 1,540.00
PCS 6,600.00
PCS 4,404.40
PCS 53,245.72
PCS 2,942.72
PCS 2,103.20
PCS 49,499.89
PCS 6,600.00
PCS 1,903.00
PCS 550.00
PCS 2,103.20
PCS 1,540.00
PCS 6,600.00
PCS 1,118.04
PCS 16,171.64
PCS 980.10
PCS 4,404.40
PCS 12,585.10
PCS 91,055.58
PCS 1,540.00
PCS 266.20
PCS 1,385.98
PCS 1,903.00
PCS 522.71
PCS 8,030.00
PCS 1,540.00
PCS 664.40
PCS 167.92
PCS 65,340.00
PCS 2,103.20
PCS 1,540.00
PCS 12,585.10
PCS 4,591.95
PCS 2,078.97
PCS 980.10
PCS 14,101.34
PCS 1,540.00
PCS 1,633.50
PCS 664.40
PCS 1,118.04
PCS 24,090.00
PCS 1,540.00
PCS 5,082.00
PCS 5,856.40
PCS 431.00
PCS 16,335.00
PCS 522.71
PCS 24,090.00
PCS 1,540.00
PCS 8,525.00
PCS 65,997.03
PCS 1,677.06
PCS 6,600.00
PCS 53,245.72
PCS 24,090.00
PCS 1,540.00
PCS 1,754.50
PCS 79,868.58
PCS 24,090.00
PCS 1,540.00
PCS 8,525.00
PCS 16,698.00
PCS 43,998.02
PCS 3,626.37
PCS 1,285.35
PCS 33,396.00
PCS 330.00
PCS 8,525.00
PCS 43,998.02
PCS 5,808.00
PCS 6,600.00
PCS 1,903.00
PCS 121.00
PCS 11,737.00
PCS 21,152.01
PCS 1,385.98
PCS 1,677.06
PCS 1,285.35
PCS 16,060.00
PCS 1,540.00
PCS 6,600.00
PCS 10,888.68
PCS 1,540.00
PCS 2,103.20
PCS 6,425.10
PCS 16,060.00
PCS 2,310.00
PCS 54,999.34
PCS 6,606.60
154,415.3
PCS
6
PCS 14,101.34
PCS 1,540.00
PCS 17,050.00
PCS 664.40
PCS 3,856.05
PCS 316.40
PCS 54,999.34
PCS 6,606.60
PCS 24,090.00
PCS 13,657.60
PCS 660.00
PCS 33,396.00
PCS 43,998.02
PCS 6,600.00
PCS 2,081.20
PCS 1,118.04
PCS 24,090.00
PCS 16,698.00
PCS 1,540.00
PCS 27,499.67
PCS 43,998.02
PCS 42,906.60
PCS 24,090.00
PCS 33,396.00
PCS 1,540.00
PCS 18,700.00
PCS 21,681.00
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 1,633.50
PCS 14,454.00
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 5,335.00
PCS 16,060.00
PCS 770.00
PCS 1,051.60
PCS 16,698.00
PCS 27,500.00
PCS 49,225.00
PCS 24,090.00
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 8,525.00
PCS 14,454.00
PCS 770.00
PCS 1,051.60
PCS 16,698.00
PCS 8,525.00
PCS 44,588.50
PCS 16,060.00
PCS 770.00
PCS 1,051.60
PCS 27,500.00
PCS 5,335.00
PCS 30,855.00
PCS 770.00
PCS 8,525.00
PCS 12,705.07
PCS 24,090.00
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 2,112.00
PCS 16,060.00
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 27,500.00
PCS 16,060.00
PCS 770.00
PCS 1,633.50
PCS 16,698.00
PCS 8,525.00
PCS 24,090.00
PCS 770.00
PCS 1,051.60
PCS 12,705.07
PCS 44,588.50
PCS 14,454.00
PCS 770.00
PCS 1,051.60
PCS 1,754.50
PCS 1,633.50
PCS 14,454.00
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 27,500.00
PCS 21,999.01
PCS 75,625.00
PCS 16,060.00
PCS 770.00
PCS 5,335.00
PCS 6,292.00
PCS 30,613.00
PCS 16,879.50
PCS 8,030.00
PCS 66,550.00
PCS 4,900.50
PCS 1,051.60
PCS 3,300.00
PCS 8,085.82
PCS 2,202.20
PCS 6,600.00
PCS 4,404.40
PCS 692.99
PCS 1,677.06
PCS 3,335.20
4,345,891.15
03-12-
1 APT010000I62004366 160708 tn. SYAMSUL
ASAM
ALI  TRAN3,753.20 3 4,128.52
2018 
2 APT010000I62004366 160708 tn. SYAMSUL RANITIDIN
ALI  3,000.00 2 3,300.00
3 APT010000I62004366 160708 tn. SYAMSUL SPOIT
ALI 3 CC 1,485.00 1 1,633.50
4 APT010000I62004366 160708 tn. SYAMSUL SPOIT
ALI 5 CC 1,595.00 1 1,754.50
5 APT010000I62004368 160718 tn. HENRA RANITIDIN 3,000.00 1 3,300.00
6 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 1 8,085.82
7 APT010000I62004368 160718 tn. HENRA SPOIT 3 CC 1,485.00 2 1,633.50
8 APT010000I62004368 160718 tn. HENRA INFUSAN N 6,570.00 1 7,227.00
9 APT010000I62004363 160685 ny. NANI .T. 
IV CATHETE12,416.00 3 13,657.60
10 APT010000I62004363 160685 ny. NANI .T. 
CAIRAN DE10,010.00 2 11,011.00
11 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  946.00 1 1,040.60
12 APT010000I62004340 155102 tn. DRS. H. PARACETA
ISHAK ABDIR  220.72 3 242.79
13 APT010000I62004340 155102 tn. DRS. H. CARBAZOC11,145.20
ISHAK ABDIR  3 12,259.72
14 APT010000I62004340 155102 tn. DRS. H. ARDIUM
ISHAK ABDIR 
8,316.00 3 9,147.60
15 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
NAC6,409.70 3 7,050.67
16 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  3,000.00 2 3,300.00
17 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 2 8,085.82
18 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,300.00 3 8,030.00
19 APT010000I62004325 160471 ny. SYARIFAHSPORETIK
ALWIAH  5,720.50 6 6,292.55
20 APT010000I62004325 160471 ny. SYARIFAHASAMALWIAH 
MEF 325.00 9 357.50
21 APT010000I62004325 160471 ny. SYARIFAHRANITIDIN
ALWIAH  629.99 6 692.99
22 APT010000I62004335 160511 tn. SUPRIADICEFIXIME
PAISAL  4,499.99 6 4,949.99
23 APT010000I62004335 160511 tn. SUPRIADIASAM
PAISAL 
MEF 325.00 6 357.50
24 APT010000I62004335 160511 tn. SUPRIADIMETRONIDA
PAISAL  285.00 9 313.50
25 APT010000I32000262 160440 tn. ABDUL WAHID
ASPILETSWALANGADI 
110.00 1 121.00
26 APT010000I32000262 160440 tn. ABDUL WAHID
FARSORBIDWALANGADI 
306.00 1 336.60
27 APT010000I32000262 160440 tn. ABDUL WAHID
ATORVASTA6,435.00
WALANGADI  1 7,078.50
28 APT010000I32000262 160440 tn. ABDUL WAHID
BISOPROLOWALANGADI 
726.00 1 798.60
29 APT010000I32000262 160440 tn. ABDUL WAHID
PARACETA WALANGADI 
220.72 3 242.79
30 APT010000I32000262 160440 tn. ABDUL WAHID
CONCORWALANGADI 
2. 597.00 1 656.70
31 APT010000I62004368 160718 tn. HENRA MECOBALAM6,600.00 1 7,260.00
32 APT010000I62004368 160718 tn. HENRA GABAPENTI 4,400.00 2 4,840.00
33 APT010000I62004368 160718 tn. HENRA CANGKANG 116.90 6 128.59
34 APT010000I62004368 160718 tn. HENRA AMITRIPTY 177.65 2 195.41
35 APT010000I62004368 160718 tn. HENRA METIL PRE 44,999.90 2 49,499.89
36 APT010000I62004368 160718 tn. HENRA RANITIDIN 3,000.00 2 3,300.00
37 APT010000I62004368 160718 tn. HENRA AMBROXOL 330.00 6 363.00
38 APT010000I62004368 160718 tn. HENRA CANGKANG 116.90 6 128.59
39 APT010000I62004368 160718 tn. HENRA CODEIN 20 1,494.00 3 1,643.40
40 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
41 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR2,002.00 1 2,202.20
42 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
43 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
44 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 27,505.00 4 30,255.50

45 APT010000I66000404 159099 ny. SITTI MULIYANA 

MECOBALA 616.00 1 677.60
46 APT010000I66000404 159099 ny. SITTI MULIYANA 
PARACETA 220.72 5 242.79
47 APT010000I66000404 159099 ny. SITTI MULIYANA 
CANGKANG 116.90 6 128.59
48 APT010000I66000404 159099 ny. SITTI MULIYANA 
CLOBAZAM 1,116.84 3 1,228.53
49 APT010000I62004358 160665 ny. MURNIATI
CEFTRIAXO19,999.10
REMPE  1 21,999.01
50 APT010000I62004358 160665 ny. MURNIATI
KETOROLAC
REMPE  7,350.75 3 8,085.82
51 APT010000I62004358 160665 ny. MURNIATI
RANITIDIN
REMPE  3,000.00 3 3,300.00
52 APT010000I62004358 160665 ny. MURNIATI
CAIRAN
REMPE 
RL 7,300.00 3 8,030.00
53 APT010000I62004358 160665 ny. MURNIATI
MASKER
REMPE 
DI 700.00 1 770.00
54 APT010000I62004358 160665 ny. MURNIATI
IV DRESSI
REMPE  4,850.00 1 5,335.00
55 APT010000I62004359 160674 ny. NURSIAH 
CEFTRIAXO19,999.10 3 21,999.01
56 APT010000I62004359 160674 ny. NURSIAH 
SANMOL I 24,202.60 3 26,622.86
57 APT010000I62004359 160674 ny. NURSIAH 
CAIRAN DE18,920.00 2 20,812.00
58 APT010000I62004359 160674 ny. NURSIAH 
CAIRAN NAC6,409.70 2 7,050.67
59 APT010000I62004365 160707 ny. FITRIANI 
ONDANSETR2,002.00 2 2,202.20
60 APT010000I62004365 160707 ny. FITRIANI 
DOMPERID 508.20 2 559.02
61 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 3,000.00 2 3,300.00
62 APT010000I62004365 160707 ny. FITRIANI 
CAIRAN NAC6,409.70 3 7,050.67
63 APT010000I62004343 160548 ny. SUGIARTI
CAIRAN
  NAC6,409.70 3 7,050.67
64 APT010000I62004343 160548 ny. SUGIARTI
CAIRAN
  AM70,188.80 1 77,207.68
65 APT010000I62004343 160548 ny. SUGIARTI
METIL
  PRE 702.00 2 772.20
66 APT010000I62004275 159982 tn. SULHAM CAIRAN SAL27,830.00 1 30,613.00
67 APT010000I62004275 159982 tn. SULHAM CAIRAN NAC6,409.70 1 7,050.67
68 APT010000I62004349 160605 nn. SARTIKA 
BETAHISTI 733.33 9 806.67
69 APT010000I62004349 160605 nn. SARTIKA 
LANSOPRAZ 946.00 6 1,040.60
70 APT010000I62004349 160605 nn. SARTIKA 
PARACETA 220.72 4 242.79
71 APT010000I62004349 160605 nn. SARTIKA 
SOTATIC T 394.90 2 434.39
72 APT010000I62004349 160605 nn. SARTIKA 
CANGKANG 116.90 4 128.59
73 APT010000I62004349 160605 nn. SARTIKA 
NEURODEX 400.00 3 440.00
74 APT010000I62004349 160605 nn. SARTIKA 
VALISANBE 236.50 2 260.15
75 APT010000I62004346 160565 tn. MOH PADANG
LANSOPRAZ
RAHANAR 
946.00 3 1,040.60
76 APT010000I62004338 155611 ny. ANDI ALWIAH
INTERHIST
  768.08 2 844.88
77 APT010000I62004338 155611 ny. ANDI ALWIAH
MICONAZOL3,925.90
  1 4,318.49
78 APT010000I62004338 155611 ny. ANDI ALWIAH
ASAM SALI
  100.00 3 110.00
79 APT010000I62004338 155611 ny. ANDI ALWIAH
POT SALEP
  2,000.00 1 2,200.00
80 APT010000I62004338 155611 ny. ANDI ALWIAH
METRONIDA8,250.00
  3 9,075.00
81 APT010000I62004338 155611 ny. ANDI ALWIAH
AMLODIPIN
  838.19 3 922.01
82 APT010000I62004338 155611 ny. ANDI ALWIAH
PARACETA
  220.72 3 242.79
83 APT010000I62004357 129453 ny. NURBAENAH 
AMLODIPIN 838.19 1 922.01
84 APT010000I62004357 129453 ny. NURBAENAH 
RAMIPRIL 1,062.77 1 1,169.04
85 APT010000I62004357 129453 ny. NURBAENAH 
HCT 25 MG 128.00 1 140.80
86 APT010000I62004357 129453 ny. NURBAENAH 
RANITIDIN 3,000.00 3 3,300.00
87 APT010000I62004357 129453 ny. NURBAENAH 
CAIRAN NAC6,409.70 2 7,050.67
 88 APT010000I62004357 129453 ny. NURBAENAH 
CAIRAN NA15,180.00 1 16,698.00
89 APT010000I62004352 160636 nn. REYSHARANITIDIN
NUR SEPTIANI  629.99 6 692.99
90 APT010000I62004352 160636 nn. REYSHADIMENHIDR
NUR SEPTIANI  121.00 6 133.10
91 APT010000I62004352 160636 nn. REYSHAZINK
NUROKSI
SEPTIANI 
604.00 3 664.40
92 APT010000I62004366 160708 tn. SYAMSULRANITIDIN
ALI  3,000.00 2 3,300.00
93 APT010000I62004366 160708 tn. SYAMSULASAM
ALI  TRAN3,753.20 2 4,128.52
94 APT010000I62004366 160708 tn. SYAMSULCAIRAN
ALI  RL 7,300.00 3 8,030.00
95 APT010000I62004366 160708 tn. SYAMSULCODEIN
ALI  20 1,494.00 3 1,643.40
96 APT010000I62004347 160593 ny. KENNIALANSOPRAZ
RATRI MULYA  946.00 3 1,040.60
97 APT010000I62004347 160593 ny. KENNIADOMPERID
RATRI MULYA  508.20 6 559.02
98 APT010000I62004347 160593 ny. KENNIACAIRAN
RATRI MULYA 
RL 7,300.00 2 8,030.00
99 APT010000I62004347 160593 ny. KENNIAHANDSCOEN
RATRI MULYA  478.00 4 525.80
100 APT010000I62004309 160384 tn. ARINOLSA
KSRSAPUTRA 
600 M 3,069.14 6 3,376.05
101 APT010000I62004309 160384 tn. ARINOLSA
CEFTAZIDIM
SAPUTRA  23,166.00 3 25,482.60
102 APT010000I62004309 160384 tn. ARINOLSA
RIFASTAR
SAPUTRA 5,115.00 3 5,626.50
103 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 9 7,260.00
104 APT010000I62004309 160384 tn. ARINOLSA
ZINKSAPUTRA 
OKSI 604.00 1 664.40
105 APT010000I62004309 160384 tn. ARINOLSA
NEURODEX
SAPUTRA  400.00 1 440.00
106 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 125.84 4 138.42
107 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 1 79.10
108 APT010000I62004319 160456 ny. MANTASIA
PIRACETAM
DG KEBO  1,293.60 1 1,422.96
109 APT010000I62004319 160456 ny. MANTASIA
RANITIDIN
DG KEBO  629.99 2 692.99
110 APT010000I62004319 160456 ny. MANTASIA
CITICOLIN
DG KEBO  6,101.33 2 6,711.47
111 APT010000I62004319 160456 ny. MANTASIA
MECOBALA
DG KEBO  616.00 1 677.60
112 APT010000I62004319 160456 ny. MANTASIA
ASPILETS
DG KEBO  110.00 1 121.00
113 APT010000I64002863 160668 tn. HARIS DG
CEFTRIAXO19,999.10
SE'RE  2 21,999.01
114 APT010000I64002863 160668 tn. HARIS DG
ASAM
SE'RE 
TRAN3,753.20 3 4,128.52
115 APT010000I64002863 160668 tn. HARIS DG
INFUS
SE'RE 
SET 17,000.00 1 18,700.00
116 APT010000I64002863 160668 tn. HARIS DG
IV CATHETE
SE'RE  7,750.00 1 8,525.00
117 APT010000I64002863 160668 tn. HARIS DG
SPOIT
SE'RE 
3 CC 1,485.00 1 1,633.50
118 APT010000I62004319 160456 ny. MANTASIA
SPORETIK
DG KEBO  5,720.50 2 6,292.55
119 APT010000I62004319 160456 ny. MANTASIA
HANDSCOEN
DG KEBO  478.00 4 525.80
120 APT010000I62004319 160456 ny. MANTASIA
CAIRAN
DG KEBO 
DE18,920.00 2 20,812.00
121 APT010000I62004319 160456 ny. MANTASIA
MASKER
DG KEBO 
DI 700.00 2 770.00
122 APT010000I62004319 160456 ny. MANTASIA
INFUSDGSET
KEBO 
17,000.00 1 18,700.00
123 APT010000I62004337 84165 tn. WILLAYANTO 
CEFTRIAXO19,999.10 3 21,999.01
124 APT010000I62004337 84165 tn. WILLAYANTO 
PARACETA 220.72 3 242.79
125 APT010000I62004337 84165 tn. WILLAYANTO 
CAIRAN RL 7,300.00 2 8,030.00
126 APT010000I62004337 84165 tn. WILLAYANTO 
CAIRAN AQ 2,860.00 1 3,146.00
127 APT010000I62004337 84165 tn. WILLAYANTO 
CONECTA 10,325.00 1 11,357.50
128 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
RANITIDIN 3,000.00 2 3,300.00
129 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
SANTAGESIK4,949.40 2 5,444.34
130 APT010000I62004344 160557 tn. AWALUDIN
CEFTRIAXO19,999.10
SYAM   3 21,999.01
131 APT010000I62004344 160557 tn. AWALUDIN
RANITIDIN
SYAM   3,000.00 2 3,300.00
132 APT010000I62004344 160557 tn. AWALUDIN
DOMPERID
SYAM   508.20 3 559.02
133 APT010000I62004360 151249 nn. WULANRANITIDIN
PURNAMASARI 3,000.00
  2 3,300.00
134 APT010000I62004360 151249 nn. WULANONDANSETR2,002.00
PURNAMASARI   2 2,202.20
135 APT010000I62004360 151249 nn. WULANCEFIXIME
PURNAMASARI 1,337.60
  2 1,471.36
136 APT010000I62004360 151249 nn. WULANCAIRAN
PURNAMASARI
RL 7,300.00
  2 8,030.00
137 APT010000I62004360 151249 nn. WULANHANDSCOEN
PURNAMASARI 478.00
  4 525.80
138 APT010000I62004360 151249 nn. WULANIVPURNAMASARI
CATHETE 7,750.00
  1 8,525.00
139 APT010000I62004360 151249 nn. WULANCAIRAN
PURNAMASARI
AQ 2,860.00
  1 3,146.00
140 APT010000I62004321 160462 ny. RABI  RANITIDIN 629.99 6 692.99
141 APT010000I62004321 160462 ny. RABI  SPORETIK 5,720.50 6 6,292.55
142 APT010000I62004321 160462 ny. RABI  HANDSCOEN 478.00 4 525.80
143 APT010000I62004321 160462 ny. RABI  MASKER DI 700.00 2 770.00
144 APT010000I62004351 118751 nn. DWI ANDIKA
CEFTRIAXO19,999.10
AM NUR  2 21,999.01
145 APT010000I62004351 118751 nn. DWI ANDIKA
RANITIDIN
AM NUR  629.99 2 692.99
146 APT010000I62004351 118751 nn. DWI ANDIKA
LANSOPRAZ
AM NUR  946.00 2 1,040.60
147 APT010000I62004351 118751 nn. DWI ANDIKA
INFUS AM
SET NUR 
17,000.00 1 18,700.00
148 APT010000I62004351 118751 nn. DWI ANDIKA
CONECTA
AM NUR 
10,325.00 1 11,357.50
149 APT010000I62004351 118751 nn. DWI ANDIKA
NEBULIZE
AM NUR 
40,535.00 1 44,588.50
150 APT010000I62004332 160501 tn. DRS. ANDI
MECOBALA
SUKMA   616.00 1 677.60
151 APT010000I62004332 160501 tn. DRS. ANDI
RANITIDIN
SUKMA   629.99 2 692.99
152 APT010000I62004332 160501 tn. DRS. ANDI
METIL
SUKMA
PRE 44,999.90
  1 49,499.89
153 APT010000I62004332 160501 tn. DRS. ANDI
CAIRAN
SUKMARL   7,300.00 2 8,030.00
154 APT010000I62004332 160501 tn. DRS. ANDI
HANDSCOEN
SUKMA   478.00 4 525.80
155 APT010000I62004332 160501 tn. DRS. ANDI
CAIRAN
SUKMANAC6,409.70
  2 7,050.67
156 APT010000I64002859 160634 tn. ABDUL RAZAK
AZITROMYC
RAMANG 
1,777.99 1 1,955.79
157 APT010000I64002859 160634 tn. ABDUL RAZAK
CEFTRIAXO19,999.10
RAMANG  2 21,999.01
158 APT010000I64002859 160634 tn. ABDUL RAZAK
HANDSCOEN
RAMANG  478.00 4 525.80
159 APT010000I64002859 160634 tn. ABDUL RAZAK
MASKER RAMANG 
DI 700.00 2 770.00
160 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID2,920.50
RAMANG  2 3,212.55
161 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG  838.19 1 922.01
162 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
163 APT010000I62004330 131115 ny. TALLASASIMUCIL
DG JINNE 
2 1,760.00 3 1,936.00
164 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 3 1,208.79
165 APT010000I62004330 131115 ny. TALLASANEURODEX
DG JINNE  400.00 1 440.00
166 APT010000I62004330 131115 ny. TALLASALANSOPRAZ
DG JINNE  946.00 1 1,040.60
167 APT010000I62004330 131115 ny. TALLASADOMPERID
DG JINNE  508.20 3 559.02
168 APT010000I62004330 131115 ny. TALLASAHANDSCOEN
DG JINNE  478.00 6 525.80
169 APT010000I62004355 160644 nn. A. HASRY
RANITIDIN
AINUN HAISYAR 
629.99 6 692.99
170 APT010000I62004355 160644 nn. A. HASRY
ZINK
AINUN
OKSI HAISYAR 
604.00 3 664.40
171 APT010000I62004355 160644 nn. A. HASRY
DOMPERID
AINUN HAISYAR 
508.20 6 559.02
172 APT010000I62004355 160644 nn. A. HASRY
HANDSCOEN
AINUN HAISYAR 
478.00 4 525.80
173 APT010000I62004355 160644 nn. A. HASRY
MASKER
AINUNDIHAISYAR 
700.00 2 770.00
174 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  2 27,499.67
175 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ONDANSETR2,002.00
BASO  2 2,202.20
176 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN RL BASO 
7,300.00 2 8,030.00
177 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOEN BASO 
478.00 4 525.80
178 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN NAC6,409.70
BASO  1 7,050.67
179 APT010000I62004354 160643 ny. SITTI MATMANI 
DIMENHIDR 121.00 6 133.10
180 APT010000I62004354 160643 ny. SITTI MATMANI 
RANITIDIN 629.99 6 692.99
181 APT010000I62004354 160643 ny. SITTI MATMANI 
MECOBALA 616.00 3 677.60
182 APT010000I62004354 160643 ny. SITTI MATMANI 
AMLODIPIN 475.19 3 522.71
183 APT010000I62004354 160643 ny. SITTI MATMANI 
CAIRAN AS 9,646.00 2 10,610.60
184 APT010000I62004354 160643 ny. SITTI MATMANI 
CLOPIDOGR 4,033.33 3 4,436.67
185 APT010000I62004354 160643 ny. SITTI MATMANI 
ATORVASTA6,435.00 3 7,078.50
186 APT010000I62004354 160643 ny. SITTI MATMANI 
CITICOLIN 6,101.33 6 6,711.47
187 APT010000I62004348 97174 nn. MULIATICEFIXIME
MUSTIKA  4,499.99 6 4,949.99
188 APT010000I62004348 97174 nn. MULIATIRANITIDIN
MUSTIKA  629.99 6 692.99
189 APT010000I62004348 97174 nn. MULIATILAKTULOSA
MUSTIKA 30,250.00 1 33,275.00
190 APT010000I62004363 160685 ny. NANI .T. 
NEFROSTER49,599.00 1 54,558.90
191 APT010000I62004363 160685 ny. NANI .T. 
FUROSEMID 190.99 3 210.09
192 APT010000I62004363 160685 ny. NANI .T. 
AMLODIPIN 838.19 3 922.01
193 APT010000I32000263 160653 tn. M NIPPIRANITIDIN
T  3,000.00 2 3,300.00
194 APT010000I32000263 160653 tn. M NIPPINATRIUM
T  D 195.91 2 215.50
195 APT010000I32000263 160653 tn. M NIPPIRECOLFAR
T  4,950.00 3 5,445.00
196 APT010000I32000263 160653 tn. M NIPPIAMLODIPIN
T  475.19 1 522.71
197 APT010000I62004314 123536 tn. MUHAMMAD
CEFIXIME
ALWI 4,499.99
MUIN SHI  2 4,949.99
198 APT010000I62004314 123536 tn. MUHAMMAD
LEVOFLOXA
ALWI MUIN
449.00
SHI  1 493.90
199 APT010000I62004314 123536 tn. MUHAMMAD
LANSOPRAZ
ALWI MUIN
946.00
SHI  1 1,040.60
200 APT010000I62004314 123536 tn. MUHAMMAD
DOMPERID
ALWI MUIN
508.20
SHI  3 559.02
201 APT010000I62004314 123536 tn. MUHAMMAD
ALPRAZOLA
ALWI MUIN
585.00
SHI  2 643.50
202 APT010000I62004328 160495 ny. BASSE DG.
SCOPAMIN
KENNA   1,121.00 9 1,233.10
203 APT010000I62004328 160495 ny. BASSE DG.
CANGKANG
KENNA   116.90 9 128.59
204 APT010000I62004328 160495 ny. BASSE DG.
ALPRAZOLA
KENNA   585.00 4 643.50
205 APT010000I62004328 160495 ny. BASSE DG.
ZINKKENNA
OKSI   604.00 1 664.40
206 APT010000I62004328 160495 ny. BASSE DG.
NEURODEX
KENNA   400.00 1 440.00
207 APT010000I62004328 160495 ny. BASSE DG.
VITAMIN
KENNAC   125.84 4 138.42
208 APT010000I62004328 160495 ny. BASSE DG.
ONDANSETR2,002.00
KENNA   3 2,202.20
209 APT010000I62004364 160621 an. D ALISHA
PARACETA
KUSUMA PUTRI
5,065.50
A  1 5,572.05
210 APT010000I31000534 65833 tn. DR. H SINRING
CAIRANYASIN 
NAC6,409.70 1 7,050.67
211 APT010000I31000534 65833 tn. DR. H SINRING
FUROSEMID2,920.50
YASIN  1 3,212.55
212 APT010000I31000534 65833 tn. DR. H SINRING
DIGOKSIN
YASIN 107.12 1 117.83
213 APT010000I31000534 65833 tn. DR. H SINRING
CAPTOPRIL
YASIN  94.05 3 103.45
214 APT010000I31000534 65833 tn. DR. H SINRING
SIMARCYASIN 
TA 975.98 1 1,073.58
215 APT010000I31000534 65833 tn. DR. H SINRING
COMBOYASIN 
KAT
60,500.00 1 66,550.00
216 APT010000I31000534 65833 tn. DR. H SINRING
CAIRANYASIN 
AQ 2,860.00 1 3,146.00
217 APT010000I31000534 65833 tn. DR. H SINRING
HANDSCOEN
YASIN 478.00 2 525.80
218 APT010000I32000263 160653 tn. M NIPPIRECOLFAR
T  4,950.00 3 5,445.00
219 APT010000I32000263 160653 tn. M NIPPIALLOPURIN
T  248.02 1 272.83
220 APT010000I32000263 160653 tn. M NIPPILANSOPRAZ
T  946.00 2 1,040.60
221 APT010000I32000263 160653 tn. M NIPPINATRIUM
T  D 195.91 2 215.50
222 APT010000I64002859 160634 tn. ABDUL RAZAK
LAKTULOSA
RAMANG 
30,250.00 1 33,275.00
223 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
EPISAN SU 51,150.00 1 56,265.00
224 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
CEFIXIME 4,499.99 2 4,949.99
225 APT010000I64002863 160668 tn. HARIS DG
FLEET
SE'RE 
PH 72,600.00 1 79,860.00
226 APT010000I62004366 160708 tn. SYAMSULLEVEMIR
ALI  F 83,950.00 1 92,345.00
227 APT010000I62004366 160708 tn. SYAMSULAPIDRA
ALI  86,999.88 1 95,699.87
228 APT010000I66000405 160570 nn. ROHANI SPOIT 3 CC 1,485.00 1 1,633.50
229 APT010000I62004360 151249 nn. WULANLANSOPRAZ
PURNAMASARI 946.00
  2 1,040.60
230 APT010000I62004360 151249 nn. WULANNEUROSAN
PURNAMASARI 1,168.50
  1 1,285.35
231 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
RL 7,300.00
  1 8,030.00
232 APT010000I31000535 160729 ny. HJ. ANDI
RANITIDIN
B HARNIATI 3,000.00
  1 3,300.00
233 APT010000I31000535 160729 ny. HJ. ANDI
NEUROSANB5,324.00
B HARNIATI   1 5,856.40
234 APT010000I31000535 160729 ny. HJ. ANDI
SPOIT
B HARNIATI
3 CC 1,485.00
  2 1,633.50
235 APT010000I62004339 160516 ny. HUSNAWATI 
LANSOPRAZ 946.00 3 1,040.60
236 APT010000I66000405 160570 nn. ROHANI SIMVASTAT 1,006.00 2 1,106.60
237 APT010000I66000405 160570 nn. ROHANI CAPTOPRIL 199.99 2 219.99
238 APT010000I66000405 160570 nn. ROHANI B COMPLEK 76.34 3 83.97
239 APT010000I66000405 160570 nn. ROHANI FARSORBID 306.00 3 336.60
1,100,000 1,210,000
240 APT010000I62004363 160685 ny. NANI .T. 
CERTOFIX 1
.00 .00
241 APT010000I62004363 160685 ny. NANI .T. 
BENANG SIL55,000.00 1 60,500.00
242 APT010000I62004363 160685 ny. NANI .T. 
LIDOCAINE 1,287.00 4 1,415.70
243 APT010000I62004363 160685 ny. NANI .T. 
SPOIT 3 CC 1,485.00 2 1,633.50
244 APT010000I62004363 160685 ny. NANI .T. 
SPOIT 10 C 2,310.00 2 2,541.00
245 APT010000I62004363 160685 ny. NANI .T. 
HANDSCOEN 478.00 20 525.80
246 APT010000I62004363 160685 ny. NANI .T. 
HANDSCOON 13,613.00 3 14,974.30
247 APT010000I66000405 160570 nn. ROHANI ZINKID TAB 2,750.00 1 3,025.00
248 APT010000I66000405 160570 nn. ROHANI VITAMIN C 125.84 2 138.42
249 APT010000I66000405 160570 nn. ROHANI HANDSCOEN 478.00 20 525.80
250 APT010000I66000405 160570 nn. ROHANI MASKER DI 700.00 5 770.00
251 APT010000I66000405 160570 nn. ROHANI OMEPRAZOL 24,999.70 2 27,499.67
252 APT010000I66000405 160570 nn. ROHANI CEFTRIAXO19,999.10 2 21,999.01
253 APT010000I66000405 160570 nn. ROHANI ALLOPURIN 248.02 3 272.83
254 APT010000I66000405 160570 nn. ROHANI INFUSAN N 6,570.00 2 7,227.00
255 APT010000I66000405 160570 nn. ROHANI METIL PRE 44,999.90 2 49,499.89
256 APT010000I66000405 160570 nn. ROHANI ONDANSETR2,002.00 3 2,202.20
257 APT010000I66000405 160570 nn. ROHANI CAIRAN KC 3,223.00 1 3,545.30
258 APT010000I62004353 160635 tn. DARWISFENTANYL
LAEDDA  041,599.80 2 45,759.78
259 APT010000I62004353 160635 tn. DARWISMIDAZOLA
LAEDDA  8,503.00 1 9,353.30
260 APT010000I62004353 160635 tn. DARWISEPHEDRINE
LAEDDA  8,569.00 1 9,425.90
261 APT010000I66000405 160570 nn. ROHANI CEDOCARD31,000.00 1 34,100.00
262 APT010000I66000405 160570 nn. ROHANI FUROSEMID2,920.50 10 3,212.55
263 APT010000I66000405 160570 nn. ROHANI SPOIT 50 12,367.00 1 13,603.70
264 APT010000I66000405 160570 nn. ROHANI PERFUSSOR21,000.00 1 23,100.00
265 APT010000I66000405 160570 nn. ROHANI SPOIT 10 C 2,310.00 1 2,541.00
266 APT010000I66000405 160570 nn. ROHANI CONECTA 10,325.00 1 11,357.50
 267 APT010000I62004353 160635 tn. DARWISDEKSAMETA1,801.80
LAEDDA  1 1,981.98
268 APT010000I62004353 160635 tn. DARWISCEFTRIAXO19,999.10
LAEDDA  2 21,999.01
269 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 3 8,085.82
270 APT010000I62004353 160635 tn. DARWISINFUSAN
LAEDDA N 6,570.00 3 7,227.00
271 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA  RL 7,300.00 3 8,030.00
272 APT010000I62004353 160635 tn. DARWISADONA
LAEDDA  INJ22,880.00 3 25,168.00
273 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
274 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
275 APT010000I62004353 160635 tn. DARWISINFUSAN
LAEDDA N 6,570.00 1 7,227.00
276 APT010000I62004353 160635 tn. DARWISFENTANYL
LAEDDA  041,599.80 2 45,759.78
277 APT010000I62004353 160635 tn. DARWISBUNASCAN56,320.00
LAEDDA  1 61,952.00
278 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA  AQ 2,860.00 2 3,146.00
279 APT010000I62004370 160721 tn. RONNY SIMUCIL
ALEXANDER  2 1,760.00 3 1,936.00
280 APT010000I62004370 160721 tn. RONNY SANMOL
ALEXANDER  T 297.00 3 326.70
281 APT010000I62004325 160471 ny. SYARIFAH
BUNASCAN56,320.00
ALWIAH  1 61,952.00
282 APT010000I62004358 160665 ny. MURNIATI
FENTANYL
REMPE 041,599.80 2 45,759.78
283 APT010000I62004358 160665 ny. MURNIATI
MIDAZOLA
REMPE  8,503.00 1 9,353.30
284 APT010000I31000535 160729 ny. HJ. ANDI
ASERING
B HARNIATI
I 9,645.90
  1 10,610.49
285 APT010000I31000535 160729 ny. HJ. ANDI
SULFITIS
B HARNIATI
T 2,288.00
  2 2,288.00
286 APT010000I62004358 160665 ny. MURNIATI
CEFTRIAXO19,999.10
REMPE  1 21,999.01
287 APT010000I62004358 160665 ny. MURNIATI
KETOROLAC
REMPE  7,350.75 1 8,085.82
288 APT010000I62004358 160665 ny. MURNIATI
RANITIDIN
REMPE  3,000.00 2 3,300.00
289 APT010000I62004366 160708 tn. SYAMSULNOVOALI  TWIS 2,083.00 2 2,291.30
290 APT010000I62004373 160757 tn. SYAHLAN 
ASAM TRAN3,753.20 3 4,128.52
291 APT010000I62004373 160757 tn. SYAHLAN 
SPOIT 5 CC 1,595.00 1 1,754.50
292 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
RL 7,300.00
P  2 8,030.00
293 APT010000I62004373 160757 tn. SYAHLAN 
CODEIN 20 1,494.00 2 1,643.40
294 APT010000I31000534 65833 tn. DR. H SINRING
INFUSAN YASIN 
N 6,570.00 1 7,227.00
295 APT010000I31000534 65833 tn. DR. H SINRING
FUROSEMID2,920.50
YASIN  4 3,212.55
296 APT010000I31000534 65833 tn. DR. H SINRING
DIGOKSIN YASIN 107.12 1 117.83
297 APT010000I31000534 65833 tn. DR. H SINRING
CAPTOPRIL YASIN  94.05 1 103.45
298 APT010000I31000534 65833 tn. DR. H SINRING
SIMARCYASIN 
TA 975.98 1 1,073.58
299 APT010000I31000534 65833 tn. DR. H SINRING
HANDSCOEN YASIN 478.00 6 525.80
300 APT010000I31000534 65833 tn. DR. H SINRING
MASKERYASIN DI 700.00 6 770.00
Sub Total   788
PCS 12,385.56

PCS 6,600.00
PCS 1,633.50
PCS 1,754.50
PCS 3,300.00
PCS 8,085.82
PCS 3,267.00
PCS 7,227.00
PCS 40,972.80
PCS 22,022.00
PCS 1,040.60
PCS 728.37
PCS 36,779.16
PCS 27,442.80
PCS 21,152.01
PCS 6,600.00
PCS 16,171.64
PCS 24,090.00
PCS 37,755.30
PCS 3,217.50
PCS 4,157.94
PCS 29,699.94
PCS 2,145.00
PCS 2,821.50
PCS 121.00
PCS 336.60
PCS 7,078.50
PCS 798.60
PCS 728.37
PCS 656.70
PCS 7,260.00
PCS 9,680.00
PCS 771.54
PCS 390.82
PCS 98,999.78
PCS 6,600.00
PCS 2,178.00
PCS 771.54
PCS 4,930.20
PCS 54,558.90
PCS 2,202.20
PCS 43,998.02
PCS 6,425.10
 121,022.0
PCS
0
PCS 677.60
PCS 1,213.95
PCS 771.54
PCS 3,685.59
PCS 21,999.01
PCS 24,257.46
PCS 9,900.00
PCS 24,090.00
PCS 770.00
PCS 5,335.00
PCS 65,997.03
PCS 79,868.58
PCS 41,624.00
PCS 14,101.34
PCS 4,404.40
PCS 1,118.04
PCS 6,600.00
PCS 21,152.01
PCS 21,152.01
PCS 77,207.68
PCS 1,544.40
PCS 30,613.00
PCS 7,050.67
PCS 7,260.03
PCS 6,243.60
PCS 971.16
PCS 868.78
PCS 514.36
PCS 1,320.00
PCS 520.30
PCS 3,121.80
PCS 1,689.76
PCS 4,318.49
PCS 330.00
PCS 2,200.00
PCS 27,225.00
PCS 2,766.03
PCS 728.37
PCS 922.01
PCS 1,169.04
PCS 140.80
PCS 9,900.00
PCS 14,101.34
PCS 16,698.00
PCS 4,157.94
PCS 798.60
PCS 1,993.20
PCS 6,600.00
PCS 8,257.04
PCS 24,090.00
PCS 4,930.20
PCS 3,121.80
PCS 3,354.12
PCS 16,060.00
PCS 2,103.20
PCS 20,256.30
PCS 76,447.80
PCS 16,879.50
PCS 65,340.00
PCS 664.40
PCS 440.00
PCS 553.68
PCS 79.10
PCS 1,422.96
PCS 1,385.98
PCS 13,422.94
PCS 677.60
PCS 121.00
PCS 43,998.02
PCS 12,385.56
PCS 18,700.00
PCS 8,525.00
PCS 1,633.50
PCS 12,585.10
PCS 2,103.20
PCS 41,624.00
PCS 1,540.00
PCS 18,700.00
PCS 65,997.03
PCS 728.37
PCS 16,060.00
PCS 3,146.00
PCS 11,357.50
PCS 6,600.00
PCS 10,888.68
PCS 65,997.03
PCS 6,600.00
PCS 1,677.06
PCS 6,600.00
PCS 4,404.40
PCS 2,942.72
PCS 16,060.00
PCS 2,103.20
PCS 8,525.00
PCS 3,146.00
PCS 4,157.94
PCS 37,755.30
PCS 2,103.20
PCS 1,540.00
PCS 43,998.02
PCS 1,385.98
PCS 2,081.20
PCS 18,700.00
PCS 11,357.50
PCS 44,588.50
PCS 677.60
PCS 1,385.98
PCS 49,499.89
PCS 16,060.00
PCS 2,103.20
PCS 14,101.34
PCS 1,955.79
PCS 43,998.02
PCS 2,103.20
PCS 1,540.00
PCS 6,425.10
PCS 922.01
PCS 7,078.50
PCS 5,808.00
PCS 3,626.37
PCS 440.00
PCS 1,040.60
PCS 1,677.06
PCS 3,154.80
PCS 4,157.94
PCS 1,993.20
PCS 3,354.12
PCS 2,103.20
PCS 1,540.00
PCS 54,999.34
PCS 4,404.40
PCS 16,060.00
PCS 2,103.20
PCS 7,050.67
PCS 798.60
PCS 4,157.94
PCS 2,032.80
PCS 1,568.13
PCS 21,221.20
PCS 13,310.01
PCS 21,235.50
PCS 40,268.82
PCS 29,699.94
PCS 4,157.94
PCS 33,275.00
PCS 54,558.90
PCS 630.27
PCS 2,766.03
PCS 6,600.00
PCS 431.00
PCS 16,335.00
PCS 522.71
PCS 9,899.98
PCS 493.90
PCS 1,040.60
PCS 1,677.06
PCS 1,287.00
PCS 11,097.90
PCS 1,157.31
PCS 2,574.00
PCS 664.40
PCS 440.00
PCS 553.68
PCS 6,606.60
PCS 5,572.05
PCS 7,050.67
PCS 3,212.55
PCS 117.83
PCS 310.35
PCS 1,073.58
PCS 66,550.00
PCS 3,146.00
PCS 1,051.60
PCS 16,335.00
PCS 272.83
PCS 2,081.20
PCS 431.00
PCS 33,275.00
PCS 56,265.00
PCS 9,899.98
PCS 79,860.00
PCS 92,345.00
PCS 95,699.87
PCS 1,633.50
PCS 2,081.20
PCS 1,285.35
PCS 8,030.00
PCS 3,300.00
PCS 5,856.40
PCS 3,267.00
PCS 3,121.80
PCS 2,213.20
PCS 439.98
PCS 251.91
PCS 1,009.80
1,210,000
PCS
.00
PCS 60,500.00
PCS 5,662.80
PCS 3,267.00
PCS 5,082.00
PCS 10,516.00
PCS 44,922.90
PCS 3,025.00
PCS 276.84
PCS 10,516.00
PCS 3,850.00
PCS 54,999.34
PCS 43,998.02
PCS 818.49
PCS 14,454.00
PCS 98,999.78
PCS 6,606.60
PCS 3,545.30
PCS 91,519.56
PCS 9,353.30
PCS 9,425.90
PCS 34,100.00
PCS 32,125.50
PCS 13,603.70
PCS 23,100.00
PCS 2,541.00
PCS 11,357.50
PCS 1,981.98
PCS 43,998.02
PCS 24,257.46
PCS 21,681.00
PCS 24,090.00
PCS 75,504.00
PCS 16,333.02
PCS 27,225.00
PCS 7,227.00
PCS 91,519.56
PCS 61,952.00
PCS 6,292.00
PCS 5,808.00
PCS 980.10
PCS 61,952.00
PCS 91,519.56
PCS 9,353.30
PCS 10,610.49
PCS 4,576.00
PCS 21,999.01
PCS 8,085.82
PCS 6,600.00
PCS 4,582.60
PCS 12,385.56
PCS 1,754.50
PCS 16,060.00
PCS 3,286.80
PCS 7,227.00
PCS 12,850.20
PCS 117.83
PCS 103.45
PCS 1,073.58
PCS 3,154.80
PCS 4,620.00
5,652,545.93
04-12-
1 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
50 12,367.00 1 13,603.70
2018 
2 APT010000I62004353 160635 tn. DARWISPERFUSSOR
LAEDDA  21,000.00 1 23,100.00
3 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 1 2,541.00
4 APT010000I62004353 160635 tn. DARWISIVLAEDDA 
CATHETE12,416.00 2 13,657.60
5 APT010000I62004353 160635 tn. DARWISINFUS
LAEDDA 
SET 17,000.00 1 18,700.00
6 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
NAC6,409.70 2 7,050.67
7 APT010000I62004353 160635 tn. DARWISURINE
LAEDDA 
BAG 8,835.00 1 9,718.50
8 APT010000I12000055 160769 tn. HAMMAMASERING
ABDULLAH 
I 9,645.90 1 10,610.49
9 APT010000I12000055 160769 tn. HAMMAMCOMBO
ABDULLAH 
PAC
60,500.00 1 66,550.00
10 APT010000I12000055 160769 tn. HAMMAMHANDSCOEN
ABDULLAH 478.00 2 525.80
11 APT010000I62004372 160749 nn. MUSDALIFA 
INFUSAN N 6,570.00 3 7,227.00
12 APT010000I62004372 160749 nn. MUSDALIFA 
RANITIDIN 3,000.00 1 3,300.00
13 APT010000I62004372 160749 nn. MUSDALIFA 
SOTATIC I 3,032.00 3 3,335.20
14 APT010000I62004353 160635 tn. DARWISTRANSFUSI19,635.00
LAEDDA  1 21,598.50
15 APT010000I62004375 141583 nn. INDAH CAIRAN
LESTARINAC6,409.70
RIDWAN  1 7,050.67
16 APT010000I62004375 141583 nn. INDAH OMEPRAZOL
LESTARI RIDWAN 
24,999.70 1 27,499.67
17 APT010000I62004375 141583 nn. INDAH SOTATIC
LESTARI RIDWAN 
I 3,032.00 3 3,335.20
1,100,000 1,210,000
18 APT010000I12000053 157685 ny. ANDI HARYATI 
CERTOFIX 1
.00 .00
19 APT010000I12000053 157685 ny. ANDI HARYATI 
INVICLOT I 10,560.00 1 11,616.00
20 APT010000I62004370 160721 tn. RONNY LIDOCAINE
ALEXANDER 1,287.00 2 1,415.70
21 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
50 C 10,000.09 1 11,000.10
22 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
20 C 5,600.00 1 6,160.00
23 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
10 C 2,310.00 2 2,541.00
24 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
3 CC 1,485.00 2 1,633.50
25 APT010000I12000054 160761 nn. OKTA SULISTIANI
BETAHISTI I.P. 733.33 3 806.67
26 APT010000I12000054 160761 nn. OKTA SULISTIANI
DIMENHIDR I.P. 121.00 1 133.10
27 APT010000I12000054 160761 nn. OKTA SULISTIANI
RANITIDIN I.P. 629.99 2 692.99
28 APT010000I12000054 160761 nn. OKTA SULISTIANI
MECOBALAI.P. 616.00 1 677.60
29 APT010000I12000054 160761 nn. OKTA SULISTIANI
SPOIT 3 CCI.P. 
1,485.00 2 1,633.50
30 APT010000I62004363 160685 ny. NANI .T. 
ASAM TRAN3,753.20 3 4,128.52
31 APT010000I62004363 160685 ny. NANI .T. 
KETOROLAC 7,350.75 3 8,085.82
32 APT010000I62004363 160685 ny. NANI .T. 
CAIRAN SAL27,830.00 1 30,613.00
33 APT010000I62004363 160685 ny. NANI .T. 
FUROSEMID2,920.50 6 3,212.55
34 APT010000I62004363 160685 ny. NANI .T. 
NEFROSTER49,599.00 1 54,558.90
35 APT010000I62004360 151249 nn. WULANCEFIXIME
PURNAMASARI
1,337.60
  6 1,471.36
36 APT010000I62004360 151249 nn. WULANLANSOPRAZ
PURNAMASARI 946.00
  6 1,040.60
37 APT010000I62004360 151249 nn. WULANNEUROSAN
PURNAMASARI
1,168.50
  3 1,285.35
38 APT010000I62004319 160456 ny. MANTASIA
CEFIXIME
DG KEBO 4,499.99 6 4,949.99
39 APT010000I62004319 160456 ny. MANTASIA
PIRACETAM
DG KEBO 1,293.60 6 1,422.96
40 APT010000I62004319 160456 ny. MANTASIA
RANITIDIN
DG KEBO  629.99 6 692.99
41 APT010000I62004319 160456 ny. MANTASIA
ASPILETS
DG KEBO  110.00 3 121.00
42 APT010000I62004319 160456 ny. MANTASIA
MECOBALA
DG KEBO  616.00 3 677.60
43 APT010000I62004319 160456 ny. MANTASIA
HANDSCOEN
DG KEBO  478.00 6 525.80
44 APT010000I62004319 160456 ny. MANTASIA
MASKER
DG KEBO 
DI 700.00 3 770.00
45 APT010000I62004344 160557 tn. AWALUDIN
LEVOFLOXA
SYAM   449.00 5 493.90
46 APT010000I62004344 160557 tn. AWALUDIN
LANSOPRAZ
SYAM   946.00 3 1,040.60
47 APT010000I62004344 160557 tn. AWALUDIN
DOMPERID
SYAM   508.20 6 559.02
48 APT010000I32000263 160653 tn. M NIPPIRECOLFAR
T  4,950.00 9 5,445.00
49 APT010000I32000263 160653 tn. M NIPPIALLOPURIN
T  248.02 3 272.83
50 APT010000I32000263 160653 tn. M NIPPINATRIUM
T  D 195.91 6 215.50
51 APT010000I32000263 160653 tn. M NIPPILANSOPRAZ
T  946.00 6 1,040.60
52 APT010000I62004337 84165 tn. WILLAYANTO 
CEFIXIME 4,499.99 2 4,949.99
53 APT010000I62004337 84165 tn. WILLAYANTO 
SANMOL T 297.00 3 326.70
54 APT010000I62004337 84165 tn. WILLAYANTO 
HANDSCOEN 478.00 6 525.80
55 APT010000I62004370 160721 tn. RONNY SIMUCIL
ALEXANDER 
2 1,760.00 3 1,936.00
56 APT010000I62004370 160721 tn. RONNY SANMOL
ALEXANDER 
T 297.00 3 326.70
57 APT010000I62004370 160721 tn. RONNY HANDSCOEN
ALEXANDER  478.00 6 525.80
58 APT010000I62004370 160721 tn. RONNY MASKER
ALEXANDER 
DI 700.00 3 770.00
59 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
RANITIDIN 3,000.00 2 3,300.00
60 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
CEFIXIME 1,337.60 2 1,471.36
61 APT010000I62004361 160677 tn. TENRI MALLAMOANG 
CAIRAN RL 7,300.00 3 8,030.00
62 APT010000I62004351 118751 nn. DWI ANDIKA
HANDSCOEN
AM NUR  478.00 6 525.80
63 APT010000I62004351 118751 nn. DWI ANDIKA
MASKER AMDINUR  700.00 3 770.00
64 APT010000I64002863 160668 tn. HARIS DG
CEFTRIAXO19,999.10
SE'RE  2 21,999.01
65 APT010000I64002863 160668 tn. HARIS DG
OMEPRAZOL
SE'RE  24,999.70 2 27,499.67
66 APT010000I64002863 160668 tn. HARIS DG
ASAM
SE'RE 
TRAN3,753.20 3 4,128.52
67 APT010000I64002863 160668 tn. HARIS DG
METRONIDA8,250.00
SE'RE  2 9,075.00
68 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN AM70,188.80
BASO  1 77,207.68
69 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ONDANSETR2,002.00
BASO  1 2,202.20
70 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN NAC6,409.70
BASO  3 7,050.67
71 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO  700.00 3 770.00
72 APT010000I62004333 159705 ny. SITTI MAEMUNAH
BETAHISTI BASO  733.33 2 806.67
73 APT010000I62004332 160501 tn. DRS. ANDI
MELOXICAM
SUKMA   923.23 1 1,015.55
74 APT010000I62004332 160501 tn. DRS. ANDI
MECOBALA
SUKMA   616.00 1 677.60
75 APT010000I62004332 160501 tn. DRS. ANDI
RANITIDIN
SUKMA   629.99 2 692.99
76 APT010000I62004332 160501 tn. DRS. ANDI
RANITIDIN
SUKMA   629.99 2 692.99
77 APT010000I62004332 160501 tn. DRS. ANDI
METIL
SUKMA
PRE 44,999.90
  1 49,499.89
78 APT010000I62004362 160683 tn. MANGKONAPADANG 
LANSOPRAZ 946.00 1 1,040.60
79 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 2 4,573.80
80 APT010000I62004362 160683 tn. MANGKONAPADANG 
CAIRAN AM88,500.01 1 97,350.01
81 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 6 525.80
82 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 3 770.00
83 APT010000I62004362 160683 tn. MANGKONAPADANG 
IV CATHETE12,416.00 1 13,657.60
84 APT010000I62004362 160683 tn. MANGKONAPADANG 
SPOIT 50 C 10,000.09 1 11,000.10
85 APT010000I62004314 123536 tn. MUHAMMAD
CEFIXIME
ALWI 1,337.60
MUIN SHI  2 1,471.36
86 APT010000I62004314 123536 tn. MUHAMMAD
LEVOFLOXA
ALWI MUIN449.00
SHI  1 493.90
87 APT010000I62004314 123536 tn. MUHAMMAD
LANSOPRAZ
ALWI MUIN946.00
SHI  1 1,040.60
88 APT010000I62004314 123536 tn. MUHAMMAD
DOMPERID
ALWI MUIN508.20
SHI  3 559.02
 89 APT010000I62004314 123536 tn. MUHAMMAD
ALPRAZOLA
ALWI MUIN
585.00
SHI  1 643.50
90 APT010000I62004328 160495 ny. BASSE DG.
ZINKKENNA
OKSI   604.00 1 664.40
91 APT010000I62004328 160495 ny. BASSE DG.
VITAMIN
KENNA B   76.34 6 83.97
92 APT010000I62004328 160495 ny. BASSE DG.
VITAMIN
KENNA C   125.84 2 138.42
93 APT010000I62004328 160495 ny. BASSE DG.
HANDSCOEN
KENNA   478.00 6 525.80
94 APT010000I62004328 160495 ny. BASSE DG.
MASKER
KENNA DI   700.00 4 770.00
95 APT010000I62004374 160756 nn. RINI RAHAYU
RANITIDIN
MEZANITA
3,000.00
P  2 3,300.00
96 APT010000I62004374 160756 nn. RINI RAHAYU
SANMOL MEZANITA
I 24,202.60
P  3 26,622.86
97 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
RL 7,300.00P  3 8,030.00
98 APT010000I12000053 157685 ny. ANDI HARYATI 
AMLODIPIN 838.19 1 922.01
99 APT010000I12000053 157685 ny. ANDI HARYATI 
NEFROSTER49,599.00 1 54,558.90
100 APT010000I12000053 157685 ny. ANDI HARYATI 
KSR 600 M 3,069.14 2 3,376.05
101 APT010000I62004309 160384 tn. ARINOLSA
ZINKSAPUTRA 
OKSI 604.00 1 664.40
102 APT010000I62004309 160384 tn. ARINOLSA
NOVASAPUTRA 
BC 150.01 6 165.01
103 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 125.84 2 138.42
104 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 1 79.10
105 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 9 7,260.00
106 APT010000I62004309 160384 tn. ARINOLSA
CEFTAZIDIM
SAPUTRA 23,166.00 3 25,482.60
107 APT010000I62004309 160384 tn. ARINOLSA
RIFASTAR
SAPUTRA 5,115.00 3 5,626.50
108 APT010000I62004309 160384 tn. ARINOLSA
HANDSCOEN
SAPUTRA  478.00 6 525.80
109 APT010000I62004309 160384 tn. ARINOLSA
MASKER
SAPUTRA 
DI 700.00 3 770.00
110 APT010000I64002859 160634 tn. ABDUL RAZAK
CODEINRAMANG 
20 1,494.00 3 1,643.40
111 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID2,920.50
RAMANG  2 3,212.55
112 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG  838.19 1 922.01
113 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
114 APT010000I64002859 160634 tn. ABDUL RAZAK
CEFTRIAXO19,999.10
RAMANG  2 21,999.01
115 APT010000I64002859 160634 tn. ABDUL RAZAK
AZITROMYC
RAMANG 
1,777.99 1 1,955.79
116 APT010000I64002859 160634 tn. ABDUL RAZAK
ASAM TRAN3,753.20
RAMANG  3 4,128.52
117 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
NAC6,409.70 2 7,050.67
118 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSINRAMANG  107.12 1 117.83
119 APT010000I62004330 131115 ny. TALLASAZINK
DG OKSI
JINNE  604.00 1 664.40
120 APT010000I62004330 131115 ny. TALLASAVITAMIN
DG JINNE 
C 125.84 2 138.42
121 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 3 1,208.79
122 APT010000I62004330 131115 ny. TALLASAHANDSCOEN
DG JINNE  478.00 6 525.80
123 APT010000I62004330 131115 ny. TALLASAMASKER
DG JINNE 
DI 700.00 3 770.00
124 APT010000I62004330 131115 ny. TALLASALANSOPRAZ
DG JINNE  946.00 2 1,040.60
125 APT010000I62004330 131115 ny. TALLASADOMPERID
DG JINNE  508.20 3 559.02
126 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 3 1,208.79
127 APT010000I62004330 131115 ny. TALLASASIMUCIL
DG JINNE 
2 1,760.00 3 1,936.00
128 APT010000I31000535 160729 ny. HJ. ANDI
URSODEOX
B HARNIATI 4,158.00
  2 4,573.80
129 APT010000I31000535 160729 ny. HJ. ANDI
SULFITIS
B HARNIATI
T 2,288.00
  2 2,288.00
130 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
AS 9,646.00
  2 10,610.60
131 APT010000I31000535 160729 ny. HJ. ANDI
HANDSCOEN
B HARNIATI 478.00
  4 525.80
132 APT010000I62004314 123536 tn. MUHAMMAD
CAIRANALWI
SAL27,830.00
MUIN SHI  2 30,613.00
133 APT010000I62004335 160511 tn. SUPRIADI
SPORETIK
PAISAL  5,720.50 6 6,292.55
134 APT010000I62004335 160511 tn. SUPRIADIMEFINAL
PAISAL 5 1,391.50 9 1,530.65
135 APT010000I62004335 160511 tn. SUPRIADITRICHODAZ
PAISAL  1,738.00 9 1,911.80
136 APT010000I62004357 129453 ny. NURBAENAH 
RAMIPRIL 675.22 3 742.74
137 APT010000I62004357 129453 ny. NURBAENAH 
AMLODIPIN 838.19 3 922.01
138 APT010000I62004357 129453 ny. NURBAENAH 
HCT 25 MG 128.00 3 140.80
139 APT010000I62004357 129453 ny. NURBAENAH 
LANSOPRAZ 946.00 6 1,040.60
140 APT010000I62004359 160674 ny. NURSIAH CAIRAN NAC6,409.70 3 7,050.67
141 APT010000I62004359 160674 ny. NURSIAH CEFTRIAXO19,999.10 3 21,999.01
142 APT010000I62004359 160674 ny. NURSIAH RANITIDIN 3,000.00 2 3,300.00
143 APT010000I62004359 160674 ny. NURSIAH DOMPERID 508.20 6 559.02
144 APT010000I62004359 160674 ny. NURSIAH NEW DIAT 557.15 4 612.87
145 APT010000I62004358 160665 ny. MURNIATICEFTRIAXO19,999.10
REMPE  2 21,999.01
146 APT010000I62004358 160665 ny. MURNIATIKETOROLAC
REMPE  7,350.75 3 8,085.82
147 APT010000I62004358 160665 ny. MURNIATIRANITIDIN
REMPE  3,000.00 2 3,300.00
148 APT010000I62004372 160749 nn. MUSDALIFA 
CAIRAN NAC6,409.70 3 7,050.67
149 APT010000I62004372 160749 nn. MUSDALIFA 
RANITIDIN 3,000.00 2 3,300.00
150 APT010000I62004372 160749 nn. MUSDALIFA 
SOTATIC I 3,032.00 3 3,335.20
151 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
152 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR2,002.00 2 2,202.20
153 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
154 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
155 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 27,505.00 2 30,255.50
156 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALAM6,600.00 1 7,260.00
157 APT010000I62004377 160765 tn. HERI  CAIRAN NAC6,409.70 3 7,050.67
158 APT010000I62004377 160765 tn. HERI  SANMOL I 24,202.60 2 26,622.86
159 APT010000I62004377 160765 tn. HERI  DOMPERID 508.20 3 559.02
160 APT010000I62004377 160765 tn. HERI  RANITIDIN 3,000.00 2 3,300.00
161 APT010000I62004373 160757 tn. SYAHLAN CODEIN 20 1,494.00 3 1,643.40
162 APT010000I62004373 160757 tn. SYAHLAN ASAM TRAN3,753.20 3 4,128.52
163 APT010000I62004373 160757 tn. SYAHLAN SANMOL I 24,202.60 3 26,622.86
164 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  946.00 1 1,040.60
165 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
RL 15,871.68 3 17,458.85
166 APT010000I62004340 155102 tn. DRS. H. CARBAZOC11,145.20
ISHAK ABDIR  3 12,259.72
167 APT010000I62004340 155102 tn. DRS. H. TRANSFUSI28,050.00
ISHAK ABDIR  1 30,855.00
168 APT010000I62004340 155102 tn. DRS. H. HANDSCOEN
ISHAK ABDIR  478.00 2 525.80
169 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 2 770.00
170 APT010000I62004340 155102 tn. DRS. H. ALPRAZOLA
ISHAK ABDIR  585.00 1 643.50
171 APT010000I32000262 160440 tn. ABDUL WAHID
CAIRAN WALANGADI 
NAC6,409.70 1 7,050.67
172 APT010000I32000262 160440 tn. ABDUL WAHID
ASPILETSWALANGADI 
110.00 1 121.00
173 APT010000I32000262 160440 tn. ABDUL WAHID
FARSORBID
WALANGADI 
306.00 3 336.60
174 APT010000I32000262 160440 tn. ABDUL WAHID
ATORVASTA6,435.00
WALANGADI  1 7,078.50
175 APT010000I32000262 160440 tn. ABDUL WAHID
CAPTOPRIL
WALANGADI 
199.99 1 219.99
176 APT010000I32000262 160440 tn. ABDUL WAHID
BISOPROLO
WALANGADI 
726.00 1 798.60
177 APT010000I32000262 160440 tn. ABDUL WAHID
SANMOLWALANGADI 
T 297.00 3 326.70
178 APT010000I32000262 160440 tn. ABDUL WAHID
RECOLFARWALANGADI 
4,950.00 2 5,445.00
179 APT010000I32000262 160440 tn. ABDUL WAHID
DULCOLAX WALANGADI 
11,858.00 2 13,043.80
180 APT010000I62004366 160708 tn. SYAMSULASAM
ALI  TRAN3,753.20 3 4,128.52
181 APT010000I62004366 160708 tn. SYAMSULMASKER
ALI  DI 700.00 1 770.00
182 APT010000I62004366 160708 tn. SYAMSULIV CATHETE
ALI  7,750.00 1 8,525.00
183 APT010000I62004368 160718 tn. HENRA METIL PRE 44,999.90 2 49,499.89
184 APT010000I62004368 160718 tn. HENRA MECOBALAM6,600.00 1 7,260.00
185 APT010000I62004368 160718 tn. HENRA RANITIDIN 3,000.00 2 3,300.00
186 APT010000I62004368 160718 tn. HENRA LEVOFLOXA 449.00 1 493.90
187 APT010000I62004368 160718 tn. HENRA GABAPENTI 4,400.00 2 4,840.00
188 APT010000I62004368 160718 tn. HENRA CANGKANG 116.90 6 128.59
189 APT010000I62004368 160718 tn. HENRA AMITRIPTY 177.65 2 195.41
190 APT010000I62004371 160744 ny. HJ. KARTINI
DIMENHIDR
SE  121.00 2 133.10
191 APT010000I62004371 160744 ny. HJ. KARTINI
BETAHISTI
SE  733.33 3 806.67
192 APT010000I62004371 160744 ny. HJ. KARTINI
GRATIZIN
SE  4,741.00 2 5,215.10
193 APT010000I62004371 160744 ny. HJ. KARTINI
NEUROSAN
SE  1,168.50 1 1,285.35
194 APT010000I62004371 160744 ny. HJ. KARTINI
SANMOL
SE  T 297.00 3 326.70
195 APT010000I62004371 160744 ny. HJ. KARTINI
CAPTOPRIL
SE  199.99 1 219.99
196 APT010000I62004371 160744 ny. HJ. KARTINI
VALISANBE
SE  236.50 1 260.15
197 APT010000I62004365 160707 ny. FITRIANI 
INTERHIST 768.08 2 844.88
198 APT010000I62004365 160707 ny. FITRIANI 
SAGESTAM12,870.00 1 14,157.00
199 APT010000I62004365 160707 ny. FITRIANI 
CEFTRIAXO19,999.10 2 21,999.01
200 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 3,000.00 2 3,300.00
201 APT010000I62004365 160707 ny. FITRIANI 
ONDANSETR2,002.00 2 2,202.20
202 APT010000I62004365 160707 ny. FITRIANI 
DOMPERID 508.20 2 559.02
203 APT010000I62004365 160707 ny. FITRIANI 
CAIRAN NAC6,409.70 3 7,050.67
204 APT010000I62004338 155611 ny. ANDI ALWIAH
MICONAZOL3,925.90
  1 4,318.49
205 APT010000I62004338 155611 ny. ANDI ALWIAH
ASAM SALI  100.00 3 110.00
206 APT010000I62004338 155611 ny. ANDI ALWIAH
POT SALEP  2,000.00 1 2,200.00
207 APT010000I62004338 155611 ny. ANDI ALWIAH
METRONIDA  285.00 9 313.50
208 APT010000I62004338 155611 ny. ANDI ALWIAH
INTERHIST  768.08 6 844.88
209 APT010000I62004338 155611 ny. ANDI ALWIAH
AMLODIPIN  838.19 3 922.01
210 APT010000I62004338 155611 ny. ANDI ALWIAH
PARACETA   220.72 9 242.79
211 APT010000I62004328 160495 ny. BASSE DG.
LANSOPRAZ
KENNA   946.00 6 1,040.60
212 APT010000I62004328 160495 ny. BASSE DG.
EPISAN
KENNA SU 51,150.00
  1 56,265.00
213 APT010000I62004328 160495 ny. BASSE DG.
SIMUCIL
KENNA 2   1,760.00 9 1,936.00
214 APT010000I64002859 160634 tn. ABDUL RAZAK
CETIRIZIN
RAMANG  999.97 3 1,099.96
215 APT010000I62004314 123536 tn. MUHAMMAD
ZINK OKSI
ALWI MUIN604.00
SHI  1 664.40
216 APT010000I62004314 123536 tn. MUHAMMAD
VITAMIN ALWIC MUIN
125.84
SHI  4 138.42
217 APT010000I62004314 123536 tn. MUHAMMAD
NOVA BALWI C MUIN150.01
SHI  6 165.01
218 APT010000I64002859 160634 tn. ABDUL RAZAK
METRONIDA
RAMANG  285.00 6 313.50
219 APT010000I64002859 160634 tn. ABDUL RAZAK
LANSOPRAZ
RAMANG  946.00 6 1,040.60
220 APT010000I62004332 160501 tn. DRS. ANDI
MELOXICAM
SUKMA   923.23 9 1,015.55
221 APT010000I62004332 160501 tn. DRS. ANDI
MECOBALA
SUKMA   616.00 9 677.60
222 APT010000I62004332 160501 tn. DRS. ANDI
RANITIDIN
SUKMA   629.99 6 692.99
223 APT010000I62004332 160501 tn. DRS. ANDI
ALPENTIN
SUKMA   1,150.05 3 1,265.06
224 APT010000I62004332 160501 tn. DRS. ANDI
CANGKANG
SUKMA   77.00 6 84.70
225 APT010000I62004332 160501 tn. DRS. ANDI
AMITRIPTY
SUKMA   177.65 1 195.41

226 APT010000I62004353 160635 tn. DARWISCAIRAN

LAEDDA 
AM70,188.80 2 77,207.68

290,400.0 319,440.0
227 APT010000I62004353 160635 tn. DARWISCLINOLEIC
LAEDDA  1
0 0
228 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 20 525.80
229 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 5 770.00
230 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
3 CC 1,485.00 2 1,633.50
231 APT010000I62004353 160635 tn. DARWISIVLAEDDA 
CATHETE 7,750.00 1 8,525.00
232 APT010000I62004353 160635 tn. DARWISINFUS
LAEDDA 
SET 17,000.00 1 18,700.00
233 APT010000I62004353 160635 tn. DARWISCONECTA
LAEDDA  10,325.00 1 11,357.50
234 APT010000I62004363 160685 ny. NANI .T. 
CAIRAN SAL27,830.00 2 30,613.00
235 APT010000I62004337 84165 tn. WILLAYANTO 
CEFIXIME 1,337.60 4 1,471.36
236 APT010000I62004337 84165 tn. WILLAYANTO 
SANMOL T 297.00 9 326.70
237 APT010000I66000405 160570 nn. ROHANI ZINKID TAB 2,750.00 1 3,025.00
238 APT010000I66000405 160570 nn. ROHANI VITAMIN C 71.91 4 79.10
239 APT010000I66000405 160570 nn. ROHANI N-ACE INJE38,500.00 2 42,350.00

240 APT010000I66000405 160570 nn. ROHANI 

CEDOCARD31,000.00 3 34,100.00

241 APT010000I66000405 160570 nn. ROHANI CEFTRIAXO19,999.10 3 21,999.01

242 APT010000I66000405 160570 nn. ROHANI OMEPRAZOL 24,999.70 2 27,499.67
243 APT010000I66000405 160570 nn. ROHANI ASAM TRAN3,753.20 1 4,128.52
244 APT010000I66000405 160570 nn. ROHANI HANDSCOEN 478.00 20 525.80
245 APT010000I66000405 160570 nn. ROHANI MASKER DI 700.00 5 770.00
246 APT010000I66000405 160570 nn. ROHANI FUROSEMID2,920.50 10 3,212.55
247 APT010000I64002863 160668 tn. HARIS DG
FLEET
SE'RE 
PH 72,600.00 1 79,860.00
248 APT010000I64002863 160668 tn. HARIS DG
SPORETIK
SE'RE  5,720.50 3 6,292.55
249 APT010000I64002863 160668 tn. HARIS DG
RANITIDIN
SE'RE  629.99 3 692.99
250 APT010000I62004351 118751 nn. DWI ANDIKA
SPORETIK
AM NUR 
5,720.50 6 6,292.55
251 APT010000I62004351 118751 nn. DWI ANDIKA
LANSOPRAZ
AM NUR 946.00 6 1,040.60
252 APT010000I62004351 118751 nn. DWI ANDIKA
AZITROMYC
AM NUR 
1,777.99 3 1,955.79
253 APT010000I62004351 118751 nn. DWI ANDIKA
AMBROXOL
AM NUR 330.00 5 363.00
254 APT010000I62004351 118751 nn. DWI ANDIKA
METIL AM
PRENUR 327.00 5 359.70
255 APT010000I62004351 118751 nn. DWI ANDIKA
CODEINAM20NUR 
1,494.00 7 1,643.40
256 APT010000I62004351 118751 nn. DWI ANDIKA
VALISANBE
AM NUR 396.00 2 435.60
257 APT010000I62004351 118751 nn. DWI ANDIKA
CANGKANG
AM NUR 75.00 9 82.50
258 APT010000I62004353 160635 tn. DARWISCEFTRIAXO19,999.10
LAEDDA  2 21,999.01
259 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 3 8,085.82
260 APT010000I62004353 160635 tn. DARWISADONA
LAEDDA 
INJ22,880.00 2 25,168.00
261 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
262 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
RL 7,149.60 3 7,864.56
263 APT010000I62004353 160635 tn. DARWISINFUSAN
LAEDDA D18,920.00 2 20,812.00
264 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  3,000.00 3 3,300.00
265 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
 266 APT010000I62004359 160674 ny. NURSIAH 
IV CATHETE 7,750.00 1 8,525.00
267 APT010000I62004382 160799 ny. ARYANISANMOL
JAYANTI I 24,202.60 1 26,622.86
268 APT010000I62004380 152559 ny. ROSNAENI 
ONDANSETR2,002.00 1 2,202.20
269 APT010000I62004380 152559 ny. ROSNAENI 
RANITIDIN 3,000.00 2 3,300.00
270 APT010000I62004380 152559 ny. ROSNAENI 
DEKSAMETA1,801.80 2 1,981.98
271 APT010000I62004380 152559 ny. ROSNAENI 
DIPENHYDR 7,700.00 1 8,470.00
272 APT010000I62004380 152559 ny. ROSNAENI 
NEUROSANB5,324.00 1 5,856.40
273 APT010000I66000405 160570 nn. ROHANI 
SIMVASTAT 359.10 2 395.01
274 APT010000I66000405 160570 nn. ROHANI 
FARSORBID 306.00 3 336.60
275 APT010000I66000405 160570 nn. ROHANI 
RANITIDIN 3,000.00 2 3,300.00
276 APT010000I66000405 160570 nn. ROHANI 
N-ACE INJE38,500.00 2 42,350.00
277 APT010000I66000405 160570 nn. ROHANI 
SOTATIC I 3,032.00 1 3,335.20
278 APT010000I12000055 160769 tn. HAMMAMFUROSEMID
ABDULLAH 190.99 1 210.09
279 APT010000I12000055 160769 tn. HAMMAMSPIRONOLA
ABDULLAH 366.30 1 402.93
280 APT010000I62004382 160799 ny. ARYANISANMOL
JAYANTI I 24,202.60 2 26,622.86
281 APT010000I62004382 160799 ny. ARYANICAIRAN
JAYANTI 
RL 7,149.60 3 7,864.56
282 APT010000I62004382 160799 ny. ARYANIRANITIDIN
JAYANTI  3,000.00 2 3,300.00
283 APT010000I62004353 160635 tn. DARWISBUNASCAN56,320.00
LAEDDA  1 61,952.00
284 APT010000I62004379 113337 tn. MUHAMMAD
SIMUCIL
ARIEF
2 1,760.00
GANI  3 1,936.00
285 APT010000I62004379 113337 tn. MUHAMMAD
CAIRANARIEF
RL 7,149.60
GANI  1 7,864.56
286 APT010000I62004379 113337 tn. MUHAMMAD
CODEINARIEF
20 1,494.00
GANI  2 1,643.40
Sub Total   845
PCS 13,603.70

PCS 23,100.00
PCS 2,541.00
PCS 27,315.20
PCS 18,700.00
PCS 14,101.34
PCS 9,718.50
PCS 10,610.49
PCS 66,550.00
PCS 1,051.60
PCS 21,681.00
PCS 3,300.00
PCS 10,005.60
PCS 21,598.50
PCS 7,050.67
PCS 27,499.67
PCS 10,005.60
1,210,000
PCS
.00
PCS 11,616.00
PCS 2,831.40
PCS 11,000.10
PCS 6,160.00
PCS 5,082.00
PCS 3,267.00
PCS 2,420.01
PCS 133.10
PCS 1,385.98
PCS 677.60
PCS 3,267.00
PCS 12,385.56
PCS 24,257.46
PCS 30,613.00
PCS 19,275.30
PCS 54,558.90
PCS 8,828.16
PCS 6,243.60
PCS 3,856.05
PCS 29,699.94
PCS 8,537.76
PCS 4,157.94
PCS 363.00
PCS 2,032.80
PCS 3,154.80
PCS 2,310.00
PCS 2,469.50
PCS 3,121.80
PCS 3,354.12
PCS 49,005.00
PCS 818.49
PCS 1,293.00
PCS 6,243.60
PCS 9,899.98
PCS 980.10
PCS 3,154.80
PCS 5,808.00
PCS 980.10
PCS 3,154.80
PCS 2,310.00
PCS 6,600.00
PCS 2,942.72
PCS 24,090.00
PCS 3,154.80
PCS 2,310.00
PCS 43,998.02
PCS 54,999.34
PCS 12,385.56
PCS 18,150.00
PCS 77,207.68
PCS 2,202.20
PCS 21,152.01
PCS 2,310.00
PCS 1,613.34
PCS 1,015.55
PCS 677.60
PCS 1,385.98
PCS 1,385.98
PCS 49,499.89
PCS 1,040.60
PCS 9,147.60
PCS 97,350.01
PCS 3,154.80
PCS 2,310.00
PCS 13,657.60
PCS 11,000.10
PCS 2,942.72
PCS 493.90
PCS 1,040.60
PCS 1,677.06
PCS 643.50
PCS 664.40
PCS 503.82
PCS 276.84
PCS 3,154.80
PCS 3,080.00
PCS 6,600.00
PCS 79,868.58
PCS 24,090.00
PCS 922.01
PCS 54,558.90
PCS 6,752.10
PCS 664.40
PCS 990.06
PCS 276.84
PCS 79.10
PCS 65,340.00
PCS 76,447.80
PCS 16,879.50
PCS 3,154.80
PCS 2,310.00
PCS 4,930.20
PCS 6,425.10
PCS 922.01
PCS 7,078.50
PCS 43,998.02
PCS 1,955.79
PCS 12,385.56
PCS 14,101.34
PCS 117.83
PCS 664.40
PCS 276.84
PCS 3,626.37
PCS 3,154.80
PCS 2,310.00
PCS 2,081.20
PCS 1,677.06
PCS 3,626.37
PCS 5,808.00
PCS 9,147.60
PCS 4,576.00
PCS 21,221.20
PCS 2,103.20
PCS 61,226.00
PCS 37,755.30
PCS 13,775.85
PCS 17,206.20
PCS 2,228.22
PCS 2,766.03
PCS 422.40
PCS 6,243.60
PCS 21,152.01
PCS 65,997.03
PCS 6,600.00
PCS 3,354.12
PCS 2,451.48
PCS 43,998.02
PCS 24,257.46
PCS 6,600.00
PCS 21,152.01
PCS 6,600.00
PCS 10,005.60
PCS 54,558.90
PCS 4,404.40
PCS 43,998.02
PCS 6,425.10
PCS 60,511.00
PCS 7,260.00
PCS 21,152.01
PCS 53,245.72
PCS 1,677.06
PCS 6,600.00
PCS 4,930.20
PCS 12,385.56
PCS 79,868.58
PCS 1,040.60
PCS 52,376.55
PCS 36,779.16
PCS 30,855.00
PCS 1,051.60
PCS 1,540.00
PCS 643.50
PCS 7,050.67
PCS 121.00
PCS 1,009.80
PCS 7,078.50
PCS 219.99
PCS 798.60
PCS 980.10
PCS 10,890.00
PCS 26,087.60
PCS 12,385.56
PCS 770.00
PCS 8,525.00
PCS 98,999.78
PCS 7,260.00
PCS 6,600.00
PCS 493.90
PCS 9,680.00
PCS 771.54
PCS 390.82
PCS 266.20
PCS 2,420.01
PCS 10,430.20
PCS 1,285.35
PCS 980.10
PCS 219.99
PCS 260.15
PCS 1,689.76
PCS 14,157.00
PCS 43,998.02
PCS 6,600.00
PCS 4,404.40
PCS 1,118.04
PCS 21,152.01
PCS 4,318.49
PCS 330.00
PCS 2,200.00
PCS 2,821.50
PCS 5,069.28
PCS 2,766.03
PCS 2,185.11
PCS 6,243.60
PCS 56,265.00
PCS 17,424.00
PCS 3,299.88
PCS 664.40
PCS 553.68
PCS 990.06
PCS 1,881.00
PCS 6,243.60
PCS 9,139.95
PCS 6,098.40
PCS 4,157.94
PCS 3,795.18
PCS 508.20
PCS 195.41

PCS 154,415.3
6
319,440.0
PCS
0
PCS 10,516.00
PCS 3,850.00
PCS 3,267.00
PCS 8,525.00
PCS 18,700.00
PCS 11,357.50
PCS 61,226.00
PCS 5,885.44
PCS 2,940.30
PCS 3,025.00
PCS 316.40
PCS 84,700.00
102,300.0
PCS
0
PCS 65,997.03
PCS 54,999.34
PCS 4,128.52
PCS 10,516.00
PCS 3,850.00
PCS 32,125.50
PCS 79,860.00
PCS 18,877.65
PCS 2,078.97
PCS 37,755.30
PCS 6,243.60
PCS 5,867.37
PCS 1,815.00
PCS 1,798.50
PCS 11,503.80
PCS 871.20
PCS 742.50
PCS 43,998.02
PCS 24,257.46
PCS 50,336.00
PCS 16,333.02
PCS 23,593.68
PCS 41,624.00
PCS 9,900.00
PCS 27,225.00
PCS 8,525.00
PCS 26,622.86
PCS 2,202.20
PCS 6,600.00
PCS 3,963.96
PCS 8,470.00
PCS 5,856.40
PCS 790.02
PCS 1,009.80
PCS 6,600.00
PCS 84,700.00
PCS 3,335.20
PCS 210.09
PCS 402.93
PCS 53,245.72
PCS 23,593.68
PCS 6,600.00
PCS 61,952.00
PCS 5,808.00
PCS 7,864.56
PCS 3,286.80
5,789,220.89
05-12-
1 APT010000I31000535 160729 ny. HJ. ANDI
HANDSCOEN
B HARNIATI 478.00
  4 525.80
2018 
2 APT010000I31000535 160729 ny. HJ. ANDI
MASKER
B HARNIATI
DI 700.00
  1 770.00
3 APT010000I31000535 160729 ny. HJ. ANDI
SPOIT
B HARNIATI
3 CC 1,485.00
  1 1,633.50
4 APT010000I31000535 160729 ny. HJ. ANDI
NASAL
B HARNIATI
CA 11,550.07
  1 12,705.07
5 APT010000I31000535 160729 ny. HJ. ANDI
ALKOHOL
B HARNIATI
S 300.00
  2 330.00
6 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
RL 7,149.60
  1 7,864.56
7 APT010000I62004383 147711 ny. HJ AISYAH 
AMLODIPIN 475.19 1 522.71
8 APT010000I62004383 147711 ny. HJ AISYAH 
BETAHISTI 733.33 1 806.67
9 APT010000I62004383 147711 ny. HJ AISYAH 
DIMENHIDR 121.00 1 133.10
10 APT010000I62004383 147711 ny. HJ AISYAH 
MECOBALAM6,600.00 1 7,260.00
11 APT010000I62004384 160808 ny. SITTI MUNA 
VALISANBE 396.00 2 435.60
12 APT010000I62004384 160808 ny. SITTI MUNA 
AMITRIPTY 177.65 2 195.41
13 APT010000I62004384 160808 ny. SITTI MUNA 
SANMOL T 297.00 6 326.70
14 APT010000I62004384 160808 ny. SITTI MUNA 
COFFEIN S 120.00 1 132.00
15 APT010000I62004384 160808 ny. SITTI MUNA 
CANGKANG 75.00 9 82.50
16 APT010000I62004384 160808 ny. SITTI MUNA 
MECOBALAM6,600.00 1 7,260.00
17 APT010000I62004384 160808 ny. SITTI MUNA 
ASPILETS 110.00 1 121.00
18 APT010000I62004384 160808 ny. SITTI MUNA 
AMLODIPIN 838.19 1 922.01
19 APT010000I62004380 152559 ny. ROSNAENI 
ONDANSET 1,309.00 9 1,439.90
20 APT010000I62004380 152559 ny. ROSNAENI 
RANITIDIN 629.99 6 692.99
21 APT010000I62004380 152559 ny. ROSNAENI 
NEUROSAN 1,168.50 6 1,285.35
22 APT010000I62004314 123536 tn. MUHAMMAD
ZINK OKSI
ALWI MUIN
604.00
SHI  3 664.40
23 APT010000I62004314 123536 tn. MUHAMMAD
VITAMINALWI
B MUIN76.34
SHI  18 83.97
24 APT010000I62004314 123536 tn. MUHAMMAD
VITAMINALWI
C MUIN71.91
SHI  6 79.10
25 APT010000I12000053 157685 ny. ANDI HARYATI 
AMLODIPIN 838.19 3 922.01
26 APT010000I62004314 123536 tn. MUHAMMAD
SPORETIK
ALWI 5,720.50
MUIN SHI  6 6,292.55
27 APT010000I62004314 123536 tn. MUHAMMAD
LANSOPRAZ
ALWI MUIN
946.00
SHI  6 1,040.60
28 APT010000I62004314 123536 tn. MUHAMMAD
LEVOFLOXA
ALWI MUIN
449.00
SHI  3 493.90
29 APT010000I62004314 123536 tn. MUHAMMAD
ALPRAZOLA
ALWI MUIN
585.00
SHI  3 643.50
30 APT010000I62004371 160744 ny. HJ. KARTINI
CAPTOPRIL
SE  199.99 2 219.99
31 APT010000I62004371 160744 ny. HJ. KARTINI
BETAHISTI
SE  733.33 9 806.67
32 APT010000I62004371 160744 ny. HJ. KARTINI
DIMENHIDR
SE  121.00 6 133.10
33 APT010000I62004371 160744 ny. HJ. KARTINI
GRATIZIN
SE  4,741.00 6 5,215.10
34 APT010000I62004371 160744 ny. HJ. KARTINI
CAIRAN
SE  NAC6,409.70 3 7,050.67
35 APT010000I62004371 160744 ny. HJ. KARTINI
MASKER
SE  DI 700.00 1 770.00
36 APT010000I62004371 160744 ny. HJ. KARTINI
HANDSCOEN
SE  478.00 4 525.80
37 APT010000I62004371 160744 ny. HJ. KARTINI
SANMOL
SE  T 297.00 5 326.70
38 APT010000I62004371 160744 ny. HJ. KARTINI
VALISANBE
SE  236.50 3 260.15
39 APT010000I32000262 160440 tn. ABDUL WAHID
ALPRAZOLA
WALANGADI 
585.00 3 643.50
40 APT010000I32000262 160440 tn. ABDUL WAHID
ASPILETSWALANGADI 
110.00 3 121.00
41 APT010000I32000262 160440 tn. ABDUL WAHID
ATORVASTA6,435.00
WALANGADI  3 7,078.50
42 APT010000I32000262 160440 tn. ABDUL WAHID
CAPTOPRIL
WALANGADI 
199.99 2 219.99
43 APT010000I32000262 160440 tn. ABDUL WAHID
BISOPROLO
WALANGADI 
726.00 3 798.60
44 APT010000I32000262 160440 tn. ABDUL WAHID
SANMOLWALANGADI 
T 297.00 9 326.70
45 APT010000I32000262 160440 tn. ABDUL WAHID
MASKERWALANGADI 
DI 700.00 2 770.00
46 APT010000I32000262 160440 tn. ABDUL WAHID
HANDSCOON
WALANGADI 
13,613.00 2 14,974.30
47 APT010000I32000262 160440 tn. ABDUL WAHID
PIROKSIKA
WALANGADI 
197.13 3 216.84
48 APT010000I62004275 159982 tn. SULHAM 
SANMOL T 297.00 9 326.70

49 APT010000I62004368 160718 tn. HENRA METIL PRE 54,054.00 2 59,459.40

50 APT010000I62004368 160718 tn. HENRA MECOBALAM6,600.00 1 7,260.00

51 APT010000I62004368 160718 tn. HENRA LEVOFLOXA 449.00 1 493.90
52 APT010000I62004368 160718 tn. HENRA MASKER DI 700.00 3 770.00
53 APT010000I62004368 160718 tn. HENRA HANDSCOEN 478.00 4 525.80
54 APT010000I62004368 160718 tn. HENRA IV CATHETE 7,750.00 1 8,525.00
55 APT010000I62004366 160708 tn. SYAMSUL PLASMINEX
ALI  13,002.00 3 14,302.20
56 APT010000I62004366 160708 tn. SYAMSUL ADONA
ALI  INJ22,880.00 3 25,168.00
57 APT010000I62004366 160708 tn. SYAMSUL CAIRAN
ALI  RL 7,149.60 4 7,864.56
58 APT010000I62004366 160708 tn. SYAMSUL IV CATHETE
ALI  7,750.00 2 8,525.00
59 APT010000I62004366 160708 tn. SYAMSUL MASKER
ALI  DI 700.00 2 770.00
60 APT010000I62004366 160708 tn. SYAMSUL CODEIN
ALI  20 1,494.00 3 1,643.40
61 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  946.00 2 1,040.60
62 APT010000I62004340 155102 tn. DRS. H. PLASMINEX
ISHAK ABDIR 
13,002.00 1 14,302.20
63 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
NAC6,409.70 3 7,050.67
64 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 3 770.00
65 APT010000I62004340 155102 tn. DRS. H. TRANSFUSI28,050.00
ISHAK ABDIR  1 30,855.00
66 APT010000I62004340 155102 tn. DRS. H. CURCUMA
ISHAK ABDIR 
1,098.90 2 1,208.79
67 APT010000I62004358 160665 ny. MURNIATIFLAMAR
REMPE 
50 1,908.50 3 2,099.35
68 APT010000I62004358 160665 ny. MURNIATISIMUCIL
REMPE 
2 1,760.00 3 1,936.00
69 APT010000I62004358 160665 ny. MURNIATISPORETIK
REMPE  5,720.50 2 6,292.55
70 APT010000I62004358 160665 ny. MURNIATIRANITIDIN
REMPE  629.99 1 692.99
71 APT010000I62004358 160665 ny. MURNIATILOMATULL23,100.00
REMPE  1 25,410.00
72 APT010000I62004372 160749 nn. MUSDALIFA 
RANITIDIN 3,000.00 2 3,300.00
73 APT010000I62004372 160749 nn. MUSDALIFA 
SOTATIC I 3,032.00 3 3,335.20
74 APT010000I62004372 160749 nn. MUSDALIFA 
CAIRAN NAC6,409.70 3 7,050.67
75 APT010000I62004372 160749 nn. MUSDALIFA 
INFUS SET 17,000.00 1 18,700.00
76 APT010000I62004372 160749 nn. MUSDALIFA 
MASKER DI 700.00 3 770.00
77 APT010000I62004359 160674 ny. NURSIAH CAIRAN NAC6,409.70 3 7,050.67
78 APT010000I62004359 160674 ny. NURSIAH CEFTRIAXO19,999.10 3 21,999.01
79 APT010000I62004359 160674 ny. NURSIAH RANITIDIN 3,000.00 2 3,300.00
80 APT010000I62004359 160674 ny. NURSIAH CAIRAN NAC6,409.70 3 7,050.67
81 APT010000I62004359 160674 ny. NURSIAH MASKER DI 700.00 2 770.00
82 APT010000I62004359 160674 ny. NURSIAH HANDSCOEN 478.00 4 525.80
83 APT010000I62004359 160674 ny. NURSIAH SPOIT 10 C 2,310.00 1 2,541.00
84 APT010000I62004373 160757 tn. SYAHLAN SANMOL I 24,202.60 3 26,622.86
85 APT010000I62004373 160757 tn. SYAHLAN MEFINAL 5 1,391.50 3 1,530.65
86 APT010000I62004373 160757 tn. SYAHLAN RIFASTAR 5,115.00 3 5,626.50
87 APT010000I62004373 160757 tn. SYAHLAN MASKER DI 700.00 3 770.00
88 APT010000I62004373 160757 tn. SYAHLAN INFUS SET 17,000.00 1 18,700.00
 89 APT010000I62004373 160757 tn. SYAHLAN 
IV CATHETE 7,750.00 1 8,525.00
90 APT010000I62004373 160757 tn. SYAHLAN 
NASAL CA 11,550.07 1 12,705.07
91 APT010000I62004373 160757 tn. SYAHLAN 
CODEIN 20 1,494.00 3 1,643.40
92 APT010000I66000404 159099 ny. SITTI MULIYANA 
- 0 0 0
93 APT010000I66000404 159099 ny. SITTI MULIYANA 
MEGABAL 1,730.00 1 1,903.00
94 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
95 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR2,002.00 2 2,202.20
96 APT010000I66000404 159099 ny. SITTI MULIYANA 
OMEPRAZOL 24,999.70 1 27,499.67
97 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
98 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 4 3,212.55
99 APT010000I62004375 141583 nn. INDAH CAIRAN
LESTARINAC6,409.70
RIDWAN  3 7,050.67
100 APT010000I62004375 141583 nn. INDAH RANITIDIN
LESTARI RIDWAN 
3,000.00 2 3,300.00
101 APT010000I62004375 141583 nn. INDAH SOTATIC
LESTARI RIDWAN 
I 3,032.00 3 3,335.20
102 APT010000I62004375 141583 nn. INDAH CAIRAN
LESTARINAC6,409.70
RIDWAN  3 7,050.67
103 APT010000I62004375 141583 nn. INDAH IV
LESTARI
CATHETE
RIDWAN 
7,750.00 1 8,525.00
104 APT010000I62004383 147711 ny. HJ AISYAH 
PIROKSIKA 106.00 1 116.60
105 APT010000I62004383 147711 ny. HJ AISYAH 
GRATIZIN 4,741.00 2 5,215.10
106 APT010000I62004383 147711 ny. HJ AISYAH 
RANITIDIN 3,000.00 2 3,300.00
107 APT010000I62004383 147711 ny. HJ AISYAH 
SANMOL T 297.00 5 326.70
108 APT010000I62004383 147711 ny. HJ AISYAH 
CANGKANG 75.00 6 82.50
109 APT010000I62004383 147711 ny. HJ AISYAH 
CLOBAZAM 1,116.84 3 1,228.53
110 APT010000I62004383 147711 ny. HJ AISYAH 
AMLODIPIN 475.19 1 522.71
111 APT010000I62004383 147711 ny. HJ AISYAH 
BETAHISTI 733.33 3 806.67
112 APT010000I62004383 147711 ny. HJ AISYAH 
DIMENHIDR 121.00 1 133.10
113 APT010000I62004383 147711 ny. HJ AISYAH 
MEGABAL 1,730.00 1 1,903.00
114 APT010000I62004365 160707 ny. FITRIANI 
CEFTRIAXO19,999.10 2 21,999.01
115 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 3,000.00 2 3,300.00
116 APT010000I62004365 160707 ny. FITRIANI 
DOMPERID 508.20 2 559.02
117 APT010000I62004365 160707 ny. FITRIANI 
CAIRAN NAC6,409.70 3 7,050.67
118 APT010000I62004365 160707 ny. FITRIANI 
CAIRAN NA15,180.00 1 16,698.00
119 APT010000I62004377 160765 tn. HERI  CAIRAN NAC6,409.70 3 7,050.67
120 APT010000I62004377 160765 tn. HERI  SANMOL T 297.00 3 326.70
121 APT010000I62004377 160765 tn. HERI  CEFTRIAXO19,999.10 3 21,999.01
122 APT010000I62004377 160765 tn. HERI  RANITIDIN 3,000.00 2 3,300.00
123 APT010000I62004377 160765 tn. HERI  CAIRAN NAC6,409.70 3 7,050.67
124 APT010000I62004377 160765 tn. HERI  MASKER DI 700.00 3 770.00
125 APT010000I62004377 160765 tn. HERI  HANDSCOEN 478.00 2 525.80
126 APT010000I62004377 160765 tn. HERI  IV CATHETE 7,750.00 1 8,525.00
127 APT010000I62004377 160765 tn. HERI  INFUS SET 17,000.00 1 18,700.00
128 APT010000I12000054 160761 nn. OKTA SULISTIANI
ASPILETS I.P. 110.00 1 121.00
129 APT010000I12000054 160761 nn. OKTA SULISTIANI
BETAHISTI I.P. 733.33 3 806.67
130 APT010000I12000054 160761 nn. OKTA SULISTIANI
DIMENHIDR I.P. 121.00 2 133.10
131 APT010000I12000054 160761 nn. OKTA SULISTIANI
RANITIDIN I.P. 
3,000.00 2 3,300.00
132 APT010000I12000054 160761 nn. OKTA SULISTIANI
MECOBALAM I.P. 
6,600.00 1 7,260.00
133 APT010000I12000054 160761 nn. OKTA SULISTIANI
CAIRAN RLI.P. 
7,149.60 4 7,864.56
134 APT010000I12000054 160761 nn. OKTA SULISTIANI
MASKER DII.P. 700.00 1 770.00
135 APT010000I31000535 160729 ny. HJ. ANDI
URSODEOX
B HARNIATI4,158.00
  2 4,573.80
136 APT010000I31000535 160729 ny. HJ. ANDI
SULFITIS
B HARNIATI
T 2,288.00
  2 2,288.00
137 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
AS 9,646.00
  2 10,610.60
138 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  2 27,499.67
139 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ONDANSETR2,002.00
BASO  1 2,202.20
140 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN AM70,188.80
BASO  1 77,207.68
141 APT010000I62004363 160685 ny. NANI .T. 
FUROSEMID2,920.50 6 3,212.55
142 APT010000I62004363 160685 ny. NANI .T. 
AMLODIPIN 838.19 1 922.01
143 APT010000I62004363 160685 ny. NANI .T. 
PLASMINEX13,002.00 3 14,302.20
144 APT010000I62004363 160685 ny. NANI .T. 
KETOROLAC 7,350.75 6 8,085.82
145 APT010000I62004330 131115 ny. TALLASAZINK
DG OKSI
JINNE  604.00 1 664.40
146 APT010000I62004330 131115 ny. TALLASAVITAMIN
DG JINNE 
C 71.91 4 79.10
147 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 3 1,208.79
148 APT010000I62004330 131115 ny. TALLASALANSOPRAZ
DG JINNE  946.00 2 1,040.60
149 APT010000I62004330 131115 ny. TALLASADOMPERID
DG JINNE  508.20 3 559.02
150 APT010000I62004330 131115 ny. TALLASASIMUCIL
DG JINNE 
2 1,760.00 3 1,936.00
151 APT010000I62004362 160683 tn. MANGKONAPADANG 
LANTUS SO83,950.02 1 92,345.02
152 APT010000I62004362 160683 tn. MANGKONAPADANG 
APIDRA 86,999.88 1 95,699.87
153 APT010000I62004362 160683 tn. MANGKONAPADANG 
NOVO TWIS 2,083.00 2 2,291.30
154 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 2 4,573.80

155 APT010000I62004362 LIVAMIN 5 216,865.0

160683 tn. MANGKONAPADANG  1 238,551.5
0 0
156 APT010000I62004362 160683 tn. MANGKONAPADANG 
LANSOPRAZ 946.00 1 1,040.60
157 APT010000I62004309 160384 tn. ARINOLSA
ZINK
SAPUTRA 
OKSI 604.00 1 664.40
158 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
B 76.34 6 83.97
159 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 71.91 2 79.10
160 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 1 79.10
161 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 6 7,260.00
162 APT010000I64002863 160668 tn. HARIS DG
OMEPRAZOL
SE'RE  24,999.70 2 27,499.67
163 APT010000I64002863 160668 tn. HARIS DG
PLASMINEX
SE'RE  2,832.50 3 3,115.75
164 APT010000I64002863 160668 tn. HARIS DG
LANTUS
SE'RE SO83,950.02 1 92,345.02
165 APT010000I62004382 160799 ny. ARYANISANMOL
JAYANTI T 297.00 3 326.70
166 APT010000I62004384 160808 ny. SITTI MUNA 
ASPILETS 110.00 1 121.00
167 APT010000I62004384 160808 ny. SITTI MUNA 
MECOBALAM6,600.00 1 7,260.00
168 APT010000I62004384 160808 ny. SITTI MUNA 
RANITIDIN 3,000.00 2 3,300.00
169 APT010000I62004384 160808 ny. SITTI MUNA 
AMLODIPIN 475.19 1 522.71
170 APT010000I12000055 160769 tn. HAMMAM FUROSEMID
ABDULLAH 190.99 2 210.09
171 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 986.39 1 1,085.03
172 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
173 APT010000I62004385 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
174 APT010000I62004370 160721 tn. RONNY SIMUCIL
ALEXANDER 
2 1,760.00 2 1,936.00
175 APT010000I62004370 160721 tn. RONNY SANMOL
ALEXANDER T 297.00 3 326.70
176 APT010000I64002859 160634 tn. ABDUL RAZAK
CEFTRIAXO19,999.10
RAMANG  2 21,999.01
177 APT010000I64002859 160634 tn. ABDUL RAZAK
PLASMINEX
RAMANG 
13,002.00 3 14,302.20
178 APT010000I64002859 160634 tn. ABDUL RAZAK
AZITROMYC
RAMANG 
1,777.99 1 1,955.79
179 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID
RAMANG 190.99 1 210.09
180 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG 107.12 1 117.83
181 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG 838.19 1 922.01
182 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
183 APT010000I64002859 160634 tn. ABDUL RAZAK
CODEINRAMANG 
20 1,494.00 3 1,643.40
184 APT010000I62004374 160756 nn. RINI RAHAYU
SANMOL MEZANITA
T 297.00P  3 326.70
185 APT010000I62004374 160756 nn. RINI RAHAYU
NEW DIAT
MEZANITA
557.15
P  6 612.87
186 APT010000I62004374 160756 nn. RINI RAHAYU
KOTRIMOKS
MEZANITA
254.10
P  6 279.51
187 APT010000I31000534 65833 tn. DR. H SINRING
FUROSEMID2,920.50
YASIN  2 3,212.55
188 APT010000I31000534 65833 tn. DR. H SINRING
DIGOKSIN
YASIN 107.12 1 117.83
189 APT010000I31000534 65833 tn. DR. H SINRING
CAPTOPRIL
YASIN 199.99 3 219.99
190 APT010000I31000534 65833 tn. DR. H SINRING
SIMARCYASIN 
TA 975.98 1 1,073.58
191 APT010000I31000534 65833 tn. DR. H SINRING
SANMOL YASIN 
T 297.00 3 326.70
192 APT010000I62004330 131115 ny. TALLASAFUROSEMID
DG JINNE  190.99 1 210.09
193 APT010000I62004330 131115 ny. TALLASALANSOPRAZ
DG JINNE  946.00 6 1,040.60
194 APT010000I62004330 131115 ny. TALLASADOMPERID
DG JINNE  508.20 9 559.02
195 APT010000I62004330 131115 ny. TALLASACURCUMA
DG JINNE  1,098.90 9 1,208.79
196 APT010000I62004330 131115 ny. TALLASASIMUCIL
DG JINNE 
2 1,760.00 9 1,936.00
104,181.0 114,599.1
197 APT010000I62004379 113337 tn. MUHAMMAD
FLEET ENE
ARIEF GANI  0 1 0
198 APT010000I66000405 160570 nn. ROHANI 
CAIRAN NAC6,409.70 2 7,050.67
199 APT010000I66000405 160570 nn. ROHANI 
CEFTRIAXO19,999.10 3 21,999.01
200 APT010000I66000405 160570 nn. ROHANI 
OMEPRAZOL24,999.70 2 27,499.67

201 APT010000I66000405 LEVOCIN I 316,030.0

160570 nn. ROHANI  1 347,633.0
0 0
202 APT010000I66000405 160570 nn. ROHANI 
ALLOPURIN 248.02 1 272.83
203 APT010000I66000405 160570 nn. ROHANI 
N-ACE INJE38,500.00 2 42,350.00
204 APT010000I66000405 160570 nn. ROHANI 
CAPTOPRIL 199.99 2 219.99
205 APT010000I66000405 160570 nn. ROHANI 
ATORVASTA6,435.00 1 7,078.50
206 APT010000I66000405 160570 nn. ROHANI 
FARSORBID 306.00 1 336.60
207 APT010000I66000405 160570 nn. ROHANI 
ZINKID TAB 2,750.00 1 3,025.00
208 APT010000I66000405 160570 nn. ROHANI 
VITAMIN C 71.91 4 79.10
209 APT010000I66000405 160570 nn. ROHANI 
FUROSEMID2,920.50 10 3,212.55

210 APT010000I66000405 160570 nn. ROHANI 

CEDOCARD31,000.00 3 34,100.00

211 APT010000I66000405 160570 nn. ROHANI 

CAIRAN NA15,180.00 1 16,698.00
212 APT010000I66000405 160570 nn. ROHANI 
HANDSCOEN 478.00 20 525.80
213 APT010000I66000405 160570 nn. ROHANI 
MASKER DI 700.00 10 770.00
214 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
215 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
216 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  3,000.00 2 3,300.00
217 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
AM70,188.80 1 77,207.68
218 APT010000I62004353 160635 tn. DARWISIVLAEDDA 
CATHETE 7,750.00 1 8,525.00
219 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 2 2,541.00
220 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
5 CC 1,595.00 2 1,754.50
221 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 20 525.80
222 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 10 770.00
223 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
RL 7,149.60 3 7,864.56
224 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
DE18,920.00 2 20,812.00
225 APT010000I62004353 160635 tn. DARWISCEFTRIAXO19,999.10
LAEDDA  2 21,999.01
226 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 3 8,085.82
227 APT010000I62004353 160635 tn. DARWISCARBAZOC11,145.20
LAEDDA  3 12,259.72
228 APT010000I62004309 160384 tn. ARINOLSA
CAIRAN
SAPUTRA 
RL 7,149.60 2 7,864.56
229 APT010000I62004309 160384 tn. ARINOLSA
MASKER
SAPUTRA 
DI 700.00 1 770.00
230 APT010000I62004309 160384 tn. ARINOLSA
HANDSCOEN
SAPUTRA  478.00 2 525.80
231 APT010000I62004309 160384 tn. ARINOLSA
INFUS
SAPUTRA 
SET 17,000.00 1 18,700.00
232 APT010000I62004309 160384 tn. ARINOLSA
CONECTA
SAPUTRA 
10,325.00 1 11,357.50
233 APT010000I62004309 160384 tn. ARINOLSA
IV CATHETE
SAPUTRA 7,750.00 1 8,525.00
234 APT010000I62004384 160808 ny. SITTI MUNA 
CAIRAN RL 7,149.60 2 7,864.56
235 APT010000I62004384 160808 ny. SITTI MUNA 
HANDSCOEN 478.00 2 525.80
236 APT010000I62004384 160808 ny. SITTI MUNA 
SPOIT 10 C 2,310.00 1 2,541.00
237 APT010000I62004384 160808 ny. SITTI MUNA 
SPOIT 5 CC 1,595.00 1 1,754.50
238 APT010000I62004384 160808 ny. SITTI MUNA 
IV CATHETE 7,750.00 1 8,525.00
239 APT010000I62004384 160808 ny. SITTI MUNA 
SPOIT 3 CC 1,485.00 1 1,633.50
240 APT010000I62004384 160808 ny. SITTI MUNA 
CAIRAN AQ 2,860.00 1 3,146.00
241 APT010000I62004370 160721 tn. RONNY CONCOR
ALEXANDER 
2. 597.00 1 656.70
242 APT010000I64002859 160634 tn. ABDUL RAZAK
PULMICORT
RAMANG 
8,540.00 3 9,394.00
243 APT010000I64002859 160634 tn. ABDUL RAZAK
NEBULIZE
RAMANG 
40,535.00 1 44,588.50
244 APT010000I62004385 148491 ny. NURBAENI 
INFUSAN N 6,712.07 2 7,383.28
245 APT010000I62004385 148491 ny. NURBAENI 
MASKER DI 700.00 1 770.00
246 APT010000I62004385 148491 ny. NURBAENI 
HANDSCOEN 478.00 2 525.80
247 APT010000I62004385 148491 ny. NURBAENI 
IV DRESSI 4,850.00 1 5,335.00
248 APT010000I62004385 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 1 2,541.00
249 APT010000I62004385 148491 ny. NURBAENI 
SPOIT 5 CC 1,595.00 1 1,754.50
250 APT010000I62004362 160683 tn. MANGKONAPADANG 
INFUS SET 17,000.00 1 18,700.00
251 APT010000I62004362 160683 tn. MANGKONAPADANG 
CONECTA 10,325.00 1 11,357.50
252 APT010000I62004362 160683 tn. MANGKONAPADANG 
IV CATHETE 7,750.00 1 8,525.00
253 APT010000I62004362 160683 tn. MANGKONAPADANG 
FOLEY CAT 33,000.00 1 36,300.00
254 APT010000I62004362 160683 tn. MANGKONAPADANG 
CAIRAN RL 7,149.60 2 7,864.56
255 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
RL 7,149.60
P  2 7,864.56
256 APT010000I62004374 160756 nn. RINI RAHAYU
MASKER MEZANITA
DI 700.00
P  1 770.00
257 APT010000I62004374 160756 nn. RINI RAHAYU
HANDSCOEN
MEZANITA
478.00
P  2 525.80
258 APT010000I62004374 160756 nn. RINI RAHAYU
SPOIT 10
MEZANITA
C 2,310.00
P  1 2,541.00
259 APT010000I62004374 160756 nn. RINI RAHAYU
SPOIT 5MEZANITA
CC 1,595.00
P  1 1,754.50
260 APT010000I62004374 160756 nn. RINI RAHAYU
CONECTAMEZANITA
10,325.00
P  1 11,357.50
261 APT010000I62004370 160721 tn. RONNY CAIRAN
ALEXANDER 
RL 7,149.60 2 7,864.56
262 APT010000I62004370 160721 tn. RONNY MASKER
ALEXANDER 
DI 700.00 1 770.00
263 APT010000I62004370 160721 tn. RONNY HANDSCOEN
ALEXANDER  478.00 2 525.80
264 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
10 C 2,310.00 1 2,541.00
265 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
5 CC 1,595.00 1 1,754.50
266 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
3 CC 1,485.00 1 1,633.50
267 APT010000I62004370 160721 tn. RONNY CAIRAN
ALEXANDER 
AQ 2,860.00 1 3,146.00
268 APT010000I31000534 65833 tn. DR. H SINRING
CAIRANYASIN 
RL 7,149.60 2 7,864.56
269 APT010000I31000534 65833 tn. DR. H SINRING
MASKERYASIN 
DI 700.00 1 770.00
270 APT010000I31000534 65833 tn. DR. H SINRING
HANDSCOEN
YASIN 478.00 2 525.80
271 APT010000I31000534 65833 tn. DR. H SINRING
CAIRANYASIN 
AQ 2,860.00 1 3,146.00
272 APT010000I31000534 65833 tn. DR. H SINRING
SPOIT 1YASIN 
CC 1,920.00 1 2,112.00
273 APT010000I31000534 65833 tn. DR. H SINRING
SPOIT 10YASIN 
C 2,310.00 1 2,541.00
274 APT010000I31000534 65833 tn. DR. H SINRING
IV DRESSI
YASIN 
4,850.00 1 5,335.00
275 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
RL 7,149.60
  2 7,864.56
276 APT010000I31000535 160729 ny. HJ. ANDI
MASKER
B HARNIATI
DI 700.00
  1 770.00
277 APT010000I31000535 160729 ny. HJ. ANDI
HANDSCOEN
B HARNIATI 478.00
  2 525.80
278 APT010000I31000535 160729 ny. HJ. ANDI
SPOIT
B HARNIATI
10 C 2,310.00
  1 2,541.00
279 APT010000I31000535 160729 ny. HJ. ANDI
IVBCATHETE
HARNIATI7,750.00
  1 8,525.00
280 APT010000I31000535 160729 ny. HJ. ANDI
SPOIT
B HARNIATI
3 CC 1,485.00
  1 1,633.50
281 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
AQ 2,860.00
  1 3,146.00
282 APT010000I62004363 160685 ny. NANI .T. 
INFUSAN N 6,712.07 2 7,383.28
283 APT010000I62004363 160685 ny. NANI .T. 
MASKER DI 700.00 1 770.00
284 APT010000I62004363 160685 ny. NANI .T. 
HANDSCOEN 478.00 2 525.80
285 APT010000I62004363 160685 ny. NANI .T. 
TRANSFUSI28,050.00 1 30,855.00
286 APT010000I62004363 160685 ny. NANI .T. 
SPOIT 10 C 2,310.00 1 2,541.00
287 APT010000I62004363 160685 ny. NANI .T. 
SPOIT 1 CC 1,920.00 1 2,112.00
288 APT010000I62004363 160685 ny. NANI .T. 
CAIRAN NA15,180.00 1 16,698.00
289 APT010000I62004382 160799 ny. ARYANIINFUSAN
JAYANTI R 9,645.50 2 10,610.05
290 APT010000I62004382 160799 ny. ARYANIMASKER
JAYANTI DI 700.00 1 770.00
291 APT010000I62004382 160799 ny. ARYANISPOIT
JAYANTI 
10 C 2,310.00 1 2,541.00
292 APT010000I62004382 160799 ny. ARYANISPOIT
JAYANTI 
5 CC 1,595.00 1 1,754.50
293 APT010000I62004382 160799 ny. ARYANIIVJAYANTI 
CATHETE 7,750.00 1 8,525.00
294 APT010000I62004370 160721 tn. RONNY ALPRAZOLA
ALEXANDER  585.00 2 643.50
295 APT010000I62004333 159705 ny. SITTI MAEMUNAH
INFUSAN N BASO 
6,712.07 2 7,383.28
296 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 700.00 1 770.00
297 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOEN BASO 
478.00 2 525.80
298 APT010000I62004333 159705 ny. SITTI MAEMUNAH
IV DRESSI BASO 
4,850.00 1 5,335.00
299 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 10 C BASO 
2,310.00 1 2,541.00
300 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 3 CC BASO 
1,485.00 1 1,633.50
301 APT010000I12000055 160769 tn. HAMMAM CAIRAN
ABDULLAH 
RL 7,149.60 2 7,864.56
302 APT010000I12000055 160769 tn. HAMMAM MASKER
ABDULLAH 
DI 700.00 1 770.00
303 APT010000I12000055 160769 tn. HAMMAM CAIRAN
ABDULLAH 
NA15,180.00 1 16,698.00
304 APT010000I12000055 160769 tn. HAMMAM HANDSCOEN
ABDULLAH 478.00 2 525.80
305 APT010000I12000055 160769 tn. HAMMAM SPOITABDULLAH 
1 CC 1,920.00 1 2,112.00
306 APT010000I12000055 160769 tn. HAMMAM SPOITABDULLAH 
3 CC 1,485.00 1 1,633.50
307 APT010000I12000055 160769 tn. HAMMAM IV DRESSI
ABDULLAH 
4,850.00 1 5,335.00
308 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
RL 7,149.60 2 7,864.56
309 APT010000I64002859 160634 tn. ABDUL RAZAK
MASKER RAMANG 
DI 700.00 1 770.00
 310 APT010000I64002859 160634 tn. ABDUL RAZAK
HANDSCOEN
RAMANG 
478.00 2 525.80
311 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 10RAMANG 
C 2,310.00 1 2,541.00
312 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 3RAMANG 
CC 1,485.00 1 1,633.50
313 APT010000I64002859 160634 tn. ABDUL RAZAK
IV CATHETE
RAMANG 
7,750.00 1 8,525.00
314 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE RL 7,149.60 2 7,864.56
315 APT010000I64002863 160668 tn. HARIS DG
MASKER
SE'RE  DI 700.00 1 770.00
316 APT010000I64002863 160668 tn. HARIS DG
HANDSCOEN
SE'RE  478.00 2 525.80
317 APT010000I64002863 160668 tn. HARIS DG
MASKER
SE'RE  DI 700.00 1 770.00
318 APT010000I64002863 160668 tn. HARIS DG
CONECTA
SE'RE  10,325.00 1 11,357.50
319 APT010000I64002863 160668 tn. HARIS DG
SPOIT
SE'RE 
10 C 2,310.00 1 2,541.00
320 APT010000I64002863 160668 tn. HARIS DG
SPOIT
SE'RE 
5 CC 1,595.00 1 1,754.50
321 APT010000I56000010 160802 tn. A NURDIN
CEFTRIAXO19,999.10
PATTA BALI  2 21,999.01
322 APT010000I56000010 160802 tn. A NURDIN
AZITROMYC
PATTA BALI 
1,777.99 1 1,955.79
323 APT010000I56000010 160802 tn. A NURDIN
PULMICORT
PATTA BALI 
8,540.00 2 9,394.00
324 APT010000I56000010 160802 tn. A NURDIN
COMBIVENT4,549.95
PATTA BALI  4 5,004.94

325 APT010000I56000010 160802 tn. A NURDIN

N-ACE
PATTA
INJE38,500.00
BALI  3 42,350.00

326 APT010000I56000010 160802 tn. A NURDIN

SANMOL
PATTATBALI 297.00 3 326.70
327 APT010000I56000010 160802 tn. A NURDIN
INFUSAN
PATTANBALI 
6,712.07 2 7,383.28
328 APT010000I56000010 160802 tn. A NURDIN
NEBULIZE
PATTA BALI 
40,535.00 1 44,588.50
329 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  2 5,444.34

330 APT010000I62004353 160635 tn. DARWISFENTANYL

LAEDDA  041,599.80 3 45,759.78

331 APT010000I62004362 160683 tn. MANGKONAPADANG 

APIDRA 86,999.88 1 95,699.87
332 APT010000I62004379 113337 tn. MUHAMMAD
CETIRIZIN
ARIEF GANI 
999.97 1 1,099.96
333 APT010000I62004379 113337 tn. MUHAMMAD
RIFASTAR
ARIEF5,115.00
GANI  2 5,626.50
334 APT010000I62004379 113337 tn. MUHAMMAD
SIMUCIL
ARIEF
2 1,760.00
GANI  3 1,936.00
335 APT010000I62004379 113337 tn. MUHAMMAD
CODEINARIEF
20 1,494.00
GANI  2 1,643.40
336 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 1 7,864.56
337 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL I 24,202.60 3 26,622.86
338 APT010000I62004275 159982 tn. SULHAM 
OMEPRAZOL 24,999.70 2 27,499.67
339 APT010000I62004378 157909 tn. FANDI AFFANDI
FENTANYLHASTA
041,599.80
  1 45,759.78
Sub Total   821

Total 3911
PCS 2,103.20

PCS 770.00
PCS 1,633.50
PCS 12,705.07
PCS 660.00
PCS 7,864.56
PCS 522.71
PCS 806.67
PCS 133.10
PCS 7,260.00
PCS 871.20
PCS 390.82
PCS 1,960.20
PCS 132.00
PCS 742.50
PCS 7,260.00
PCS 121.00
PCS 922.01
PCS 12,959.10
PCS 4,157.94
PCS 7,712.10
PCS 1,993.20
PCS 1,511.46
PCS 474.60
PCS 2,766.03
PCS 37,755.30
PCS 6,243.60
PCS 1,481.70
PCS 1,930.50
PCS 439.98
PCS 7,260.03
PCS 798.60
PCS 31,290.60
PCS 21,152.01
PCS 770.00
PCS 2,103.20
PCS 1,633.50
PCS 780.45
PCS 1,930.50
PCS 363.00
PCS 21,235.50
PCS 439.98
PCS 2,395.80
PCS 2,940.30
PCS 1,540.00
PCS 29,948.60
PCS 650.52
PCS 2,940.30
118,918.8
PCS
0
PCS 7,260.00
PCS 493.90
PCS 2,310.00
PCS 2,103.20
PCS 8,525.00
PCS 42,906.60
PCS 75,504.00
PCS 31,458.24
PCS 17,050.00
PCS 1,540.00
PCS 4,930.20
PCS 2,081.20
PCS 14,302.20
PCS 21,152.01
PCS 2,310.00
PCS 30,855.00
PCS 2,417.58
PCS 6,298.05
PCS 5,808.00
PCS 12,585.10
PCS 692.99
PCS 25,410.00
PCS 6,600.00
PCS 10,005.60
PCS 21,152.01
PCS 18,700.00
PCS 2,310.00
PCS 21,152.01
PCS 65,997.03
PCS 6,600.00
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 79,868.58
PCS 4,591.95
PCS 16,879.50
PCS 2,310.00
PCS 18,700.00
PCS 8,525.00
PCS 12,705.07
PCS 4,930.20
- 0
PCS 1,903.00
PCS 54,558.90
PCS 4,404.40
PCS 27,499.67
PCS 43,998.02
PCS 12,850.20
PCS 21,152.01
PCS 6,600.00
PCS 10,005.60
PCS 21,152.01
PCS 8,525.00
PCS 116.60
PCS 10,430.20
PCS 6,600.00
PCS 1,633.50
PCS 495.00
PCS 3,685.59
PCS 522.71
PCS 2,420.01
PCS 133.10
PCS 1,903.00
PCS 43,998.02
PCS 6,600.00
PCS 1,118.04
PCS 21,152.01
PCS 16,698.00
PCS 21,152.01
PCS 980.10
PCS 65,997.03
PCS 6,600.00
PCS 21,152.01
PCS 2,310.00
PCS 1,051.60
PCS 8,525.00
PCS 18,700.00
PCS 121.00
PCS 2,420.01
PCS 266.20
PCS 6,600.00
PCS 7,260.00
PCS 31,458.24
PCS 770.00
PCS 9,147.60
PCS 4,576.00
PCS 21,221.20
PCS 54,999.34
PCS 2,202.20
PCS 77,207.68
PCS 19,275.30
PCS 922.01
PCS 42,906.60
PCS 48,514.92
PCS 664.40
PCS 316.40
PCS 3,626.37
PCS 2,081.20
PCS 1,677.06
PCS 5,808.00
PCS 92,345.02
PCS 95,699.87
PCS 4,582.60
PCS 9,147.60
238,551.5
PCS
0
PCS 1,040.60
PCS 664.40
PCS 503.82
PCS 158.20
PCS 79.10
PCS 43,560.00
PCS 54,999.34
PCS 9,347.25
PCS 92,345.02
PCS 980.10
PCS 121.00
PCS 7,260.00
PCS 6,600.00
PCS 522.71
PCS 420.18
PCS 1,085.03
PCS 922.01
PCS 5,949.85
PCS 3,872.00
PCS 980.10
PCS 43,998.02
PCS 42,906.60
PCS 1,955.79
PCS 210.09
PCS 117.83
PCS 922.01
PCS 7,078.50
PCS 4,930.20
PCS 980.10
PCS 3,677.22
PCS 1,677.06
PCS 6,425.10
PCS 117.83
PCS 659.97
PCS 1,073.58
PCS 980.10
PCS 210.09
PCS 6,243.60
PCS 5,031.18
PCS 10,879.11
PCS 17,424.00
114,599.1
PCS 0
PCS 14,101.34
PCS 65,997.03
PCS 54,999.34

PCS 347,633.0
0
PCS 272.83
PCS 84,700.00
PCS 439.98
PCS 7,078.50
PCS 336.60
PCS 3,025.00
PCS 316.40
PCS 32,125.50
102,300.0
PCS
0
PCS 16,698.00
PCS 10,516.00
PCS 7,700.00
PCS 27,225.00
PCS 16,333.02
PCS 6,600.00
PCS 77,207.68
PCS 8,525.00
PCS 5,082.00
PCS 3,509.00
PCS 10,516.00
PCS 7,700.00
PCS 23,593.68
PCS 41,624.00
PCS 43,998.02
PCS 24,257.46
PCS 36,779.16
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 18,700.00
PCS 11,357.50
PCS 8,525.00
PCS 15,729.12
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 8,525.00
PCS 1,633.50
PCS 3,146.00
PCS 656.70
PCS 28,182.00
PCS 44,588.50
PCS 14,766.56
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 2,541.00
PCS 1,754.50
PCS 18,700.00
PCS 11,357.50
PCS 8,525.00
PCS 36,300.00
PCS 15,729.12
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 11,357.50
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 3,146.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 3,146.00
PCS 2,112.00
PCS 2,541.00
PCS 5,335.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 8,525.00
PCS 1,633.50
PCS 3,146.00
PCS 14,766.56
PCS 770.00
PCS 1,051.60
PCS 30,855.00
PCS 2,541.00
PCS 2,112.00
PCS 16,698.00
PCS 21,220.10
PCS 770.00
PCS 2,541.00
PCS 1,754.50
PCS 8,525.00
PCS 1,287.00
PCS 14,766.56
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 2,541.00
PCS 1,633.50
PCS 15,729.12
PCS 770.00
PCS 16,698.00
PCS 1,051.60
PCS 2,112.00
PCS 1,633.50
PCS 5,335.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,633.50
PCS 8,525.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 770.00
PCS 11,357.50
PCS 2,541.00
PCS 1,754.50
PCS 43,998.02
PCS 1,955.79
PCS 18,788.00
PCS 20,019.76
127,050.0
PCS
0
PCS 980.10
PCS 14,766.56
PCS 44,588.50
PCS 10,888.68
137,279.3
PCS
4
PCS 95,699.87
PCS 1,099.96
PCS 11,253.00
PCS 5,808.00
PCS 3,286.80
PCS 7,864.56
PCS 79,868.58
PCS 54,999.34
PCS 45,759.78
5,236,599.18
 27,032,2
42.31
06-12-
1 APT010000I62004314 123536 tn. MUHAMMAD
DOMPERID
ALWI MUIN
508.20
SHI  3 559.02
2018 
2 APT010000I64002859 160634 tn. ABDUL RAZAK
METIL PRE
RAMANG 819.00 1 900.90
3 APT010000I64002859 160634 tn. ABDUL RAZAK
LANSOPRAZ
RAMANG 946.00 1 1,040.60
4 APT010000I62004385 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
5 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
6 APT010000I62004385 148491 ny. NURBAENI 
ASPILETS 110.00 1 121.00
7 APT010000I62004385 148491 ny. NURBAENI 
MECOBALAM6,600.00 1 7,260.00
8 APT010000I62004385 148491 ny. NURBAENI 
FUROSEMID 190.99 1 210.09
9 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
10 APT010000I62004379 113337 tn. MUHAMMAD
B COMPLEK
ARIEF GANI 
76.34 6 83.97
11 APT010000I62004379 113337 tn. MUHAMMAD
NEUROSAN
ARIEF1,168.50
GANI  1 1,285.35
12 APT010000I62004353 160635 tn. DARWISIVLAEDDA 
CATHETE 7,750.00 1 8,525.00
13 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 10 525.80
14 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,7,350.75
BA   2 8,085.82
15 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF,6,600.00
BA   1 7,260.00
16 APT010000I62004390 160844 tn. H. ANDIOMEPRAZOL
AZAS MANAF,
24,999.70
BA   1 27,499.67
17 APT010000I62004390 160844 tn. H. ANDIALPENTIN
AZAS MANAF,1,150.05
BA   2 1,265.06
18 APT010000I62004390 160844 tn. H. ANDICANGKANG
AZAS MANAF,116.90
BA   6 128.59
19 APT010000I62004390 160844 tn. H. ANDIAMITRIPTY
AZAS MANAF,177.65
BA   2 195.41
20 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 4 525.80
21 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA DI 700.00 1 770.00
22 APT010000I62004394 160864 tn. LUTHERCAIRAN
MARRIBA 
RL 7,149.60 1 7,864.56
23 APT010000I62004393 130394 tn. ANDI SURYATMAN
CAIRAN RL EKA
7,149.60
JAYA  1 9,294.49
24 APT010000I62004393 130394 tn. ANDI SURYATMAN
INFUS SET 17,000.00
EKA JAYA  1 22,100.00
25 APT010000I62004393 130394 tn. ANDI SURYATMAN
IV CATHETE EKA
7,750.00
JAYA  1 10,462.50
26 APT010000I62004393 130394 tn. ANDI SURYATMAN
HANDSCOENEKA 478.00
JAYA  2 645.30
27 APT010000I62004393 130394 tn. ANDI SURYATMAN
IV DRESSI EKA
4,850.00
JAYA  1 6,790.00
28 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA AM70,188.80 1 77,207.68
29 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA NAC6,409.70 2 7,050.67
30 APT010000I66000405 160570 nn. ROHANI CEFTRIAXO19,999.10 3 21,999.01
31 APT010000I66000405 160570 nn. ROHANI N-ACE INJE38,500.00 2 42,350.00
32 APT010000I66000405 160570 nn. ROHANI OMEPRAZOL 24,999.70 2 27,499.67
33 APT010000I66000405 160570 nn. ROHANI ALLOPURIN 248.02 1 272.83
34 APT010000I66000405 160570 nn. ROHANI CAPTOPRIL 199.99 2 219.99
35 APT010000I66000405 160570 nn. ROHANI ZINKID TAB 2,750.00 1 3,025.00
36 APT010000I66000405 160570 nn. ROHANI VITAMIN C 125.84 2 138.42
316,030.0 347,633.0
37 APT010000I66000405 160570 nn. ROHANI 
LEVOCIN I 1
0 0
38 APT010000I66000405 160570 nn. ROHANI 
ATORVASTA6,435.00 1 7,078.50
39 APT010000I66000405 160570 nn. ROHANI 
FARSORBID 306.00 3 336.60
40 APT010000I66000405 160570 nn. ROHANI 
FUROSEMID2,920.50 10 3,212.55

41 APT010000I66000405 160570 nn. ROHANI 

CEDOCARD31,000.00 3 34,100.00

42 APT010000I62004353 160635 tn. DARWISCEFTRIAXO19,999.10

LAEDDA  2 21,999.01
43 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
44 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
45 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  3,000.00 3 3,300.00
46 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 2 2,541.00
47 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
3 CC 1,485.00 2 1,633.50
48 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 20 525.80
49 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 10 770.00
50 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,149.60 3 7,864.56
51 APT010000I62004374 160756 nn. RINI RAHAYU
KOTRIMOKS
MEZANITA
254.10
P  4 279.51
52 APT010000I62004374 160756 nn. RINI RAHAYU
NEW DIAT
MEZANITA
557.15
P  6 612.87
53 APT010000I62004374 160756 nn. RINI RAHAYU
SANMOL MEZANITA
T 297.00P  3 326.70
54 APT010000I62004379 113337 tn. MUHAMMAD
CETIRIZIN
ARIEF GANI 
999.97 1 1,099.96
55 APT010000I62004379 113337 tn. MUHAMMAD
RIFASTAR
ARIEF5,115.00
GANI  2 5,626.50
56 APT010000I62004379 113337 tn. MUHAMMAD
B COMPLEK
ARIEF GANI 
76.34 6 83.97
57 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
58 APT010000I62004379 113337 tn. MUHAMMAD
INFUSANARIEF
N 6,712.07
GANI  2 7,383.28
59 APT010000I62004379 113337 tn. MUHAMMAD
HANDSCOEN
ARIEF GANI 
478.00 2 525.80
60 APT010000I62004379 113337 tn. MUHAMMAD
MASKER ARIEF
DI GANI 
700.00 1 770.00
61 APT010000I62004379 113337 tn. MUHAMMAD
IV CATHETE
ARIEF7,750.00
GANI  1 8,525.00
62 APT010000I62004379 113337 tn. MUHAMMAD
IV DRESSI
ARIEF4,850.00
GANI  1 5,335.00
63 APT010000I62004379 113337 tn. MUHAMMAD
SPOIT 10
ARIEF
C 2,310.00
GANI  1 2,541.00
64 APT010000I62004379 113337 tn. MUHAMMAD
SPOIT 5ARIEF
CC 1,595.00
GANI  1 1,754.50
65 APT010000I62004379 113337 tn. MUHAMMAD
SPOIT 1ARIEF
CC 1,920.00
GANI  1 2,112.00
66 APT010000I62004379 113337 tn. MUHAMMAD
CAIRANARIEF
AQ 2,860.00
GANI  1 3,146.00
67 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  1 27,499.67
68 APT010000I62004333 159705 ny. SITTI MAEMUNAH
IV CATHETE12,416.00
BASO  2 13,657.60
69 APT010000I62004333 159705 ny. SITTI MAEMUNAH
TRANSFUSI28,050.00
BASO  1 30,855.00
70 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CONECTA 10,325.00
BASO  1 11,357.50
71 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 50 12,367.00
BASO  1 13,603.70
72 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 20 C BASO 
5,600.00 1 6,160.00
73 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 10 C BASO 
2,310.00 1 2,541.00
74 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOON 12,100.00
BASO  1 13,310.00
75 APT010000I62004372 160749 nn. MUSDALIFA 
RANITIDIN 629.99 6 692.99
76 APT010000I62004372 160749 nn. MUSDALIFA 
INFUSAN N 6,712.07 3 7,383.28
77 APT010000I62004372 160749 nn. MUSDALIFA 
HANDSCOEN 478.00 2 525.80
78 APT010000I62004372 160749 nn. MUSDALIFA 
MASKER DI 700.00 1 770.00
79 APT010000I62004372 160749 nn. MUSDALIFA 
IV DRESSI 4,850.00 1 5,335.00
80 APT010000I62004372 160749 nn. MUSDALIFA 
IV CATHETE 7,750.00 1 8,525.00
81 APT010000I62004382 160799 ny. ARYANISANMOL
JAYANTI T 297.00 3 326.70
82 APT010000I62004382 160799 ny. ARYANICAIRAN
JAYANTI 
RL 7,149.60 2 7,864.56
83 APT010000I62004382 160799 ny. ARYANIHANDSCOEN
JAYANTI  478.00 2 525.80
84 APT010000I62004382 160799 ny. ARYANIMASKER
JAYANTI DI 700.00 1 770.00
85 APT010000I62004382 160799 ny. ARYANIIVJAYANTI 
CATHETE12,416.00 1 13,657.60
86 APT010000I62004382 160799 ny. ARYANISPOIT
JAYANTI 
10 C 2,310.00 1 2,541.00
87 APT010000I62004382 160799 ny. ARYANICAIRAN
JAYANTI 
AQ 2,860.00 1 3,146.00
 88 APT010000I62004382 160799 ny. ARYANISPOIT
JAYANTI 
3 CC 1,485.00 1 1,633.50
89 APT010000I62004382 160799 ny. ARYANIIVJAYANTI 
DRESSI 4,850.00 1 5,335.00
90 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
91 APT010000I62004385 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
92 APT010000I62004385 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
93 APT010000I62004385 148491 ny. NURBAENI 
METOCLOPR5,500.00 2 6,050.00
94 APT010000I62004385 148491 ny. NURBAENI 
OMEPRAZOL 24,999.70 2 27,499.67
95 APT010000I62004385 148491 ny. NURBAENI 
INFUSAN N 6,712.07 2 7,383.28
96 APT010000I62004385 148491 ny. NURBAENI 
HANDSCOEN 478.00 2 525.80
97 APT010000I62004385 148491 ny. NURBAENI 
MASKER DI 700.00 1 770.00
98 APT010000I62004385 148491 ny. NURBAENI 
CONECTA 10,325.00 1 11,357.50
99 APT010000I62004385 148491 ny. NURBAENI 
IV CATHETE 7,750.00 1 8,525.00
100 APT010000I62004385 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 1 2,541.00
101 APT010000I62004385 148491 ny. NURBAENI 
IV DRESSI 4,850.00 1 5,335.00
102 APT010000I62004385 148491 ny. NURBAENI 
CAIRAN AQ 2,860.00 1 3,146.00
103 APT010000I62004384 160808 ny. SITTI MUNA 
CAIRAN RL 7,149.60 2 7,864.56
104 APT010000I62004384 160808 ny. SITTI MUNA 
MECOBALAM6,600.00 1 7,260.00
105 APT010000I62004384 160808 ny. SITTI MUNA 
RANITIDIN 3,000.00 2 3,300.00
106 APT010000I62004384 160808 ny. SITTI MUNA 
ASPILETS 110.00 1 121.00
107 APT010000I62004384 160808 ny. SITTI MUNA 
AMLODIPIN 475.19 1 522.71
108 APT010000I62004384 160808 ny. SITTI MUNA 
PIRACETAM77,000.00 1 84,700.00
109 APT010000I62004384 160808 ny. SITTI MUNA 
HANDSCOEN 478.00 2 525.80
110 APT010000I62004384 160808 ny. SITTI MUNA 
MASKER DI 700.00 1 770.00
111 APT010000I62004384 160808 ny. SITTI MUNA 
IV CATHETE 7,750.00 1 8,525.00
112 APT010000I62004384 160808 ny. SITTI MUNA 
SPOIT 10 C 2,310.00 1 2,541.00
113 APT010000I62004384 160808 ny. SITTI MUNA 
CAIRAN AQ 2,860.00 1 3,146.00
114 APT010000I62004384 160808 ny. SITTI MUNA 
SANMOL T 297.00 2 326.70
115 APT010000I62004384 160808 ny. SITTI MUNA 
CANGKANG 116.90 2 128.59
116 APT010000I62004314 123536 tn. MUHAMMAD
CEFIXIME
ALWI 4,499.99
MUIN SHI  6 4,949.99
117 APT010000I62004314 123536 tn. MUHAMMAD
DOMPERID
ALWI MUIN
508.20
SHI  9 559.02
118 APT010000I62004314 123536 tn. MUHAMMAD
LEVOFLOXA
ALWI MUIN
449.00
SHI  3 493.90
119 APT010000I62004314 123536 tn. MUHAMMAD
INFUSAN
ALWIN 6,712.07
MUIN SHI  2 7,383.28
120 APT010000I62004314 123536 tn. MUHAMMAD
INFUSAN
ALWIR 9,645.50
MUIN SHI  2 10,610.05
121 APT010000I62004314 123536 tn. MUHAMMAD
CONECTA
ALWI10,325.00
MUIN SHI  1 11,357.50
122 APT010000I62004314 123536 tn. MUHAMMAD
IV DRESSI
ALWI 4,850.00
MUIN SHI  1 5,335.00
123 APT010000I62004314 123536 tn. MUHAMMAD
SPOIT 10
ALWI
C 2,310.00
MUIN SHI  1 2,541.00
124 APT010000I62004314 123536 tn. MUHAMMAD
IV CATHETE
ALWI 7,750.00
MUIN SHI  1 8,525.00
125 APT010000I62004314 123536 tn. MUHAMMAD
CAIRANALWI
AQ 2,860.00
MUIN SHI  1 3,146.00
126 APT010000I62004370 160721 tn. RONNY SIMUCIL
ALEXANDER 
2 1,760.00 3 1,936.00
127 APT010000I62004370 160721 tn. RONNY INFUSAN
ALEXANDER 
N 6,712.07 2 7,383.28
128 APT010000I62004370 160721 tn. RONNY HANDSCOEN
ALEXANDER  478.00 2 525.80
129 APT010000I62004370 160721 tn. RONNY MASKER
ALEXANDER 
DI 700.00 1 770.00
130 APT010000I62004370 160721 tn. RONNY IVALEXANDER 
CATHETE12,416.00 1 13,657.60
131 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
10 C 2,310.00 1 2,541.00
132 APT010000I62004370 160721 tn. RONNY CAIRAN
ALEXANDER 
AQ 2,860.00 1 3,146.00
133 APT010000I62004370 160721 tn. RONNY SPOIT
ALEXANDER 
3 CC 1,485.00 1 1,633.50
134 APT010000I62004393 130394 tn. ANDI SURYATMAN
SOTATIC I EKA
3,032.00
JAYA  2 5,154.40
135 APT010000I62004393 130394 tn. ANDI SURYATMAN
CAIRAN RL EKA
7,149.60
JAYA  3 9,294.49
136 APT010000I62004393 130394 tn. ANDI SURYATMAN
SPOIT 10 C EKA
2,310.00
JAYA  1 3,118.50
137 APT010000I62004393 130394 tn. ANDI SURYATMAN
SPOIT 3 CC EKA
1,485.00
JAYA  1 2,004.75
138 APT010000I62004370 160721 tn. RONNY CEFIXIME
ALEXANDER 4,499.99 6 4,949.99
139 APT010000I62004370 160721 tn. RONNY BISOPROLO
ALEXANDER  726.00 2 798.60
140 APT010000I62004370 160721 tn. RONNY ALPRAZOLA
ALEXANDER  585.00 3 643.50
141 APT010000I62004314 123536 tn. MUHAMMAD
ZINK OKSI
ALWI MUIN
604.00
SHI  3 664.40
142 APT010000I62004314 123536 tn. MUHAMMAD
B COMPLEK
ALWI MUIN
76.34
SHI  16 83.97
143 APT010000I62004314 123536 tn. MUHAMMAD
VITAMIN
ALWI
C MUIN
71.91
SHI  12 79.10

144 APT010000I62004314 123536 tn. MUHAMMAD

VIP ALBUM66,000.00
ALWI MUIN SHI  6 66,000.00

145 APT010000I12000055 160769 tn. HAMMAM FUROSEMID

ABDULLAH 190.99 2 210.09
146 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 986.39 1 1,085.03
147 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 9 7,260.00
148 APT010000I62004309 160384 tn. ARINOLSA
INFUSAN
SAPUTRA 
N 6,712.07 2 7,383.28
149 APT010000I62004309 160384 tn. ARINOLSA
HANDSCOEN
SAPUTRA  478.00 2 525.80
150 APT010000I62004309 160384 tn. ARINOLSA
MASKER
SAPUTRA 
DI 700.00 1 770.00
151 APT010000I62004309 160384 tn. ARINOLSA
IV CATHETE
SAPUTRA 7,750.00 1 8,525.00
152 APT010000I62004309 160384 tn. ARINOLSA
IV DRESSI
SAPUTRA 4,850.00 1 5,335.00
153 APT010000I62004309 160384 tn. ARINOLSA
CAIRAN
SAPUTRA 
AQ 2,860.00 1 3,146.00
154 APT010000I62004309 160384 tn. ARINOLSA
CONECTA
SAPUTRA 10,325.00 1 11,357.50
155 APT010000I62004309 160384 tn. ARINOLSA
ZINKSAPUTRA 
OKSI 604.00 1 664.40
156 APT010000I62004309 160384 tn. ARINOLSA
B COMPLEK
SAPUTRA  76.34 6 83.97
157 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 71.91 4 79.10
158 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 1 79.10
159 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 6 7,260.00
160 APT010000I12000055 160769 tn. HAMMAM IV CATHETE
ABDULLAH 
12,416.00 2 13,657.60
161 APT010000I12000055 160769 tn. HAMMAM CONECTA
ABDULLAH 
10,325.00 1 11,357.50
162 APT010000I12000055 160769 tn. HAMMAM TRANSFUSI28,050.00
ABDULLAH  1 30,855.00
163 APT010000I12000055 160769 tn. HAMMAM SPOIT
ABDULLAH 
50 12,367.00 1 13,603.70
164 APT010000I12000055 160769 tn. HAMMAM SPOIT
ABDULLAH 
20 C 5,600.00 2 6,160.00
165 APT010000I12000055 160769 tn. HAMMAM SPOIT
ABDULLAH 
10 C 2,310.00 2 2,541.00
166 APT010000I12000055 160769 tn. HAMMAM HANDSCOON
ABDULLAH 
12,100.00 1 13,310.00
167 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
RL 7,149.60
P  2 7,864.56
168 APT010000I62004374 160756 nn. RINI RAHAYU
HANDSCOEN
MEZANITA478.00
P  2 525.80
169 APT010000I62004374 160756 nn. RINI RAHAYU
MASKER MEZANITA
DI 700.00P  1 770.00
170 APT010000I62004374 160756 nn. RINI RAHAYU
IV CATHETE
MEZANITA
12,416.00
P  1 13,657.60
171 APT010000I62004374 160756 nn. RINI RAHAYU
SPOIT 5MEZANITA
CC 1,595.00
P  1 1,754.50
172 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
AQ 2,860.00
P  1 3,146.00
173 APT010000I62004374 160756 nn. RINI RAHAYU
SPOIT 10
MEZANITA
C 2,310.00
P  1 2,541.00
174 APT010000I62004362 160683 tn. MANGKONAPADANG 
DULCOLAX 2,247.81 2 2,472.59
175 APT010000I62004362 160683 tn. MANGKONAPADANG 
DULCOLAX 11,858.00 2 13,043.80
176 APT010000I62004362 160683 tn. MANGKONAPADANG 
RANITIDIN 629.99 1 692.99
177 APT010000I62004362 160683 tn. MANGKONAPADANG 
URDAFALK 5,527.50 2 6,080.25
178 APT010000I62004362 160683 tn. MANGKONAPADANG 
CAIRAN RL 7,149.60 2 7,864.56
179 APT010000I62004362 160683 tn. MANGKONAPADANG 
CAIRAN AQ 2,860.00 2 3,146.00
180 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 2 525.80
181 APT010000I62004362 160683 tn. MANGKONAPADANG 
CONECTA 10,325.00 1 11,357.50
182 APT010000I62004362 160683 tn. MANGKONAPADANG 
IV CATHETE 7,750.00 1 8,525.00
183 APT010000I62004362 160683 tn. MANGKONAPADANG 
SPOIT 5 CC 1,595.00 1 1,754.50
184 APT010000I62004362 160683 tn. MANGKONAPADANG 
SPOIT 10 C 2,310.00 1 2,541.00
185 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 1 770.00
186 APT010000I64002863 160668 tn. HARIS DG
CEFTRIAXO19,999.10
SE'RE  2 21,999.01
187 APT010000I64002863 160668 tn. HARIS DG
OMEPRAZOL
SE'RE  24,999.70 2 27,499.67
188 APT010000I64002863 160668 tn. HARIS DG
METRONIDA8,250.00
SE'RE  2 9,075.00
189 APT010000I64002863 160668 tn. HARIS DG
ASAM
SE'RE 
TRAN3,753.20 3 4,128.52
190 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE RL 7,149.60 2 7,864.56
191 APT010000I64002863 160668 tn. HARIS DG
HANDSCOEN
SE'RE  478.00 2 525.80
192 APT010000I64002863 160668 tn. HARIS DG
MASKER
SE'RE  DI 700.00 1 770.00
193 APT010000I64002863 160668 tn. HARIS DG
IV CATHETE
SE'RE  7,750.00 1 8,525.00
194 APT010000I64002863 160668 tn. HARIS DG
IV DRESSI
SE'RE  4,850.00 1 5,335.00
195 APT010000I64002863 160668 tn. HARIS DG
CAIRAN
SE'RE AQ 2,860.00 1 3,146.00
196 APT010000I64002863 160668 tn. HARIS DG
CONECTA
SE'RE  10,325.00 1 11,357.50
197 APT010000I64002859 160634 tn. ABDUL RAZAK
CEFTRIAXO19,999.10
RAMANG  2 21,999.01
198 APT010000I64002859 160634 tn. ABDUL RAZAK
AZITROMYC
RAMANG 
1,777.99 1 1,955.79
199 APT010000I64002859 160634 tn. ABDUL RAZAK
CETIRIZIN
RAMANG 999.97 1 1,099.96
200 APT010000I64002859 160634 tn. ABDUL RAZAK
ASAM TRAN3,753.20
RAMANG  3 4,128.52
201 APT010000I64002859 160634 tn. ABDUL RAZAK
PULMICORT
RAMANG 
8,540.00 3 9,394.00
202 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
RL 7,149.60 2 7,864.56
203 APT010000I64002859 160634 tn. ABDUL RAZAK
HANDSCOEN
RAMANG 478.00 4 525.80
204 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 10
RAMANG 
C 2,310.00 1 2,541.00
205 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 5RAMANG 
CC 1,595.00 1 1,754.50
206 APT010000I64002859 160634 tn. ABDUL RAZAK
IV CATHETE
RAMANG 
7,750.00 1 8,525.00
207 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
AQ 2,860.00 2 3,146.00
208 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID
RAMANG 190.99 1 210.09
209 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG 107.12 1 117.83
210 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG 838.19 1 922.01
211 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
212 APT010000I62004359 160674 ny. NURSIAH 
RANITIDIN 629.99 6 692.99
213 APT010000I62004359 160674 ny. NURSIAH 
DOMPERID 508.20 6 559.02
214 APT010000I62004359 160674 ny. NURSIAH 
INFUSAN N 6,712.07 3 7,383.28
215 APT010000I62004359 160674 ny. NURSIAH 
HANDSCOEN 478.00 2 525.80
216 APT010000I62004359 160674 ny. NURSIAH 
MASKER DI 700.00 1 770.00
217 APT010000I62004359 160674 ny. NURSIAH 
IV CATHETE 7,750.00 1 8,525.00
218 APT010000I62004359 160674 ny. NURSIAH 
IV DRESSI 4,850.00 1 5,335.00
219 APT010000I62004375 141583 nn. INDAH CIPROFLOX
LESTARI RIDWAN 
770.00 6 847.00
220 APT010000I62004375 141583 nn. INDAH RANITIDIN
LESTARI RIDWAN 
629.99 6 692.99
221 APT010000I62004375 141583 nn. INDAH INFUSAN
LESTARI RIDWAN 
N 6,712.07 3 7,383.28
222 APT010000I62004375 141583 nn. INDAH HANDSCOEN
LESTARI RIDWAN 
478.00 2 525.80
223 APT010000I62004375 141583 nn. INDAH MASKER
LESTARI RIDWAN 
DI 700.00 1 770.00
224 APT010000I62004375 141583 nn. INDAH IVLESTARI
CATHETE
RIDWAN 
7,750.00 1 8,525.00
225 APT010000I62004375 141583 nn. INDAH IVLESTARI
DRESSIRIDWAN 
4,850.00 1 5,335.00
226 APT010000I31000534 65833 tn. DR. H SINRING
FUROSEMID
YASIN 190.99 3 210.09
227 APT010000I31000534 65833 tn. DR. H SINRING
DIGOKSINYASIN 107.12 3 117.83
228 APT010000I31000534 65833 tn. DR. H SINRING
CAPTOPRIL
YASIN 199.99 9 219.99
229 APT010000I31000534 65833 tn. DR. H SINRING
AMLODIPIN
YASIN 475.19 3 522.71
230 APT010000I31000534 65833 tn. DR. H SINRING
SIMARCYASIN 
TA 975.98 3 1,073.58
231 APT010000I31000534 65833 tn. DR. H SINRING
SANMOL YASIN 
T 297.00 6 326.70
232 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
233 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
234 APT010000I62004394 160864 tn. LUTHERRANITIDIN
MARRIBA  629.99 2 692.99
235 APT010000I62004365 160707 ny. FITRIANI 
ERYSANBE 1,408.00 9 1,408.00
236 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 629.99 6 692.99
237 APT010000I62004365 160707 ny. FITRIANI 
DOMPERID 508.20 6 559.02
238 APT010000I62004365 160707 ny. FITRIANI 
INTERHIST 768.08 9 844.88
239 APT010000I62004365 160707 ny. FITRIANI 
SAGESTAM12,870.00 1 14,157.00
240 APT010000I62004372 160749 nn. MUSDALIFA 
SIMUCIL 2 1,760.00 6 1,936.00
241 APT010000I62004384 160808 ny. SITTI MUNA 
CLOBAZAM 1,116.84 1 1,228.53
242 APT010000I62004373 160757 tn. SYAHLAN 
ASAM TRAN3,753.20 3 4,128.52
243 APT010000I62004373 160757 tn. SYAHLAN 
SANMOL T 297.00 3 326.70
244 APT010000I62004373 160757 tn. SYAHLAN 
CAIRAN NA15,180.00 1 16,698.00
245 APT010000I62004373 160757 tn. SYAHLAN 
HANDSCOEN 478.00 2 525.80
246 APT010000I62004373 160757 tn. SYAHLAN 
MASKER DI 700.00 1 770.00
247 APT010000I62004373 160757 tn. SYAHLAN 
IV DRESSI 4,850.00 1 5,335.00
248 APT010000I62004373 160757 tn. SYAHLAN 
IV CATHETE 7,750.00 1 8,525.00
249 APT010000I62004395 160870 ny. HARERACAIRAN
S.Pd  RL 7,149.60 2 7,864.56
250 APT010000I62004395 160870 ny. HARERARANITIDIN
S.Pd  629.99 3 692.99
251 APT010000I62004395 160870 ny. HARERAVERTIGOSA
S.Pd  4,528.33 3 4,981.17
252 APT010000I62004395 160870 ny. HARERAGRATIZIN
S.Pd  4,741.00 2 5,215.10
253 APT010000I62004395 160870 ny. HARERASOTATIC
S.Pd  T 394.90 2 434.39
254 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,
7,350.75
BA   3 8,085.82
255 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF,
6,600.00
BA   1 7,260.00
256 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
257 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   2 525.80
258 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   1 770.00
259 APT010000I62004390 160844 tn. H. ANDIIVAZAS
CATHETE
MANAF,
7,750.00
BA   1 8,525.00
260 APT010000I62004365 160707 ny. FITRIANI 
INFUSAN N 6,712.07 1 7,383.28
261 APT010000I62004365 160707 ny. FITRIANI 
CEFTRIAXO19,999.10 2 21,999.01
262 APT010000I62004365 160707 ny. FITRIANI 
RANITIDIN 3,000.00 2 3,300.00
263 APT010000I62004365 160707 ny. FITRIANI 
DOMPERID 508.20 2 559.02
264 APT010000I62004365 160707 ny. FITRIANI 
HANDSCOEN 478.00 2 525.80
265 APT010000I62004365 160707 ny. FITRIANI 
MASKER DI 700.00 1 770.00
266 APT010000I62004365 160707 ny. FITRIANI 
IV DRESSI 4,850.00 1 5,335.00
267 APT010000I62004365 160707 ny. FITRIANI 
IV CATHETE 7,750.00 1 8,525.00
268 APT010000I12000054 160761 nn. OKTA SULISTIANI
BETAHISTI I.P. 733.33 3 806.67
269 APT010000I12000054 160761 nn. OKTA SULISTIANI
DIMENHIDR I.P. 121.00 2 133.10
270 APT010000I12000054 160761 nn. OKTA SULISTIANI
RANITIDIN I.P. 629.99 2 692.99
271 APT010000I12000054 160761 nn. OKTA SULISTIANI
MECOBALAI.P. 616.00 1 677.60
272 APT010000I12000054 160761 nn. OKTA SULISTIANI
ASPILETS I.P. 110.00 1 121.00
273 APT010000I12000054 160761 nn. OKTA SULISTIANI
CAIRAN RLI.P. 
7,149.60 3 7,864.56
274 APT010000I12000054 160761 nn. OKTA SULISTIANI
HANDSCOEN I.P. 478.00 2 525.80
275 APT010000I12000054 160761 nn. OKTA SULISTIANI
MASKER DII.P. 700.00 1 770.00
276 APT010000I12000054 160761 nn. OKTA SULISTIANI
IV CATHETEI.P. 
7,750.00 1 8,525.00
277 APT010000I12000054 160761 nn. OKTA SULISTIANI
IV DRESSI I.P. 
4,850.00 1 5,335.00
278 APT010000I12000054 160761 nn. OKTA SULISTIANI
CAIRAN NA15,180.00
I.P.  1 16,698.00
279 APT010000I62004358 160665 ny. MURNIATISPORETIK
REMPE  5,720.50 3 6,292.55
280 APT010000I62004358 160665 ny. MURNIATIFLAMAR
REMPE 
50 1,908.50 2 2,099.35
281 APT010000I62004358 160665 ny. MURNIATIRANITIDIN
REMPE  629.99 2 692.99
282 APT010000I62004358 160665 ny. MURNIATISANMOL
REMPE 
T 297.00 3 326.70
283 APT010000I62004358 160665 ny. MURNIATICAIRAN
REMPE 
RL 7,149.60 3 7,864.56
284 APT010000I62004358 160665 ny. MURNIATIHANDSCOEN
REMPE  478.00 2 525.80
285 APT010000I62004358 160665 ny. MURNIATIMASKER
REMPE 
DI 700.00 1 770.00
286 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
RL 7,149.60 3 7,864.56
287 APT010000I62004340 155102 tn. DRS. H. ASAM
ISHAK TRAN3,753.20
ABDIR  2 4,128.52
288 APT010000I62004340 155102 tn. DRS. H. SANMOL
ISHAK ABDIR 
T 297.00 3 326.70
289 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
RL 7,149.60 3 7,864.56
290 APT010000I62004340 155102 tn. DRS. H. HANDSCOEN
ISHAK ABDIR  478.00 2 525.80
291 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 1 770.00
292 APT010000I62004340 155102 tn. DRS. H. TRANSFUSI28,050.00
ISHAK ABDIR  1 30,855.00
293 APT010000I62004340 155102 tn. DRS. H. IV
ISHAK
CATHETE
ABDIR 
7,750.00 1 8,525.00
294 APT010000I62004340 155102 tn. DRS. H. IV
ISHAK
DRESSI
ABDIR 
4,850.00 1 5,335.00
295 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 240.24 2 264.26
296 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALA 616.00 1 677.60
297 APT010000I66000404 159099 ny. SITTI MULIYANA 
IV DRESSI 4,850.00 1 5,335.00
298 APT010000I66000404 159099 ny. SITTI MULIYANA 
CAIRAN NA15,180.00 1 16,698.00
299 APT010000I66000404 159099 ny. SITTI MULIYANA 
HANDSCOEN 478.00 2 525.80
300 APT010000I66000404 159099 ny. SITTI MULIYANA 
MASKER DI 700.00 1 770.00
301 APT010000I62004368 160718 tn. HENRA MECOBALA 616.00 1 677.60
302 APT010000I62004368 160718 tn. HENRA LEVOFLOXA 449.00 2 493.90
303 APT010000I62004368 160718 tn. HENRA RANITIDIN 629.99 2 692.99
304 APT010000I62004368 160718 tn. HENRA PARACETA 220.72 1 242.79
305 APT010000I62004368 160718 tn. HENRA CLOBAZAM 1,116.84 1 1,228.53
306 APT010000I62004368 160718 tn. HENRA DULCOLAX 11,858.00 2 13,043.80
307 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 2 8,085.82
308 APT010000I62004368 160718 tn. HENRA CAIRAN RL 7,149.60 3 7,864.56
309 APT010000I62004368 160718 tn. HENRA HANDSCOEN 478.00 1 525.80
310 APT010000I62004368 160718 tn. HENRA MASKER DI 700.00 1 770.00
311 APT010000I62004368 160718 tn. HENRA IV CATHETE 7,750.00 1 8,525.00
312 APT010000I62004368 160718 tn. HENRA IV DRESSI 4,850.00 1 5,335.00
313 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR2,002.00 1 2,202.20
314 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
315 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
316 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 3 326.70
317 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 3 7,864.56
318 APT010000I62004391 160813 tn. SUHERMAN 
HANDSCOEN 478.00 2 525.80
319 APT010000I62004391 160813 tn. SUHERMAN 
MASKER DI 700.00 1 770.00
320 APT010000I62004391 160813 tn. SUHERMAN 
IV CATHETE 7,750.00 1 8,525.00
321 APT010000I62004275 159982 tn. SULHAM METOCLOPR5,500.00 3 6,050.00
322 APT010000I62004275 159982 tn. SULHAM RANITIDIN 3,000.00 2 3,300.00
323 APT010000I62004275 159982 tn. SULHAM CAIRAN SAL27,830.00 1 30,613.00
324 APT010000I62004275 159982 tn. SULHAM INFUSAN N 6,712.07 1 7,383.28
325 APT010000I62004275 159982 tn. SULHAM CONECTA 10,325.00 1 11,357.50
326 APT010000I62004378 157909 tn. FANDI AFFANDI
CEFTRIAXO19,999.10
HASTA   2 21,999.01
327 APT010000I62004378 157909 tn. FANDI AFFANDI
SAGESTAM HASTA
10,186.00
  3 11,204.60
328 APT010000I62004378 157909 tn. FANDI AFFANDI
KETOROLAC HASTA
7,350.75
  3 8,085.82
329 APT010000I62004378 157909 tn. FANDI AFFANDI
RANITIDIN HASTA
3,000.00
  2 3,300.00
330 APT010000I62004366 160708 tn. SYAMSULCAIRAN
ALI  RL 7,149.60 3 7,864.56
331 APT010000I62004366 160708 tn. SYAMSULASAM
ALI  TRAN3,753.20 3 4,128.52
332 APT010000I62004366 160708 tn. SYAMSULADONA
ALI  INJ22,880.00 3 25,168.00
333 APT010000I62004366 160708 tn. SYAMSULCAIRAN
ALI  RL 7,149.60 3 7,864.56
334 APT010000I62004366 160708 tn. SYAMSULHANDSCOEN
ALI  478.00 2 525.80
335 APT010000I62004366 160708 tn. SYAMSULMASKER
ALI  DI 700.00 1 770.00
336 APT010000I62004366 160708 tn. SYAMSULIV CATHETE
ALI  7,750.00 1 8,525.00
337 APT010000I62004366 160708 tn. SYAMSULIV DRESSI
ALI  4,850.00 1 5,335.00
338 APT010000I62004378 157909 tn. FANDI AFFANDI
LOMATULL23,100.00
HASTA   2 25,410.00
339 APT010000I62004391 160813 tn. SUHERMAN 
B COMPLEK 76.34 2 83.97
340 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
341 APT010000I62004383 147711 ny. HJ AISYAH 
CAIRAN RL 7,149.60 2 7,864.56
342 APT010000I62004383 147711 ny. HJ AISYAH 
AMLODIPIN 475.19 1 522.71
343 APT010000I62004383 147711 ny. HJ AISYAH 
BETAHISTI 733.33 3 806.67
344 APT010000I62004383 147711 ny. HJ AISYAH 
DIMENHIDR 121.00 1 133.10
345 APT010000I62004383 147711 ny. HJ AISYAH 
MECOBALA 616.00 1 677.60
346 APT010000I62004383 147711 ny. HJ AISYAH 
RANITIDIN 629.99 2 692.99
347 APT010000I62004383 147711 ny. HJ AISYAH 
GRATIZIN 4,741.00 2 5,215.10
348 APT010000I62004383 147711 ny. HJ AISYAH 
PIROKSIKA 197.13 1 216.84
349 APT010000I62004383 147711 ny. HJ AISYAH 
CAIRAN RL 7,149.60 3 7,864.56
350 APT010000I62004383 147711 ny. HJ AISYAH 
HANDSCOEN 478.00 2 525.80
351 APT010000I62004383 147711 ny. HJ AISYAH 
MASKER DI 700.00 1 770.00
352 APT010000I62004383 147711 ny. HJ AISYAH 
IV CATHETE 7,750.00 1 8,525.00
353 APT010000I62004383 147711 ny. HJ AISYAH 
IV DRESSI 4,850.00 1 5,335.00
354 APT010000I62004377 160765 tn. HERI  - 0 0 0
355 APT010000I62004377 160765 tn. HERI  CAIRAN NAC6,409.70 3 7,050.67
356 APT010000I62004377 160765 tn. HERI  SAGESTAM10,186.00 3 11,204.60
357 APT010000I62004377 160765 tn. HERI  CEFTRIAXO19,999.10 2 21,999.01
358 APT010000I62004377 160765 tn. HERI  CAIRAN NAC6,409.70 3 7,050.67
359 APT010000I62004377 160765 tn. HERI  CAIRAN NA15,180.00 1 16,698.00
360 APT010000I64002859 160634 tn. ABDUL RAZAK
METIL PRE
RAMANG 819.00 2 900.90
361 APT010000I62004396 159610 ny. RITHA TANDI
COMBO LEMBANG 
PAC60,500.00 1 66,550.00
362 APT010000I62004396 159610 ny. RITHA TANDI
CAIRANLEMBANG 
RL 7,149.60 1 7,864.56
363 APT010000I62004396 159610 ny. RITHA TANDI
MASKERLEMBANG 
DI 700.00 1 770.00
364 APT010000I62004396 159610 ny. RITHA TANDI
HANDSCOEN
LEMBANG 478.00 4 525.80
365 APT010000I62004396 159610 ny. RITHA TANDI
TRANSFUSI28,050.00
LEMBANG  1 30,855.00
366 APT010000I64002863 160668 tn. HARIS DG
CEFIXIME
SE'RE  1,337.60 6 1,471.36
367 APT010000I64002863 160668 tn. HARIS DG
RANITIDIN
SE'RE  629.99 6 692.99
368 APT010000I64002863 160668 tn. HARIS DG
GLIMEPIRI
SE'RE  519.00 5 570.90

369 APT010000I64002863 160668 tn. HARIS DG

SANMOL
SE'RE  I 24,202.60 9 26,622.86

370 APT010000I62004373 160757 tn. SYAHLAN 

CODEIN 20 1,494.00 2 1,643.40
371 APT010000I62004366 160708 tn. SYAMSUL
CODEIN
ALI  20 1,494.00 3 1,643.40
372 APT010000I63003073 124832 ny. A. ROSDIANA
CAIRANSINRANG 
RL 7,149.60 1 7,864.56
373 APT010000I63003073 124832 ny. A. ROSDIANA
AMLODIPIN
SINRANG 
475.19 1 522.71
374 APT010000I63003073 124832 ny. A. ROSDIANA
SANMOL SINRANG 
T 297.00 3 326.70
375 APT010000I63003073 124832 ny. A. ROSDIANA
CODEINSINRANG 
20 1,494.00 2 1,643.40
316,030.0 347,633.0
376 APT010000I66000405 160570 nn. ROHANI 
LEVOCIN I 0 2 0
377 APT010000I66000405 160570 nn. ROHANI 
HUMI FLO 56,018.00 1 61,619.80
378 APT010000I62004353 160635 tn. DARWISCEFTRIAXO19,999.10
LAEDDA  2 21,999.01
379 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  1 5,444.34
380 APT010000I62004353 160635 tn. DARWISBUNASCAN56,320.00
LAEDDA  1 61,952.00
381 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,149.60 1 7,864.56
382 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 2 2,541.00
383 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
5 CC 1,595.00 2 1,754.50
384 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
3 CC 1,485.00 2 1,633.50
385 APT010000I62004396 159610 ny. RITHA TANDI
NEFROSTER
LEMBANG 
49,599.00 1 54,558.90
386 APT010000I62004396 159610 ny. RITHA TANDI
DULCOLAX
LEMBANG 
11,858.00 2 13,043.80
387 APT010000I62004396 159610 ny. RITHA TANDI
CAIRANLEMBANG 
RL 7,149.60 2 7,864.56
388 APT010000I62004396 159610 ny. RITHA TANDI
CONECTA
LEMBANG 
10,325.00 1 11,357.50
389 APT010000I62004396 159610 ny. RITHA TANDI
INFUS LEMBANG 
SET 17,000.00 1 18,700.00
390 APT010000I62004396 159610 ny. RITHA TANDI
URESIXLEMBANG 
INJ 6,151.36 1 6,766.50
391 APT010000I62004398 144402 tn. RAFANDI
ALPRAZOLA
ALWI  585.00 5 643.50
392 APT010000I62004398 144402 tn. RAFANDI
BUSCOPAN
ALWI  2,613.30 9 2,874.63
393 APT010000I62004398 144402 tn. RAFANDI
DOMPERID
ALWI  508.20 9 559.02
394 APT010000I62004398 144402 tn. RAFANDI
CANGKANG
ALWI  116.90 9 128.59
395 APT010000I62004309 160384 tn. ARINOLSA
- SAPUTRA  0 0 0
396 APT010000I62004309 160384 tn. ARINOLSA
RIFAMPISI
SAPUTRA  791.00 3 870.10
397 APT010000I62004309 160384 tn. ARINOLSA
ISONIAZID
SAPUTRA  350.00 2 385.00
398 APT010000I62004309 160384 tn. ARINOLSA
PIRAZINAM
SAPUTRA  295.00 6 324.50
399 APT010000I62004309 160384 tn. ARINOLSA
ETAMBUTOL
SAPUTRA  478.00 5 525.80
 400 APT010000I62004309 160384 tn. ARINOLSA
CANGKANG
SAPUTRA  75.00 9 82.50
401 APT010000I62004381 160797 tn. ISHAK  RANITIDIN 3,000.00 2 4,560.00
402 APT010000I62004381 160797 tn. ISHAK  PARACETA 220.72 3 297.97
403 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
RL 7,149.60 1 7,864.56
404 APT010000I62004397 160511 tn. SUPRIADI
RANITIDIN
PAISAL  3,000.00 2 3,300.00
405 APT010000I62004397 160511 tn. SUPRIADI
ONDANSETR2,002.00
PAISAL  3 2,202.20
406 APT010000I62004397 160511 tn. SUPRIADI
FUROSEMID2,920.50
PAISAL  1 3,212.55
407 APT010000I62004397 160511 tn. SUPRIADI
DEKSAMETA1,801.80
PAISAL  1 1,981.98
Sub Total   920
PCS 1,677.06

PCS 900.90
PCS 1,040.60
PCS 5,949.85
PCS 922.01
PCS 121.00
PCS 7,260.00
PCS 210.09
PCS 664.40
PCS 503.82
PCS 1,285.35
PCS 8,525.00
PCS 5,258.00
PCS 16,171.64
PCS 7,260.00
PCS 27,499.67
PCS 2,530.12
PCS 771.54
PCS 390.82
PCS 2,103.20
PCS 770.00
PCS 7,864.56
PCS 9,294.49
PCS 22,100.00
PCS 10,462.50
PCS 1,290.60
PCS 6,790.00
PCS 77,207.68
PCS 14,101.34
PCS 65,997.03
PCS 84,700.00
PCS 54,999.34
PCS 272.83
PCS 439.98
PCS 3,025.00
PCS 276.84
347,633.0
PCS
0
PCS 7,078.50
PCS 1,009.80
PCS 32,125.50
102,300.0
PCS
0
PCS 43,998.02
PCS 27,225.00
PCS 16,333.02
PCS 9,900.00
PCS 5,082.00
PCS 3,267.00
PCS 10,516.00
PCS 7,700.00
PCS 23,593.68
PCS 1,118.04
PCS 3,677.22
PCS 980.10
PCS 1,099.96
PCS 11,253.00
PCS 503.82
PCS 664.40
PCS 14,766.56
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 2,541.00
PCS 1,754.50
PCS 2,112.00
PCS 3,146.00
PCS 27,499.67
PCS 27,315.20
PCS 30,855.00
PCS 11,357.50
PCS 13,603.70
PCS 6,160.00
PCS 2,541.00
PCS 13,310.00
PCS 4,157.94
PCS 22,149.84
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,525.00
PCS 980.10
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 13,657.60
PCS 2,541.00
PCS 3,146.00
PCS 1,633.50
PCS 5,335.00
PCS 922.01
PCS 5,989.50
PCS 43,998.02
PCS 12,100.00
PCS 54,999.34
PCS 14,766.56
PCS 1,051.60
PCS 770.00
PCS 11,357.50
PCS 8,525.00
PCS 2,541.00
PCS 5,335.00
PCS 3,146.00
PCS 15,729.12
PCS 7,260.00
PCS 6,600.00
PCS 121.00
PCS 522.71
PCS 84,700.00
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 2,541.00
PCS 3,146.00
PCS 653.40
PCS 257.18
PCS 29,699.94
PCS 5,031.18
PCS 1,481.70
PCS 14,766.56
PCS 21,220.10
PCS 11,357.50
PCS 5,335.00
PCS 2,541.00
PCS 8,525.00
PCS 3,146.00
PCS 5,808.00
PCS 14,766.56
PCS 1,051.60
PCS 770.00
PCS 13,657.60
PCS 2,541.00
PCS 3,146.00
PCS 1,633.50
PCS 10,308.80
PCS 27,883.47
PCS 3,118.50
PCS 2,004.75
PCS 29,699.94
PCS 1,597.20
PCS 1,930.50
PCS 1,993.20
PCS 1,343.52
PCS 949.20
396,000.0
PCS 0
PCS 420.18
PCS 1,085.03
PCS 65,340.00
PCS 14,766.56
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 3,146.00
PCS 11,357.50
PCS 664.40
PCS 503.82
PCS 316.40
PCS 79.10
PCS 43,560.00
PCS 27,315.20
PCS 11,357.50
PCS 30,855.00
PCS 13,603.70
PCS 12,320.00
PCS 5,082.00
PCS 13,310.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 13,657.60
PCS 1,754.50
PCS 3,146.00
PCS 2,541.00
PCS 4,945.18
PCS 26,087.60
PCS 692.99
PCS 12,160.50
PCS 15,729.12
PCS 6,292.00
PCS 1,051.60
PCS 11,357.50
PCS 8,525.00
PCS 1,754.50
PCS 2,541.00
PCS 770.00
PCS 43,998.02
PCS 54,999.34
PCS 18,150.00
PCS 12,385.56
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 3,146.00
PCS 11,357.50
PCS 43,998.02
PCS 1,955.79
PCS 1,099.96
PCS 12,385.56
PCS 28,182.00
PCS 15,729.12
PCS 2,103.20
PCS 2,541.00
PCS 1,754.50
PCS 8,525.00
PCS 6,292.00
PCS 210.09
PCS 117.83
PCS 922.01
PCS 7,078.50
PCS 4,157.94
PCS 3,354.12
PCS 22,149.84
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 5,082.00
PCS 4,157.94
PCS 22,149.84
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 630.27
PCS 353.49
PCS 1,979.91
PCS 1,568.13
PCS 3,220.74
PCS 1,960.20
PCS 216.84
PCS 16,335.00
PCS 1,385.98
PCS 12,672.00
PCS 4,157.94
PCS 3,354.12
PCS 7,603.92
PCS 14,157.00
PCS 11,616.00
PCS 1,228.53
PCS 12,385.56
PCS 980.10
PCS 16,698.00
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,525.00
PCS 15,729.12
PCS 2,078.97
PCS 14,943.51
PCS 10,430.20
PCS 868.78
PCS 24,257.46
PCS 7,260.00
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 7,383.28
PCS 43,998.02
PCS 6,600.00
PCS 1,118.04
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,525.00
PCS 2,420.01
PCS 266.20
PCS 1,385.98
PCS 677.60
PCS 121.00
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 16,698.00
PCS 18,877.65
PCS 4,198.70
PCS 1,385.98
PCS 980.10
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 23,593.68
PCS 8,257.04
PCS 980.10
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 30,855.00
PCS 8,525.00
PCS 5,335.00
PCS 528.52
PCS 677.60
PCS 5,335.00
PCS 16,698.00
PCS 1,051.60
PCS 770.00
PCS 677.60
PCS 987.80
PCS 1,385.98
PCS 242.79
PCS 1,228.53
PCS 26,087.60
PCS 16,171.64
PCS 23,593.68
PCS 525.80
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 2,202.20
PCS 43,998.02
PCS 6,425.10
PCS 980.10
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 18,150.00
PCS 6,600.00
PCS 30,613.00
PCS 7,383.28
PCS 11,357.50
PCS 43,998.02
PCS 33,613.80
PCS 24,257.46
PCS 6,600.00
PCS 23,593.68
PCS 12,385.56
PCS 75,504.00
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 50,820.00
PCS 167.94
PCS 2,747.80
PCS 15,729.12
PCS 522.71
PCS 2,420.01
PCS 133.10
PCS 677.60
PCS 1,385.98
PCS 10,430.20
PCS 216.84
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
- 0
PCS 21,152.01
PCS 33,613.80
PCS 43,998.02
PCS 21,152.01
PCS 16,698.00
PCS 1,801.80
PCS 66,550.00
PCS 7,864.56
PCS 770.00
PCS 2,103.20
PCS 30,855.00
PCS 8,828.16
PCS 4,157.94
PCS 2,854.50
239,605.7
PCS 4
PCS 3,286.80
PCS 4,930.20
PCS 7,864.56
PCS 522.71
PCS 980.10
PCS 3,286.80
695,266.0
PCS 0
PCS 61,619.80
PCS 43,998.02
PCS 5,444.34
PCS 61,952.00
PCS 7,864.56
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 54,558.90
PCS 26,087.60
PCS 15,729.12
PCS 11,357.50
PCS 18,700.00
PCS 6,766.50
PCS 3,217.50
PCS 25,871.67
PCS 5,031.18
PCS 1,157.31
- 0
PCS 2,610.30
PCS 770.00
PCS 1,947.00
PCS 2,629.00
PCS 742.50
PCS 9,120.00
PCS 893.91
PCS 7,864.56
PCS 6,600.00
PCS 6,606.60
PCS 3,212.55
PCS 1,981.98
5,897,403.39
07-12-
1 APT010000I66000405 160570 nn. ROHANI 
INFUSAN N 6,712.07 1 7,383.28
2018 
2 APT010000I66000405 160570 nn. ROHANI 
CAIRAN AS 9,646.00 2 10,610.60

3 APT010000I62004401 150626 tn. SAHARUDDIN 

OMEPRAZOL
24,999.70 6 27,499.67

4 APT010000I62004401 150626 tn. SAHARUDDIN 

SPOIT 50 12,367.00 1 13,603.70
5 APT010000I62004401 150626 tn. SAHARUDDIN 
PERFUSSOR21,000.00 1 23,100.00
6 APT010000I62004398 144402 tn. RAFANDI
BUSCOPAN
ALWI  2,613.30 9 2,874.63
7 APT010000I62004398 144402 tn. RAFANDI
DOMPERID
ALWI  508.20 9 559.02
8 APT010000I62004398 144402 tn. RAFANDI
CANGKANG
ALWI  75.00 9 82.50
9 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN RL 7,149.60 2 7,864.56
10 APT010000I62004402 160911 ny. ANDI JUMANI 
CEFTRIAXO19,999.10 2 21,999.01
11 APT010000I62004402 160911 ny. ANDI JUMANI 
KETOROLAC 7,350.75 3 8,085.82
12 APT010000I62004402 160911 ny. ANDI JUMANI 
RANITIDIN 3,000.00 2 3,300.00
186,120.0 186,120.0
13 APT010000I62004402 160911 ny. ANDI JUMANI 
TETAGAM 2 0 1 0
14 APT010000I62004402 160911 ny. ANDI JUMANI 
SPOIT 1 CC 1,920.00 1 2,112.00
15 APT010000I62004402 160911 ny. ANDI JUMANI 
SPOIT 3 CC 1,485.00 2 1,633.50
16 APT010000I62004402 160911 ny. ANDI JUMANI 
SPOIT 10 C 2,310.00 1 2,541.00
17 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN AQ 2,860.00 1 3,146.00
18 APT010000I62004402 160911 ny. ANDI JUMANI 
HANDSCOON 12,100.00 1 13,310.00
19 APT010000I62004402 160911 ny. ANDI JUMANI 
KAPAS AL 300.00 4 330.00
20 APT010000I62004381 160797 tn. ISHAK  SANMOL T 297.00 3 386.10
21 APT010000I62004381 160797 tn. ISHAK  RANITIDIN 3,000.00 2 4,560.00
22 APT010000I62004381 160797 tn. ISHAK  METIL PRE 54,054.00 1 89,189.10
23 APT010000I62004384 160808 ny. SITTI MUNA 
MECOBALA 462.00 3 508.20
24 APT010000I62004384 160808 ny. SITTI MUNA 
RANITIDIN 629.99 6 692.99
25 APT010000I62004384 160808 ny. SITTI MUNA 
ASPILETS 110.00 3 121.00
26 APT010000I62004384 160808 ny. SITTI MUNA 
AMLODIPIN 475.19 3 522.71
27 APT010000I62004384 160808 ny. SITTI MUNA 
SANMOL T 297.00 3 326.70
28 APT010000I62004384 160808 ny. SITTI MUNA 
COFFEIN S 120.00 20 132.00
29 APT010000I62004384 160808 ny. SITTI MUNA 
CANGKANG 75.00 6 82.50
30 APT010000I62004384 160808 ny. SITTI MUNA 
PIRACETAM 618.31 3 680.14
31 APT010000I62004384 160808 ny. SITTI MUNA 
VALISANBE 236.50 6 260.15
32 APT010000I62004384 160808 ny. SITTI MUNA 
AMITRIPTY 177.65 1 195.41
33 APT010000I62004366 160708 tn. SYAMSULCODEIN
ALI  20 1,494.00 5 1,643.40
34 APT010000I62004366 160708 tn. SYAMSULASAM
ALI  TRA 1,386.00 9 1,524.60
35 APT010000I62004366 160708 tn. SYAMSULCAIRAN
ALI  RL 7,149.60 3 7,864.56
36 APT010000I62004366 160708 tn. SYAMSULHANDSCOEN
ALI  478.00 2 525.80
37 APT010000I62004366 160708 tn. SYAMSULMASKER
ALI  DI 700.00 1 770.00
38 APT010000I62004366 160708 tn. SYAMSULSPOIT
ALI 1 CC 1,920.00 1 2,112.00
39 APT010000I62004366 160708 tn. SYAMSULSPOIT
ALI 3 CC 1,485.00 1 1,633.50
40 APT010000I62004383 147711 ny. HJ AISYAH 
AMLODIPIN 475.19 3 522.71
41 APT010000I62004383 147711 ny. HJ AISYAH 
BETAHISTI 733.33 9 806.67
42 APT010000I62004383 147711 ny. HJ AISYAH 
DIMENHIDR 121.00 3 133.10
43 APT010000I62004383 147711 ny. HJ AISYAH 
MECOBALA 616.00 3 677.60
44 APT010000I62004383 147711 ny. HJ AISYAH 
RANITIDIN 629.99 6 692.99
45 APT010000I62004383 147711 ny. HJ AISYAH 
GRATIZIN 4,741.00 6 5,215.10
46 APT010000I62004383 147711 ny. HJ AISYAH 
PIROKSIKA 197.13 3 216.84
47 APT010000I12000054 160761 nn. OKTA SULISTIANI
BETAHISTI I.P. 733.33 9 806.67
48 APT010000I12000054 160761 nn. OKTA SULISTIANI
DIMENHIDR I.P. 121.00 6 133.10
49 APT010000I12000054 160761 nn. OKTA SULISTIANI
RANITIDIN I.P. 629.99 6 692.99
50 APT010000I12000054 160761 nn. OKTA SULISTIANI
MECOBALAI.P. 462.00 3 508.20
51 APT010000I12000054 160761 nn. OKTA SULISTIANI
ASPILETS I.P. 110.00 3 121.00
52 APT010000I12000054 160761 nn. OKTA SULISTIANI
BIOSANBE I.P. 
1,017.50 6 1,119.25
53 APT010000I62004362 160683 tn. MANGKONAPADANG 
LANSOPRAZ 946.00 1 1,040.60
54 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 2 4,573.80
216,865.0 238,551.5
55 APT010000I62004362 160683 tn. MANGKONAPADANG 
LIVAMIN 5 0 1 0
56 APT010000I62004362 160683 tn. MANGKONAPADANG 
INFUSAN N 6,712.07 2 7,383.28
57 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 2 770.00
58 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 2 525.80
59 APT010000I62004362 160683 tn. MANGKONAPADANG 
IV CATHETE 7,750.00 1 8,525.00
60 APT010000I62004309 160384 tn. ARINOLSA
ZINKSAPUTRA 
OKSI 604.00 1 664.40
61 APT010000I62004309 160384 tn. ARINOLSA
B COMPLEK
SAPUTRA  76.34 6 83.97
62 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 125.84 4 138.42
63 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 1 79.10
64 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 6 7,260.00
65 APT010000I31000535 160729 ny. HJ. ANDI
URSODEOX
B HARNIATI
4,158.00
  2 4,573.80
66 APT010000I31000535 160729 ny. HJ. ANDI
RANITIDIN
B HARNIATI
2,402.95
  2 2,643.24
67 APT010000I31000535 160729 ny. HJ. ANDI
ASERING
B HARNIATI
I 9,645.90
  3 10,610.49
68 APT010000I31000535 160729 ny. HJ. ANDI
MASKER
B HARNIATI
DI 700.00
  2 770.00
69 APT010000I31000535 160729 ny. HJ. ANDI
HANDSCOEN
B HARNIATI 478.00
  2 525.80
70 APT010000I31000535 160729 ny. HJ. ANDI
CAIRAN
B HARNIATI
NA15,180.00
  1 16,698.00
71 APT010000I62004399 109339 nn. AINUN CAIRAN
CAHYANI RL 7,149.60 1 7,864.56
72 APT010000I62004399 109339 nn. AINUN CEFTRIAXO19,999.10
CAHYANI  2 21,999.01
73 APT010000I62004399 109339 nn. AINUN RANITIDIN
CAHYANI  2,402.95 2 2,643.24
74 APT010000I62004399 109339 nn. AINUN DOMPERID
CAHYANI  508.20 2 559.02
75 APT010000I64002859 160634 tn. ABDUL RAZAK
METIL PRE
RAMANG 
327.00 4 359.70
76 APT010000I64002859 160634 tn. ABDUL RAZAK
LANSOPRAZ
RAMANG 
946.00 2 1,040.60
77 APT010000I64002859 160634 tn. ABDUL RAZAK
MASKER RAMANG 
DI 700.00 2 770.00
78 APT010000I64002859 160634 tn. ABDUL RAZAK
HANDSCOEN
RAMANG 
478.00 2 525.80
79 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 10RAMANG 
C 2,310.00 1 2,541.00
80 APT010000I64002859 160634 tn. ABDUL RAZAK
IV CATHETE
RAMANG 
7,750.00 1 8,525.00
81 APT010000I62004398 144402 tn. RAFANDI
INFUSAN
ALWI  N 6,712.07 1 7,383.28
82 APT010000I62004398 144402 tn. RAFANDI
RANITIDIN
ALWI  2,402.95 2 2,643.24
83 APT010000I62004398 144402 tn. RAFANDI
CAIRAN
ALWI  RL 7,149.60 2 7,864.56
84 APT010000I62004398 144402 tn. RAFANDI
MASKER
ALWI  DI 700.00 2 770.00
85 APT010000I62004398 144402 tn. RAFANDI
SPOIT
ALWI 
3 CC 1,485.00 1 1,633.50
86 APT010000I62004398 144402 tn. RAFANDI
SPOIT
ALWI 
5 CC 1,595.00 1 1,754.50
 87 APT010000I62004398 144402 tn. RAFANDIHANDSCOON
ALWI  12,100.00 1 13,310.00
88 APT010000I62004395 160870 ny. HARERARANITIDIN
S.Pd  2,402.95 2 2,643.24
89 APT010000I62004395 160870 ny. HARERAMECOBALAM
S.Pd  6,600.00 1 7,260.00
90 APT010000I62004395 160870 ny. HARERABETAHISTI
S.Pd  733.33 3 806.67
91 APT010000I62004395 160870 ny. HARERAGRATIZIN
S.Pd  4,741.00 2 5,215.10
92 APT010000I62004395 160870 ny. HARERASOTATIC
S.Pd  T 394.90 2 434.39
93 APT010000I62004395 160870 ny. HARERACAIRAN
S.Pd  RL 7,149.60 2 7,864.56
94 APT010000I62004395 160870 ny. HARERAMASKER
S.Pd  DI 700.00 2 770.00
95 APT010000I62004395 160870 ny. HARERAHANDSCOEN
S.Pd  478.00 2 525.80
96 APT010000I62004400 159800 ny. NURWAHIDAH
CEFTAZIDIM
KUSYAIRY 
23,166.00 3 25,482.60
97 APT010000I62004400 159800 ny. NURWAHIDAH
SANMOLKUSYAIRY 
I 24,202.60 3 26,622.86
98 APT010000I62004400 159800 ny. NURWAHIDAH
ONDANSETR3,630.00
KUSYAIRY  3 3,993.00
99 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN AM70,188.80
BASO  1 77,207.68
100 APT010000I62004333 159705 ny. SITTI MAEMUNAH
INFUSAN N BASO 
6,712.07 2 7,383.28
101 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 700.00 2 770.00
102 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOEN BASO 
478.00 2 525.80
103 APT010000I62004333 159705 ny. SITTI MAEMUNAH
IV DRESSI BASO 
4,850.00 1 5,335.00
104 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CONECTA 10,325.00
BASO  1 11,357.50
105 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
106 APT010000I62004379 113337 tn. MUHAMMAD
B COMPLEK
ARIEF GANI 
76.34 6 83.97
107 APT010000I62004379 113337 tn. MUHAMMAD
MASKER ARIEF
DI GANI 
700.00 2 770.00
108 APT010000I62004379 113337 tn. MUHAMMAD
HANDSCOON
ARIEF
12,100.00
GANI  1 13,310.00
109 APT010000I62004379 113337 tn. MUHAMMAD
HANDSCOEN
ARIEF GANI 
478.00 2 525.80
110 APT010000I62004379 113337 tn. MUHAMMAD
KAPAS ARIEF
AL GANI 
300.00 1 330.00
111 APT010000I62004379 113337 tn. MUHAMMAD
IV CATHETE
ARIEF7,750.00
GANI  1 8,525.00
112 APT010000I62004379 113337 tn. MUHAMMAD
CETIRIZIN
ARIEF GANI 
266.01 1 292.61
113 APT010000I62004379 113337 tn. MUHAMMAD
KSR 600ARIEF
M 3,069.14
GANI  2 3,376.05
114 APT010000I62004379 113337 tn. MUHAMMAD
COMBIVENT4,549.95
ARIEF GANI  1 5,004.94
115 APT010000I62004379 113337 tn. MUHAMMAD
CODEINARIEF
20 1,494.00
GANI  2 1,643.40
116 APT010000I12000055 160769 tn. HAMMAM FUROSEMID
ABDULLAH 190.99 1 210.09
117 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 285.75 1 314.33
118 APT010000I12000055 160769 tn. HAMMAM INFUSAN
ABDULLAH 
N 6,712.07 2 7,383.28
119 APT010000I12000055 160769 tn. HAMMAM SPOIT
ABDULLAH 
10 C 2,310.00 1 2,541.00
120 APT010000I12000055 160769 tn. HAMMAM IV DRESSI
ABDULLAH 4,850.00 1 5,335.00
121 APT010000I12000055 160769 tn. HAMMAM IV CATHETE
ABDULLAH 7,750.00 1 8,525.00
122 APT010000I12000055 160769 tn. HAMMAM NEBULIZE
ABDULLAH 
40,535.00 1 44,588.50
123 APT010000I62004374 160756 nn. RINI RAHAYU
SANMOL MEZANITA
T 297.00P  3 326.70
124 APT010000I62004374 160756 nn. RINI RAHAYU
NEW DIATMEZANITA
557.15
P  6 612.87
125 APT010000I62004374 160756 nn. RINI RAHAYU
KOTRIMOKS
MEZANITA
254.10
P  2 279.51
126 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
RL 7,149.60
P  3 7,864.56
127 APT010000I62004374 160756 nn. RINI RAHAYU
MASKER MEZANITA
DI 700.00
P  2 770.00
128 APT010000I62004374 160756 nn. RINI RAHAYU
HANDSCOEN
MEZANITA
478.00
P  2 525.80
129 APT010000I62004374 160756 nn. RINI RAHAYU
SPOIT 5MEZANITA
CC 1,595.00
P  1 1,754.50
130 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
NA15,180.00
P  1 16,698.00
131 APT010000I62004374 160756 nn. RINI RAHAYU
KAPAS MEZANITA
AL 300.00
P  2 330.00
132 APT010000I63003073 124832 ny. A. ROSDIANA
CODEINSINRANG 
20 1,494.00 2 1,643.40
133 APT010000I63003073 124832 ny. A. ROSDIANA
AMLODIPIN
SINRANG 838.19 1 922.01
134 APT010000I63003073 124832 ny. A. ROSDIANA
BISOPROLO
SINRANG 726.00 1 798.60
135 APT010000I63003073 124832 ny. A. ROSDIANA
ASPILETS
SINRANG 110.00 1 121.00
136 APT010000I63003073 124832 ny. A. ROSDIANA
CAIRANSINRANG 
RL 7,149.60 2 7,864.56
137 APT010000I63003073 124832 ny. A. ROSDIANA
HANDSCOEN
SINRANG 478.00 2 525.80
138 APT010000I63003073 124832 ny. A. ROSDIANA
MASKER SINRANG 
DI 700.00 1 770.00
139 APT010000I63003073 124832 ny. A. ROSDIANA
MASKER SINRANG 
O 19,519.99 1 21,471.99
140 APT010000I63003073 124832 ny. A. ROSDIANA
IV CATHETE
SINRANG 
7,750.00 1 8,525.00
141 APT010000I63003073 124832 ny. A. ROSDIANA
CAIRANSINRANG 
NA15,180.00 1 16,698.00
142 APT010000I62004382 160799 ny. ARYANICAIRAN
JAYANTI 
RL 7,149.60 3 7,864.56
143 APT010000I62004382 160799 ny. ARYANISANMOL
JAYANTI T 297.00 3 326.70
144 APT010000I62004382 160799 ny. ARYANIRANITIDIN
JAYANTI  2,402.95 2 2,643.24
145 APT010000I62004382 160799 ny. ARYANIMASKER
JAYANTI DI 700.00 2 770.00
146 APT010000I62004382 160799 ny. ARYANIHANDSCOEN
JAYANTI  478.00 2 525.80
147 APT010000I62004382 160799 ny. ARYANIKAPAS
JAYANTI 
AL 300.00 2 330.00
148 APT010000I62004382 160799 ny. ARYANIIVJAYANTI 
CATHETE 7,750.00 1 8,525.00
149 APT010000I62004382 160799 ny. ARYANIHANDSCOON
JAYANTI  13,613.00 1 14,974.30
150 APT010000I62004382 160799 ny. ARYANISPOIT
JAYANTI 
5 CC 1,595.00 1 1,754.50
151 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
152 APT010000I62004394 160864 tn. LUTHERRANITIDIN
MARRIBA  2,402.95 1 2,643.24
153 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
154 APT010000I62004385 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
155 APT010000I62004385 148491 ny. NURBAENI 
CEFTRIAXO 6,617.38 2 7,279.12
156 APT010000I62004385 148491 ny. NURBAENI 
OMEPRAZOL 24,999.70 2 27,499.67
157 APT010000I62004385 148491 ny. NURBAENI 
SOTATIC I 3,032.00 2 3,335.20
158 APT010000I62004385 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
159 APT010000I62004385 148491 ny. NURBAENI 
HANDSCOEN 478.00 2 525.80
160 APT010000I62004385 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 2 2,541.00
161 APT010000I62004385 148491 ny. NURBAENI 
INFUSAN N 6,712.07 2 7,383.28
162 APT010000I62004385 148491 ny. NURBAENI 
CAIRAN NA15,180.00 1 16,698.00
163 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 3 7,864.56
164 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 4 326.70
165 APT010000I62004391 160813 tn. SUHERMAN 
B COMPLEK 76.34 2 83.97
166 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
167 APT010000I62004391 160813 tn. SUHERMAN 
HANDSCOEN 478.00 2 525.80
168 APT010000I62004391 160813 tn. SUHERMAN 
MASKER DI 700.00 1 770.00
169 APT010000I62004391 160813 tn. SUHERMAN 
SPOIT 1 CC 1,920.00 1 2,112.00
170 APT010000I62004391 160813 tn. SUHERMAN 
SPOIT 3 CC 1,485.00 1 1,633.50
171 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,7,350.75
BA   3 8,085.82
172 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF,6,600.00
BA   1 7,260.00
173 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   2 7,864.56
174 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   2 525.80
175 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   1 770.00
176 APT010000I62004390 160844 tn. H. ANDIIVAZAS
DRESSI
MANAF,4,850.00
BA   1 5,335.00
177 APT010000I62004390 160844 tn. H. ANDICONECTA
AZAS MANAF,
10,325.00
BA   1 11,357.50
178 APT010000I62004390 160844 tn. H. ANDIIVAZAS
DRESSI
MANAF,
4,850.00
BA   1 5,335.00
179 APT010000I62004377 160765 tn. HERI  SANMOL I 24,202.60 3 26,622.86
180 APT010000I62004377 160765 tn. HERI  CEFTRIAXO 6,617.38 2 7,279.12
181 APT010000I62004377 160765 tn. HERI  RANITIDIN 2,402.95 2 2,643.24
182 APT010000I62004377 160765 tn. HERI  INFUSAN N 6,712.07 1 7,383.28
183 APT010000I62004377 160765 tn. HERI  HANDSCOEN 478.00 2 525.80
184 APT010000I62004377 160765 tn. HERI  MASKER DI 700.00 1 770.00
185 APT010000I62004377 160765 tn. HERI  SPOIT 3 CC 1,485.00 1 1,633.50
186 APT010000I62004377 160765 tn. HERI  SPOIT 5 CC 1,595.00 1 1,754.50
187 APT010000I62004368 160718 tn. HENRA MECOBALAM6,600.00 1 7,260.00
316,030.0 347,633.0
188 APT010000I62004368 160718 tn. HENRA LEVOCIN I 0 1 0
189 APT010000I62004368 160718 tn. HENRA GABAPENTI 4,400.00 2 4,840.00
190 APT010000I62004368 160718 tn. HENRA CANGKANG 75.00 6 82.50
191 APT010000I62004368 160718 tn. HENRA RANITIDIN 2,402.95 2 2,643.24
192 APT010000I62004368 160718 tn. HENRA DULCOLAX 11,858.00 2 13,043.80
193 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 2 8,085.82
194 APT010000I62004368 160718 tn. HENRA CAIRAN RL 7,149.60 3 7,864.56
195 APT010000I62004368 160718 tn. HENRA HANDSCOEN 478.00 2 525.80
196 APT010000I62004368 160718 tn. HENRA MASKER DI 700.00 1 770.00
197 APT010000I62004368 160718 tn. HENRA IV DRESSI 4,850.00 1 5,335.00
198 APT010000I62004368 160718 tn. HENRA IV CATHETE12,416.00 1 13,657.60
199 APT010000I62004368 160718 tn. HENRA AMITRIPTY 177.65 2 195.41
200 APT010000I62004378 157909 tn. FANDI AFFANDI
METRONIDAHASTA 285.00
  9 313.50
201 APT010000I62004378 157909 tn. FANDI AFFANDI
LEVOFLOXAHASTA 449.00
  3 493.90
202 APT010000I62004396 159610 ny. RITHA TANDI
CAIRANLEMBANG 
RL 7,149.60 3 7,864.56
203 APT010000I62004396 159610 ny. RITHA TANDI
HANDSCOEN
LEMBANG  478.00 6 525.80
204 APT010000I62004396 159610 ny. RITHA TANDI
MASKERLEMBANG 
DI 700.00 1 770.00
205 APT010000I62004396 159610 ny. RITHA TANDI
NEFROSTER
LEMBANG 
49,599.00 1 54,558.90
206 APT010000I62004275 159982 tn. SULHAM  SOTATIC I 3,032.00 3 3,335.20
207 APT010000I62004275 159982 tn. SULHAM  RANITIDIN 2,402.95 2 2,643.24
208 APT010000I62004397 160511 tn. SUPRIADIRANITIDIN
PAISAL  2,402.95 3 2,643.24
209 APT010000I62004397 160511 tn. SUPRIADISOTATIC
PAISAL I 3,032.00 1 3,335.20
210 APT010000I62004397 160511 tn. SUPRIADIEPISAN
PAISAL 
SU 51,150.00 1 56,265.00
211 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  946.00 1 1,040.60
212 APT010000I62004340 155102 tn. DRS. H. HANDSCOON
ISHAK ABDIR 
13,613.00 1 14,974.30
213 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 1 770.00
214 APT010000I62004340 155102 tn. DRS. H. IV
ISHAK
CATHETE
ABDIR 
12,416.00 1 13,657.60
215 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 240.24 2 264.26
216 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALA 616.00 1 677.60
217 APT010000I66000404 159099 ny. SITTI MULIYANA 
SANMOL T 297.00 4 326.70
218 APT010000I66000404 159099 ny. SITTI MULIYANA 
CLOBAZAM 1,116.84 2 1,228.53
219 APT010000I66000404 159099 ny. SITTI MULIYANA 
CANGKANG 75.00 6 82.50
220 APT010000I62004358 160665 ny. MURNIATICEFIXIME
REMPE  4,499.99 6 4,949.99
221 APT010000I62004358 160665 ny. MURNIATI
NATRIUM
REMPE D 195.91 9 215.50
222 APT010000I62004358 160665 ny. MURNIATI
RANITIDIN
REMPE  132.01 6 145.21
223 APT010000I62004373 160757 tn. SYAHLAN 
CODEIN 20 1,494.00 2 1,643.40
224 APT010000I62004373 160757 tn. SYAHLAN 
RIFAMPICI 1,500.00 1 1,650.00
225 APT010000I62004373 160757 tn. SYAHLAN 
ISONIAZID 350.00 2 385.00
226 APT010000I62004373 160757 tn. SYAHLAN 
ETAMBUTOL 478.00 3 525.80
227 APT010000I62004373 160757 tn. SYAHLAN 
PIRAZINAM 295.00 2 324.50
228 APT010000I62004373 160757 tn. SYAHLAN 
SANMOL T 297.00 3 326.70
229 APT010000I62004373 160757 tn. SYAHLAN 
ASAM TRAN3,493.88 3 3,843.26
230 APT010000I62004373 160757 tn. SYAHLAN 
HANDSCOEN 478.00 2 525.80
231 APT010000I62004373 160757 tn. SYAHLAN 
MASKER DI 700.00 1 770.00
232 APT010000I62004373 160757 tn. SYAHLAN 
IV CATHETE12,416.00 1 13,657.60
233 APT010000I62004403 150726 ny. ST HASNAH 
NASAL CA 11,550.07 1 12,705.07
234 APT010000I62004403 150726 ny. ST HASNAH 
CONECTA 10,325.00 1 11,357.50
235 APT010000I62004403 150726 ny. ST HASNAH 
NEFROSTER49,599.00 1 54,558.90
236 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID2,920.50 4 3,212.55
237 APT010000I62004403 150726 ny. ST HASNAH 
DIOVAN 16 1,525.49 1 1,678.04
238 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 3 221.48
239 APT010000I62004403 150726 ny. ST HASNAH 
ATORVASTA6,435.00 1 7,078.50
240 APT010000I66000404 159099 ny. SITTI MULIYANA 
CLOBAZAM 1,116.84 2 1,228.53

241 APT010000I62004401 150626 tn. SAHARUDDIN 

OMEPRAZOL
24,999.70 4 27,499.67

242 APT010000I62004401 150626 tn. SAHARUDDIN 

EPISAN SU 51,150.00 1 56,265.00
243 APT010000I66000405 160570 nn. ROHANI 
INFUSAN N 6,712.07 4 7,383.28

244 APT010000I66000405 CEFTRIAXO199,991.0

160570 nn. ROHANI  2 219,990.1
0 0
245 APT010000I66000405 160570 nn. ROHANI 
CAIRAN NA15,180.00 1 16,698.00
246 APT010000I66000405 160570 nn. ROHANI 
OMEPRAZOL 24,999.70 2 27,499.67
247 APT010000I66000405 160570 nn. ROHANI 
ALLOPURIN 248.02 1 272.83
248 APT010000I66000405 160570 nn. ROHANI 
ZINKID TAB 2,750.00 1 3,025.00
249 APT010000I66000405 160570 nn. ROHANI 
VITAMIN C 71.91 2 79.10
316,030.0 347,633.0
250 APT010000I66000405 160570 nn. ROHANI 
LEVOCIN I 2
0 0
251 APT010000I66000405 160570 nn. ROHANI 
SPOIT 10 C 2,310.00 2 2,541.00
252 APT010000I66000405 160570 nn. ROHANI 
SPOIT 5 CC 1,595.00 2 1,754.50
253 APT010000I66000405 160570 nn. ROHANI 
SPOIT 3 CC 1,485.00 2 1,633.50
254 APT010000I66000405 160570 nn. ROHANI 
HANDSCOEN 478.00 20 525.80
255 APT010000I66000405 160570 nn. ROHANI 
MASKER DI 700.00 15 770.00
256 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA AM70,188.80 1 77,207.68
257 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,149.60 3 7,864.56
290,400.0 319,440.0
258 APT010000I62004353 160635 tn. DARWISCLINOLEIC
LAEDDA  0 1 0

259 APT010000I62004353 LAEDDA  199,991.0

160635 tn. DARWISCEFTRIAXO 2 219,990.1
0 0
260 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
261 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
262 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  2,402.95 3 2,643.24
263 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 3 2,541.00
264 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
5 CC 1,595.00 2 1,754.50
265 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
3 CC 1,485.00 2 1,633.50
266 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 20 525.80
267 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 20 770.00
268 APT010000I32000266 127819 ny. ANDI HERMIATY
NASAL CADAMRI 
11,550.07 1 12,705.07
269 APT010000I32000266 127819 ny. ANDI HERMIATY
COMBO PAC DAMRI 
60,500.00 1 66,550.00
270 APT010000I32000266 127819 ny. ANDI HERMIATY
CAIRAN RLDAMRI 
7,149.60 1 7,864.56
271 APT010000I32000266 127819 ny. ANDI HERMIATY
HANDSCOEN DAMRI 
478.00 2 525.80
272 APT010000I32000266 127819 ny. ANDI HERMIATY
FUROSEMID2,920.50
DAMRI  2 3,212.55
273 APT010000I32000266 127819 ny. ANDI HERMIATY
SANMOL IDAMRI 
24,202.60 1 26,622.86
274 APT010000I32000266 127819 ny. ANDI HERMIATY
SPOIT 3 CCDAMRI 
1,485.00 2 1,633.50
275 APT010000I32000266 127819 ny. ANDI HERMIATY
COMBO KAT DAMRI 
60,500.00 1 66,550.00
276 APT010000I32000266 127819 ny. ANDI HERMIATY
CONECTADAMRI 
25,000.00 1 27,500.00
277 APT010000I32000266 127819 ny. ANDI HERMIATY
HANDSCOON DAMRI 
12,100.00 1 13,310.00
278 APT010000I32000266 127819 ny. ANDI HERMIATY
MASKER DI DAMRI 
700.00 1 770.00
279 APT010000I62004309 160384 tn. ARINOLSA
RIFAMPICI
SAPUTRA 1,500.00 1 1,650.00
280 APT010000I62004309 160384 tn. ARINOLSA
ETAMBUTOL
SAPUTRA  478.00 4 525.80
281 APT010000I62004309 160384 tn. ARINOLSA
ISONIAZID
SAPUTRA  350.00 7 385.00
282 APT010000I62004309 160384 tn. ARINOLSA
PIRAZINAM
SAPUTRA  295.00 2 324.50
283 APT010000I62004309 160384 tn. ARINOLSA
INFUSAN
SAPUTRA 
N 6,712.07 2 7,383.28
284 APT010000I62004309 160384 tn. ARINOLSA
HANDSCOEN
SAPUTRA  478.00 2 525.80
285 APT010000I62004309 160384 tn. ARINOLSA
MASKER
SAPUTRA 
DI 700.00 1 770.00
286 APT010000I62004309 160384 tn. ARINOLSA
IV CATHETE
SAPUTRA 7,750.00 1 8,525.00
287 APT010000I62004309 160384 tn. ARINOLSA
IV DRESSI
SAPUTRA 4,850.00 1 5,335.00
288 APT010000I62004309 160384 tn. ARINOLSA
CAIRAN
SAPUTRA 
AQ 2,860.00 1 3,146.00
289 APT010000I62004309 160384 tn. ARINOLSA
CONECTA
SAPUTRA 
10,325.00 1 11,357.50
290 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID2,920.50
RAMANG  1 3,212.55
291 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG 107.12 1 117.83
292 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG 838.19 1 922.01
293 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
294 APT010000I62004400 159800 ny. NURWAHIDAH
MECOBALAM
KUSYAIRY 
6,600.00 1 7,260.00
295 APT010000I62004400 159800 ny. NURWAHIDAH
CITICOLIN
KUSYAIRY 
27,505.00 2 30,255.50
296 APT010000I62004382 160799 ny. ARYANIEPISAN
JAYANTI 
SU 51,150.00 1 56,265.00
297 APT010000I62004382 160799 ny. ARYANISANMOL
JAYANTI T 297.00 9 326.70
298 APT010000I62004382 160799 ny. ARYANIMETIL
JAYANTI 
PRE 702.00 6 772.20
299 APT010000I62004382 160799 ny. ARYANIALPRAZOLA
JAYANTI  1,915.83 3 2,107.42
300 APT010000I62004404 160904 tn. BAYU SAPUTRA 
CAIRAN RL 7,149.60 1 7,864.56
301 APT010000I62004404 160904 tn. BAYU SAPUTRA 
COMBO PAC 60,500.00 1 66,550.00
302 APT010000I62004404 160904 tn. BAYU SAPUTRA 
NEW DIAT 557.15 4 612.87
303 APT010000I62004404 160904 tn. BAYU SAPUTRA 
KOTRIMOKS 254.10 4 279.51
304 APT010000I32000266 127819 ny. ANDI HERMIATY
IV CATHETEDAMRI 
7,750.00 1 8,525.00
305 APT010000I32000266 127819 ny. ANDI HERMIATY
IV CATHETEDAMRI 
7,750.00 2 8,525.00
 306 APT010000I32000266 127819 ny. ANDI HERMIATY
SPOIT 10 CDAMRI 
2,310.00 2 2,541.00
307 APT010000I32000266 127819 ny. ANDI HERMIATY
ELEKTRODA DAMRI 
4,000.00 5 4,400.00
308 APT010000I62004402 160911 ny. ANDI JUMANI 
SAGESTAM10,186.00 3 11,204.60
309 APT010000I62004402 160911 ny. ANDI JUMANI 
METRONIDA8,250.00 3 9,075.00
1,100,000 1,210,000
310 APT010000I32000266 127819 ny. ANDI HERMIATY
CERTOFIXDAMRI  1
.00 .00
Sub Total   799
PCS 7,383.28

PCS 21,221.20

PCS 164,998.0
2
PCS 13,603.70
PCS 23,100.00
PCS 25,871.67
PCS 5,031.18
PCS 742.50
PCS 15,729.12
PCS 43,998.02
PCS 24,257.46
PCS 6,600.00
186,120.0
PCS 0
PCS 2,112.00
PCS 3,267.00
PCS 2,541.00
PCS 3,146.00
PCS 13,310.00
PCS 1,320.00
PCS 1,158.30
PCS 9,120.00
PCS 89,189.10
PCS 1,524.60
PCS 4,157.94
PCS 363.00
PCS 1,568.13
PCS 980.10
PCS 2,640.00
PCS 495.00
PCS 2,040.42
PCS 1,560.90
PCS 195.41
PCS 8,217.00
PCS 13,721.40
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 2,112.00
PCS 1,633.50
PCS 1,568.13
PCS 7,260.03
PCS 399.30
PCS 2,032.80
PCS 4,157.94
PCS 31,290.60
PCS 650.52
PCS 7,260.03
PCS 798.60
PCS 4,157.94
PCS 1,524.60
PCS 363.00
PCS 6,715.50
PCS 1,040.60
PCS 9,147.60
238,551.5
PCS 0
PCS 14,766.56
PCS 1,540.00
PCS 1,051.60
PCS 8,525.00
PCS 664.40
PCS 503.82
PCS 553.68
PCS 79.10
PCS 43,560.00
PCS 9,147.60
PCS 5,286.48
PCS 31,831.47
PCS 1,540.00
PCS 1,051.60
PCS 16,698.00
PCS 7,864.56
PCS 43,998.02
PCS 5,286.48
PCS 1,118.04
PCS 1,438.80
PCS 2,081.20
PCS 1,540.00
PCS 1,051.60
PCS 2,541.00
PCS 8,525.00
PCS 7,383.28
PCS 5,286.48
PCS 15,729.12
PCS 1,540.00
PCS 1,633.50
PCS 1,754.50
PCS 13,310.00
PCS 5,286.48
PCS 7,260.00
PCS 2,420.01
PCS 10,430.20
PCS 868.78
PCS 15,729.12
PCS 1,540.00
PCS 1,051.60
PCS 76,447.80
PCS 79,868.58
PCS 11,979.00
PCS 77,207.68
PCS 14,766.56
PCS 1,540.00
PCS 1,051.60
PCS 5,335.00
PCS 11,357.50
PCS 664.40
PCS 503.82
PCS 1,540.00
PCS 13,310.00
PCS 1,051.60
PCS 330.00
PCS 8,525.00
PCS 292.61
PCS 6,752.10
PCS 5,004.94
PCS 3,286.80
PCS 210.09
PCS 314.33
PCS 14,766.56
PCS 2,541.00
PCS 5,335.00
PCS 8,525.00
PCS 44,588.50
PCS 980.10
PCS 3,677.22
PCS 559.02
PCS 23,593.68
PCS 1,540.00
PCS 1,051.60
PCS 1,754.50
PCS 16,698.00
PCS 660.00
PCS 3,286.80
PCS 922.01
PCS 798.60
PCS 121.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 21,471.99
PCS 8,525.00
PCS 16,698.00
PCS 23,593.68
PCS 980.10
PCS 5,286.48
PCS 1,540.00
PCS 1,051.60
PCS 660.00
PCS 8,525.00
PCS 14,974.30
PCS 1,754.50
PCS 16,335.00
PCS 2,643.24
PCS 922.01
PCS 5,949.85
PCS 14,558.24
PCS 54,999.34
PCS 6,670.40
PCS 1,540.00
PCS 1,051.60
PCS 5,082.00
PCS 14,766.56
PCS 16,698.00
PCS 23,593.68
PCS 1,306.80
PCS 167.94
PCS 2,747.80
PCS 1,051.60
PCS 770.00
PCS 2,112.00
PCS 1,633.50
PCS 24,257.46
PCS 7,260.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 11,357.50
PCS 5,335.00
PCS 79,868.58
PCS 14,558.24
PCS 5,286.48
PCS 7,383.28
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 1,754.50
PCS 7,260.00
347,633.0
PCS 0
PCS 9,680.00
PCS 495.00
PCS 5,286.48
PCS 26,087.60
PCS 16,171.64
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 13,657.60
PCS 390.82
PCS 2,821.50
PCS 1,481.70
PCS 23,593.68
PCS 3,154.80
PCS 770.00
PCS 54,558.90
PCS 10,005.60
PCS 5,286.48
PCS 7,929.72
PCS 3,335.20
PCS 56,265.00
PCS 1,040.60
PCS 14,974.30
PCS 770.00
PCS 13,657.60
PCS 528.52
PCS 677.60
PCS 1,306.80
PCS 2,457.06
PCS 495.00
PCS 29,699.94
PCS 1,939.50
PCS 871.26
PCS 3,286.80
PCS 1,650.00
PCS 770.00
PCS 1,577.40
PCS 649.00
PCS 980.10
PCS 11,529.78
PCS 1,051.60
PCS 770.00
PCS 13,657.60
PCS 12,705.07
PCS 11,357.50
PCS 54,558.90
PCS 12,850.20
PCS 1,678.04
PCS 664.44
PCS 7,078.50
PCS 2,457.06
109,998.6
PCS 8
PCS 56,265.00
PCS 29,533.12

PCS 439,980.2
0
PCS 16,698.00
PCS 54,999.34
PCS 272.83
PCS 3,025.00
PCS 158.20
695,266.0
PCS
0
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 10,516.00
PCS 11,550.00
PCS 77,207.68
PCS 23,593.68
319,440.0
PCS 0
439,980.2
PCS
0
PCS 27,225.00
PCS 16,333.02
PCS 7,929.72
PCS 7,623.00
PCS 3,509.00
PCS 3,267.00
PCS 10,516.00
PCS 15,400.00
PCS 12,705.07
PCS 66,550.00
PCS 7,864.56
PCS 1,051.60
PCS 6,425.10
PCS 26,622.86
PCS 3,267.00
PCS 66,550.00
PCS 27,500.00
PCS 13,310.00
PCS 770.00
PCS 1,650.00
PCS 2,103.20
PCS 2,695.00
PCS 649.00
PCS 14,766.56
PCS 1,051.60
PCS 770.00
PCS 8,525.00
PCS 5,335.00
PCS 3,146.00
PCS 11,357.50
PCS 3,212.55
PCS 117.83
PCS 922.01
PCS 7,078.50
PCS 7,260.00
PCS 60,511.00
PCS 56,265.00
PCS 2,940.30
PCS 4,633.20
PCS 6,322.26
PCS 7,864.56
PCS 66,550.00
PCS 2,451.48
PCS 1,118.04
PCS 8,525.00
PCS 17,050.00
PCS 5,082.00
PCS 22,000.00
PCS 33,613.80
PCS 27,225.00
1,210,000
PCS
.00
7,346,038.21
08-12-
1 APT010000I62004340 155102 tn. DRS. H. DULCOLAX
ISHAK ABDIR 
2,247.81 2 2,472.59
2018 
2 APT010000I62004340 155102 tn. DRS. H. DULCOLAX
ISHAK ABDIR 
11,858.00 2 13,043.80
3 APT010000I64002893 160944 tn. MUHAMMADCAIRANSU'ADHIE 
RL 7,149.60 2 7,864.56
4 APT010000I64002893 160944 tn. MUHAMMADCOMBOSU'ADHIE 
PAC
60,500.00 1 66,550.00
5 APT010000I64002893 160944 tn. MUHAMMADHANDSCOEN
SU'ADHIE 
478.00 4 525.80
6 APT010000I64002893 160944 tn. MUHAMMADRANITIDIN
SU'ADHIE 
2,402.95 1 2,643.24
7 APT010000I64002893 160944 tn. MUHAMMADSANMOL SU'ADHIE 
T 297.00 11 326.70
8 APT010000I64002893 160944 tn. MUHAMMADSPOIT 3SU'ADHIE 
CC 1,485.00 1 1,633.50
9 APT010000I62004407 160945 nn. KHAIRUN CAIRAN
NISWAH
RL YUSUF 
7,149.60 1 7,864.56
10 APT010000I62004407 160945 nn. KHAIRUN COMBO
NISWAH
PAC
6YUSUF 
0,500.00 1 66,550.00
11 APT010000I62004407 160945 nn. KHAIRUN RANITIDIN
NISWAH YUSUF 
2,402.95 1 2,643.24
12 APT010000I62004407 160945 nn. KHAIRUN KETOROLAC
NISWAH YUSUF 
7,350.75 1 8,085.82
13 APT010000I62004407 160945 nn. KHAIRUN SPOIT
NISWAH
3 CC YUSUF 
1,485.00 2 1,633.50
14 APT010000I62004407 160945 nn. KHAIRUN HANDSCOEN
NISWAH YUSUF 
478.00 4 525.80
15 APT010000I12000062 139631 tn. IBRAHIM CAIRAN
KADIR NAC6,409.70 2 7,050.67
16 APT010000I12000062 139631 tn. IBRAHIM NEBULIZE
KADIR  40,535.00 1 44,588.50
17 APT010000I12000062 139631 tn. IBRAHIM COMBIVENT4,549.95
KADIR  3 5,004.94
18 APT010000I12000062 139631 tn. IBRAHIM PULMICORT
KADIR  8,540.00 2 9,394.00
19 APT010000I12000062 139631 tn. IBRAHIM AMLODIPIN
KADIR  838.19 1 922.01
20 APT010000I12000062 139631 tn. IBRAHIM - KADIR  0 0 0
21 APT010000I62004404 160904 tn. BAYU SAPUTRA 
RANITIDIN 629.99 6 692.99
22 APT010000I62004404 160904 tn. BAYU SAPUTRA 
NEW DIAT 557.15 8 612.87
23 APT010000I62004404 160904 tn. BAYU SAPUTRA 
KOTRIMOKS 254.10 12 279.51
24 APT010000I62004404 160904 tn. BAYU SAPUTRA 
NYSTATIN 24,006.40 1 26,407.04
25 APT010000I62004392 120291 ny. MARLINA CEFOTAXIM15,004.00 2 16,504.40
26 APT010000I62004392 120291 ny. MARLINA KETOROLAC 7,350.75 2 8,085.82
27 APT010000I62004392 120291 ny. MARLINA RANITIDIN 2,402.95 2 2,643.24
28 APT010000I62004392 120291 ny. MARLINA DULCOLAX 11,858.00 2 13,043.80
29 APT010000I62004392 120291 ny. MARLINA CAIRAN RL 7,149.60 3 7,864.56
30 APT010000I62004392 120291 ny. MARLINA MASKER DI 700.00 1 770.00
31 APT010000I62004392 120291 ny. MARLINA HANDSCOON 12,100.00 2 13,310.00
32 APT010000I62004392 120291 ny. MARLINA IV DRESSI 4,850.00 2 5,335.00
33 APT010000I62004392 120291 ny. MARLINA CONECTA 10,325.00 2 11,357.50
34 APT010000I62004392 120291 ny. MARLINA INFUS SET 17,000.00 1 18,700.00
35 APT010000I62004402 160911 ny. ANDI JUMANI 
CEFTRIAXO19,999.10 2 21,999.01
36 APT010000I62004402 160911 ny. ANDI JUMANI 
RANITIDIN 2,402.95 2 2,643.24
37 APT010000I62004402 160911 ny. ANDI JUMANI 
KETOROLAC 7,350.75 3 8,085.82
38 APT010000I62004402 160911 ny. ANDI JUMANI 
METRONIDA8,250.00 3 9,075.00
39 APT010000I62004402 160911 ny. ANDI JUMANI 
GENTAMICI 3,507.65 3 3,858.41
40 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN RL 7,149.60 3 7,864.56
41 APT010000I62004402 160911 ny. ANDI JUMANI 
SPOIT 5 CC 1,595.00 2 1,754.50
42 APT010000I62004402 160911 ny. ANDI JUMANI 
SPOIT 3 CC 1,485.00 2 1,633.50
43 APT010000I62004402 160911 ny. ANDI JUMANI 
MASKER DI 700.00 1 770.00
44 APT010000I62004402 160911 ny. ANDI JUMANI 
HANDSCOEN 478.00 2 525.80
45 APT010000I62004402 160911 ny. ANDI JUMANI 
TRANSFUSI28,050.00 1 30,855.00
46 APT010000I62004377 160765 tn. HERI  LEVOFLOXA 449.00 3 493.90
47 APT010000I62004377 160765 tn. HERI  SANMOL T 297.00 9 326.70
48 APT010000I62004377 160765 tn. HERI  IV CATHETE 7,750.00 3 8,525.00
49 APT010000I62004377 160765 tn. HERI  IV DRESSI 4,850.00 2 5,335.00
50 APT010000I62004377 160765 tn. HERI  MASKER DI 700.00 2 770.00
51 APT010000I62004377 160765 tn. HERI  HANDSCOON 12,100.00 2 13,310.00
52 APT010000I62004377 160765 tn. HERI  SPOIT 50 12,367.00 2 13,603.70
53 APT010000I62004377 160765 tn. HERI  SPOIT 5 CC 1,595.00 2 1,754.50
54 APT010000I62004373 160757 tn. SYAHLAN SANMOL T 297.00 9 326.70
55 APT010000I62004373 160757 tn. SYAHLAN RIFAMPISI 791.00 3 870.10
56 APT010000I62004373 160757 tn. SYAHLAN ISONIAZID 350.00 2 385.00
57 APT010000I62004373 160757 tn. SYAHLAN ETAMBUTOL 478.00 6 525.80
58 APT010000I62004373 160757 tn. SYAHLAN PIRAZINAM 295.00 6 324.50
59 APT010000I62004373 160757 tn. SYAHLAN CONECTA 10,325.00 2 11,357.50
60 APT010000I62004373 160757 tn. SYAHLAN HANDSCOEN 478.00 2 525.80
61 APT010000I62004373 160757 tn. SYAHLAN IV DRESSI 4,850.00 2 5,335.00
62 APT010000I62004373 160757 tn. SYAHLAN SPOIT 10 C 2,310.00 2 2,541.00
63 APT010000I62004373 160757 tn. SYAHLAN SPOIT 5 CC 1,595.00 3 1,754.50
64 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  851.29 1 936.42
65 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
RL 7,149.60 3 7,864.56
66 APT010000I62004390 160844 tn. H. ANDIGABAPENTI
AZAS MANAF,4,400.00
BA   2 4,840.00
67 APT010000I62004390 160844 tn. H. ANDICANGKANG
AZAS MANAF, 75.00
BA   6 82.50
68 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,7,350.75
BA   3 8,085.82
69 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF,6,600.00
BA   1 7,260.00
70 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
71 APT010000I62004390 160844 tn. H. ANDISPOIT
AZAS 10
MANAF,
C 2,310.00
BA   2 2,541.00
72 APT010000I62004390 160844 tn. H. ANDISPOIT
AZAS 5MANAF,
CC 1,595.00
BA   2 1,754.50
73 APT010000I62004390 160844 tn. H. ANDISPOIT
AZAS 3MANAF,
CC 1,485.00
BA   2 1,633.50
74 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   2 770.00
75 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   2 525.80
76 APT010000I62004390 160844 tn. H. ANDIIVAZAS
DRESSI
MANAF,
4,850.00
BA   2 5,335.00
77 APT010000I62004390 160844 tn. H. ANDIAMITRIPTY
AZAS MANAF,177.65
BA   2 195.41
78 APT010000I62004275 159982 tn. SULHAM  DOMPERID 508.20 3 559.02
79 APT010000I62004275 159982 tn. SULHAM  GABAPENTI 4,400.00 2 4,840.00
80 APT010000I62004368 160718 tn. HENRA MECOBALAM6,600.00 1 7,260.00
81 APT010000I62004368 160718 tn. HENRA RANITIDIN 2,402.95 2 2,643.24
82 APT010000I62004368 160718 tn. HENRA DULCOLAX 11,858.00 2 13,043.80
83 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 2 8,085.82
84 APT010000I62004368 160718 tn. HENRA IV DRESSI 4,850.00 2 5,335.00
85 APT010000I62004368 160718 tn. HENRA CONECTA 10,325.00 2 11,357.50
86 APT010000I62004368 160718 tn. HENRA HANDSCOEN 478.00 2 525.80
87 APT010000I62004368 160718 tn. HENRA INFUSAN N 6,712.06 1 7,383.27
88 APT010000I62004368 160718 tn. HENRA TRANSFUSI28,050.00 1 30,855.00
89 APT010000I62004368 160718 tn. HENRA SPOIT 10 C 2,310.00 5 2,541.00
 90 APT010000I62004368 160718 tn. HENRA SPOIT 5 CC 1,595.00 2 1,754.50
91 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,149.60 3 7,864.56
92 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
93 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
94 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  7,687.68 3 8,456.45
95 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA AM70,188.80 1 77,207.68
96 APT010000I62004353 160635 tn. DARWISHANDSCOON
LAEDDA  12,100.00 1 13,310.00
97 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 2 770.00
98 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 2 2,541.00
99 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
5 CC 1,595.00 2 1,754.50
100 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
1 CC 1,920.00 2 2,112.00

101 APT010000I62004401 150626 tn. SAHARUDDIN 

OMEPRAZOL
24,999.70 4 27,499.67

102 APT010000I62004401 150626 tn. SAHARUDDIN 

INFUSAN N 6,712.06 1 7,383.27
103 APT010000I62004401 150626 tn. SAHARUDDIN 
CAIRAN DE18,920.00 2 20,812.00
104 APT010000I62004401 150626 tn. SAHARUDDIN 
INFUSAN N 6,712.06 6 7,383.27
105 APT010000I62004401 150626 tn. SAHARUDDIN 
CAIRAN DE18,920.00 3 20,812.00
106 APT010000I62004401 150626 tn. SAHARUDDIN 
CONECTA 10,325.00 2 11,357.50
107 APT010000I62004401 150626 tn. SAHARUDDIN 
TRANSFUSI28,050.00 1 30,855.00
108 APT010000I62004401 150626 tn. SAHARUDDIN 
CAIRAN NA15,180.00 2 16,698.00
109 APT010000I62004401 150626 tn. SAHARUDDIN 
TRANSOFIX 8,500.00 1 9,350.00
110 APT010000I62004386 149341 tn. MUH BASRI 
KETOROLAC 7,350.75 3 8,085.82
111 APT010000I62004386 149341 tn. MUH BASRI 
CEFTRIAXO19,999.10 2 21,999.01
112 APT010000I62004386 149341 tn. MUH BASRI 
CARBAZOC11,145.20 1 12,259.72
113 APT010000I62004386 149341 tn. MUH BASRI 
CAIRAN RL 7,149.60 3 7,864.56
114 APT010000I62004386 149341 tn. MUH BASRI 
INFUS SET 17,000.00 1 18,700.00
115 APT010000I62004386 149341 tn. MUH BASRI 
MASKER DI 700.00 2 770.00
116 APT010000I62004386 149341 tn. MUH BASRI 
SPOIT 10 C 2,310.00 2 2,541.00
117 APT010000I62004386 149341 tn. MUH BASRI 
SPOIT 5 CC 1,595.00 2 1,754.50
118 APT010000I62004386 149341 tn. MUH BASRI 
SPOIT 1 CC 1,920.00 2 2,112.00
119 APT010000I12000062 139631 tn. IBRAHIM
INFUSAN
KADIR  N 6,712.06 4 7,383.27
120 APT010000I12000062 139631 tn. IBRAHIM
COMBIVENT4,549.95
KADIR  3 5,004.94
121 APT010000I12000062 139631 tn. IBRAHIM
PULMICORT
KADIR  8,540.00 3 9,394.00
122 APT010000I12000062 139631 tn. IBRAHIM
AMLODIPIN
KADIR  838.19 1 922.01
123 APT010000I12000062 139631 tn. IBRAHIM
HANDSCOEN
KADIR  478.00 2 525.80
124 APT010000I12000062 139631 tn. IBRAHIM
MASKER
KADIR  DI 700.00 2 770.00
125 APT010000I12000062 139631 tn. IBRAHIM
SPOIT
KADIR 
5 CC 1,595.00 2 1,754.50
126 APT010000I12000062 139631 tn. IBRAHIM
SPOIT
KADIR 
3 CC 1,485.00 2 1,633.50
127 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 1 7,864.56
128 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 6 326.70
129 APT010000I62004391 160813 tn. SUHERMAN 
B COMPLEK 76.34 2 83.97
130 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
131 APT010000I62004397 160511 tn. SUPRIADI
RANITIDIN
PAISAL  7,687.68 3 8,456.45
132 APT010000I62004397 160511 tn. SUPRIADI
SOTATIC
PAISAL I 3,032.00 1 3,335.20
133 APT010000I62004397 160511 tn. SUPRIADI
CEFTRIAXO19,999.10
PAISAL  2 21,999.01
134 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
RL 7,149.60 3 7,864.56
135 APT010000I62004397 160511 tn. SUPRIADI
CONECTA
PAISAL  10,325.00 3 11,357.50
136 APT010000I62004397 160511 tn. SUPRIADI
IV DRESSI
PAISAL  4,850.00 2 5,335.00
137 APT010000I62004397 160511 tn. SUPRIADI
MASKER
PAISAL DI 700.00 1 770.00
138 APT010000I62004397 160511 tn. SUPRIADI
HANDSCOEN
PAISAL  478.00 2 525.80
139 APT010000I62004397 160511 tn. SUPRIADI
IV CATHETE
PAISAL  7,750.00 2 8,525.00
140 APT010000I62004396 159610 ny. RITHA TANDI
NEFROSTER
LEMBANG 
49,599.00 1 54,558.90
141 APT010000I62004396 159610 ny. RITHA TANDI
CONECTA
LEMBANG 
10,325.00 2 11,357.50
142 APT010000I62004396 159610 ny. RITHA TANDI
HANDSCOEN
LEMBANG  478.00 2 525.80
143 APT010000I62004396 159610 ny. RITHA TANDI
TRANSFUSI28,050.00
LEMBANG  1 30,855.00
144 APT010000I62004396 159610 ny. RITHA TANDI
IV CATHETE
LEMBANG 
7,750.00 2 8,525.00
145 APT010000I62004396 159610 ny. RITHA TANDI
IV DRESSI
LEMBANG 
4,850.00 2 5,335.00
146 APT010000I62004396 159610 ny. RITHA TANDI
SPOIT LEMBANG 
5 CC 1,595.00 2 1,754.50
147 APT010000I62004396 159610 ny. RITHA TANDI
SPOIT LEMBANG 
1 CC 1,920.00 2 2,112.00
148 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 6,101.33 2 6,711.47
149 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALA 462.00 1 508.20
150 APT010000I66000404 159099 ny. SITTI MULIYANA 
RANITIDIN 7,687.68 2 8,456.45
151 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
152 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
153 APT010000I62004374 160756 nn. RINI RAHAYU
SANMOL MEZANITA
T 297.00P  3 326.70
154 APT010000I62004374 160756 nn. RINI RAHAYU
KOTRIMOKS
MEZANITA254.10
P  4 279.51
155 APT010000I62004374 160756 nn. RINI RAHAYU
CAIRANMEZANITA
RL 7,149.60
P  3 7,864.56
156 APT010000I62004374 160756 nn. RINI RAHAYU
MASKER MEZANITA
DI 700.00P  2 770.00
157 APT010000I62004374 160756 nn. RINI RAHAYU
HANDSCOEN
MEZANITA478.00
P  2 525.80
158 APT010000I62004374 160756 nn. RINI RAHAYU
IV DRESSI
MEZANITA
4,850.00
P  1 5,335.00
159 APT010000I62004374 160756 nn. RINI RAHAYU
KAPAS MEZANITA
AL 300.00
P  2 330.00
160 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 870.34 1 957.38
161 APT010000I12000055 160769 tn. HAMMAM FUROSEMID2,920.50
ABDULLAH  2 3,212.55
162 APT010000I12000055 160769 tn. HAMMAM CAIRAN
ABDULLAH 
RL 7,149.60 3 7,864.56
163 APT010000I12000055 160769 tn. HAMMAM SPOIT
ABDULLAH 
3 CC 1,485.00 1 1,633.50
164 APT010000I12000055 160769 tn. HAMMAM HANDSCOEN
ABDULLAH 478.00 2 525.80
165 APT010000I12000055 160769 tn. HAMMAM IV DRESSI
ABDULLAH 4,850.00 1 5,335.00
166 APT010000I12000055 160769 tn. HAMMAM MASKER
ABDULLAH 
DI 700.00 1 770.00
167 APT010000I62004379 113337 tn. MUHAMMAD
CODEINARIEF
20 1,494.00
GANI  2 1,643.40
168 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
169 APT010000I62004379 113337 tn. MUHAMMAD
B COMPLEK
ARIEF GANI 
76.34 6 83.97
170 APT010000I62004379 113337 tn. MUHAMMAD
CETIRIZIN
ARIEF GANI 
266.01 1 292.61
171 APT010000I62004379 113337 tn. MUHAMMAD
COMBIVENT4,549.95
ARIEF GANI  3 5,004.94
172 APT010000I62004379 113337 tn. MUHAMMAD
KSR 600ARIEF
M 1,755.00
GANI  2 1,930.50
173 APT010000I62004385 148491 ny. NURBAENI 
CAIRAN RL 7,149.60 2 7,864.56
174 APT010000I62004385 148491 ny. NURBAENI 
KAPAS AL 300.00 2 330.00
175 APT010000I62004385 148491 ny. NURBAENI 
SPOIT 3 CC 1,485.00 1 1,633.50
176 APT010000I62004385 148491 ny. NURBAENI 
HANDSCOEN 478.00 2 525.80
177 APT010000I62004385 148491 ny. NURBAENI 
MASKER DI 700.00 1 770.00
178 APT010000I62004385 148491 ny. NURBAENI 
NEFROSTER49,599.00 1 54,558.90
179 APT010000I62004385 148491 ny. NURBAENI 
SANMOL I 24,202.60 3 26,622.86
180 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
181 APT010000I62004385 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
182 APT010000I62004385 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
183 APT010000I62004385 148491 ny. NURBAENI 
SOTATIC I 3,032.00 2 3,335.20
184 APT010000I63003073 124832 ny. A. ROSDIANA
CAIRANSINRANG 
RL 7,149.60 2 7,864.56
185 APT010000I63003073 124832 ny. A. ROSDIANA
CEFTRIAXO19,999.10
SINRANG  2 21,999.01
186 APT010000I63003073 124832 ny. A. ROSDIANA
SANMOL SINRANG 
I 24,202.60 3 26,622.86
187 APT010000I63003073 124832 ny. A. ROSDIANA
ASPILETS
SINRANG 816.20 1 897.82
188 APT010000I63003073 124832 ny. A. ROSDIANA
BISOPROLO
SINRANG 726.00 1 798.60
189 APT010000I63003073 124832 ny. A. ROSDIANA
HANDSCOEN
SINRANG 478.00 6 525.80
190 APT010000I63003073 124832 ny. A. ROSDIANA
MASKER SINRANG 
DI 700.00 3 770.00
191 APT010000I63003073 124832 ny. A. ROSDIANA
INFUS SET
SINRANG 
17,000.00 3 18,700.00
192 APT010000I63003073 124832 ny. A. ROSDIANA
SPOIT 3SINRANG 
CC 1,485.00 1 1,633.50
193 APT010000I63003073 124832 ny. A. ROSDIANA
CODEINSINRANG 
20 1,494.00 2 1,643.40
194 APT010000I62004405 160937 ny. ANGGU' 
CAIRAN NA15,180.00 3 16,698.00
195 APT010000I62004405 160937 ny. ANGGU' 
METRONIDA8,250.00 3 9,075.00
196 APT010000I62004405 160937 ny. ANGGU' 
CEFTRIAXO19,999.10 2 21,999.01
197 APT010000I62004405 160937 ny. ANGGU' 
PREGABAL 5,500.00 2 6,050.00
198 APT010000I62004405 160937 ny. ANGGU' 
LANTUS SO83,950.02 1 92,345.02
199 APT010000I62004405 160937 ny. ANGGU' 
APIDRA 86,999.88 1 95,699.87
200 APT010000I62004405 160937 ny. ANGGU' 
CAIRAN RL 7,149.60 2 7,864.56
201 APT010000I62004405 160937 ny. ANGGU' 
HANDSCOEN 478.00 2 525.80
202 APT010000I62004405 160937 ny. ANGGU' 
MASKER DI 700.00 1 770.00
203 APT010000I62004405 160937 ny. ANGGU' 
SPOIT 3 CC 1,485.00 1 1,633.50
204 APT010000I62004405 160937 ny. ANGGU' 
INFUS SET 17,000.00 1 18,700.00
205 APT010000I62004398 144402 tn. RAFANDI
RANITIDIN
ALWI  7,687.68 2 8,456.45
206 APT010000I62004398 144402 tn. RAFANDI
INFUSAN
ALWI  N 6,712.06 3 7,383.27
207 APT010000I62004398 144402 tn. RAFANDI
CAIRAN
ALWI  RL 7,149.60 1 7,864.56
208 APT010000I62004398 144402 tn. RAFANDI
MASKER
ALWI  DI 700.00 1 770.00
209 APT010000I62004398 144402 tn. RAFANDI
HANDSCOEN
ALWI  478.00 2 525.80
210 APT010000I62004398 144402 tn. RAFANDI
SPOIT
ALWI 3 CC 1,485.00 1 1,633.50
211 APT010000I62004398 144402 tn. RAFANDI
INFUS
ALWI SET 17,000.00 1 18,700.00
212 APT010000I62004309 160384 tn. ARINOLSA
RIFAMPICI
SAPUTRA 1,500.00 3 1,650.00
213 APT010000I62004309 160384 tn. ARINOLSA
ISONIAZID
SAPUTRA  350.00 1 385.00
214 APT010000I62004309 160384 tn. ARINOLSA
ETAMBUTOL
SAPUTRA  478.00 1 525.80
215 APT010000I62004309 160384 tn. ARINOLSA
PIRAZINAM
SAPUTRA  295.00 6 324.50
216 APT010000I62004309 160384 tn. ARINOLSA
CANGKANG
SAPUTRA  75.00 3 82.50
217 APT010000I62004309 160384 tn. ARINOLSA
IV CATHETE
SAPUTRA 7,750.00 1 8,525.00
218 APT010000I62004309 160384 tn. ARINOLSA
KAPAS
SAPUTRA 
AL 300.00 1 330.00
219 APT010000I62004309 160384 tn. ARINOLSA
SPOIT
SAPUTRA 
10 C 2,310.00 1 2,541.00
220 APT010000I62004309 160384 tn. ARINOLSA
MASKER
SAPUTRA 
DI 700.00 1 770.00
221 APT010000I62004309 160384 tn. ARINOLSA
HANDSCOEN
SAPUTRA  478.00 2 525.80
222 APT010000I62004309 160384 tn. ARINOLSA
CAIRAN
SAPUTRA 
RL 7,149.60 1 7,864.56
223 APT010000I62004309 160384 tn. ARINOLSA
ZINKSAPUTRA 
OKSI 604.00 3 664.40
224 APT010000I62004309 160384 tn. ARINOLSA
B COMPLEK
SAPUTRA  76.34 18 83.97
225 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
C 125.84 12 138.42
226 APT010000I62004309 160384 tn. ARINOLSA
VITAMIN
SAPUTRA 
A 71.91 3 79.10
227 APT010000I62004309 160384 tn. ARINOLSA
VIPSAPUTRA 
ALBUM 6,600.00 6 7,260.00
228 APT010000I62004395 160870 ny. HARERARANITIDIN
S.Pd  629.99 6 692.99
229 APT010000I62004395 160870 ny. HARERAMECOBALA
S.Pd  616.00 3 677.60
230 APT010000I62004395 160870 ny. HARERABETAHISTI
S.Pd  733.33 9 806.67
231 APT010000I62004395 160870 ny. HARERAGRATIZIN
S.Pd  4,741.00 6 5,215.10
232 APT010000I62004395 160870 ny. HARERACAIRAN
S.Pd  RL 7,149.60 2 7,864.56
233 APT010000I62004395 160870 ny. HARERAMASKER
S.Pd  DI 700.00 2 770.00
234 APT010000I62004395 160870 ny. HARERAHANDSCOEN
S.Pd  478.00 2 525.80
235 APT010000I62004395 160870 ny. HARERAKAPAS
S.Pd  AL 300.00 2 330.00
236 APT010000I62004395 160870 ny. HARERAIVS.Pd 
DRESSI 4,850.00 1 5,335.00
237 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN RL BASO 
7,149.60 2 7,864.56
238 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 700.00 1 770.00
239 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 5 CC BASO 
1,595.00 1 1,754.50
240 APT010000I62004333 159705 ny. SITTI MAEMUNAH
IV DRESSI BASO 
4,850.00 1 5,335.00
241 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOEN BASO 
478.00 2 525.80
242 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  1 27,499.67
243 APT010000I62004403 150726 ny. ST HASNAH 
NEFROSTER49,599.00 1 54,558.90
244 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID2,920.50 2 3,212.55
245 APT010000I62004403 150726 ny. ST HASNAH 
DIOVAN 16 1,525.49 1 1,678.04
246 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 3 221.48
247 APT010000I62004403 150726 ny. ST HASNAH 
ATORVASTA6,435.00 1 7,078.50
248 APT010000I62004403 150726 ny. ST HASNAH 
CAIRAN RL 7,149.60 2 7,864.56
249 APT010000I62004403 150726 ny. ST HASNAH 
HANDSCOEN 478.00 2 525.80
250 APT010000I62004403 150726 ny. ST HASNAH 
MASKER DI 700.00 1 770.00
251 APT010000I62004403 150726 ny. ST HASNAH 
IV DRESSI 4,850.00 1 5,335.00
252 APT010000I62004403 150726 ny. ST HASNAH 
SPOIT 5 CC 1,595.00 1 1,754.50
253 APT010000I62004399 109339 nn. AINUN CEFTRIAXO19,999.10
CAHYANI  2 21,999.01
254 APT010000I62004399 109339 nn. AINUN RANITIDIN
CAHYANI  7,687.68 2 8,456.45
255 APT010000I62004399 109339 nn. AINUN DOMPERID
CAHYANI  508.20 3 559.02
256 APT010000I62004399 109339 nn. AINUN LAXADINE
CAHYANI  50,800.00 1 55,880.00
257 APT010000I62004399 109339 nn. AINUN CAIRAN
CAHYANI RL 7,149.60 2 7,864.56
258 APT010000I62004399 109339 nn. AINUN MASKER
CAHYANI DI 700.00 1 770.00
259 APT010000I62004399 109339 nn. AINUN SPOIT
CAHYANI 
3 CC 1,485.00 1 1,633.50
260 APT010000I62004399 109339 nn. AINUN IVCAHYANI 
DRESSI 4,850.00 1 5,335.00
261 APT010000I62004399 109339 nn. AINUN SPOIT
CAHYANI 
10 C 2,310.00 1 2,541.00
262 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
263 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA  T 297.00 3 326.70
264 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
265 APT010000I62004394 160864 tn. LUTHERRANITIDIN
MARRIBA  7,687.68 3 8,456.45
266 APT010000I62004394 160864 tn. LUTHERMETIL
MARRIBA 
PRE 766.50 1 843.15
267 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 2 4,573.80
268 APT010000I62004362 160683 tn. MANGKONAPADANG 
LANSOPRAZ 851.29 1 936.42
 216,865.0 238,551.5
269 APT010000I62004362 160683 tn. MANGKONAPADANG 
LIVAMIN 5 1
0 0
270 APT010000I62004362 160683 tn. MANGKONAPADANG 
CAIRAN RL 7,149.60 3 7,864.56
271 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 1 770.00
272 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 2 525.80
273 APT010000I62004362 160683 tn. MANGKONAPADANG 
IV DRESSI 4,850.00 1 5,335.00
274 APT010000I62004362 160683 tn. MANGKONAPADANG 
KAPAS AL 300.00 2 330.00
275 APT010000I62004362 160683 tn. MANGKONAPADANG 
SPOIT 10 C 2,310.00 2 2,541.00
276 APT010000I66000405 160570 nn. ROHANI 
SIMUCIL 2 1,760.00 3 1,936.00
277 APT010000I66000405 160570 nn. ROHANI 
LANSOPRAZ 851.29 2 936.42
278 APT010000I66000405 160570 nn. ROHANI 
ALLOPURIN 248.02 1 272.83
279 APT010000I66000405 160570 nn. ROHANI 
CAIRAN RL 7,149.60 2 7,864.56
280 APT010000I66000405 160570 nn. ROHANI 
HANDSCOEN 478.00 2 525.80
281 APT010000I66000405 160570 nn. ROHANI 
MASKER DI 700.00 1 770.00
282 APT010000I66000405 160570 nn. ROHANI 
SPOIT 3 CC 1,485.00 1 1,633.50
283 APT010000I66000405 160570 nn. ROHANI 
IV CATHETE 7,750.00 1 8,525.00
284 APT010000I66000405 160570 nn. ROHANI 
ZINK OKSI 604.00 1 664.40
285 APT010000I66000405 160570 nn. ROHANI 
VITAMIN C 125.84 4 138.42
286 APT010000I64002859 160634 tn. ABDUL RAZAK
CODEINRAMANG 
20 1,494.00 3 1,643.40
287 APT010000I64002859 160634 tn. ABDUL RAZAK
CETIRIZIN
RAMANG 
266.01 1 292.61
288 APT010000I64002859 160634 tn. ABDUL RAZAK
PULMICORT
RAMANG 
8,540.00 3 9,394.00
289 APT010000I64002859 160634 tn. ABDUL RAZAK
METIL PRE
RAMANG 
766.50 4 843.15
290 APT010000I64002859 160634 tn. ABDUL RAZAK
LANSOPRAZ
RAMANG 
851.29 2 936.42
291 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID
RAMANG 
190.99 1 210.09
292 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG 
107.12 1 117.83
293 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG 
838.19 1 922.01
294 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50

295 APT010000I64002859 160634 tn. ABDUL RAZAK

LIVAMIN 5 216,865.0
RAMANG  1 238,551.5
0 0

296 APT010000I62004400 159800 ny. NURWAHIDAH

CAIRAN KUSYAIRY 
AM70,188.80 2 77,207.68

297 APT010000I62004400 159800 ny. NURWAHIDAH

CAIRAN KUSYAIRY 
RL 7,149.60 1 7,864.56
298 APT010000I62004400 159800 ny. NURWAHIDAH
HANDSCOEN
KUSYAIRY 
478.00 2 525.80
299 APT010000I62004400 159800 ny. NURWAHIDAH
MASKERKUSYAIRY 
DI 700.00 1 770.00
300 APT010000I62004400 159800 ny. NURWAHIDAH
SPOIT 3 KUSYAIRY 
CC 1,485.00 1 1,633.50
301 APT010000I62004400 159800 ny. NURWAHIDAH
IV CATHETE
KUSYAIRY 
7,750.00 1 8,525.00

302 APT010000I62004400 159800 ny. NURWAHIDAH

CITICOLIN
KUSYAIRY 
27,505.00 4 30,255.50

303 APT010000I62004400 159800 ny. NURWAHIDAH

MECOBALAM
KUSYAIRY 
6,600.00 1 7,260.00
304 APT010000I64002859 160634 tn. ABDUL RAZAK
SALBUTAM
RAMANG 88.00 3 96.80

305 APT010000I64002859 160634 tn. ABDUL RAZAK

CAIRANRAMANG 
AM70,188.80 2 77,207.68

306 APT010000I62004398 144402 tn. RAFANDI

REBAMIPID
ALWI  1,540.00 2 1,694.00
307 APT010000I62004379 113337 tn. MUHAMMAD
PULMICORT
ARIEF8,540.00
GANI  3 9,394.00
308 APT010000I62004407 160945 nn. KHAIRUN
RANITIDIN
NISWAH YUSUF 
7,687.68 2 8,456.45
 309 APT010000I62004407 160945 nn. KHAIRUN
SANTAGESIK4,949.40
NISWAH YUSUF  3 5,444.34
310 APT010000I62004400 159800 ny. NURWAHIDAH
NOREPINEF25,839.00
KUSYAIRY  2 28,422.90
311 APT010000I62004400 159800 ny. NURWAHIDAH
PERFUSSOR
KUSYAIRY 
21,000.00 1 23,100.00
312 APT010000I62004400 159800 ny. NURWAHIDAH
SPOIT 50KUSYAIRY 
12,367.00 1 13,603.70
313 APT010000I62004402 160911 ny. ANDI JUMANI 
FENTANYL 041,599.80 2 45,759.78
314 APT010000I12000055 160769 tn. HAMMAMSIMUCIL
ABDULLAH 
2 1,760.00 6 1,936.00
315 APT010000I62004393 130394 tn. ANDI SURYATMAN
CAIRAN RL EKA
7,149.60
JAYA  2 9,294.49
316 APT010000I62004393 130394 tn. ANDI SURYATMAN
RANITIDIN EKA
7,687.68
JAYA  2 11,685.27
317 APT010000I62004379 113337 tn. MUHAMMAD
ALPRAZOLA
ARIEF1,915.83
GANI  2 2,107.42
318 APT010000I62004408 160971 tn. MUH TAUFIK 
COMBO PAC 60,500.00 1 66,550.00
319 APT010000I62004408 160971 tn. MUH TAUFIK 
CAIRAN RL 7,149.60 1 7,864.56
320 APT010000I62004408 160971 tn. MUH TAUFIK 
SPOIT 3 CC 1,485.00 2 1,633.50
321 APT010000I62004408 160971 tn. MUH TAUFIK 
HANDSCOEN 478.00 4 525.80
322 APT010000I62004408 160971 tn. MUH TAUFIK 
ALKOHOL S 300.00 2 330.00
323 APT010000I62004408 160971 tn. MUH TAUFIK 
PARACETA 11,990.00 1 13,189.00
324 APT010000I62004408 160971 tn. MUH TAUFIK 
RANITIDIN 7,687.68 1 8,456.45
325 APT010000I62004408 160971 tn. MUH TAUFIK 
SANTAGESIK4,949.40 1 5,444.34
Sub Total   738
PCS 4,945.18

PCS 26,087.60
PCS 15,729.12
PCS 66,550.00
PCS 2,103.20
PCS 2,643.24
PCS 3,593.70
PCS 1,633.50
PCS 7,864.56
PCS 66,550.00
PCS 2,643.24
PCS 8,085.82
PCS 3,267.00
PCS 2,103.20
PCS 14,101.34
PCS 44,588.50
PCS 15,014.82
PCS 18,788.00
PCS 922.01
- 0
PCS 4,157.94
PCS 4,902.96
PCS 3,354.12
PCS 26,407.04
PCS 33,008.80
PCS 16,171.64
PCS 5,286.48
PCS 26,087.60
PCS 23,593.68
PCS 770.00
PCS 26,620.00
PCS 10,670.00
PCS 22,715.00
PCS 18,700.00
PCS 43,998.02
PCS 5,286.48
PCS 24,257.46
PCS 27,225.00
PCS 11,575.23
PCS 23,593.68
PCS 3,509.00
PCS 3,267.00
PCS 770.00
PCS 1,051.60
PCS 30,855.00
PCS 1,481.70
PCS 2,940.30
PCS 25,575.00
PCS 10,670.00
PCS 1,540.00
PCS 26,620.00
PCS 27,207.40
PCS 3,509.00
PCS 2,940.30
PCS 2,610.30
PCS 770.00
PCS 3,154.80
PCS 1,947.00
PCS 22,715.00
PCS 1,051.60
PCS 10,670.00
PCS 5,082.00
PCS 5,263.50
PCS 936.42
PCS 23,593.68
PCS 9,680.00
PCS 495.00
PCS 24,257.46
PCS 7,260.00
PCS 23,593.68
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 1,540.00
PCS 1,051.60
PCS 10,670.00
PCS 390.82
PCS 1,677.06
PCS 9,680.00
PCS 7,260.00
PCS 5,286.48
PCS 26,087.60
PCS 16,171.64
PCS 10,670.00
PCS 22,715.00
PCS 1,051.60
PCS 7,383.27
PCS 30,855.00
PCS 12,705.00
PCS 3,509.00
PCS 23,593.68
PCS 27,225.00
PCS 16,333.02
PCS 25,369.35
PCS 77,207.68
PCS 13,310.00
PCS 1,540.00
PCS 5,082.00
PCS 3,509.00
PCS 4,224.00
109,998.6
PCS 8
PCS 7,383.27
PCS 41,624.00
PCS 44,299.62
PCS 62,436.00
PCS 22,715.00
PCS 30,855.00
PCS 33,396.00
PCS 9,350.00
PCS 24,257.46
PCS 43,998.02
PCS 12,259.72
PCS 23,593.68
PCS 18,700.00
PCS 1,540.00
PCS 5,082.00
PCS 3,509.00
PCS 4,224.00
PCS 29,533.08
PCS 15,014.82
PCS 28,182.00
PCS 922.01
PCS 1,051.60
PCS 1,540.00
PCS 3,509.00
PCS 3,267.00
PCS 7,864.56
PCS 1,960.20
PCS 167.94
PCS 2,747.80
PCS 25,369.35
PCS 3,335.20
PCS 43,998.02
PCS 23,593.68
PCS 34,072.50
PCS 10,670.00
PCS 770.00
PCS 1,051.60
PCS 17,050.00
PCS 54,558.90
PCS 22,715.00
PCS 1,051.60
PCS 30,855.00
PCS 17,050.00
PCS 10,670.00
PCS 3,509.00
PCS 4,224.00
PCS 13,422.94
PCS 508.20
PCS 16,912.90
PCS 43,998.02
PCS 6,425.10
PCS 980.10
PCS 1,118.04
PCS 23,593.68
PCS 1,540.00
PCS 1,051.60
PCS 5,335.00
PCS 660.00
PCS 957.38
PCS 6,425.10
PCS 23,593.68
PCS 1,633.50
PCS 1,051.60
PCS 5,335.00
PCS 770.00
PCS 3,286.80
PCS 664.40
PCS 503.82
PCS 292.61
PCS 15,014.82
PCS 3,861.00
PCS 15,729.12
PCS 660.00
PCS 1,633.50
PCS 1,051.60
PCS 770.00
PCS 54,558.90
PCS 79,868.58
PCS 922.01
PCS 5,989.50
PCS 43,998.02
PCS 6,670.40
PCS 15,729.12
PCS 43,998.02
PCS 79,868.58
PCS 897.82
PCS 798.60
PCS 3,154.80
PCS 2,310.00
PCS 56,100.00
PCS 1,633.50
PCS 3,286.80
PCS 50,094.00
PCS 27,225.00
PCS 43,998.02
PCS 12,100.00
PCS 92,345.02
PCS 95,699.87
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 18,700.00
PCS 16,912.90
PCS 22,149.81
PCS 7,864.56
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 18,700.00
PCS 4,950.00
PCS 385.00
PCS 525.80
PCS 1,947.00
PCS 247.50
PCS 8,525.00
PCS 330.00
PCS 2,541.00
PCS 770.00
PCS 1,051.60
PCS 7,864.56
PCS 1,993.20
PCS 1,511.46
PCS 1,661.04
PCS 237.30
PCS 43,560.00
PCS 4,157.94
PCS 2,032.80
PCS 7,260.03
PCS 31,290.60
PCS 15,729.12
PCS 1,540.00
PCS 1,051.60
PCS 660.00
PCS 5,335.00
PCS 15,729.12
PCS 770.00
PCS 1,754.50
PCS 5,335.00
PCS 1,051.60
PCS 27,499.67
PCS 54,558.90
PCS 6,425.10
PCS 1,678.04
PCS 664.44
PCS 7,078.50
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 1,754.50
PCS 43,998.02
PCS 16,912.90
PCS 1,677.06
PCS 55,880.00
PCS 15,729.12
PCS 770.00
PCS 1,633.50
PCS 5,335.00
PCS 2,541.00
PCS 216.84
PCS 980.10
PCS 16,335.00
PCS 25,369.35
PCS 843.15
PCS 9,147.60
PCS 936.42
 238,551.5
PCS
0
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 660.00
PCS 5,082.00
PCS 5,808.00
PCS 1,872.84
PCS 272.83
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 8,525.00
PCS 664.40
PCS 553.68
PCS 4,930.20
PCS 292.61
PCS 28,182.00
PCS 3,372.60
PCS 1,872.84
PCS 210.09
PCS 117.83
PCS 922.01
PCS 7,078.50
238,551.5
PCS
0

PCS 154,415.3
6
PCS 7,864.56
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 8,525.00
121,022.0
PCS
0
PCS 7,260.00
PCS 290.40
154,415.3
PCS 6
PCS 3,388.00
PCS 28,182.00
PCS 16,912.90
PCS 16,333.02
PCS 56,845.80
PCS 23,100.00
PCS 13,603.70
PCS 91,519.56
PCS 11,616.00
PCS 18,588.98
PCS 23,370.54
PCS 4,214.84
PCS 66,550.00
PCS 7,864.56
PCS 3,267.00
PCS 2,103.20
PCS 660.00
PCS 13,189.00
PCS 8,456.45
PCS 5,444.34
5,217,645.97
09-12-
1 APT010000I62004374 160756 nn. RINI RAHAYU
- MEZANITA P 0 0 0
2018 
2 APT010000I62004374 160756 nn. RINI RAHAYU
PARACETA
MEZANITA220.72
P  3 242.79
3 APT010000I62004374 160756 nn. RINI RAHAYU
KOTRIMOKS
MEZANITA254.10
P  2 279.51
4 APT010000I62004374 160756 nn. RINI RAHAYU
HANDSCOEN
MEZANITA478.00
P  4 525.80
5 APT010000I62004374 160756 nn. RINI RAHAYU
MASKERMEZANITA
DI 700.00
P  2 770.00
6 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
7 APT010000I62004394 160864 tn. LUTHERPARACETA
MARRIBA  220.72 3 242.79
8 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
9 APT010000I62004394 160864 tn. LUTHERRANITIDIN
MARRIBA  7,687.68 3 8,456.45
10 APT010000I62004394 160864 tn. LUTHERMETIL
MARRIBA 
PRE 766.50 1 843.15
11 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 4 525.80
12 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA DI 700.00 2 770.00
13 APT010000I12000055 160769 tn. HAMMAM SIMUCIL
ABDULLAH 
2 1,760.00 3 1,936.00
14 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 870.34 1 957.38
15 APT010000I12000055 160769 tn. HAMMAM FUROSEMID
ABDULLAH 190.99 2 210.09
16 APT010000I12000055 160769 tn. HAMMAM CAIRAN
ABDULLAH 
RL 7,149.60 2 7,864.56
17 APT010000I12000055 160769 tn. HAMMAM MASKER
ABDULLAH 
DI 700.00 2 770.00
18 APT010000I12000055 160769 tn. HAMMAM IV CATHETE
ABDULLAH 
7,750.00 1 8,525.00
19 APT010000I62004407 160945 nn. KHAIRUNRANITIDIN
NISWAH YUSUF 
7,687.68 2 8,456.45
20 APT010000I62004407 160945 nn. KHAIRUNSOTATIC
NISWAHI YUSUF 
3,032.00 3 3,335.20
21 APT010000I62004407 160945 nn. KHAIRUNCAIRAN
NISWAH
RL YUSUF 
7,149.60 2 7,864.56
22 APT010000I62004407 160945 nn. KHAIRUNMASKER
NISWAHDI YUSUF 
700.00 1 770.00
23 APT010000I62004407 160945 nn. KHAIRUNHANDSCOEN
NISWAH YUSUF 
478.00 4 525.80
24 APT010000I62004407 160945 nn. KHAIRUNSPOIT
NISWAH
3 CC YUSUF 
1,485.00 2 1,633.50
25 APT010000I62004407 160945 nn. KHAIRUNSPOIT
NISWAH
10 C YUSUF 
2,310.00 2 2,541.00
26 APT010000I62004385 148491 ny. NURBAENI 
NEFROSTER49,599.00 1 54,558.90
27 APT010000I62004385 148491 ny. NURBAENI 
SANMOL I 24,202.60 3 26,622.86
28 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
29 APT010000I62004385 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
30 APT010000I62004385 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
31 APT010000I62004385 148491 ny. NURBAENI 
SOTATIC I 3,032.00 2 3,335.20
32 APT010000I62004385 148491 ny. NURBAENI 
LANSOPRAZ 851.29 1 936.42
33 APT010000I62004385 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
34 APT010000I62004385 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
35 APT010000I62004379 113337 tn. MUHAMMAD
VITAMINARIEF
B GANI 
146.99 6 161.69
36 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
37 APT010000I62004379 113337 tn. MUHAMMAD
CAIRANARIEF
RL 7,149.60
GANI  2 7,864.56
38 APT010000I62004379 113337 tn. MUHAMMAD
MASKER ARIEF
DI GANI 
700.00 2 770.00
39 APT010000I62004379 113337 tn. MUHAMMAD
HANDSCOEN
ARIEF GANI 
478.00 4 525.80
40 APT010000I62004379 113337 tn. MUHAMMAD
CETIRIZIN
ARIEF GANI 
266.01 1 292.61
41 APT010000I62004379 113337 tn. MUHAMMAD
COMBIVENT4,549.95
ARIEF GANI  3 5,004.94
42 APT010000I62004379 113337 tn. MUHAMMAD
KSR 600ARIEF
M 1,755.00
GANI  2 1,930.50
43 APT010000I62004379 113337 tn. MUHAMMAD
PULMICORT
ARIEF8,540.00
GANI  3 9,394.00
44 APT010000I62004379 113337 tn. MUHAMMAD
CODEINARIEF
20 1,494.00
GANI  2 1,643.40
45 APT010000I63003073 124832 ny. A. ROSDIANA
BISOPROLO
SINRANG 726.00 1 798.60
46 APT010000I63003073 124832 ny. A. ROSDIANA
ASPILETS
SINRANG 816.20 1 897.82
47 APT010000I63003073 124832 ny. A. ROSDIANA
CEFTRIAXO19,999.10
SINRANG  2 21,999.01
48 APT010000I63003073 124832 ny. A. ROSDIANA
SANMOLSINRANG 
I 24,202.60 3 26,622.86
49 APT010000I63003073 124832 ny. A. ROSDIANA
HANDSCOEN
SINRANG 478.00 4 525.80
50 APT010000I63003073 124832 ny. A. ROSDIANA
MASKERSINRANG 
DI 700.00 2 770.00
51 APT010000I63003073 124832 ny. A. ROSDIANA
CODEINSINRANG 
20 1,494.00 2 1,643.40
52 APT010000I62004399 109339 nn. AINUN CEFTRIAXO19,999.10
CAHYANI  2 21,999.01
53 APT010000I62004399 109339 nn. AINUN RANITIDIN
CAHYANI  7,687.68 2 8,456.45
54 APT010000I62004399 109339 nn. AINUN CAIRAN
CAHYANI 
RL 7,149.60 2 7,864.56
55 APT010000I62004399 109339 nn. AINUN MASKER
CAHYANI DI 700.00 2 770.00
56 APT010000I62004398 144402 tn. RAFANDI
CAIRAN
ALWI  NAC6,409.70 2 7,050.67
57 APT010000I62004398 144402 tn. RAFANDI
MASKER
ALWI  DI 700.00 2 770.00
58 APT010000I62004398 144402 tn. RAFANDI
HANDSCOEN
ALWI  478.00 4 525.80
59 APT010000I62004398 144402 tn. RAFANDI
INFUS
ALWI 
SET 7,920.00 1 8,712.00
60 APT010000I66000405 160570 nn. ROHANI 
LANSOPRAZ 851.29 2 936.42
61 APT010000I66000405 160570 nn. ROHANI 
ALLOPURIN 248.02 1 272.83
62 APT010000I66000405 160570 nn. ROHANI 
VITAMIN C 71.91 4 79.10
63 APT010000I66000405 160570 nn. ROHANI 
ZINK OKSI 604.00 1 664.40
64 APT010000I66000405 160570 nn. ROHANI 
SIMUCIL 2 1,760.00 3 1,936.00
65 APT010000I66000405 160570 nn. ROHANI 
HANDSCOEN 478.00 4 525.80
66 APT010000I66000405 160570 nn. ROHANI 
MASKER DI 700.00 2 770.00
216,865.0 238,551.5
67 APT010000I64002859 160634 tn. ABDUL RAZAK
LIVAMIN
RAMANG 
5 1
0 0
68 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID
RAMANG  190.99 1 210.09
69 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG  107.12 1 117.83
70 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
NAC6,409.70 1 7,050.67
71 APT010000I64002859 160634 tn. ABDUL RAZAK
MASKERRAMANG 
DI 700.00 2 770.00
72 APT010000I64002859 160634 tn. ABDUL RAZAK
HANDSCOEN
RAMANG  478.00 4 525.80
73 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
AQ 2,860.00 2 3,146.00
74 APT010000I64002859 160634 tn. ABDUL RAZAK
IV CATHETE
RAMANG 
7,750.00 1 8,525.00
75 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ONDANSETR8,735.98
BASO  2 9,609.58
76 APT010000I62004333 159705 ny. SITTI MAEMUNAH
OMEPRAZOL 24,999.70
BASO  1 27,499.67
77 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOEN BASO 
478.00 4 525.80
78 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 
700.00 2 770.00
79 APT010000I62004405 160937 ny. ANGGU' CEFTRIAXO19,999.10 2 21,999.01
80 APT010000I62004405 160937 ny. ANGGU' METRONIDA8,250.00 3 9,075.00
81 APT010000I62004405 160937 ny. ANGGU' PREGABAL 5,500.00 2 6,050.00
82 APT010000I62004405 160937 ny. ANGGU' AMLODIPIN 838.19 1 922.01
83 APT010000I62004405 160937 ny. ANGGU' CAIRAN NAC6,409.70 2 7,050.67
84 APT010000I62004405 160937 ny. ANGGU' MASKER DI 700.00 2 770.00
85 APT010000I62004405 160937 ny. ANGGU' HANDSCOEN 478.00 4 525.80
86 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID2,920.50 4 3,212.55
87 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 3 221.48
88 APT010000I62004403 150726 ny. ST HASNAH 
ATORVASTA6,435.00 1 7,078.50
 89 APT010000I62004403 150726 ny. ST HASNAH 
NEFROSTER49,599.00 1 54,558.90
90 APT010000I62004403 150726 ny. ST HASNAH 
HANDSCOEN 478.00 4 525.80
91 APT010000I62004403 150726 ny. ST HASNAH 
MASKER DI 700.00 2 770.00
92 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 2 4,573.80
216,865.0 238,551.5
93 APT010000I62004362 160683 tn. MANGKONAPADANG 
LIVAMIN 5 1
0 0
94 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 4 525.80
95 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 2 770.00
96 APT010000I62004362 160683 tn. MANGKONAPADANG 
LANSOPRAZ 851.29 1 936.42
97 APT010000I62004409 160979 ny. HJ JUMRIAH
CAIRANDGNAC6,409.70
KINANG  3 7,050.67
98 APT010000I62004409 160979 ny. HJ JUMRIAH
SIMUCIL
DG 2KINANG 
1,760.00 2 1,936.00
99 APT010000I62004409 160979 ny. HJ JUMRIAH
NEUROSANB5,324.00
DG KINANG  1 5,856.40
100 APT010000I62004409 160979 ny. HJ JUMRIAH
PARACETA
DG KINANG 
220.72 2 242.79
101 APT010000I62004409 160979 ny. HJ JUMRIAH
AMLODIPIN
DG KINANG 
838.19 1 922.01
102 APT010000I62004391 160813 tn. SUHERMAN 
CEFADROXI 877.80 2 965.58
103 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
104 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR8,735.98 1 9,609.58
105 APT010000I62004391 160813 tn. SUHERMAN 
OMEPRAZOL 24,999.70 1 27,499.67
106 APT010000I62004392 120291 ny. MARLINA 
CEFOTAXIM15,004.00 2 16,504.40
107 APT010000I62004392 120291 ny. MARLINA 
KETOROLAC 7,350.75 2 8,085.82
108 APT010000I62004392 120291 ny. MARLINA 
RANITIDIN 7,687.68 2 8,456.45
109 APT010000I62004392 120291 ny. MARLINA 
CAIRAN RL 7,149.60 3 7,864.56
110 APT010000I62004402 160911 ny. ANDI JUMANI 
CEFTRIAXO19,999.10 2 21,999.01
111 APT010000I62004402 160911 ny. ANDI JUMANI 
RANITIDIN 7,687.68 2 8,456.45
112 APT010000I62004402 160911 ny. ANDI JUMANI 
KETOROLAC 7,350.75 3 8,085.82
113 APT010000I62004402 160911 ny. ANDI JUMANI 
METRONIDA8,250.00 3 9,075.00
114 APT010000I62004402 160911 ny. ANDI JUMANI 
SAGESTAM10,186.00 3 11,204.60
115 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN RL 7,149.60 3 7,864.56
116 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 6,101.33 2 6,711.47
117 APT010000I66000404 159099 ny. SITTI MULIYANA 
MEGABAL 1,730.00 1 1,903.00
118 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
119 APT010000I66000404 159099 ny. SITTI MULIYANA 
RANITIDIN 7,687.68 2 8,456.45
120 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
121 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 1 3,212.55
122 APT010000I66000404 159099 ny. SITTI MULIYANA 
COMBIVENT4,549.95 2 5,004.94
123 APT010000I62004409 160979 ny. HJ JUMRIAH
CAIRANDGNAC6,409.70
KINANG  1 7,050.67
124 APT010000I62004409 160979 ny. HJ JUMRIAH
NEUROSANB5,324.00
DG KINANG  1 5,856.40
125 APT010000I62004409 160979 ny. HJ JUMRIAH
AMLODIPIN
DG KINANG 
838.19 1 922.01
126 APT010000I62004409 160979 ny. HJ JUMRIAH
SIMUCIL
DG 2KINANG 
1,760.00 2 1,936.00
127 APT010000I62004409 160979 ny. HJ JUMRIAH
PARACETA
DG KINANG 
220.72 2 242.79
128 APT010000I62004402 160911 ny. ANDI JUMANI 
CEFTRIAXO19,999.10 2 21,999.01
129 APT010000I62004402 160911 ny. ANDI JUMANI 
GENTAMICI 3,507.65 3 3,858.41
130 APT010000I62004402 160911 ny. ANDI JUMANI 
METRONIDA8,250.00 3 9,075.00
131 APT010000I62004397 160511 tn. SUPRIADI
CONECTA
PAISAL  10,325.00 1 11,357.50
132 APT010000I62004397 160511 tn. SUPRIADI
IV CATHETE
PAISAL  7,750.00 1 8,525.00
133 APT010000I62004397 160511 tn. SUPRIADI
MASKER
PAISAL DI 700.00 2 770.00
134 APT010000I62004397 160511 tn. SUPRIADI
RANITIDIN
PAISAL  7,687.68 3 8,456.45
135 APT010000I62004397 160511 tn. SUPRIADI
SOTATIC
PAISAL I 3,032.00 2 3,335.20
136 APT010000I62004397 160511 tn. SUPRIADI
CEFTRIAXO19,999.10
PAISAL  2 21,999.01
137 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF, 7,350.75
BA   3 8,085.82
138 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF, 6,600.00
BA   1 7,260.00
139 APT010000I62004401 150626 tn. SAHARUDDIN 
CAIRAN NAC6,409.70 3 7,050.67
140 APT010000I62004401 150626 tn. SAHARUDDIN 
MASKER DI 700.00 3 770.00
141 APT010000I62004401 150626 tn. SAHARUDDIN 
HANDSCOEN 478.00 4 525.80
142 APT010000I62004401 150626 tn. SAHARUDDIN 
OMEPRAZOL 24,999.70 2 27,499.67
143 APT010000I12000062 139631 tn. IBRAHIMCAIRAN
KADIR NAC6,409.70 2 7,050.67
144 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  3 5,004.94
145 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 2 9,394.00
146 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 1 922.01
147 APT010000I12000062 139631 tn. IBRAHIMCAIRAN
KADIR NA15,180.00 1 16,698.00
148 APT010000I12000062 139631 tn. IBRAHIMSUNGKUP
KADIR  44,750.00 1 49,225.00
149 APT010000I12000062 139631 tn. IBRAHIMMASKER
KADIR  DI 700.00 2 770.00
150 APT010000I62004396 159610 ny. RITHA TANDI
NEFROSTER
LEMBANG 
49,599.00 1 54,558.90
151 APT010000I62004396 159610 ny. RITHA TANDI
TRANSFUSI28,050.00
LEMBANG  1 30,855.00
152 APT010000I62004396 159610 ny. RITHA TANDI
CONECTA
LEMBANG 
10,325.00 1 11,357.50
153 APT010000I62004396 159610 ny. RITHA TANDI
IV CATHETE
LEMBANG 
7,750.00 1 8,525.00
154 APT010000I62004396 159610 ny. RITHA TANDI
MASKERLEMBANG 
DI 700.00 2 770.00
155 APT010000I62004396 159610 ny. RITHA TANDI
HANDSCOEN
LEMBANG  478.00 4 525.80
156 APT010000I62004398 144402 tn. RAFANDILANSOPRAZ
ALWI  851.29 6 936.42
157 APT010000I62004398 144402 tn. RAFANDIREBAMIPID
ALWI  1,540.00 6 1,694.00
158 APT010000I62004398 144402 tn. RAFANDIBUSCOPAN
ALWI  4,327.40 9 4,760.14
159 APT010000I62004398 144402 tn. RAFANDIDOMPERID
ALWI  508.20 9 559.02
160 APT010000I62004398 144402 tn. RAFANDICANGKANG
ALWI  75.00 9 82.50
161 APT010000I62004398 144402 tn. RAFANDIALPRAZOL
ALWI  1,023.66 3 1,126.03
162 APT010000I32000266 127819 ny. ANDI HERMIATY
PARACETADAMRI  220.72 3 242.79
163 APT010000I32000266 127819 ny. ANDI HERMIATY
CAIRAN RLDAMRI 
7,149.60 3 7,864.56
164 APT010000I32000266 127819 ny. ANDI HERMIATY
INFUS SETDAMRI 
7,920.00 1 8,712.00
165 APT010000I32000266 127819 ny. ANDI HERMIATY
CONECTADAMRI 
10,325.00 1 11,357.50
166 APT010000I32000266 127819 ny. ANDI HERMIATY
HANDSCOEN DAMRI 
478.00 4 525.80
167 APT010000I32000266 127819 ny. ANDI HERMIATY
NASAL CADAMRI 
11,550.07 1 12,705.07
168 APT010000I62004368 160718 tn. HENRA RANITIDIN 7,687.68 2 8,456.45
169 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 2 8,085.82

170 APT010000I62004368 160718 tn. HENRA LEVOFLOXA66,000.00 2 72,600.00

171 APT010000I62004368 160718 tn. HENRA MEGABAL 1,730.00 1 1,903.00

172 APT010000I62004368 160718 tn. HENRA GABAPENTI 4,400.00 2 4,840.00
173 APT010000I64002893 160944 tn. MUHAMMAD
PARACETA
SU'ADHIE 
220.72 3 242.79
174 APT010000I64002893 160944 tn. MUHAMMAD
CAIRANSU'ADHIE 
RL 7,149.60 3 7,864.56
175 APT010000I64002893 160944 tn. MUHAMMAD
IV CATHETE
SU'ADHIE 
7,750.00 1 8,525.00
176 APT010000I64002893 160944 tn. MUHAMMAD
CONECTA
SU'ADHIE 
10,325.00 1 11,357.50
177 APT010000I64002893 160944 tn. MUHAMMADMASKER SU'ADHIE 
DI 700.00 2 770.00
178 APT010000I64002893 160944 tn. MUHAMMADHANDSCOON
SU'ADHIE 
13,613.00 1 14,974.30
179 APT010000I62004340 155102 tn. DRS. H. PARACETA
ISHAK ABDIR  220.72 3 242.79
180 APT010000I62004340 155102 tn. DRS. H. LANSOPRAZ
ISHAK ABDIR  851.29 1 936.42
181 APT010000I62004275 159982 tn. SULHAM  DOMPERID 508.20 3 559.02
182 APT010000I62004275 159982 tn. SULHAM  RANITIDIN 7,687.68 2 8,456.45
183 APT010000I62004275 159982 tn. SULHAM  PARACETA 220.72 3 242.79
184 APT010000I62004275 159982 tn. SULHAM  GABAPENTI 4,400.00 2 4,840.00
185 APT010000I62004275 159982 tn. SULHAM  CAIRAN NAC6,409.70 3 7,050.67
186 APT010000I62004353 160635 tn. DARWISCEFTRIAXO19,999.10
LAEDDA  2 21,999.01
187 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00
LAEDDA  3 9,075.00
188 APT010000I62004353 160635 tn. DARWISSANTAGESIK4,949.40
LAEDDA  3 5,444.34
189 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  7,687.68 3 8,456.45
190 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
AM70,188.80 1 77,207.68
191 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
RL 7,149.60 2 7,864.56
192 APT010000I62004353 160635 tn. DARWISINFUS
LAEDDA 
SET 7,920.00 1 8,712.00
193 APT010000I62004353 160635 tn. DARWISCONECTA
LAEDDA  10,325.00 1 11,357.50
194 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 2 770.00
195 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 6 525.80
196 APT010000I62004386 149341 tn. MUH BASRI 
CEFTRIAXO19,999.10 2 21,999.01
197 APT010000I62004386 149341 tn. MUH BASRI 
KETOROLAC 7,350.75 3 8,085.82
198 APT010000I62004386 149341 tn. MUH BASRI 
ADONA INJ22,880.00 3 25,168.00
199 APT010000I62004386 149341 tn. MUH BASRI 
CAIRAN RL 7,149.60 3 7,864.56
200 APT010000I62004386 149341 tn. MUH BASRI 
HANDSCOEN 478.00 6 525.80
201 APT010000I62004386 149341 tn. MUH BASRI 
HANDSCOON 13,613.00 3 14,974.30
202 APT010000I62004386 149341 tn. MUH BASRI 
MASKER DI 700.00 2 770.00
203 APT010000I32000266 127819 ny. ANDI HERMIATY
AMLODIPINDAMRI 
838.19 1 922.01
204 APT010000I64002893 160944 tn. MUHAMMADCEFTRIAXO19,999.10
SU'ADHIE  3 21,999.01
205 APT010000I64002893 160944 tn. MUHAMMADCAIRANSU'ADHIE 
NA15,180.00 1 16,698.00
206 APT010000I62004392 120291 ny. MARLINA SPORETIK 5,720.50 6 6,292.55
207 APT010000I62004392 120291 ny. MARLINA PLASMINEX 2,832.50 9 3,115.75
208 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 3 5,004.94
209 APT010000I62004410 160990 tn. SARIM  SIMUCIL 2 1,760.00 3 1,936.00
210 APT010000I62004410 160990 tn. SARIM  FUROSEMID2,920.50 1 3,212.55
211 APT010000I62004333 159705 ny. SITTI MAEMUNAH
KOTRIMOKSBASO 254.10 4 279.51
212 APT010000I62004333 159705 ny. SITTI MAEMUNAH
TETRASIKLI BASO 
241.00 12 265.10
213 APT010000I62004412 161003 tn. MUH YUSUF
INFUSAN
SAPUTRA 
N 6,712.06 1 7,383.27
214 APT010000I62004412 161003 tn. MUH YUSUF
KOTRIMOKS
SAPUTRA  254.10 2 279.51
215 APT010000I62004412 161003 tn. MUH YUSUF
SANMOL
SAPUTRA 
T 297.00 3 326.70
216 APT010000I62004412 161003 tn. MUH YUSUF
NEW SAPUTRA 
DIAT 557.15 3 612.87
217 APT010000I64002859 160634 tn. ABDUL RAZAK
ALPRAZOLA
RAMANG 
1,915.83 1 2,107.42
218 APT010000I62004408 160971 tn. MUH TAUFIK 
CAIRAN RL 7,149.60 3 7,864.56
219 APT010000I62004408 160971 tn. MUH TAUFIK 
PARACETA 11,990.00 3 13,189.00
220 APT010000I62004408 160971 tn. MUH TAUFIK 
NEUROSANB5,324.00 1 5,856.40
221 APT010000I62004408 160971 tn. MUH TAUFIK 
SIMUCIL 2 1,760.00 2 1,936.00
Sub Total   525
- 0

PCS 728.37
PCS 559.02
PCS 2,103.20
PCS 1,540.00
PCS 216.84
PCS 728.37
PCS 16,335.00
PCS 25,369.35
PCS 843.15
PCS 2,103.20
PCS 1,540.00
PCS 5,808.00
PCS 957.38
PCS 420.18
PCS 15,729.12
PCS 1,540.00
PCS 8,525.00
PCS 16,912.90
PCS 10,005.60
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 3,267.00
PCS 5,082.00
PCS 54,558.90
PCS 79,868.58
PCS 922.01
PCS 5,949.85
PCS 43,998.02
PCS 6,670.40
PCS 936.42
PCS 2,103.20
PCS 1,540.00
PCS 970.14
PCS 664.40
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 292.61
PCS 15,014.82
PCS 3,861.00
PCS 28,182.00
PCS 3,286.80
PCS 798.60
PCS 897.82
PCS 43,998.02
PCS 79,868.58
PCS 2,103.20
PCS 1,540.00
PCS 3,286.80
PCS 43,998.02
PCS 16,912.90
PCS 15,729.12
PCS 1,540.00
PCS 14,101.34
PCS 1,540.00
PCS 2,103.20
PCS 8,712.00
PCS 1,872.84
PCS 272.83
PCS 316.40
PCS 664.40
PCS 5,808.00
PCS 2,103.20
PCS 1,540.00
238,551.5
PCS
0
PCS 210.09
PCS 117.83
PCS 7,050.67
PCS 1,540.00
PCS 2,103.20
PCS 6,292.00
PCS 8,525.00
PCS 19,219.16
PCS 27,499.67
PCS 2,103.20
PCS 1,540.00
PCS 43,998.02
PCS 27,225.00
PCS 12,100.00
PCS 922.01
PCS 14,101.34
PCS 1,540.00
PCS 2,103.20
PCS 12,850.20
PCS 664.44
PCS 7,078.50
PCS 54,558.90
PCS 2,103.20
PCS 1,540.00
PCS 9,147.60
238,551.5
PCS
0
PCS 2,103.20
PCS 1,540.00
PCS 936.42
PCS 21,152.01
PCS 3,872.00
PCS 5,856.40
PCS 485.58
PCS 922.01
PCS 1,931.16
PCS 2,747.80
PCS 9,609.58
PCS 27,499.67
PCS 33,008.80
PCS 16,171.64
PCS 16,912.90
PCS 23,593.68
PCS 43,998.02
PCS 16,912.90
PCS 24,257.46
PCS 27,225.00
PCS 33,613.80
PCS 23,593.68
PCS 13,422.94
PCS 1,903.00
PCS 54,558.90
PCS 16,912.90
PCS 43,998.02
PCS 3,212.55
PCS 10,009.88
PCS 7,050.67
PCS 5,856.40
PCS 922.01
PCS 3,872.00
PCS 485.58
PCS 43,998.02
PCS 11,575.23
PCS 27,225.00
PCS 11,357.50
PCS 8,525.00
PCS 1,540.00
PCS 25,369.35
PCS 6,670.40
PCS 43,998.02
PCS 24,257.46
PCS 7,260.00
PCS 21,152.01
PCS 2,310.00
PCS 2,103.20
PCS 54,999.34
PCS 14,101.34
PCS 15,014.82
PCS 18,788.00
PCS 922.01
PCS 16,698.00
PCS 49,225.00
PCS 1,540.00
PCS 54,558.90
PCS 30,855.00
PCS 11,357.50
PCS 8,525.00
PCS 1,540.00
PCS 2,103.20
PCS 5,618.52
PCS 10,164.00
PCS 42,841.26
PCS 5,031.18
PCS 742.50
PCS 3,378.09
PCS 728.37
PCS 23,593.68
PCS 8,712.00
PCS 11,357.50
PCS 2,103.20
PCS 12,705.07
PCS 16,912.90
PCS 16,171.64
145,200.0
PCS
0
PCS 1,903.00
PCS 9,680.00
PCS 728.37
PCS 23,593.68
PCS 8,525.00
PCS 11,357.50
PCS 1,540.00
PCS 14,974.30
PCS 728.37
PCS 936.42
PCS 1,677.06
PCS 16,912.90
PCS 728.37
PCS 9,680.00
PCS 21,152.01
PCS 43,998.02
PCS 27,225.00
PCS 16,333.02
PCS 25,369.35
PCS 77,207.68
PCS 15,729.12
PCS 8,712.00
PCS 11,357.50
PCS 1,540.00
PCS 3,154.80
PCS 43,998.02
PCS 24,257.46
PCS 75,504.00
PCS 23,593.68
PCS 3,154.80
PCS 44,922.90
PCS 1,540.00
PCS 922.01
PCS 65,997.03
PCS 16,698.00
PCS 37,755.30
PCS 28,041.75
PCS 15,014.82
PCS 5,808.00
PCS 3,212.55
PCS 1,118.04
PCS 3,181.20
PCS 7,383.27
PCS 559.02
PCS 980.10
PCS 1,838.61
PCS 2,107.42
PCS 23,593.68
PCS 39,567.00
PCS 5,856.40
PCS 3,872.00
3,558,249.27
10-12-
1 APT010000I32000269 152599 nn. NURAENI
RANITIDIN
MUS   7,687.68 2 8,456.45
2018 
2 APT010000I32000269 152599 nn. NURAENI
CEFTRIAXO19,999.10
MUS   2 21,999.01
3 APT010000I32000269 152599 nn. NURAENI
INFUSAN
MUS   N 6,712.06 2 7,383.27
4 APT010000I32000269 152599 nn. NURAENI
ELEKTRODA
MUS   4,000.00 5 4,400.00
5 APT010000I32000269 152599 nn. NURAENI
MASKER
MUS   DI 700.00 5 770.00
6 APT010000I32000269 152599 nn. NURAENI
HANDSCOEN
MUS   478.00 30 525.80
7 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS10  C 2,310.00 2 2,541.00
8 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS3 CC
  1,485.00 2 1,633.50
9 APT010000I62004414 137811 nn. SRI RATNA
COMBO
DEWIPACS.IP 
60,500.00 1 66,550.00
10 APT010000I62004414 137811 nn. SRI RATNA
CAIRAN
DEWIRLS.IP 
7,149.60 1 7,864.56
11 APT010000I62004414 137811 nn. SRI RATNA
SPOIT
DEWI
3 CCS.IP 
1,485.00 2 1,633.50
12 APT010000I62004414 137811 nn. SRI RATNA
HANDSCOEN
DEWI S.IP 478.00 4 525.80
13 APT010000I62004414 137811 nn. SRI RATNA
SANTAGESIK4,949.40
DEWI S.IP  1 5,444.34
14 APT010000I62004414 137811 nn. SRI RATNA
ASAMDEWI
TRAN3,493.88
S.IP  1 3,843.26
15 APT010000I62004415 157845 nn. LASMINI 
RANITIDIN 7,687.68 2 8,456.45
16 APT010000I62004415 157845 nn. LASMINI 
NEW DIAT 557.15 6 612.87
17 APT010000I62004415 157845 nn. LASMINI 
CAIRAN RL 7,149.60 1 7,864.56
18 APT010000I62004415 157845 nn. LASMINI 
SPOIT 3 CC 1,485.00 1 1,633.50
19 APT010000I31000538 160984 an. ABDULLAH 
VITAMIN B 146.99 5 161.69
20 APT010000I31000538 160984 an. ABDULLAH 
FOLAVIT 4 847.00 13 931.70
21 APT010000I31000538 160984 an. ABDULLAH 
VITAMIN C 71.91 1 79.10
22 APT010000I62004393 130394 tn. ANDI SURYATMAN
RANITIDIN EKA 629.99
JAYA  6 818.99
23 APT010000I32000269 152599 nn. NURAENI
AZITROMYC
MUS   1,777.99 1 1,955.79
24 APT010000I32000269 152599 nn. NURAENI
SIMUCIL
MUS   2 1,760.00 3 1,936.00
25 APT010000I32000269 152599 nn. NURAENI
INFUSAN
MUS   N 6,712.06 4 7,383.27
26 APT010000I31000538 160984 an. ABDULLAH 
CEFTRIAXO19,999.10 2 21,999.01
27 APT010000I31000538 160984 an. ABDULLAH 
CAIRAN NA15,180.00 1 16,698.00
28 APT010000I31000538 160984 an. ABDULLAH 
B COMPLEK 76.34 1 83.97
29 APT010000I31000538 160984 an. ABDULLAH 
VITAMIN C 125.84 1 138.42
30 APT010000I31000538 160984 an. ABDULLAH 
FOLAVIT 4 847.00 13 931.70
31 APT010000I31000538 160984 an. ABDULLAH 
HANDSCOEN 478.00 2 525.80
32 APT010000I31000538 160984 an. ABDULLAH 
IV CATHETE 7,750.00 1 8,525.00
33 APT010000I62004407 160945 nn. KHAIRUN
RANITIDIN
NISWAH YUSUF 
7,687.68 1 8,456.45
34 APT010000I62004407 160945 nn. KHAIRUN
DOMPERID
NISWAH YUSUF 508.20 3 559.02
35 APT010000I62004407 160945 nn. KHAIRUN
CAIRAN
NISWAH
RL YUSUF 
7,149.60 2 7,864.56
36 APT010000I62004407 160945 nn. KHAIRUN
IV DRESSI
NISWAH YUSUF 
4,850.00 2 5,335.00
37 APT010000I62004407 160945 nn. KHAIRUN
CAIRAN
NISWAH
NA15,180.00
YUSUF  2 16,698.00
38 APT010000I62004407 160945 nn. KHAIRUN
IV CATHETE
NISWAH YUSUF 
7,750.00 1 8,525.00
39 APT010000I62004407 160945 nn. KHAIRUN
HANDSCOEN
NISWAH YUSUF 478.00 2 525.80
40 APT010000I62004407 160945 nn. KHAIRUN
SPOIT
NISWAH
3 CC YUSUF 
1,485.00 2 1,633.50
41 APT010000I62004407 160945 nn. KHAIRUN
SPOIT
NISWAH
10 C YUSUF 
2,310.00 2 2,541.00
42 APT010000I12000055 160769 tn. HAMMAMFUROSEMID
ABDULLAH 190.99 1 210.09
43 APT010000I12000055 160769 tn. HAMMAMSPIRONOLA
ABDULLAH 870.34 1 957.38
44 APT010000I12000055 160769 tn. HAMMAMCAIRAN
ABDULLAH 
RL 7,149.60 1 7,864.56
45 APT010000I12000055 160769 tn. HAMMAMMASKER
ABDULLAH 
DI 700.00 1 770.00
46 APT010000I12000055 160769 tn. HAMMAMHANDSCOON
ABDULLAH 
12,100.00 2 13,310.00
47 APT010000I64002859 160634 tn. ABDUL RAZAK
- RAMANG  0 0 0
48 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID
RAMANG 190.99 3 210.09
49 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG 107.12 2 117.83
50 APT010000I64002859 160634 tn. ABDUL RAZAK
AMLODIPIN
RAMANG 838.19 2 922.01
51 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
52 APT010000I64002859 160634 tn. ABDUL RAZAK
VITAMIN
RAMANG 
K 7,920.00 2 8,712.00

53 APT010000I64002859 160634 tn. ABDUL RAZAK

LIVAMIN 5 216,865.0
RAMANG  1 238,551.5
0 0
54 APT010000I64002859 160634 tn. ABDUL RAZAK
CETIRIZIN
RAMANG 
266.01 1 292.61
55 APT010000I64002859 160634 tn. ABDUL RAZAK
SALBUTAM
RAMANG 88.00 3 96.80
56 APT010000I64002859 160634 tn. ABDUL RAZAK
NEURODEX
RAMANG 
1,540.00 2 1,694.00
57 APT010000I64002859 160634 tn. ABDUL RAZAK
LANSOPRAZ
RAMANG 
851.29 2 936.42
58 APT010000I64002859 160634 tn. ABDUL RAZAK
CAIRANRAMANG 
RL 7,149.60 2 7,864.56
59 APT010000I64002859 160634 tn. ABDUL RAZAK
MASKER RAMANG 
DI 700.00 1 770.00
60 APT010000I64002859 160634 tn. ABDUL RAZAK
HANDSCOEN
RAMANG 
478.00 2 525.80
61 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 10
RAMANG 
C 2,310.00 1 2,541.00
62 APT010000I64002859 160634 tn. ABDUL RAZAK
SPOIT 3RAMANG 
CC 1,485.00 1 1,633.50
63 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 3 5,004.94
64 APT010000I62004410 160990 tn. SARIM  SIMUCIL 2 1,760.00 3 1,936.00
65 APT010000I62004410 160990 tn. SARIM  INFUSAN N 6,712.06 2 7,383.27
66 APT010000I62004410 160990 tn. SARIM  MASKER DI 700.00 2 770.00
67 APT010000I62004410 160990 tn. SARIM  HANDSCOEN 478.00 2 525.80
68 APT010000I62004410 160990 tn. SARIM  SPOIT 10 C 2,310.00 1 2,541.00
69 APT010000I62004410 160990 tn. SARIM  IV DRESSI 4,850.00 1 5,335.00
70 APT010000I62004410 160990 tn. SARIM  SPOIT 3 CC 1,485.00 1 1,633.50
71 APT010000I62004410 160990 tn. SARIM  NEBULIZE 40,535.00 1 44,588.50
72 APT010000I62004394 160864 tn. LUTHERMETIL
MARRIBA 
PRE 766.50 1 843.15
73 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
74 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA T 297.00 6 326.70
75 APT010000I62004394 160864 tn. LUTHERL-CISIN
MARRIBA  2,890.80 3 3,179.88
76 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 2 5,445.00
77 APT010000I62004394 160864 tn. LUTHERCAIRAN
MARRIBA 
RL 7,149.60 2 7,864.56
78 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA DI 700.00 1 770.00
79 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 6 525.80
80 APT010000I62004394 160864 tn. LUTHERCAIRAN
MARRIBA 
AQ 2,860.00 3 3,146.00
81 APT010000I62004394 160864 tn. LUTHERSPOIT
MARRIBA 
5 CC 1,595.00 3 1,754.50
82 APT010000I62004394 160864 tn. LUTHERSPOIT
MARRIBA 
3 CC 1,485.00 3 1,633.50
83 APT010000I62004412 161003 tn. MUH YUSUF
KOTRIMOKS
SAPUTRA 254.10 2 279.51
84 APT010000I62004412 161003 tn. MUH YUSUF
NEW SAPUTRA 
DIAT 557.15 3 612.87
85 APT010000I62004412 161003 tn. MUH YUSUF
INFUSAN
SAPUTRA 
N 6,712.06 2 7,383.27
86 APT010000I62004412 161003 tn. MUH YUSUF
MASKER
SAPUTRA 
DI 700.00 1 770.00
87 APT010000I62004412 161003 tn. MUH YUSUF
HANDSCOEN
SAPUTRA 478.00 2 525.80
88 APT010000I62004412 161003 tn. MUH YUSUF
CAIRAN
SAPUTRA 
AQ 2,860.00 1 3,146.00
 89 APT010000I62004412 161003 tn. MUH YUSUF
SPOITSAPUTRA 
3 CC 1,485.00 1 1,633.50
90 APT010000I62004412 161003 tn. MUH YUSUF
IV CATHETE
SAPUTRA 
7,750.00 1 8,525.00
91 APT010000I62004412 161003 tn. MUH YUSUF
CAIRAN
SAPUTRA 
NA15,180.00 1 16,698.00
92 APT010000I62004379 113337 tn. MUHAMMAD
KSR 600ARIEF
M 1,755.00
GANI  2 1,930.50
93 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
94 APT010000I62004379 113337 tn. MUHAMMAD
B COMPLEK
ARIEF GANI 
76.34 6 83.97
95 APT010000I62004379 113337 tn. MUHAMMAD
PULMICORT
ARIEF8,540.00
GANI  3 9,394.00
96 APT010000I62004379 113337 tn. MUHAMMAD
COMBIVENT4,549.95
ARIEF GANI  3 5,004.94
97 APT010000I62004379 113337 tn. MUHAMMAD
ALPRAZOLA
ARIEF1,915.83
GANI  1 2,107.42
98 APT010000I62004379 113337 tn. MUHAMMAD
CODEINARIEF
20 1,494.00
GANI  2 1,643.40
99 APT010000I63003073 124832 ny. A. ROSDIANA
CODEINSINRANG 
20 1,494.00 2 1,643.40
100 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID2,920.50 4 3,212.55
101 APT010000I62004403 150726 ny. ST HASNAH 
NEFROSTER49,599.00 1 54,558.90
102 APT010000I62004403 150726 ny. ST HASNAH 
DIOVAN 16 1,525.49 1 1,678.04
103 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 3 221.48
104 APT010000I62004403 150726 ny. ST HASNAH 
ATORVASTA6,435.00 1 7,078.50
105 APT010000I62004405 160937 ny. ANGGU' SPORETIK 5,720.50 2 6,292.55
106 APT010000I62004405 160937 ny. ANGGU' PREGABAL 5,500.00 2 6,050.00
107 APT010000I62004405 160937 ny. ANGGU' AMLODIPIN 838.19 1 922.01
108 APT010000I62004405 160937 ny. ANGGU' CAIRAN RL 7,149.60 2 7,864.56
109 APT010000I62004405 160937 ny. ANGGU' MASKER DI 700.00 2 770.00
110 APT010000I62004405 160937 ny. ANGGU' HANDSCOEN 478.00 2 525.80
111 APT010000I62004405 160937 ny. ANGGU' IV DRESSI 4,850.00 1 5,335.00
112 APT010000I62004333 159705 ny. SITTI MAEMUNAH
NEFROSTER49,599.00
BASO  1 54,558.90
113 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOEN BASO 
478.00 2 525.80
114 APT010000I62004333 159705 ny. SITTI MAEMUNAH
MASKER DI BASO 
700.00 1 770.00
115 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 3 CC BASO 
1,485.00 1 1,633.50
116 APT010000I62004333 159705 ny. SITTI MAEMUNAH
IV DRESSI BASO 
4,850.00 1 5,335.00
117 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 5 CC BASO 
1,595.00 1 1,754.50
118 APT010000I12000064 160998 ny. KURNIATI
RANITIDIN
HAMZAH 7,687.68 2 8,456.45
119 APT010000I12000064 160998 ny. KURNIATI
SANMOL
HAMZAH 
T 297.00 3 326.70
120 APT010000I12000064 160998 ny. KURNIATI
CAIRAN
HAMZAH 
RL 7,149.60 2 7,864.56
121 APT010000I12000064 160998 ny. KURNIATI
MASKER
HAMZAH 
DI 700.00 2 770.00
122 APT010000I12000064 160998 ny. KURNIATI
HANDSCOEN
HAMZAH  478.00 2 525.80
123 APT010000I12000064 160998 ny. KURNIATI
CAIRAN
HAMZAH 
NA15,180.00 2 16,698.00
124 APT010000I12000064 160998 ny. KURNIATI
CONECTA
HAMZAH  25,000.00 1 27,500.00
125 APT010000I12000064 160998 ny. KURNIATI
SPOIT
HAMZAH 
3 CC 1,485.00 1 1,633.50
126 APT010000I12000064 160998 ny. KURNIATI
SPOIT
HAMZAH 
10 C 2,310.00 1 2,541.00
216,865.0 238,551.5
127 APT010000I62004362 160683 tn. MANGKONAPADANG 
LIVAMIN 5 0 1 0
128 APT010000I62004362 160683 tn. MANGKONAPADANG 
CEFOTAXIM15,004.00 3 16,504.40
129 APT010000I62004362 160683 tn. MANGKONAPADANG 
RANITIDIN 629.99 2 692.99
130 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 2 4,573.80
131 APT010000I62004362 160683 tn. MANGKONAPADANG 
HANDSCOEN 478.00 6 525.80
132 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 3 770.00
133 APT010000I63003073 124832 ny. A. ROSDIANA
SPORETIK
SINRANG 5,720.50 6 6,292.55
134 APT010000I63003073 124832 ny. A. ROSDIANA
ASPILETS
SINRANG  816.20 3 897.82
135 APT010000I63003073 124832 ny. A. ROSDIANA
BISOPROLO
SINRANG  726.00 2 798.60
136 APT010000I66000405 160570 nn. ROHANI RANITIDIN 629.99 6 692.99
137 APT010000I66000405 160570 nn. ROHANI ALLOPURIN 248.02 3 272.83
138 APT010000I66000405 160570 nn. ROHANI ZINK OKSI 604.00 3 664.40
139 APT010000I66000405 160570 nn. ROHANI VITAMIN C 125.84 12 138.42
140 APT010000I62004414 137811 nn. SRI RATNA
ASAMDEWI
TRAN3,493.88
S.IP  3 3,843.26
141 APT010000I62004417 153069 by. MUHAMMAD
IV CATHETE
AL YUSUF
16,720.00
FANDI  1 18,392.00
142 APT010000I62004417 153069 by. MUHAMMAD
ASERINGALI YUSUF
9,645.90
FANDI  1 10,610.49
143 APT010000I62004417 153069 by. MUHAMMAD
CONECTAAL YUSUF
25,000.00
FANDI  1 27,500.00
144 APT010000I62004417 153069 by. MUHAMMAD
ZINK SYR
AL YUSUF
30,250.00
FANDI  1 33,275.00
145 APT010000I62004417 153069 by. MUHAMMAD
ONDANSETR8,735.98
AL YUSUF FANDI  1 9,609.58
146 APT010000I62004417 153069 by. MUHAMMAD
ELKANAALSYYUSUF
22,440.00
FANDI  1 24,684.00
147 APT010000I62004417 153069 by. MUHAMMAD
SPOIT 3AL
CCYUSUF
1,485.00
FANDI  1 1,633.50
148 APT010000I62004417 153069 by. MUHAMMAD
INFUS SET
AL YUSUF
7,920.00
FANDI  1 8,712.00
149 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ZINK OKSI BASO  604.00 1 664.40
150 APT010000I62004333 159705 ny. SITTI MAEMUNAH
NEURODEX BASO  770.00 1 847.00
151 APT010000I64002859 160634 tn. ABDUL RAZAK
KETOROLAC
RAMANG 7,350.75 3 8,085.82
152 APT010000I64002859 160634 tn. ABDUL RAZAK
DULCOLAX
RAMANG 2,247.81 2 2,472.59
153 APT010000I64002859 160634 tn. ABDUL RAZAK
DULCOLAX
RAMANG 
23,571.24 2 25,928.36
154 APT010000I62004403 150726 ny. ST HASNAH 
FARSORBID 569.18 3 626.10
155 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID 190.99 1 210.09
156 APT010000I62004402 160911 ny. ANDI JUMANI 
LOMATULL23,100.00 1 25,410.00
157 APT010000I62004402 160911 ny. ANDI JUMANI 
CEFTRIAXO19,999.10 2 21,999.01
158 APT010000I62004402 160911 ny. ANDI JUMANI 
GENTAMICI 3,507.65 3 3,858.41
159 APT010000I62004402 160911 ny. ANDI JUMANI 
METRONIDA8,250.00 3 9,075.00
160 APT010000I62004402 160911 ny. ANDI JUMANI 
KETOROLAC 7,350.75 3 8,085.82
161 APT010000I62004402 160911 ny. ANDI JUMANI 
RANITIDIN 7,687.68 2 8,456.45
162 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN RL 7,149.60 3 7,864.56
163 APT010000I62004402 160911 ny. ANDI JUMANI 
MASKER DI 700.00 1 770.00
164 APT010000I62004402 160911 ny. ANDI JUMANI 
HANDSCOEN 478.00 2 525.80
165 APT010000I62004402 160911 ny. ANDI JUMANI 
IV DRESSI 4,850.00 1 5,335.00
166 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN NA15,180.00 1 16,698.00
167 APT010000I62004413 161015 ny. HERLINA 
SANMOL T 297.00 3 326.70
168 APT010000I62004413 161015 ny. HERLINA 
RANITIDIN 7,687.68 2 8,456.45
169 APT010000I62004413 161015 ny. HERLINA 
SIMUCIL 2 1,760.00 3 1,936.00
170 APT010000I62004275 159982 tn. SULHAM SANMOL T 297.00 9 326.70
171 APT010000I62004275 159982 tn. SULHAM DOMPERID 508.20 9 559.02
172 APT010000I62004275 159982 tn. SULHAM MASKER DI 700.00 1 770.00
173 APT010000I62004275 159982 tn. SULHAM INFUSAN N 6,712.06 3 7,383.27
174 APT010000I62004275 159982 tn. SULHAM HANDSCOEN 478.00 2 525.80
175 APT010000I62004368 160718 tn. HENRA LEVOFLOXA 449.00 1 493.90
176 APT010000I62004368 160718 tn. HENRA MECOBALAM6,600.00 1 7,260.00
177 APT010000I62004368 160718 tn. HENRA RANITIDIN 7,687.68 2 8,456.45
178 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 2 8,085.82
179 APT010000I62004368 160718 tn. HENRA NEURODEX 770.00 1 847.00
180 APT010000I62004368 160718 tn. HENRA MASKER DI 700.00 1 770.00
181 APT010000I62004368 160718 tn. HENRA HANDSCOEN 478.00 2 525.80
182 APT010000I62004368 160718 tn. HENRA INFUS SET 7,920.00 1 8,712.00
183 APT010000I64002893 160944 tn. MUHAMMADSANMOL SU'ADHIE 
I 24,202.60 3 26,622.86
184 APT010000I64002893 160944 tn. MUHAMMADINFUSANSU'ADHIE 
N 6,712.06 2 7,383.27
185 APT010000I64002893 160944 tn. MUHAMMADCAIRANSU'ADHIE 
NA15,180.00 1 16,698.00
186 APT010000I64002893 160944 tn. MUHAMMADHANDSCOEN
SU'ADHIE 
478.00 2 525.80
187 APT010000I64002893 160944 tn. MUHAMMADMASKER SU'ADHIE 
DI 700.00 1 770.00
188 APT010000I32000266 127819 ny. ANDI HERMIATY
SPORETIKDAMRI 
5,720.50 6 6,292.55
189 APT010000I32000266 127819 ny. ANDI HERMIATY
AMLODIPIN DAMRI 
838.19 3 922.01
190 APT010000I62004405 160937 ny. ANGGU'  NATRIUM D 195.91 2 215.50
191 APT010000I62004405 160937 ny. ANGGU'  L-CISIN 2,890.80 4 3,179.88
192 APT010000I62004415 157845 nn. LASMINI NEW DIAT 557.15 6 612.87
193 APT010000I62004353 160635 tn. DARWISSANMOL
LAEDDA T 297.00 3 326.70
194 APT010000I62004353 160635 tn. DARWISZINKLAEDDA 
OKSI 604.00 1 664.40
195 APT010000I62004353 160635 tn. DARWISBLAEDDA 
COMPLEK 76.34 6 83.97
196 APT010000I62004353 160635 tn. DARWISVITAMIN
LAEDDA C 125.84 4 138.42
197 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA AM70,188.80 1 77,207.68
198 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,149.60 3 7,864.56
199 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 1 770.00
200 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 2 525.80
201 APT010000I62004396 159610 ny. RITHA TANDI
NEFROSTER
LEMBANG 
49,599.00 1 54,558.90
202 APT010000I62004396 159610 ny. RITHA TANDI
DULCOLAX
LEMBANG 
23,571.24 2 25,928.36
203 APT010000I62004396 159610 ny. RITHA TANDI
MASKER LEMBANG 
DI 700.00 1 770.00
204 APT010000I62004396 159610 ny. RITHA TANDI
HANDSCOEN
LEMBANG 478.00 2 525.80
205 APT010000I62004396 159610 ny. RITHA TANDI
IV CATHETE
LEMBANG 
7,750.00 1 8,525.00
206 APT010000I62004396 159610 ny. RITHA TANDI
SPOIT LEMBANG 
1 CC 1,920.00 1 2,112.00
207 APT010000I62004340 155102 tn. DRS. H. CAIRAN
ISHAK ABDIR 
RL 7,149.60 2 7,864.56
208 APT010000I62004340 155102 tn. DRS. H. SANMOL
ISHAK ABDIR 
T 297.00 3 326.70
209 APT010000I62004340 155102 tn. DRS. H. RANITIDIN
ISHAK ABDIR  629.99 1 692.99
210 APT010000I62004340 155102 tn. DRS. H. GABAPENTI
ISHAK ABDIR 4,400.00 2 4,840.00
211 APT010000I62004340 155102 tn. DRS. H. MASKER
ISHAK ABDIR 
DI 700.00 1 770.00
212 APT010000I62004340 155102 tn. DRS. H. HANDSCOON
ISHAK ABDIR 
13,613.00 1 14,974.30
213 APT010000I62004340 155102 tn. DRS. H. IV
ISHAK
CATHETE
ABDIR 
7,750.00 1 8,525.00
214 APT010000I62004340 155102 tn. DRS. H. TRANSFUSI28,050.00
ISHAK ABDIR  1 30,855.00
215 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 6 326.70
216 APT010000I62004391 160813 tn. SUHERMAN 
B COMPLEK 76.34 2 83.97
217 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
218 APT010000I62004391 160813 tn. SUHERMAN 
CEFADROXI 877.80 2 965.58
219 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR8,735.98 3 9,609.58
220 APT010000I62004391 160813 tn. SUHERMAN 
ASAM MEF 325.00 3 357.50
221 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 4 7,864.56
222 APT010000I62004391 160813 tn. SUHERMAN 
MASKER DI 700.00 1 770.00
223 APT010000I62004391 160813 tn. SUHERMAN 
HANDSCOEN 478.00 2 525.80
224 APT010000I62004391 160813 tn. SUHERMAN 
IV CATHETE 7,750.00 1 8,525.00
225 APT010000I62004391 160813 tn. SUHERMAN 
CEFTRIAXO19,999.10 2 21,999.01
226 APT010000I62004386 149341 tn. MUH BASRI 
CEFTRIAXO19,999.10 2 21,999.01
227 APT010000I62004386 149341 tn. MUH BASRI 
KETOROLAC 7,350.75 3 8,085.82
228 APT010000I62004386 149341 tn. MUH BASRI 
CARBAZOC11,145.20 3 12,259.72
229 APT010000I62004386 149341 tn. MUH BASRI 
CAIRAN RL 7,149.60 2 7,864.56
230 APT010000I62004386 149341 tn. MUH BASRI 
IV CATHETE 7,750.00 1 8,525.00
231 APT010000I62004386 149341 tn. MUH BASRI 
SPOIT 3 CC 1,485.00 1 1,633.50
232 APT010000I62004386 149341 tn. MUH BASRI 
HANDSCOEN 478.00 2 525.80
233 APT010000I62004386 149341 tn. MUH BASRI 
MASKER DI 700.00 1 770.00
234 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
235 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   2 770.00
236 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   2 525.80
237 APT010000I62004390 160844 tn. H. ANDIIVAZAS
DRESSI
MANAF,4,850.00
BA   1 5,335.00
238 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
NA15,180.00
BA   1 16,698.00
239 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
240 APT010000I62004390 160844 tn. H. ANDIMECOBALA
AZAS MANAF,616.00
BA   1 677.60
241 APT010000I62004390 160844 tn. H. ANDIRANITIDIN
AZAS MANAF,629.99
BA   1 692.99
242 APT010000I62004390 160844 tn. H. ANDIDULCOLAX
AZAS MANAF,
23,571.24
BA   2 25,928.36
243 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  3 5,004.94
244 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00

245 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 54,054.00 2 59,459.40

246 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN

KADIR  838.19 1 922.01
247 APT010000I12000062 139631 tn. IBRAHIMINFUSAN
KADIR  N 6,712.06 2 7,383.27
248 APT010000I66000404 159099 ny. SITTI MULIYANA 
MASKER DI 700.00 1 770.00
249 APT010000I66000404 159099 ny. SITTI MULIYANA 
HANDSCOEN 478.00 2 525.80
250 APT010000I66000404 159099 ny. SITTI MULIYANA 
IV DRESSI 4,850.00 1 5,335.00
251 APT010000I66000404 159099 ny. SITTI MULIYANA 
SPOIT 5 CC 1,595.00 1 1,754.50
252 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALA 616.00 1 677.60
253 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
254 APT010000I66000404 159099 ny. SITTI MULIYANA 
RANITIDIN 7,687.68 2 8,456.45
255 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
256 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
257 APT010000I66000404 159099 ny. SITTI MULIYANA 
COMBIVENT4,549.95 2 5,004.94
258 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 6,101.33 2 6,711.47
259 APT010000I62004401 150626 tn. SAHARUDDIN 
OMEPRAZOL 24,999.70 2 27,499.67
260 APT010000I62004401 150626 tn. SAHARUDDIN 
INFUSAN N 6,712.06 3 7,383.27
261 APT010000I62004401 150626 tn. SAHARUDDIN 
MASKER DI 700.00 1 770.00
262 APT010000I62004401 150626 tn. SAHARUDDIN 
HANDSCOEN 478.00 2 525.80
263 APT010000I62004401 150626 tn. SAHARUDDIN 
SPOIT 5 CC 1,595.00 1 1,754.50
264 APT010000I62004401 150626 tn. SAHARUDDIN 
SPOIT 1 CC 1,920.00 1 2,112.00
265 APT010000I62004397 160511 tn. SUPRIADI
RANITIDIN
PAISAL  7,687.68 2 8,456.45
266 APT010000I62004397 160511 tn. SUPRIADI
CEFTRIAXO19,999.10
PAISAL  2 21,999.01
 267 APT010000I62004397 160511 tn. SUPRIADI
SOTATIC
PAISAL I 3,032.00 1 3,335.20
268 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
DE18,920.00 3 20,812.00
269 APT010000I62004397 160511 tn. SUPRIADI
MASKER
PAISAL DI 700.00 1 770.00
270 APT010000I62004397 160511 tn. SUPRIADI
HANDSCOEN
PAISAL  478.00 2 525.80
271 APT010000I62004397 160511 tn. SUPRIADI
SPOIT
PAISAL 
10 C 2,310.00 1 2,541.00
272 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
NA15,180.00 1 16,698.00
273 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
274 APT010000I62004411 138920 tn. LACCA LALING 
INFUSAN N 6,712.06 1 7,383.27

275 APT010000I62004409 160979 ny. HJ JUMRIAH

N-ACEDG
INJKINANG 
38,500.00 3 42,350.00

276 APT010000I62004409 160979 ny. HJ JUMRIAH

NEUROSANB5,324.00
DG KINANG  1 5,856.40
277 APT010000I62004409 160979 ny. HJ JUMRIAH
SANMOL
DG KINANG 
I 24,202.60 3 26,622.86
278 APT010000I62004409 160979 ny. HJ JUMRIAH
AMLODIPIN
DG KINANG 
838.19 1 922.01
279 APT010000I62004409 160979 ny. HJ JUMRIAH
MECOBALA
DG KINANG 
616.00 1 677.60
280 APT010000I62004409 160979 ny. HJ JUMRIAH
PIRACETAM
DG KINANG 
618.31 4 680.14
281 APT010000I62004409 160979 ny. HJ JUMRIAH
SANMOL
DG KINANG 
T 297.00 4 326.70
282 APT010000I62004409 160979 ny. HJ JUMRIAH
COFFEIN
DG SKINANG 
120.00 2 132.00
283 APT010000I62004409 160979 ny. HJ JUMRIAH
CANGKANG
DG KINANG 75.00 6 82.50
284 APT010000I62004409 160979 ny. HJ JUMRIAH
BETAHISTI
DG KINANG 
733.33 3 806.67
285 APT010000I62004409 160979 ny. HJ JUMRIAH
VALISANBE
DG KINANG 
236.50 3 260.15
286 APT010000I62004409 160979 ny. HJ JUMRIAH
AMITRIPTY
DG KINANG 
177.65 2 195.41
287 APT010000I62004386 149341 tn. MUH BASRI 
SPORETIK 5,720.50 6 6,292.55
288 APT010000I62004386 149341 tn. MUH BASRI 
FARGETIX 500.00 9 550.00
289 APT010000I62004417 153069 by. MUHAMMAD
CEFOTAXIM
AL YUSUF
15,004.00
FANDI  1 16,504.40
290 APT010000I62004417 153069 by. MUHAMMAD
CAIRANALNA15,180.00
YUSUF FANDI  1 16,698.00
291 APT010000I62004417 153069 by. MUHAMMAD
SPOIT 10
ALCYUSUF
2,310.00
FANDI  1 2,541.00
292 APT010000I62004408 160971 tn. MUH TAUFIK 
PARACETA 220.72 3 242.79
293 APT010000I62004408 160971 tn. MUH TAUFIK 
SIMUCIL 2 1,760.00 3 1,936.00
294 APT010000I62004408 160971 tn. MUH TAUFIK 
CETIRIZIN 266.01 2 292.61
295 APT010000I62004408 160971 tn. MUH TAUFIK 
NEUROSANB5,324.00 1 5,856.40

296 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  54,054.00 2 59,459.40

297 APT010000I32000269 152599 nn. NURAENI

PUMPITOR
MUS   62,693.82 2 68,963.20

298 APT010000I62004411 138920 tn. LACCA LALING 

LANTUS SO83,950.02 1 92,345.02
299 APT010000I62004411 138920 tn. LACCA LALING 
APIDRA 86,999.88 1 95,699.87
300 APT010000I62004411 138920 tn. LACCA LALING 
LEVOFLOXA 449.00 1 493.90
301 APT010000I62004411 138920 tn. LACCA LALING 
NOVO TWIS 2,083.00 1 2,291.30
302 APT010000I62004422 161070 nn. IAN HASDITA
COMBO SIRVANA 
PAC
60,500.00 1 66,550.00
303 APT010000I62004422 161070 nn. IAN HASDITA
CAIRANSIRVANA 
RL 7,149.60 3 7,864.56
304 APT010000I62004422 161070 nn. IAN HASDITA
ONDANSETR8,735.98
SIRVANA  1 9,609.58
305 APT010000I62004422 161070 nn. IAN HASDITA
RANITIDIN
SIRVANA 
7,687.68 2 8,456.45
306 APT010000I62004422 161070 nn. IAN HASDITA
SPOIT 3SIRVANA 
CC 1,485.00 3 1,633.50
Sub Total   700
Total 3682
PCS 16,912.90

PCS 43,998.02
PCS 14,766.54
PCS 22,000.00
PCS 3,850.00
PCS 15,774.00
PCS 5,082.00
PCS 3,267.00
PCS 66,550.00
PCS 7,864.56
PCS 3,267.00
PCS 2,103.20
PCS 5,444.34
PCS 3,843.26
PCS 16,912.90
PCS 3,677.22
PCS 7,864.56
PCS 1,633.50
PCS 808.45
PCS 12,112.10
PCS 79.10
PCS 4,913.94
PCS 1,955.79
PCS 5,808.00
PCS 29,533.08
PCS 43,998.02
PCS 16,698.00
PCS 83.97
PCS 138.42
PCS 12,112.10
PCS 1,051.60
PCS 8,525.00
PCS 8,456.45
PCS 1,677.06
PCS 15,729.12
PCS 10,670.00
PCS 33,396.00
PCS 8,525.00
PCS 1,051.60
PCS 3,267.00
PCS 5,082.00
PCS 210.09
PCS 957.38
PCS 7,864.56
PCS 770.00
PCS 26,620.00
- 0
PCS 630.27
PCS 235.66
PCS 1,844.02
PCS 7,078.50
PCS 17,424.00

PCS 238,551.5
0
PCS 292.61
PCS 290.40
PCS 3,388.00
PCS 1,872.84
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,633.50
PCS 15,014.82
PCS 5,808.00
PCS 14,766.54
PCS 1,540.00
PCS 1,051.60
PCS 2,541.00
PCS 5,335.00
PCS 1,633.50
PCS 44,588.50
PCS 843.15
PCS 216.84
PCS 1,960.20
PCS 9,539.64
PCS 10,890.00
PCS 15,729.12
PCS 770.00
PCS 3,154.80
PCS 9,438.00
PCS 5,263.50
PCS 4,900.50
PCS 559.02
PCS 1,838.61
PCS 14,766.54
PCS 770.00
PCS 1,051.60
PCS 3,146.00
PCS 1,633.50
PCS 8,525.00
PCS 16,698.00
PCS 3,861.00
PCS 664.40
PCS 503.82
PCS 28,182.00
PCS 15,014.82
PCS 2,107.42
PCS 3,286.80
PCS 3,286.80
PCS 12,850.20
PCS 54,558.90
PCS 1,678.04
PCS 664.44
PCS 7,078.50
PCS 12,585.10
PCS 12,100.00
PCS 922.01
PCS 15,729.12
PCS 1,540.00
PCS 1,051.60
PCS 5,335.00
PCS 54,558.90
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 5,335.00
PCS 1,754.50
PCS 16,912.90
PCS 980.10
PCS 15,729.12
PCS 1,540.00
PCS 1,051.60
PCS 33,396.00
PCS 27,500.00
PCS 1,633.50
PCS 2,541.00
238,551.5
PCS 0
PCS 49,513.20
PCS 1,385.98
PCS 9,147.60
PCS 3,154.80
PCS 2,310.00
PCS 37,755.30
PCS 2,693.46
PCS 1,597.20
PCS 4,157.94
PCS 818.49
PCS 1,993.20
PCS 1,661.04
PCS 11,529.78
PCS 18,392.00
PCS 10,610.49
PCS 27,500.00
PCS 33,275.00
PCS 9,609.58
PCS 24,684.00
PCS 1,633.50
PCS 8,712.00
PCS 664.40
PCS 847.00
PCS 24,257.46
PCS 4,945.18
PCS 51,856.72
PCS 1,878.30
PCS 210.09
PCS 25,410.00
PCS 43,998.02
PCS 11,575.23
PCS 27,225.00
PCS 24,257.46
PCS 16,912.90
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 16,698.00
PCS 980.10
PCS 16,912.90
PCS 5,808.00
PCS 2,940.30
PCS 5,031.18
PCS 770.00
PCS 22,149.81
PCS 1,051.60
PCS 493.90
PCS 7,260.00
PCS 16,912.90
PCS 16,171.64
PCS 847.00
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 79,868.58
PCS 14,766.54
PCS 16,698.00
PCS 1,051.60
PCS 770.00
PCS 37,755.30
PCS 2,766.03
PCS 431.00
PCS 12,719.52
PCS 3,677.22
PCS 980.10
PCS 664.40
PCS 503.82
PCS 553.68
PCS 77,207.68
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 54,558.90
PCS 51,856.72
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 2,112.00
PCS 15,729.12
PCS 980.10
PCS 692.99
PCS 9,680.00
PCS 770.00
PCS 14,974.30
PCS 8,525.00
PCS 30,855.00
PCS 1,960.20
PCS 167.94
PCS 2,747.80
PCS 1,931.16
PCS 28,828.74
PCS 1,072.50
PCS 31,458.24
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 43,998.02
PCS 43,998.02
PCS 24,257.46
PCS 36,779.16
PCS 15,729.12
PCS 8,525.00
PCS 1,633.50
PCS 1,051.60
PCS 770.00
PCS 23,593.68
PCS 1,540.00
PCS 1,051.60
PCS 5,335.00
PCS 16,698.00
PCS 897.82
PCS 677.60
PCS 692.99
PCS 51,856.72
PCS 15,014.82
PCS 28,182.00
118,918.8
PCS
0
PCS 922.01
PCS 14,766.54
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 1,754.50
PCS 677.60
PCS 54,558.90
PCS 16,912.90
PCS 43,998.02
PCS 6,425.10
PCS 10,009.88
PCS 13,422.94
PCS 54,999.34
PCS 22,149.81
PCS 770.00
PCS 1,051.60
PCS 1,754.50
PCS 2,112.00
PCS 16,912.90
PCS 43,998.02
PCS 3,335.20
PCS 62,436.00
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 16,698.00
PCS 43,998.02
PCS 7,383.27

PCS 127,050.0
0
PCS 5,856.40
PCS 79,868.58
PCS 922.01
PCS 677.60
PCS 2,720.56
PCS 1,306.80
PCS 264.00
PCS 495.00
PCS 2,420.01
PCS 780.45
PCS 390.82
PCS 37,755.30
PCS 4,950.00
PCS 16,504.40
PCS 16,698.00
PCS 2,541.00
PCS 728.37
PCS 5,808.00
PCS 585.22
PCS 5,856.40
118,918.8
PCS
0
137,926.4
PCS 0
PCS 92,345.02
PCS 95,699.87
PCS 493.90
PCS 2,291.30
PCS 66,550.00
PCS 23,593.68
PCS 9,609.58
PCS 16,912.90
PCS 4,900.50
4,576,244.24
 26,595,5
81.08
11-12-
1 APT010000I62004423 161069 ny. ST AISAYAH
METFORMI
TAHANG 190.00 2 209.00
2018 
2 APT010000I62004423 161069 ny. ST AISAYAH
ONDANSETR8,735.98
TAHANG  1 9,609.58
3 APT010000I62004423 161069 ny. ST AISAYAH
RANITIDIN
TAHANG 7,687.68 1 8,456.45
4 APT010000I62004423 161069 ny. ST AISAYAH
KETOROLAC
TAHANG 7,350.75 1 8,085.82
5 APT010000I62004423 161069 ny. ST AISAYAH
COMBO
TAHANG 
PAC60,500.00 1 66,550.00
6 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
RL 7,149.60 2 7,864.56
7 APT010000I32000269 152599 nn. NURAENICEFTRIAXO19,999.10
MUS   1 21,999.01
8 APT010000I32000269 152599 nn. NURAENICEFTRIAXO19,999.10
MUS   2 21,999.01

9 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  54,054.00 2 59,459.40

10 APT010000I32000269 152599 nn. NURAENI

OMEPRAZOL
MUS   24,999.70 2 27,499.67
11 APT010000I32000269 152599 nn. NURAENI
CETIRIZIN
MUS   266.01 2 292.61
12 APT010000I32000269 152599 nn. NURAENI
INFUSAN
MUS   N 6,712.06 4 7,383.27
13 APT010000I32000269 152599 nn. NURAENI
MASKER
MUS   DI 700.00 5 770.00
14 APT010000I32000269 152599 nn. NURAENI
HANDSCOEN
MUS   478.00 10 525.80

15 APT010000I64002893 160944 tn. MUHAMMAD

SANMOL
SU'ADHIE 
I 24,202.60 4 26,622.86

16 APT010000I64002893 160944 tn. MUHAMMADCEFTRIAXO19,999.10

SU'ADHIE  3 21,999.01
17 APT010000I64002893 160944 tn. MUHAMMADCAIRANSU'ADHIE 
NA15,180.00 1 16,698.00
18 APT010000I64002893 160944 tn. MUHAMMADCAIRANSU'ADHIE 
NAC6,409.70 6 7,050.67
19 APT010000I62004416 160951 tn. ARIFUDDIN 
CEFTRIAXO19,999.10 2 21,999.01
20 APT010000I62004340 155102 tn. DRS. H. ARDIUM
ISHAK ABDIR 
8,316.00 9 9,147.60
21 APT010000I62004340 155102 tn. DRS. H. KSR
ISHAK
600ABDIR 
M 1,755.00 6 1,930.50
22 APT010000I62004340 155102 tn. DRS. H. ALPENTIN
ISHAK ABDIR 
2,425.50 6 2,668.05
23 APT010000I62004413 161015 ny. HERLINA SANMOL T 297.00 3 326.70
24 APT010000I62004413 161015 ny. HERLINA SIMUCIL 2 1,760.00 3 1,936.00
25 APT010000I62004413 161015 ny. HERLINA NEURODEX 770.00 1 847.00
26 APT010000I62004413 161015 ny. HERLINA CAIRAN NAC6,409.70 3 7,050.67
27 APT010000I62004413 161015 ny. HERLINA ALPRAZOLA 1,915.83 1 2,107.42
28 APT010000I62004419 159873 tn. SYARIF S 
CEFTRIAXO19,999.10 2 21,999.01
29 APT010000I62004419 159873 tn. SYARIF S 
KETOROLAC 7,350.75 3 8,085.82
30 APT010000I62004419 159873 tn. SYARIF S 
RANITIDIN 7,687.68 3 8,456.45
31 APT010000I62004424 161085 tn. H. BAKING 
CAIRAN RL 7,149.60 1 7,864.56
32 APT010000I31000538 160984 an. ABDULLAH 
CEFTRIAXO19,999.10 2 21,999.01
33 APT010000I31000538 160984 an. ABDULLAH 
CAIRAN NA15,180.00 1 16,698.00
34 APT010000I31000538 160984 an. ABDULLAH 
NOVA B C 150.01 1 165.01
35 APT010000I31000538 160984 an. ABDULLAH 
FOLAVIT 4 847.00 1 931.70
36 APT010000I31000538 160984 an. ABDULLAH 
VITAMIN C 125.84 1 138.42
37 APT010000I62004407 160945 nn. KHAIRUN OMEPRAZO
NISWAH YUSUF 
704.37 3 774.80
38 APT010000I62004407 160945 nn. KHAIRUN DOMPERID
NISWAH YUSUF 
508.20 9 559.02
39 APT010000I62004407 160945 nn. KHAIRUN MASKER
NISWAH
DI YUSUF 
700.00 1 770.00
40 APT010000I62004405 160937 ny. ANGGU'  CEFTRIAXO19,999.10 2 21,999.01
41 APT010000I62004405 160937 ny. ANGGU'  METRONIDA8,250.00 3 9,075.00
42 APT010000I62004405 160937 ny. ANGGU'  CEFTRIAXO19,999.10 2 21,999.01
43 APT010000I62004405 160937 ny. ANGGU' PREGABAL 5,500.00 1 6,050.00
44 APT010000I62004405 160937 ny. ANGGU' RECOLFAR 4,950.00 1 5,445.00
45 APT010000I62004405 160937 ny. ANGGU' AMLODIPIN 838.19 1 922.01
46 APT010000I62004405 160937 ny. ANGGU' NATRIUM D 195.91 2 215.50
47 APT010000I12000064 160998 ny. KURNIATI
SANMOL
HAMZAH T 297.00 9 326.70
48 APT010000I12000064 160998 ny. KURNIATI
LEVOFLOXA
HAMZAH  449.00 3 493.90
49 APT010000I12000064 160998 ny. KURNIATI
MASKER
HAMZAH 
DI 700.00 1 770.00
50 APT010000I62004423 161069 ny. ST AISAYAH
LANTUS
TAHANG 
SO83,950.02 1 92,345.02
51 APT010000I62004423 161069 ny. ST AISAYAH
APIDRA
TAHANG 
86,999.88 1 95,699.87
52 APT010000I62004423 161069 ny. ST AISAYAH
NOVOTAHANG 
TWIS 2,083.00 2 2,291.30
53 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
NAC6,409.70 2 7,050.67
54 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
55 APT010000I62004423 161069 ny. ST AISAYAH
METRONIDA8,250.00
TAHANG  3 9,075.00
56 APT010000I12000055 160769 tn. HAMMAM FUROSEMID
ABDULLAH 190.99 1 210.09
57 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 870.34 1 957.38
58 APT010000I62004403 150726 ny. ST HASNAH 
NEFROSTER49,599.00 1 54,558.90
59 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID2,920.50 4 3,212.55
60 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 3 221.48
61 APT010000I62004403 150726 ny. ST HASNAH 
DIOVAN 16 1,525.49 1 1,678.04
62 APT010000I62004408 160971 tn. MUH TAUFIK 
CAIRAN RL 7,149.60 2 7,864.56
63 APT010000I62004408 160971 tn. MUH TAUFIK 
SANMOL T 297.00 3 326.70
64 APT010000I62004408 160971 tn. MUH TAUFIK 
CETIRIZIN 266.01 2 292.61
65 APT010000I62004408 160971 tn. MUH TAUFIK 
NEUROSANB5,324.00 1 5,856.40
66 APT010000I62004408 160971 tn. MUH TAUFIK 
SIMUCIL 2 1,760.00 3 1,936.00
67 APT010000I62004333 159705 ny. SITTI MAEMUNAH
NEFROSTER49,599.00
BASO  1 54,558.90
68 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ZINK OKSI BASO 
604.00 1 664.40
69 APT010000I62004333 159705 ny. SITTI MAEMUNAH
NEURODEX BASO 770.00 1 847.00
70 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN RL BASO 
7,149.60 1 7,864.56
71 APT010000I62004379 113337 tn. MUHAMMAD
PULMICORT
ARIEF8,540.00
GANI  2 9,394.00
72 APT010000I62004379 113337 tn. MUHAMMAD
COMBIVENT4,549.95
ARIEF GANI  1 5,004.94
73 APT010000I62004379 113337 tn. MUHAMMAD
NOVA BARIEF
C GANI 
150.01 6 165.01
74 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 1 664.40
75 APT010000I62004379 113337 tn. MUHAMMAD
CAIRANARIEF
RL 7,149.60
GANI  2 7,864.56
76 APT010000I62004385 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
77 APT010000I62004385 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
78 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
79 APT010000I62004385 148491 ny. NURBAENI 
CAIRAN RL 7,149.60 2 7,864.56
80 APT010000I62004417 153069 by. MUHAMMAD
CEFTRIAXO19,999.10
AL YUSUF FANDI  2 21,999.01
81 APT010000I62004417 153069 by. MUHAMMAD
ONDANSETR8,735.98
AL YUSUF FANDI  2 9,609.58
82 APT010000I62004422 161070 nn. IAN HASDITA
CAIRANSIRVANA 
NAC6,409.70 1 7,050.67
83 APT010000I62004422 161070 nn. IAN HASDITA
RANITIDIN
SIRVANA 
7,687.68 2 8,456.45
84 APT010000I62004422 161070 nn. IAN HASDITA
SOTATIC
SIRVANA 
I 3,032.00 3 3,335.20
85 APT010000I62004422 161070 nn. IAN HASDITA
PULMICORT
SIRVANA 
8,540.00 3 9,394.00
86 APT010000I64002859 160634 tn. ABDUL RAZAK
FUROSEMID
RAMANG 190.99 1 210.09
87 APT010000I64002859 160634 tn. ABDUL RAZAK
DIGOKSIN
RAMANG 107.12 1 117.83
 88 APT010000I64002859 160634 tn. ABDUL RAZAK
KENDARON
RAMANG 
1,027.00 1 1,129.70
89 APT010000I64002859 160634 tn. ABDUL RAZAK
ATORVASTA6,435.00
RAMANG  1 7,078.50
90 APT010000I64002859 160634 tn. ABDUL RAZAK
NEURODEX
RAMANG 
770.00 2 847.00

91 APT010000I64002859 160634 tn. ABDUL RAZAK

LIVAMIN 5 216,865.0
RAMANG  1 238,551.5
0 0
92 APT010000I64002859 160634 tn. ABDUL RAZAK
VITAMIN
RAMANG 
K 7,920.00 2 8,712.00
93 APT010000I62004362 160683 tn. MANGKONAPADANG 
SPORETIK 5,720.50 2 6,292.55
94 APT010000I62004362 160683 tn. MANGKONAPADANG 
MASKER DI 700.00 1 770.00
95 APT010000I62004415 157845 nn. LASMINI 
CAIRAN RL 7,149.60 3 7,864.56
96 APT010000I62004415 157845 nn. LASMINI 
NEW DIAT 557.15 6 612.87
97 APT010000I62004415 157845 nn. LASMINI 
MASKER DI 700.00 1 770.00
98 APT010000I62004414 137811 nn. SRI RATNA
CAIRAN
DEWIRLS.IP 
7,149.60 2 7,864.56
99 APT010000I62004414 137811 nn. SRI RATNA
ASAMDEWI
TRAS.IP 
1,386.00 3 1,524.60
100 APT010000I62004414 137811 nn. SRI RATNA
CAIRAN
DEWIRLS.IP 
7,149.60 2 7,864.56
101 APT010000I62004421 161061 ny. MEGAWATI
MASKER
ACO DI 700.00 1 770.00
102 APT010000I62004421 161061 ny. MEGAWATI
SANMOL
ACO T 297.00 6 326.70
103 APT010000I62004421 161061 ny. MEGAWATI
SOTATIC
ACO T 394.90 3 434.39
104 APT010000I62004421 161061 ny. MEGAWATI
COFFEIN
ACO S 120.00 120 132.00
105 APT010000I62004421 161061 ny. MEGAWATI
CANGKANG
ACO  116.90 6 128.59
106 APT010000I62004421 161061 ny. MEGAWATI
RANITIDIN
ACO  7,687.68 2 8,456.45
107 APT010000I62004421 161061 ny. MEGAWATI
NEURODEX
ACO  770.00 1 847.00
108 APT010000I62004421 161061 ny. MEGAWATI
VALISANBE
ACO  236.50 3 260.15
109 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
110 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA T 297.00 6 326.70
111 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 2 5,445.00
112 APT010000I62004412 161003 tn. MUH YUSUF
KOTRIMOKS
SAPUTRA  254.10 4 279.51
113 APT010000I62004412 161003 tn. MUH YUSUF
SIMUCIL
SAPUTRA 
2 1,760.00 3 1,936.00
114 APT010000I62004412 161003 tn. MUH YUSUF
NEW SAPUTRA 
DIAT 557.15 3 612.87
115 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 4 5,004.94
116 APT010000I62004410 160990 tn. SARIM  KETOROLAC 7,350.75 3 8,085.82
117 APT010000I62004410 160990 tn. SARIM  SIMUCIL 2 1,760.00 3 1,936.00
118 APT010000I62004417 153069 by. MUHAMMAD
PROBIOALKIYUSUF
13,354.00
FANDI  6 14,689.40
119 APT010000I62004417 153069 by. MUHAMMAD
SAGESTAM12,870.00
AL YUSUF FANDI  1 14,157.00
120 APT010000I62004422 161070 nn. IAN HASDITA
RANITIDIN
SIRVANA  629.99 6 692.99
121 APT010000I62004422 161070 nn. IAN HASDITA
DOMPERID
SIRVANA  508.20 9 559.02
122 APT010000I62004422 161070 nn. IAN HASDITA
SANMOLSIRVANA 
T 297.00 9 326.70
123 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 3 326.70
124 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL I 24,202.60 2 26,622.86
125 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
126 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR8,735.98 3 9,609.58
127 APT010000I62004391 160813 tn. SUHERMAN 
MEFINAL 5 1,391.50 3 1,530.65
128 APT010000I62004391 160813 tn. SUHERMAN 
CEFTRIAXO19,999.10 2 21,999.01
129 APT010000I62004409 160979 ny. HJ JUMRIAH
SIMUCIL
DG 2KINANG 
1,760.00 3 1,936.00
130 APT010000I62004409 160979 ny. HJ JUMRIAH
NEUROSANB5,324.00
DG KINANG  1 5,856.40
131 APT010000I62004409 160979 ny. HJ JUMRIAH
SANMOL
DG KINANG 
T 297.00 3 326.70
132 APT010000I62004409 160979 ny. HJ JUMRIAH
AMPISILLI
DG KINANG 
350.00 4 385.00
133 APT010000I62004409 160979 ny. HJ JUMRIAH
MECOBALA
DG KINANG 
616.00 1 677.60
134 APT010000I62004409 160979 ny. HJ JUMRIAH
BETAHISTI
DG KINANG 
733.33 3 806.67
135 APT010000I62004397 160511 tn. SUPRIADI
RANITIDIN
PAISAL  7,687.68 3 8,456.45
136 APT010000I62004397 160511 tn. SUPRIADI
CEFTRIAXO19,999.10
PAISAL  2 21,999.01
137 APT010000I62004397 160511 tn. SUPRIADI
SOTATIC
PAISAL I 3,032.00 2 3,335.20
138 APT010000I62004397 160511 tn. SUPRIADI
EPISAN
PAISAL 
SU 51,150.00 1 56,265.00
139 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
DE18,920.00 2 20,812.00
140 APT010000I62004397 160511 tn. SUPRIADI
FOLEY
PAISAL 
CAT 33,000.00 1 36,300.00
141 APT010000I62004397 160511 tn. SUPRIADI
URINE
PAISAL 
BAG 8,835.00 1 9,718.50
142 APT010000I62004401 150626 tn. SAHARUDDIN 
CAIRAN NAC6,409.70 3 7,050.67
143 APT010000I62004401 150626 tn. SAHARUDDIN 
OMEPRAZOL 24,999.70 2 27,499.67
144 APT010000I62004401 150626 tn. SAHARUDDIN 
EPISAN SU 51,150.00 1 56,265.00
145 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
146 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
147 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
148 APT010000I62004353 160635 tn. DARWISSANMOL
LAEDDA T 297.00 3 326.70
149 APT010000I62004353 160635 tn. DARWISKETOROLAC
LAEDDA  7,350.75 3 8,085.82
150 APT010000I62004353 160635 tn. DARWISZINK
LAEDDA 
OKSI 604.00 1 664.40
151 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA AM70,188.80 1 77,207.68
152 APT010000I62004353 160635 tn. DARWISNOVA
LAEDDA 
BC 150.01 6 165.01
153 APT010000I62004353 160635 tn. DARWISVITAMIN
LAEDDA C 125.84 6 138.42

154 APT010000I62004353 160635 tn. DARWISLEVOFLOXA

LAEDDA  66,000.00 2 72,600.00

155 APT010000I62004353 160635 tn. DARWISMETRONIDA8,250.00

LAEDDA  3 9,075.00
156 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  7,687.68 3 8,456.45
157 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA RL 7,149.60 3 7,864.56
158 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 1 770.00
159 APT010000I62004353 160635 tn. DARWISHANDSCOEN
LAEDDA  478.00 2 525.80
160 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
3 CC 1,485.00 1 1,633.50
161 APT010000I62004353 160635 tn. DARWISSPOIT
LAEDDA 
10 C 2,310.00 1 2,541.00
162 APT010000I62004368 160718 tn. HENRA CAIRAN NAC6,409.70 3 7,050.67
163 APT010000I62004368 160718 tn. HENRA HANDSCOEN 478.00 2 525.80
164 APT010000I62004368 160718 tn. HENRA MASKER DI 700.00 1 770.00
165 APT010000I62004368 160718 tn. HENRA MASKER DI 700.00 1 770.00
166 APT010000I62004368 160718 tn. HENRA CONECTA 10,325.00 1 11,357.50
167 APT010000I62004368 160718 tn. HENRA IV CATHETE 7,750.00 1 8,525.00
168 APT010000I62004402 160911 ny. ANDI JUMANI 
CEFIXIME 4,950.00 6 5,445.00
169 APT010000I62004402 160911 ny. ANDI JUMANI 
RANITIDIN 629.99 6 692.99
170 APT010000I62004402 160911 ny. ANDI JUMANI 
CAIRAN RL 7,149.60 3 7,864.56
171 APT010000I62004402 160911 ny. ANDI JUMANI 
HANDSCOEN 478.00 2 525.80
172 APT010000I62004402 160911 ny. ANDI JUMANI 
MASKER DI 700.00 1 770.00
173 APT010000I12000062 139631 tn. IBRAHIM
COMBIVENT4,549.95
KADIR  2 5,004.94
174 APT010000I12000062 139631 tn. IBRAHIM
PULMICORT
KADIR  8,540.00 3 9,394.00
175 APT010000I12000062 139631 tn. IBRAHIM
AMLODIPIN
KADIR  838.19 1 922.01
176 APT010000I12000062 139631 tn. IBRAHIM
METIL
KADIR 
PRE 54,054.00 2 59,459.40

177 APT010000I62004390 160844 tn. H. ANDIRANITIDIN

AZAS MANAF,
7,687.68
BA   2 8,456.45
178 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,
6,101.33
BA   2 6,711.47
179 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
180 APT010000I62004368 160718 tn. HENRA MECOBALA 616.00 1 677.60
181 APT010000I62004368 160718 tn. HENRA LEVOFLOXA 449.00 2 493.90
182 APT010000I62004368 160718 tn. HENRA GABAPENTI 4,400.00 2 4,840.00
183 APT010000I62004368 160718 tn. HENRA CANGKANG 116.90 6 128.59
184 APT010000I62004368 160718 tn. HENRA CLOBAZAM 1,116.84 1 1,228.53
185 APT010000I62004368 160718 tn. HENRA KETOROLAC 7,350.75 2 8,085.82
186 APT010000I62004368 160718 tn. HENRA RANITIDIN 7,687.68 2 8,456.45
187 APT010000I62004368 160718 tn. HENRA AMITRIPTY 177.65 3 195.41
188 APT010000I66000404 159099 ny. SITTI MULIYANA 
CITICOLIN 6,101.33 2 6,711.47
189 APT010000I66000404 159099 ny. SITTI MULIYANA 
MECOBALA 616.00 1 677.60
190 APT010000I66000404 159099 ny. SITTI MULIYANA 
SANMOL T 297.00 4 326.70
191 APT010000I66000404 159099 ny. SITTI MULIYANA 
CANGKANG 116.90 6 128.59
192 APT010000I66000404 159099 ny. SITTI MULIYANA 
NEFROSTER49,599.00 1 54,558.90
193 APT010000I66000404 159099 ny. SITTI MULIYANA 
ONDANSETR8,735.98 2 9,609.58
194 APT010000I66000404 159099 ny. SITTI MULIYANA 
CEFTRIAXO19,999.10 2 21,999.01
195 APT010000I66000404 159099 ny. SITTI MULIYANA 
FUROSEMID2,920.50 2 3,212.55
196 APT010000I66000404 159099 ny. SITTI MULIYANA 
COMBIVENT4,549.95 2 5,004.94
197 APT010000I66000404 159099 ny. SITTI MULIYANA 
CLOBAZAM 1,116.84 3 1,228.53
198 APT010000I64002914 161092 tn. HERMAN CAIRAN
YUSUF RL 7,149.60 1 7,864.56
199 APT010000I64002914 161092 tn. HERMAN COMBO
YUSUF PAC
60,500.00 1 66,550.00
200 APT010000I64002914 161092 tn. HERMAN HANDSCOEN
YUSUF  478.00 4 525.80
201 APT010000I64002914 161092 tn. HERMAN SANMOL
YUSUF T 297.00 3 326.70
202 APT010000I64002914 161092 tn. HERMAN SIMUCIL
YUSUF 2 1,760.00 3 1,936.00
203 APT010000I64002914 161092 tn. HERMAN MASKER
YUSUF DI 700.00 2 770.00
204 APT010000I62004403 150726 ny. ST HASNAH 
FARSORBID 569.18 3 626.10

205 APT010000I64002859 160634 tn. ABDUL RAZAK

CITICOLIN
RAMANG 
27,505.00 4 30,255.50

206 APT010000I64002859 160634 tn. ABDUL RAZAK

NEUROSANB5,324.00
RAMANG  1 5,856.40
207 APT010000I62004424 161085 tn. H. BAKING 
KETOROLAC 7,350.75 2 8,085.82
208 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,687.68 2 8,456.45

209 APT010000I62004424 161085 tn. H. BAKING 

METIL PRE 54,054.00 3 59,459.40

210 APT010000I62004424 161085 tn. H. BAKING 

GABAPENTI 4,400.00 1 4,840.00
211 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 116.90 6 128.59
212 APT010000I62004424 161085 tn. H. BAKING 
MECOBALAM6,600.00 1 7,260.00
213 APT010000I62004424 161085 tn. H. BAKING 
AMITRIPTY 177.65 2 195.41
214 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SPOIT 50 12,367.00
BASO  1 13,603.70
215 APT010000I62004333 159705 ny. SITTI MAEMUNAH
HANDSCOON13,613.00
BASO  1 14,974.30
216 APT010000I62004333 159705 ny. SITTI MAEMUNAH
SANMOL I 24,202.60
BASO  1 26,622.86
217 APT010000I62004425 161105 ny. RAMLAH COMBIVENT4,549.95 1 5,004.94
 218 APT010000I62004425 161105 ny. RAMLAH 
SPOIT 3 CC 1,485.00 1 1,633.50
219 APT010000I62004425 161105 ny. RAMLAH 
NASAL CA 11,550.07 1 12,705.07
220 APT010000I62004425 161105 ny. RAMLAH 
HANDSCOEN 478.00 2 525.80
221 APT010000I62004425 161105 ny. RAMLAH 
NEBULIZE 40,535.00 1 44,588.50
222 APT010000I62004425 161105 ny. RAMLAH 
CAIRAN RL 7,149.60 1 7,864.56
223 APT010000I62004425 161105 ny. RAMLAH 
COMBO PAC 60,500.00 1 66,550.00
224 APT010000I32000269 152599 nn. NURAENI
AZITROMYC
MUS   1,777.99 1 1,955.79
225 APT010000I32000269 152599 nn. NURAENI
SIMUCIL
MUS   2 1,760.00 3 1,936.00
226 APT010000I32000269 152599 nn. NURAENI
SIMUCIL
MUS   2 1,760.00 3 1,936.00
227 APT010000I32000269 152599 nn. NURAENI
IV CATHETE
MUS   7,750.00 1 8,525.00
228 APT010000I62004413 161015 ny. HERLINA 
SANMOL T 297.00 6 326.70
229 APT010000I62004413 161015 ny. HERLINA 
SIMUCIL 2 1,760.00 6 1,936.00
230 APT010000I62004413 161015 ny. HERLINA 
NEUROSAN 1,168.50 2 1,285.35
231 APT010000I62004391 160813 tn. SUHERMAN 
PARACETA 11,990.00 1 13,189.00
232 APT010000I62004426 144442 nn. NURFADHILLAH
CAIRAN RLARIFIN 
7,149.60 1 7,864.56
233 APT010000I62004425 161105 ny. RAMLAH 
DEKSAMETA1,801.80 1 1,981.98
234 APT010000I62004425 161105 ny. RAMLAH 
ONDANSETR8,735.98 1 9,609.58
235 APT010000I62004425 161105 ny. RAMLAH 
COMBIVENT4,549.95 1 5,004.94
236 APT010000I62004425 161105 ny. RAMLAH 
SPOIT 3 CC 1,485.00 3 1,633.50
237 APT010000I62004425 161105 ny. RAMLAH 
SIMUCIL 2 1,760.00 3 1,936.00
238 APT010000I62004425 161105 ny. RAMLAH 
OMEPRAZO 704.37 1 774.80
239 APT010000I62004425 161105 ny. RAMLAH 
CAIRAN RL 7,149.60 2 7,864.56
240 APT010000I62004414 137811 nn. SRI RATNA
LAXADINE
DEWI S.IP 
50,800.00 1 55,880.00
241 APT010000I31000538 160984 an. ABDULLAH 
PARACETA 11,990.00 2 13,189.00
242 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
7,687.68 1 8,456.45
243 APT010000I12000066 134815 tn. HASTANKETOROLAC
BASO MAKKASAU 
7,350.75 1 8,085.82
244 APT010000I12000066 134815 tn. HASTANPARACETA
BASO MAKKASAU 
11,990.00 2 13,189.00
245 APT010000I12000066 134815 tn. HASTANCAIRAN
BASO MAKKASAU 
RL 7,149.60 1 7,864.56
246 APT010000I12000066 134815 tn. HASTANCOMBO
BASO MAKKASAU 
PAC
60,500.00 1 66,550.00
247 APT010000I12000066 134815 tn. HASTANSPOIT
BASO3MAKKASAU 
CC 1,485.00 2 1,633.50
248 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
7,687.68 2 8,456.45
249 APT010000I12000066 134815 tn. HASTANKETOROLAC
BASO MAKKASAU 
7,350.75 1 8,085.82
250 APT010000I12000066 134815 tn. HASTANHANDSCOEN
BASO MAKKASAU 
478.00 2 525.80
251 APT010000I12000066 134815 tn. HASTANIVBASO
CATHETE
MAKKASAU 
7,750.00 2 8,525.00
Sub Total   714
PCS 418.00

PCS 9,609.58
PCS 8,456.45
PCS 8,085.82
PCS 66,550.00
PCS 15,729.12
PCS 21,999.01
PCS 43,998.02
118,918.8
PCS
0
PCS 54,999.34
PCS 585.22
PCS 29,533.08
PCS 3,850.00
PCS 5,258.00
106,491.4
PCS
4
PCS 65,997.03
PCS 16,698.00
PCS 42,304.02
PCS 43,998.02
PCS 82,328.40
PCS 11,583.00
PCS 16,008.30
PCS 980.10
PCS 5,808.00
PCS 847.00
PCS 21,152.01
PCS 2,107.42
PCS 43,998.02
PCS 24,257.46
PCS 25,369.35
PCS 7,864.56
PCS 43,998.02
PCS 16,698.00
PCS 165.01
PCS 931.70
PCS 138.42
PCS 2,324.40
PCS 5,031.18
PCS 770.00
PCS 43,998.02
PCS 27,225.00
PCS 43,998.02
PCS 6,050.00
PCS 5,445.00
PCS 922.01
PCS 431.00
PCS 2,940.30
PCS 1,481.70
PCS 770.00
PCS 92,345.02
PCS 95,699.87
PCS 4,582.60
PCS 14,101.34
PCS 43,998.02
PCS 27,225.00
PCS 210.09
PCS 957.38
PCS 54,558.90
PCS 12,850.20
PCS 664.44
PCS 1,678.04
PCS 15,729.12
PCS 980.10
PCS 585.22
PCS 5,856.40
PCS 5,808.00
PCS 54,558.90
PCS 664.40
PCS 847.00
PCS 7,864.56
PCS 18,788.00
PCS 5,004.94
PCS 990.06
PCS 664.40
PCS 15,729.12
PCS 43,998.02
PCS 5,949.85
PCS 922.01
PCS 15,729.12
PCS 43,998.02
PCS 19,219.16
PCS 7,050.67
PCS 16,912.90
PCS 10,005.60
PCS 28,182.00
PCS 210.09
PCS 117.83
PCS 1,129.70
PCS 7,078.50
PCS 1,694.00

PCS 238,551.5
0
PCS 17,424.00
PCS 12,585.10
PCS 770.00
PCS 23,593.68
PCS 3,677.22
PCS 770.00
PCS 15,729.12
PCS 4,573.80
PCS 15,729.12
PCS 770.00
PCS 1,960.20
PCS 1,303.17
PCS 15,840.00
PCS 771.54
PCS 16,912.90
PCS 847.00
PCS 780.45
PCS 216.84
PCS 1,960.20
PCS 10,890.00
PCS 1,118.04
PCS 5,808.00
PCS 1,838.61
PCS 20,019.76
PCS 24,257.46
PCS 5,808.00
PCS 88,136.40
PCS 14,157.00
PCS 4,157.94
PCS 5,031.18
PCS 2,940.30
PCS 980.10
PCS 53,245.72
PCS 2,747.80
PCS 28,828.74
PCS 4,591.95
PCS 43,998.02
PCS 5,808.00
PCS 5,856.40
PCS 980.10
PCS 1,540.00
PCS 677.60
PCS 2,420.01
PCS 25,369.35
PCS 43,998.02
PCS 6,670.40
PCS 56,265.00
PCS 41,624.00
PCS 36,300.00
PCS 9,718.50
PCS 21,152.01
PCS 54,999.34
PCS 56,265.00
PCS 43,998.02
PCS 12,100.00
PCS 16,171.64
PCS 980.10
PCS 24,257.46
PCS 664.40
PCS 77,207.68
PCS 990.06
PCS 830.52
145,200.0
PCS
0
PCS 27,225.00
PCS 25,369.35
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 2,541.00
PCS 21,152.01
PCS 1,051.60
PCS 770.00
PCS 770.00
PCS 11,357.50
PCS 8,525.00
PCS 32,670.00
PCS 4,157.94
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 10,009.88
PCS 28,182.00
PCS 922.01
 118,918.8
PCS
0
PCS 16,912.90
PCS 13,422.94
PCS 897.82
PCS 677.60
PCS 987.80
PCS 9,680.00
PCS 771.54
PCS 1,228.53
PCS 16,171.64
PCS 16,912.90
PCS 586.23
PCS 13,422.94
PCS 677.60
PCS 1,306.80
PCS 771.54
PCS 54,558.90
PCS 19,219.16
PCS 43,998.02
PCS 6,425.10
PCS 10,009.88
PCS 3,685.59
PCS 7,864.56
PCS 66,550.00
PCS 2,103.20
PCS 980.10
PCS 5,808.00
PCS 1,540.00
PCS 1,878.30
121,022.0
PCS
0
PCS 5,856.40
PCS 16,171.64
PCS 16,912.90
178,378.2
PCS
0
PCS 4,840.00
PCS 771.54
PCS 7,260.00
PCS 390.82
PCS 13,603.70
PCS 14,974.30
PCS 26,622.86
PCS 5,004.94
PCS 1,633.50
PCS 12,705.07
PCS 1,051.60
PCS 44,588.50
PCS 7,864.56
PCS 66,550.00
PCS 1,955.79
PCS 5,808.00
PCS 5,808.00
PCS 8,525.00
PCS 1,960.20
PCS 11,616.00
PCS 2,570.70
PCS 13,189.00
PCS 7,864.56
PCS 1,981.98
PCS 9,609.58
PCS 5,004.94
PCS 4,900.50
PCS 5,808.00
PCS 774.80
PCS 15,729.12
PCS 55,880.00
PCS 26,378.00
PCS 8,456.45
PCS 8,085.82
PCS 26,378.00
PCS 7,864.56
PCS 66,550.00
PCS 3,267.00
PCS 16,912.90
PCS 8,085.82
PCS 1,051.60
PCS 17,050.00
4,740,008.00
12-12-
1 APT010000I62004362 160683 tn. MANGKONAPADANG 
SPORETIK 5,720.50 1 6,292.55
2018 
2 APT010000I62004362 160683 tn. MANGKONAPADANG 
OMEPRAZO 704.37 2 774.80
3 APT010000I62004362 160683 tn. MANGKONAPADANG 
MICARDIS 5,408.95 1 5,949.85
4 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS50  12,367.00 2 13,603.70
5 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS20  C 5,600.00 1 6,160.00
6 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS10  C 2,310.00 1 2,541.00
7 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS5 CC
  1,595.00 1 1,754.50
8 APT010000I32000269 152599 nn. NURAENI
IV CATHETE
MUS   12,416.00 1 13,657.60
9 APT010000I32000269 152599 nn. NURAENI
CONECTA
MUS   25,000.00 1 27,500.00
10 APT010000I32000269 152599 nn. NURAENI
TRANSFUSI28,050.00
MUS   1 30,855.00
11 APT010000I32000269 152599 nn. NURAENI
HANDSCOON
MUS   13,613.00 1 14,974.30
12 APT010000I32000269 152599 nn. NURAENI
LIDOCAINE
MUS   1,287.00 3 1,415.70
13 APT010000I32000269 152599 nn. NURAENI
CEFTRIAXO19,999.10
MUS   2 21,999.01
14 APT010000I32000269 152599 nn. NURAENI
AZITROMYC
MUS   1,777.99 1 1,955.79
15 APT010000I32000269 152599 nn. NURAENI
HANDSCOEN
MUS   478.00 6 525.80
16 APT010000I32000269 152599 nn. NURAENI
CAIRAN
MUS NAC6,409.70
  4 7,050.67
17 APT010000I32000269 152599 nn. NURAENI
MASKER
MUS   DI 700.00 6 770.00
18 APT010000I32000269 152599 nn. NURAENI
CEFTRIAXO19,999.10
MUS   2 21,999.01

19 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  54,054.00 2 59,459.40

20 APT010000I32000269 152599 nn. NURAENIOMEPRAZOL

MUS   24,999.70 2 27,499.67
21 APT010000I32000269 152599 nn. NURAENIAZITROMYC
MUS   1,777.99 1 1,955.79
22 APT010000I32000269 152599 nn. NURAENISIMUCIL
MUS   2 1,760.00 3 1,936.00
23 APT010000I32000269 152599 nn. NURAENICETIRIZIN
MUS   266.01 2 292.61
24 APT010000I62004426 144442 nn. NURFADHILLAH
ASERING ARIFIN 
I 9,645.90 1 10,610.49
25 APT010000I62004426 144442 nn. NURFADHILLAH
CEFOTAXIM ARIFIN 
15,004.00 3 16,504.40
26 APT010000I62004426 144442 nn. NURFADHILLAH
SOTATIC IARIFIN 
3,032.00 3 3,335.20
27 APT010000I62004426 144442 nn. NURFADHILLAH
RANITIDINARIFIN 
7,687.68 3 8,456.45
28 APT010000I31000538 160984 an. ABDULLAH 
CEFTRIAXO19,999.10 2 21,999.01
29 APT010000I31000538 160984 an. ABDULLAH 
NOVA B C 150.01 1 165.01
30 APT010000I31000538 160984 an. ABDULLAH 
FOLAVIT 4 847.00 1 931.70
31 APT010000I31000538 160984 an. ABDULLAH 
CAIRAN RL 7,149.60 4 7,864.56
32 APT010000I31000538 160984 an. ABDULLAH 
SANMOL I 24,202.60 2 26,622.86
33 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 1 21,999.01
34 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
35 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
36 APT010000I62004397 160511 tn. SUPRIADI
RANITIDIN
PAISAL  7,687.68 3 8,456.45
37 APT010000I62004397 160511 tn. SUPRIADI
CEFTRIAXO19,999.10
PAISAL  2 21,999.01
38 APT010000I62004397 160511 tn. SUPRIADI
SOTATIC
PAISAL I 3,032.00 2 3,335.20
39 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
40 APT010000I62004390 160844 tn. H. ANDISPOIT
AZAS 5MANAF,
CC 1,595.00
BA   5 1,754.50
41 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF, 7,350.75
BA   2 8,085.82
42 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,27,505.00
BA   2 30,255.50
43 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
44 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF, 6,600.00
BA   1 7,260.00
45 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN NAC6,409.70 3 7,050.67
46 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL I 24,202.60 2 26,622.86
47 APT010000I62004391 160813 tn. SUHERMAN 
NOVA B C 150.01 2 165.01
48 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
49 APT010000I62004391 160813 tn. SUHERMAN 
CEFTRIAXO19,999.10 2 21,999.01
50 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR8,735.98 2 9,609.58
51 APT010000I62004391 160813 tn. SUHERMAN 
ASAM MEF 325.00 2 357.50
52 APT010000I64002893 160944 tn. MUHAMMAD
CAIRANSU'ADHIE 
NAC6,409.70 0 7,050.67
53 APT010000I64002893 160944 tn. MUHAMMAD
SANTAGESIK4,949.40
SU'ADHIE  3 5,444.34
54 APT010000I64002893 160944 tn. MUHAMMAD
VOLUVENSU'ADHIE 
621,780.00 1 23,958.00
55 APT010000I64002893 160944 tn. MUHAMMAD
CAIRANSU'ADHIE 
NAC6,409.70 3 7,050.67
56 APT010000I64002914 161092 tn. HERMAN SANMOL
YUSUF T 297.00 4 326.70
57 APT010000I64002914 161092 tn. HERMAN CAIRAN
YUSUF 
AS 9,645.90 4 10,610.49
58 APT010000I64002914 161092 tn. HERMAN MASKER
YUSUF DI 700.00 3 770.00
59 APT010000I62004426 144442 nn. NURFADHILLAH
CAIRAN AS ARIFIN 
9,645.90 1 10,610.49
60 APT010000I62004426 144442 nn. NURFADHILLAH
VOLUVENARIFIN 
621,780.00 1 23,958.00
61 APT010000I62004426 144442 nn. NURFADHILLAH
CEFTRIAXO19,999.10
ARIFIN  3 21,999.01
62 APT010000I62004419 159873 tn. SYARIF S 
CIPROFLOX 770.00 2 847.00
63 APT010000I62004419 159873 tn. SYARIF S 
KETOROLAC 7,350.75 2 8,085.82
64 APT010000I62004419 159873 tn. SYARIF S 
SANMOL T 297.00 3 326.70
65 APT010000I62004409 160979 ny. HJ JUMRIAH
SANMOLDG KINANG 
T 297.00 5 326.70
66 APT010000I62004409 160979 ny. HJ JUMRIAH
COFFEIN
DG SKINANG 
120.00 120 132.00
67 APT010000I62004409 160979 ny. HJ JUMRIAH
CANGKANG
DG KINANG 
116.90 9 128.59
68 APT010000I62004409 160979 ny. HJ JUMRIAH
SANMOLDG KINANG 
T 297.00 12 326.70
69 APT010000I62004409 160979 ny. HJ JUMRIAH
MECOBALA
DG KINANG 
616.00 3 677.60
70 APT010000I62004409 160979 ny. HJ JUMRIAH
BETAHISTI
DG KINANG 
733.33 9 806.67
71 APT010000I62004409 160979 ny. HJ JUMRIAH
VALISANBE
DG KINANG 
236.50 3 260.15
72 APT010000I62004409 160979 ny. HJ JUMRIAH
AMITRIPTY
DG KINANG 
177.65 2 195.41
73 APT010000I62004409 160979 ny. HJ JUMRIAH
SIMUCIL
DG 2KINANG 
1,760.00 9 1,936.00
74 APT010000I62004409 160979 ny. HJ JUMRIAH
GABAPENTI
DG KINANG 
4,400.00 6 4,840.00
75 APT010000I62004409 160979 ny. HJ JUMRIAH
AMLODIPIN
DG KINANG 
838.19 3 922.01
76 APT010000I32000269 152599 nn. NURAENICOMBIVENT4,549.95
MUS   3 5,004.94
77 APT010000I32000269 152599 nn. NURAENIMASKER
MUS   DI 700.00 1 770.00
78 APT010000I62004401 150626 tn. SAHARUDDIN 
OMEPRAZOL 24,999.70 2 27,499.67
79 APT010000I62004401 150626 tn. SAHARUDDIN 
EPISAN SU 51,150.00 1 56,265.00
80 APT010000I62004424 161085 tn. H. BAKING 
KETOROLAC 7,350.75 2 8,085.82
81 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,687.68 2 8,456.45
82 APT010000I62004424 161085 tn. H. BAKING 
MECOBALAM6,600.00 1 7,260.00
83 APT010000I12000066 134815 tn. HASTANSANMOL
BASO MAKKASAU 
T 297.00 3 326.70
84 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
7,687.68 2 8,456.45
85 APT010000I12000066 134815 tn. HASTANKETOROLAC
BASO MAKKASAU 
7,350.75 2 8,085.82
86 APT010000I12000066 134815 tn. HASTANDOMPERID
BASO MAKKASAU 
508.20 2 559.02
87 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  4 5,004.94
88 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
 89 APT010000I12000062 139631 tn. IBRAHIM
METIL
KADIR 
PRE 54,054.00 2 59,459.40

90 APT010000I12000062 139631 tn. IBRAHIM

SIMUCIL
KADIR  2 1,760.00 3 1,936.00
91 APT010000I12000062 139631 tn. IBRAHIM
AMLODIPIN
KADIR  838.19 1 922.01
92 APT010000I62004396 159610 ny. RITHA TANDI
NEFROSTER
LEMBANG 
49,599.00 1 54,558.90
93 APT010000I62004396 159610 ny. RITHA TANDI
DULCOLAX
LEMBANG 
23,571.24 1 25,928.36
94 APT010000I62004353 160635 tn. DARWISSOTATIC
LAEDDA T 394.90 3 434.39
95 APT010000I62004353 160635 tn. DARWISRANITIDIN
LAEDDA  629.99 2 692.99

96 APT010000I62004353 160635 tn. DARWISFLEET ENE 104,181.0

LAEDDA  1 114,599.1
0 0
97 APT010000I62004353 160635 tn. DARWISSANMOL
LAEDDA T 297.00 3 326.70
98 APT010000I62004353 160635 tn. DARWIS- LAEDDA  0 0 0
99 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA AM70,188.80 1 77,207.68
100 APT010000I62004353 160635 tn. DARWISZINK
LAEDDA 
OKSI 604.00 1 664.40
101 APT010000I62004353 160635 tn. DARWISNOVA
LAEDDA 
BC 150.01 6 165.01
102 APT010000I62004353 160635 tn. DARWISVITAMIN
LAEDDA C 125.84 4 138.42
103 APT010000I50000013 160742 tn. TAN INGCEFTRIAXO19,999.10
KIAT  2 21,999.01
104 APT010000I50000013 160742 tn. TAN INGRANITIDIN
KIAT  7,687.68 2 8,456.45
105 APT010000I50000013 160742 tn. TAN INGKETOROLAC
KIAT  7,350.75 2 8,085.82
106 APT010000I62004405 160937 ny. ANGGU' CEFIXIME 4,950.00 6 5,445.00
107 APT010000I62004405 160937 ny. ANGGU' PREGABAL 5,500.00 6 6,050.00
108 APT010000I62004405 160937 ny. ANGGU' RECOLFAR 4,950.00 3 5,445.00
109 APT010000I62004405 160937 ny. ANGGU' AMLODIPIN 838.19 3 922.01
110 APT010000I62004408 160971 tn. MUH TAUFIK 
CEFIXIME 4,950.00 2 5,445.00
111 APT010000I62004408 160971 tn. MUH TAUFIK 
SANMOL T 297.00 3 326.70
112 APT010000I62004408 160971 tn. MUH TAUFIK 
CEFIXIME 4,950.00 2 5,445.00
113 APT010000I62004408 160971 tn. MUH TAUFIK 
NEUROSANB5,324.00 1 5,856.40
114 APT010000I62004403 150726 ny. ST HASNAH 
SPIRONOLA 285.75 1 314.33
115 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 3 221.48
116 APT010000I62004403 150726 ny. ST HASNAH 
CLOBAZAM 1,116.84 3 1,228.53
117 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID 191.00 1 210.10
118 APT010000I62004403 150726 ny. ST HASNAH 
ISOSORBID 102.85 3 113.14
119 APT010000I62004403 150726 ny. ST HASNAH 
NEFROSTER49,599.00 1 54,558.90
120 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
NAC6,409.70 2 7,050.67
121 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
122 APT010000I62004423 161069 ny. ST AISAYAH
METRONIDA8,250.00
TAHANG  3 9,075.00
123 APT010000I62004423 161069 ny. ST AISAYAH
MASKER
TAHANG 
DI 700.00 1 770.00
124 APT010000I62004333 159705 ny. SITTI MAEMUNAH
ZINK OKSI BASO 604.00 3 664.40
125 APT010000I62004333 159705 ny. SITTI MAEMUNAH
NEURODEX BASO  770.00 3 847.00
126 APT010000I62004333 159705 ny. SITTI MAEMUNAH
CAIRAN RL BASO 
7,149.60 2 7,864.56
127 APT010000I62004379 113337 tn. MUHAMMAD
ALPRAZOLA
ARIEF1,915.83
GANI  3 2,107.42
128 APT010000I62004379 113337 tn. MUHAMMAD
ZINK OKSI
ARIEF GANI 
604.00 3 664.40
129 APT010000I62004379 113337 tn. MUHAMMAD
NOVA BARIEF
C GANI 
150.01 18 165.01
130 APT010000I12000055 160769 tn. HAMMAM FUROSEMID
ABDULLAH 191.00 3 210.10
131 APT010000I12000055 160769 tn. HAMMAM SPIRONOLA
ABDULLAH 870.34 3 957.38
132 APT010000I12000055 160769 tn. HAMMAM CAIRAN
ABDULLAH 
RL 7,149.60 2 7,864.56
133 APT010000I62004412 161003 tn. MUH YUSUF
KOTRIMOKS
SAPUTRA  254.10 6 279.51
134 APT010000I62004412 161003 tn. MUH YUSUF
SIMUCIL
SAPUTRA 
2 1,760.00 9 1,936.00
135 APT010000I62004412 161003 tn. MUH YUSUF
NEW SAPUTRA 
DIAT 557.15 4 612.87
136 APT010000I62004362 160683 tn. MANGKONAPADANG 
CEFIXIME 4,950.00 6 5,445.00
137 APT010000I62004362 160683 tn. MANGKONAPADANG 
URSODEOX 4,158.00 6 4,573.80
138 APT010000I62004362 160683 tn. MANGKONAPADANG 
RANITIDIN 629.99 6 692.99
139 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
140 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
141 APT010000I62004394 160864 tn. LUTHERMETIL
MARRIBA 
PRE 766.50 2 843.15
142 APT010000I62004394 160864 tn. LUTHERNEW
MARRIBA 
DIAT 557.15 6 612.87
143 APT010000I62004394 160864 tn. LUTHERRANITIDIN
MARRIBA  629.99 2 692.99
144 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 4 5,004.94
145 APT010000I62004410 160990 tn. SARIM  KETOROLAC 7,350.75 3 8,085.82
146 APT010000I62004410 160990 tn. SARIM  SIMUCIL 2 1,760.00 3 1,936.00
147 APT010000I62004410 160990 tn. SARIM  ASAM MEF 325.00 3 357.50
148 APT010000I62004425 161105 ny. RAMLAH COMBIVENT4,549.95 3 5,004.94
149 APT010000I62004425 161105 ny. RAMLAH ONDANSETR8,735.98 2 9,609.58
150 APT010000I62004425 161105 ny. RAMLAH COMBIVENT4,549.95 3 5,004.94
151 APT010000I62004425 161105 ny. RAMLAH ONDANSETR8,735.98 2 9,609.58
152 APT010000I62004425 161105 ny. RAMLAH RANITIDIN 7,687.68 2 8,456.45
153 APT010000I62004425 161105 ny. RAMLAH SIMUCIL 2 1,760.00 3 1,936.00
154 APT010000I62004415 157845 nn. LASMINI 
RANITIDIN 629.99 6 692.99
155 APT010000I62004421 161061 ny. MEGAWATI
RANITIDIN
ACO  629.99 6 692.99
156 APT010000I62004421 161061 ny. MEGAWATI
NEURODEX
ACO  770.00 3 847.00
157 APT010000I62004421 161061 ny. MEGAWATI
SANMOL
ACO T 297.00 3 326.70
158 APT010000I62004421 161061 ny. MEGAWATI
METILACO 
PRE 475.79 3 523.37
159 APT010000I62004421 161061 ny. MEGAWATI
COFFEIN
ACO S 120.00 60 132.00
160 APT010000I62004421 161061 ny. MEGAWATI
CANGKANG
ACO  116.90 6 128.59
161 APT010000I62004421 161061 ny. MEGAWATI
VALISANBE
ACO  236.50 3 260.15
162 APT010000I62004414 137811 nn. SRI RATNA
RANITIDIN
DEWI S.IP 
7,687.68 2 8,456.45
163 APT010000I62004414 137811 nn. SRI RATNA
CAIRAN
DEWINAC6,409.70
S.IP  3 7,050.67
164 APT010000I62004414 137811 nn. SRI RATNA
ASAMDEWI
TRAN3,493.88
S.IP  3 3,843.26
165 APT010000I62004414 137811 nn. SRI RATNA
MASKER
DEWIDIS.IP 700.00 1 770.00
166 APT010000I62004414 137811 nn. SRI RATNA
HANDSCOEN
DEWI S.IP 478.00 2 525.80
167 APT010000I32000269 152599 nn. NURAENILIDOCAINE
MUS   1,287.00 1 1,415.70
168 APT010000I32000269 152599 nn. NURAENISPOIT
MUS3 CC
  1,485.00 1 1,633.50
169 APT010000I32000269 152599 nn. NURAENIIV CATHETE
MUS   12,416.00 1 13,657.60
170 APT010000I32000269 152599 nn. NURAENIELEKTRODA
MUS   4,000.00 5 4,400.00
171 APT010000I32000269 152599 nn. NURAENICONECTA
MUS   25,000.00 1 27,500.00
172 APT010000I32000269 152599 nn. NURAENIHANDSCOEN
MUS   478.00 20 525.80
173 APT010000I62004430 161153 tn. MUH NURDIN 
COMBO PAC 60,500.00 1 66,550.00
174 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN RL 7,149.60 1 7,864.56
175 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 4 525.80
176 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 2 770.00
177 APT010000I62004423 161069 ny. ST AISAYAH
TRANSFUSI28,050.00
TAHANG  1 30,855.00
178 APT010000I62004423 161069 ny. ST AISAYAH
FUROSEMID2,920.50
TAHANG  1 3,212.55
179 APT010000I62004401 150626 tn. SAHARUDDIN 
OMEPRAZO 704.37 6 774.80
180 APT010000I62004401 150626 tn. SAHARUDDIN 
ACETYLCYS 1,100.00 9 1,210.00
181 APT010000I62004401 150626 tn. SAHARUDDIN 
ASAM MEF 325.00 9 357.50
182 APT010000I62004431 161168 ny. ZULAEHAH 
IV CATHETE12,416.00 1 13,657.60
183 APT010000I62004431 161168 ny. ZULAEHAH 
CAIRAN RL 7,149.60 1 7,864.56
184 APT010000I62004431 161168 ny. ZULAEHAH 
IV DRESSI 4,850.00 1 5,335.00
185 APT010000I62004431 161168 ny. ZULAEHAH 
INFUS SET 7,920.00 1 8,712.00
186 APT010000I62004431 161168 ny. ZULAEHAH 
KAPAS AL 300.00 2 330.00
187 APT010000I62004431 161168 ny. ZULAEHAH 
MASKER DI 700.00 2 770.00
188 APT010000I62004431 161168 ny. ZULAEHAH 
SANTAGESIK4,949.40 1 5,444.34
189 APT010000I62004431 161168 ny. ZULAEHAH 
RANITIDIN 7,687.68 1 8,456.45
190 APT010000I62004428 161138 tn. SUTRISNO 
CEFTRIAXO19,999.10 2 21,999.01
191 APT010000I62004428 161138 tn. SUTRISNO 
MECOBALA 616.00 1 677.60
192 APT010000I12000062 139631 tn. IBRAHIMOMEPRAZOL
KADIR  24,999.70 1 27,499.67
193 APT010000I50000013 160742 tn. TAN INGMETAMIZOL7,700.00
KIAT  3 8,470.00
194 APT010000I62004425 161105 ny. RAMLAH AMBROXOL 199.65 9 219.62
195 APT010000I62004425 161105 ny. RAMLAH SALBUTAM 88.00 9 96.80
196 APT010000I62004425 161105 ny. RAMLAH METIL PRE 475.79 5 523.37
197 APT010000I62004425 161105 ny. RAMLAH CANGKANG 116.90 9 128.59
198 APT010000I62004385 148491 ny. NURBAENI 
CEFIXIME 4,950.00 6 5,445.00
199 APT010000I62004385 148491 ny. NURBAENI 
SANMOL T 297.00 9 326.70
200 APT010000I62004432 160277 tn. SULAEMAN 
FEEDING T 42,800.00 1 47,080.00
201 APT010000I62004432 160277 tn. SULAEMAN 
SPOIT 10 C 2,310.00 1 2,541.00
202 APT010000I62004432 160277 tn. SULAEMAN 
CAIRAN AQ 2,860.00 1 3,146.00
203 APT010000I62004432 160277 tn. SULAEMAN 
COMBO KAT 60,500.00 1 66,550.00
204 APT010000I62004432 160277 tn. SULAEMAN 
HANDSCOEN 478.00 4 525.80
205 APT010000I62004426 144442 nn. NURFADHILLAH
SANMOL ARIFIN 
I 24,202.60 1 26,622.86
206 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL I 24,202.60 3 26,622.86
207 APT010000I31000538 160984 an. ABDULLAH 
FOLAVIT 4 847.00 2 931.70
208 APT010000I62004433 161174 tn. LALA  SPOIT 3 CC 1,485.00 1 1,633.50
209 APT010000I62004433 161174 tn. LALA  KETOROLAC 7,350.75 1 8,085.82
210 APT010000I62004436 161180 ny. HAPSAH IV CATHETE 7,750.00 1 8,525.00
211 APT010000I62004436 161180 ny. HAPSAH INFUSAN N 6,712.06 1 7,383.27
212 APT010000I62004436 161180 ny. HAPSAH COMBO PAC 60,500.00 1 66,550.00
213 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 2 5,004.94
214 APT010000I62004417 153069 by. MUHAMMAD
PROBIOAL KIYUSUF
13,354.00
FANDI  2 14,689.40
215 APT010000I62004430 161153 tn. MUH NURDIN 
SANMOL I 24,202.60 2 26,622.86
216 APT010000I62004434 151459 tn. MUH EQIIV FARDIANSYAH 
CATHETE 7,750.00 1 8,525.00
217 APT010000I62004434 151459 tn. MUH EQIINFUS
FARDIANSYAH 
SET 7,920.00 1 8,712.00
218 APT010000I62004434 151459 tn. MUH EQIIV FARDIANSYAH 
DRESSI 4,850.00 1 5,335.00
219 APT010000I62004434 151459 tn. MUH EQIHANDSCOEN
FARDIANSYAH 478.00 2 525.80
220 APT010000I62004434 151459 tn. MUH EQIMASKER
FARDIANSYAH 
DI 700.00 2 770.00
221 APT010000I62004434 151459 tn. MUH EQICAIRAN
FARDIANSYAH 
RL 7,149.60 1 7,864.56
 222 APT010000I62004434 151459 tn. MUH EQI
RANITIDIN
FARDIANSYAH 
7,040.00 1 7,744.00
223 APT010000I62004434 151459 tn. MUH EQI
KETOROLAC
FARDIANSYAH 
7,350.75 1 8,085.82
224 APT010000I62004416 160951 tn. ARIFUDDIN 
CEFTRIAXO19,999.10 2 21,999.01
225 APT010000I62004416 160951 tn. ARIFUDDIN 
RANITIDIN 7,040.00 2 7,744.00
226 APT010000I62004416 160951 tn. ARIFUDDIN 
KETOROLAC 7,350.75 3 8,085.82
227 APT010000I62004429 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
228 APT010000I62004429 161146 ny. NIRWANA 
SOTATIC I 3,032.00 3 3,335.20
229 APT010000I62004429 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
230 APT010000I62004429 161146 ny. NIRWANA 
SANTAGESIK4,949.40 3 5,444.34
231 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN NAC6,409.70 1 7,050.67
232 APT010000I62004430 161153 tn. MUH NURDIN 
LANTUS SO83,950.02 1 92,345.02
233 APT010000I62004430 161153 tn. MUH NURDIN 
APIDRA 86,999.88 1 95,699.87
234 APT010000I62004430 161153 tn. MUH NURDIN 
NOVO TWIS 2,083.00 2 2,291.30
Sub Total   832
PCS 6,292.55

PCS 1,549.60
PCS 5,949.85
PCS 27,207.40
PCS 6,160.00
PCS 2,541.00
PCS 1,754.50
PCS 13,657.60
PCS 27,500.00
PCS 30,855.00
PCS 14,974.30
PCS 4,247.10
PCS 43,998.02
PCS 1,955.79
PCS 3,154.80
PCS 28,202.68
PCS 4,620.00
PCS 43,998.02
118,918.8
PCS 0
PCS 54,999.34
PCS 1,955.79
PCS 5,808.00
PCS 585.22
PCS 10,610.49
PCS 49,513.20
PCS 10,005.60
PCS 25,369.35
PCS 43,998.02
PCS 165.01
PCS 931.70
PCS 31,458.24
PCS 53,245.72
PCS 21,999.01
PCS 12,100.00
PCS 16,171.64
PCS 25,369.35
PCS 43,998.02
PCS 6,670.40
PCS 23,593.68
PCS 8,772.50
PCS 16,171.64
PCS 60,511.00
PCS 897.82
PCS 7,260.00
PCS 21,152.01
PCS 53,245.72
PCS 330.02
PCS 2,747.80
PCS 43,998.02
PCS 19,219.16
PCS 715.00
PCS 0.00
PCS 16,333.02
PCS 23,958.00
PCS 21,152.01
PCS 1,306.80
PCS 42,441.96
PCS 2,310.00
PCS 10,610.49
PCS 23,958.00
PCS 65,997.03
PCS 1,694.00
PCS 16,171.64
PCS 980.10
PCS 1,633.50
PCS 15,840.00
PCS 1,157.31
PCS 3,920.40
PCS 2,032.80
PCS 7,260.03
PCS 780.45
PCS 390.82
PCS 17,424.00
PCS 29,040.00
PCS 2,766.03
PCS 15,014.82
PCS 770.00
PCS 54,999.34
PCS 56,265.00
PCS 16,171.64
PCS 16,912.90
PCS 7,260.00
PCS 980.10
PCS 16,912.90
PCS 16,171.64
PCS 1,118.04
PCS 20,019.76
PCS 28,182.00
 118,918.8
PCS
0
PCS 5,808.00
PCS 922.01
PCS 54,558.90
PCS 25,928.36
PCS 1,303.17
PCS 1,385.98

PCS 114,599.1
0
PCS 980.10
- 0
PCS 77,207.68
PCS 664.40
PCS 990.06
PCS 553.68
PCS 43,998.02
PCS 16,912.90
PCS 16,171.64
PCS 32,670.00
PCS 36,300.00
PCS 16,335.00
PCS 2,766.03
PCS 10,890.00
PCS 980.10
PCS 10,890.00
PCS 5,856.40
PCS 314.33
PCS 664.44
PCS 3,685.59
PCS 210.10
PCS 339.42
PCS 54,558.90
PCS 14,101.34
PCS 43,998.02
PCS 27,225.00
PCS 770.00
PCS 1,993.20
PCS 2,541.00
PCS 15,729.12
PCS 6,322.26
PCS 1,993.20
PCS 2,970.18
PCS 630.30
PCS 2,872.14
PCS 15,729.12
PCS 1,677.06
PCS 17,424.00
PCS 2,451.48
PCS 32,670.00
PCS 27,442.80
PCS 4,157.94
PCS 216.84
PCS 16,335.00
PCS 1,686.30
PCS 3,677.22
PCS 1,385.98
PCS 20,019.76
PCS 24,257.46
PCS 5,808.00
PCS 1,072.50
PCS 15,014.82
PCS 19,219.16
PCS 15,014.82
PCS 19,219.16
PCS 16,912.90
PCS 5,808.00
PCS 4,157.94
PCS 4,157.94
PCS 2,541.00
PCS 980.10
PCS 1,570.11
PCS 7,920.00
PCS 771.54
PCS 780.45
PCS 16,912.90
PCS 21,152.01
PCS 11,529.78
PCS 770.00
PCS 1,051.60
PCS 1,415.70
PCS 1,633.50
PCS 13,657.60
PCS 22,000.00
PCS 27,500.00
PCS 10,516.00
PCS 66,550.00
PCS 7,864.56
PCS 2,103.20
PCS 1,540.00
PCS 30,855.00
PCS 3,212.55
PCS 4,648.80
PCS 10,890.00
PCS 3,217.50
PCS 13,657.60
PCS 7,864.56
PCS 5,335.00
PCS 8,712.00
PCS 660.00
PCS 1,540.00
PCS 5,444.34
PCS 8,456.45
PCS 43,998.02
PCS 677.60
PCS 27,499.67
PCS 25,410.00
PCS 1,976.58
PCS 871.20
PCS 2,616.85
PCS 1,157.31
PCS 32,670.00
PCS 2,940.30
PCS 47,080.00
PCS 2,541.00
PCS 3,146.00
PCS 66,550.00
PCS 2,103.20
PCS 26,622.86
PCS 79,868.58
PCS 1,863.40
PCS 1,633.50
PCS 8,085.82
PCS 8,525.00
PCS 7,383.27
PCS 66,550.00
PCS 10,009.88
PCS 29,378.80
PCS 53,245.72
PCS 8,525.00
PCS 8,712.00
PCS 5,335.00
PCS 1,051.60
PCS 1,540.00
PCS 7,864.56
PCS 7,744.00
PCS 8,085.82
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 43,998.02
PCS 10,005.60
PCS 15,488.00
PCS 16,333.02
PCS 7,050.67
PCS 92,345.02
PCS 95,699.87
PCS 4,582.60
3,972,829.75
13-12-
1 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID 191.00 1 210.10
2018 
2 APT010000I62004385 148491 ny. NURBAENI 
LANSOGRA 1,000.00 1 1,100.00
3 APT010000I62004436 161180 ny. HAPSAH 
FUROSEMID2,920.50 4 3,212.55
4 APT010000I62004436 161180 ny. HAPSAH 
AMLODIPIN 475.19 1 522.71
5 APT010000I32000269 152599 nn. NURAENI
HANDSCOEN
MUS   478.00 10 525.80
6 APT010000I32000269 152599 nn. NURAENI
MASKER
MUS   DI 700.00 3 770.00
7 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS10  C 2,310.00 1 2,541.00
8 APT010000I32000269 152599 nn. NURAENI
CAIRAN
MUS NA15,180.00
  1 16,698.00
9 APT010000I32000269 152599 nn. NURAENI
SPOIT
MUS3 CC
  1,485.00 1 1,633.50
10 APT010000I32000269 152599 nn. NURAENI
CEFTRIAXO19,999.10
MUS   2 21,999.01

11 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  54,054.00 2 59,459.40

12 APT010000I32000269 152599 nn. NURAENIOMEPRAZOL

MUS   24,999.70 2 27,499.67
13 APT010000I32000269 152599 nn. NURAENICOMBIVENT4,549.95
MUS   3 5,004.94
14 APT010000I32000269 152599 nn. NURAENIAZITROMYC
MUS   1,777.99 1 1,955.79
15 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
NAC6,409.70 1 7,050.67
16 APT010000I62004397 160511 tn. SUPRIADI
TRANSFUSI28,050.00
PAISAL  1 30,855.00
17 APT010000I62004397 160511 tn. SUPRIADI
CEFTRIAXO19,999.10
PAISAL  2 21,999.01
18 APT010000I62004424 161085 tn. H. BAKING 
CAIRAN RL 7,149.60 3 7,864.56
19 APT010000I62004424 161085 tn. H. BAKING 
SPOIT 5 CC 1,595.00 5 1,754.50
20 APT010000I62004424 161085 tn. H. BAKING 
KETOROLAC 7,350.75 2 8,085.82
21 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,687.68 2 8,456.45

22 APT010000I62004424 161085 tn. H. BAKING 

METIL PRE 54,054.00 2 59,459.40

23 APT010000I62004424 161085 tn. H. BAKING 

MECOBALAM6,600.00 1 7,260.00
24 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  4 5,004.94
25 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 2 9,394.00
26 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 1 922.01

27 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 54,054.00 2 59,459.40

28 APT010000I12000062 139631 tn. IBRAHIM

SIMUCIL
KADIR  2 1,760.00 3 1,936.00
29 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 6 847.00
30 APT010000I62004433 161174 tn. LALA  SAGESTAM12,870.00 1 14,157.00
31 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
32 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
33 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
34 APT010000I62004428 161138 tn. SUTRISNO 
CEFTRIAXO19,999.10 2 21,999.01
35 APT010000I62004428 161138 tn. SUTRISNO 
RANITIDIN 7,687.68 2 8,456.45

36 APT010000I62004428 161138 tn. SUTRISNO 

METIL PRE 54,054.00 2 59,459.40

37 APT010000I62004428 161138 tn. SUTRISNO 

SANMOL T 297.00 3 326.70
38 APT010000I62004428 161138 tn. SUTRISNO 
NYSTATIN 24,006.40 1 26,407.04
39 APT010000I62004428 161138 tn. SUTRISNO 
AMBROXOL 199.65 3 219.62
40 APT010000I64002893 160944 tn. MUHAMMAD
SANTAGESIK4,949.40
SU'ADHIE  3 5,444.34
41 APT010000I64002893 160944 tn. MUHAMMAD
VOLUVEN
SU'ADHIE 
621,780.00 1 23,958.00
42 APT010000I64002893 160944 tn. MUHAMMAD
CAIRANSU'ADHIE 
NAC6,409.70 3 7,050.67
43 APT010000I62004416 160951 tn. ARIFUDDIN 
CEFTRIAXO19,999.10 2 21,999.01
44 APT010000I62004416 160951 tn. ARIFUDDIN 
KETOROLAC 7,350.75 3 8,085.82
45 APT010000I62004416 160951 tn. ARIFUDDIN 
RANITIDIN 7,687.68 3 8,456.45
46 APT010000I62004409 160979 ny. HJ JUMRIAH
PIRACETAM
DG KINANG 
1,293.60 10 1,422.96
47 APT010000I62004409 160979 ny. HJ JUMRIAH
MECOBALA
DG KINANG 
616.00 2 677.60
48 APT010000I62004409 160979 ny. HJ JUMRIAH
BETAHISTI
DG KINANG 
733.33 6 806.67
49 APT010000I62004409 160979 ny. HJ JUMRIAH
SIMUCIL
DG 2KINANG 
1,760.00 9 1,936.00
50 APT010000I62004409 160979 ny. HJ JUMRIAH
NEURODEX
DG KINANG 
770.00 3 847.00
51 APT010000I62004409 160979 ny. HJ JUMRIAH
AMLODIPIN
DG KINANG 
838.19 3 922.01
52 APT010000I62004409 160979 ny. HJ JUMRIAH
GABAPENTI
DG KINANG 
4,400.00 6 4,840.00
53 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
54 APT010000I62004390 160844 tn. H. ANDISANMOL
AZAS MANAF,
I 24,202.60
BA   3 26,622.86
55 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,7,350.75
BA   2 8,085.82

56 APT010000I62004390 160844 tn. H. ANDICITICOLIN

AZAS MANAF,
27,505.00
BA   4 30,255.50

57 APT010000I62004390 160844 tn. H. ANDIASPILETS

AZAS MANAF,816.20
BA   1 897.82
58 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF,6,600.00
BA   1 7,260.00
59 APT010000I62004390 160844 tn. H. ANDIALPRAZOLA
AZAS MANAF,1,915.83
BA   1 2,107.42
60 APT010000I62004419 159873 tn. SYARIF S 
SANMOL T 297.00 9 326.70
61 APT010000I31000538 160984 an. ABDULLAH 
KETOROLAC 7,350.75 3 8,085.82
62 APT010000I31000538 160984 an. ABDULLAH 
RANITIDIN 7,687.68 2 8,456.45
63 APT010000I62004353 160635 tn. DARWISCAIRAN
LAEDDA 
AM70,188.80 1 77,207.68
64 APT010000I62004353 160635 tn. DARWISZINK
LAEDDA 
OKSI 604.00 1 664.40
65 APT010000I62004353 160635 tn. DARWISNOVA
LAEDDA 
BC 150.01 6 165.01
66 APT010000I62004353 160635 tn. DARWISVITAMIN
LAEDDA C 125.84 4 138.42
67 APT010000I62004353 160635 tn. DARWISMASKER
LAEDDA DI 700.00 1 770.00
68 APT010000I62004353 160635 tn. DARWISCOMBIVENT4,549.95
LAEDDA  3 5,004.94
69 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 4 7,864.56
70 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL I 24,202.60 3 26,622.86
71 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
72 APT010000I62004391 160813 tn. SUHERMAN 
CEFTRIAXO19,999.10 2 21,999.01
73 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR8,735.98 3 9,609.58
74 APT010000I31000538 160984 an. ABDULLAH 
CEFIXIME 4,950.00 2 5,445.00
75 APT010000I31000538 160984 an. ABDULLAH 
AMBROXOL 199.65 3 219.62
76 APT010000I31000538 160984 an. ABDULLAH 
NOVA B C 150.01 1 165.01
77 APT010000I31000538 160984 an. ABDULLAH 
VITAMIN C 125.84 1 138.42
78 APT010000I31000538 160984 an. ABDULLAH 
FOLAVIT 4 847.00 1 931.70
79 APT010000I12000066 134815 tn. HASTANSPORETIK
BASO MAKKASAU 
5,720.50 2 6,292.55
80 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
629.99 2 692.99
81 APT010000I12000066 134815 tn. HASTANDOMPERID
BASO MAKKASAU 
508.20 2 559.02
82 APT010000I12000066 134815 tn. HASTANCAIRAN
BASO MAKKASAU 
RL 7,149.60 3 7,864.56
83 APT010000I62004426 144442 nn. NURFADHILLAH
VOLUVENARIFIN 
621,780.00 1 23,958.00
84 APT010000I62004426 144442 nn. NURFADHILLAH
SOTATIC IARIFIN 
3,032.00 3 3,335.20
 85 APT010000I62004426 144442 nn. NURFADHILLAH
CEFTRIAXO19,999.10
ARIFIN  3 21,999.01
86 APT010000I62004426 144442 nn. NURFADHILLAH
CAIRAN ASARIFIN 
9,645.90 4 10,610.49
87 APT010000I50000013 160742 tn. TAN INGCEFTRIAXO19,999.10
KIAT  2 21,999.01
88 APT010000I50000013 160742 tn. TAN INGSANTAGESIK4,949.40
KIAT  3 5,444.34
89 APT010000I50000013 160742 tn. TAN INGRANITIDIN
KIAT  7,687.68 3 8,456.45
90 APT010000I62004431 161168 ny. ZULAEHAH 
SANMOL T 297.00 5 326.70
91 APT010000I62004431 161168 ny. ZULAEHAH 
SOTATIC T 394.90 3 434.39
92 APT010000I62004431 161168 ny. ZULAEHAH 
COFFEIN S 120.00 120 132.00
93 APT010000I62004431 161168 ny. ZULAEHAH 
CANGKANG 116.90 6 128.59
94 APT010000I62004431 161168 ny. ZULAEHAH 
NEURODEX 770.00 3 847.00
95 APT010000I64002914 161092 tn. HERMAN CEFTRIAXO19,999.10
YUSUF  3 21,999.01
96 APT010000I64002914 161092 tn. HERMAN RANITIDIN
YUSUF  7,687.68 2 8,456.45
97 APT010000I64002914 161092 tn. HERMAN SANMOL
YUSUF I 24,202.60 2 26,622.86
98 APT010000I64002914 161092 tn. HERMAN CAIRAN
YUSUF 
AS 9,645.90 4 10,610.49
99 APT010000I62004414 137811 nn. SRI RATNA
METFORMI
DEWI S.IP 190.00 6 209.00
100 APT010000I62004403 150726 ny. ST HASNAH 
ADALAT OR 7,487.00 3 8,235.70
101 APT010000I62004403 150726 ny. ST HASNAH 
CLONIDINE 201.34 9 221.48
102 APT010000I62004403 150726 ny. ST HASNAH 
MICARDIS 5,408.95 3 5,949.85
103 APT010000I62004403 150726 ny. ST HASNAH 
CLOBAZAM 1,116.84 3 1,228.53
104 APT010000I62004403 150726 ny. ST HASNAH 
CLOBAZAM 1,116.84 3 1,228.53
105 APT010000I62004403 150726 ny. ST HASNAH 
ATORVASTA6,435.00 3 7,078.50
106 APT010000I62004403 150726 ny. ST HASNAH 
FUROSEMID 191.00 6 210.10
107 APT010000I62004403 150726 ny. ST HASNAH 
FARSORBID 569.18 9 626.10
108 APT010000I62004385 148491 ny. NURBAENI 
AMLODIPIN 838.19 3 922.01
109 APT010000I62004385 148491 ny. NURBAENI 
MICARDIS 5,408.95 3 5,949.85
110 APT010000I62004385 148491 ny. NURBAENI 
CEFIXIME 4,950.00 6 5,445.00
111 APT010000I62004385 148491 ny. NURBAENI 
SANMOL T 297.00 9 326.70
112 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 4 5,004.94
113 APT010000I62004410 160990 tn. SARIM  KETOROLAC 7,350.75 3 8,085.82
114 APT010000I62004410 160990 tn. SARIM  SIMUCIL 2 1,760.00 3 1,936.00
115 APT010000I62004410 160990 tn. SARIM  SANMOL T 297.00 3 326.70
116 APT010000I62004410 160990 tn. SARIM  CAIRAN NAC6,409.70 3 7,050.67
117 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
118 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
119 APT010000I62004394 160864 tn. LUTHERNEW
MARRIBA 
DIAT 557.15 6 612.87
120 APT010000I62004394 160864 tn. LUTHEROMEPRAZO
MARRIBA  704.37 2 774.80
121 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA T 297.00 3 326.70
122 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO
TAHANG 199.99 2 219.99
123 APT010000I62004423 161069 ny. ST AISAYAH
CIPROFLOX25,080.00
TAHANG  1 27,588.00

124 APT010000I62004423 161069 ny. ST AISAYAH

METRONIDA
TAHANG 
56,718.20 3 62,390.02

125 APT010000I62004423 161069 ny. ST AISAYAH

CAIRAN
TAHANG 
NAC6,409.70 3 7,050.67
126 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO 199.99 2 219.99
127 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN RL 7,149.60 2 7,864.56
128 APT010000I62004429 161146 ny. NIRWANA 
CEFTRIAXO 199.99 2 219.99
129 APT010000I62004429 161146 ny. NIRWANA 
SOTATIC T 394.90 1 434.39
130 APT010000I62004429 161146 ny. NIRWANA 
RANITIDIN 7,687.68 2 8,456.45
131 APT010000I62004429 161146 ny. NIRWANA 
CAIRAN AS 9,645.90 2 10,610.49
132 APT010000I62004425 161105 ny. RAMLAH COMBIVENT4,549.95 2 5,004.94
133 APT010000I62004425 161105 ny. RAMLAH OMEPRAZO 704.37 4 774.80
134 APT010000I62004425 161105 ny. RAMLAH SPORETIK 5,720.50 2 6,292.55
135 APT010000I62004425 161105 ny. RAMLAH SIMUCIL 2 1,760.00 3 1,936.00
136 APT010000I62004437 147766 ny. SITTI NORMI 
RANITIDIN 7,687.68 2 8,456.45
137 APT010000I62004437 147766 ny. SITTI NORMI 
DOMPERID 508.20 3 559.02
138 APT010000I62004437 147766 ny. SITTI NORMI 
METFORMI 190.00 3 209.00
139 APT010000I62004439 125128 tn. ZULFIKAR
DEKSAMETA1,801.80
KAMALUDDIN  2 1,981.98
140 APT010000I62004439 125128 tn. ZULFIKAR
RANITIDIN
KAMALUDDIN 
7,687.68 2 8,456.45
141 APT010000I62004439 125128 tn. ZULFIKAR
DOMPERID
KAMALUDDIN 
508.20 2 559.02
142 APT010000I62004439 125128 tn. ZULFIKAR
SANMOL
KAMALUDDIN 
T 297.00 3 326.70
143 APT010000I62004408 160971 tn. MUH TAUFIK 
CAIRAN RL 7,149.60 4 7,864.56
144 APT010000I62004408 160971 tn. MUH TAUFIK 
SANMOL T 297.00 3 326.70
145 APT010000I62004408 160971 tn. MUH TAUFIK 
SIMUCIL 2 1,760.00 3 1,936.00
146 APT010000I62004408 160971 tn. MUH TAUFIK 
CLONIDINE 201.34 2 221.48
147 APT010000I62004408 160971 tn. MUH TAUFIK 
NEUROSANB5,324.00 1 5,856.40
148 APT010000I62004408 160971 tn. MUH TAUFIK 
SPORETIK 5,720.50 2 6,292.55
149 APT010000I64002917 160918 ny. HJ. MARWIAH 
HANDSCOEN 478.00 4 525.80
150 APT010000I64002917 160918 ny. HJ. MARWIAH 
MASKER DI 700.00 1 770.00
151 APT010000I62004432 160277 tn. SULAEMAN 
MASKER DI 700.00 1 770.00
152 APT010000I62004432 160277 tn. SULAEMAN 
HANDSCOEN 478.00 4 525.80
153 APT010000I62004438 161181 ny. HERLINA 
RANITIDIN 7,687.68 3 8,456.45
154 APT010000I62004438 161181 ny. HERLINA 
BUSCOPAN 4,327.40 9 4,760.14
155 APT010000I62004438 161181 ny. HERLINA 
SANMOL T 297.00 9 326.70
156 APT010000I62004438 161181 ny. HERLINA 
CANGKANG 116.90 9 128.59
157 APT010000I62004438 161181 ny. HERLINA 
SANPRIMA 902.00 4 992.20
158 APT010000I62004438 161181 ny. HERLINA 
ZINK OKSI 604.00 1 664.40
159 APT010000I62004438 161181 ny. HERLINA 
NEW DIAT 557.15 6 612.87
160 APT010000I62004410 160990 tn. SARIM  CODIPRON10,502.80 2 11,553.08
161 APT010000I62004417 153069 by. MUHAMMAD
CEFOTAXIM
AL YUSUF
15,004.00
FANDI  2 16,504.40
162 APT010000I62004417 153069 by. MUHAMMAD
HISTAPAN
AL YUSUF
676.50
FANDI  2 744.15
163 APT010000I62004417 153069 by. MUHAMMAD
PREDNISON
AL YUSUF
224.99
FANDI  9 247.49
164 APT010000I62004417 153069 by. MUHAMMAD
SALBUTAM
AL YUSUF
102.85
FANDI  2 113.14
165 APT010000I62004417 153069 by. MUHAMMAD
EPEXOLAL
TAYUSUF
869.00
FANDI  2 955.90
166 APT010000I62004417 153069 by. MUHAMMAD
KERTASAL
PUYUSUF
613.00
FANDI  9 674.30
167 APT010000I62004417 153069 by. MUHAMMAD
TREMENZA
AL YUSUF
1,485.00
FANDI  2 1,633.50
168 APT010000I31000538 160984 an. ABDULLAH 
SANMOL T 297.00 3 326.70
169 APT010000I62004426 144442 nn. NURFADHILLAH
CAIRAN SAL
ARIFIN 
27,830.00 1 30,613.00
170 APT010000I62004426 144442 nn. NURFADHILLAH
INFUSAN ARIFIN 
N 6,712.06 3 7,383.27
171 APT010000I62004426 144442 nn. NURFADHILLAH
KSR 600 M
ARIFIN 
1,755.00 2 1,930.50
172 APT010000I62004426 144442 nn. NURFADHILLAH
INFUSAN ARIFIN 
R 9,645.50 2 10,610.05
173 APT010000I62004353 160635 tn. DARWISSOTATIC
LAEDDA T 394.90 3 434.39
 174 APT010000I50000024 161199 ny. RAHMAWATI 
RANITIDIN 7,040.00 2 7,744.00
175 APT010000I50000024 161199 ny. RAHMAWATI 
ONDANSETR5,500.00 3 6,050.00
176 APT010000I50000024 161199 ny. RAHMAWATI 
DIMENHIDR 121.00 2 133.10
177 APT010000I50000024 161199 ny. RAHMAWATI 
NEURODEX 770.00 1 847.00
178 APT010000I50000024 161199 ny. RAHMAWATI 
INFUSAN N 6,712.06 3 7,383.27
179 APT010000I32000269 152599 nn. NURAENI
INTERHIST
MUS   768.08 2 844.88
180 APT010000I62004397 160511 tn. SUPRIADI
INFUSAN
PAISAL N 6,712.06 6 7,383.27
181 APT010000I62004397 160511 tn. SUPRIADI
TRANSOFIX
PAISAL  8,500.00 1 9,350.00

182 APT010000I62004391 160813 tn. SUHERMAN 

LEVOFLOXA66,000.00 2 72,600.00

183 APT010000I62004437 147766 ny. SITTI NORMI 

SANMOL I 24,202.60 3 26,622.86
184 APT010000I62004437 147766 ny. SITTI NORMI 
DEKSAMETA1,801.80 2 1,981.98
185 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 3 847.00
186 APT010000I62004433 161174 tn. LALA  CETIRIZIN 266.01 3 292.61
187 APT010000I32000269 152599 nn. NURAENIHIDROCORT4,911.00
MUS   1 5,402.10
188 APT010000I32000269 152599 nn. NURAENIHANDSCOEN
MUS   478.00 10 525.80
189 APT010000I32000269 152599 nn. NURAENIMASKER
MUS   DI 700.00 3 770.00
190 APT010000I32000269 152599 nn. NURAENIIV CATHETE
MUS   7,750.00 2 8,525.00
191 APT010000I32000269 152599 nn. NURAENICONECTA
MUS   25,000.00 1 27,500.00
192 APT010000I32000269 152599 nn. NURAENIALKOHOL
MUS   S 300.00 5 330.00
193 APT010000I32000269 152599 nn. NURAENIINFUS
MUSSET
  7,920.00 1 8,712.00
194 APT010000I32000269 152599 nn. NURAENISPOIT
MUS
10  C 2,310.00 1 2,541.00
195 APT010000I32000269 152599 nn. NURAENICAIRAN
MUS NA15,180.00
  1 16,698.00
196 APT010000I62004434 151459 tn. MUH EQIKETOROLAC
FARDIANSYAH 
7,350.75 3 8,085.82
197 APT010000I62004434 151459 tn. MUH EQIRANITIDIN
FARDIANSYAH 
7,040.00 2 7,744.00
198 APT010000I62004434 151459 tn. MUH EQICAIRAN
FARDIANSYAH 
RL 7,149.60 3 7,864.56
199 APT010000I62004437 147766 ny. SITTI NORMI 
LEVEMIR F 83,950.00 1 92,345.00
200 APT010000I62004437 147766 ny. SITTI NORMI 
SANTAGESIK4,949.40 1 5,444.34
201 APT010000I62004437 147766 ny. SITTI NORMI 
HANDSCOEN 478.00 2 525.80
202 APT010000I62004440 161194 ny. NASYATI 
CEFTRIAXO19,999.10 1 21,999.01
203 APT010000I62004440 161194 ny. NASYATI 
CAIRAN AQ 2,860.00 1 3,146.00
204 APT010000I62004440 161194 ny. NASYATI 
SPOIT 1 CC 1,920.00 1 2,112.00
205 APT010000I62004440 161194 ny. NASYATI 
SPOIT 10 C 2,310.00 1 2,541.00
206 APT010000I62004440 161194 ny. NASYATI 
RANITIDIN 7,040.00 1 7,744.00
207 APT010000I62004440 161194 ny. NASYATI 
KETOROLAC 7,350.75 1 8,085.82
208 APT010000I62004440 161194 ny. NASYATI 
CAIRAN RL 7,149.60 1 7,864.56
209 APT010000I62004440 161194 ny. NASYATI 
SPOIT 3 CC 1,485.00 2 1,633.50
Sub Total   721
PCS 210.10

PCS 1,100.00
PCS 12,850.20
PCS 522.71
PCS 5,258.00
PCS 2,310.00
PCS 2,541.00
PCS 16,698.00
PCS 1,633.50
PCS 43,998.02
118,918.8
PCS 0
PCS 54,999.34
PCS 15,014.82
PCS 1,955.79
PCS 7,050.67
PCS 30,855.00
PCS 43,998.02
PCS 23,593.68
PCS 8,772.50
PCS 16,171.64
PCS 16,912.90

PCS 118,918.8
0
PCS 7,260.00
PCS 20,019.76
PCS 18,788.00
PCS 922.01

PCS 118,918.8
0
PCS 5,808.00
PCS 5,082.00
PCS 14,157.00
PCS 43,998.02
PCS 16,171.64
PCS 12,100.00
PCS 43,998.02
PCS 16,912.90
118,918.8
PCS
0
PCS 980.10
PCS 26,407.04
PCS 658.86
PCS 16,333.02
PCS 23,958.00
PCS 21,152.01
PCS 43,998.02
PCS 24,257.46
PCS 25,369.35
PCS 14,229.60
PCS 1,355.20
PCS 4,840.02
PCS 17,424.00
PCS 2,541.00
PCS 2,766.03
PCS 29,040.00
PCS 23,593.68
PCS 79,868.58
PCS 16,171.64
121,022.0
PCS
0
PCS 897.82
PCS 7,260.00
PCS 2,107.42
PCS 2,940.30
PCS 24,257.46
PCS 16,912.90
PCS 77,207.68
PCS 664.40
PCS 990.06
PCS 553.68
PCS 770.00
PCS 15,014.82
PCS 31,458.24
PCS 79,868.58
PCS 2,747.80
PCS 43,998.02
PCS 28,828.74
PCS 10,890.00
PCS 658.86
PCS 165.01
PCS 138.42
PCS 931.70
PCS 12,585.10
PCS 1,385.98
PCS 1,118.04
PCS 23,593.68
PCS 23,958.00
PCS 10,005.60
PCS 65,997.03
PCS 42,441.96
PCS 43,998.02
PCS 16,333.02
PCS 25,369.35
PCS 1,633.50
PCS 1,303.17
PCS 15,840.00
PCS 771.54
PCS 2,541.00
PCS 65,997.03
PCS 16,912.90
PCS 53,245.72
PCS 42,441.96
PCS 1,254.00
PCS 24,707.10
PCS 1,993.32
PCS 17,849.55
PCS 3,685.59
PCS 3,685.59
PCS 21,235.50
PCS 1,260.60
PCS 5,634.90
PCS 2,766.03
PCS 17,849.55
PCS 32,670.00
PCS 2,940.30
PCS 20,019.76
PCS 24,257.46
PCS 5,808.00
PCS 980.10
PCS 21,152.01
PCS 216.84
PCS 16,335.00
PCS 3,677.22
PCS 1,549.60
PCS 980.10
PCS 439.98
PCS 27,588.00
187,170.0
PCS
6
PCS 21,152.01
PCS 439.98
PCS 15,729.12
PCS 439.98
PCS 434.39
PCS 16,912.90
PCS 21,220.98
PCS 10,009.88
PCS 3,099.20
PCS 12,585.10
PCS 5,808.00
PCS 16,912.90
PCS 1,677.06
PCS 627.00
PCS 3,963.96
PCS 16,912.90
PCS 1,118.04
PCS 980.10
PCS 31,458.24
PCS 980.10
PCS 5,808.00
PCS 442.96
PCS 5,856.40
PCS 12,585.10
PCS 2,103.20
PCS 770.00
PCS 770.00
PCS 2,103.20
PCS 25,369.35
PCS 42,841.26
PCS 2,940.30
PCS 1,157.31
PCS 3,968.80
PCS 664.40
PCS 3,677.22
PCS 23,106.16
PCS 33,008.80
PCS 1,488.30
PCS 2,227.41
PCS 226.28
PCS 1,911.80
PCS 6,068.70
PCS 3,267.00
PCS 980.10
PCS 30,613.00
PCS 22,149.81
PCS 3,861.00
PCS 21,220.10
PCS 1,303.17
PCS 15,488.00
PCS 18,150.00
PCS 266.20
PCS 847.00
PCS 22,149.81
PCS 1,689.76
PCS 44,299.62
PCS 9,350.00

PCS 145,200.0
0
PCS 79,868.58
PCS 3,963.96
PCS 2,541.00
PCS 877.83
PCS 5,402.10
PCS 5,258.00
PCS 2,310.00
PCS 17,050.00
PCS 27,500.00
PCS 1,650.00
PCS 8,712.00
PCS 2,541.00
PCS 16,698.00
PCS 24,257.46
PCS 15,488.00
PCS 23,593.68
PCS 92,345.00
PCS 5,444.34
PCS 1,051.60
PCS 21,999.01
PCS 3,146.00
PCS 2,112.00
PCS 2,541.00
PCS 7,744.00
PCS 8,085.82
PCS 7,864.56
PCS 3,267.00
3,843,448.02
14-12-
1 APT010000I65003081 161225 tn. YUDHA CAIRAN
  RL 7,149.60 1 7,864.56
2018 
2 APT010000I65003081 161225 tn. YUDHA MASKER
  DI 700.00 2 770.00
3 APT010000I64002922 161222 ny. CINNONG 
CEFTRIAXO19,999.10 2 21,999.01
4 APT010000I64002922 161222 ny. CINNONG 
ASAM TRAN3,493.88 3 3,843.26
5 APT010000I64002922 161222 ny. CINNONG 
KETOROLAC 7,350.75 3 8,085.82
6 APT010000I64002922 161222 ny. CINNONG 
RANITIDIN 7,040.00 2 7,744.00
7 APT010000I64002922 161222 ny. CINNONG 
SPOIT 5 CC 1,595.00 2 1,754.50
8 APT010000I64002922 161222 ny. CINNONG 
SPOIT 10 C 2,310.00 3 2,541.00
9 APT010000I64002922 161222 ny. CINNONG 
SPOIT 3 CC 1,485.00 3 1,633.50
10 APT010000I64002922 161222 ny. CINNONG 
SPOIT 1 CC 1,920.00 3 2,112.00
11 APT010000I64002922 161222 ny. CINNONG 
CAIRAN AQ 2,860.00 1 3,146.00
12 APT010000I64002922 161222 ny. CINNONG 
HANDSCOEN 478.00 2 525.80
13 APT010000I64002923 161237 ny. HAMI  FEEDING T 42,800.00 1 47,080.00
14 APT010000I64002923 161237 ny. HAMI  HANDSCOEN4,796.00 1 5,275.60
15 APT010000I64002923 161237 ny. HAMI  CAIRAN DE18,920.00 2 20,812.00
16 APT010000I64002923 161237 ny. HAMI  SPOIT 10 C 2,310.00 1 2,541.00
17 APT010000I64002923 161237 ny. HAMI  COMBO PAC 60,500.00 1 66,550.00
18 APT010000I64002923 161237 ny. HAMI  INFUS SET 7,920.00 1 8,712.00
19 APT010000I62004442 72845 ny. LAILY NUZLIKHA
CAIRAN RLAZIS 
7,149.60 1 7,864.56
20 APT010000I62004442 72845 ny. LAILY NUZLIKHA
COMBO PACAZIS 
60,500.00 1 66,550.00
21 APT010000I62004442 72845 ny. LAILY NUZLIKHA
SANTAGESIK4,949.40
AZIS  1 5,444.34
22 APT010000I62004442 72845 ny. LAILY NUZLIKHA
SPOIT 3 CC
AZIS 
1,485.00 1 1,633.50
23 APT010000I62004442 72845 ny. LAILY NUZLIKHA
HANDSCOENAZIS 478.00 2 525.80
24 APT010000I64002893 160944 tn. MUHAMMAD
LEVOFLOXA
SU'ADHIE 
449.00 3 493.90
25 APT010000I64002893 160944 tn. MUHAMMAD
SANMOLSU'ADHIE 
T 297.00 9 326.70
26 APT010000I64002893 160944 tn. MUHAMMAD
INFUSAN
SU'ADHIE 
N 6,712.06 4 7,383.27
27 APT010000I64002893 160944 tn. MUHAMMAD
HANDSCOEN
SU'ADHIE 
478.00 4 525.80
28 APT010000I64002893 160944 tn. MUHAMMAD
MASKERSU'ADHIE 
DI 700.00 2 770.00
29 APT010000I31000538 160984 an. ABDULLAH 
CEFIXIME 4,950.00 6 5,445.00
30 APT010000I31000538 160984 an. ABDULLAH 
AMBROXOL 199.65 9 219.62
31 APT010000I31000538 160984 an. ABDULLAH 
SANMOL T 297.00 9 326.70
32 APT010000I62004431 161168 ny. ZULAEHAH 
NEURODEX 770.00 3 847.00
33 APT010000I62004431 161168 ny. ZULAEHAH 
CAIRAN RL 7,149.60 2 7,864.56
34 APT010000I62004431 161168 ny. ZULAEHAH 
MASKER DI 700.00 2 770.00
35 APT010000I62004431 161168 ny. ZULAEHAH 
HANDSCOEN 478.00 4 525.80
36 APT010000I62004431 161168 ny. ZULAEHAH 
SPOIT 3 CC 1,485.00 1 1,633.50
37 APT010000I62004431 161168 ny. ZULAEHAH 
IV CATHETE 7,750.00 1 8,525.00
38 APT010000I62004431 161168 ny. ZULAEHAH 
SANMOL T 297.00 2 326.70
39 APT010000I62004431 161168 ny. ZULAEHAH 
SOTATIC T 394.90 2 434.39
40 APT010000I62004431 161168 ny. ZULAEHAH 
CANGKANG 116.90 2 128.59
41 APT010000I62004408 160971 tn. MUH TAUFIK 
CETIRIZIN 266.01 6 292.61
42 APT010000I62004408 160971 tn. MUH TAUFIK 
NEURODEX 770.00 3 847.00
43 APT010000I62004408 160971 tn. MUH TAUFIK 
CEFIXIME 4,950.00 3 5,445.00
44 APT010000I62004408 160971 tn. MUH TAUFIK 
CAIRAN RL 7,149.60 2 7,864.56
45 APT010000I62004408 160971 tn. MUH TAUFIK 
MASKER DI 700.00 1 770.00
46 APT010000I62004408 160971 tn. MUH TAUFIK 
HANDSCOEN 478.00 2 525.80
47 APT010000I62004408 160971 tn. MUH TAUFIK 
IV DRESSI 4,850.00 1 5,335.00
48 APT010000I62004408 160971 tn. MUH TAUFIK 
INFUS SET 7,920.00 1 8,712.00
49 APT010000I62004425 161105 ny. RAMLAH 
CEFIXIME 4,950.00 6 5,445.00
50 APT010000I62004425 161105 ny. RAMLAH 
RANITIDIN 629.99 6 692.99
51 APT010000I62004425 161105 ny. RAMLAH 
CAIRAN RL 7,149.60 2 7,864.56
52 APT010000I62004425 161105 ny. RAMLAH 
MASKER DI 700.00 1 770.00
53 APT010000I62004425 161105 ny. RAMLAH 
HANDSCOEN 478.00 2 525.80
54 APT010000I62004425 161105 ny. RAMLAH 
IV DRESSI 4,850.00 1 5,335.00
55 APT010000I62004425 161105 ny. RAMLAH 
CONECTA 13,200.00 1 14,520.00
56 APT010000I50000024 161199 ny. RAHMAWATI 
DIMENHIDR 121.00 6 133.10
57 APT010000I50000024 161199 ny. RAHMAWATI 
RANITIDIN 629.99 6 692.99
58 APT010000I50000024 161199 ny. RAHMAWATI 
NEURODEX 770.00 3 847.00
59 APT010000I62004438 161181 ny. HERLINA 
ZINK OKSI 604.00 3 664.40
60 APT010000I62004438 161181 ny. HERLINA 
KOTRIMOKS 254.10 12 279.51
61 APT010000I62004438 161181 ny. HERLINA 
CAIRAN FU41,388.90 2 45,527.79
62 APT010000I62004438 161181 ny. HERLINA 
MASKER DI 700.00 2 770.00
63 APT010000I62004438 161181 ny. HERLINA 
HANDSCOEN 478.00 4 525.80
64 APT010000I62004438 161181 ny. HERLINA 
IV CATHETE 7,750.00 1 8,525.00
65 APT010000I62004436 161180 ny. HAPSAH 
FUROSEMID2,920.50 1 3,212.55
66 APT010000I62004436 161180 ny. HAPSAH 
AMLODIPIN 475.19 1 522.71
67 APT010000I62004436 161180 ny. HAPSAH 
MASKER DI 700.00 2 770.00
68 APT010000I62004436 161180 ny. HAPSAH 
HANDSCOEN 478.00 4 525.80
69 APT010000I62004436 161180 ny. HAPSAH 
IV CATHETE 7,750.00 1 8,525.00
70 APT010000I62004436 161180 ny. HAPSAH 
SPOIT 3 CC 1,485.00 1 1,633.50
71 APT010000I62004429 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
72 APT010000I62004429 161146 ny. NIRWANA 
SANTAGESIK4,949.40 3 5,444.34
73 APT010000I62004429 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
74 APT010000I62004429 161146 ny. NIRWANA 
INFUSAN R 9,645.50 2 10,610.05
75 APT010000I62004429 161146 ny. NIRWANA 
MASKER DI 700.00 1 770.00
76 APT010000I62004429 161146 ny. NIRWANA 
HANDSCOEN 478.00 2 525.80
77 APT010000I62004429 161146 ny. NIRWANA 
IV DRESSI 4,850.00 1 5,335.00
78 APT010000I62004429 161146 ny. NIRWANA 
HANDSCOEN 478.00 2 525.80
79 APT010000I62004439 125128 tn. ZULFIKAR
CAIRAN
KAMALUDDIN 
RL 7,149.60 2 7,864.56
80 APT010000I62004439 125128 tn. ZULFIKAR
RANITIDIN
KAMALUDDIN 
7,040.00 2 7,744.00
81 APT010000I62004439 125128 tn. ZULFIKAR
LANSOPRAZ
KAMALUDDIN 851.29 1 936.42
82 APT010000I62004439 125128 tn. ZULFIKAR
EPISAN
KAMALUDDIN 
SU 51,150.00 1 56,265.00
83 APT010000I62004439 125128 tn. ZULFIKAR
SANMOL
KAMALUDDIN 
T 297.00 9 326.70
84 APT010000I62004439 125128 tn. ZULFIKAR
METIL
KAMALUDDIN 
PRE 702.00 5 772.20
85 APT010000I62004439 125128 tn. ZULFIKAR
CANGKANG
KAMALUDDIN 116.90 9 128.59
86 APT010000I62004439 125128 tn. ZULFIKAR
MASKER
KAMALUDDIN 
DI 700.00 1 770.00
87 APT010000I62004439 125128 tn. ZULFIKAR
HANDSCOEN
KAMALUDDIN 478.00 2 525.80
88 APT010000I62004439 125128 tn. ZULFIKAR
IV DRESSI
KAMALUDDIN 
4,850.00 1 5,335.00
89 APT010000I62004439 125128 tn. ZULFIKAR
CONECTA
KAMALUDDIN 
13,200.00 1 14,520.00
 90 APT010000I62004439 125128 tn. ZULFIKAR
VALISANBE
KAMALUDDIN  236.50 5 260.15
91 APT010000I62004394 160864 tn. LUTHERCEFTRIAXO19,999.10
MARRIBA  2 21,999.01
92 APT010000I62004394 160864 tn. LUTHEROMEPRAZOL
MARRIBA 24,999.70 2 27,499.67
93 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA  I 24,202.60 3 26,622.86
94 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
95 APT010000I62004394 160864 tn. LUTHERL-CISIN
MARRIBA  2,890.80 3 3,179.88
96 APT010000I62004394 160864 tn. LUTHERNEW
MARRIBA 
DIAT 557.15 6 612.87
97 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA  DI 700.00 2 770.00
98 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 4 525.80
99 APT010000I62004394 160864 tn. LUTHERSPOIT
MARRIBA 
3 CC 1,485.00 1 1,633.50
100 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO19,999.10 2 21,999.01

101 APT010000I62004430 161153 tn. MUH NURDIN 

PARACETA 68,062.50 3 74,868.75

102 APT010000I62004430 161153 tn. MUH NURDIN 

IV CATHETE 7,750.00 1 8,525.00
103 APT010000I62004430 161153 tn. MUH NURDIN 
INFUSAN N 6,712.06 2 7,383.27
104 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 1 770.00
105 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN4,796.00 1 5,275.60
106 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 4 525.80
107 APT010000I62004432 160277 tn. SULAEMAN 
MASKER DI 700.00 2 770.00
108 APT010000I62004432 160277 tn. SULAEMAN 
HANDSCOEN 478.00 4 525.80
109 APT010000I62004432 160277 tn. SULAEMAN 
HANDSCOEN4,796.00 1 5,275.60
110 APT010000I62004432 160277 tn. SULAEMAN 
IV CATHETE 7,750.00 1 8,525.00
111 APT010000I62004437 147766 ny. SITTI NORMI 
CIPROFLOX25,080.00 2 27,588.00
112 APT010000I62004437 147766 ny. SITTI NORMI 
RANITIDIN 7,040.00 2 7,744.00
113 APT010000I62004437 147766 ny. SITTI NORMI 
DOMPERID 508.20 2 559.02
114 APT010000I62004437 147766 ny. SITTI NORMI 
LANSOPRAZ 851.29 2 936.42
115 APT010000I62004437 147766 ny. SITTI NORMI 
METFORMI 190.00 2 209.00
116 APT010000I62004437 147766 ny. SITTI NORMI 
INFUSAN N 6,712.06 3 7,383.27
117 APT010000I62004437 147766 ny. SITTI NORMI 
MASKER DI 700.00 2 770.00
118 APT010000I62004437 147766 ny. SITTI NORMI 
HANDSCOEN4,796.00 4 5,275.60
119 APT010000I62004437 147766 ny. SITTI NORMI 
IV CATHETE 7,750.00 1 8,525.00
120 APT010000I62004437 147766 ny. SITTI NORMI 
SPOIT 3 CC 1,485.00 1 1,633.50
121 APT010000I62004437 147766 ny. SITTI NORMI 
CAIRAN NA15,180.00 1 16,698.00
122 APT010000I62004417 153069 by. MUHAMMAD
MASKER ALDIYUSUF
700.00
FANDI  1 770.00
123 APT010000I62004417 153069 by. MUHAMMAD
IV CATHETE
AL YUSUF
16,720.00
FANDI  2 18,392.00
124 APT010000I62004417 153069 by. MUHAMMAD
IV CATHETE
AL YUSUF
7,750.00
FANDI  1 8,525.00
125 APT010000I62004417 153069 by. MUHAMMAD
HANDSCOEN
AL YUSUF478.00
FANDI  2 525.80
126 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 4 5,004.94
127 APT010000I62004410 160990 tn. SARIM  KETOROLAC 7,350.75 3 8,085.82
128 APT010000I62004410 160990 tn. SARIM  SANMOL T 297.00 3 326.70
129 APT010000I62004410 160990 tn. SARIM  INFUSAN N 6,712.06 2 7,383.27
130 APT010000I62004410 160990 tn. SARIM  MASKER DI 700.00 1 770.00
131 APT010000I62004410 160990 tn. SARIM  HANDSCOEN 478.00 2 525.80
132 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
133 APT010000I62004423 161069 ny. ST AISAYAH
LEVOFLOXA
TAHANG 449.00 1 493.90
134 APT010000I62004423 161069 ny. ST AISAYAH
INFUSAN
TAHANG 
N 6,712.06 3 7,383.27
135 APT010000I62004423 161069 ny. ST AISAYAH
MASKER
TAHANG 
DI 700.00 1 770.00
136 APT010000I62004423 161069 ny. ST AISAYAH
HANDSCOEN
TAHANG 
4,796.00 1 5,275.60
137 APT010000I62004423 161069 ny. ST AISAYAH
HANDSCOEN
TAHANG 478.00 4 525.80
138 APT010000I62004423 161069 ny. ST AISAYAH
IV CATHETE
TAHANG 
7,750.00 1 8,525.00
139 APT010000I65003086 161248 ny. JUMANIA 
INFUSAN N 6,712.06 1 7,383.27
140 APT010000I65003086 161248 ny. JUMANIA 
TRANSFUSI28,050.00 1 30,855.00
141 APT010000I65003086 161248 ny. JUMANIA 
NASAL CA 11,550.07 1 12,705.07
142 APT010000I65003086 161248 ny. JUMANIA 
CONECTA 25,000.00 1 27,500.00
143 APT010000I32000269 152599 nn. NURAENICEFTRIAXO19,999.10
MUS   2 21,999.01
144 APT010000I32000269 152599 nn. NURAENIOMEPRAZOL
MUS   24,999.70 2 27,499.67
145 APT010000I32000269 152599 nn. NURAENIMETIL
MUSPRE
  49,500.00 1 54,450.00
146 APT010000I32000269 152599 nn. NURAENICOMBIVENT4,549.95
MUS   2 5,004.94
147 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MELOXICAMAZIS 250.00 1 275.00
148 APT010000I62004442 72845 ny. LAILY NUZLIKHA
METIL PREAZIS 702.00 2 772.20
149 APT010000I62004442 72845 ny. LAILY NUZLIKHA
RANITIDINAZIS 
7,040.00 2 7,744.00
150 APT010000I62004442 72845 ny. LAILY NUZLIKHA
CAIRAN RLAZIS 
7,149.60 2 7,864.56
151 APT010000I62004424 161085 tn. H. BAKING 
AMITRIPTY 177.65 2 195.41
152 APT010000I62004424 161085 tn. H. BAKING 
KETOROLAC 7,350.75 2 8,085.82

153 APT010000I62004424 161085 tn. H. BAKING 

METIL PRE 49,500.00 2 54,450.00

154 APT010000I62004424 161085 tn. H. BAKING 

MECOBALAM6,600.00 1 7,260.00
155 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,040.00 2 7,744.00
156 APT010000I62004424 161085 tn. H. BAKING 
SIPENTIN 6,138.00 2 6,751.80
157 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 116.90 6 128.59
158 APT010000I62004424 161085 tn. H. BAKING 
CAIRAN RL 7,149.60 3 7,864.56
159 APT010000I62004424 161085 tn. H. BAKING 
HANDSCOEN 478.00 4 525.80
160 APT010000I62004424 161085 tn. H. BAKING 
MASKER DI 700.00 2 770.00
161 APT010000I62004428 161138 tn. SUTRISNO 
CEFTRIAXO19,999.10 2 21,999.01
162 APT010000I62004428 161138 tn. SUTRISNO 
RANITIDIN 7,040.00 2 7,744.00

163 APT010000I62004428 161138 tn. SUTRISNO 

METIL PRE 49,500.00 2 54,450.00

164 APT010000I62004428 161138 tn. SUTRISNO 

NYSTATIN 24,200.00 1 26,620.00
165 APT010000I62004428 161138 tn. SUTRISNO 
AMBROXOL 199.65 3 219.62
166 APT010000I62004428 161138 tn. SUTRISNO 
CAIRAN RL 7,149.60 4 7,864.56
167 APT010000I62004428 161138 tn. SUTRISNO 
HANDSCOEN 478.00 4 525.80
168 APT010000I62004428 161138 tn. SUTRISNO 
MASKER DI 700.00 2 770.00
169 APT010000I62004416 160951 tn. ARIFUDDIN 
CEFTRIAXO19,999.10 2 21,999.01
170 APT010000I62004416 160951 tn. ARIFUDDIN 
RANITIDIN 7,040.00 2 7,744.00
171 APT010000I62004416 160951 tn. ARIFUDDIN 
KETOROLAC 7,350.75 3 8,085.82
172 APT010000I62004416 160951 tn. ARIFUDDIN 
CAIRAN RL 7,149.60 4 7,864.56
173 APT010000I62004416 160951 tn. ARIFUDDIN 
HANDSCOEN 478.00 4 525.80
174 APT010000I62004416 160951 tn. ARIFUDDIN 
MASKER DI 700.00 2 770.00
175 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
176 APT010000I62004411 138920 tn. LACCA LALING 
INFUSAN N 6,712.06 3 7,383.27
177 APT010000I62004411 138920 tn. LACCA LALING 
CAIRAN NA15,180.00 1 16,698.00
178 APT010000I62004411 138920 tn. LACCA LALING 
HANDSCOEN 478.00 4 525.80
179 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
180 APT010000I62004411 138920 tn. LACCA LALING 
LEVOFLOXA66,000.00 1 72,600.00
181 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
182 APT010000I62004411 138920 tn. LACCA LALING 
MASKER DI 700.00 2 770.00
183 APT010000I50000013 160742 tn. TAN INGCEFTRIAXO19,999.10
KIAT  2 21,999.01
184 APT010000I50000013 160742 tn. TAN INGSANTAGESIK4,949.40
KIAT  3 5,444.34
185 APT010000I50000013 160742 tn. TAN INGRANITIDIN
KIAT  7,040.00 2 7,744.00
186 APT010000I50000013 160742 tn. TAN INGCAIRAN
KIAT  RL 7,149.60 4 7,864.56
187 APT010000I50000013 160742 tn. TAN INGHANDSCOEN
KIAT  478.00 4 525.80
188 APT010000I50000013 160742 tn. TAN INGMASKER
KIAT  DI 700.00 2 770.00
189 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 3 7,864.56
190 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL I 24,202.60 3 26,622.86
191 APT010000I62004391 160813 tn. SUHERMAN 
B COMPLEK 76.34 2 83.97
192 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
193 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR5,500.00 3 6,050.00
194 APT010000I62004391 160813 tn. SUHERMAN 
MEFINAL 5 1,391.50 2 1,530.65
195 APT010000I62004391 160813 tn. SUHERMAN 
LEVOFLOXA 449.00 1 493.90
196 APT010000I62004391 160813 tn. SUHERMAN 
HANDSCOEN 478.00 4 525.80
197 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   4 525.80

198 APT010000I62004390 160844 tn. H. ANDIPARACETA

AZAS MANAF,
68,062.50
BA   3 74,868.75

199 APT010000I62004390 160844 tn. H. ANDIKETOROLAC

AZAS MANAF,7,350.75
BA   2 8,085.82
200 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,7,332.97
BA   2 8,066.26
201 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
202 APT010000I62004390 160844 tn. H. ANDIMECOBALA
AZAS MANAF,616.00
BA   1 677.60
203 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
204 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   1 770.00
205 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   2 525.80
206 APT010000I62004390 160844 tn. H. ANDISPOIT
AZAS 5MANAF,
CC 1,595.00
BA   1 1,754.50
207 APT010000I62004390 160844 tn. H. ANDINEW
AZASDIAT
MANAF,557.15
BA   4 612.87
208 APT010000I62004397 160511 tn. SUPRIADI
EPISAN
PAISAL 
SU 51,150.00 1 56,265.00
209 APT010000I62004397 160511 tn. SUPRIADI
INFUSAN
PAISAL N 6,712.06 3 7,383.27
210 APT010000I62004397 160511 tn. SUPRIADI
CAIRAN
PAISAL 
NA15,180.00 1 16,698.00
211 APT010000I62004397 160511 tn. SUPRIADI
MASKER
PAISAL DI 700.00 2 770.00
212 APT010000I62004397 160511 tn. SUPRIADI
HANDSCOEN
PAISAL  478.00 4 525.80
213 APT010000I12000066 134815 tn. HASTANCAIRAN
BASO MAKKASAU 
RL 7,149.60 6 7,864.56
214 APT010000I12000066 134815 tn. HASTANCEFTRIAXO19,999.10
BASO MAKKASAU  1 21,999.01
215 APT010000I12000066 134815 tn. HASTANKETOROLAC
BASO MAKKASAU 
7,350.75 2 8,085.82
216 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
7,040.00 2 7,744.00
217 APT010000I12000066 134815 tn. HASTANURSODEOX
BASO MAKKASAU 
4,158.00 2 4,573.80
218 APT010000I64002914 161092 tn. HERMAN CEFTRIAXO19,999.10
YUSUF  3 21,999.01
219 APT010000I64002914 161092 tn. HERMAN RANITIDIN
YUSUF  7,040.00 2 7,744.00
220 APT010000I64002914 161092 tn. HERMAN SANMOL
YUSUF T 297.00 4 326.70
221 APT010000I64002914 161092 tn. HERMANINFUSAN
YUSUF  R 9,645.50 4 10,610.05
222 APT010000I64002914 161092 tn. HERMANMASKER
YUSUF DI 700.00 1 770.00
223 APT010000I64002914 161092 tn. HERMANHANDSCOEN
YUSUF  478.00 2 525.80
224 APT010000I64002914 161092 tn. HERMANSPOIT
YUSUF 
3 CC 1,485.00 1 1,633.50
225 APT010000I64002914 161092 tn. HERMANSPOIT
YUSUF 
10 C 2,310.00 1 2,541.00
226 APT010000I12000062 139631 tn. IBRAHIM
INFUSAN
KADIR  N 6,712.06 2 7,383.27
227 APT010000I12000062 139631 tn. IBRAHIM
COMBIVENT4,549.95
KADIR  4 5,004.94
228 APT010000I12000062 139631 tn. IBRAHIM
PULMICORT
KADIR  8,540.00 3 9,394.00
229 APT010000I12000062 139631 tn. IBRAHIM
AMLODIPIN
KADIR  838.19 1 922.01

230 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 49,500.00 2 54,450.00

231 APT010000I12000062 139631 tn. IBRAHIMMASKER

KADIR  DI 700.00 1 770.00
232 APT010000I12000062 139631 tn. IBRAHIMHANDSCOEN
KADIR  478.00 2 525.80
233 APT010000I62004440 161194 ny. NASYATI 
CAIRAN RL 7,149.60 3 7,864.56
234 APT010000I62004440 161194 ny. NASYATI 
HANDSCOEN 478.00 4 525.80
235 APT010000I62004440 161194 ny. NASYATI 
MASKER DI 700.00 2 770.00
236 APT010000I62004440 161194 ny. NASYATI 
IV CATHETE12,416.00 1 13,657.60
237 APT010000I62004440 161194 ny. NASYATI 
SPOIT 10 C 2,310.00 2 2,541.00
238 APT010000I62004440 161194 ny. NASYATI 
SPOIT 1 CC 1,920.00 2 2,112.00
239 APT010000I62004440 161194 ny. NASYATI 
CEFTRIAXO19,999.10 2 21,999.01
240 APT010000I62004440 161194 ny. NASYATI 
KETOROLAC 7,350.75 3 8,085.82
241 APT010000I62004435 161179 ny. HASNAWATY
KETOROLAC
H  7,350.75 3 8,085.82
242 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 2 7,744.00
243 APT010000I62004435 161179 ny. HASNAWATY
CAIRANH RL 7,149.60 3 7,864.56
244 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOEN
H  478.00 4 525.80
245 APT010000I62004435 161179 ny. HASNAWATY
MASKER H  DI 700.00 2 770.00
246 APT010000I62004390 160844 tn. H. ANDIALPRAZOLA
AZAS MANAF,1,915.83
BA   1 2,107.42
247 APT010000I62004430 161153 tn. MUH NURDIN 
LEVOFLOXA 449.00 1 493.90
248 APT010000I65003081 161225 tn. YUDHA COMBIVENT4,549.95
  3 5,004.94
249 APT010000I65003081 161225 tn. YUDHA NEBULIZE
  40,535.00 1 44,588.50
250 APT010000I62004444 161259 ny. RESMIATI 
INFUSAN N 6,712.06 1 7,383.27
251 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 3 847.00
252 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
253 APT010000I65003086 161248 ny. JUMANIA 
SANMOL I 24,202.60 3 26,622.86
254 APT010000I65003086 161248 ny. JUMANIA 
TRANSFUSI28,050.00 1 30,855.00
255 APT010000I62004423 161069 ny. ST AISAYAH
CAIRANTAHANG 
DE10,010.00 3 11,011.00
256 APT010000I62004423 161069 ny. ST AISAYAH
CAIRANTAHANG 
DE 7,499.80 1 8,249.78
257 APT010000I62004426 144442 nn. NURFADHILLAH
INFUSAN ARIFIN 
R 9,645.50 4 10,610.05
258 APT010000I50000013 160742 tn. TAN INGCEFIXIME
KIAT  4,950.00 2 5,445.00
259 APT010000I50000013 160742 tn. TAN INGSANMOL
KIAT  T 297.00 3 326.70
260 APT010000I50000013 160742 tn. TAN INGNEURODEX
KIAT  770.00 2 847.00
261 APT010000I64002914 161092 tn. HERMAN CAIRAN
YUSUF 
RL 7,149.60 2 7,864.56
262 APT010000I64002914 161092 tn. HERMAN SIMUCIL
YUSUF 2 1,760.00 2 1,936.00
263 APT010000I64002914 161092 tn. HERMAN DOMPERID
YUSUF  508.20 3 559.02
264 APT010000I62004434 151459 tn. MUH EQIRANITIDIN
FARDIANSYAH 
7,040.00 2 7,744.00
 265 APT010000I62004434 151459 tn. MUH EQI
KETOROLAC
FARDIANSYAH 
7,350.75 1 8,085.82
266 APT010000I64002923 161237 ny. HAMI  FEEDING T 42,800.00 1 47,080.00
267 APT010000I64002923 161237 ny. HAMI  SPOIT 50 C 10,000.09 1 11,000.10
268 APT010000I62004444 161259 ny. RESMIATI 
RANITIDIN 7,040.00 2 7,744.00
269 APT010000I62004444 161259 ny. RESMIATI 
DOMPERID 508.20 3 559.02
270 APT010000I62004445 161150 ny. WA HASNI 
CEFTRIAXO19,999.10 2 21,999.01
Sub Total   647
PCS 7,864.56

PCS 1,540.00
PCS 43,998.02
PCS 11,529.78
PCS 24,257.46
PCS 15,488.00
PCS 3,509.00
PCS 7,623.00
PCS 4,900.50
PCS 6,336.00
PCS 3,146.00
PCS 1,051.60
PCS 47,080.00
PCS 5,275.60
PCS 41,624.00
PCS 2,541.00
PCS 66,550.00
PCS 8,712.00
PCS 7,864.56
PCS 66,550.00
PCS 5,444.34
PCS 1,633.50
PCS 1,051.60
PCS 1,481.70
PCS 2,940.30
PCS 29,533.08
PCS 2,103.20
PCS 1,540.00
PCS 32,670.00
PCS 1,976.58
PCS 2,940.30
PCS 2,541.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 1,633.50
PCS 8,525.00
PCS 653.40
PCS 868.78
PCS 257.18
PCS 1,755.66
PCS 2,541.00
PCS 16,335.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 8,712.00
PCS 32,670.00
PCS 4,157.94
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 14,520.00
PCS 798.60
PCS 4,157.94
PCS 2,541.00
PCS 1,993.20
PCS 3,354.12
PCS 91,055.58
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 3,212.55
PCS 522.71
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 1,633.50
PCS 43,998.02
PCS 16,333.02
PCS 15,488.00
PCS 21,220.10
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 1,051.60
PCS 15,729.12
PCS 15,488.00
PCS 936.42
PCS 56,265.00
PCS 2,940.30
PCS 3,861.00
PCS 1,157.31
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 14,520.00
PCS 1,300.75
PCS 43,998.02
PCS 54,999.34
PCS 79,868.58
PCS 216.84
PCS 9,539.64
PCS 3,677.22
PCS 1,540.00
PCS 2,103.20
PCS 1,633.50
PCS 43,998.02
224,606.2
PCS 5
PCS 8,525.00
PCS 14,766.54
PCS 770.00
PCS 5,275.60
PCS 2,103.20
PCS 1,540.00
PCS 2,103.20
PCS 5,275.60
PCS 8,525.00
PCS 55,176.00
PCS 15,488.00
PCS 1,118.04
PCS 1,872.84
PCS 418.00
PCS 22,149.81
PCS 1,540.00
PCS 21,102.40
PCS 8,525.00
PCS 1,633.50
PCS 16,698.00
PCS 770.00
PCS 36,784.00
PCS 8,525.00
PCS 1,051.60
PCS 20,019.76
PCS 24,257.46
PCS 980.10
PCS 14,766.54
PCS 770.00
PCS 1,051.60
PCS 43,998.02
PCS 493.90
PCS 22,149.81
PCS 770.00
PCS 5,275.60
PCS 2,103.20
PCS 8,525.00
PCS 7,383.27
PCS 30,855.00
PCS 12,705.07
PCS 27,500.00
PCS 43,998.02
PCS 54,999.34
PCS 54,450.00
PCS 10,009.88
PCS 275.00
PCS 1,544.40
PCS 15,488.00
PCS 15,729.12
PCS 390.82
PCS 16,171.64
108,900.0
PCS 0
PCS 7,260.00
PCS 15,488.00
PCS 13,503.60
PCS 771.54
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 43,998.02
PCS 15,488.00
108,900.0
PCS
0
PCS 26,620.00
PCS 658.86
PCS 31,458.24
PCS 2,103.20
PCS 1,540.00
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 31,458.24
PCS 2,103.20
PCS 1,540.00
PCS 43,998.02
PCS 22,149.81
PCS 16,698.00
PCS 2,103.20
PCS 16,171.64
PCS 72,600.00
PCS 12,100.00
PCS 1,540.00
PCS 43,998.02
PCS 16,333.02
PCS 15,488.00
PCS 31,458.24
PCS 2,103.20
PCS 1,540.00
PCS 23,593.68
PCS 79,868.58
PCS 167.94
PCS 2,747.80
PCS 18,150.00
PCS 3,061.30
PCS 493.90
PCS 2,103.20
PCS 2,103.20
224,606.2
PCS
5
PCS 16,171.64
PCS 16,132.52
PCS 897.82
PCS 677.60
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 1,754.50
PCS 2,451.48
PCS 56,265.00
PCS 22,149.81
PCS 16,698.00
PCS 1,540.00
PCS 2,103.20
PCS 47,187.36
PCS 21,999.01
PCS 16,171.64
PCS 15,488.00
PCS 9,147.60
PCS 65,997.03
PCS 15,488.00
PCS 1,306.80
PCS 42,440.20
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 2,541.00
PCS 14,766.54
PCS 20,019.76
PCS 28,182.00
PCS 922.01
108,900.0
PCS
0
PCS 770.00
PCS 1,051.60
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 13,657.60
PCS 5,082.00
PCS 4,224.00
PCS 43,998.02
PCS 24,257.46
PCS 24,257.46
PCS 15,488.00
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 2,107.42
PCS 493.90
PCS 15,014.82
PCS 44,588.50
PCS 7,383.27
PCS 2,541.00
PCS 43,998.02
PCS 79,868.58
PCS 30,855.00
PCS 33,033.00
PCS 8,249.78
PCS 42,440.20
PCS 10,890.00
PCS 980.10
PCS 1,694.00
PCS 15,729.12
PCS 3,872.00
PCS 1,677.06
PCS 15,488.00
PCS 8,085.82
PCS 47,080.00
PCS 11,000.10
PCS 15,488.00
PCS 1,677.06
PCS 43,998.02
4,553,564.66
15-12-
1 APT010000I65003088 161272 tn. MUSTARI 
CAIRAN RL 7,149.60 1 7,864.56
2018 
2 APT010000I65003088 161272 tn. MUSTARI 
COMBO PAC 60,500.00 1 66,550.00
3 APT010000I65003088 161272 tn. MUSTARI 
HANDSCOEN 478.00 4 525.80
4 APT010000I65003088 161272 tn. MUSTARI 
PARACETA 220.72 4 242.79
5 APT010000I65003088 161272 tn. MUSTARI 
RANITIDIN 7,040.00 1 7,744.00
6 APT010000I65003088 161272 tn. MUSTARI 
SOTATIC I 3,032.00 1 3,335.20
7 APT010000I65003088 161272 tn. MUSTARI 
SPOIT 3 CC 1,485.00 2 1,633.50
8 APT010000I62004447 161273 tn. BACO BIN
COMBO
SENGKI 
KAT
60,500.00 1 66,550.00
9 APT010000I62004447 161273 tn. BACO BIN
CAIRAN
SENGKI 
AQ 2,860.00 1 3,146.00
10 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN RL 7,149.60 4 7,864.56
11 APT010000I62004391 160813 tn. SUHERMAN 
CAIRAN NA15,180.00 1 16,698.00
12 APT010000I62004391 160813 tn. SUHERMAN 
HANDSCOEN 478.00 2 525.80
13 APT010000I62004391 160813 tn. SUHERMAN 
MASKER DI 700.00 1 770.00
14 APT010000I62004391 160813 tn. SUHERMAN 
B COMPLEK 76.34 2 83.97
15 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 2 1,373.90
16 APT010000I62004391 160813 tn. SUHERMAN 
ONDANSETR5,500.00 2 6,050.00
17 APT010000I62004391 160813 tn. SUHERMAN 
LEVOFLOXA 449.00 1 493.90
18 APT010000I62004440 161194 ny. NASYATI 
CEFTRIAXO19,999.10 2 21,999.01
19 APT010000I62004440 161194 ny. NASYATI 
RANITIDIN 7,040.00 2 7,744.00
20 APT010000I62004440 161194 ny. NASYATI 
KETOROLAC 7,350.75 3 8,085.82
21 APT010000I62004440 161194 ny. NASYATI 
CAIRAN RL 7,149.60 3 7,864.56
22 APT010000I62004440 161194 ny. NASYATI 
HANDSCOEN 478.00 2 525.80
23 APT010000I62004440 161194 ny. NASYATI 
SPOIT 10 C 2,310.00 1 2,541.00
24 APT010000I62004440 161194 ny. NASYATI 
MASKER DI 700.00 2 770.00
25 APT010000I50000013 160742 tn. TAN INGCEFIXIME
KIAT  1,317.02 6 1,448.73
26 APT010000I50000013 160742 tn. TAN INGSANMOL
KIAT  T 297.00 9 326.70
27 APT010000I50000013 160742 tn. TAN INGNEURODEX
KIAT  770.00 6 847.00
28 APT010000I50000013 160742 tn. TAN INGCAIRAN
KIAT  RL 7,149.60 3 7,864.56
29 APT010000I50000013 160742 tn. TAN INGHANDSCOEN
KIAT  478.00 2 525.80
30 APT010000I50000013 160742 tn. TAN INGSPOIT
KIAT 10 C 2,310.00 1 2,541.00
31 APT010000I50000013 160742 tn. TAN INGSPOIT
KIAT 3 CC 1,485.00 1 1,633.50
32 APT010000I50000013 160742 tn. TAN INGIVKIAT 
CATHETE 7,750.00 1 8,525.00
33 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
34 APT010000I62004411 138920 tn. LACCA LALING 
LEVOFLOXA 449.00 1 493.90
35 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
36 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 3 6,050.00
37 APT010000I62004411 138920 tn. LACCA LALING 
INFUSAN N 6,712.06 3 7,383.27
38 APT010000I62004411 138920 tn. LACCA LALING 
IV CATHETE 7,750.00 2 8,525.00
39 APT010000I62004411 138920 tn. LACCA LALING 
HANDSCOEN 478.00 2 525.80
40 APT010000I62004411 138920 tn. LACCA LALING 
SPOIT 5 CC 1,595.00 2 1,754.50
41 APT010000I62004411 138920 tn. LACCA LALING 
CAIRAN NA15,180.00 3 16,698.00
42 APT010000I64002923 161237 ny. HAMI  CEFTRIAXO19,999.10 2 21,999.01
43 APT010000I64002923 161237 ny. HAMI  CAIRAN DE18,920.00 2 20,812.00
44 APT010000I64002923 161237 ny. HAMI  MASKER DI 700.00 2 770.00
45 APT010000I64002923 161237 ny. HAMI  TRANSFUSI28,050.00 1 30,855.00
46 APT010000I64002914 161092 tn. HERMANLEVOFLOXA
YUSUF  449.00 3 493.90
47 APT010000I64002914 161092 tn. HERMANSANMOL
YUSUF T 297.00 9 326.70

48 APT010000I62004424 161085 tn. H. BAKING 

METIL PRE 49,500.00 2 54,450.00

49 APT010000I62004424 161085 tn. H. BAKING 

MECOBALAM6,600.00 1 7,260.00
50 APT010000I62004424 161085 tn. H. BAKING 
KETOROLAC 7,350.75 2 8,085.82
51 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,040.00 2 7,744.00
52 APT010000I62004424 161085 tn. H. BAKING 
CAIRAN RL 7,149.60 3 7,864.56
53 APT010000I62004424 161085 tn. H. BAKING 
CAIRAN NA15,180.00 2 16,698.00
54 APT010000I62004424 161085 tn. H. BAKING 
HANDSCOEN 478.00 6 525.80
55 APT010000I62004426 144442 nn. NURFADHILLAH
ASERING ARIFIN 
I 9,645.90 4 10,610.49
56 APT010000I62004426 144442 nn. NURFADHILLAH
VOLUVENARIFIN 
621,780.00 1 23,958.00
57 APT010000I62004426 144442 nn. NURFADHILLAH
LEVOFLOXAARIFIN 
449.00 1 493.90
58 APT010000I62004426 144442 nn. NURFADHILLAH
KSR 600 MARIFIN 
1,755.00 1 1,930.50
59 APT010000I62004426 144442 nn. NURFADHILLAH
IV CATHETE
ARIFIN 
7,750.00 1 8,525.00
60 APT010000I62004426 144442 nn. NURFADHILLAH
SPOIT 3 CC
ARIFIN 
1,485.00 1 1,633.50
61 APT010000I62004426 144442 nn. NURFADHILLAH
MASKER DIARIFIN 
700.00 1 770.00
62 APT010000I62004426 144442 nn. NURFADHILLAH
HANDSCOENARIFIN 
478.00 2 525.80
63 APT010000I12000062 139631 tn. IBRAHIMINFUSAN
KADIR  N 6,712.06 1 7,383.27
64 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  3 5,004.94
65 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00

66 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 49,500.00 2 54,450.00

67 APT010000I12000062 139631 tn. IBRAHIM

AMLODIPIN
KADIR  838.19 1 922.01
68 APT010000I12000062 139631 tn. IBRAHIM
MASKER
KADIR  DI 700.00 1 770.00
69 APT010000I12000062 139631 tn. IBRAHIM
HANDSCOEN
KADIR  478.00 2 525.80
70 APT010000I12000062 139631 tn. IBRAHIM
SPOIT
KADIR 
3 CC 1,485.00 1 1,633.50
71 APT010000I62004428 161138 tn. SUTRISNO 
CAIRAN RL 7,149.60 2 7,864.56
72 APT010000I62004428 161138 tn. SUTRISNO 
CEFTRIAXO19,999.10 2 21,999.01
73 APT010000I62004428 161138 tn. SUTRISNO 
RANITIDIN 7,040.00 2 7,744.00
74 APT010000I62004428 161138 tn. SUTRISNO 
METIL PRE 49,500.00 1 54,450.00
75 APT010000I62004428 161138 tn. SUTRISNO 
AMBROXOL 199.65 3 219.62
76 APT010000I12000066 134815 tn. HASTANCEFTRIAXO19,999.10
BASO MAKKASAU  2 21,999.01
77 APT010000I12000066 134815 tn. HASTANKETOROLAC
BASO MAKKASAU 
7,350.75 2 8,085.82
78 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
7,040.00 2 7,744.00
79 APT010000I12000066 134815 tn. HASTANURSODEOX
BASO MAKKASAU 
4,158.00 2 4,573.80
80 APT010000I12000066 134815 tn. HASTANCAIRAN
BASO MAKKASAU 
RL 7,149.60 3 7,864.56
81 APT010000I12000066 134815 tn. HASTANMASKER
BASO MAKKASAU 
DI 700.00 3 770.00
82 APT010000I12000066 134815 tn. HASTANIVBASO
CATHETE
MAKKASAU 
7,750.00 2 8,525.00
83 APT010000I12000066 134815 tn. HASTANSPOIT
BASO10
MAKKASAU 
C 2,310.00 2 2,541.00
84 APT010000I12000066 134815 tn. HASTANSPOIT
BASO3MAKKASAU 
CC 1,485.00 2 1,633.50
85 APT010000I12000066 134815 tn. HASTANHANDSCOEN
BASO MAKKASAU 
478.00 2 525.80
86 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 3 847.00
87 APT010000I62004433 161174 tn. LALA  SAGESTAM12,870.00 1 14,157.00
 88 APT010000I62004433 161174 tn. LALA  INFUSAN N 6,712.06 3 7,383.27
89 APT010000I62004433 161174 tn. LALA  MASKER DI 700.00 3 770.00
90 APT010000I62004433 161174 tn. LALA  HANDSCOEN 478.00 6 525.80
91 APT010000I62004433 161174 tn. LALA  IV CATHETE 7,750.00 2 8,525.00
92 APT010000I62004433 161174 tn. LALA  SPOIT 5 CC 1,595.00 2 1,754.50
93 APT010000I62004433 161174 tn. LALA  SPOIT 3 CC 1,485.00 2 1,633.50
94 APT010000I62004435 161179 ny. HASNAWATY
KETOROLAC
H  7,350.75 3 8,085.82
95 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 3 7,744.00
96 APT010000I62004435 161179 ny. HASNAWATY
CAIRANH RL 7,149.60 3 7,864.56
97 APT010000I62004435 161179 ny. HASNAWATY
MASKER H  DI 700.00 2 770.00
98 APT010000I62004435 161179 ny. HASNAWATY
IV CATHETE
H  7,750.00 2 8,525.00
99 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOEN
H  478.00 2 525.80
100 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOON
H  13,613.00 1 14,974.30
101 APT010000I62004397 160511 tn. SUPRIADI
CONECTA
PAISAL  25,000.00 2 27,500.00
102 APT010000I62004397 160511 tn. SUPRIADI
IV CATHETE
PAISAL  7,750.00 2 8,525.00
103 APT010000I62004397 160511 tn. SUPRIADI
MASKER
PAISAL DI 700.00 2 770.00
104 APT010000I62004397 160511 tn. SUPRIADI
SPOIT
PAISAL 
5 CC 1,595.00 2 1,754.50
105 APT010000I62004397 160511 tn. SUPRIADI
SPOIT
PAISAL 
3 CC 1,485.00 2 1,633.50
106 APT010000I62004397 160511 tn. SUPRIADI
INFUS
PAISAL 
SET 7,920.00 1 8,712.00
107 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,7,350.75
BA   2 8,085.82
108 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,7,332.97
BA   2 8,066.26
109 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
110 APT010000I62004390 160844 tn. H. ANDIMECOBALA
AZAS MANAF,462.00
BA   1 508.20
111 APT010000I62004390 160844 tn. H. ANDINEW
AZASDIAT
MANAF,557.15
BA   4 612.87
112 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
113 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   2 525.80
114 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   1 770.00
115 APT010000I65003086 161248 ny. JUMANIA 
SANMOL I 24,202.60 3 26,622.86
116 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
117 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
118 APT010000I65003086 161248 ny. JUMANIA 
OMEPRAZO 704.37 2 774.80
119 APT010000I65003086 161248 ny. JUMANIA 
INFUSAN N 6,712.06 3 7,383.27
120 APT010000I65003086 161248 ny. JUMANIA 
MASKER DI 700.00 1 770.00
121 APT010000I65003086 161248 ny. JUMANIA 
HANDSCOEN 478.00 6 525.80
122 APT010000I62004430 161153 tn. MUH NURDIN 
SANMOL I 24,202.60 3 26,622.86
123 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO19,999.10 2 21,999.01
124 APT010000I62004430 161153 tn. MUH NURDIN 
LEVOFLOXA66,000.00 1 72,600.00
125 APT010000I62004430 161153 tn. MUH NURDIN 
INFUSAN N 6,712.06 3 7,383.27
126 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 2 525.80
127 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 1 770.00
128 APT010000I62004430 161153 tn. MUH NURDIN 
INFUS SET 7,920.00 1 8,712.00
129 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
130 APT010000I62004423 161069 ny. ST AISAYAH
LEVOFLOXA
TAHANG 449.00 1 493.90

131 APT010000I62004423 161069 ny. ST AISAYAH

METRONIDA
TAHANG 
56,718.20 3 62,390.02
132 APT010000I62004423 161069 ny. ST AISAYAH
INFUSAN
TAHANG 
N 6,712.06 3 7,383.27
133 APT010000I62004423 161069 ny. ST AISAYAH
MASKER
TAHANG 
DI 700.00 1 770.00
134 APT010000I62004423 161069 ny. ST AISAYAH
TRANSFUSI28,050.00
TAHANG  1 30,855.00
135 APT010000I62004423 161069 ny. ST AISAYAH
INFUSTAHANG 
SET 7,920.00 2 8,712.00
136 APT010000I62004442 72845 ny. LAILY NUZLIKHA
METIL PREAZIS 702.00 2 772.20
137 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MELOXICAMAZIS 250.00 1 275.00
138 APT010000I62004442 72845 ny. LAILY NUZLIKHA
RANITIDINAZIS 
7,040.00 2 7,744.00
139 APT010000I62004442 72845 ny. LAILY NUZLIKHA
CAIRAN RLAZIS 
7,149.60 2 7,864.56
140 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MASKER DIAZIS 700.00 1 770.00
141 APT010000I62004442 72845 ny. LAILY NUZLIKHA
HANDSCOENAZIS 478.00 2 525.80
142 APT010000I62004442 72845 ny. LAILY NUZLIKHA
SPOIT 5 CC
AZIS 
1,595.00 1 1,754.50
143 APT010000I62004442 72845 ny. LAILY NUZLIKHA
IV DRESSIAZIS 
4,850.00 1 5,335.00
144 APT010000I62004394 160864 tn. LUTHERCEFTRIAXO19,999.10
MARRIBA  2 21,999.01
145 APT010000I62004394 160864 tn. LUTHEROMEPRAZOL
MARRIBA 24,999.70 2 27,499.67
146 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA I 24,202.60 3 26,622.86
147 APT010000I62004394 160864 tn. LUTHERNEW
MARRIBA 
DIAT 557.15 6 612.87
148 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
149 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
150 APT010000I62004394 160864 tn. LUTHERCAIRAN
MARRIBA 
RL 7,149.60 2 7,864.56
151 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA DI 700.00 1 770.00
152 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 2 525.80
153 APT010000I62004394 160864 tn. LUTHERINFUS
MARRIBA 
SET 7,920.00 1 8,712.00
154 APT010000I62004394 160864 tn. LUTHERCAIRAN
MARRIBA 
NA15,180.00 1 16,698.00
155 APT010000I62004394 160864 tn. LUTHERSPOIT
MARRIBA 
10 C 2,310.00 1 2,541.00
156 APT010000I62004410 160990 tn. SARIM  COMBIVENT4,549.95 4 5,004.94
157 APT010000I62004410 160990 tn. SARIM  KETOROLAC 7,350.75 3 8,085.82
158 APT010000I62004410 160990 tn. SARIM  SIMUCIL 2 1,760.00 3 1,936.00
159 APT010000I62004410 160990 tn. SARIM  INFUSAN N 6,712.06 2 7,383.27
160 APT010000I62004410 160990 tn. SARIM  MASKER DI 700.00 1 770.00
161 APT010000I62004410 160990 tn. SARIM  HANDSCOEN 478.00 2 525.80
162 APT010000I62004410 160990 tn. SARIM  INFUS SET 7,920.00 1 8,712.00
163 APT010000I62004437 147766 ny. SITTI NORMI 
RANITIDIN 7,040.00 2 7,744.00
164 APT010000I62004437 147766 ny. SITTI NORMI 
DOMPERID 508.20 2 559.02
165 APT010000I62004437 147766 ny. SITTI NORMI 
METFORMI 190.00 2 209.00
166 APT010000I62004437 147766 ny. SITTI NORMI 
LANSOPRAZ 851.29 1 936.42
167 APT010000I62004437 147766 ny. SITTI NORMI 
HANDSCOEN 478.00 2 525.80
168 APT010000I62004437 147766 ny. SITTI NORMI 
MASKER DI 700.00 1 770.00
169 APT010000I62004437 147766 ny. SITTI NORMI 
INFUS SET 7,920.00 1 8,712.00
170 APT010000I62004437 147766 ny. SITTI NORMI 
SPOIT 3 CC 1,485.00 1 1,633.50
171 APT010000I62004436 161180 ny. HAPSAH FUROSEMID2,920.50 6 3,212.55
172 APT010000I62004436 161180 ny. HAPSAH SANMOL I 24,202.60 2 26,622.86
173 APT010000I62004436 161180 ny. HAPSAH AMLODIPIN 838.19 1 922.01
174 APT010000I62004436 161180 ny. HAPSAH CONECTA 25,000.00 1 27,500.00
175 APT010000I62004436 161180 ny. HAPSAH INFUSAN N 6,712.06 2 7,383.27
176 APT010000I62004436 161180 ny. HAPSAH CAIRAN NA15,180.00 1 16,698.00
177 APT010000I62004436 161180 ny. HAPSAH 
SPOIT 3 CC 1,485.00 1 1,633.50
178 APT010000I32000269 152599 nn. NURAENI
CEFTRIAXO19,999.10
MUS   2 21,999.01

179 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  49,500.00 2 54,450.00

180 APT010000I32000269 152599 nn. NURAENI

CAIRAN
MUS RL
  7,149.60 3 7,864.56
181 APT010000I32000269 152599 nn. NURAENI
CAIRAN
MUS NA15,180.00
  1 16,698.00
182 APT010000I62004429 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
183 APT010000I62004429 161146 ny. NIRWANA 
SANTAGESIK4,949.40 3 5,444.34
184 APT010000I62004429 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
185 APT010000I62004429 161146 ny. NIRWANA 
ASERING I 9,645.90 2 10,610.49
186 APT010000I62004429 161146 ny. NIRWANA 
MASKER DI 700.00 1 770.00
187 APT010000I62004429 161146 ny. NIRWANA 
HANDSCOEN 478.00 2 525.80
188 APT010000I62004429 161146 ny. NIRWANA 
CONECTA 13,200.00 1 14,520.00
189 APT010000I62004444 161259 ny. RESMIATI 
RANITIDIN 7,040.00 2 7,744.00
190 APT010000I62004444 161259 ny. RESMIATI 
DOMPERID 508.20 3 559.02
191 APT010000I62004444 161259 ny. RESMIATI 
CAIRAN RL 7,149.60 2 7,864.56
192 APT010000I62004444 161259 ny. RESMIATI 
MASKER DI 700.00 1 770.00
193 APT010000I62004444 161259 ny. RESMIATI 
HANDSCOEN 478.00 2 525.80
194 APT010000I62004444 161259 ny. RESMIATI 
INFUS SET 7,920.00 1 8,712.00
195 APT010000I65003081 161225 tn. YUDHA COMBIVENT4,549.95
  3 5,004.94
196 APT010000I65003081 161225 tn. YUDHA SIMUCIL
  2 1,760.00 3 1,936.00
197 APT010000I65003081 161225 tn. YUDHA INFUSAN
  N 6,712.06 2 7,383.27
198 APT010000I65003081 161225 tn. YUDHA HANDSCOEN
  478.00 2 525.80
199 APT010000I65003081 161225 tn. YUDHA MASKER
  DI 700.00 2 770.00
200 APT010000I65003081 161225 tn. YUDHA INFUS
  SET 7,920.00 1 8,712.00
201 APT010000I62004439 125128 tn. ZULFIKAR
RANITIDIN
KAMALUDDIN 
7,040.00 2 7,744.00
202 APT010000I62004439 125128 tn. ZULFIKAR
LANSOPRAZ
KAMALUDDIN 851.29 1 936.42
203 APT010000I62004439 125128 tn. ZULFIKAR
CAIRAN
KAMALUDDIN 
RL 7,149.60 2 7,864.56
204 APT010000I62004439 125128 tn. ZULFIKAR
MASKER
KAMALUDDIN 
DI 700.00 1 770.00
205 APT010000I62004439 125128 tn. ZULFIKAR
HANDSCOEN
KAMALUDDIN 478.00 2 525.80
206 APT010000I62004439 125128 tn. ZULFIKAR
CONECTA
KAMALUDDIN 
13,200.00 1 14,520.00
207 APT010000I65003087 161267 tn. ISKANDAR 
INFUSAN N 6,712.06 2 7,383.27
208 APT010000I65003087 161267 tn. ISKANDAR 
VOLUVEN 621,780.00 1 23,958.00
209 APT010000I65003087 161267 tn. ISKANDAR 
SANMOL I 24,202.60 2 26,622.86
210 APT010000I65003087 161267 tn. ISKANDAR 
SOTATIC I 3,032.00 2 3,335.20
211 APT010000I65003087 161267 tn. ISKANDAR 
METIL PRE 49,500.00 1 54,450.00
212 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOEN 478.00 2 525.80
213 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 1 770.00
214 APT010000I65003087 161267 tn. ISKANDAR 
CONECTA 13,200.00 1 14,520.00
215 APT010000I65003087 161267 tn. ISKANDAR 
INFUS SET 7,920.00 1 8,712.00
216 APT010000I62004417 153069 by. MUHAMMAD
IV CATHETE
AL YUSUF
16,720.00
FANDI  1 18,392.00
217 APT010000I62004417 153069 by. MUHAMMAD
HANDSCOEN
AL YUSUF478.00
FANDI  2 525.80
218 APT010000I62004417 153069 by. MUHAMMAD
HANDSCOON
AL YUSUF
12,100.00
FANDI  1 13,310.00
219 APT010000I62004417 153069 by. MUHAMMAD
MASKERALDIYUSUF
700.00
FANDI  1 770.00
220 APT010000I62004417 153069 by. MUHAMMAD
KOTRIMOKS2,439.00
AL YUSUF FANDI  1 2,682.90
221 APT010000I62004447 161273 tn. BACO BIN
NEW
SENGKI 
DIAT 557.15 6 612.87
222 APT010000I62004448 110642 ny. ST NORMA
NEWDGDIAT
BAU  557.15 6 612.87
223 APT010000I62004448 110642 ny. ST NORMA
KOTRIMOKS
DG BAU  254.10 8 279.51
224 APT010000I62004448 110642 ny. ST NORMA
SANMOL
DG BAU 
T 297.00 3 326.70
225 APT010000I62004448 110642 ny. ST NORMA
RANITIDIN
DG BAU 7,040.00 2 7,744.00
226 APT010000I62004416 160951 tn. ARIFUDDIN 
CEFIXIME 4,950.00 6 5,445.00
227 APT010000I62004416 160951 tn. ARIFUDDIN 
SANMOL T 297.00 9 326.70
228 APT010000I62004390 160844 tn. H. ANDIALPRAZOLA
AZAS MANAF,
1,915.83
BA   1 2,107.42

229 APT010000I64002923 161237 ny. HAMI  VASCON IN99,000.00 2 108,900.0

0
230 APT010000I64002923 161237 ny. HAMI  SPOIT 50 12,367.00 1 13,603.70
231 APT010000I62004448 110642 ny. ST NORMA
MELOXICAM
DG BAU  250.00 2 275.00
232 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MELOXICAMAZIS 250.00 1 275.00
233 APT010000I62004442 72845 ny. LAILY NUZLIKHA
OMEPRAZO AZIS 704.37 2 774.80
234 APT010000I62004442 72845 ny. LAILY NUZLIKHA
EPISAN SUAZIS 
51,150.00 1 56,265.00
235 APT010000I65003081 161225 tn. YUDHA CEFTAZIDIM
  23,166.00 3 25,482.60
236 APT010000I65003081 161225 tn. YUDHA PULMICORT
  8,540.00 3 9,394.00
237 APT010000I62004433 161174 tn. LALA  ONDANSETR5,500.00 2 6,050.00
238 APT010000I62004433 161174 tn. LALA  RANITIDIN 7,040.00 2 7,744.00
239 APT010000I62004433 161174 tn. LALA  DOMPERID 508.20 6 559.02
240 APT010000I62004433 161174 tn. LALA  URSODEOX 4,158.00 6 4,573.80
241 APT010000I62004429 161146 ny. NIRWANA 
CEFIXIME 4,950.00 6 5,445.00
242 APT010000I62004429 161146 ny. NIRWANA 
RANITIDIN 629.99 6 692.99
243 APT010000I62004429 161146 ny. NIRWANA 
URSODEOX 4,158.00 6 4,573.80
244 APT010000I62004429 161146 ny. NIRWANA 
RHODIUM 6,050.00 9 6,655.00
245 APT010000I62004428 161138 tn. SUTRISNO 
CEFIXIME 4,950.00 6 5,445.00
246 APT010000I62004428 161138 tn. SUTRISNO 
RANITIDIN 629.99 6 692.99
247 APT010000I62004428 161138 tn. SUTRISNO 
METIL PRE 475.79 5 523.37
248 APT010000I62004428 161138 tn. SUTRISNO 
AMBROXOL 199.65 6 219.62
249 APT010000I62004391 160813 tn. SUHERMAN 
CTM TAB 1,249.00 4 1,373.90
250 APT010000I62004391 160813 tn. SUHERMAN 
NOVA B C 150.01 4 165.01
251 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 9 326.70
252 APT010000I62004391 160813 tn. SUHERMAN 
LEVOFLOXA 449.00 2 493.90
253 APT010000I62004391 160813 tn. SUHERMAN 
SANMOL T 297.00 9 326.70
254 APT010000I62004437 147766 ny. SITTI NORMI 
NEFROSTER49,599.00 1 54,558.90
255 APT010000I62004437 147766 ny. SITTI NORMI 
GLIMEPIRI 1,257.80 2 1,383.57
256 APT010000I65003089 161295 nn. SURAYACOMBO
  PAC
60,500.00 1 66,550.00
257 APT010000I65003089 161295 nn. SURAYAHANDSCOEN
  478.00 4 525.80
258 APT010000I62004445 161150 ny. WA HASNI 
CEFTRIAXO19,999.10 2 21,999.01
259 APT010000I62004445 161150 ny. WA HASNI 
KETOROLAC 7,350.75 3 8,085.82
260 APT010000I62004445 161150 ny. WA HASNI 
RANITIDIN 7,040.00 3 7,744.00
261 APT010000I64002922 161222 ny. CINNONG 
RANITIDIN 7,040.00 2 7,744.00
262 APT010000I64002922 161222 ny. CINNONG 
KETOROLAC 7,350.75 2 8,085.82
263 APT010000I64002922 161222 ny. CINNONG 
CEFTRIAXO19,999.10 2 21,999.01
264 APT010000I65003087 161267 tn. ISKANDAR 
VOLUVEN 621,780.00 2 23,958.00
 265 APT010000I62004449 161279 ny. JUMARIA 
CAIRAN NAC6,409.70 2 7,050.67
266 APT010000I62004449 161279 ny. JUMARIA 
SANMOL T 297.00 3 326.70
267 APT010000I62004449 161279 ny. JUMARIA 
SIMUCIL 2 1,760.00 3 1,936.00
268 APT010000I62004449 161279 ny. JUMARIA 
RANITIDIN 7,040.00 2 7,744.00
269 APT010000I65003089 161295 nn. SURAYALANSOPRAZ
  851.29 1 936.42
270 APT010000I65003089 161295 nn. SURAYADOMPERID
  508.20 2 559.02
271 APT010000I65003089 161295 nn. SURAYANASAL
  CA 11,550.07 1 12,705.07

272 APT010000I64002917 160918 ny. HJ. MARWIAH 

FENTANYL 041,599.80 5 45,759.78

273 APT010000I64002917 160918 ny. HJ. MARWIAH 

METAMIZOL4,999.99 2 5,499.99
274 APT010000I64002917 160918 ny. HJ. MARWIAH 
SPOIT 50 12,367.00 1 13,603.70
275 APT010000I64002917 160918 ny. HJ. MARWIAH 
PERFUSSOR21,000.00 1 23,100.00
276 APT010000I64002917 160918 ny. HJ. MARWIAH 
SPOIT 3 CC 1,485.00 2 1,633.50
277 APT010000I64002917 160918 ny. HJ. MARWIAH 
SPOIT 10 C 2,310.00 1 2,541.00
278 APT010000I64002917 160918 ny. HJ. MARWIAH 
CEFTRIAXO19,999.10 2 21,999.01
279 APT010000I64002917 160918 ny. HJ. MARWIAH 
KETOROLAC 7,350.75 2 8,085.82
280 APT010000I64002929 161294 ny. HASNAH 
CAIRAN NAC6,409.70 1 7,050.67
281 APT010000I64002929 161294 ny. HASNAH 
CEFTRIAXO19,999.10 2 21,999.01

282 APT010000I64002929 161294 ny. HASNAH 

METIL PRE 49,500.00 2 54,450.00

283 APT010000I62004456 150708 ny. HJ. ZAENAB

RANITIDIN
  7,040.00 1 7,744.00
284 APT010000I62004456 150708 ny. HJ. ZAENAB
KETOROLAC
  7,350.75 1 8,085.82
285 APT010000I62004456 150708 ny. HJ. ZAENAB
SPOIT  3 CC 1,485.00 2 1,633.50
286 APT010000I62004456 150708 ny. HJ. ZAENAB
CAIRAN
  RL 7,149.60 1 7,864.56
287 APT010000I62004456 150708 ny. HJ. ZAENAB
COMBO  PAC 60,500.00 1 66,550.00
288 APT010000I62004448 110642 ny. ST NORMA
CAIRAN
DG BAU 
RL 7,149.60 2 7,864.56
289 APT010000I62004448 110642 ny. ST NORMA
COMBO
DG BAU 
PAC
60,500.00 1 66,550.00
290 APT010000I62004448 110642 ny. ST NORMA
HANDSCOEN
DG BAU  478.00 2 525.80
291 APT010000I62004448 110642 ny. ST NORMA
ONDANSETR5,500.00
DG BAU  1 6,050.00
292 APT010000I62004448 110642 ny. ST NORMA
SPOIT
DG3 BAU 
CC 1,485.00 1 1,633.50
293 APT010000I62004448 110642 ny. ST NORMA
NEWDG DIAT
BAU  557.15 4 612.87
294 APT010000I62004448 110642 ny. ST NORMA
SANMOL
DG BAU 
T 297.00 3 326.70
295 APT010000I65003087 161267 tn. ISKANDAR 
NASAL CA 11,550.07 1 12,705.07
296 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN NAC6,409.70 1 7,050.67
297 APT010000I65003087 161267 tn. ISKANDAR 
IV CATHETE 7,750.00 1 8,525.00
298 APT010000I65003087 161267 tn. ISKANDAR 
KAPAS AL 300.00 2 330.00
299 APT010000I65003087 161267 tn. ISKANDAR 
IV DRESSI 4,850.00 1 5,335.00
Sub Total   688

Total 3602
PCS 7,864.56

PCS 66,550.00
PCS 2,103.20
PCS 971.16
PCS 7,744.00
PCS 3,335.20
PCS 3,267.00
PCS 66,550.00
PCS 3,146.00
PCS 31,458.24
PCS 16,698.00
PCS 1,051.60
PCS 770.00
PCS 167.94
PCS 2,747.80
PCS 12,100.00
PCS 493.90
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 23,593.68
PCS 1,051.60
PCS 2,541.00
PCS 1,540.00
PCS 8,692.38
PCS 2,940.30
PCS 5,082.00
PCS 23,593.68
PCS 1,051.60
PCS 2,541.00
PCS 1,633.50
PCS 8,525.00
PCS 43,998.02
PCS 493.90
PCS 16,171.64
PCS 18,150.00
PCS 22,149.81
PCS 17,050.00
PCS 1,051.60
PCS 3,509.00
PCS 50,094.00
PCS 43,998.02
PCS 41,624.00
PCS 1,540.00
PCS 30,855.00
PCS 1,481.70
PCS 2,940.30

PCS 108,900.0
0
PCS 7,260.00
PCS 16,171.64
PCS 15,488.00
PCS 23,593.68
PCS 33,396.00
PCS 3,154.80
PCS 42,441.96
PCS 23,958.00
PCS 493.90
PCS 1,930.50
PCS 8,525.00
PCS 1,633.50
PCS 770.00
PCS 1,051.60
PCS 7,383.27
PCS 15,014.82
PCS 28,182.00
108,900.0
PCS
0
PCS 922.01
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 15,729.12
PCS 43,998.02
PCS 15,488.00
PCS 54,450.00
PCS 658.86
PCS 43,998.02
PCS 16,171.64
PCS 15,488.00
PCS 9,147.60
PCS 23,593.68
PCS 2,310.00
PCS 17,050.00
PCS 5,082.00
PCS 3,267.00
PCS 1,051.60
PCS 2,541.00
PCS 14,157.00
PCS 22,149.81
PCS 2,310.00
PCS 3,154.80
PCS 17,050.00
PCS 3,509.00
PCS 3,267.00
PCS 24,257.46
PCS 23,232.00
PCS 23,593.68
PCS 1,540.00
PCS 17,050.00
PCS 1,051.60
PCS 14,974.30
PCS 55,000.00
PCS 17,050.00
PCS 1,540.00
PCS 3,509.00
PCS 3,267.00
PCS 8,712.00
PCS 16,171.64
PCS 16,132.52
PCS 897.82
PCS 508.20
PCS 2,451.48
PCS 23,593.68
PCS 1,051.60
PCS 770.00
PCS 79,868.58
PCS 18,150.00
PCS 43,998.02
PCS 1,549.60
PCS 22,149.81
PCS 770.00
PCS 3,154.80
PCS 79,868.58
PCS 43,998.02
PCS 72,600.00
PCS 22,149.81
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 43,998.02
PCS 493.90
187,170.0
PCS
6
PCS 22,149.81
PCS 770.00
PCS 30,855.00
PCS 17,424.00
PCS 1,544.40
PCS 275.00
PCS 15,488.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 1,754.50
PCS 5,335.00
PCS 43,998.02
PCS 54,999.34
PCS 79,868.58
PCS 3,677.22
PCS 216.84
PCS 16,335.00
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 16,698.00
PCS 2,541.00
PCS 20,019.76
PCS 24,257.46
PCS 5,808.00
PCS 14,766.54
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 15,488.00
PCS 1,118.04
PCS 418.00
PCS 936.42
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 1,633.50
PCS 19,275.30
PCS 53,245.72
PCS 922.01
PCS 27,500.00
PCS 14,766.54
PCS 16,698.00
PCS 1,633.50
PCS 43,998.02

PCS 108,900.0
0
PCS 23,593.68
PCS 16,698.00
PCS 43,998.02
PCS 16,333.02
PCS 15,488.00
PCS 21,220.98
PCS 770.00
PCS 1,051.60
PCS 14,520.00
PCS 15,488.00
PCS 1,677.06
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 15,014.82
PCS 5,808.00
PCS 14,766.54
PCS 1,051.60
PCS 1,540.00
PCS 8,712.00
PCS 15,488.00
PCS 936.42
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 14,520.00
PCS 14,766.54
PCS 23,958.00
PCS 53,245.72
PCS 6,670.40
PCS 54,450.00
PCS 1,051.60
PCS 770.00
PCS 14,520.00
PCS 8,712.00
PCS 18,392.00
PCS 1,051.60
PCS 13,310.00
PCS 770.00
PCS 2,682.90
PCS 3,677.22
PCS 3,677.22
PCS 2,236.08
PCS 980.10
PCS 15,488.00
PCS 32,670.00
PCS 2,940.30
PCS 2,107.42

PCS 217,800.0
0
PCS 13,603.70
PCS 550.00
PCS 275.00
PCS 1,549.60
PCS 56,265.00
PCS 76,447.80
PCS 28,182.00
PCS 12,100.00
PCS 15,488.00
PCS 3,354.12
PCS 27,442.80
PCS 32,670.00
PCS 4,157.94
PCS 27,442.80
PCS 59,895.00
PCS 32,670.00
PCS 4,157.94
PCS 2,616.85
PCS 1,317.72
PCS 5,495.60
PCS 660.04
PCS 2,940.30
PCS 987.80
PCS 2,940.30
PCS 54,558.90
PCS 2,767.14
PCS 66,550.00
PCS 2,103.20
PCS 43,998.02
PCS 24,257.46
PCS 23,232.00
PCS 15,488.00
PCS 16,171.64
PCS 43,998.02
PCS 47,916.00
PCS 14,101.34
PCS 980.10
PCS 5,808.00
PCS 15,488.00
PCS 936.42
PCS 1,118.04
PCS 12,705.07

PCS 228,798.9
0
PCS 10,999.98
PCS 13,603.70
PCS 23,100.00
PCS 3,267.00
PCS 2,541.00
PCS 43,998.02
PCS 16,171.64
PCS 7,050.67
PCS 43,998.02
108,900.0
PCS
0
PCS 7,744.00
PCS 8,085.82
PCS 3,267.00
PCS 7,864.56
PCS 66,550.00
PCS 15,729.12
PCS 66,550.00
PCS 1,051.60
PCS 6,050.00
PCS 1,633.50
PCS 2,451.48
PCS 980.10
PCS 12,705.07
PCS 7,050.67
PCS 8,525.00
PCS 660.00
PCS 5,335.00
5,432,370.47
 22,542,2
20.90
16-12-
1 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
CAIRAN RL 7,149.60 1 7,864.56
2018 
2 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
SANMOL I 24,202.60 3 26,622.86
3 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
NEURODEX 770.00 1 847.00
4 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
DOMPERID 508.20 2 559.02
5 APT010000I62004452 11679 ny. I KANENNENG 
CAIRAN NAC6,409.70 1 7,050.67
6 APT010000I62004452 11679 ny. I KANENNENG 
CEFTRIAXO19,999.10 1 21,999.01
7 APT010000I62004452 11679 ny. I KANENNENG 
SANMOL T 297.00 3 326.70
8 APT010000I62004452 11679 ny. I KANENNENG 
SIMUCIL 2 1,760.00 3 1,936.00
9 APT010000I64002917 160918 ny. HJ. MARWIAH 
SANTAGESIK4,949.40 2 5,444.34
10 APT010000I64002917 160918 ny. HJ. MARWIAH 
SPOIT 3 CC 1,485.00 1 1,633.50
11 APT010000I64002917 160918 ny. HJ. MARWIAH 
SPOIT 10 C 2,310.00 1 2,541.00
12 APT010000I64002917 160918 ny. HJ. MARWIAH 
AQUADEST12,000.00 2 13,200.00

13 APT010000I64002917 160918 ny. HJ. MARWIAH 

FENTANYL 041,599.80 5 45,759.78

14 APT010000I62004453 161309 ny. SURIATIINFUSAN

DG. SUNGGU
N 6,712.06
  22 7,383.27

15 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10

DG. SUNGGU   2 21,999.01
16 APT010000I62004453 161309 ny. SURIATILANTUS
DG. SUNGGU
SO83,950.02
  1 92,345.02
17 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
18 APT010000I62004453 161309 ny. SURIATINOVO
DG. SUNGGU
TWIS 2,083.00
  1 2,291.30
19 APT010000I32000269 152599 nn. NURAENI
CEFTRIAXO19,999.10
MUS   2 21,999.01

20 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  49,500.00 2 54,450.00

21 APT010000I32000269 152599 nn. NURAENIOMEPRAZOL

MUS   24,999.70 2 27,499.67
22 APT010000I32000269 152599 nn. NURAENICAIRAN
MUS NA15,180.00
  2 16,698.00
23 APT010000I32000269 152599 nn. NURAENICONECTA
MUS   13,200.00 1 14,520.00
24 APT010000I32000269 152599 nn. NURAENIHANDSCOEN
MUS   478.00 2 525.80
25 APT010000I65003081 161225 tn. YUDHA COMBIVENT4,549.95
  2 5,004.94
26 APT010000I65003081 161225 tn. YUDHA CEFTAZIDIM
  23,166.00 3 25,482.60
27 APT010000I65003081 161225 tn. YUDHA AMBROXOL
  199.65 3 219.62
28 APT010000I65003081 161225 tn. YUDHA SIMUCIL
  2 1,760.00 3 1,936.00
29 APT010000I65003081 161225 tn. YUDHA MASKER
  DI 700.00 2 770.00
30 APT010000I65003081 161225 tn. YUDHA INFUSAN
  N 6,712.06 2 7,383.27
31 APT010000I65003081 161225 tn. YUDHA TRANSFUSI28,050.00
  1 30,855.00
32 APT010000I65003081 161225 tn. YUDHA HANDSCOEN
  478.00 2 525.80
33 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
DE10,010.00 2 11,011.00
34 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
DE18,920.00 3 20,812.00
35 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
36 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
NA15,180.00 2 16,698.00
37 APT010000I62004423 161069 ny. ST AISAYAH
MASKER
TAHANG 
DI 700.00 1 770.00
38 APT010000I62004423 161069 ny. ST AISAYAH
HANDSCOEN
TAHANG 478.00 2 525.80
39 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO19,999.10 2 21,999.01
40 APT010000I62004430 161153 tn. MUH NURDIN 
LEVOFLOXA 449.00 1 493.90
41 APT010000I62004430 161153 tn. MUH NURDIN 
INFUSAN N 6,712.06 2 7,383.27
42 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 1 770.00
43 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 2 525.80
44 APT010000I62004430 161153 tn. MUH NURDIN 
IV CATHETE 7,750.00 2 8,525.00
45 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
46 APT010000I65003086 161248 ny. JUMANIA 
SANMOL I 24,202.60 2 26,622.86
47 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
48 APT010000I65003086 161248 ny. JUMANIA 
OMEPRAZO 704.37 2 774.80
49 APT010000I65003086 161248 ny. JUMANIA 
INFUSAN N 6,712.06 2 7,383.27
50 APT010000I65003086 161248 ny. JUMANIA 
SPOIT 5 CC 1,595.00 1 1,754.50
51 APT010000I65003086 161248 ny. JUMANIA 
CONECTA 13,200.00 1 14,520.00
52 APT010000I65003086 161248 ny. JUMANIA 
INFUS SET 7,920.00 1 8,712.00
53 APT010000I62004394 160864 tn. LUTHERCEFTRIAXO19,999.10
MARRIBA  2 21,999.01
54 APT010000I62004394 160864 tn. LUTHEROMEPRAZOL
MARRIBA 24,999.70 2 27,499.67
55 APT010000I62004394 160864 tn. LUTHERSANMOL
MARRIBA I 24,202.60 3 26,622.86
56 APT010000I62004394 160864 tn. LUTHERNEW
MARRIBA 
DIAT 557.15 6 612.87
57 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
58 APT010000I62004436 161180 ny. HAPSAH FUROSEMID2,920.50 6 3,212.55
59 APT010000I62004436 161180 ny. HAPSAH AMLODIPIN 475.19 1 522.71
60 APT010000I62004436 161180 ny. HAPSAH SANMOL I 24,202.60 3 26,622.86
61 APT010000I62004436 161180 ny. HAPSAH HANDSCOEN 478.00 2 525.80
62 APT010000I62004436 161180 ny. HAPSAH MASKER DI 700.00 2 770.00
63 APT010000I62004439 125128 tn. ZULFIKAR
LANSOPRAZ
KAMALUDDIN 851.29 1 936.42
64 APT010000I62004439 125128 tn. ZULFIKAR
RANITIDIN
KAMALUDDIN 
7,040.00 2 7,744.00
65 APT010000I62004439 125128 tn. ZULFIKAR
CAIRAN
KAMALUDDIN 
RL 7,149.60 2 7,864.56
66 APT010000I62004439 125128 tn. ZULFIKAR
MASKER
KAMALUDDIN 
DI 700.00 2 770.00
67 APT010000I62004439 125128 tn. ZULFIKAR
IV DRESSI
KAMALUDDIN 
4,850.00 2 5,335.00
68 APT010000I62004439 125128 tn. ZULFIKAR
BUSCOPAN
KAMALUDDIN 
4,327.40 9 4,760.14
69 APT010000I62004439 125128 tn. ZULFIKAR
DOMPERID
KAMALUDDIN 508.20 9 559.02
70 APT010000I62004439 125128 tn. ZULFIKAR
CANGKANG
KAMALUDDIN  75.00 9 82.50
71 APT010000I62004439 125128 tn. ZULFIKAR
ALPRAZOLA
KAMALUDDIN 
1,915.83 5 2,107.42
72 APT010000I64002922 161222 ny. CINNONG 
RANITIDIN 7,040.00 2 7,744.00
73 APT010000I64002922 161222 ny. CINNONG 
KETOROLAC 7,350.75 3 8,085.82
74 APT010000I64002922 161222 ny. CINNONG 
CEFTRIAXO19,999.10 2 21,999.01
75 APT010000I64002922 161222 ny. CINNONG 
HANDSCOEN 478.00 2 525.80
76 APT010000I64002922 161222 ny. CINNONG 
MASKER DI 700.00 2 770.00
77 APT010000I62004437 147766 ny. SITTI NORMI 
NEFROSTER49,599.00 1 54,558.90
78 APT010000I62004437 147766 ny. SITTI NORMI 
RANITIDIN 7,040.00 2 7,744.00
79 APT010000I62004437 147766 ny. SITTI NORMI 
LANSOPRAZ 851.29 1 936.42
80 APT010000I62004437 147766 ny. SITTI NORMI 
GLIMEPIRI 1,257.80 1 1,383.57
81 APT010000I62004437 147766 ny. SITTI NORMI 
SANMOL T 297.00 3 326.70
82 APT010000I62004437 147766 ny. SITTI NORMI 
CAIRAN RL 7,149.60 2 7,864.56
83 APT010000I62004437 147766 ny. SITTI NORMI 
SPOIT 5 CC 1,595.00 1 1,754.50

84 APT010000I65003087 161267 tn. ISKANDAR 

CAIRAN GE88,300.30 2 97,130.33

85 APT010000I65003087 161267 tn. ISKANDAR 

SANMOL I 24,202.60 1 26,622.86
 86 APT010000I65003087 161267 tn. ISKANDAR 
SOTATIC I 3,032.00 1 3,335.20
87 APT010000I65003087 161267 tn. ISKANDAR 
METIL PRE 49,500.00 1 54,450.00
88 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN RL 7,149.60 2 7,864.56
89 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 2 770.00
90 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOON 12,100.00 1 13,310.00
91 APT010000I65003087 161267 tn. ISKANDAR 
SPOIT 3 CC 1,485.00 2 1,633.50
92 APT010000I62004444 161259 ny. RESMIATI 
DOMPERID 508.20 9 559.02
93 APT010000I62004444 161259 ny. RESMIATI 
METFORMI 190.00 6 209.00
94 APT010000I62004444 161259 ny. RESMIATI 
INFUSAN N 6,712.06 3 7,383.27
95 APT010000I62004444 161259 ny. RESMIATI 
MASKER DI 700.00 2 770.00
96 APT010000I62004444 161259 ny. RESMIATI 
HANDSCOEN 478.00 4 525.80
97 APT010000I62004444 161259 ny. RESMIATI 
SPOIT 3 CC 1,485.00 2 1,633.50
98 APT010000I62004444 161259 ny. RESMIATI 
SPOIT 10 C 2,310.00 1 2,541.00
99 APT010000I64002929 161294 ny. HASNAH 
CEFTAZIDIM23,166.00 2 25,482.60

100 APT010000I64002929 161294 ny. HASNAH 

METIL PRE 49,500.00 2 54,450.00

101 APT010000I64002929 161294 ny. HASNAH INFUSAN N 6,712.06 2 7,383.27

102 APT010000I64002929 161294 ny. HASNAH HANDSCOEN 478.00 2 525.80
103 APT010000I64002929 161294 ny. HASNAH MASKER DI 700.00 1 770.00
104 APT010000I64002929 161294 ny. HASNAH TRANSFUSI28,050.00 1 30,855.00
105 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MELOXICAMAZIS 250.00 2 275.00
106 APT010000I62004442 72845 ny. LAILY NUZLIKHA
METIL PREAZIS 702.00 2 772.20
107 APT010000I62004442 72845 ny. LAILY NUZLIKHA
OMEPRAZO AZIS 704.37 2 774.80
108 APT010000I62004442 72845 ny. LAILY NUZLIKHA
CAIRAN RLAZIS 
7,149.60 3 7,864.56
109 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MASKER DIAZIS 700.00 2 770.00
110 APT010000I62004442 72845 ny. LAILY NUZLIKHA
HANDSCOENAZIS 478.00 6 525.80
111 APT010000I62004442 72845 ny. LAILY NUZLIKHA
SPOIT 3 CC
AZIS 
1,485.00 1 1,633.50
112 APT010000I62004448 110642 ny. ST NORMA
NEWDGDIAT
BAU  557.15 6 612.87
113 APT010000I62004448 110642 ny. ST NORMA
KOTRIMOKS
DG BAU  254.10 4 279.51
114 APT010000I62004448 110642 ny. ST NORMA
RANITIDIN
DG BAU 7,040.00 2 7,744.00
115 APT010000I62004448 110642 ny. ST NORMA
SANMOL
DG BAU 
T 297.00 3 326.70
116 APT010000I62004448 110642 ny. ST NORMA
CAIRAN
DG BAU 
RL 7,149.60 2 7,864.56
117 APT010000I62004448 110642 ny. ST NORMA
SPOIT
DG5 BAU 
CC 1,595.00 1 1,754.50
118 APT010000I62004448 110642 ny. ST NORMA
INFUS
DGSET
BAU 7,920.00 1 8,712.00
119 APT010000I62004445 161150 ny. WA HASNI 
CEFTRIAXO19,999.10 2 21,999.01
120 APT010000I62004445 161150 ny. WA HASNI 
RANITIDIN 7,040.00 2 7,744.00
121 APT010000I62004445 161150 ny. WA HASNI 
KETOROLAC 7,350.75 3 8,085.82
122 APT010000I62004445 161150 ny. WA HASNI 
CAIRAN RL 7,149.60 3 7,864.56
123 APT010000I62004445 161150 ny. WA HASNI 
MASKER DI 700.00 2 770.00
124 APT010000I62004445 161150 ny. WA HASNI 
HANDSCOEN 478.00 4 525.80
125 APT010000I62004445 161150 ny. WA HASNI 
IV CATHETE12,416.00 1 13,657.60
126 APT010000I62004455 161316 ny. MARIAH SANMOL I 24,202.60 3 26,622.86
127 APT010000I62004455 161316 ny. MARIAH OMEPRAZOL 24,999.70 1 27,499.67
128 APT010000I62004455 161316 ny. MARIAH CEFTRIAXO19,999.10 2 21,999.01
129 APT010000I62004455 161316 ny. MARIAH CAIRAN RL 7,149.60 3 7,864.56
130 APT010000I62004455 161316 ny. MARIAH MASKER DI 700.00 3 770.00
131 APT010000I62004455 161316 ny. MARIAH HANDSCOON 13,613.00 3 14,974.30
132 APT010000I65003089 161295 nn. SURAYALANSOPRAZ
  851.29 2 936.42
133 APT010000I65003089 161295 nn. SURAYADOMPERID
  508.20 3 559.02
134 APT010000I65003089 161295 nn. SURAYAMASKER
  DI 700.00 2 770.00
135 APT010000I65003089 161295 nn. SURAYAHANDSCOEN
  478.00 6 525.80
136 APT010000I65003089 161295 nn. SURAYACAIRAN
  RL 7,149.60 3 7,864.56
137 APT010000I62004440 161194 ny. NASYATI 
CAIRAN RL 7,149.60 3 7,864.56
138 APT010000I62004440 161194 ny. NASYATI 
CEFTRIAXO19,999.10 2 21,999.01
139 APT010000I62004440 161194 ny. NASYATI 
RANITIDIN 7,040.00 2 7,744.00
140 APT010000I62004440 161194 ny. NASYATI 
KETOROLAC 7,350.75 2 8,085.82
141 APT010000I12000062 139631 tn. IBRAHIMINFUSAN
KADIR  N 6,712.06 3 7,383.27
142 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  3 5,004.94
143 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
144 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 1 922.01
145 APT010000I12000062 139631 tn. IBRAHIMMETIL
KADIR 
PRE 49,500.00 1 54,450.00
146 APT010000I62004435 161179 ny. HASNAWATY
KETOROLAC
H  7,350.75 3 8,085.82
147 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 3 7,744.00
148 APT010000I62004435 161179 ny. HASNAWATY
CAIRANH RL 7,149.60 3 7,864.56
149 APT010000I62004435 161179 ny. HASNAWATY
CEFTRIAXO19,999.10
H  3 21,999.01
150 APT010000I62004426 144442 nn. NURFADHILLAH
ASERING ARIFIN 
I 9,645.90 3 10,610.49
151 APT010000I62004426 144442 nn. NURFADHILLAH
LEVOFLOXA ARIFIN 
449.00 2 493.90
152 APT010000I62004426 144442 nn. NURFADHILLAH
KSR 600 M ARIFIN 
1,755.00 1 1,930.50
153 APT010000I62004426 144442 nn. NURFADHILLAH
CAIRAN GE88,300.30
ARIFIN  1 97,130.33
154 APT010000I62004390 160844 tn. H. ANDIGABAPENTI
AZAS MANAF, 4,400.00
BA   2 4,840.00
155 APT010000I62004390 160844 tn. H. ANDINEW
AZASDIAT
MANAF,557.15
BA   3 612.87
156 APT010000I62004390 160844 tn. H. ANDIMECOBALAM
AZAS MANAF, 6,600.00
BA   1 7,260.00
157 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF, 7,350.75
BA   2 8,085.82
158 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,27,505.00
BA   1 30,255.50
159 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
160 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
161 APT010000I62004390 160844 tn. H. ANDISANMOL
AZAS MANAF,
I 24,202.60
BA   3 26,622.86
162 APT010000I62004390 160844 tn. H. ANDIALPRAZOL
AZAS MANAF, 1,023.66
BA   1 1,126.03
163 APT010000I12000066 134815 tn. HASTANCAIRAN
BASO MAKKASAU 
RL 7,149.60 3 7,864.56
164 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 3 8,085.82
165 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
166 APT010000I62004411 138920 tn. LACCA LALING 
LEVOFLOXA 449.00 3 493.90
167 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
168 APT010000I62004411 138920 tn. LACCA LALING 
INFUSAN N 6,712.06 3 7,383.27
169 APT010000I62004411 138920 tn. LACCA LALING 
MASKER DI 700.00 3 770.00
170 APT010000I62004411 138920 tn. LACCA LALING 
HANDSCOEN 478.00 6 525.80
171 APT010000I62004411 138920 tn. LACCA LALING 
CONECTA 13,200.00 2 14,520.00
172 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
SANMOL I 24,202.60 3 26,622.86
173 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
NEUROSANB5,324.00 1 5,856.40
174 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
DOMPERID 508.20 3 559.02
175 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
CAIRAN RL 7,149.60 3 7,864.56
176 APT010000I62004449 161279 ny. JUMARIA 
RANITIDIN 7,040.00 2 7,744.00
177 APT010000I62004449 161279 ny. JUMARIA 
DOMPERID 508.20 3 559.02
178 APT010000I62004449 161279 ny. JUMARIA 
KETOROLAC 7,350.75 2 8,085.82
179 APT010000I62004449 161279 ny. JUMARIA 
SIMUCIL 2 1,760.00 3 1,936.00
180 APT010000I62004449 161279 ny. JUMARIA 
SANMOL T 297.00 3 326.70
181 APT010000I65003088 161272 tn. MUSTARI 
SANTAGESIK4,949.40 3 5,444.34
182 APT010000I65003088 161272 tn. MUSTARI 
CAIRAN RL 7,149.60 3 7,864.56
183 APT010000I65003088 161272 tn. MUSTARI 
RANITIDIN 7,040.00 2 7,744.00
184 APT010000I65003088 161272 tn. MUSTARI 
ONDANSETR5,500.00 3 6,050.00

185 APT010000I65003088 161272 tn. MUSTARI 

N-ACE INJ 38,500.00 3 42,350.00

186 APT010000I62004452 11679 ny. I KANENNENG 

CEFTRIAXO19,999.10 2 21,999.01
187 APT010000I62004452 11679 ny. I KANENNENG 
SANMOL T 297.00 3 326.70
188 APT010000I62004452 11679 ny. I KANENNENG 
SIMUCIL 2 1,760.00 3 1,936.00
189 APT010000I62004452 11679 ny. I KANENNENG 
INFUSAN N 6,712.06 3 7,383.27
190 APT010000I62004452 11679 ny. I KANENNENG 
MASKER DI 700.00 2 770.00
191 APT010000I62004452 11679 ny. I KANENNENG 
IV CATHETE 7,750.00 1 8,525.00
192 APT010000I62004452 11679 ny. I KANENNENG 
HANDSCOEN 478.00 2 525.80
193 APT010000I62004424 161085 tn. H. BAKING 
CAIRAN RL 7,149.60 3 7,864.56
194 APT010000I62004424 161085 tn. H. BAKING 
MECOBALAM6,600.00 1 7,260.00
195 APT010000I62004424 161085 tn. H. BAKING 
KETOROLAC 7,350.75 2 8,085.82
196 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,040.00 2 7,744.00
197 APT010000I62004424 161085 tn. H. BAKING 
METIL PRE 49,500.00 1 54,450.00
198 APT010000I62004424 161085 tn. H. BAKING 
MASKER DI 700.00 2 770.00
199 APT010000I62004424 161085 tn. H. BAKING 
HANDSCOEN 478.00 6 525.80
200 APT010000I62004424 161085 tn. H. BAKING 
SPOIT 10 C 2,310.00 1 2,541.00
201 APT010000I62004456 150708 ny. HJ. ZAENAB
INFUSAN
  N 6,712.06 1 7,383.27
202 APT010000I62004456 150708 ny. HJ. ZAENAB
KETOROLAC
  7,350.75 2 8,085.82
203 APT010000I62004456 150708 ny. HJ. ZAENAB
RANITIDIN
  7,040.00 3 7,744.00
204 APT010000I62004456 150708 ny. HJ. ZAENAB
CEFTRIAXO19,999.10
  2 21,999.01
205 APT010000I12000066 134815 tn. HASTANCEFIXIME
BASO MAKKASAU 
4,950.00 6 5,445.00
206 APT010000I12000066 134815 tn. HASTANSANMOL
BASO MAKKASAU 
T 297.00 9 326.70
207 APT010000I12000066 134815 tn. HASTANRANITIDIN
BASO MAKKASAU 
629.99 6 692.99
208 APT010000I64002917 160918 ny. HJ. MARWIAH 
SANTAGESIK4,949.40 2 5,444.34
209 APT010000I64002917 160918 ny. HJ. MARWIAH 
CEFTRIAXO19,999.10 1 21,999.01
210 APT010000I64002917 160918 ny. HJ. MARWIAH 
CAIRAN RL 7,149.60 2 7,864.56
211 APT010000I64002917 160918 ny. HJ. MARWIAH 
HANDSCOEN 478.00 20 525.80
212 APT010000I64002917 160918 ny. HJ. MARWIAH 
CAIRAN AQ 2,860.00 1 3,146.00
213 APT010000I64002917 160918 ny. HJ. MARWIAH 
IV CATHETE 7,750.00 2 8,525.00
214 APT010000I62004460 118212 tn. COLLENG 
PUMPITOR 62,693.82 1 68,963.20
215 APT010000I62004460 118212 tn. COLLENG 
METAMIZOL4,999.99 3 5,499.99
216 APT010000I62004458 140766 ny. BANONG FARGOXIN 30,800.00 1 30,800.00
217 APT010000I62004458 140766 ny. BANONG ACETYLCYS 1,100.00 3 1,210.00
218 APT010000I64002933 159225 tn. ADAM  CEFTRIAXO19,999.10 2 21,999.01
 219 APT010000I64002933 159225 tn. ADAM  IV CATHETE12,416.00 1 13,657.60
220 APT010000I64002933 159225 tn. ADAM  CONECTA 13,200.00 1 14,520.00
221 APT010000I64002933 159225 tn. ADAM  INFUS SET 7,920.00 1 8,712.00
222 APT010000I64002933 159225 tn. ADAM  HANDSCOEN 478.00 2 525.80
223 APT010000I64002933 159225 tn. ADAM  MASKER DI 700.00 1 770.00
224 APT010000I64002933 159225 tn. ADAM  SPOIT 10 C 2,310.00 1 2,541.00
225 APT010000I64002933 159225 tn. ADAM  SPOIT 1 CC 1,920.00 1 2,112.00
226 APT010000I62004462 109792 tn. MALLANG 
CAIRAN NAC6,409.70 2 7,050.67

227 APT010000I62004462 109792 tn. MALLANG 

OMEPRAZOL
24,999.70 8 27,499.67

228 APT010000I62004462 109792 tn. MALLANG 

CAIRAN NA15,180.00 2 16,698.00
229 APT010000I62004455 161316 ny. MARIAH 
SANMOL T 297.00 1 326.70
230 APT010000I62004455 161316 ny. MARIAH 
SIMUCIL 2 1,760.00 3 1,936.00
231 APT010000I62004459 161318 tn. MOCH IQBAL
CEFTRIAXO19,999.10
IBRAHIM  2 21,999.01

232 APT010000I62004459 161318 tn. MOCH IQBAL

METRONIDA
IBRAHIM 
56,718.20 2 62,390.02

233 APT010000I62004459 161318 tn. MOCH IQBAL

SANTAGESIK4,949.40
IBRAHIM  1 5,444.34
234 APT010000I62004459 161318 tn. MOCH IQBAL
RANITIDIN
IBRAHIM 
7,040.00 3 7,744.00
235 APT010000I62004458 140766 ny. BANONG 
OMEPRAZOL 24,999.70 2 27,499.67
236 APT010000I62004458 140766 ny. BANONG 
SPOIT 10 C 2,310.00 1 2,541.00
237 APT010000I62004458 140766 ny. BANONG 
DIGOKSIN 107.12 1 117.83
238 APT010000I62004458 140766 ny. BANONG 
CAIRAN RL 7,149.60 1 7,864.56
239 APT010000I62004458 140766 ny. BANONG 
INFUS SET 7,920.00 1 8,712.00
240 APT010000I62004458 140766 ny. BANONG 
COMBO PAC 60,500.00 1 66,550.00
241 APT010000I62004458 140766 ny. BANONG 
NEUROSANB5,324.00 1 5,856.40
242 APT010000I62004458 140766 ny. BANONG 
RANITIDIN 7,040.00 1 7,744.00
243 APT010000I62004458 140766 ny. BANONG 
SPOIT 3 CC 1,485.00 2 1,633.50
244 APT010000I62004459 161318 tn. MOCH IQBAL
CAIRANIBRAHIM 
RL 7,149.60 2 7,864.56
245 APT010000I62004459 161318 tn. MOCH IQBAL
HANDSCOEN
IBRAHIM 
478.00 4 525.80
246 APT010000I62004459 161318 tn. MOCH IQBAL
CONECTA
IBRAHIM 
13,200.00 1 14,520.00
247 APT010000I62004459 161318 tn. MOCH IQBAL
COMBO IBRAHIM 
PAC
60,500.00 1 66,550.00
Sub Total   619
PCS 7,864.56

PCS 79,868.58
PCS 847.00
PCS 1,118.04
PCS 7,050.67
PCS 21,999.01
PCS 980.10
PCS 5,808.00
PCS 10,888.68
PCS 1,633.50
PCS 2,541.00
PCS 26,400.00
228,798.9
PCS
0
162,431.9
PCS
4
PCS 43,998.02
PCS 92,345.02
PCS 980.10
PCS 2,291.30
PCS 43,998.02
108,900.0
PCS
0
PCS 54,999.34
PCS 33,396.00
PCS 14,520.00
PCS 1,051.60
PCS 10,009.88
PCS 76,447.80
PCS 658.86
PCS 5,808.00
PCS 1,540.00
PCS 14,766.54
PCS 30,855.00
PCS 1,051.60
PCS 22,022.00
PCS 62,436.00
PCS 43,998.02
PCS 33,396.00
PCS 770.00
PCS 1,051.60
PCS 43,998.02
PCS 493.90
PCS 14,766.54
PCS 770.00
PCS 1,051.60
PCS 17,050.00
PCS 18,150.00
PCS 53,245.72
PCS 43,998.02
PCS 1,549.60
PCS 14,766.54
PCS 1,754.50
PCS 14,520.00
PCS 8,712.00
PCS 43,998.02
PCS 54,999.34
PCS 79,868.58
PCS 3,677.22
PCS 16,335.00
PCS 19,275.30
PCS 522.71
PCS 79,868.58
PCS 1,051.60
PCS 1,540.00
PCS 936.42
PCS 15,488.00
PCS 15,729.12
PCS 1,540.00
PCS 10,670.00
PCS 42,841.26
PCS 5,031.18
PCS 742.50
PCS 10,537.10
PCS 15,488.00
PCS 24,257.46
PCS 43,998.02
PCS 1,051.60
PCS 1,540.00
PCS 54,558.90
PCS 15,488.00
PCS 936.42
PCS 1,383.57
PCS 980.10
PCS 15,729.12
PCS 1,754.50
194,260.6
PCS
6
PCS 26,622.86
PCS 3,335.20
PCS 54,450.00
PCS 15,729.12
PCS 1,540.00
PCS 13,310.00
PCS 3,267.00
PCS 5,031.18
PCS 1,254.00
PCS 22,149.81
PCS 1,540.00
PCS 2,103.20
PCS 3,267.00
PCS 2,541.00
PCS 50,965.20
108,900.0
PCS 0
PCS 14,766.54
PCS 1,051.60
PCS 770.00
PCS 30,855.00
PCS 550.00
PCS 1,544.40
PCS 1,549.60
PCS 23,593.68
PCS 1,540.00
PCS 3,154.80
PCS 1,633.50
PCS 3,677.22
PCS 1,118.04
PCS 15,488.00
PCS 980.10
PCS 15,729.12
PCS 1,754.50
PCS 8,712.00
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 13,657.60
PCS 79,868.58
PCS 27,499.67
PCS 43,998.02
PCS 23,593.68
PCS 2,310.00
PCS 44,922.90
PCS 1,872.84
PCS 1,677.06
PCS 1,540.00
PCS 3,154.80
PCS 23,593.68
PCS 23,593.68
PCS 43,998.02
PCS 15,488.00
PCS 16,171.64
PCS 22,149.81
PCS 15,014.82
PCS 28,182.00
PCS 922.01
PCS 54,450.00
PCS 24,257.46
PCS 23,232.00
PCS 23,593.68
PCS 65,997.03
PCS 31,831.47
PCS 987.80
PCS 1,930.50
PCS 97,130.33
PCS 9,680.00
PCS 1,838.61
PCS 7,260.00
PCS 16,171.64
PCS 30,255.50
PCS 897.82
PCS 23,593.68
PCS 79,868.58
PCS 1,126.03
PCS 23,593.68
PCS 24,257.46
PCS 12,100.00
PCS 1,481.70
PCS 43,998.02
PCS 22,149.81
PCS 2,310.00
PCS 3,154.80
PCS 29,040.00
PCS 79,868.58
PCS 5,856.40
PCS 1,677.06
PCS 23,593.68
PCS 15,488.00
PCS 1,677.06
PCS 16,171.64
PCS 5,808.00
PCS 980.10
PCS 16,333.02
PCS 23,593.68
PCS 15,488.00
PCS 18,150.00
127,050.0
PCS
0
PCS 43,998.02
PCS 980.10
PCS 5,808.00
PCS 22,149.81
PCS 1,540.00
PCS 8,525.00
PCS 1,051.60
PCS 23,593.68
PCS 7,260.00
PCS 16,171.64
PCS 15,488.00
PCS 54,450.00
PCS 1,540.00
PCS 3,154.80
PCS 2,541.00
PCS 7,383.27
PCS 16,171.64
PCS 23,232.00
PCS 43,998.02
PCS 32,670.00
PCS 2,940.30
PCS 4,157.94
PCS 10,888.68
PCS 21,999.01
PCS 15,729.12
PCS 10,516.00
PCS 3,146.00
PCS 17,050.00
PCS 68,963.20
PCS 16,499.97
PCS 30,800.00
PCS 3,630.00
PCS 43,998.02
PCS 13,657.60
PCS 14,520.00
PCS 8,712.00
PCS 1,051.60
PCS 770.00
PCS 2,541.00
PCS 2,112.00
PCS 14,101.34

PCS 219,997.3
6
PCS 33,396.00
PCS 326.70
PCS 5,808.00
PCS 43,998.02
124,780.0
PCS 4
PCS 5,444.34
PCS 23,232.00
PCS 54,999.34
PCS 2,541.00
PCS 117.83
PCS 7,864.56
PCS 8,712.00
PCS 66,550.00
PCS 5,856.40
PCS 7,744.00
PCS 3,267.00
PCS 15,729.12
PCS 2,103.20
PCS 14,520.00
PCS 66,550.00
5,620,038.33
17-12-
1 APT010000I62004445 161150 ny. WA HASNI 
CIPROFLOX 770.00 2 847.00
2018 
2 APT010000I62004445 161150 ny. WA HASNI 
RANITIDIN 629.99 3 692.99
3 APT010000I62004445 161150 ny. WA HASNI 
ASAM MEF 325.00 3 357.50
4 APT010000I64002933 159225 tn. ADAM  SPOIT 1 CC 1,920.00 1 2,112.00
5 APT010000I64002933 159225 tn. ADAM  CEFTRIAXO19,999.10 1 21,999.01
6 APT010000I65003089 161295 nn. SURAYA-   0 0 0
7 APT010000I65003089 161295 nn. SURAYAN-ACE
  KAP 2,200.00 3 2,420.00
8 APT010000I65003089 161295 nn. SURAYASANMOL
  T 297.00 3 326.70
9 APT010000I12000071 150670 ny. DESTY MELYANI 
COMBO PAC 60,500.00 1 66,550.00
10 APT010000I12000071 150670 ny. DESTY MELYANI 
CAIRAN RL 7,149.60 1 7,864.56
11 APT010000I12000071 150670 ny. DESTY MELYANI 
HANDSCOEN 478.00 2 525.80
12 APT010000I12000071 150670 ny. DESTY MELYANI 
IV CATHETE16,720.00 2 18,392.00
13 APT010000I65003089 161295 nn. SURAYASPOIT
  50 12,367.00 3 13,603.70
14 APT010000I65003089 161295 nn. SURAYASPOIT
  20 C 5,600.00 1 6,160.00
15 APT010000I65003089 161295 nn. SURAYASPOIT
  10 C 2,310.00 1 2,541.00
16 APT010000I65003089 161295 nn. SURAYASPOIT
  5 CC 1,595.00 1 1,754.50
17 APT010000I65003089 161295 nn. SURAYAFOLEY
  CAT 19,140.00 2 21,054.00
18 APT010000I65003089 161295 nn. SURAYACONECTA
  25,000.00 1 27,500.00
19 APT010000I65003089 161295 nn. SURAYAHANDSCOEN
  4,796.00 1 5,275.60
20 APT010000I65003089 161295 nn. SURAYALIDOCAINE
  1,287.00 3 1,415.70
21 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 2 847.00
22 APT010000I62004433 161174 tn. LALA  ACETYLCYS 1,100.00 3 1,210.00
23 APT010000I62004433 161174 tn. LALA  CEFTRIAXO19,999.10 1 21,999.01
24 APT010000I62004433 161174 tn. LALA  DEKSAMETA1,801.80 3 1,981.98
25 APT010000I62004433 161174 tn. LALA  URSODEOX 4,158.00 2 4,573.80
26 APT010000I62004433 161174 tn. LALA  RANITIDIN 7,040.00 2 7,744.00
27 APT010000I62004433 161174 tn. LALA  DOMPERID 508.20 2 559.02
28 APT010000I62004433 161174 tn. LALA  MASKER DI 700.00 1 770.00
29 APT010000I62004433 161174 tn. LALA  HANDSCOEN 478.00 2 525.80
30 APT010000I62004433 161174 tn. LALA  SPOIT 10 C 2,310.00 1 2,541.00

31 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 49,500.00 2 54,450.00

32 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN

KADIR  838.19 1 922.01
33 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
34 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  3 5,004.94
35 APT010000I12000062 139631 tn. IBRAHIMMASKER
KADIR  DI 700.00 1 770.00
36 APT010000I12000062 139631 tn. IBRAHIMHANDSCOEN
KADIR  478.00 4 525.80
37 APT010000I12000062 139631 tn. IBRAHIMSPOIT
KADIR 
3 CC 1,485.00 1 1,633.50
38 APT010000I12000062 139631 tn. IBRAHIMCAIRAN
KADIR NAC6,409.70 1 7,050.67
39 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 2 21,999.01
40 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
41 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
42 APT010000I62004456 150708 ny. HJ. ZAENAB
SANMOL
  T 297.00 3 326.70
43 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
CAIRAN RL 7,149.60 4 7,864.56
44 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
PARACETA 68,062.50 3 74,868.75

45 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 

DOMPERID 508.20 2 559.02
46 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
METAMIZOL4,999.99 2 5,499.99
47 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
RANITIDIN 7,040.00 2 7,744.00
48 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
MASKER DI 700.00 3 770.00
49 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
CONECTA 13,200.00 2 14,520.00
50 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
HANDSCOEN 478.00 6 525.80
51 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
CAIRAN NA15,180.00 1 16,698.00
52 APT010000I62004449 161279 ny. JUMARIA 
CAIRAN NAC6,409.70 3 7,050.67
53 APT010000I62004449 161279 ny. JUMARIA 
SANMOL T 297.00 3 326.70
54 APT010000I62004449 161279 ny. JUMARIA 
ACETYLCYS 1,100.00 3 1,210.00
55 APT010000I62004449 161279 ny. JUMARIA 
RANITIDIN 7,040.00 2 7,744.00
56 APT010000I62004449 161279 ny. JUMARIA 
CEFTRIAXO19,999.10 2 21,999.01
57 APT010000I62004459 161318 tn. MOCH IQBAL
CEFTRIAXO19,999.10
IBRAHIM  2 21,999.01
58 APT010000I62004459 161318 tn. MOCH IQBAL
METAMIZOL4,999.99
IBRAHIM  3 5,499.99
59 APT010000I62004459 161318 tn. MOCH IQBAL
RANITIDIN
IBRAHIM 
7,040.00 3 7,744.00
60 APT010000I62004459 161318 tn. MOCH IQBAL
CAIRANIBRAHIM 
RL 7,149.60 3 7,864.56
61 APT010000I62004459 161318 tn. MOCH IQBAL
CONECTA
IBRAHIM 
13,200.00 2 14,520.00
62 APT010000I62004459 161318 tn. MOCH IQBAL
MASKERIBRAHIM 
DI 700.00 2 770.00
63 APT010000I62004455 161316 ny. MARIAH 
CAIRAN RL 7,149.60 4 7,864.56
64 APT010000I62004455 161316 ny. MARIAH 
CONECTA 13,200.00 1 14,520.00
65 APT010000I62004455 161316 ny. MARIAH 
MASKER DI 700.00 2 770.00
66 APT010000I62004455 161316 ny. MARIAH 
ACETYLCYS 1,100.00 3 1,210.00
67 APT010000I62004455 161316 ny. MARIAH 
SANMOL T 297.00 3 326.70
68 APT010000I62004455 161316 ny. MARIAH 
CEFTAZIDIM23,166.00 3 25,482.60
69 APT010000I62004455 161316 ny. MARIAH 
HANDSCOEN 478.00 4 525.80
70 APT010000I62004426 144442 nn. NURFADHILLAH
LEVOFLOXAARIFIN 
449.00 1 493.90
71 APT010000I62004426 144442 nn. NURFADHILLAH
KSR 600 MARIFIN 
1,755.00 1 1,930.50
72 APT010000I62004426 144442 nn. NURFADHILLAH
CURCUMA ARIFIN 
1,098.90 2 1,208.79
73 APT010000I62004426 144442 nn. NURFADHILLAH
ASERING ARIFIN 
I 9,645.90 4 10,610.49
74 APT010000I62004426 144442 nn. NURFADHILLAH
MASKER DIARIFIN 
700.00 2 770.00
75 APT010000I62004426 144442 nn. NURFADHILLAH
HANDSCOENARIFIN 
478.00 6 525.80
76 APT010000I62004426 144442 nn. NURFADHILLAH
CONECTAARIFIN 
13,200.00 1 14,520.00
77 APT010000I62004452 11679 ny. I KANENNENG 
CAIRAN NAC6,409.70 2 7,050.67
78 APT010000I62004452 11679 ny. I KANENNENG 
CEFTRIAXO19,999.10 1 21,999.01
79 APT010000I62004452 11679 ny. I KANENNENG 
SANMOL T 297.00 3 326.70
80 APT010000I62004452 11679 ny. I KANENNENG 
ACETYLCYS 1,100.00 3 1,210.00
81 APT010000I62004452 11679 ny. I KANENNENG 
CAIRAN NAC6,409.70 3 7,050.67
82 APT010000I62004452 11679 ny. I KANENNENG 
CONECTA 13,200.00 1 14,520.00
83 APT010000I62004452 11679 ny. I KANENNENG 
MASKER DI 700.00 2 770.00
84 APT010000I62004452 11679 ny. I KANENNENG 
INFUS SET 7,920.00 1 8,712.00
85 APT010000I62004452 11679 ny. I KANENNENG 
IV CATHETE 7,750.00 1 8,525.00

86 APT010000I62004390 160844 tn. H. ANDIPARACETA

AZAS MANAF,
68,062.50
BA   3 74,868.75
 87 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF,
7,350.75
BA   2 8,085.82
88 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,
7,332.97
BA   2 8,066.26
89 APT010000I62004390 160844 tn. H. ANDIASPILETS
AZAS MANAF,816.20
BA   1 897.82
90 APT010000I62004390 160844 tn. H. ANDIMEGABAL
AZAS MANAF,
1,730.00
BA   1 1,903.00
91 APT010000I62004390 160844 tn. H. ANDILODIA
AZAS MANAF,
TAB 1,045.00
BA   2 1,149.50
92 APT010000I62004390 160844 tn. H. ANDIZINK
AZASOKSI
MANAF,604.00
BA   1 664.40
93 APT010000I62004390 160844 tn. H. ANDIALPRAZOLA
AZAS MANAF,
1,915.83
BA   1 2,107.42
94 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
95 APT010000I62004390 160844 tn. H. ANDIIVAZAS
CATHETE
MANAF,
7,750.00
BA   1 8,525.00
96 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   2 770.00
97 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   6 525.80
98 APT010000I65003088 161272 tn. MUSTARI 
RANITIDIN 7,040.00 2 7,744.00
99 APT010000I65003088 161272 tn. MUSTARI 
SANMOL T 297.00 3 326.70
100 APT010000I65003088 161272 tn. MUSTARI 
METAMIZOL4,999.99 2 5,499.99
101 APT010000I65003088 161272 tn. MUSTARI 
CAIRAN RL 7,149.60 3 7,864.56
102 APT010000I65003088 161272 tn. MUSTARI 
CONECTA 13,200.00 2 14,520.00
103 APT010000I65003088 161272 tn. MUSTARI 
HANDSCOEN 478.00 6 525.80
104 APT010000I65003088 161272 tn. MUSTARI 
IV CATHETE 7,750.00 2 8,525.00
105 APT010000I62004440 161194 ny. NASYATI 
CEFTRIAXO19,999.10 2 21,999.01
106 APT010000I62004440 161194 ny. NASYATI 
KETOROLAC 7,350.75 3 8,085.82
107 APT010000I62004440 161194 ny. NASYATI 
RANITIDIN 7,040.00 3 7,744.00
108 APT010000I62004440 161194 ny. NASYATI 
CAIRAN RL 7,149.60 3 7,864.56
109 APT010000I62004440 161194 ny. NASYATI 
HANDSCOEN 478.00 4 525.80
110 APT010000I62004440 161194 ny. NASYATI 
MASKER DI 700.00 1 770.00
111 APT010000I62004440 161194 ny. NASYATI 
HANDSCOEN 478.00 4 525.80
112 APT010000I62004440 161194 ny. NASYATI 
MASKER DI 700.00 3 770.00
113 APT010000I62004440 161194 ny. NASYATI 
INFUS SET 7,920.00 2 8,712.00
114 APT010000I62004440 161194 ny. NASYATI 
IV CATHETE 7,750.00 1 8,525.00
115 APT010000I62004460 118212 tn. COLLENG 
METAMIZOL4,999.99 3 5,499.99
116 APT010000I62004460 118212 tn. COLLENG 
CAIRAN RL 7,149.60 3 7,864.56
117 APT010000I62004460 118212 tn. COLLENG 
MASKER DI 700.00 1 770.00
118 APT010000I62004460 118212 tn. COLLENG 
HANDSCOEN 478.00 2 525.80
119 APT010000I62004460 118212 tn. COLLENG 
SPOIT 3 CC 1,485.00 1 1,633.50
120 APT010000I62004460 118212 tn. COLLENG 
SPOIT 5 CC 1,595.00 1 1,754.50
121 APT010000I62004435 161179 ny. HASNAWATY
KETOROLAC
H  7,350.75 3 8,085.82
122 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 3 7,744.00
123 APT010000I62004435 161179 ny. HASNAWATY
CAIRANH RL 7,149.60 3 7,864.56
124 APT010000I62004435 161179 ny. HASNAWATY
MASKER H  DI 700.00 1 770.00
125 APT010000I62004435 161179 ny. HASNAWATY
IV CATHETE
H  7,750.00 1 8,525.00
126 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOEN
H  478.00 2 525.80
127 APT010000I62004424 161085 tn. H. BAKING 
METIL PRE 49,500.00 1 54,450.00
128 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 7,040.00 2 7,744.00
129 APT010000I62004424 161085 tn. H. BAKING 
MECOBALAM6,600.00 1 7,260.00
130 APT010000I62004424 161085 tn. H. BAKING 
GABAPENTI 4,400.00 2 4,840.00
131 APT010000I62004424 161085 tn. H. BAKING 
SANMOL T 297.00 3 326.70
132 APT010000I62004424 161085 tn. H. BAKING 
AMITRIPTY 177.65 2 195.41
133 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 75.00 6 82.50
134 APT010000I65003081 161225 tn. YUDHA KETOROLAC
  7,350.75 3 8,085.82
135 APT010000I65003081 161225 tn. YUDHA CEFTAZIDIM
  23,166.00 3 25,482.60
136 APT010000I65003081 161225 tn. YUDHA COMBIVENT4,549.95
  3 5,004.94

137 APT010000I65003086 161248 ny. JUMANIA 

PARACETA 68,062.50 3 74,868.75

138 APT010000I65003086 161248 ny. JUMANIA 

ONDANSETR5,500.00 3 6,050.00
139 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
140 APT010000I65003086 161248 ny. JUMANIA 
RANITIDIN 7,040.00 2 7,744.00
141 APT010000I32000269 152599 nn. NURAENI
CEFIXIME
MUS   4,950.00 2 5,445.00

142 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  49,500.00 2 54,450.00

143 APT010000I32000269 152599 nn. NURAENIOMEPRAZOL

MUS   24,999.70 2 27,499.67
144 APT010000I32000269 152599 nn. NURAENICAIRAN
MUS RL
  7,149.60 2 7,864.56
145 APT010000I32000269 152599 nn. NURAENIMASKER
MUS   DI 700.00 1 770.00
146 APT010000I32000269 152599 nn. NURAENIHANDSCOEN
MUS   478.00 2 525.80
147 APT010000I32000269 152599 nn. NURAENISPOIT
MUS10  C 2,310.00 1 2,541.00
148 APT010000I32000269 152599 nn. NURAENICAIRAN
MUS NA15,180.00
  1 16,698.00
149 APT010000I32000269 152599 nn. NURAENINYSTATIN
MUS   24,200.00 1 26,620.00
150 APT010000I32000269 152599 nn. NURAENIDULCOLAX
MUS   23,571.24 1 25,928.36
151 APT010000I62004436 161180 ny. HAPSAH FUROSEMID2,920.50 2 3,212.55
152 APT010000I62004436 161180 ny. HAPSAH AMLODIPIN 838.19 1 922.01
153 APT010000I62004436 161180 ny. HAPSAH MASKER DI 700.00 1 770.00
154 APT010000I62004436 161180 ny. HAPSAH HANDSCOEN 478.00 2 525.80
155 APT010000I62004436 161180 ny. HAPSAH CONECTA 13,200.00 1 14,520.00
156 APT010000I62004436 161180 ny. HAPSAH INFUS SET 7,920.00 1 8,712.00
157 APT010000I62004436 161180 ny. HAPSAH SPOIT 10 C 2,310.00 1 2,541.00
158 APT010000I62004436 161180 ny. HAPSAH SPOIT 5 CC 1,595.00 1 1,754.50
159 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO19,999.10 2 21,999.01
160 APT010000I62004430 161153 tn. MUH NURDIN 
LEVOFLOXA 449.00 1 493.90
161 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN NAC6,409.70 2 7,050.67
162 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 1 770.00
163 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 2 525.80
164 APT010000I62004430 161153 tn. MUH NURDIN 
SPOIT 10 C 2,310.00 1 2,541.00
165 APT010000I62004430 161153 tn. MUH NURDIN 
INFUS SET 7,920.00 1 8,712.00
166 APT010000I62004430 161153 tn. MUH NURDIN 
IV CATHETE 7,750.00 1 8,525.00
167 APT010000I62004437 147766 ny. SITTI NORMI 
GLIMEPIRI 1,257.80 2 1,383.57
168 APT010000I62004437 147766 ny. SITTI NORMI 
RANITIDIN 7,040.00 2 7,744.00
169 APT010000I62004437 147766 ny. SITTI NORMI 
DOMPERID 508.20 2 559.02
170 APT010000I62004437 147766 ny. SITTI NORMI 
MECOBALAM6,600.00 1 7,260.00
171 APT010000I62004437 147766 ny. SITTI NORMI 
CAIRAN NAC6,409.70 2 7,050.67
172 APT010000I62004437 147766 ny. SITTI NORMI 
MASKER DI 700.00 1 770.00
173 APT010000I62004437 147766 ny. SITTI NORMI 
HANDSCOEN 478.00 2 525.80
174 APT010000I62004437 147766 ny. SITTI NORMI 
IV CATHETE 7,750.00 1 8,525.00
175 APT010000I62004437 147766 ny. SITTI NORMI 
INFUS SET 7,920.00 1 8,712.00
176 APT010000I62004394 160864 tn. LUTHERCEFTRIAXO19,999.10
MARRIBA  2 21,999.01
177 APT010000I62004394 160864 tn. LUTHEROMEPRAZOL
MARRIBA 24,999.70 1 27,499.67
178 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 3 5,445.00
179 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  197.13 1 216.84
180 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA 
DI 700.00 1 770.00
181 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 2 525.80
182 APT010000I62004394 160864 tn. LUTHERSPOIT
MARRIBA 
10 C 2,310.00 1 2,541.00
183 APT010000I62004394 160864 tn. LUTHERINFUS
MARRIBA 
SET 7,920.00 1 8,712.00
184 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
185 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
186 APT010000I62004453 161309 ny. SURIATIMETAMIZOL4,999.99
DG. SUNGGU   3 5,499.99
187 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU7,040.00
  2 7,744.00
188 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
NAC6,409.70
  2 7,050.67
189 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  2 770.00
190 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
191 APT010000I62004453 161309 ny. SURIATIHANDSCOON
DG. SUNGGU
13,613.00
  1 14,974.30
192 APT010000I62004457 76534 tn. SAHABUDDIN 
- 0 0 0
193 APT010000I62004457 76534 tn. SAHABUDDIN 
RANITIDIN 629.99 1 692.99
194 APT010000I62004457 76534 tn. SAHABUDDIN 
CURCUMA 1,098.90 3 1,208.79
195 APT010000I62004457 76534 tn. SAHABUDDIN 
NEUROSAN 1,168.50 1 1,285.35
196 APT010000I62004457 76534 tn. SAHABUDDIN 
SANMOL T 297.00 3 326.70
197 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN NAC6,409.70 2 7,050.67
198 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 4 525.80
199 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 2 770.00
200 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 3 CC 1,485.00 1 1,633.50
201 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MELOXICAM AZIS 250.00 6 275.00
202 APT010000I62004442 72845 ny. LAILY NUZLIKHA
METIL PREAZIS 702.00 5 772.20
203 APT010000I64002929 161294 ny. HASNAH CAIRAN NAC6,409.70 2 7,050.67
204 APT010000I64002929 161294 ny. HASNAH CEFTAZIDIM23,166.00 2 25,482.60

205 APT010000I64002929 161294 ny. HASNAH 

METIL PRE 49,500.00 2 54,450.00

206 APT010000I64002929 161294 ny. HASNAH 

OMEPRAZOL 24,999.70 2 27,499.67
207 APT010000I64002929 161294 ny. HASNAH 
DIPENHYDR 7,700.00 1 8,470.00
208 APT010000I62004445 161150 ny. WA HASNI 
FARGETIX 407.00 6 447.70
209 APT010000I62004445 161150 ny. WA HASNI 
RANITIDIN 629.99 6 692.99
210 APT010000I62004445 161150 ny. WA HASNI 
CIPROFLOX 770.00 4 847.00
211 APT010000I65003087 161267 tn. ISKANDAR 
METIL PRE 49,500.00 1 54,450.00
212 APT010000I65003087 161267 tn. ISKANDAR 
RANITIDIN 7,040.00 2 7,744.00
213 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN NAC6,409.70 2 7,050.67
214 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOEN 478.00 2 525.80
215 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 1 770.00
216 APT010000I65003087 161267 tn. ISKANDAR 
INFUS SET 7,920.00 1 8,712.00
217 APT010000I62004448 110642 ny. ST NORMA
NEWDGDIAT
BAU  557.15 3 612.87
218 APT010000I62004448 110642 ny. ST NORMA
KOTRIMOKS
DG BAU  254.10 4 279.51
219 APT010000I62004448 110642 ny. ST NORMA
RANITIDIN
DG BAU 7,040.00 2 7,744.00
220 APT010000I62004448 110642 ny. ST NORMA
SANMOL
DG BAU 
T 297.00 3 326.70
221 APT010000I62004448 110642 ny. ST NORMA
CAIRAN
DG BAU 
RL 7,149.60 2 7,864.56
222 APT010000I62004448 110642 ny. ST NORMA
HANDSCOEN
DG BAU  478.00 2 525.80
223 APT010000I62004448 110642 ny. ST NORMA
MASKER
DG BAU 
DI 700.00 1 770.00
224 APT010000I62004448 110642 ny. ST NORMA
INFUS
DGSET
BAU 7,920.00 1 8,712.00
225 APT010000I62004439 125128 tn. ZULFIKAR
EPISAN
KAMALUDDIN 
SU 51,150.00 1 56,265.00
226 APT010000I62004439 125128 tn. ZULFIKAR
RANITIDIN
KAMALUDDIN 629.99 2 692.99
227 APT010000I64002922 161222 ny. CINNONG 
CEFIXIME 4,950.00 6 5,445.00
228 APT010000I64002922 161222 ny. CINNONG 
SANMOL T 297.00 9 326.70
229 APT010000I62004454 161313 ny. DG LAWI 
SANMOL T 297.00 9 326.70
230 APT010000I62004454 161313 ny. DG LAWI 
NEUROSAN 1,168.50 3 1,285.35
231 APT010000I62004458 140766 ny. BANONG 
FUROSEMID 190.99 1 210.09
232 APT010000I62004458 140766 ny. BANONG 
SPIRONOLA 285.75 1 314.33
233 APT010000I62004458 140766 ny. BANONG 
DIGOKSIN 107.12 1 117.83
234 APT010000I62004458 140766 ny. BANONG 
SIMARC TA 975.98 1 1,073.58
235 APT010000I62004458 140766 ny. BANONG 
CETIRIZIN 266.01 1 292.61
236 APT010000I62004458 140766 ny. BANONG 
IV CATHETE 7,750.00 1 8,525.00
237 APT010000I62004458 140766 ny. BANONG 
HANDSCOEN 478.00 4 525.80
238 APT010000I62004458 140766 ny. BANONG 
MASKER DI 700.00 2 770.00
239 APT010000I62004458 140766 ny. BANONG 
CAIRAN NA15,180.00 1 16,698.00

240 APT010000I64002917 160918 ny. HJ. MARWIAH 

FENTANYL 041,599.80 5 45,759.78

241 APT010000I64002917 160918 ny. HJ. MARWIAH 

CAIRAN RL 7,149.60 3 7,864.56
242 APT010000I64002917 160918 ny. HJ. MARWIAH 
METAMIZOL4,999.99 3 5,499.99
243 APT010000I64002917 160918 ny. HJ. MARWIAH 
CEFTRIAXO19,999.10 2 21,999.01
244 APT010000I64002917 160918 ny. HJ. MARWIAH 
MASKER DI 700.00 5 770.00
245 APT010000I64002917 160918 ny. HJ. MARWIAH 
HANDSCOEN 478.00 20 525.80
246 APT010000I64002933 159225 tn. ADAM  CEFTRIAXO19,999.10 2 21,999.01
247 APT010000I64002933 159225 tn. ADAM  KETOROLAC 7,350.75 3 8,085.82
248 APT010000I64002933 159225 tn. ADAM  RANITIDIN 7,040.00 2 7,744.00

249 APT010000I64002933 159225 tn. ADAM  METRONIDA

56,718.20 3 62,390.02

250 APT010000I62004436 161180 ny. HAPSAH 

OMEPRAZOL 24,999.70 2 27,499.67
251 APT010000I62004436 161180 ny. HAPSAH 
SANMOL I 24,202.60 1 26,622.86
252 APT010000I62004436 161180 ny. HAPSAH 
BENANG SIL55,000.00 1 60,500.00
1,100,000 1,210,000
253 APT010000I62004436 161180 ny. HAPSAH 
CERTOFIX 1
.00 .00
254 APT010000I62004436 161180 ny. HAPSAH 
SPOIT 3 CC 1,485.00 2 1,633.50
255 APT010000I62004436 161180 ny. HAPSAH 
SPOIT 10 C 2,310.00 2 2,541.00
256 APT010000I62004436 161180 ny. HAPSAH 
HANDSCOON 12,100.00 3 13,310.00
257 APT010000I62004436 161180 ny. HAPSAH 
HANDSCOEN 478.00 8 525.80

258 APT010000I64002917 160918 ny. HJ. MARWIAH 

FENTANYL 041,599.80 5 45,759.78

259 APT010000I64002917 160918 ny. HJ. MARWIAH 

CAIRAN RL 7,149.60 3 7,864.56
 260 APT010000I64002917 160918 ny. HJ. MARWIAH 
SANTAGESIK4,949.40 3 5,444.34
261 APT010000I64002917 160918 ny. HJ. MARWIAH 
CEFTRIAXO19,999.10 2 21,999.01
262 APT010000I64002917 160918 ny. HJ. MARWIAH 
MASKER DI 700.00 5 770.00
263 APT010000I64002917 160918 ny. HJ. MARWIAH 
HANDSCOEN 478.00 20 525.80
264 APT010000I64002935 161336 nn. IRENE TIVANI 
OMEPRAZOL24,999.70 2 27,499.67

265 APT010000I64002935 161336 nn. IRENE TIVANI 

PARACETA 68,062.50 3 74,868.75

266 APT010000I64002935 161336 nn. IRENE TIVANI 

CEFTRIAXO19,999.10 2 21,999.01
267 APT010000I64002935 161336 nn. IRENE TIVANI 
TRANSFUSI28,050.00 1 30,855.00
268 APT010000I64002935 161336 nn. IRENE TIVANI 
IV CATHETE12,416.00 1 13,657.60
269 APT010000I64002935 161336 nn. IRENE TIVANI 
CONECTA 25,000.00 1 27,500.00
270 APT010000I64002935 161336 nn. IRENE TIVANI 
SPOIT 1 CC 1,920.00 1 2,112.00
271 APT010000I64002935 161336 nn. IRENE TIVANI 
SPOIT 10 C 2,310.00 1 2,541.00
272 APT010000I64002935 161336 nn. IRENE TIVANI 
OMEPRAZOL 24,999.70 2 27,499.67
273 APT010000I64002935 161336 nn. IRENE TIVANI 
CEFTRIAXO19,999.10 2 21,999.01
253,550.0 278,905.0
274 APT010000I62004467 161370 tn. ANDI TRIADI
SKINTRACT
WAHYUDI  1
0 0
275 APT010000I62004467 161370 tn. ANDI TRIADI
CEFTRIAXO19,999.10
WAHYUDI  1 21,999.01
276 APT010000I62004467 161370 tn. ANDI TRIADI
KETOROLAC
WAHYUDI 
7,350.75 1 8,085.82
277 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI 
7,040.00 1 7,744.00
Sub Total   647
PCS 1,694.00

PCS 2,078.97
PCS 1,072.50
PCS 2,112.00
PCS 21,999.01
- 0
PCS 7,260.00
PCS 980.10
PCS 66,550.00
PCS 7,864.56
PCS 1,051.60
PCS 36,784.00
PCS 40,811.10
PCS 6,160.00
PCS 2,541.00
PCS 1,754.50
PCS 42,108.00
PCS 27,500.00
PCS 5,275.60
PCS 4,247.10
PCS 1,694.00
PCS 3,630.00
PCS 21,999.01
PCS 5,945.94
PCS 9,147.60
PCS 15,488.00
PCS 1,118.04
PCS 770.00
PCS 1,051.60
PCS 2,541.00
108,900.0
PCS
0
PCS 922.01
PCS 28,182.00
PCS 15,014.82
PCS 770.00
PCS 2,103.20
PCS 1,633.50
PCS 7,050.67
PCS 43,998.02
PCS 16,171.64
PCS 12,100.00
PCS 980.10
PCS 31,458.24
 224,606.2
PCS
5
PCS 1,118.04
PCS 10,999.98
PCS 15,488.00
PCS 2,310.00
PCS 29,040.00
PCS 3,154.80
PCS 16,698.00
PCS 21,152.01
PCS 980.10
PCS 3,630.00
PCS 15,488.00
PCS 43,998.02
PCS 43,998.02
PCS 16,499.97
PCS 23,232.00
PCS 23,593.68
PCS 29,040.00
PCS 1,540.00
PCS 31,458.24
PCS 14,520.00
PCS 1,540.00
PCS 3,630.00
PCS 980.10
PCS 76,447.80
PCS 2,103.20
PCS 493.90
PCS 1,930.50
PCS 2,417.58
PCS 42,441.96
PCS 1,540.00
PCS 3,154.80
PCS 14,520.00
PCS 14,101.34
PCS 21,999.01
PCS 980.10
PCS 3,630.00
PCS 21,152.01
PCS 14,520.00
PCS 1,540.00
PCS 8,712.00
PCS 8,525.00
224,606.2
PCS
5
PCS 16,171.64
PCS 16,132.52
PCS 897.82
PCS 1,903.00
PCS 2,299.00
PCS 664.40
PCS 2,107.42
PCS 23,593.68
PCS 8,525.00
PCS 1,540.00
PCS 3,154.80
PCS 15,488.00
PCS 980.10
PCS 10,999.98
PCS 23,593.68
PCS 29,040.00
PCS 3,154.80
PCS 17,050.00
PCS 43,998.02
PCS 24,257.46
PCS 23,232.00
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 2,103.20
PCS 2,310.00
PCS 17,424.00
PCS 8,525.00
PCS 16,499.97
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 1,754.50
PCS 24,257.46
PCS 23,232.00
PCS 23,593.68
PCS 770.00
PCS 8,525.00
PCS 1,051.60
PCS 54,450.00
PCS 15,488.00
PCS 7,260.00
PCS 9,680.00
PCS 980.10
PCS 390.82
PCS 495.00
PCS 24,257.46
PCS 76,447.80
PCS 15,014.82
224,606.2
PCS
5
PCS 18,150.00
PCS 43,998.02
PCS 15,488.00
PCS 10,890.00
108,900.0
PCS 0
PCS 54,999.34
PCS 15,729.12
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 16,698.00
PCS 26,620.00
PCS 25,928.36
PCS 6,425.10
PCS 922.01
PCS 770.00
PCS 1,051.60
PCS 14,520.00
PCS 8,712.00
PCS 2,541.00
PCS 1,754.50
PCS 43,998.02
PCS 493.90
PCS 14,101.34
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 8,712.00
PCS 8,525.00
PCS 2,767.14
PCS 15,488.00
PCS 1,118.04
PCS 7,260.00
PCS 14,101.34
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 8,712.00
PCS 43,998.02
PCS 27,499.67
PCS 16,335.00
PCS 216.84
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 8,712.00
PCS 43,998.02
PCS 980.10
PCS 16,499.97
PCS 15,488.00
PCS 14,101.34
PCS 1,540.00
PCS 2,103.20
PCS 14,974.30
- 0
PCS 692.99
PCS 3,626.37
PCS 1,285.35
PCS 980.10
PCS 14,101.34
PCS 2,103.20
PCS 1,540.00
PCS 1,633.50
PCS 1,650.00
PCS 3,861.00
PCS 14,101.34
PCS 50,965.20
108,900.0
PCS
0
PCS 54,999.34
PCS 8,470.00
PCS 2,686.20
PCS 4,157.94
PCS 3,388.00
PCS 54,450.00
PCS 15,488.00
PCS 14,101.34
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 1,838.61
PCS 1,118.04
PCS 15,488.00
PCS 980.10
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 56,265.00
PCS 1,385.98
PCS 32,670.00
PCS 2,940.30
PCS 2,940.30
PCS 3,856.05
PCS 210.09
PCS 314.33
PCS 117.83
PCS 1,073.58
PCS 292.61
PCS 8,525.00
PCS 2,103.20
PCS 1,540.00
PCS 16,698.00
228,798.9
PCS
0
PCS 23,593.68
PCS 16,499.97
PCS 43,998.02
PCS 3,850.00
PCS 10,516.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
187,170.0
PCS
6
PCS 54,999.34
PCS 26,622.86
PCS 60,500.00
1,210,000
PCS
.00
PCS 3,267.00
PCS 5,082.00
PCS 39,930.00
PCS 4,206.40
228,798.9
PCS
0
PCS 23,593.68
PCS 16,333.02
PCS 43,998.02
PCS 3,850.00
PCS 10,516.00
PCS 54,999.34
224,606.2
PCS
5
PCS 43,998.02
PCS 30,855.00
PCS 13,657.60
PCS 27,500.00
PCS 2,112.00
PCS 2,541.00
PCS 54,999.34
PCS 43,998.02
278,905.0
PCS
0
PCS 21,999.01
PCS 8,085.82
PCS 7,744.00
6,962,896.70
18-12-
1 APT010000I32000274 161389 tn. JUNUS LAMBA 
CAIRAN RL 7,149.60 2 7,864.56
2018 
2 APT010000I32000274 161389 tn. JUNUS LAMBA 
INFUS SET 7,920.00 1 8,712.00

3 APT010000I32000274 161389 tn. JUNUS LAMBA 

CITICOLIN 27,505.00 4 30,255.50

4 APT010000I32000274 161389 tn. JUNUS LAMBA 

RANITIDIN 7,040.00 2 7,744.00
5 APT010000I32000274 161389 tn. JUNUS LAMBA 
NEURODEX 770.00 1 847.00
6 APT010000I32000274 161389 tn. JUNUS LAMBA 
CLOPIDOGR 2,722.50 1 2,994.75
7 APT010000I32000274 161389 tn. JUNUS LAMBA 
SPOIT 5 CC 1,595.00 2 1,754.50
8 APT010000I32000274 161389 tn. JUNUS LAMBA 
SPOIT 3 CC 1,485.00 2 1,633.50
9 APT010000I62004437 147766 ny. SITTI NORMI 
GLIMEPIRI 1,257.80 6 1,383.57
10 APT010000I62004437 147766 ny. SITTI NORMI 
RANITIDIN 629.99 6 692.99
11 APT010000I62004437 147766 ny. SITTI NORMI 
DOMPERID 508.20 6 559.02
12 APT010000I62004437 147766 ny. SITTI NORMI 
GABAPENTI 4,400.00 6 4,840.00
13 APT010000I62004437 147766 ny. SITTI NORMI 
NEUROSAN 1,168.50 3 1,285.35
14 APT010000I62004437 147766 ny. SITTI NORMI 
CIPROFLOX 770.00 6 847.00
15 APT010000I62004437 147766 ny. SITTI NORMI 
CANGKANG 75.00 6 82.50
16 APT010000I62004437 147766 ny. SITTI NORMI 
AMITRIPTY 177.65 1 195.41

17 APT010000I64002935 161336 nn. IRENE TIVANI 

PUMPITOR 62,693.82 4 68,963.20

18 APT010000I64002935 161336 nn. IRENE TIVANI 

CEFTRIAXO19,999.10 2 21,999.01
19 APT010000I64002935 161336 nn. IRENE TIVANI 
PERFUSSOR21,000.00 1 23,100.00
20 APT010000I64002935 161336 nn. IRENE TIVANI 
SPOIT 50 12,367.00 1 13,603.70
21 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO19,999.10 2 21,999.01
22 APT010000I62004430 161153 tn. MUH NURDIN 
LEVOFLOXA 449.00 1 493.90
23 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN NAC6,409.70 2 7,050.67
24 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 1 770.00
25 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 2 525.80
26 APT010000I62004430 161153 tn. MUH NURDIN 
SPOIT 10 C 2,310.00 1 2,541.00
27 APT010000I62004430 161153 tn. MUH NURDIN 
IV CATHETE 7,750.00 1 8,525.00
28 APT010000I62004436 161180 ny. HAPSAH 
NEFROSTER49,599.00 1 54,558.90
29 APT010000I62004436 161180 ny. HAPSAH 
FUROSEMID2,920.50 2 3,212.55

30 APT010000I62004436 161180 ny. HAPSAH 

PUMPITOR 62,693.82 2 68,963.20

31 APT010000I62004436 161180 ny. HAPSAH MASKER DI 700.00 1 770.00

32 APT010000I62004436 161180 ny. HAPSAH HANDSCOEN 478.00 2 525.80
33 APT010000I62004436 161180 ny. HAPSAH SPOIT 10 C 2,310.00 1 2,541.00
34 APT010000I62004436 161180 ny. HAPSAH SPOIT 5 CC 1,595.00 1 1,754.50
35 APT010000I62004436 161180 ny. HAPSAH INFUS SET 7,920.00 1 8,712.00
36 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
37 APT010000I62004423 161069 ny. ST AISAYAH
KETOROLAC
TAHANG 7,350.75 3 8,085.82
38 APT010000I62004423 161069 ny. ST AISAYAH
RANITIDIN
TAHANG 7,040.00 2 7,744.00
39 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
RL 7,149.60 2 7,864.56
40 APT010000I62004423 161069 ny. ST AISAYAH
HANDSCOEN
TAHANG 478.00 2 525.80
41 APT010000I62004423 161069 ny. ST AISAYAH
MASKER
TAHANG 
DI 700.00 1 770.00
42 APT010000I65003087 161267 tn. ISKANDAR 
METIL PRE 49,500.00 1 54,450.00

43 APT010000I65003087 CAIRAN CO224,999.5

161267 tn. ISKANDAR  1 247,499.4
0 5
44 APT010000I65003087 161267 tn. ISKANDAR 
RANITIDIN 7,040.00 2 7,744.00
45 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN NAC6,409.70 3 7,050.67
46 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOEN 478.00 2 525.80
47 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 2 770.00
48 APT010000I65003087 161267 tn. ISKANDAR 
CONECTA 13,200.00 1 14,520.00
49 APT010000I65003087 161267 tn. ISKANDAR 
INFUS SET 7,920.00 1 8,712.00
50 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
51 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
52 APT010000I65003086 161248 ny. JUMANIA 
CAIRAN RL 7,149.60 2 7,864.56
53 APT010000I65003086 161248 ny. JUMANIA 
HANDSCOEN 478.00 2 525.80
54 APT010000I65003086 161248 ny. JUMANIA 
MASKER DI 700.00 1 770.00
55 APT010000I65003086 161248 ny. JUMANIA 
INFUS SET 7,920.00 1 8,712.00
56 APT010000I64002929 161294 ny. HASNAH 
CEFTRIAXO19,999.10 1 21,999.01

57 APT010000I64002929 161294 ny. HASNAH 

METIL PRE 49,500.00 2 54,450.00

58 APT010000I64002929 161294 ny. HASNAH CAIRAN RL 7,149.60 2 7,864.56

59 APT010000I64002929 161294 ny. HASNAH HANDSCOEN 478.00 2 525.80
60 APT010000I64002929 161294 ny. HASNAH MASKER DI 700.00 1 770.00
61 APT010000I64002929 161294 ny. HASNAH CONECTA 13,200.00 1 14,520.00
62 APT010000I65003081 161225 tn. YUDHA CEFTAZIDIM
  23,166.00 2 25,482.60
63 APT010000I65003081 161225 tn. YUDHA KETOROLAC
  7,350.75 3 8,085.82
64 APT010000I65003081 161225 tn. YUDHA CAIRAN
  RL 7,149.60 12 7,864.56
65 APT010000I65003081 161225 tn. YUDHA MASKER
  DI 700.00 1 770.00
66 APT010000I65003081 161225 tn. YUDHA HANDSCOEN
  478.00 2 525.80
67 APT010000I65003081 161225 tn. YUDHA INFUS
  SET 7,920.00 1 8,712.00
68 APT010000I62004463 160654 nn. NUR FADILLAH
CEFTRIAXO19,999.10
RIZKY  2 21,999.01
69 APT010000I62004463 160654 nn. NUR FADILLAH
KETOROLAC
RIZKY 
7,350.75 3 8,085.82
70 APT010000I62004463 160654 nn. NUR FADILLAH
RANITIDIN
RIZKY 
7,040.00 2 7,744.00
71 APT010000I62004463 160654 nn. NUR FADILLAH
CAIRAN RL
RIZKY 
7,149.60 2 7,864.56
72 APT010000I62004463 160654 nn. NUR FADILLAH
HANDSCOEN
RIZKY 478.00 2 525.80
73 APT010000I62004463 160654 nn. NUR FADILLAH
MASKERRIZKY 
DI 700.00 1 770.00
74 APT010000I62004463 160654 nn. NUR FADILLAH
INFUS SET
RIZKY 
7,920.00 1 8,712.00
75 APT010000I62004448 110642 ny. ST NORMA
VITAMIN
DG BAU 
B 146.99 6 161.69
76 APT010000I62004442 72845 ny. LAILY NUZLIKHA
- AZIS  0 0 0
77 APT010000I62004442 72845 ny. LAILY NUZLIKHA
MELOXICAMAZIS 250.00 2 275.00
78 APT010000I62004457 76534 tn. SAHABUDDIN 
CURCUMA 1,098.90 3 1,208.79
79 APT010000I62004457 76534 tn. SAHABUDDIN 
NEUROSAN 1,168.50 2 1,285.35
80 APT010000I62004457 76534 tn. SAHABUDDIN 
ONDANSETR5,500.00 2 6,050.00
81 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN NAC6,409.70 2 7,050.67
82 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 4 525.80
83 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 1 770.00
84 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 3 CC 1,485.00 1 1,633.50
 85 APT010000I32000269 152599 nn. NURAENI
METIL
MUSPRE
  49,500.00 2 54,450.00

86 APT010000I32000269 152599 nn. NURAENI

PUMPITOR
MUS   62,693.82 2 68,963.20

104,181.0 114,599.1
87 APT010000I32000269 152599 nn. NURAENI
FLEET
MUSENE
  1
0 0
88 APT010000I32000269 152599 nn. NURAENISPORETIK
MUS   5,720.50 2 6,292.55
89 APT010000I32000269 152599 nn. NURAENIMASKER
MUS   DI 700.00 1 770.00
90 APT010000I32000269 152599 nn. NURAENIHANDSCOEN
MUS   478.00 2 525.80
91 APT010000I32000269 152599 nn. NURAENISPOIT
MUS10  C 2,310.00 1 2,541.00
92 APT010000I32000269 152599 nn. NURAENISPOIT
MUS5 CC
  1,595.00 1 1,754.50
93 APT010000I32000269 152599 nn. NURAENIIV CATHETE
MUS   7,750.00 1 8,525.00
94 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
95 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
96 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU 7,040.00
  2 7,744.00
97 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
NAC6,409.70
  3 7,050.67
98 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  2 770.00
99 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
100 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU 4,796.00
  1 5,275.60
101 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
10 C 2,310.00
  2 2,541.00
102 APT010000I62004394 160864 tn. LUTHERCAIRAN
MARRIBA 
NA15,180.00 1 16,698.00
103 APT010000I62004394 160864 tn. LUTHERHANDSCOEN
MARRIBA  478.00 2 525.80
104 APT010000I62004394 160864 tn. LUTHERMASKER
MARRIBA DI 700.00 1 770.00
105 APT010000I62004394 160864 tn. LUTHERPIROKSIKA
MARRIBA  106.00 6 116.60
106 APT010000I62004394 160864 tn. LUTHERRECOLFAR
MARRIBA  4,950.00 9 5,445.00
107 APT010000I32000274 161389 tn. JUNUS LAMBA 
DIGOKSIN 107.12 1 117.83
108 APT010000I62004424 161085 tn. H. BAKING 
MEGABAL 1,730.00 1 1,903.00
109 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 629.99 2 692.99
110 APT010000I62004424 161085 tn. H. BAKING 
GABAPENTI 4,400.00 2 4,840.00
111 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 75.00 2 82.50
112 APT010000I62004424 161085 tn. H. BAKING 
SANMOL T 297.00 2 326.70
113 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 75.00 2 82.50
114 APT010000I62004424 161085 tn. H. BAKING 
AMLODIPIN 475.19 2 522.71
115 APT010000I62004424 161085 tn. H. BAKING 
AMITRIPTY 177.65 1 195.41
116 APT010000I62004424 161085 tn. H. BAKING 
CLOBAZAM 1,116.84 1 1,228.53
117 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
ASERING I 9,645.90 1 10,610.49

118 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 

PARACETA 68,062.50 3 74,868.75

119 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 

RANITIDIN 7,040.00 2 7,744.00
120 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
DOMPERID 508.20 2 559.02
121 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
DOXYCYCLI 481.34 2 529.47

122 APT010000I62004390 160844 tn. H. ANDIPARACETA

AZAS MANAF,
68,062.50
BA   3 74,868.75

123 APT010000I62004390 160844 tn. H. ANDIKETOROLAC

AZAS MANAF,
7,350.75
BA   2 8,085.82
124 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF,
7,332.97
BA   2 8,066.26
125 APT010000I62004390 160844 tn. H. ANDIMEGABAL
AZAS MANAF,
1,730.00
BA   1 1,903.00
126 APT010000I62004390 160844 tn. H. ANDIZINK
AZASOKSI
MANAF,604.00
BA   1 664.40
127 APT010000I62004390 160844 tn. H. ANDINEW
AZASDIAT
MANAF,557.15
BA   6 612.87
128 APT010000I62004390 160844 tn. H. ANDIKALIUM
AZAS MANAF,
DI 566.42
BA   2 623.06
129 APT010000I62004452 11679 ny. I KANENNENG 
SPORETIK 5,720.50 6 6,292.55
130 APT010000I62004452 11679 ny. I KANENNENG 
IBUPROFEN 235.95 9 259.55
131 APT010000I62004452 11679 ny. I KANENNENG 
CEFTRIAXO19,999.10 2 21,999.01
132 APT010000I62004440 161194 ny. NASYATI 
CEFTRIAXO19,999.10 2 21,999.01
133 APT010000I62004440 161194 ny. NASYATI 
KETOROLAC 7,350.75 3 8,085.82
134 APT010000I62004440 161194 ny. NASYATI 
RANITIDIN 7,040.00 2 7,744.00
135 APT010000I62004440 161194 ny. NASYATI 
CAIRAN RL 7,149.60 3 7,864.56
136 APT010000I62004440 161194 ny. NASYATI 
MASKER DI 700.00 1 770.00
137 APT010000I62004440 161194 ny. NASYATI 
IV CATHETE 7,750.00 1 8,525.00
138 APT010000I62004459 161318 tn. MOCH IQBAL
CEFTRIAXO19,999.10
IBRAHIM  2 21,999.01

139 APT010000I62004459 161318 tn. MOCH IQBAL

METRONIDA
IBRAHIM 
56,718.20 2 62,390.02

140 APT010000I62004459 161318 tn. MOCH IQBAL

METAMIZOL4,999.99
IBRAHIM  2 5,499.99
141 APT010000I62004459 161318 tn. MOCH IQBAL
RANITIDIN
IBRAHIM 
7,040.00 2 7,744.00
142 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 3 847.00
143 APT010000I62004433 161174 tn. LALA  SAGESTAM12,870.00 1 14,157.00
144 APT010000I62004433 161174 tn. LALA  CAIRAN NAC6,409.70 2 7,050.67
145 APT010000I62004433 161174 tn. LALA  DEKSAMETA1,801.80 2 1,981.98
146 APT010000I62004433 161174 tn. LALA  DOMPERID 508.20 2 559.02
147 APT010000I62004433 161174 tn. LALA  CEFTRIAXO19,999.10 0 21,999.01
148 APT010000I62004433 161174 tn. LALA  URDAFALK 5,527.50 2 6,080.25
149 APT010000I62004433 161174 tn. LALA  MASKER DI 700.00 1 770.00
150 APT010000I62004433 161174 tn. LALA  HANDSCOEN 478.00 2 525.80
151 APT010000I62004433 161174 tn. LALA  SPOIT 3 CC 1,485.00 1 1,633.50
152 APT010000I62004433 161174 tn. LALA  SPOIT 20 C 5,600.00 1 6,160.00
153 APT010000I12000062 139631 tn. IBRAHIM
- KADIR  0 0 0

154 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 49,500.00 2 54,450.00

155 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95

KADIR  3 5,004.94
156 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
157 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  475.19 2 522.71
158 APT010000I12000062 139631 tn. IBRAHIMMASKER
KADIR  DI 700.00 1 770.00
159 APT010000I12000062 139631 tn. IBRAHIMHANDSCOEN
KADIR  478.00 2 525.80
160 APT010000I62004449 161279 ny. JUMARIA 
CEFTRIAXO19,999.10 2 21,999.01
161 APT010000I62004449 161279 ny. JUMARIA 
IBUPROFEN 235.95 3 259.55
162 APT010000I62004456 150708 ny. HJ. ZAENAB
CEFTRIAXO19,999.10
  2 21,999.01
163 APT010000I62004456 150708 ny. HJ. ZAENAB
KETOROLAC
  7,350.75 3 8,085.82
164 APT010000I62004456 150708 ny. HJ. ZAENAB
RANITIDIN
  7,040.00 2 7,744.00
165 APT010000I62004462 109792 tn. MALLANG 
CAIRAN NAC6,409.70 4 7,050.67

166 APT010000I62004462 109792 tn. MALLANG 

OMEPRAZOL
24,999.70 4 27,499.67
167 APT010000I62004462 109792 tn. MALLANG 
PERFUSSOR21,000.00 1 23,100.00
168 APT010000I62004462 109792 tn. MALLANG 
SPOIT 50 12,367.00 1 13,603.70
169 APT010000I62004460 118212 tn. COLLENG 
METAMIZOL4,999.99 3 5,499.99
170 APT010000I62004458 140766 ny. BANONG 
FUROSEMID 190.99 2 210.09
171 APT010000I62004458 140766 ny. BANONG 
SPIRONOLA 870.34 1 957.38
172 APT010000I62004458 140766 ny. BANONG 
DIGOKSIN 107.12 2 117.83
173 APT010000I62004458 140766 ny. BANONG 
SIMARC TA 975.98 2 1,073.58
174 APT010000I62004458 140766 ny. BANONG 
CAPTOPRIL 94.05 3 103.45
175 APT010000I62004458 140766 ny. BANONG 
CETIRIZIN 266.01 2 292.61
176 APT010000I62004458 140766 ny. BANONG 
VENTOLIN N9,886.80 3 10,875.48
177 APT010000I62004458 140766 ny. BANONG 
CAIRAN RL 7,149.60 3 7,864.56
178 APT010000I62004458 140766 ny. BANONG 
HANDSCOEN 478.00 4 525.80
179 APT010000I62004458 140766 ny. BANONG 
MASKER DI 700.00 2 770.00
180 APT010000I62004411 138920 tn. LACCA LALING 
LEVOFLOXA 449.00 1 493.90
181 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
182 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 1 21,999.01
183 APT010000I65003089 161295 nn. SURAYARANITIDIN
  629.99 1 692.99
184 APT010000I65003089 161295 nn. SURAYAIBUPROFEN
  235.95 3 259.55
185 APT010000I62004435 161179 ny. HASNAWATY
FOLEY H 
CAT 33,000.00 1 36,300.00
186 APT010000I62004435 161179 ny. HASNAWATY
URINE H 
BAG 8,835.00 1 9,718.50
187 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  923.23 1 1,015.55
188 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 2 7,744.00
189 APT010000I62004435 161179 ny. HASNAWATY
SULFADIAZ20,699.80
H  1 22,769.78
190 APT010000I62004455 161316 ny. MARIAH 
IBUPROFEN 235.95 3 259.55
191 APT010000I62004455 161316 ny. MARIAH 
CEFTAZIDIM23,166.00 3 25,482.60
192 APT010000I62004455 161316 ny. MARIAH 
CARBAZOC11,145.20 3 12,259.72
193 APT010000I62004426 144442 nn. NURFADHILLAH
LEVOFLOXAARIFIN 
449.00 3 493.90
194 APT010000I62004426 144442 nn. NURFADHILLAH
CURCUMA ARIFIN 
1,098.90 6 1,208.79
195 APT010000I62004426 144442 nn. NURFADHILLAH
KSR 600 MARIFIN 
1,755.00 6 1,930.50
196 APT010000I64002933 159225 tn. ADAM  CEFTRIAXO19,999.10 2 21,999.01
197 APT010000I64002933 159225 tn. ADAM  KETOROLAC 7,350.75 3 8,085.82
198 APT010000I64002933 159225 tn. ADAM  RANITIDIN 7,040.00 2 7,744.00

199 APT010000I64002933 159225 tn. ADAM  METRONIDA

56,718.20 3 62,390.02

200 APT010000I65003088 161272 tn. MUSTARI 

- 0 0 0
201 APT010000I62004394 160864 tn. LUTHERCEFIXIME
MARRIBA  4,950.00 6 5,445.00
202 APT010000I62004394 160864 tn. LUTHERMELOXICAM
MARRIBA  250.00 6 275.00
203 APT010000I62004436 161180 ny. HAPSAH 
HANDSCOON 13,613.00 2 14,974.30
204 APT010000I62004436 161180 ny. HAPSAH 
HANDSCOEN 478.00 4 525.80
205 APT010000I62004394 160864 tn. LUTHERCURCUMA
MARRIBA  1,098.90 9 1,208.79
206 APT010000I64002917 160918 ny. HJ. MARWIAH 
CAIRAN RL 7,149.60 3 7,864.56
207 APT010000I64002917 160918 ny. HJ. MARWIAH 
CAIRAN DE18,920.00 2 20,812.00
208 APT010000I64002917 160918 ny. HJ. MARWIAH 
CEFTRIAXO19,999.10 2 21,999.01
209 APT010000I64002917 160918 ny. HJ. MARWIAH 
METAMIZOL4,999.99 3 5,499.99
210 APT010000I64002917 160918 ny. HJ. MARWIAH 
KETOROLAC 7,350.75 3 8,085.82
211 APT010000I64002917 160918 ny. HJ. MARWIAH 
RANITIDIN 7,040.00 2 7,744.00
212 APT010000I64002917 160918 ny. HJ. MARWIAH 
OMEPRAZOL 24,999.70 1 27,499.67
213 APT010000I64002917 160918 ny. HJ. MARWIAH 
SPOIT 10 C 2,310.00 1 2,541.00
214 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN SAL27,830.00 1 30,613.00
215 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN RL 7,149.60 2 7,864.56
216 APT010000I62004457 76534 tn. SAHABUDDIN 
INFUSAN N 6,712.06 1 7,383.27
217 APT010000I62004462 109792 tn. MALLANG 
BUSCOPAN 4,327.40 9 4,760.14
218 APT010000I62004462 109792 tn. MALLANG 
SOTATIC T 394.90 9 434.39

219 APT010000I62004462 109792 tn. MALLANG 

OMEPRAZOL
24,999.70 4 27,499.67

220 APT010000I62004462 109792 tn. MALLANG 

ALPRAZOLA 1,915.83 9 2,107.42
221 APT010000I64002945 161387 tn. RAHMADCAIRAN
NUR  NAC6,409.70 3 7,050.67
222 APT010000I64002945 161387 tn. RAHMADIBUPROFEN
NUR  235.95 3 259.55
223 APT010000I64002945 161387 tn. RAHMADSPOIT
NUR 3 CC 1,485.00 1 1,633.50
224 APT010000I64002945 161387 tn. RAHMADHANDSCOEN
NUR  478.00 2 525.80
225 APT010000I64002945 161387 tn. RAHMADCAIRAN
NUR  AQ 2,860.00 1 3,146.00
226 APT010000I64002945 161387 tn. RAHMADHANDSCOEN
NUR  4,796.00 1 5,275.60
227 APT010000I64002945 161387 tn. RAHMADMASKER
NUR  DI 700.00 2 770.00
228 APT010000I64002945 161387 tn. RAHMADSPOIT
NUR 10 C 2,310.00 2 2,541.00
229 APT010000I62004467 161370 tn. ANDI TRIADI
CEFTRIAXO19,999.10
WAHYUDI  2 21,999.01
230 APT010000I62004467 161370 tn. ANDI TRIADI
KETOROLAC
WAHYUDI 
7,350.75 2 8,085.82
231 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI 
7,040.00 2 7,744.00
232 APT010000I62004467 161370 tn. ANDI TRIADI
PERFUSSOR
WAHYUDI 
21,000.00 1 23,100.00
233 APT010000I32000274 161389 tn. JUNUS LAMBA 
CAIRAN RL 7,149.60 2 7,864.56
234 APT010000I62004470 157170 tn. H. HANAFI 
RANITIDIN 7,040.00 2 7,744.00
235 APT010000I62004470 157170 tn. H. HANAFI 
KETOROLAC 7,350.75 2 8,085.82
236 APT010000I62004470 157170 tn. H. HANAFI 
CEFOTAXIM15,004.00 2 16,504.40
237 APT010000I50000046 161450 tn. H. ABDULLAH
HANDSCOEN
BASONDENG 
478.00 2 525.80
238 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
RL 7,149.60 2 7,864.56
239 APT010000I50000046 161450 tn. H. ABDULLAH
COMBO BASONDENG 
PAC60,500.00 1 66,550.00
240 APT010000I50000046 161450 tn. H. ABDULLAH
COMBIVENT4,549.95
BASONDENG  1 5,004.94
241 APT010000I50000046 161450 tn. H. ABDULLAH
VERTIGOSA
BASONDENG 
4,528.33 2 4,981.17
242 APT010000I50000046 161450 tn. H. ABDULLAH
RANITIDIN
BASONDENG 
7,040.00 1 7,744.00
243 APT010000I50000046 161450 tn. H. ABDULLAH
NEUROSANB5,324.00
BASONDENG  1 5,856.40
244 APT010000I50000046 161450 tn. H. ABDULLAH
SPOIT 3BASONDENG 
CC 1,485.00 3 1,633.50
245 APT010000I50000046 161450 tn. H. ABDULLAH
NASAL BASONDENG 
CA 11,550.07 1 12,705.07
246 APT010000I62004467 161370 tn. ANDI TRIADI
FENTANYL
WAHYUDI 
041,599.80 2 45,759.78
247 APT010000I62004467 161370 tn. ANDI TRIADI
PETHIDIN
WAHYUDI 
H13,191.42 1 14,510.56
248 APT010000I62004467 161370 tn. ANDI TRIADI
MIDAZOLA
WAHYUDI 
8,503.00 3 9,353.30
249 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
CAIRAN RL 7,149.60 1 7,864.56
250 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
COMBO PAC 60,500.00 1 66,550.00
251 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
HANDSCOEN 478.00 8 525.80
252 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
HANDSCOEN 478.00 8 525.80
253 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
RANITIDIN 7,040.00 1 7,744.00
254 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
DULCOLAX 23,571.24 2 25,928.36
 255 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
SPOIT 3 CC 1,485.00 1 1,633.50
256 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
SANTAGESIK4,949.40 1 5,444.34
257 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
CAIRAN RL 7,149.60 3 7,864.56
258 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
RANITIDIN 7,040.00 1 7,744.00
259 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
EPISAN SU 51,150.00 1 56,265.00
260 APT010000I12000074 161418 ny. HJ MUHALLADU 
CEFTRIAXO19,999.10 1 21,999.01
261 APT010000I12000074 161418 ny. HJ MUHALLADU 
CAIRAN NAC6,409.70 2 7,050.67
262 APT010000I62004467 161370 tn. ANDI TRIADI
KETOROLAC
WAHYUDI 
7,350.75 3 8,085.82
263 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI 
7,040.00 3 7,744.00
264 APT010000I62004467 161370 tn. ANDI TRIADI
CEFTRIAXO19,999.10
WAHYUDI  2 21,999.01
Sub Total   612
PCS 15,729.12

PCS 8,712.00

PCS 121,022.0
0
PCS 15,488.00
PCS 847.00
PCS 2,994.75
PCS 3,509.00
PCS 3,267.00
PCS 8,301.42
PCS 4,157.94
PCS 3,354.12
PCS 29,040.00
PCS 3,856.05
PCS 5,082.00
PCS 495.00
PCS 195.41
275,852.8
PCS
0
PCS 43,998.02
PCS 23,100.00
PCS 13,603.70
PCS 43,998.02
PCS 493.90
PCS 14,101.34
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 8,525.00
PCS 54,558.90
PCS 6,425.10
137,926.4
PCS 0
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 8,712.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 54,450.00

PCS 247,499.4
5
PCS 15,488.00
PCS 21,152.01
PCS 1,051.60
PCS 1,540.00
PCS 14,520.00
PCS 8,712.00
PCS 18,150.00
PCS 43,998.02
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 21,999.01
108,900.0
PCS
0
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 14,520.00
PCS 50,965.20
PCS 24,257.46
PCS 94,374.72
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 970.14
- 0
PCS 550.00
PCS 3,626.37
PCS 2,570.70
PCS 12,100.00
PCS 14,101.34
PCS 2,103.20
PCS 770.00
PCS 1,633.50
 108,900.0
PCS
0

PCS 137,926.4
0
114,599.1
PCS
0
PCS 12,585.10
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 8,525.00
PCS 43,998.02
PCS 980.10
PCS 15,488.00
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 5,275.60
PCS 5,082.00
PCS 16,698.00
PCS 1,051.60
PCS 770.00
PCS 699.60
PCS 49,005.00
PCS 117.83
PCS 1,903.00
PCS 1,385.98
PCS 9,680.00
PCS 165.00
PCS 653.40
PCS 165.00
PCS 1,045.42
PCS 195.41
PCS 1,228.53
PCS 10,610.49
224,606.2
PCS
5
PCS 15,488.00
PCS 1,118.04
PCS 1,058.94
224,606.2
PCS
5
PCS 16,171.64
PCS 16,132.52
PCS 1,903.00
PCS 664.40
PCS 3,677.22
PCS 1,246.12
PCS 37,755.30
PCS 2,335.95
PCS 43,998.02
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 23,593.68
PCS 770.00
PCS 8,525.00
PCS 43,998.02
124,780.0
PCS 4
PCS 10,999.98
PCS 15,488.00
PCS 2,541.00
PCS 14,157.00
PCS 14,101.34
PCS 3,963.96
PCS 1,118.04
PCS 0.00
PCS 12,160.50
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 6,160.00
- 0
108,900.0
PCS
0
PCS 15,014.82
PCS 28,182.00
PCS 1,045.42
PCS 770.00
PCS 1,051.60
PCS 43,998.02
PCS 778.65
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 28,202.68
109,998.6
PCS
8
PCS 23,100.00
PCS 13,603.70
PCS 16,499.97
PCS 420.18
PCS 957.38
PCS 235.66
PCS 2,147.16
PCS 310.35
PCS 585.22
PCS 32,626.44
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 493.90
PCS 12,100.00
PCS 21,999.01
PCS 692.99
PCS 778.65
PCS 36,300.00
PCS 9,718.50
PCS 1,015.55
PCS 15,488.00
PCS 22,769.78
PCS 778.65
PCS 76,447.80
PCS 36,779.16
PCS 1,481.70
PCS 7,252.74
PCS 11,583.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
187,170.0
PCS 6
- 0
PCS 32,670.00
PCS 1,650.00
PCS 29,948.60
PCS 2,103.20
PCS 10,879.11
PCS 23,593.68
PCS 41,624.00
PCS 43,998.02
PCS 16,499.97
PCS 24,257.46
PCS 15,488.00
PCS 27,499.67
PCS 2,541.00
PCS 30,613.00
PCS 15,729.12
PCS 7,383.27
PCS 42,841.26
PCS 3,909.51

PCS 109,998.6
8
PCS 18,966.78
PCS 21,152.01
PCS 778.65
PCS 1,633.50
PCS 1,051.60
PCS 3,146.00
PCS 5,275.60
PCS 1,540.00
PCS 5,082.00
PCS 43,998.02
PCS 16,171.64
PCS 15,488.00
PCS 23,100.00
PCS 15,729.12
PCS 15,488.00
PCS 16,171.64
PCS 33,008.80
PCS 1,051.60
PCS 15,729.12
PCS 66,550.00
PCS 5,004.94
PCS 9,962.34
PCS 7,744.00
PCS 5,856.40
PCS 4,900.50
PCS 12,705.07
PCS 91,519.56
PCS 14,510.56
PCS 28,059.90
PCS 7,864.56
PCS 66,550.00
PCS 4,206.40
PCS 4,206.40
PCS 7,744.00
PCS 51,856.72
PCS 1,633.50
PCS 5,444.34
PCS 23,593.68
PCS 7,744.00
PCS 56,265.00
PCS 21,999.01
PCS 14,101.34
PCS 24,257.46
PCS 23,232.00
PCS 43,998.02
5,868,739.12
19-12-
1 APT010000I62004457 76534 tn. SAHABUDDIN 
ACETYLCYS 1,100.00 3 1,210.00
2018 
2 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
3 APT010000I62004471 148491 ny. NURBAENI 
OMEPRAZOL 24,999.70 1 27,499.67
4 APT010000I62004471 148491 ny. NURBAENI 
METOCLOPR5,500.00 2 6,050.00
5 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
6 APT010000I32000274 161389 tn. JUNUS LAMBA 
CAIRAN RL 7,149.60 3 7,864.56
7 APT010000I32000274 161389 tn. JUNUS LAMBA 
SPOIT 5 CC 1,595.00 1 1,754.50
8 APT010000I32000274 161389 tn. JUNUS LAMBA 
CITICOLIN 27,505.00 2 30,255.50
9 APT010000I32000274 161389 tn. JUNUS LAMBA 
RANITIDIN 7,040.00 2 7,744.00
10 APT010000I32000274 161389 tn. JUNUS LAMBA 
NEURODEX 770.00 1 847.00
11 APT010000I32000274 161389 tn. JUNUS LAMBA 
CLOPIDOGR 2,722.50 1 2,994.75
12 APT010000I32000274 161389 tn. JUNUS LAMBA 
DIGOKSIN 107.12 1 117.83
13 APT010000I32000274 161389 tn. JUNUS LAMBA 
HANDSCOEN 478.00 12 525.80
14 APT010000I32000274 161389 tn. JUNUS LAMBA 
MASKER DI 700.00 6 770.00
15 APT010000I32000274 161389 tn. JUNUS LAMBA 
KAPAS AL 300.00 5 330.00
16 APT010000I32000274 161389 tn. JUNUS LAMBA 
IV CATHETE 7,750.00 1 8,525.00
17 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
RL 7,149.60 1 7,864.56
18 APT010000I64002934 161233 tn. SYARIFUDDIN 
CAPTOPRIL 199.99 1 269.99
19 APT010000I64002934 161233 tn. SYARIFUDDIN 
SPIRONOLA 285.75 1 394.34
20 APT010000I64002934 161233 tn. SYARIFUDDIN 
FUROSEMID2,920.50 4 3,796.65
21 APT010000I64002934 161233 tn. SYARIFUDDIN 
RANITIDIN 7,040.00 2 10,700.80
22 APT010000I64002934 161233 tn. SYARIFUDDIN 
CLOPIDOGR 2,722.50 1 3,675.38
23 APT010000I64002934 161233 tn. SYARIFUDDIN 
ASPILETS 816.20 1 1,061.06
24 APT010000I64002934 161233 tn. SYARIFUDDIN 
DIGOKSIN 107.12 4 166.04
25 APT010000I62004456 150708 ny. HJ. ZAENAB
IBUPROFEN
  134.20 9 147.62
26 APT010000I64002945 161387 tn. RAHMAD - NUR  0 0 0
27 APT010000I64002945 161387 tn. RAHMAD CAIRAN
NUR  RL 7,149.60 4 7,864.56
28 APT010000I64002945 161387 tn. RAHMAD SANMOL
NUR  T 297.00 3 326.70
29 APT010000I64002945 161387 tn. RAHMAD CETIRIZIN
NUR  266.01 1 292.61
30 APT010000I64002945 161387 tn. RAHMAD MASKER
NUR  DI 700.00 2 770.00
31 APT010000I64002945 161387 tn. RAHMAD HANDSCOEN
NUR  478.00 4 525.80
32 APT010000I64002945 161387 tn. RAHMAD HANDSCOON
NUR  13,613.00 1 14,974.30
33 APT010000I62004430 161153 tn. MUH NURDIN 
CEFTRIAXO19,999.10 2 21,999.01
34 APT010000I62004430 161153 tn. MUH NURDIN 
PREGABAL 7,623.00 3 8,385.30
35 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN NAC6,409.70 3 7,050.67
36 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 2 770.00
37 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 4 525.80
38 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN NA15,180.00 1 16,698.00
39 APT010000I62004430 161153 tn. MUH NURDIN 
SPOIT 10 C 2,310.00 2 2,541.00
40 APT010000I62004430 161153 tn. MUH NURDIN 
NASAL CA 11,550.07 1 12,705.07
41 APT010000I62004430 161153 tn. MUH NURDIN 
ALPRAZOLA 1,915.83 1 2,107.42
42 APT010000I62004466 161346 ny. RABI  DOMPERID 508.20 10 660.66
43 APT010000I62004466 161346 ny. RABI  SANMOL T 297.00 10 386.10
44 APT010000I62004466 161346 ny. RABI  VALISANBE 396.00 2 534.60
45 APT010000I62004466 161346 ny. RABI  NEURODEX 770.00 10 1,255.10
46 APT010000I62004423 161069 ny. ST AISAYAH
CEFTRIAXO19,999.10
TAHANG  2 21,999.01
47 APT010000I62004423 161069 ny. ST AISAYAH
KETOROLAC
TAHANG 7,350.75 3 8,085.82
48 APT010000I62004423 161069 ny. ST AISAYAH
RANITIDIN
TAHANG 7,040.00 2 7,744.00
49 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
DE18,920.00 2 20,812.00
50 APT010000I62004423 161069 ny. ST AISAYAH
HANDSCOEN
TAHANG 478.00 4 525.80
51 APT010000I62004423 161069 ny. ST AISAYAH
MASKER
TAHANG 
DI 700.00 1 770.00
52 APT010000I62004423 161069 ny. ST AISAYAH
IV DRESSI
TAHANG 4,850.00 1 5,335.00
53 APT010000I62004423 161069 ny. ST AISAYAH
CONECTA
TAHANG 
13,200.00 1 14,520.00
54 APT010000I65003086 161248 ny. JUMANIA 
SANMOL I 24,202.60 3 26,622.86
55 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
56 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 1 21,999.01
57 APT010000I65003086 161248 ny. JUMANIA 
CAIRAN NAC6,409.70 3 7,050.67
58 APT010000I65003086 161248 ny. JUMANIA 
MASKER DI 700.00 1 770.00
59 APT010000I65003086 161248 ny. JUMANIA 
IV CATHETE 7,750.00 2 8,525.00
60 APT010000I62004424 161085 tn. H. BAKING 
AMLODIPIN 838.19 3 922.01
61 APT010000I62004424 161085 tn. H. BAKING 
MICARDIS 5,408.95 3 5,949.85
62 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 629.99 6 692.99
63 APT010000I62004424 161085 tn. H. BAKING 
MECOBALA 616.00 3 677.60
64 APT010000I62004424 161085 tn. H. BAKING 
MELOXICAM 250.00 6 275.00
65 APT010000I62004455 161316 ny. MARIAH CARBAZOC11,145.20 1 12,259.72
66 APT010000I62004455 161316 ny. MARIAH CEFTAZIDIM23,166.00 3 25,482.60
67 APT010000I62004455 161316 ny. MARIAH IBUPROFEN 134.20 3 147.62
68 APT010000I62004440 161194 ny. NASYATI 
CEFIXIME 4,950.00 6 5,445.00
69 APT010000I62004440 161194 ny. NASYATI 
ASAM MEF 325.00 9 357.50
70 APT010000I62004440 161194 ny. NASYATI 
RANITIDIN 629.99 6 692.99
71 APT010000I62004458 140766 ny. BANONG CETIRIZIN 266.01 2 292.61
72 APT010000I62004458 140766 ny. BANONG FUROSEMID 190.99 1 210.09
73 APT010000I62004458 140766 ny. BANONG SPIRONOLA 285.75 1 314.33
74 APT010000I62004458 140766 ny. BANONG DIGOKSIN 107.12 1 117.83
75 APT010000I62004458 140766 ny. BANONG SIMARC TA 975.98 1 1,073.58
76 APT010000I62004458 140766 ny. BANONG VENTOLIN N9,886.80 3 10,875.48
77 APT010000I62004458 140766 ny. BANONG CAIRAN RL 7,149.60 3 7,864.56
78 APT010000I62004458 140766 ny. BANONG MASKER DI 700.00 2 770.00
79 APT010000I62004458 140766 ny. BANONG HANDSCOEN 478.00 4 525.80
80 APT010000I62004458 140766 ny. BANONG CANDESAR 5,500.00 1 6,050.00
81 APT010000I62004411 138920 tn. LACCA LALING 
LEVOFLOXA 449.00 1 493.90
82 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 2 6,050.00
83 APT010000I62004411 138920 tn. LACCA LALING 
RANITIDIN 629.99 2 692.99
84 APT010000I62004411 138920 tn. LACCA LALING 
KETOROLAC 7,350.75 2 8,085.82
85 APT010000I62004411 138920 tn. LACCA LALING 
CEFTRIAXO19,999.10 1 21,999.01

86 APT010000I62004462 109792 tn. MALLANG 

PUMPITOR 62,693.82 4 68,963.20

87 APT010000I62004460 118212 tn. COLLENG 

PUMPITOR 62,693.82 1 68,963.20
88 APT010000I62004460 118212 tn. COLLENG 
SANTAGESIK4,949.40 3 5,444.34
 89 APT010000I62004460 118212 tn. COLLENG 
CAIRAN RL 7,149.60 3 7,864.56
90 APT010000I62004460 118212 tn. COLLENG 
MASKER DI 700.00 1 770.00
91 APT010000I62004460 118212 tn. COLLENG 
HANDSCOEN 478.00 2 525.80
92 APT010000I62004460 118212 tn. COLLENG 
SPOIT 3 CC 1,485.00 1 1,633.50
93 APT010000I62004460 118212 tn. COLLENG 
SPOIT 5 CC 1,595.00 1 1,754.50
94 APT010000I62004460 118212 tn. COLLENG 
IV CATHETE 7,750.00 1 8,525.00
95 APT010000I65003089 161295 nn. SURAYAMASKER
  DI 700.00 1 770.00
96 APT010000I65003089 161295 nn. SURAYAHANDSCOEN
  478.00 2 525.80
97 APT010000I65003089 161295 nn. SURAYALANSOPRAZ
  851.29 1 936.42
98 APT010000I62004449 161279 ny. JUMARIA 
MASKER DI 700.00 1 770.00
99 APT010000I62004449 161279 ny. JUMARIA 
HANDSCOEN 478.00 4 525.80
100 APT010000I62004433 161174 tn. LALA  CIPROFLOX 770.00 2 847.00
101 APT010000I62004433 161174 tn. LALA  CEFTRIAXO19,999.10 2 21,999.01
102 APT010000I62004433 161174 tn. LALA  DEKSAMETA1,801.80 2 1,981.98
103 APT010000I62004433 161174 tn. LALA  RANITIDIN 7,040.00 2 7,744.00
104 APT010000I62004433 161174 tn. LALA  URSODEOX 4,158.00 2 4,573.80
105 APT010000I62004433 161174 tn. LALA  LAKTULOSA30,250.00 1 33,275.00
106 APT010000I12000062 139631 tn. IBRAHIM
CAIRAN
KADIR NAC6,409.70 1 7,050.67
107 APT010000I12000062 139631 tn. IBRAHIM
COMBIVENT4,549.95
KADIR  3 5,004.94
108 APT010000I12000062 139631 tn. IBRAHIM
PULMICORT
KADIR  8,540.00 3 9,394.00
109 APT010000I12000062 139631 tn. IBRAHIM
AMLODIPIN
KADIR  838.19 1 922.01

110 APT010000I12000062 139631 tn. IBRAHIM

METIL
KADIR 
PRE 49,500.00 2 54,450.00

111 APT010000I12000062 139631 tn. IBRAHIM

MASKER
KADIR  DI 700.00 1 770.00
112 APT010000I12000062 139631 tn. IBRAHIM
HANDSCOEN
KADIR  478.00 2 525.80
113 APT010000I12000062 139631 tn. IBRAHIM
SPOIT
KADIR 
5 CC 1,595.00 1 1,754.50
114 APT010000I64002933 159225 tn. ADAM  CEFIXIME 4,950.00 6 5,445.00
115 APT010000I12000071 150670 ny. DESTY MELYANI 
SANTAGESIK4,949.40 1 5,444.34
116 APT010000I12000071 150670 ny. DESTY MELYANI 
CAIRAN RL 7,149.60 3 7,864.56
117 APT010000I12000071 150670 ny. DESTY MELYANI 
MASKER DI 700.00 2 770.00
118 APT010000I12000071 150670 ny. DESTY MELYANI 
SPOIT 10 C 2,310.00 1 2,541.00
119 APT010000I12000071 150670 ny. DESTY MELYANI 
SPOIT 3 CC 1,485.00 1 1,633.50
120 APT010000I12000071 150670 ny. DESTY MELYANI 
SPOIT 1 CC 1,920.00 1 2,112.00
121 APT010000I12000071 150670 ny. DESTY MELYANI 
HANDSCOEN 478.00 4 525.80
122 APT010000I12000071 150670 ny. DESTY MELYANI 
IV CATHETE 7,750.00 1 8,525.00
123 APT010000I62004459 161318 tn. MOCH IQBAL
CEFTRIAXO19,999.10
IBRAHIM  2 21,999.01
124 APT010000I62004459 161318 tn. MOCH IQBAL
SANTAGESIK4,949.40
IBRAHIM  3 5,444.34
125 APT010000I62004459 161318 tn. MOCH IQBAL
CAIRANIBRAHIM 
RL 7,149.60 1 7,864.56
126 APT010000I62004459 161318 tn. MOCH IQBAL
MASKERIBRAHIM 
DI 700.00 1 770.00
127 APT010000I62004459 161318 tn. MOCH IQBAL
HANDSCOEN
IBRAHIM 
478.00 2 525.80
128 APT010000I62004459 161318 tn. MOCH IQBAL
SPOIT IBRAHIM 
10 C 2,310.00 1 2,541.00
129 APT010000I62004459 161318 tn. MOCH IQBAL
SPOIT IBRAHIM 
3 CC 1,485.00 1 1,633.50
130 APT010000I62004459 161318 tn. MOCH IQBAL
SPOIT IBRAHIM 
5 CC 1,595.00 1 1,754.50
131 APT010000I62004459 161318 tn. MOCH IQBAL
IV CATHETE
IBRAHIM 
7,750.00 1 8,525.00
132 APT010000I62004459 161318 tn. MOCH IQBAL
IV DRESSI
IBRAHIM 
4,850.00 1 5,335.00
133 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 2 7,744.00
134 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  923.23 1 1,015.55
135 APT010000I62004435 161179 ny. HASNAWATY
MASKER H  DI 700.00 1 770.00
136 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOEN
H  478.00 6 525.80
137 APT010000I62004435 161179 ny. HASNAWATY
CAIRANH DE18,920.00 3 20,812.00
138 APT010000I62004435 161179 ny. HASNAWATY
SPOIT 10
H  C 2,310.00 1 2,541.00
139 APT010000I62004435 161179 ny. HASNAWATY
SPOIT 3H CC 1,485.00 1 1,633.50
140 APT010000I62004450 161296 tn. AGIL MUHIMUDDIN 
DOXYCYCLI 481.34 6 529.47
141 APT010000I62004390 160844 tn. H. ANDIKETOROLAC
AZAS MANAF, 7,350.75
BA   2 8,085.82
142 APT010000I62004390 160844 tn. H. ANDILANSOPRAZ
AZAS MANAF,851.29
BA   1 936.42
143 APT010000I62004390 160844 tn. H. ANDICITICOLIN
AZAS MANAF, 7,332.97
BA   2 8,066.26
144 APT010000I62004390 160844 tn. H. ANDIMECOBALA
AZAS MANAF,616.00
BA   1 677.60
145 APT010000I62004390 160844 tn. H. ANDINEW
AZASDIAT
MANAF,557.15
BA   6 612.87
146 APT010000I62004390 160844 tn. H. ANDIZINK
AZASOKSI
MANAF,604.00
BA   1 664.40
147 APT010000I62004390 160844 tn. H. ANDINATRIUM
AZAS MANAF,
D 195.91
BA   2 215.50
148 APT010000I62004390 160844 tn. H. ANDIBIOSANBE
AZAS MANAF, 1,017.50
BA   1 1,119.25
149 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   2 7,864.56
150 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   1 770.00
151 APT010000I62004390 160844 tn. H. ANDIHANDSCOEN
AZAS MANAF,478.00
BA   4 525.80
152 APT010000I62004390 160844 tn. H. ANDIALPRAZOLA
AZAS MANAF, 1,915.83
BA   1 2,107.42
153 APT010000I62004475 141894 ny. HATIJAH 
NEW DIAT 557.15 4 612.87
154 APT010000I62004475 141894 ny. HATIJAH 
NATRIUM D 195.91 3 215.50
155 APT010000I62004475 141894 ny. HATIJAH 
RANITIDIN 629.99 6 692.99
156 APT010000I62004475 141894 ny. HATIJAH 
COMBO PAC 60,500.00 1 66,550.00
157 APT010000I62004475 141894 ny. HATIJAH 
CAIRAN RL 7,149.60 2 7,864.56
158 APT010000I62004475 141894 ny. HATIJAH 
HANDSCOEN 478.00 4 525.80
159 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
RANITIDIN 7,040.00 2 7,744.00
160 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
CAIRAN RL 7,149.60 2 7,864.56
161 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
HANDSCOEN 478.00 4 525.80
162 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
MASKER DI 700.00 1 770.00
163 APT010000I32000274 161389 tn. JUNUS LAMBA 
SIMARC TA 975.98 1 1,073.58
164 APT010000I32000274 161389 tn. JUNUS LAMBA 
DIGOKSIN 107.12 1 117.83
165 APT010000I62004424 161085 tn. H. BAKING 
AMLODIPIN 838.19 3 922.01
166 APT010000I62004424 161085 tn. H. BAKING 
MICARDIS 5,408.95 3 5,949.85
167 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 629.99 6 692.99
168 APT010000I62004424 161085 tn. H. BAKING 
MECOBALA 616.00 3 677.60
169 APT010000I62004424 161085 tn. H. BAKING 
MELOXICAM 250.00 6 275.00
170 APT010000I12000062 139631 tn. IBRAHIMCODIPRONT
KADIR  7,937.60 3 8,731.36
171 APT010000I62004463 160654 nn. NUR FADILLAH
CEFIXIMERIZKY 
4,950.00 6 5,445.00
172 APT010000I62004463 160654 nn. NUR FADILLAH
IBUPROFENRIZKY 235.95 6 259.55
173 APT010000I62004463 160654 nn. NUR FADILLAH
RANITIDINRIZKY 
7,040.00 2 7,744.00
174 APT010000I62004394 160864 tn. LUTHERKSR
MARRIBA 
600 M 1,755.00 6 1,930.50
175 APT010000I62004394 160864 tn. LUTHERCURCUMA
MARRIBA  1,098.90 9 1,208.79
176 APT010000I62004436 161180 ny. HAPSAH NEFROSTER49,599.00 1 54,558.90
177 APT010000I62004436 161180 ny. HAPSAH FUROSEMID2,920.50 2 3,212.55
178 APT010000I62004436 161180 ny. HAPSAH 
ASAM TRAN3,493.88 3 3,843.26
179 APT010000I62004436 161180 ny. HAPSAH 
KETOROLAC 7,350.75 3 8,085.82
180 APT010000I62004436 161180 ny. HAPSAH 
CONECTA 13,200.00 2 14,520.00
181 APT010000I62004436 161180 ny. HAPSAH 
TRANSFUSI28,050.00 1 30,855.00
182 APT010000I62004436 161180 ny. HAPSAH 
IV CATHETE 7,750.00 2 8,525.00
183 APT010000I62004436 161180 ny. HAPSAH 
IV DRESSI 4,850.00 1 5,335.00
184 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
185 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU
7,040.00
  2 7,744.00
186 APT010000I62004453 161309 ny. SURIATISANTAGESIK4,949.40
DG. SUNGGU   2 5,444.34
187 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
NAC6,409.70
  3 7,050.67
188 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  1 770.00
189 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
190 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
NA15,180.00
  1 16,698.00
191 APT010000I62004453 161309 ny. SURIATIIVDG.
CATHETE
SUNGGU
7,750.00
  2 8,525.00
192 APT010000I62004453 161309 ny. SURIATITRANSFUSI28,050.00
DG. SUNGGU   1 30,855.00
193 APT010000I65003087 161267 tn. ISKANDAR 
VOLUVEN 621,780.00 1 23,958.00
194 APT010000I65003087 161267 tn. ISKANDAR 
METIL PRE 49,500.00 1 54,450.00
195 APT010000I65003087 161267 tn. ISKANDAR 
RANITIDIN 7,040.00 2 7,744.00
196 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN NAC6,409.70 2 7,050.67
197 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOEN 478.00 2 525.80
198 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 1 770.00
199 APT010000I65003087 161267 tn. ISKANDAR 
IV DRESSI 4,850.00 1 5,335.00
200 APT010000I65003087 161267 tn. ISKANDAR 
CONECTA 13,200.00 1 14,520.00
201 APT010000I32000269 152599 nn. NURAENI
CEFIXIME
MUS   4,950.00 2 5,445.00

202 APT010000I32000269 152599 nn. NURAENI

METIL
MUSPRE
  49,500.00 2 54,450.00

203 APT010000I64002935 161336 nn. IRENE TIVANI 

PUMPITOR 62,693.82 2 68,963.20

204 APT010000I64002935 161336 nn. IRENE TIVANI 

CEFTRIAXO19,999.10 2 21,999.01
205 APT010000I64002935 161336 nn. IRENE TIVANI 
CAIRAN RL 7,149.60 2 7,864.56
206 APT010000I64002935 161336 nn. IRENE TIVANI 
HANDSCOEN 478.00 2 525.80
207 APT010000I64002935 161336 nn. IRENE TIVANI 
MASKER DI 700.00 1 770.00
208 APT010000I64002935 161336 nn. IRENE TIVANI 
IV DRESSI 4,850.00 1 5,335.00
209 APT010000I64002935 161336 nn. IRENE TIVANI 
INFUS SET 7,920.00 1 8,712.00
210 APT010000I64002917 160918 ny. HJ. MARWIAH 
CEFTRIAXO19,999.10 2 21,999.01
211 APT010000I64002917 160918 ny. HJ. MARWIAH 
KETOROLAC 7,350.75 3 8,085.82
212 APT010000I64002929 161294 ny. HASNAH 
CEFTAZIDIM23,166.00 2 25,482.60
213 APT010000I64002929 161294 ny. HASNAH 
METIL PRE 49,500.00 1 54,450.00
214 APT010000I64002929 161294 ny. HASNAH 
CAIRAN NAC6,409.70 2 7,050.67
215 APT010000I64002929 161294 ny. HASNAH 
HANDSCOEN 478.00 2 525.80
216 APT010000I64002929 161294 ny. HASNAH 
MASKER DI 700.00 1 770.00
217 APT010000I64002929 161294 ny. HASNAH 
IV DRESSI 4,850.00 1 5,335.00
218 APT010000I64002929 161294 ny. HASNAH 
INFUS SET 7,920.00 1 8,712.00
219 APT010000I62004467 161370 tn. ANDI TRIADI
CEFTRIAXO19,999.10
WAHYUDI  2 21,999.01
220 APT010000I62004467 161370 tn. ANDI TRIADI
KETOROLAC
WAHYUDI 
7,350.75 3 8,085.82
221 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI 
7,040.00 2 7,744.00
222 APT010000I62004467 161370 tn. ANDI TRIADI
CAIRANWAHYUDI 
RL 7,149.60 3 7,864.56
223 APT010000I62004467 161370 tn. ANDI TRIADI
MASKERWAHYUDI 
DI 700.00 1 770.00
224 APT010000I62004467 161370 tn. ANDI TRIADI
HANDSCOEN
WAHYUDI 
478.00 2 525.80
225 APT010000I62004467 161370 tn. ANDI TRIADI
INFUSWAHYUDI 
SET 7,920.00 1 8,712.00
226 APT010000I62004467 161370 tn. ANDI TRIADI
IV CATHETE
WAHYUDI 
7,750.00 1 8,525.00
227 APT010000I62004470 157170 tn. H. HANAFI 
CEFOTAXIM15,004.00 2 16,504.40
228 APT010000I62004470 157170 tn. H. HANAFI 
KETOROLAC 7,350.75 2 8,085.82
229 APT010000I62004470 157170 tn. H. HANAFI 
RANITIDIN 7,040.00 2 7,744.00
230 APT010000I62004457 76534 tn. SAHABUDDIN 
PUMPITOR 11,330.00 1 12,463.00
231 APT010000I62004457 76534 tn. SAHABUDDIN 
CURCUMA 1,098.90 3 1,208.79
232 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 2 847.00
233 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN NAC6,409.70 1 7,050.67
234 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 2 525.80
235 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 1 770.00
236 APT010000I62004457 76534 tn. SAHABUDDIN 
IV DRESSI 4,850.00 1 5,335.00
237 APT010000I62004457 76534 tn. SAHABUDDIN 
INFUS SET 7,920.00 1 8,712.00
238 APT010000I32000274 161389 tn. JUNUS LAMBA 
ELEKTRODA 4,000.00 5 4,400.00
239 APT010000I32000274 161389 tn. JUNUS LAMBA 
FOLEY CAT 30,000.00 1 33,000.00
240 APT010000I62004411 138920 tn. LACCA LALING 
SPORETIK 5,720.50 6 6,292.55
241 APT010000I62004411 138920 tn. LACCA LALING 
PREGABAL 5,500.00 6 6,050.00
242 APT010000I62004411 138920 tn. LACCA LALING 
TRADOSIK 4,076.00 9 4,483.60
243 APT010000I62004470 157170 tn. H. HANAFI 
MELOXICAM 923.23 1 1,015.55

244 APT010000I62004470 157170 tn. H. HANAFI 

METIL PRE 49,500.00 2 54,450.00

245 APT010000I62004453 161309 ny. SURIATIDULCOLAX

DG. SUNGGU
23,571.24
  2 25,928.36
246 APT010000I62004433 161174 tn. LALA  VITAMIN K 7,920.00 3 8,712.00
247 APT010000I65003081 161225 tn. YUDHA CEFIXIME
  4,950.00 6 5,445.00
248 APT010000I65003081 161225 tn. YUDHA AZITROMYC
  1,777.99 6 1,955.79
249 APT010000I62004460 118212 tn. COLLENG 
CAIRAN RL 7,149.60 3 7,864.56
250 APT010000I62004470 157170 tn. H. HANAFI 
EPEXOL TA 869.00 1 955.90
251 APT010000I62004470 157170 tn. H. HANAFI 
CODEIN 20 1,494.00 1 1,643.40
252 APT010000I62004423 161069 ny. ST AISAYAH
CAIRAN
TAHANG 
DE18,920.00 2 20,812.00
253 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
SAL27,830.00 1 30,613.00
254 APT010000I50000046 161450 tn. H. ABDULLAH
CEFTRIAXO19,999.10
BASONDENG  2 21,999.01
255 APT010000I50000046 161450 tn. H. ABDULLAH
COMBIVENT4,549.95
BASONDENG  3 5,004.94
256 APT010000I50000046 161450 tn. H. ABDULLAH
EPEXOLBASONDENG 
TA 869.00 3 955.90
257 APT010000I50000046 161450 tn. H. ABDULLAH
RANITIDIN
BASONDENG 
7,040.00 2 7,744.00
258 APT010000I50000046 161450 tn. H. ABDULLAH
KSR 600BASONDENG 
M 1,755.00 2 1,930.50
259 APT010000I62004475 141894 ny. HATIJAH 
CAIRAN RL 7,149.60 3 7,864.56

260 APT010000I62004475 141894 ny. HATIJAH 

METRONIDA
56,718.20 3 62,390.02

261 APT010000I62004475 141894 ny. HATIJAH 

NEW DIAT 557.15 6 612.87
262 APT010000I62004475 141894 ny. HATIJAH 
ONDANSETR5,500.00 3 6,050.00
263 APT010000I64002956 161471 tn. NATHANIEL
CAIRAN
SALU 
RL 7,149.60 3 7,864.56
Sub Total   644
PCS 3,630.00

PCS 922.01
PCS 27,499.67
PCS 12,100.00
PCS 5,989.50
PCS 23,593.68
PCS 1,754.50
PCS 60,511.00
PCS 15,488.00
PCS 847.00
PCS 2,994.75
PCS 117.83
PCS 6,309.60
PCS 4,620.00
PCS 1,650.00
PCS 8,525.00
PCS 7,864.56
PCS 269.99
PCS 394.34
PCS 15,186.60
PCS 21,401.60
PCS 3,675.38
PCS 1,061.06
PCS 664.16
PCS 1,328.58
- 0
PCS 31,458.24
PCS 980.10
PCS 292.61
PCS 1,540.00
PCS 2,103.20
PCS 14,974.30
PCS 43,998.02
PCS 25,155.90
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 16,698.00
PCS 5,082.00
PCS 12,705.07
PCS 2,107.42
PCS 6,606.60
PCS 3,861.00
PCS 1,069.20
PCS 12,551.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 41,624.00
PCS 2,103.20
PCS 770.00
PCS 5,335.00
PCS 14,520.00
PCS 79,868.58
PCS 18,150.00
PCS 21,999.01
PCS 21,152.01
PCS 770.00
PCS 17,050.00
PCS 2,766.03
PCS 17,849.55
PCS 4,157.94
PCS 2,032.80
PCS 1,650.00
PCS 12,259.72
PCS 76,447.80
PCS 442.86
PCS 32,670.00
PCS 3,217.50
PCS 4,157.94
PCS 585.22
PCS 210.09
PCS 314.33
PCS 117.83
PCS 1,073.58
PCS 32,626.44
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 6,050.00
PCS 493.90
PCS 12,100.00
PCS 1,385.98
PCS 16,171.64
PCS 21,999.01
275,852.8
PCS
0
PCS 68,963.20
PCS 16,333.02
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 770.00
PCS 1,051.60
PCS 936.42
PCS 770.00
PCS 2,103.20
PCS 1,694.00
PCS 43,998.02
PCS 3,963.96
PCS 15,488.00
PCS 9,147.60
PCS 33,275.00
PCS 7,050.67
PCS 15,014.82
PCS 28,182.00
PCS 922.01
108,900.0
PCS
0
PCS 770.00
PCS 1,051.60
PCS 1,754.50
PCS 32,670.00
PCS 5,444.34
PCS 23,593.68
PCS 1,540.00
PCS 2,541.00
PCS 1,633.50
PCS 2,112.00
PCS 2,103.20
PCS 8,525.00
PCS 43,998.02
PCS 16,333.02
PCS 7,864.56
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 5,335.00
PCS 15,488.00
PCS 1,015.55
PCS 770.00
PCS 3,154.80
PCS 62,436.00
PCS 2,541.00
PCS 1,633.50
PCS 3,176.82
PCS 16,171.64
PCS 936.42
PCS 16,132.52
PCS 677.60
PCS 3,677.22
PCS 664.40
PCS 431.00
PCS 1,119.25
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 2,107.42
PCS 2,451.48
PCS 646.50
PCS 4,157.94
PCS 66,550.00
PCS 15,729.12
PCS 2,103.20
PCS 15,488.00
PCS 15,729.12
PCS 2,103.20
PCS 770.00
PCS 1,073.58
PCS 117.83
PCS 2,766.03
PCS 17,849.55
PCS 4,157.94
PCS 2,032.80
PCS 1,650.00
PCS 26,194.08
PCS 32,670.00
PCS 1,557.30
PCS 15,488.00
PCS 11,583.00
PCS 10,879.11
PCS 54,558.90
PCS 6,425.10
PCS 11,529.78
PCS 24,257.46
PCS 29,040.00
PCS 30,855.00
PCS 17,050.00
PCS 5,335.00
PCS 43,998.02
PCS 15,488.00
PCS 10,888.68
PCS 21,152.01
PCS 770.00
PCS 2,103.20
PCS 16,698.00
PCS 17,050.00
PCS 30,855.00
PCS 23,958.00
PCS 54,450.00
PCS 15,488.00
PCS 14,101.34
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 14,520.00
PCS 10,890.00

PCS 108,900.0
0
137,926.4
PCS
0
PCS 43,998.02
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,712.00
PCS 43,998.02
PCS 24,257.46
PCS 50,965.20
PCS 54,450.00
PCS 14,101.34
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,712.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 8,525.00
PCS 33,008.80
PCS 16,171.64
PCS 15,488.00
PCS 12,463.00
PCS 3,626.37
PCS 1,694.00
PCS 7,050.67
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,712.00
PCS 22,000.00
PCS 33,000.00
PCS 37,755.30
PCS 36,300.00
PCS 40,352.40
PCS 1,015.55

PCS 108,900.0
0
PCS 51,856.72
PCS 26,136.00
PCS 32,670.00
PCS 11,734.74
PCS 23,593.68
PCS 955.90
PCS 1,643.40
PCS 41,624.00
PCS 30,613.00
PCS 43,998.02
PCS 15,014.82
PCS 2,867.70
PCS 15,488.00
PCS 3,861.00
PCS 23,593.68
187,170.0
PCS 6
PCS 3,677.22
PCS 18,150.00
PCS 23,593.68
4,343,264.42
20-12-
1 APT010000I62004476 161475 ny. ANDI MASTURA 
ASERING I 9,645.90 1 10,610.49
2018 
2 APT010000I62004476 161475 ny. ANDI MASTURA 
SANMOL I 24,202.60 3 26,622.86
3 APT010000I62004480 127819 ny. ANDI HERMIATY
CONECTADAMRI 
25,000.00 1 27,500.00
4 APT010000I62004480 127819 ny. ANDI HERMIATY
DESOXIMET DAMRI 
11,500.50 1 12,650.56
5 APT010000I62004480 127819 ny. ANDI HERMIATY
HANDSCOEN DAMRI 
478.00 4 525.80
6 APT010000I62004480 127819 ny. ANDI HERMIATY
SPOIT 3 CCDAMRI 
1,485.00 1 1,633.50
7 APT010000I65003098 155366 tn. DUDUNG CEFTRIAXO19,999.10 2 21,999.01
8 APT010000I65003098 155366 tn. DUDUNG SANMOL T 297.00 3 326.70
9 APT010000I65003098 155366 tn. DUDUNG AMBROXOL 199.65 3 219.62
10 APT010000I65003098 155366 tn. DUDUNG COMBIVENT4,549.95 3 5,004.94
11 APT010000I65003098 155366 tn. DUDUNG RANITIDIN 7,040.00 2 7,744.00
12 APT010000I65003098 155366 tn. DUDUNG PULMICORT 8,540.00 3 9,394.00
13 APT010000I65003098 155366 tn. DUDUNG NEBULIZE 40,535.00 1 44,588.50
14 APT010000I62004471 148491 ny. NURBAENI 
OMEPRAZOL 24,999.70 1 27,499.67
15 APT010000I62004471 148491 ny. NURBAENI 
SOTATIC I 3,032.00 2 3,335.20
16 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
17 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
18 APT010000I64002958 161490 ny. HJ. JUMUDIA 
CAIRAN RL 7,149.60 2 7,864.56
19 APT010000I64002945 161387 tn. RAHMAD CODEIN
NUR  10 605.00 1 665.50
20 APT010000I64002945 161387 tn. RAHMAD SANMOL
NUR  T 297.00 3 326.70
21 APT010000I64002945 161387 tn. RAHMAD CAIRAN
NUR  RL 7,149.60 3 7,864.56
22 APT010000I64002945 161387 tn. RAHMAD MASKER
NUR  DI 700.00 2 770.00
23 APT010000I64002945 161387 tn. RAHMAD HANDSCOEN
NUR  478.00 4 525.80
24 APT010000I64002945 161387 tn. RAHMAD HANDSCOON
NUR  12,100.00 2 13,310.00
25 APT010000I62004470 157170 tn. H. HANAFI 
CEFTRIAXO19,999.10 2 21,999.01
26 APT010000I62004470 157170 tn. H. HANAFI 
RANITIDIN 7,040.00 2 7,744.00

27 APT010000I62004470 157170 tn. H. HANAFI 

METIL PRE 49,500.00 2 54,450.00

28 APT010000I62004470 157170 tn. H. HANAFI 

MELOXICAM 923.23 1 1,015.55
29 APT010000I62004470 157170 tn. H. HANAFI 
CAIRAN RL 7,149.60 2 7,864.56
30 APT010000I62004470 157170 tn. H. HANAFI 
HANDSCOEN 478.00 2 525.80
31 APT010000I62004470 157170 tn. H. HANAFI 
MASKER DI 700.00 1 770.00
32 APT010000I62004470 157170 tn. H. HANAFI 
INFUS SET 7,920.00 1 8,712.00
33 APT010000I64002917 160918 ny. HJ. MARWIAH 
SANMOL T 297.00 3 326.70
34 APT010000I64002917 160918 ny. HJ. MARWIAH 
FARGETIX 407.00 3 447.70
35 APT010000I64002917 160918 ny. HJ. MARWIAH 
CIPROFLOX 770.00 2 847.00
36 APT010000I62004475 141894 ny. HATIJAH 
CAIRAN RL 7,149.60 1 7,864.56
37 APT010000I62004475 141894 ny. HATIJAH 
CAIRAN RL 7,149.60 3 7,864.56
38 APT010000I62004475 141894 ny. HATIJAH 
HANDSCOEN 478.00 4 525.80
39 APT010000I62004475 141894 ny. HATIJAH 
CAIRAN NA15,180.00 1 16,698.00
40 APT010000I62004475 141894 ny. HATIJAH 
AMLODIPIN 838.19 1 922.01
41 APT010000I12000074 161418 ny. HJ MUHALLADU 
SANMOL T 297.00 3 326.70
42 APT010000I12000074 161418 ny. HJ MUHALLADU 
CAIRAN RL 7,149.60 2 7,864.56
43 APT010000I12000074 161418 ny. HJ MUHALLADU 
HANDSCOEN 478.00 2 525.80
44 APT010000I12000074 161418 ny. HJ MUHALLADU 
MASKER DI 700.00 1 770.00
45 APT010000I12000074 161418 ny. HJ MUHALLADU 
TRANSFUSI28,050.00 1 30,855.00
46 APT010000I12000074 161418 ny. HJ MUHALLADU 
CEFTRIAXO19,999.10 2 21,999.01
47 APT010000I12000074 161418 ny. HJ MUHALLADU 
METAMIZOL4,999.99 2 5,499.99
48 APT010000I62004467 161370 tn. ANDI TRIADI
LOMATULL23,100.00
WAHYUDI  2 25,410.00
49 APT010000I62004467 161370 tn. ANDI TRIADI
CEFTRIAXO19,999.10
WAHYUDI  2 21,999.01
50 APT010000I62004467 161370 tn. ANDI TRIADI
KETOROLAC
WAHYUDI 7,350.75 3 8,085.82
51 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI 7,040.00 2 7,744.00
52 APT010000I62004467 161370 tn. ANDI TRIADI
CAIRAN
WAHYUDI 
RL 7,149.60 3 7,864.56
53 APT010000I62004467 161370 tn. ANDI TRIADI
HANDSCOEN
WAHYUDI  478.00 4 525.80
54 APT010000I62004467 161370 tn. ANDI TRIADI
IV CATHETE
WAHYUDI 7,750.00 1 8,525.00
55 APT010000I62004467 161370 tn. ANDI TRIADI
MASKER
WAHYUDI 
DI 700.00 1 770.00
56 APT010000I62004467 161370 tn. ANDI TRIADI
INFUSWAHYUDI 
SET 7,920.00 1 8,712.00
57 APT010000I32000269 152599 nn. NURAENISPORETIK
MUS   5,720.50 2 6,292.55
58 APT010000I32000269 152599 nn. NURAENIMETIL
MUSPRE
  49,500.00 1 54,450.00
59 APT010000I32000269 152599 nn. NURAENIEPEXOL
MUS TA
  869.00 3 955.90
60 APT010000I32000269 152599 nn. NURAENICONECTA
MUS   13,200.00 1 14,520.00
61 APT010000I32000269 152599 nn. NURAENIINFUS
MUSSET
  7,920.00 1 8,712.00
62 APT010000I32000269 152599 nn. NURAENINASAL
MUSCA  11,550.07 1 12,705.07
63 APT010000I32000274 161389 tn. JUNUS LAMBA 
CITICOLIN 7,332.97 6 8,066.26
64 APT010000I32000274 161389 tn. JUNUS LAMBA 
NEURODEX 770.00 3 847.00
65 APT010000I32000274 161389 tn. JUNUS LAMBA 
RANITIDIN 629.99 6 692.99
66 APT010000I32000274 161389 tn. JUNUS LAMBA 
DIGOKSIN 107.12 3 117.83
67 APT010000I32000274 161389 tn. JUNUS LAMBA 
SIMARC TA 975.98 3 1,073.58
68 APT010000I32000274 161389 tn. JUNUS LAMBA 
CAIRAN RL 7,149.60 2 7,864.56
69 APT010000I32000274 161389 tn. JUNUS LAMBA 
HANDSCOEN 478.00 2 525.80
70 APT010000I32000274 161389 tn. JUNUS LAMBA 
MASKER DI 700.00 1 770.00
71 APT010000I32000274 161389 tn. JUNUS LAMBA 
CONECTA 13,200.00 1 14,520.00
72 APT010000I62004423 161069 ny. ST AISAYAH
SPORETIK
TAHANG  5,720.50 6 6,292.55
73 APT010000I62004423 161069 ny. ST AISAYAH
RANITIDIN
TAHANG 629.99 6 692.99
74 APT010000I62004423 161069 ny. ST AISAYAH
FARGOXIN
TAHANG 153.00 9 168.30
75 APT010000I62004430 161153 tn. MUH NURDIN 
ALPRAZOLA 1,915.83 3 2,107.42
76 APT010000I62004430 161153 tn. MUH NURDIN 
LEVOFLOXA 449.00 3 493.90
77 APT010000I62004430 161153 tn. MUH NURDIN 
PREGABAL 5,500.00 9 6,050.00
78 APT010000I62004430 161153 tn. MUH NURDIN 
SPORETIK 5,720.50 6 6,292.55
79 APT010000I62004430 161153 tn. MUH NURDIN 
CAIRAN NAC6,409.70 2 7,050.67
80 APT010000I62004430 161153 tn. MUH NURDIN 
HANDSCOEN 478.00 2 525.80
81 APT010000I62004430 161153 tn. MUH NURDIN 
MASKER DI 700.00 1 770.00
82 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
OMEPRAZOL 24,999.70 2 27,499.67
83 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
CAIRAN RL 7,149.60 2 7,864.56
84 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
HANDSCOEN 478.00 2 525.80
85 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
MASKER DI 700.00 1 770.00
86 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
CONECTA 13,200.00 1 14,520.00

87 APT010000I65003086 161248 ny. JUMANIA 

PARACETA 68,062.50 3 74,868.75
 88 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
89 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
90 APT010000I65003086 161248 ny. JUMANIA 
PUMPITOR 11,330.00 2 12,463.00
91 APT010000I65003086 161248 ny. JUMANIA 
CAIRAN NAC6,409.70 3 7,050.67
92 APT010000I65003086 161248 ny. JUMANIA 
HANDSCOEN 478.00 4 525.80
93 APT010000I65003086 161248 ny. JUMANIA 
TRANSFUSI28,050.00 1 30,855.00
94 APT010000I65003086 161248 ny. JUMANIA 
MASKER DI 700.00 1 770.00
95 APT010000I62004457 76534 tn. SAHABUDDIN 
PUMPITOR 11,330.00 1 12,463.00
96 APT010000I62004457 76534 tn. SAHABUDDIN 
CURCUMA 1,098.90 3 1,208.79
97 APT010000I62004457 76534 tn. SAHABUDDIN 
EPEXOL TA 869.00 3 955.90
98 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 1 847.00
99 APT010000I64002929 161294 ny. HASNAH CEFTAZIDIM23,166.00 2 25,482.60
100 APT010000I64002929 161294 ny. HASNAH METIL PRE 49,500.00 1 54,450.00
101 APT010000I64002929 161294 ny. HASNAH CAIRAN NAC6,409.70 3 7,050.67
102 APT010000I64002929 161294 ny. HASNAH HANDSCOEN 478.00 4 525.80
103 APT010000I64002929 161294 ny. HASNAH MASKER DI 700.00 1 770.00
104 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
105 APT010000I62004471 148491 ny. NURBAENI 
CAIRAN NA15,180.00 2 16,698.00
106 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
107 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 1 770.00
108 APT010000I50000046 161450 tn. H. ABDULLAH
CEFTRIAXO19,999.10
BASONDENG  2 21,999.01
109 APT010000I50000046 161450 tn. H. ABDULLAH
COMBIVENT4,549.95
BASONDENG  2 5,004.94
110 APT010000I50000046 161450 tn. H. ABDULLAH
EPEXOLBASONDENG 
TA 869.00 3 955.90
111 APT010000I50000046 161450 tn. H. ABDULLAH
RANITIDIN
BASONDENG 
7,040.00 2 7,744.00
112 APT010000I50000046 161450 tn. H. ABDULLAH
KSR 600
BASONDENG 
M 1,755.00 2 1,930.50
113 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
RL 7,149.60 3 7,864.56
114 APT010000I50000046 161450 tn. H. ABDULLAH
HANDSCOEN
BASONDENG 
478.00 4 525.80
115 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
NA15,180.00 1 16,698.00
116 APT010000I50000046 161450 tn. H. ABDULLAH
MASKERBASONDENG 
DI 700.00 1 770.00
117 APT010000I50000046 161450 tn. H. ABDULLAH
TRANSFUSI28,050.00
BASONDENG  1 30,855.00
118 APT010000I65003087 161267 tn. ISKANDAR 
VOLUVEN 621,780.00 1 23,958.00
119 APT010000I65003087 161267 tn. ISKANDAR 
RANITIDIN 7,040.00 2 7,744.00
120 APT010000I65003087 161267 tn. ISKANDAR 
URDAFALK 5,527.50 2 6,080.25
121 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN NAC6,409.70 3 7,050.67
122 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 2 770.00
123 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOEN 478.00 4 525.80
124 APT010000I65003087 161267 tn. ISKANDAR 
CONECTA 13,200.00 1 14,520.00
125 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN NA15,180.00 1 16,698.00
126 APT010000I62004424 161085 tn. H. BAKING 
GABAPENTI 4,400.00 2 4,840.00
127 APT010000I62004424 161085 tn. H. BAKING 
KERTAS PU 613.00 6 674.30
128 APT010000I62004424 161085 tn. H. BAKING 
MEGABAL 1,730.00 3 1,903.00
129 APT010000I62004424 161085 tn. H. BAKING 
RANITIDIN 629.99 6 692.99
130 APT010000I62004424 161085 tn. H. BAKING 
SANMOL T 297.00 6 326.70
131 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 75.00 6 82.50
132 APT010000I62004424 161085 tn. H. BAKING 
MELOXICAM 923.23 6 1,015.55
133 APT010000I62004424 161085 tn. H. BAKING 
METIL PRE 702.00 3 772.20
134 APT010000I62004424 161085 tn. H. BAKING 
CANGKANG 75.00 6 82.50
135 APT010000I62004424 161085 tn. H. BAKING 
AMLODIPIN 838.19 3 922.01
136 APT010000I62004424 161085 tn. H. BAKING 
MICARDIS 5,408.95 3 5,949.85
137 APT010000I62004424 161085 tn. H. BAKING 
AMITRIPTY 177.65 2 195.41
138 APT010000I62004424 161085 tn. H. BAKING 
CLOBAZAM 1,116.84 3 1,228.53
139 APT010000I62004449 161279 ny. JUMARIA 
SPORETIK 5,720.50 6 6,292.55
140 APT010000I62004449 161279 ny. JUMARIA 
EPEXOL TA 869.00 9 955.90
141 APT010000I62004449 161279 ny. JUMARIA 
FARGETIX 407.00 9 447.70
142 APT010000I62004477 143142 ny. ANDI MARDIANA
CAIRAN NAC6,409.70
MACHMUD  3 7,050.67
143 APT010000I62004477 143142 ny. ANDI MARDIANA
NEFROSTER MACHMUD 
49,599.00 1 54,558.90
144 APT010000I62004477 143142 ny. ANDI MARDIANA
AMLODIPIN MACHMUD 
838.19 1 922.01
145 APT010000I62004477 143142 ny. ANDI MARDIANA
MICARDIS MACHMUD 
5,408.95 1 5,949.85
146 APT010000I12000071 150670 ny. DESTY MELYANI 
CEFTRIAXO19,999.10 3 21,999.01
147 APT010000I12000071 150670 ny. DESTY MELYANI 
CAIRAN NA15,180.00 2 16,698.00
148 APT010000I12000071 150670 ny. DESTY MELYANI 
CAIRAN RL 7,149.60 2 7,864.56
149 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 2 2,099.35

150 APT010000I62004476 161475 ny. ANDI MASTURA 

PARACETA 68,062.50 3 74,868.75

151 APT010000I62004476 161475 ny. ANDI MASTURA 

CAIRAN RL 7,149.60 2 7,864.56
152 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 2 770.00
153 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 4 525.80
154 APT010000I62004458 140766 ny. BANONG 
FUROSEMID 190.99 1 210.09
155 APT010000I62004458 140766 ny. BANONG 
SPIRONOLA 285.75 1 314.33
156 APT010000I62004458 140766 ny. BANONG 
DIGOKSIN 107.12 1 117.83
157 APT010000I62004458 140766 ny. BANONG 
EPEXOL TA 869.00 2 955.90
158 APT010000I62004458 140766 ny. BANONG 
MICARDIS 5,408.95 1 5,949.85
159 APT010000I62004458 140766 ny. BANONG 
CANDESAR 5,500.00 1 6,050.00
160 APT010000I62004458 140766 ny. BANONG 
FARSORBID 569.18 3 626.10
161 APT010000I62004458 140766 ny. BANONG 
MASKER DI 700.00 0 770.00
162 APT010000I62004458 140766 ny. BANONG 
HANDSCOEN 478.00 4 525.80
163 APT010000I62004458 140766 ny. BANONG 
CAIRAN RL 7,149.60 2 7,864.56

164 APT010000I62004462 109792 tn. MALLANG 

OMEPRAZOL
24,999.70 8 27,499.67

165 APT010000I62004390 160844 tn. H. ANDICITICOLIN

AZAS MANAF,7,332.97
BA   6 8,066.26
166 APT010000I62004390 160844 tn. H. ANDIPUMPITOR
AZAS MANAF,
11,330.00
BA   3 12,463.00
167 APT010000I62004390 160844 tn. H. ANDIMEGABAL
AZAS MANAF,1,730.00
BA   3 1,903.00
168 APT010000I62004390 160844 tn. H. ANDIKALIUM
AZAS MANAF,
DI 566.42
BA   6 623.06
169 APT010000I62004390 160844 tn. H. ANDINEW
AZASDIAT
MANAF,557.15
BA   16 612.87
170 APT010000I62004390 160844 tn. H. ANDIZINK
AZASOKSI
MANAF,604.00
BA   3 664.40
171 APT010000I62004390 160844 tn. H. ANDICAIRAN
AZAS MANAF,
RL 7,149.60
BA   3 7,864.56
172 APT010000I62004390 160844 tn. H. ANDIMASKER
AZAS MANAF,
DI 700.00
BA   1 770.00
173 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN FU41,388.90 1 45,527.79

174 APT010000I64002917 COLOSTOM121,630.0

160918 ny. HJ. MARWIAH  2 133,793.0
0 0
175 APT010000I64002958 161490 ny. HJ. JUMUDIA 
METIL PRE 49,500.00 2 54,450.00

176 APT010000I64002958 161490 ny. HJ. JUMUDIA 

MECOBALAM6,600.00 1 7,260.00
177 APT010000I64002958 161490 ny. HJ. JUMUDIA 
RANITIDIN 7,040.00 2 7,744.00
178 APT010000I64002958 161490 ny. HJ. JUMUDIA 
GABAPENTI 4,400.00 1 4,840.00
179 APT010000I64002958 161490 ny. HJ. JUMUDIA 
CANGKANG 75.00 2 82.50
180 APT010000I64002958 161490 ny. HJ. JUMUDIA 
AMITRIPTY 177.65 2 195.41
181 APT010000I12000062 139631 tn. IBRAHIMCODIPRON10,502.80
KADIR  3 11,553.08
182 APT010000I62004459 161318 tn. MOCH IQBAL
CEFADROXI
IBRAHIM 877.80 9 965.58
183 APT010000I62004459 161318 tn. MOCH IQBAL
FARGETIX
IBRAHIM 407.00 9 447.70
184 APT010000I62004459 161318 tn. MOCH IQBAL
RANITIDIN
IBRAHIM 629.99 6 692.99
185 APT010000I62004460 118212 tn. COLLENG 
METAMIZOL4,999.99 3 5,499.99
186 APT010000I62004460 118212 tn. COLLENG 
OMEPRAZOL 24,999.70 2 27,499.67
187 APT010000I62004433 161174 tn. LALA  CEFTRIAXO19,999.10 2 21,999.01
188 APT010000I62004433 161174 tn. LALA  DEKSAMETA1,801.80 2 1,981.98
189 APT010000I62004433 161174 tn. LALA  RANITIDIN 7,040.00 2 7,744.00
190 APT010000I62004433 161174 tn. LALA  URDAFALK 5,527.50 2 6,080.25
191 APT010000I62004433 161174 tn. LALA  VIP ALBUM 6,600.00 6 7,260.00
192 APT010000I62004433 161174 tn. LALA  EPEXOL TA 869.00 3 955.90
193 APT010000I62004433 161174 tn. LALA  VITAMIN K 7,920.00 3 8,712.00

194 APT010000I62004453 161309 ny. SURIATIMETRONIDA

DG. SUNGGU
56,718.20
  3 62,390.02

195 APT010000I62004453 161309 ny. SURIATIMETAMIZOL4,999.99

DG. SUNGGU   3 5,499.99
196 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU
7,040.00
  3 7,744.00
197 APT010000I12000078 161476 ny. SURIYATI 
ASERING I 9,645.90 1 10,610.49

198 APT010000I12000078 161476 ny. SURIYATI 

PARACETA 68,062.50 3 74,868.75

199 APT010000I12000078 161476 ny. SURIYATI 

METOCLOPR5,500.00 3 6,050.00
200 APT010000I62004478 116304 ny. SARTIAH 
CAIRAN RL 7,149.60 3 7,864.56
201 APT010000I62004478 116304 ny. SARTIAH 
KOTRIMOKS 254.10 4 279.51
202 APT010000I62004478 116304 ny. SARTIAH 
NEW DIAT 557.15 2 612.87
203 APT010000I62004478 116304 ny. SARTIAH 
ONDANSETR5,500.00 3 6,050.00
204 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  923.23 1 1,015.55
205 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 2 7,744.00
206 APT010000I62004455 161316 ny. MARIAH 
CARBAZOC11,145.20 3 12,259.72
207 APT010000I62004455 161316 ny. MARIAH 
CEFTAZIDIM23,166.00 3 25,482.60

208 APT010000I62004455 161316 ny. MARIAH 

PARACETA 68,062.50 3 74,868.75

209 APT010000I62004469 161424 ny. NOER ISMAH 

SANMOL T 297.00 3 326.70
210 APT010000I62004436 161180 ny. HAPSAH 
FUROSEMID 190.99 1 210.09
211 APT010000I62004436 161180 ny. HAPSAH 
PUMPITOR 11,330.00 2 12,463.00
212 APT010000I62004467 161370 tn. ANDI TRIADI
LOMATULL23,100.00
WAHYUDI  2 25,410.00
169,850.0
213 APT010000I62004467 161370 tn. ANDI TRIADI
TENSOCREP
WAHYUDI  1 186,835.0
0 0
214 APT010000I62004470 157170 tn. H. HANAFI 
NEBULIZE 40,535.00 1 44,588.50
 215 APT010000I12000062 139631 tn. IBRAHIM
METIL
KADIR 
PRE 49,500.00 2 54,450.00

216 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95

KADIR  3 5,004.94
217 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
218 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 1 922.01
219 APT010000I62004485 161500 nn. IRAWATICAIRAN
  RL 7,149.60 1 7,864.56
220 APT010000I62004485 161500 nn. IRAWATISPOIT
  3 CC 1,485.00 1 1,633.50
221 APT010000I62004473 161358 ny. MASSINAE 
CEFTRIAXO19,999.10 2 21,999.01
222 APT010000I62004473 161358 ny. MASSINAE 
KETOROLAC 7,350.75 3 8,085.82
223 APT010000I62004473 161358 ny. MASSINAE 
RANITIDIN 7,040.00 2 7,744.00
224 APT010000I62004460 118212 tn. COLLENG 
RANITIDIN 629.99 2 692.99
225 APT010000I62004460 118212 tn. COLLENG 
ASAM MEF 325.00 3 357.50
226 APT010000I62004460 118212 tn. COLLENG 
DULCOLAX 23,571.24 1 25,928.36
227 APT010000I62004481 147195 nn. A FITRIAH
NEW RAMADHANI 
DIAT 557.15 4 612.87
228 APT010000I62004481 147195 nn. A FITRIAH
BUSCOPAN
RAMADHANI 
4,327.40 3 4,760.14
229 APT010000I62004486 161525 tn. UMAR M FUROSEMID2,920.50 1 3,212.55
230 APT010000I62004486 161525 tn. UMAR M ISOSORBID 102.85 1 113.14
231 APT010000I62004486 161525 tn. UMAR M ASPILETS 816.20 1 897.82
232 APT010000I62004486 161525 tn. UMAR M KETOROLAC 7,350.75 1 8,085.82
233 APT010000I62004486 161525 tn. UMAR M SIMVASTAT 751.94 2 827.13
234 APT010000I62004486 161525 tn. UMAR M RANITIDIN 7,040.00 2 7,744.00
235 APT010000I62004486 161525 tn. UMAR M SPOIT 3 CC 1,485.00 3 1,633.50
236 APT010000I62004482 128389 tn. MUHAMMAD
FUROSEMID2,920.50
BAKTIR SYARIEF  1 3,212.55
237 APT010000I62004482 128389 tn. MUHAMMAD
AMLODIPIN
BAKTIR 838.19
SYARIEF  1 922.01
238 APT010000I62004482 128389 tn. MUHAMMAD
SIMUCILBAKTIR
2 1,760.00
SYARIEF  1 1,936.00
239 APT010000I32000269 152599 nn. NURAENIEPISAN
MUS SU
  51,150.00 1 56,265.00
240 APT010000I32000269 152599 nn. NURAENIMETIL
MUSPRE
  702.00 1 772.20
241 APT010000I62004472 161449 tn. NUR ROHMAT 
CAIRAN AQ 2,860.00 2 3,146.00
242 APT010000I62004472 161449 tn. NUR ROHMAT 
CEFTRIAXO19,999.10 1 21,999.01
243 APT010000I62004472 161449 tn. NUR ROHMAT 
KETOROLAC 7,350.75 1 8,085.82
244 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 1 7,744.00
245 APT010000I62004472 161449 tn. NUR ROHMAT 
CAIRAN RL 7,149.60 2 7,864.56
246 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 10 C 2,310.00 3 2,541.00
247 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 3 CC 1,485.00 3 1,633.50
248 APT010000I64002956 161471 tn. NATHANIEL
CEFTRIAXO19,999.10
SALU  2 21,999.01
249 APT010000I64002956 161471 tn. NATHANIEL
PIRACETAM
SALU  10,670.00 2 11,737.00
250 APT010000I64002956 161471 tn. NATHANIEL
KETOROLAC
SALU  7,350.75 2 8,085.82
251 APT010000I64002956 161471 tn. NATHANIEL
RANITIDIN
SALU  7,040.00 1 7,744.00
Sub Total   640

Total 3162
PCS 10,610.49

PCS 79,868.58
PCS 27,500.00
PCS 12,650.56
PCS 2,103.20
PCS 1,633.50
PCS 43,998.02
PCS 980.10
PCS 658.86
PCS 15,014.82
PCS 15,488.00
PCS 28,182.00
PCS 44,588.50
PCS 27,499.67
PCS 6,670.40
PCS 922.01
PCS 5,989.50
PCS 15,729.12
PCS 665.50
PCS 980.10
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 26,620.00
PCS 43,998.02
PCS 15,488.00
108,900.0
PCS
0
PCS 1,015.55
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 980.10
PCS 1,343.10
PCS 1,694.00
PCS 7,864.56
PCS 23,593.68
PCS 2,103.20
PCS 16,698.00
PCS 922.01
PCS 980.10
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 30,855.00
PCS 43,998.02
PCS 10,999.98
PCS 50,820.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 23,593.68
PCS 2,103.20
PCS 8,525.00
PCS 770.00
PCS 8,712.00
PCS 12,585.10
PCS 54,450.00
PCS 2,867.70
PCS 14,520.00
PCS 8,712.00
PCS 12,705.07
PCS 48,397.56
PCS 2,541.00
PCS 4,157.94
PCS 353.49
PCS 3,220.74
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 14,520.00
PCS 37,755.30
PCS 4,157.94
PCS 1,514.70
PCS 6,322.26
PCS 1,481.70
PCS 54,450.00
PCS 37,755.30
PCS 14,101.34
PCS 1,051.60
PCS 770.00
PCS 54,999.34
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 14,520.00
224,606.2
PCS
5
PCS 43,998.02
PCS 18,150.00
PCS 24,926.00
PCS 21,152.01
PCS 2,103.20
PCS 30,855.00
PCS 770.00
PCS 12,463.00
PCS 3,626.37
PCS 2,867.70
PCS 847.00
PCS 50,965.20
PCS 54,450.00
PCS 21,152.01
PCS 2,103.20
PCS 770.00
PCS 1,540.00
PCS 33,396.00
PCS 2,103.20
PCS 770.00
PCS 43,998.02
PCS 10,009.88
PCS 2,867.70
PCS 15,488.00
PCS 3,861.00
PCS 23,593.68
PCS 2,103.20
PCS 16,698.00
PCS 770.00
PCS 30,855.00
PCS 23,958.00
PCS 15,488.00
PCS 12,160.50
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 14,520.00
PCS 16,698.00
PCS 9,680.00
PCS 4,045.80
PCS 5,709.00
PCS 4,157.94
PCS 1,960.20
PCS 495.00
PCS 6,093.30
PCS 2,316.60
PCS 495.00
PCS 2,766.03
PCS 17,849.55
PCS 390.82
PCS 3,685.59
PCS 37,755.30
PCS 8,603.10
PCS 4,029.30
PCS 21,152.01
PCS 54,558.90
PCS 922.01
PCS 5,949.85
PCS 65,997.03
PCS 33,396.00
PCS 15,729.12
PCS 4,198.70
224,606.2
PCS
5
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 210.09
PCS 314.33
PCS 117.83
PCS 1,911.80
PCS 5,949.85
PCS 6,050.00
PCS 1,878.30
PCS 0.00
PCS 2,103.20
PCS 15,729.12
219,997.3
PCS 6
PCS 48,397.56
PCS 37,389.00
PCS 5,709.00
PCS 3,738.36
PCS 9,805.92
PCS 1,993.20
PCS 23,593.68
PCS 770.00
PCS 45,527.79
267,586.0
PCS
0
 108,900.0
PCS
0
PCS 7,260.00
PCS 15,488.00
PCS 4,840.00
PCS 165.00
PCS 390.82
PCS 34,659.24
PCS 8,690.22
PCS 4,029.30
PCS 4,157.94
PCS 16,499.97
PCS 54,999.34
PCS 43,998.02
PCS 3,963.96
PCS 15,488.00
PCS 12,160.50
PCS 43,560.00
PCS 2,867.70
PCS 26,136.00
187,170.0
PCS 6
PCS 16,499.97
PCS 23,232.00
PCS 10,610.49

PCS 224,606.2
5
PCS 18,150.00
PCS 23,593.68
PCS 1,118.04
PCS 1,225.74
PCS 18,150.00
PCS 1,015.55
PCS 15,488.00
PCS 36,779.16
PCS 76,447.80
224,606.2
PCS
5
PCS 980.10
PCS 210.09
PCS 24,926.00
PCS 50,820.00
186,835.0
PCS
0
PCS 44,588.50
 108,900.0
PCS
0
PCS 15,014.82
PCS 28,182.00
PCS 922.01
PCS 7,864.56
PCS 1,633.50
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 1,385.98
PCS 1,072.50
PCS 25,928.36
PCS 2,451.48
PCS 14,280.42
PCS 3,212.55
PCS 113.14
PCS 897.82
PCS 8,085.82
PCS 1,654.26
PCS 15,488.00
PCS 4,900.50
PCS 3,212.55
PCS 922.01
PCS 1,936.00
PCS 56,265.00
PCS 772.20
PCS 6,292.00
PCS 21,999.01
PCS 8,085.82
PCS 7,744.00
PCS 15,729.12
PCS 7,623.00
PCS 4,900.50
PCS 43,998.02
PCS 23,474.00
PCS 16,171.64
PCS 7,744.00
5,586,187.67
 28,381,1
26.24
21-12-
1 APT010000I62004488 102792 tn. ZAINAL AMLODIPIN
ARIFIN  838.19 1 922.01
2018 
2 APT010000I62004488 102792 tn. ZAINAL MICARDIS
ARIFIN  5,408.95 1 5,949.85
3 APT010000I62004488 102792 tn. ZAINAL N-ACE
ARIFIN INJ 38,500.00 2 42,350.00
4 APT010000I62004486 161525 tn. UMAR M CONECTA 13,200.00 1 14,520.00
5 APT010000I62004486 161525 tn. UMAR M FUROSEMID2,920.50 2 3,212.55
6 APT010000I62004486 161525 tn. UMAR M CAPTOPRIL 199.99 2 219.99
7 APT010000I62004486 161525 tn. UMAR M RANITIDIN 7,040.00 2 7,744.00

8 APT010000I62004462 109792 tn. MALLANG 

PUMPITOR 62,693.82 4 68,963.20

9 APT010000I12000078 161476 ny. SURIYATI 

CAIRAN AS 9,645.90 4 10,610.49
10 APT010000I12000078 161476 ny. SURIYATI 
SANMOL I 24,202.60 3 26,622.86
11 APT010000I12000078 161476 ny. SURIYATI 
METOCLOPR5,500.00 3 6,050.00
12 APT010000I62004476 161475 ny. ANDI MASTURA 
SANMOL I 24,202.60 3 26,622.86
13 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 25 869.00 2 955.90
14 APT010000I62004486 161525 tn. UMAR M 
FUROSEMID2,920.50 2 3,212.55
15 APT010000I62004486 161525 tn. UMAR M 
CAPTOPRIL 199.99 1 219.99
16 APT010000I62004486 161525 tn. UMAR M 
RANITIDIN 7,040.00 2 7,744.00
17 APT010000I62004458 140766 ny. BANONG 
FUROSEMID 190.99 3 210.09
18 APT010000I62004458 140766 ny. BANONG 
SPIRONOLA 870.34 1 957.38
19 APT010000I62004458 140766 ny. BANONG 
DIGOKSIN 107.12 3 117.83
20 APT010000I62004458 140766 ny. BANONG 
SIMARC TA 975.98 3 1,073.58
21 APT010000I62004458 140766 ny. BANONG 
CANDESAR 5,500.00 3 6,050.00
22 APT010000I62004458 140766 ny. BANONG 
SALBUTAM 88.00 9 96.80
23 APT010000I62004458 140766 ny. BANONG 
NITROKAF 1,793.99 6 1,973.39
24 APT010000I62004460 118212 tn. COLLENG 
KETOROLAC 7,350.75 3 8,085.82
25 APT010000I62004460 118212 tn. COLLENG 
METAMIZOL4,999.99 3 5,499.99
26 APT010000I62004460 118212 tn. COLLENG 
FARGETIX 407.00 3 447.70
27 APT010000I62004433 161174 tn. LALA  CEFTRIAXO19,999.10 1 21,999.01
28 APT010000I62004433 161174 tn. LALA  RANITIDIN 7,040.00 2 7,744.00
29 APT010000I62004433 161174 tn. LALA  VITAMIN K 7,920.00 3 8,712.00
30 APT010000I62004433 161174 tn. LALA  VIP ALBUM 6,600.00 6 7,260.00
31 APT010000I62004433 161174 tn. LALA  URSODEOX 4,158.00 2 4,573.80
32 APT010000I62004478 116304 ny. SARTIAH 
KOTRIMOKS 254.10 12 279.51
33 APT010000I62004478 116304 ny. SARTIAH 
NEW DIAT 557.15 8 612.87
34 APT010000I62004478 116304 ny. SARTIAH 
ONDANSET 2,151.00 6 2,366.10
35 APT010000I62004477 143142 ny. ANDI MARDIANA
AMLODIPINMACHMUD 
838.19 1 922.01
36 APT010000I62004477 143142 ny. ANDI MARDIANA
MICARDIS MACHMUD 
5,408.95 1 5,949.85
37 APT010000I62004455 161316 ny. MARIAH 
ADONA TA 2,217.60 3 2,439.36
38 APT010000I62004455 161316 ny. MARIAH 
CEFTAZIDIM23,166.00 3 25,482.60
39 APT010000I62004473 161358 ny. MASSINAE 
CEFTRIAXO19,999.10 2 21,999.01
40 APT010000I62004473 161358 ny. MASSINAE 
KETOROLAC 7,350.75 3 8,085.82
41 APT010000I62004473 161358 ny. MASSINAE 
RANITIDIN 7,040.00 2 7,744.00
42 APT010000I62004473 161358 ny. MASSINAE 
SANTAGESIK4,949.40 1 5,444.34
43 APT010000I12000062 139631 tn. IBRAHIM
COMBIVENT4,549.95
KADIR  3 5,004.94
44 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
45 APT010000I12000062 139631 tn. IBRAHIMPUMPITOR
KADIR  11,330.00 1 12,463.00
46 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 1 922.01
47 APT010000I62004485 161500 nn. IRAWATINEW
  DIAT 557.15 3 612.87
48 APT010000I62004485 161500 nn. IRAWATIALPRAZOLA
  1,915.83 1 2,107.42
49 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,330.00 2 12,463.00
50 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
51 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 2 275.00
52 APT010000I62004471 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
53 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
54 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
EPISAN SU 51,150.00 1 56,265.00
55 APT010000I62004468 161404 nn. ARYA RISNAYANTI 
PUMPITOR 11,330.00 6 12,463.00
56 APT010000I62004475 141894 ny. HATIJAH 
TRICHODAZ 1,738.00 9 1,911.80
57 APT010000I62004475 141894 ny. HATIJAH 
NEW DIAT 557.15 10 612.87
58 APT010000I62004475 141894 ny. HATIJAH 
ONDANSET 2,151.00 5 2,366.10
59 APT010000I62004475 141894 ny. HATIJAH 
AMLODIPIN 838.19 3 922.01
60 APT010000I64002958 161490 ny. HJ. JUMUDIA 
METIL PRE 49,500.00 1 54,450.00
61 APT010000I64002958 161490 ny. HJ. JUMUDIA 
MECOBALAM6,600.00 1 7,260.00
62 APT010000I64002958 161490 ny. HJ. JUMUDIA 
RANITIDIN 7,040.00 2 7,744.00
63 APT010000I64002958 161490 ny. HJ. JUMUDIA 
MELOXICAM 923.23 1 1,015.55
64 APT010000I64002945 161387 tn. RAHMAD CODEIN
NUR  20 1,494.00 1 1,643.40
65 APT010000I64002945 161387 tn. RAHMAD SANMOL
NUR  T 297.00 3 326.70
66 APT010000I64002945 161387 tn. RAHMAD CETIRIZIN
NUR  266.01 1 292.61
67 APT010000I62004467 161370 tn. ANDI TRIADI
CEFTRIAXO19,999.10
WAHYUDI  2 21,999.01
68 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI 
7,040.00 2 7,744.00
69 APT010000I62004467 161370 tn. ANDI TRIADI
KETOROLAC
WAHYUDI 
7,350.75 3 8,085.82
70 APT010000I62004470 157170 tn. H. HANAFI 
METIL PRE 49,500.00 1 54,450.00
71 APT010000I62004470 157170 tn. H. HANAFI 
MELOXICAM 923.23 1 1,015.55
72 APT010000I62004470 157170 tn. H. HANAFI 
SIMUCIL 2 1,760.00 3 1,936.00
73 APT010000I62004470 157170 tn. H. HANAFI 
LEVOFLOXA 449.00 1 493.90
74 APT010000I62004470 157170 tn. H. HANAFI 
MECOBALAM6,600.00 1 7,260.00
75 APT010000I62004482 128389 tn. MUHAMMAD
FUROSEMID2,920.50
BAKTIR SYARIEF  2 3,212.55
76 APT010000I62004482 128389 tn. MUHAMMAD
AMLODIPIN
BAKTIR 838.19
SYARIEF  1 922.01
77 APT010000I62004482 128389 tn. MUHAMMAD
RAMIPRIL
BAKTIR 562.68
SYARIEF  1 618.95
78 APT010000I62004453 161309 ny. SURIATIANBACIM
DG. SUNGGUV39,597.00
  2 39,597.00
79 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
80 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
81 APT010000I62004453 161309 ny. SURIATIMETAMIZOL4,999.99
DG. SUNGGU   3 5,499.99
82 APT010000I62004481 147195 nn. A FITRIAH
HYOSCINE
RAMADHANI 
7,480.00 3 8,228.00
83 APT010000I62004481 147195 nn. A FITRIAH
NEW RAMADHANI 
DIAT 557.15 6 612.87
84 APT010000I64002929 161294 ny. HASNAH CEFTAZIDIM23,166.00 2 25,482.60
85 APT010000I64002929 161294 ny. HASNAH METIL PRE 49,500.00 1 54,450.00

86 APT010000I64002929 161294 ny. HASNAH 

PUMPITOR 62,693.82 2 68,963.20

87 APT010000I50000046 161450 tn. H. ABDULLAH

RANITIDIN
BASONDENG 
7,040.00 2 7,744.00
 88 APT010000I50000046 161450 tn. H. ABDULLAH
CEFTRIAXO19,999.10
BASONDENG  2 21,999.01
89 APT010000I50000046 161450 tn. H. ABDULLAH
COMBIVENT4,549.95
BASONDENG  3 5,004.94
90 APT010000I50000046 161450 tn. H. ABDULLAH
EPEXOLBASONDENG 
TA 869.00 3 955.90
91 APT010000I50000046 161450 tn. H. ABDULLAH
KSR 600
BASONDENG 
M 1,755.00 2 1,930.50
92 APT010000I50000046 161450 tn. H. ABDULLAH
HANDSCOEN
BASONDENG 
478.00 4 525.80
93 APT010000I50000046 161450 tn. H. ABDULLAH
MASKERBASONDENG 
DI 700.00 1 770.00
94 APT010000I50000046 161450 tn. H. ABDULLAH
SANMOLBASONDENG 
T 297.00 3 326.70
95 APT010000I65003098 155366 tn. DUDUNG 
CEFTRIAXO19,999.10 2 21,999.01
96 APT010000I65003098 155366 tn. DUDUNG 
EPEXOL TA 869.00 3 955.90
97 APT010000I65003098 155366 tn. DUDUNG 
COMBIVENT4,549.95 3 5,004.94
98 APT010000I65003098 155366 tn. DUDUNG 
RANITIDIN 7,040.00 2 7,744.00
99 APT010000I65003098 155366 tn. DUDUNG 
SANMOL T 297.00 3 326.70
100 APT010000I32000269 152599 nn. NURAENI
SPORETIK
MUS   5,720.50 2 6,292.55
101 APT010000I32000269 152599 nn. NURAENI
METIL
MUSPRE
  819.00 2 900.90
102 APT010000I32000269 152599 nn. NURAENI
PUMPITOR
MUS   11,330.00 2 12,463.00
104,181.0 114,599.1
103 APT010000I32000269 152599 nn. NURAENI
FLEET
MUSENE
  1
0 0
104 APT010000I62004436 161180 ny. HAPSAH  PUMPITOR 11,330.00 1 12,463.00
105 APT010000I62004436 161180 ny. HAPSAH  AMLODIPIN 838.19 1 922.01
106 APT010000I65003086 161248 ny. JUMANIA CEFTRIAXO19,999.10 2 21,999.01
107 APT010000I65003086 161248 ny. JUMANIA ONDANSETR5,500.00 3 6,050.00
108 APT010000I65003086 161248 ny. JUMANIA PUMPITOR 11,330.00 2 12,463.00
109 APT010000I65003086 161248 ny. JUMANIA LEVOFLOXA 449.00 1 493.90
110 APT010000I65003087 161267 tn. ISKANDAR 
URSODEOX 4,158.00 2 4,573.80
111 APT010000I65003087 161267 tn. ISKANDAR 
VOLUVEN 621,780.00 1 23,958.00
112 APT010000I65003087 161267 tn. ISKANDAR 
RANITIDIN 7,040.00 2 7,744.00
113 APT010000I12000074 161418 ny. HJ MUHALLADU 
SANMOL T 297.00 3 326.70
114 APT010000I62004457 76534 tn. SAHABUDDIN 
PUMPITOR 11,330.00 1 12,463.00
115 APT010000I62004457 76534 tn. SAHABUDDIN 
EPEXOL TA 869.00 3 955.90
116 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 3 1,930.50
117 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 
7,040.00 2 7,744.00
118 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 235.95 3 259.55
119 APT010000I62004490 161536 nn. RISKI INDASARI
EPISAN SU
AMIR 
51,150.00 1 56,265.00
120 APT010000I62004433 161174 tn. LALA  CEFIXIME 4,950.00 6 5,445.00
121 APT010000I62004433 161174 tn. LALA  URSODEOX 4,158.00 4 4,573.80
122 APT010000I62004433 161174 tn. LALA  VIP ALBUM 6,600.00 6 7,260.00
123 APT010000I62004433 161174 tn. LALA  PUMPITOR 11,330.00 3 12,463.00
124 APT010000I62004433 161174 tn. LALA  SAGESTAM12,870.00 1 14,157.00
125 APT010000I64002956 161471 tn. NATHANIEL
CEFTRIAXO19,999.10
SALU  2 21,999.01
126 APT010000I64002956 161471 tn. NATHANIEL
RANITIDIN
SALU  7,040.00 2 7,744.00
127 APT010000I64002956 161471 tn. NATHANIEL
KETOROLAC
SALU  7,350.75 2 8,085.82
128 APT010000I64002956 161471 tn. NATHANIEL
PIRACETAM
SALU  10,670.00 2 11,737.00
129 APT010000I64002956 161471 tn. NATHANIEL
CAIRAN
SALU 
NAC6,409.70 3 7,050.67
130 APT010000I64002956 161471 tn. NATHANIEL
HANDSCOEN
SALU  478.00 4 525.80
131 APT010000I64002956 161471 tn. NATHANIEL
CONECTA
SALU  13,200.00 2 14,520.00
132 APT010000I64002956 161471 tn. NATHANIEL
IV CATHETE
SALU  7,750.00 1 8,525.00
133 APT010000I62004488 102792 tn. ZAINAL MICARDIS
ARIFIN  5,408.95 1 5,949.85
134 APT010000I62004488 102792 tn. ZAINAL AMLODIPIN
ARIFIN  838.19 1 922.01
135 APT010000I62004488 102792 tn. ZAINAL COMBIVENT4,549.95
ARIFIN  3 5,004.94
136 APT010000I62004488 102792 tn. ZAINAL NEBULIZE
ARIFIN  40,535.00 1 44,588.50
137 APT010000I62004488 102792 tn. ZAINAL MASKER
ARIFIN  DI 700.00 1 770.00
138 APT010000I62004488 102792 tn. ZAINAL MASKER
ARIFIN  DI 700.00 1 770.00
139 APT010000I62004488 102792 tn. ZAINAL IV
ARIFIN 
CATHETE 7,750.00 1 8,525.00
140 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  7,040.00 2 7,744.00
141 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  923.23 1 1,015.55
142 APT010000I62004469 161424 ny. NOER ISMAH 
SANMOL T 297.00 9 326.70
143 APT010000I62004469 161424 ny. NOER ISMAH 
CIPROFLOX 770.00 6 847.00
144 APT010000I12000071 150670 ny. DESTY MELYANI 
CEFTRIAXO19,999.10 2 21,999.01
145 APT010000I12000071 150670 ny. DESTY MELYANI 
KETOROLAC 7,350.75 3 8,085.82
146 APT010000I62004460 118212 tn. COLLENG 
RANITIDIN 629.99 6 692.99
147 APT010000I62004460 118212 tn. COLLENG 
FARGETIX 407.00 9 447.70
148 APT010000I62004460 118212 tn. COLLENG 
TRICHODAZ 1,738.00 9 1,911.80
149 APT010000I65003086 161248 ny. JUMANIA 
CAIRAN RL 7,149.60 3 7,864.56
150 APT010000I65003086 161248 ny. JUMANIA 
HANDSCOEN 478.00 6 525.80
151 APT010000I65003086 161248 ny. JUMANIA 
MASKER DI 700.00 3 770.00
152 APT010000I65003086 161248 ny. JUMANIA 
SPOIT 10 C 2,310.00 2 2,541.00
153 APT010000I65003086 161248 ny. JUMANIA 
SPOIT 5 CC 1,595.00 2 1,754.50
154 APT010000I65003086 161248 ny. JUMANIA 
INFUS SET 7,920.00 1 8,712.00
155 APT010000I64002945 161387 tn. RAHMAD IV NUR 
CATHETE 7,750.00 1 8,525.00
156 APT010000I64002945 161387 tn. RAHMAD INFUS
NUR SET 7,920.00 1 8,712.00
157 APT010000I64002945 161387 tn. RAHMAD SPOIT
NUR 10 C 2,310.00 1 2,541.00
158 APT010000I64002945 161387 tn. RAHMAD SPOIT
NUR 5 CC 1,595.00 1 1,754.50
159 APT010000I64002945 161387 tn. RAHMAD SPOIT
NUR 3 CC 1,485.00 2 1,633.50
160 APT010000I64002945 161387 tn. RAHMAD CAIRAN
NUR  RL 7,149.60 2 7,864.56
161 APT010000I64002945 161387 tn. RAHMAD HANDSCOEN
NUR  478.00 2 525.80
162 APT010000I64002945 161387 tn. RAHMAD MASKER
NUR  DI 700.00 1 770.00
163 APT010000I12000074 161418 ny. HJ MUHALLADU 
HANDSCOEN 478.00 4 525.80
164 APT010000I12000074 161418 ny. HJ MUHALLADU 
MASKER DI 700.00 2 770.00
165 APT010000I12000074 161418 ny. HJ MUHALLADU 
CAIRAN RL 7,149.60 3 7,864.56
166 APT010000I12000074 161418 ny. HJ MUHALLADU 
SPOIT 10 C 2,310.00 2 2,541.00
167 APT010000I12000074 161418 ny. HJ MUHALLADU 
SPOIT 5 CC 1,595.00 2 1,754.50
168 APT010000I62004482 128389 tn. MUHAMMAD
MASKER BAKTIR
DI 700.00
SYARIEF  1 770.00
169 APT010000I62004482 128389 tn. MUHAMMAD
SPOIT 10
BAKTIR
C 2,310.00
SYARIEF  1 2,541.00
170 APT010000I62004482 128389 tn. MUHAMMAD
SPOIT 3BAKTIR
CC 1,485.00
SYARIEF  1 1,633.50
171 APT010000I62004482 128389 tn. MUHAMMAD
SPOIT 1BAKTIR
CC 1,920.00
SYARIEF  1 2,112.00
172 APT010000I62004482 128389 tn. MUHAMMAD
HANDSCOEN
BAKTIR 478.00
SYARIEF  4 525.80
173 APT010000I62004482 128389 tn. MUHAMMAD
CONECTABAKTIR
13,200.00
SYARIEF  1 14,520.00
174 APT010000I62004471 148491 ny. NURBAENI 
INFUSAN N 6,712.06 2 7,383.27
175 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
176 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 1 770.00
177 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 1 2,541.00
178 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 5 CC 1,595.00 1 1,754.50
179 APT010000I62004471 148491 ny. NURBAENI 
CONECTA 13,200.00 1 14,520.00
180 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN RL 7,149.60 2 7,864.56
181 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOEN 478.00 4 525.80
182 APT010000I65003087 161267 tn. ISKANDAR 
MASKER DI 700.00 2 770.00
183 APT010000I65003087 161267 tn. ISKANDAR 
INFUS SET 7,920.00 1 8,712.00
184 APT010000I62004436 161180 ny. HAPSAH 
HANDSCOEN 478.00 4 525.80
185 APT010000I62004436 161180 ny. HAPSAH 
MASKER DI 700.00 2 770.00
186 APT010000I62004436 161180 ny. HAPSAH 
CAIRAN RL 7,149.60 3 7,864.56
187 APT010000I62004436 161180 ny. HAPSAH 
SPOIT 10 C 2,310.00 2 2,541.00
188 APT010000I62004436 161180 ny. HAPSAH 
SPOIT 5 CC 1,595.00 2 1,754.50
189 APT010000I62004436 161180 ny. HAPSAH 
INFUS SET 7,920.00 1 8,712.00
190 APT010000I64002929 161294 ny. HASNAH 
CAIRAN RL 7,149.60 2 7,864.56
191 APT010000I64002929 161294 ny. HASNAH 
HANDSCOEN 478.00 4 525.80
192 APT010000I64002929 161294 ny. HASNAH 
MASKER DI 700.00 1 770.00
193 APT010000I64002929 161294 ny. HASNAH 
SPOIT 10 C 2,310.00 2 2,541.00
194 APT010000I64002929 161294 ny. HASNAH 
SPOIT 3 CC 1,485.00 1 1,633.50
195 APT010000I64002929 161294 ny. HASNAH 
CONECTA 13,200.00 1 14,520.00
196 APT010000I64002929 161294 ny. HASNAH 
TRANSFUSI28,050.00 1 30,855.00
197 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
RL 7,149.60
  2 7,864.56
198 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
199 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  1 770.00
200 APT010000I62004453 161309 ny. SURIATIINFUS
DG. SUNGGU
SET 7,920.00
  1 8,712.00
201 APT010000I62004470 157170 tn. H. HANAFI 
CAIRAN RL 7,149.60 3 7,864.56
202 APT010000I62004470 157170 tn. H. HANAFI 
MASKER DI 700.00 2 770.00
203 APT010000I62004470 157170 tn. H. HANAFI 
HANDSCOEN 478.00 4 525.80
204 APT010000I62004470 157170 tn. H. HANAFI 
SPOIT 10 C 2,310.00 2 2,541.00
205 APT010000I62004470 157170 tn. H. HANAFI 
SPOIT 5 CC 1,595.00 2 1,754.50
206 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
RL 7,149.60 2 7,864.56
207 APT010000I50000046 161450 tn. H. ABDULLAH
HANDSCOEN
BASONDENG 
478.00 4 525.80
208 APT010000I50000046 161450 tn. H. ABDULLAH
MASKER BASONDENG 
DI 700.00 1 770.00
209 APT010000I50000046 161450 tn. H. ABDULLAH
SPOIT 10
BASONDENG 
C 2,310.00 2 2,541.00
210 APT010000I50000046 161450 tn. H. ABDULLAH
SPOIT 3BASONDENG 
CC 1,485.00 2 1,633.50
211 APT010000I50000046 161450 tn. H. ABDULLAH
SPOIT 5BASONDENG 
CC 1,595.00 1 1,754.50
212 APT010000I50000046 161450 tn. H. ABDULLAH
CONECTABASONDENG 
13,200.00 1 14,520.00
213 APT010000I65003098 155366 tn. DUDUNG 
CAIRAN RL 7,149.60 3 7,864.56
214 APT010000I65003098 155366 tn. DUDUNG 
HANDSCOEN 478.00 4 525.80
215 APT010000I65003098 155366 tn. DUDUNG 
MASKER DI 700.00 1 770.00
216 APT010000I65003098 155366 tn. DUDUNG 
SPOIT 3 CC 1,485.00 2 1,633.50
217 APT010000I65003098 155366 tn. DUDUNG 
SPOIT 10 C 2,310.00 2 2,541.00
218 APT010000I65003098 155366 tn. DUDUNG 
CONECTA 13,200.00 1 14,520.00
219 APT010000I62004467 161370 tn. ANDI TRIADI
CAIRANWAHYUDI 
RL 7,149.60 3 7,864.56
220 APT010000I62004467 161370 tn. ANDI TRIADI
SPOITWAHYUDI 
10 C 2,310.00 2 2,541.00
221 APT010000I62004467 161370 tn. ANDI TRIADI
SPOITWAHYUDI 
3 CC 1,485.00 2 1,633.50
222 APT010000I62004467 161370 tn. ANDI TRIADI
SPOITWAHYUDI 
5 CC 1,595.00 1 1,754.50
223 APT010000I62004467 161370 tn. ANDI TRIADI
HANDSCOEN
WAHYUDI  478.00 4 525.80
224 APT010000I62004467 161370 tn. ANDI TRIADI
MASKERWAHYUDI 
DI 700.00 1 770.00
225 APT010000I62004467 161370 tn. ANDI TRIADI
TRANSFUSI28,050.00
WAHYUDI  1 30,855.00
226 APT010000I62004467 161370 tn. ANDI TRIADI
IV CATHETE
WAHYUDI 
7,750.00 1 8,525.00
227 APT010000I62004472 161449 tn. NUR ROHMAT 
CEFTRIAXO19,999.10 2 21,999.01
228 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 2 7,744.00
229 APT010000I62004472 161449 tn. NUR ROHMAT 
KETOROLAC 7,350.75 3 8,085.82
230 APT010000I62004472 161449 tn. NUR ROHMAT 
KETOROLAC 7,350.75 3 8,085.82
231 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 2 7,744.00
232 APT010000I62004472 161449 tn. NUR ROHMAT 
CAIRAN RL 7,149.60 2 7,864.56
233 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOEN 478.00 2 525.80
234 APT010000I62004472 161449 tn. NUR ROHMAT 
MASKER DI 700.00 1 770.00
235 APT010000I62004472 161449 tn. NUR ROHMAT 
IV DRESSI 4,850.00 1 5,335.00
236 APT010000I62004472 161449 tn. NUR ROHMAT 
TRANSFUSI28,050.00 1 30,855.00
237 APT010000I62004472 161449 tn. NUR ROHMAT 
KETOROLAC 7,350.75 1 8,085.82
238 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 1 7,744.00
239 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 3 CC 1,485.00 2 1,633.50
240 APT010000I62004473 161358 ny. MASSINAE 
CAIRAN RL 7,149.60 4 7,864.56
241 APT010000I62004462 109792 tn. MALLANG 
CAIRAN RL 7,149.60 4 7,864.56
242 APT010000I12000078 161476 ny. SURIYATI 
INFUSAN R 9,645.50 4 10,610.05
243 APT010000I62004476 161475 ny. ANDI MASTURA 
INFUSAN R 9,645.50 4 10,610.05
244 APT010000I62004476 161475 ny. ANDI MASTURA 
TRANSFUSI28,050.00 1 30,855.00
245 APT010000I62004436 161180 ny. HAPSAH 
AMLODIPIN 838.19 3 922.01
246 APT010000I62004494 161562 tn. MUH AGUS
CAIRAN
BASRI
RL BASTIAN 
7,149.60 1 7,864.56
247 APT010000I62004494 161562 tn. MUH AGUS
CAIRAN
BASRI
RL BASTIAN 
7,149.60 3 7,864.56
248 APT010000I62004494 161562 tn. MUH AGUS
RANITIDIN
BASRI BASTIAN 
7,040.00 2 7,744.00
249 APT010000I62004494 161562 tn. MUH AGUS
DOMPERID
BASRI BASTIAN 
508.20 3 559.02
250 APT010000I62004495 161566 tn. ABD KADIR 
CAIRAN RL 7,149.60 1 7,864.56
251 APT010000I62004496 161569 nn. ANDI INDRI
COMBOBATARI 
PAC60,500.00 1 66,550.00
252 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 1 7,864.56
253 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 1 7,744.00
254 APT010000I62004496 161569 nn. ANDI INDRI
SANMOL
BATARI 
I 24,202.60 1 26,622.86
255 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
3 CC 1,485.00 2 1,633.50
256 APT010000I62004496 161569 nn. ANDI INDRI
METILBATARI 
PRE 49,500.00 1 54,450.00
257 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 1 7,744.00
258 APT010000I62004496 161569 nn. ANDI INDRI
CEFTRIAXO19,999.10
BATARI  2 21,999.01
259 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
AQ 2,860.00 1 3,146.00
260 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
10 C 2,310.00 1 2,541.00
261 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
1 CC 1,920.00 1 2,112.00
262 APT010000I62004497 161572 an. AHMADCAIRAN
NUR FAUZAN 
RL 7,149.60 1 7,864.56
263 APT010000I62004497 161572 an. AHMADCOMBO
NUR FAUZAN 
PAC60,500.00 1 66,550.00
264 APT010000I62004497 161572 an. AHMADRANITIDIN
NUR FAUZAN 7,040.00 1 7,744.00
265 APT010000I62004497 161572 an. AHMADONDANSETR5,500.00
NUR FAUZAN  1 6,050.00
266 APT010000I62004497 161572 an. AHMADSPOIT
NUR 3FAUZAN 
CC 1,485.00 2 1,633.50
 267 APT010000I62004497 161572 an. AHMADHANDSCOEN
NUR FAUZAN 478.00 2 525.80
268 APT010000I65003107 161571 ny. SALFIAHKETOROLAC
DG SAYU  7,350.75 1 8,085.82
269 APT010000I65003107 161571 ny. SALFIAHSPOIT
DG SAYU 
3 CC 1,485.00 1 1,633.50
270 APT010000I65003107 161571 ny. SALFIAHCOMBO
DG SAYU 
PAC
60,500.00 1 66,550.00
271 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
RL 7,149.60 1 7,864.56
272 APT010000I65003107 161571 ny. SALFIAHHYOSCINE
DG SAYU  7,480.00 1 8,228.00
273 APT010000I65003107 161571 ny. SALFIAHRANITIDIN
DG SAYU  7,040.00 1 7,744.00
Sub Total   636
PCS 922.01

PCS 5,949.85
PCS 84,700.00
PCS 14,520.00
PCS 6,425.10
PCS 439.98
PCS 15,488.00

PCS 275,852.8
0
PCS 42,441.96
PCS 79,868.58
PCS 18,150.00
PCS 79,868.58
PCS 1,911.80
PCS 6,425.10
PCS 219.99
PCS 15,488.00
PCS 630.27
PCS 957.38
PCS 353.49
PCS 3,220.74
PCS 18,150.00
PCS 871.20
PCS 11,840.34
PCS 24,257.46
PCS 16,499.97
PCS 1,343.10
PCS 21,999.01
PCS 15,488.00
PCS 26,136.00
PCS 43,560.00
PCS 9,147.60
PCS 3,354.12
PCS 4,902.96
PCS 14,196.60
PCS 922.01
PCS 5,949.85
PCS 7,318.08
PCS 76,447.80
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 5,444.34
PCS 15,014.82
PCS 28,182.00
PCS 12,463.00
PCS 922.01
PCS 1,838.61
PCS 2,107.42
PCS 24,926.00
PCS 922.01
PCS 550.00
PCS 5,949.85
PCS 43,998.02
PCS 56,265.00
PCS 74,778.00
PCS 17,206.20
PCS 6,128.70
PCS 11,830.50
PCS 2,766.03
PCS 54,450.00
PCS 7,260.00
PCS 15,488.00
PCS 1,015.55
PCS 1,643.40
PCS 980.10
PCS 292.61
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 54,450.00
PCS 1,015.55
PCS 5,808.00
PCS 493.90
PCS 7,260.00
PCS 6,425.10
PCS 922.01
PCS 618.95
PCS 79,194.00
PCS 43,998.02
PCS 980.10
PCS 16,499.97
PCS 24,684.00
PCS 3,677.22
PCS 50,965.20
PCS 54,450.00
137,926.4
PCS
0
PCS 15,488.00
PCS 43,998.02
PCS 15,014.82
PCS 2,867.70
PCS 3,861.00
PCS 2,103.20
PCS 770.00
PCS 980.10
PCS 43,998.02
PCS 2,867.70
PCS 15,014.82
PCS 15,488.00
PCS 980.10
PCS 12,585.10
PCS 1,801.80
PCS 24,926.00
114,599.1
PCS
0
PCS 12,463.00
PCS 922.01
PCS 43,998.02
PCS 18,150.00
PCS 24,926.00
PCS 493.90
PCS 9,147.60
PCS 23,958.00
PCS 15,488.00
PCS 980.10
PCS 12,463.00
PCS 2,867.70
PCS 5,791.50
PCS 15,488.00
PCS 778.65
PCS 56,265.00
PCS 32,670.00
PCS 18,295.20
PCS 43,560.00
PCS 37,389.00
PCS 14,157.00
PCS 43,998.02
PCS 15,488.00
PCS 16,171.64
PCS 23,474.00
PCS 21,152.01
PCS 2,103.20
PCS 29,040.00
PCS 8,525.00
PCS 5,949.85
PCS 922.01
PCS 15,014.82
PCS 44,588.50
PCS 770.00
PCS 770.00
PCS 8,525.00
PCS 15,488.00
PCS 1,015.55
PCS 2,940.30
PCS 5,082.00
PCS 43,998.02
PCS 24,257.46
PCS 4,157.94
PCS 4,029.30
PCS 17,206.20
PCS 23,593.68
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 8,712.00
PCS 8,525.00
PCS 8,712.00
PCS 2,541.00
PCS 1,754.50
PCS 3,267.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 2,103.20
PCS 1,540.00
PCS 23,593.68
PCS 5,082.00
PCS 3,509.00
PCS 770.00
PCS 2,541.00
PCS 1,633.50
PCS 2,112.00
PCS 2,103.20
PCS 14,520.00
PCS 14,766.54
PCS 2,103.20
PCS 770.00
PCS 2,541.00
PCS 1,754.50
PCS 14,520.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 8,712.00
PCS 2,103.20
PCS 1,540.00
PCS 23,593.68
PCS 5,082.00
PCS 3,509.00
PCS 8,712.00
PCS 15,729.12
PCS 2,103.20
PCS 770.00
PCS 5,082.00
PCS 1,633.50
PCS 14,520.00
PCS 30,855.00
PCS 15,729.12
PCS 2,103.20
PCS 770.00
PCS 8,712.00
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 15,729.12
PCS 2,103.20
PCS 770.00
PCS 5,082.00
PCS 3,267.00
PCS 1,754.50
PCS 14,520.00
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 3,267.00
PCS 5,082.00
PCS 14,520.00
PCS 23,593.68
PCS 5,082.00
PCS 3,267.00
PCS 1,754.50
PCS 2,103.20
PCS 770.00
PCS 30,855.00
PCS 8,525.00
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 24,257.46
PCS 15,488.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 30,855.00
PCS 8,085.82
PCS 7,744.00
PCS 3,267.00
PCS 31,458.24
PCS 31,458.24
PCS 42,440.20
PCS 42,440.20
PCS 30,855.00
PCS 2,766.03
PCS 7,864.56
PCS 23,593.68
PCS 15,488.00
PCS 1,677.06
PCS 7,864.56
PCS 66,550.00
PCS 7,864.56
PCS 7,744.00
PCS 26,622.86
PCS 3,267.00
PCS 54,450.00
PCS 7,744.00
PCS 43,998.02
PCS 3,146.00
PCS 2,541.00
PCS 2,112.00
PCS 7,864.56
PCS 66,550.00
PCS 7,744.00
PCS 6,050.00
PCS 3,267.00
PCS 1,051.60
PCS 8,085.82
PCS 1,633.50
PCS 66,550.00
PCS 7,864.56
PCS 8,228.00
PCS 7,744.00
4,480,307.81
22-12-
1 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN RL 7,149.60 6 7,864.56
2018 
2 APT010000I65003101 161497 ny. LILY HAFSAH 
SPOIT 3 CC 1,485.00 2 1,633.50
3 APT010000I65003101 161497 ny. LILY HAFSAH 
CONECTA 13,200.00 1 14,520.00
4 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOEN 478.00 4 525.80
5 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN NA15,180.00 2 16,698.00
6 APT010000I65003101 161497 ny. LILY HAFSAH 
IV CATHETE16,720.00 1 18,392.00
7 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOEN
H  478.00 6 525.80
8 APT010000I62004435 161179 ny. HASNAWATY
MASKER H  DI 700.00 1 770.00
9 APT010000I62004435 161179 ny. HASNAWATY
CAIRANH RL 7,149.60 3 7,864.56
10 APT010000I62004435 161179 ny. HASNAWATY
IV CATHETE
H  16,720.00 1 18,392.00
11 APT010000I62004435 161179 ny. HASNAWATY
SPOIT 5H CC 1,595.00 2 1,754.50
12 APT010000I62004435 161179 ny. HASNAWATY
CONECTAH  13,200.00 1 14,520.00
13 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  629.99 2 692.99
14 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 3 7,864.56
15 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOON
BATARI 13,613.00 2 14,974.30
16 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 1 770.00
17 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
NA15,180.00 2 16,698.00
18 APT010000I62004495 161566 tn. ABD KADIR 
INFUSAN N 6,712.06 4 7,383.27
19 APT010000I62004495 161566 tn. ABD KADIR 
HANDSCOEN 478.00 4 525.80
20 APT010000I62004495 161566 tn. ABD KADIR 
SPOIT 10 C 2,310.00 2 2,541.00
21 APT010000I62004495 161566 tn. ABD KADIR 
SPOIT 5 CC 1,595.00 2 1,754.50
22 APT010000I62004495 161566 tn. ABD KADIR 
CONECTA 13,200.00 1 14,520.00
23 APT010000I62004495 161566 tn. ABD KADIR 
MASKER DI 700.00 2 770.00
24 APT010000I62004455 161316 ny. MARIAH INFUSAN N 6,712.06 3 7,383.27
25 APT010000I62004455 161316 ny. MARIAH HANDSCOEN 478.00 4 525.80
26 APT010000I62004455 161316 ny. MARIAH MASKER DI 700.00 2 770.00
27 APT010000I62004455 161316 ny. MARIAH SPOIT 10 C 2,310.00 1 2,541.00
28 APT010000I12000062 139631 tn. IBRAHIMINFUSAN
KADIR  N 6,712.06 2 7,383.27
29 APT010000I12000062 139631 tn. IBRAHIMMASKER
KADIR  DI 700.00 1 770.00
30 APT010000I12000062 139631 tn. IBRAHIMHANDSCOEN
KADIR  478.00 2 525.80
31 APT010000I12000062 139631 tn. IBRAHIMSPOIT
KADIR 
1 CC 1,920.00 1 2,112.00
32 APT010000I62004486 161525 tn. UMAR M HANDSCOEN 478.00 4 525.80
33 APT010000I62004486 161525 tn. UMAR M MASKER DI 700.00 2 770.00
34 APT010000I62004486 161525 tn. UMAR M CAIRAN NA15,180.00 2 16,698.00
35 APT010000I62004486 161525 tn. UMAR M SPOIT 10 C 2,310.00 1 2,541.00
36 APT010000I62004486 161525 tn. UMAR M SPOIT 1 CC 1,920.00 1 2,112.00
37 APT010000I62004476 161475 ny. ANDI MASTURA 
ASERING I 9,645.90 3 10,610.49
38 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 1 770.00
39 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 2 525.80
40 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 3 CC 1,485.00 1 1,633.50
41 APT010000I12000078 161476 ny. SURIYATI 
ASERING I 9,645.90 6 10,610.49
42 APT010000I12000078 161476 ny. SURIYATI 
MASKER DI 700.00 2 770.00
43 APT010000I12000078 161476 ny. SURIYATI 
HANDSCOEN 478.00 4 525.80
44 APT010000I12000071 150670 ny. DESTY MELYANI 
CAIRAN RL 7,149.60 3 7,864.56
45 APT010000I12000071 150670 ny. DESTY MELYANI 
MASKER DI 700.00 2 770.00
46 APT010000I12000071 150670 ny. DESTY MELYANI 
HANDSCOEN 478.00 4 525.80
47 APT010000I62004485 161500 nn. IRAWATICAIRAN
  RL 7,149.60 6 7,864.56
48 APT010000I62004485 161500 nn. IRAWATIHANDSCOEN
  478.00 4 525.80
49 APT010000I62004485 161500 nn. IRAWATIMASKER
  DI 700.00 2 770.00
50 APT010000I62004473 161358 ny. MASSINAE 
CAIRAN RL 7,149.60 3 7,864.56
51 APT010000I62004473 161358 ny. MASSINAE 
HANDSCOEN 478.00 4 525.80
52 APT010000I62004473 161358 ny. MASSINAE 
MASKER DI 700.00 2 770.00
53 APT010000I62004462 109792 tn. MALLANG 
INFUSAN N 6,712.06 4 7,383.27
54 APT010000I62004462 109792 tn. MALLANG 
MASKER DI 700.00 2 770.00
55 APT010000I62004462 109792 tn. MALLANG 
HANDSCOEN 478.00 4 525.80
56 APT010000I62004482 128389 tn. MUHAMMAD
CONECTABAKTIR
13,200.00
SYARIEF  1 14,520.00
57 APT010000I62004482 128389 tn. MUHAMMAD
SPOIT 3BAKTIR
CC 1,485.00
SYARIEF  2 1,633.50
58 APT010000I62004482 128389 tn. MUHAMMAD
HANDSCOEN
BAKTIR 478.00
SYARIEF  4 525.80
59 APT010000I62004482 128389 tn. MUHAMMAD
MASKER BAKTIR
DI 700.00
SYARIEF  2 770.00
60 APT010000I62004482 128389 tn. MUHAMMAD
HANDSCOON
BAKTIR
13,613.00
SYARIEF  1 14,974.30
61 APT010000I62004482 128389 tn. MUHAMMAD
NASAL BAKTIR
CA 11,550.07
SYARIEF  1 12,705.07
62 APT010000I62004493 161561 ny. DINARE INFUSAN N 6,712.06 2 7,383.27
63 APT010000I62004493 161561 ny. DINARE HANDSCOEN 478.00 4 525.80
64 APT010000I62004493 161561 ny. DINARE MASKER DI 700.00 2 770.00
65 APT010000I62004493 161561 ny. DINARE SPOIT 10 C 2,310.00 2 2,541.00
66 APT010000I62004493 161561 ny. DINARE SPOIT 1 CC 1,920.00 1 2,112.00
67 APT010000I62004493 161561 ny. DINARE IV CATHETE12,416.00 1 13,657.60
68 APT010000I62004493 161561 ny. DINARE CONECTA 13,200.00 1 14,520.00
69 APT010000I62004493 161561 ny. DINARE INFUS SET 7,920.00 1 8,712.00
70 APT010000I62004493 161561 ny. DINARE NASAL CA 11,550.07 1 12,705.07
71 APT010000I64002958 161490 ny. HJ. JUMUDIA 
CAIRAN RL 7,149.60 2 7,864.56
72 APT010000I64002958 161490 ny. HJ. JUMUDIA 
HANDSCOEN 478.00 4 525.80
73 APT010000I64002958 161490 ny. HJ. JUMUDIA 
MASKER DI 700.00 2 770.00
74 APT010000I64002958 161490 ny. HJ. JUMUDIA 
CONECTA 13,200.00 1 14,520.00
75 APT010000I64002958 161490 ny. HJ. JUMUDIA 
SPOIT 5 CC 1,595.00 2 1,754.50
76 APT010000I64002958 161490 ny. HJ. JUMUDIA 
INFUS SET 7,920.00 1 8,712.00
77 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
78 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
79 APT010000I62004471 148491 ny. NURBAENI 
CONECTA 13,200.00 1 14,520.00
80 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 1 2,541.00
81 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 5 CC 1,595.00 1 1,754.50
82 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 3 CC 1,485.00 2 1,633.50
83 APT010000I12000074 161418 ny. HJ MUHALLADU 
CAIRAN RL 7,149.60 2 7,864.56
84 APT010000I12000074 161418 ny. HJ MUHALLADU 
HANDSCOEN 478.00 4 525.80
85 APT010000I12000074 161418 ny. HJ MUHALLADU 
MASKER DI 700.00 2 770.00
86 APT010000I12000074 161418 ny. HJ MUHALLADU 
CONECTA 13,200.00 1 14,520.00
87 APT010000I12000074 161418 ny. HJ MUHALLADU 
INFUS SET 7,920.00 1 8,712.00
88 APT010000I12000074 161418 ny. HJ MUHALLADU 
SPOIT 10 C 2,310.00 1 2,541.00
89 APT010000I12000074 161418 ny. HJ MUHALLADU 
SPOIT 5 CC 1,595.00 1 1,754.50
 90 APT010000I12000074 161418 ny. HJ MUHALLADU 
SPOIT 3 CC 1,485.00 1 1,633.50
91 APT010000I62004457 76534 tn. SAHABUDDIN 
INFUSAN N 6,712.06 6 7,383.27
92 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 4 525.80
93 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 2 770.00
94 APT010000I62004457 76534 tn. SAHABUDDIN 
CONECTA 13,200.00 1 14,520.00
95 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 5 CC 1,595.00 2 1,754.50
96 APT010000I62004457 76534 tn. SAHABUDDIN 
INFUS SET 7,920.00 1 8,712.00
97 APT010000I32000269 152599 nn. NURAENI CAIRAN
MUS RL
  7,149.60 2 7,864.56
98 APT010000I32000269 152599 nn. NURAENI HANDSCOEN
MUS   478.00 4 525.80
99 APT010000I32000269 152599 nn. NURAENI MASKER
MUS   DI 700.00 2 770.00
100 APT010000I32000269 152599 nn. NURAENI CONECTA
MUS   13,200.00 1 14,520.00
101 APT010000I32000269 152599 nn. NURAENI SPOIT
MUS10  C 2,310.00 2 2,541.00
102 APT010000I32000269 152599 nn. NURAENI SPOIT
MUS5 CC
  1,595.00 2 1,754.50
103 APT010000I32000269 152599 nn. NURAENI INFUS
MUSSET
  7,920.00 1 8,712.00
104 APT010000I65003086 161248 ny. JUMANIA INFUSAN N 6,712.06 3 7,383.27
105 APT010000I65003086 161248 ny. JUMANIA HANDSCOEN 478.00 4 525.80
106 APT010000I65003086 161248 ny. JUMANIA MASKER DI 700.00 2 770.00
107 APT010000I65003086 161248 ny. JUMANIA CONECTA 13,200.00 1 14,520.00
108 APT010000I65003086 161248 ny. JUMANIA SPOIT 10 C 2,310.00 1 2,541.00
109 APT010000I65003086 161248 ny. JUMANIA SPOIT 5 CC 1,595.00 2 1,754.50
110 APT010000I65003086 161248 ny. JUMANIA SPOIT 3 CC 1,485.00 2 1,633.50
111 APT010000I65003086 161248 ny. JUMANIA INFUS SET 7,920.00 1 8,712.00
112 APT010000I65003098 155366 tn. DUDUNG  HANDSCOON 12,100.00 2 13,310.00
113 APT010000I65003098 155366 tn. DUDUNG  MASKER DI 700.00 2 770.00
114 APT010000I65003098 155366 tn. DUDUNG  CONECTA 13,200.00 1 14,520.00
115 APT010000I65003098 155366 tn. DUDUNG  CAIRAN AQ 2,860.00 2 3,146.00
116 APT010000I65003098 155366 tn. DUDUNG  INFUSAN N 6,712.06 2 7,383.27
117 APT010000I62004490 161536 nn. RISKI INDASARI
CAIRAN RLAMIR 
7,149.60 3 7,864.56
118 APT010000I62004490 161536 nn. RISKI INDASARI
HANDSCOENAMIR 478.00 4 525.80
119 APT010000I62004490 161536 nn. RISKI INDASARI
MASKER AMIR 
DI 700.00 2 770.00
120 APT010000I62004490 161536 nn. RISKI INDASARI
CONECTAAMIR 
13,200.00 2 14,520.00
121 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 3 CC
AMIR 
1,485.00 2 1,633.50
122 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 5 CC
AMIR 
1,595.00 2 1,754.50
123 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 10AMIR 
C 2,310.00 2 2,541.00
124 APT010000I62004490 161536 nn. RISKI INDASARI
INFUS SETAMIR 
7,920.00 1 8,712.00
125 APT010000I62004494 161562 tn. MUH AGUSCAIRAN
BASRI
RL BASTIAN 
7,149.60 2 7,864.56
126 APT010000I62004494 161562 tn. MUH AGUSHANDSCOEN
BASRI BASTIAN 
478.00 4 525.80
127 APT010000I62004494 161562 tn. MUH AGUSMASKER
BASRIDIBASTIAN 
700.00 2 770.00
128 APT010000I62004494 161562 tn. MUH AGUSSPOIT
BASRI
3 CC BASTIAN 
1,485.00 2 1,633.50
129 APT010000I62004494 161562 tn. MUH AGUSCONECTA
BASRI BASTIAN 
13,200.00 1 14,520.00
130 APT010000I62004494 161562 tn. MUH AGUSINFUS
BASRI
SET BASTIAN 
7,920.00 1 8,712.00
131 APT010000I64002945 161387 tn. RAHMAD CAIRAN
NUR  RL 7,149.60 3 7,864.56
132 APT010000I64002945 161387 tn. RAHMAD HANDSCOEN
NUR  478.00 4 525.80
133 APT010000I64002945 161387 tn. RAHMAD MASKER
NUR  DI 700.00 2 770.00
134 APT010000I64002945 161387 tn. RAHMAD CONECTA
NUR  13,200.00 1 14,520.00
135 APT010000I62004481 147195 nn. A FITRIAH
CAIRAN
RAMADHANI 
RL 7,149.60 3 7,864.56
136 APT010000I62004481 147195 nn. A FITRIAH
HANDSCOEN
RAMADHANI  478.00 4 525.80
137 APT010000I62004481 147195 nn. A FITRIAH
MASKER
RAMADHANI 
DI 700.00 2 770.00
138 APT010000I62004481 147195 nn. A FITRIAH
CONECTA
RAMADHANI 13,200.00 2 14,520.00
139 APT010000I62004481 147195 nn. A FITRIAH
SPOIT
RAMADHANI 
3 CC 1,485.00 2 1,633.50
140 APT010000I50000046 161450 tn. H. ABDULLAH
INFUSANBASONDENG 
N 6,712.06 2 7,383.27
141 APT010000I50000046 161450 tn. H. ABDULLAH
HANDSCOON
BASONDENG 
12,100.00 2 13,310.00
142 APT010000I50000046 161450 tn. H. ABDULLAH
SPOIT 3BASONDENG 
CC 1,485.00 2 1,633.50
143 APT010000I50000046 161450 tn. H. ABDULLAH
CAIRANBASONDENG 
AQ 2,860.00 1 3,146.00
144 APT010000I62004470 157170 tn. H. HANAFI 
CAIRAN RL 7,149.60 2 7,864.56
145 APT010000I62004470 157170 tn. H. HANAFI 
SPOIT 5 CC 1,595.00 2 1,754.50
146 APT010000I62004470 157170 tn. H. HANAFI 
HANDSCOON 12,100.00 1 13,310.00
147 APT010000I62004470 157170 tn. H. HANAFI 
CAIRAN AQ 2,860.00 2 3,146.00
148 APT010000I64002929 161294 ny. HASNAH INFUSAN N 6,712.06 2 7,383.27
149 APT010000I64002929 161294 ny. HASNAH HANDSCOON 12,100.00 2 13,310.00
150 APT010000I64002929 161294 ny. HASNAH SPOIT 3 CC 1,485.00 2 1,633.50
151 APT010000I64002929 161294 ny. HASNAH CAIRAN AQ 2,860.00 2 3,146.00
152 APT010000I62004467 161370 tn. ANDI TRIADI
INFUSAN
WAHYUDI 
N 6,712.06 2 7,383.27
153 APT010000I62004467 161370 tn. ANDI TRIADI
HANDSCOON
WAHYUDI 12,100.00 2 13,310.00
154 APT010000I65003087 161267 tn. ISKANDAR 
INFUSAN N 6,712.06 2 7,383.27
155 APT010000I65003087 161267 tn. ISKANDAR 
SPOIT 3 CC 1,485.00 1 1,633.50
156 APT010000I65003087 161267 tn. ISKANDAR 
CAIRAN AQ 2,860.00 2 3,146.00
157 APT010000I65003087 161267 tn. ISKANDAR 
HANDSCOON 13,613.00 2 14,974.30
158 APT010000I62004453 161309 ny. SURIATIINFUSAN
DG. SUNGGUN 6,712.06
  2 7,383.27
159 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
3 CC 1,485.00
  2 1,633.50
160 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
AQ 2,860.00
  2 3,146.00
161 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00  4 525.80
162 APT010000I62004494 161562 tn. MUH AGUS
EPISAN
BASRI
SU BASTIAN 
51,150.00 1 56,265.00
163 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  RL 7,149.60 3 7,864.56
164 APT010000I62004499 161575 tn. ALIF PRADITYA
DOMPERID  508.20 3 559.02
165 APT010000I62004499 161575 tn. ALIF PRADITYA
NEUROSANB5,324.00
  1 5,856.40
166 APT010000I62004495 161566 tn. ABD KADIR 
ADONA INJ22,880.00 3 25,168.00
167 APT010000I62004495 161566 tn. ABD KADIR 
VITAMIN K 7,920.00 3 8,712.00
168 APT010000I62004495 161566 tn. ABD KADIR 
ASAM TRAN3,493.88 3 3,843.26
169 APT010000I62004495 161566 tn. ABD KADIR 
RANITIDIN 7,040.00 3 7,744.00
170 APT010000I62004495 161566 tn. ABD KADIR 
HYOSCINE 7,480.00 3 8,228.00
171 APT010000I62004494 161562 tn. MUH AGUS
ALPRAZOLA
BASRI BASTIAN 
1,915.83 1 2,107.42
172 APT010000I62004494 161562 tn. MUH AGUS
RANITIDIN
BASRI BASTIAN 
7,040.00 2 7,744.00
173 APT010000I62004494 161562 tn. MUH AGUS
VOSEDON
BASRI TBASTIAN 
2,431.00 3 2,674.10
174 APT010000I62004467 161370 tn. ANDI TRIADI
CEFIXIME
WAHYUDI  1,317.02 12 1,448.73
175 APT010000I62004467 161370 tn. ANDI TRIADI
RANITIDIN
WAHYUDI  629.99 6 692.99
176 APT010000I62004467 161370 tn. ANDI TRIADI
MELOXICAM
WAHYUDI  923.23 3 1,015.55
177 APT010000I62004481 147195 nn. A FITRIAH
BUSCOPAN
RAMADHANI  4,327.40 6 4,760.14
178 APT010000I32000269 152599 nn. NURAENICEFIXIME
MUS   1,317.02 12 1,448.73
179 APT010000I32000269 152599 nn. NURAENIMETIL
MUSPRE  702.00 12 772.20
180 APT010000I32000269 152599 nn. NURAENI
NYSTATIN
MUS   24,200.00 1 26,620.00
181 APT010000I32000269 152599 nn. NURAENI
EPISAN
MUS SU
  51,150.00 1 56,265.00
182 APT010000I32000269 152599 nn. NURAENI
NEURODEX
MUS   770.00 3 847.00
183 APT010000I32000269 152599 nn. NURAENI
OMEPRAZO
MUS   704.37 6 774.80
184 APT010000I50000046 161450 tn. H. ABDULLAH
CEFIXIME
BASONDENG 
1,317.02 12 1,448.73
185 APT010000I50000046 161450 tn. H. ABDULLAH
EPEXOLBASONDENG 
TA 869.00 9 955.90
186 APT010000I50000046 161450 tn. H. ABDULLAH
AZITROMYC
BASONDENG 
1,777.99 3 1,955.79
187 APT010000I50000046 161450 tn. H. ABDULLAH
SPORETIK
BASONDENG 
5,720.50 3 6,292.55
188 APT010000I50000046 161450 tn. H. ABDULLAH
KSR 600
BASONDENG 
M 1,755.00 6 1,930.50
189 APT010000I62004470 157170 tn. H. HANAFI 
LEVOFLOXA 449.00 1 493.90
190 APT010000I62004470 157170 tn. H. HANAFI 
MELOXICAM 250.00 1 275.00
191 APT010000I62004470 157170 tn. H. HANAFI 
N-ACE INJE38,500.00 1 42,350.00
192 APT010000I62004470 157170 tn. H. HANAFI 
BECLOV INJ13,418.20 1 14,760.02
193 APT010000I62004470 157170 tn. H. HANAFI 
METIL PRE 49,500.00 1 54,450.00
194 APT010000I62004457 76534 tn. SAHABUDDIN 
OMEPRAZO 704.37 1 774.80
195 APT010000I62004457 76534 tn. SAHABUDDIN 
EPEXOL TA 869.00 3 955.90
196 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 1 847.00
197 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 3 1,930.50
198 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01

199 APT010000I65003086 161248 ny. JUMANIA 

PARACETA 68,062.50 3 74,868.75

200 APT010000I65003086 161248 ny. JUMANIA 

ONDANSETR5,500.00 3 6,050.00
201 APT010000I65003086 161248 ny. JUMANIA 
PUMPITOR 11,330.00 2 12,463.00
202 APT010000I65003086 161248 ny. JUMANIA 
LEVOFLOXA 449.00 1 493.90
203 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
204 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  2 326.70
205 APT010000I62004453 161309 ny. SURIATIMETAMIZOL4,999.99
DG. SUNGGU   3 5,499.99

206 APT010000I62004453 161309 ny. SURIATIMETRONIDA

DG. SUNGGU
56,718.20
  3 62,390.02

207 APT010000I62004453 161309 ny. SURIATIRANITIDIN

DG. SUNGGU
7,040.00
  3 7,744.00
208 APT010000I12000074 161418 ny. HJ MUHALLADU 
SANMOL T 297.00 3 326.70
209 APT010000I64002945 161387 tn. RAHMAD- NUR  0 0 0
210 APT010000I64002945 161387 tn. RAHMADSANMOL
NUR  T 297.00 3 326.70
211 APT010000I64002945 161387 tn. RAHMADCETIRIZIN
NUR  266.01 1 292.61
212 APT010000I65003098 155366 tn. DUDUNG 
CEFTRIAXO19,999.10 2 21,999.01
213 APT010000I65003098 155366 tn. DUDUNG 
EPEXOL TA 869.00 3 955.90
214 APT010000I65003098 155366 tn. DUDUNG 
COMBIVENT4,549.95 3 5,004.94
215 APT010000I65003098 155366 tn. DUDUNG 
RANITIDIN 7,040.00 2 7,744.00

216 APT010000I62004471 148491 ny. NURBAENI 

PUMPITOR 62,693.82 2 68,963.20

217 APT010000I62004471 148491 ny. NURBAENI 

MELOXICAM 250.00 1 275.00
218 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
219 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
220 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 
7,040.00 2 7,744.00
221 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 235.95 3 259.55
222 APT010000I62004490 161536 nn. RISKI INDASARI
CEFADROXI
AMIR 877.80 2 965.58
223 APT010000I64002929 161294 ny. HASNAH  CEFTAZIDIM23,166.00 3 25,482.60
224 APT010000I64002929 161294 ny. HASNAH  METIL PRE 49,500.00 1 54,450.00
225 APT010000I64002929 161294 ny. HASNAH  PUMPITOR 11,330.00 2 12,463.00
226 APT010000I64002958 161490 ny. HJ. JUMUDIA 
MEGABAL 1,730.00 3 1,903.00
227 APT010000I64002958 161490 ny. HJ. JUMUDIA 
RANITIDIN 629.99 6 692.99
228 APT010000I64002958 161490 ny. HJ. JUMUDIA 
MELOXICAM 923.23 3 1,015.55
229 APT010000I64002958 161490 ny. HJ. JUMUDIA 
GABAPENTI 4,400.00 1 4,840.00
230 APT010000I64002958 161490 ny. HJ. JUMUDIA 
CANGKANG 116.90 6 128.59
231 APT010000I64002958 161490 ny. HJ. JUMUDIA 
AMITRIPTY 177.65 2 195.41
232 APT010000I62004485 161500 nn. IRAWATI NEW
  DIAT 557.15 6 612.87
233 APT010000I62004485 161500 nn. IRAWATI ALPRAZOLA
  1,915.83 1 2,107.42
234 APT010000I62004473 161358 ny. MASSINAE 
SPORETIK 5,720.50 6 6,292.55
235 APT010000I62004473 161358 ny. MASSINAE 
SANMOL T 297.00 9 326.70
236 APT010000I62004473 161358 ny. MASSINAE 
NEURODEX 770.00 6 847.00

237 APT010000I62004476 161475 ny. ANDI MASTURA 

PARACETA 68,062.50 3 74,868.75

238 APT010000I62004476 161475 ny. ANDI MASTURA 

FLAMAR 50 1,908.50 2 2,099.35
239 APT010000I12000071 150670 ny. DESTY MELYANI 
CEFTRIAXO19,999.10 2 21,999.01
240 APT010000I12000071 150670 ny. DESTY MELYANI 
KETOROLAC 7,350.75 3 8,085.82
241 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  629.99 2 692.99
242 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  250.00 1 275.00
243 APT010000I62004455 161316 ny. MARIAH 
SPORETIK 5,720.50 6 6,292.55

244 APT010000I12000078 161476 ny. SURIYATI 

PARACETA 68,062.50 3 74,868.75

245 APT010000I12000078 161476 ny. SURIYATI 

METOCLOPR5,500.00 3 6,050.00
246 APT010000I12000078 161476 ny. SURIYATI 
CEFTRIAXO19,999.10 2 21,999.01
247 APT010000I12000078 161476 ny. SURIYATI 
LODIA TAB 1,045.00 6 1,149.50
248 APT010000I62004462 109792 tn. MALLANG 
INFUSAN N 6,712.06 5 7,383.27
249 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
RL 7,149.60 3 7,864.56
250 APT010000I65003107 161571 ny. SALFIAHMETOCLOPR5,500.00
DG SAYU  3 6,050.00
251 APT010000I65003107 161571 ny. SALFIAHRANITIDIN
DG SAYU  7,040.00 2 7,744.00
252 APT010000I65003107 161571 ny. SALFIAHSANMOL
DG SAYU 
T 297.00 2 326.70
253 APT010000I62004497 161572 an. AHMADONDANSETR5,500.00
NUR FAUZAN  2 6,050.00
254 APT010000I62004497 161572 an. AHMADEPEXOL
NUR FAUZAN 
TA 869.00 3 955.90
255 APT010000I62004486 161525 tn. UMAR M FUROSEMID2,920.50 2 3,212.55
256 APT010000I62004486 161525 tn. UMAR M CAPTOPRIL 199.99 1 219.99
257 APT010000I62004486 161525 tn. UMAR M RANITIDIN 7,040.00 2 7,744.00
258 APT010000I62004486 161525 tn. UMAR M SPIRONOLA 870.34 1 957.38
259 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 2 7,744.00
260 APT010000I62004496 161569 nn. ANDI INDRI
CEFTRIAXO19,999.10
BATARI  2 21,999.01
261 APT010000I62004496 161569 nn. ANDI INDRI
DOMPERID
BATARI  508.20 2 559.02
262 APT010000I65003101 161497 ny. LILY HAFSAH 
VOLUVEN 621,780.00 1 23,958.00
263 APT010000I65003101 161497 ny. LILY HAFSAH 
SANMOL T 297.00 3 326.70
264 APT010000I62004486 161525 tn. UMAR M DIGOKSIN 107.12 3 117.83
265 APT010000I12000062 139631 tn. IBRAHIM
COMBIVENT4,549.95
KADIR  3 5,004.94
266 APT010000I12000062 139631 tn. IBRAHIM
PULMICORT
KADIR  8,540.00 3 9,394.00
267 APT010000I12000062 139631 tn. IBRAHIM
PUMPITOR
KADIR  11,330.00 1 12,463.00
268 APT010000I12000062 139631 tn. IBRAHIM
AMLODIPIN
KADIR  838.19 1 922.01
269 APT010000I64002945 161387 tn. RAHMADSPORETIK
NUR  5,720.50 6 6,292.55
270 APT010000I64002945 161387 tn. RAHMADCETIRIZIN
NUR  266.01 3 292.61
271 APT010000I62004471 148491 ny. NURBAENI 
SPORETIK 5,720.50 2 6,292.55
272 APT010000I62004436 161180 ny. HAPSAH 
AMLODIPIN 838.19 3 922.01
273 APT010000I62004462 109792 tn. MALLANG 
PUMPITOR 11,330.00 3 12,463.00
274 APT010000I64002945 161387 tn. RAHMADSANMOL
NUR  T 297.00 9 326.70
275 APT010000I62004482 128389 tn. MUHAMMAD
ALPRAZOLA
BAKTIR
1,915.83
SYARIEF  2 2,107.42
276 APT010000I62004482 128389 tn. MUHAMMAD
FUROSEMID
BAKTIR 190.99
SYARIEF  3 210.09
277 APT010000I62004482 128389 tn. MUHAMMAD
RAMIPRIL
BAKTIR 562.68
SYARIEF  2 618.95
278 APT010000I62004482 128389 tn. MUHAMMAD
AMLODIPIN
BAKTIR 838.19
SYARIEF  3 922.01
279 APT010000I62004504 161146 ny. NIRWANA 
COMBO PAC 60,500.00 1 66,550.00
280 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN RL 7,149.60 1 7,864.56
281 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 4 525.80
282 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 2 770.00
283 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 3 CC 1,485.00 2 1,633.50
284 APT010000I62004504 161146 ny. NIRWANA 
RANITIDIN 7,040.00 1 7,744.00
285 APT010000I62004504 161146 ny. NIRWANA 
SANTAGESIK4,949.40 1 5,444.34
286 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 2 21,999.01
287 APT010000I62004506 161611 tn. ALI NGURAWAN 
ASAM TRAN3,493.88 3 3,843.26
288 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 2 7,744.00
289 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 1 7,864.56
290 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 3 CC 1,485.00 3 1,633.50
291 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 5 CC 1,595.00 2 1,754.50
292 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 10 C 2,310.00 2 2,541.00
293 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN AQ 2,860.00 1 3,146.00
294 APT010000I62004503 159886 tn. MUH BASIR
IV CATHETE
LALANG 7,750.00 1 10,462.50

295 APT010000I65003101 161497 ny. LILY HAFSAH 

METIL PRE 49,500.00 3 54,450.00

296 APT010000I65003101 161497 ny. LILY HAFSAH 

NEW DIAT 557.15 4 612.87
297 APT010000I65003101 161497 ny. LILY HAFSAH 
OMEPRAZOL24,999.70 2 27,499.67
298 APT010000I65003101 161497 ny. LILY HAFSAH 
SANMOL I 24,202.60 3 26,622.86
299 APT010000I62004504 161146 ny. NIRWANA 
KETOROLAC 7,350.75 1 8,085.82
300 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 2 525.80
301 APT010000I62004504 161146 ny. NIRWANA 
RANITIDIN 7,040.00 1 7,744.00
302 APT010000I62004504 161146 ny. NIRWANA 
SALOFALK 4,675.00 2 5,142.50
303 APT010000I62004504 161146 ny. NIRWANA 
CURCUMA 1,098.90 2 1,208.79
304 APT010000I62004504 161146 ny. NIRWANA 
CEFIXIME 1,317.02 2 1,448.73
305 APT010000I65003107 161571 ny. SALFIAHKOTRIMOKS
DG SAYU  254.10 4 279.51
306 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
RL 7,149.60 3 7,864.56
307 APT010000I65003107 161571 ny. SALFIAHHANDSCOEN
DG SAYU  478.00 4 525.80
308 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
NA15,180.00 2 16,698.00
 309 APT010000I62004500 161581 ny. SERI BINTANG 
HANDSCOEN 478.00 4 525.80
310 APT010000I62004500 161581 ny. SERI BINTANG 
MASKER DI 700.00 1 770.00
311 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 3 CC 1,485.00 2 1,633.50
312 APT010000I62004500 161581 ny. SERI BINTANG 
IV CATHETE 7,750.00 2 8,525.00
313 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 5 CC 1,595.00 2 1,754.50
314 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN RL 7,149.60 2 7,864.56
315 APT010000I64002929 161294 ny. HASNAH HANDSCOEN 478.00 4 525.80
316 APT010000I64002929 161294 ny. HASNAH IV CATHETE 7,750.00 2 8,525.00
317 APT010000I64002929 161294 ny. HASNAH SPOIT 10 C 2,310.00 2 2,541.00
318 APT010000I64002929 161294 ny. HASNAH SPOIT 5 CC 1,595.00 2 1,754.50
319 APT010000I64002929 161294 ny. HASNAH SPOIT 3 CC 1,485.00 2 1,633.50
320 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 2 525.80
321 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
322 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
323 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
324 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 10 C 2,310.00 1 2,541.00
325 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN RL 7,149.60 2 7,864.56
326 APT010000I32000269 152599 nn. NURAENIHANDSCOEN
MUS   478.00 2 525.80
327 APT010000I32000269 152599 nn. NURAENIIV CATHETE
MUS   7,750.00 1 8,525.00
328 APT010000I32000269 152599 nn. NURAENISPOIT
MUS3 CC
  1,485.00 1 1,633.50
329 APT010000I32000269 152599 nn. NURAENISPOIT
MUS5 CC
  1,595.00 1 1,754.50
330 APT010000I32000269 152599 nn. NURAENISPOIT
MUS10  C 2,310.00 1 2,541.00
Sub Total   817
PCS 47,187.36

PCS 3,267.00
PCS 14,520.00
PCS 2,103.20
PCS 33,396.00
PCS 18,392.00
PCS 3,154.80
PCS 770.00
PCS 23,593.68
PCS 18,392.00
PCS 3,509.00
PCS 14,520.00
PCS 1,385.98
PCS 23,593.68
PCS 29,948.60
PCS 770.00
PCS 33,396.00
PCS 29,533.08
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 14,520.00
PCS 1,540.00
PCS 22,149.81
PCS 2,103.20
PCS 1,540.00
PCS 2,541.00
PCS 14,766.54
PCS 770.00
PCS 1,051.60
PCS 2,112.00
PCS 2,103.20
PCS 1,540.00
PCS 33,396.00
PCS 2,541.00
PCS 2,112.00
PCS 31,831.47
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 63,662.94
PCS 1,540.00
PCS 2,103.20
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 47,187.36
PCS 2,103.20
PCS 1,540.00
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 29,533.08
PCS 1,540.00
PCS 2,103.20
PCS 14,520.00
PCS 3,267.00
PCS 2,103.20
PCS 1,540.00
PCS 14,974.30
PCS 12,705.07
PCS 14,766.54
PCS 2,103.20
PCS 1,540.00
PCS 5,082.00
PCS 2,112.00
PCS 13,657.60
PCS 14,520.00
PCS 8,712.00
PCS 12,705.07
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 3,509.00
PCS 8,712.00
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 2,541.00
PCS 1,754.50
PCS 3,267.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 8,712.00
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 44,299.62
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 3,509.00
PCS 8,712.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 5,082.00
PCS 3,509.00
PCS 8,712.00
PCS 22,149.81
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 2,541.00
PCS 3,509.00
PCS 3,267.00
PCS 8,712.00
PCS 26,620.00
PCS 1,540.00
PCS 14,520.00
PCS 6,292.00
PCS 14,766.54
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 29,040.00
PCS 3,267.00
PCS 3,509.00
PCS 5,082.00
PCS 8,712.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 3,267.00
PCS 14,520.00
PCS 8,712.00
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 29,040.00
PCS 3,267.00
PCS 14,766.54
PCS 26,620.00
PCS 3,267.00
PCS 3,146.00
PCS 15,729.12
PCS 3,509.00
PCS 13,310.00
PCS 6,292.00
PCS 14,766.54
PCS 26,620.00
PCS 3,267.00
PCS 6,292.00
PCS 14,766.54
PCS 26,620.00
PCS 14,766.54
PCS 1,633.50
PCS 6,292.00
PCS 29,948.60
PCS 14,766.54
PCS 3,267.00
PCS 6,292.00
PCS 2,103.20
PCS 56,265.00
PCS 23,593.68
PCS 1,677.06
PCS 5,856.40
PCS 75,504.00
PCS 26,136.00
PCS 11,529.78
PCS 23,232.00
PCS 24,684.00
PCS 2,107.42
PCS 15,488.00
PCS 8,022.30
PCS 17,384.76
PCS 4,157.94
PCS 3,046.65
PCS 28,560.84
PCS 17,384.76
PCS 9,266.40
PCS 26,620.00
PCS 56,265.00
PCS 2,541.00
PCS 4,648.80
PCS 17,384.76
PCS 8,603.10
PCS 5,867.37
PCS 18,877.65
PCS 11,583.00
PCS 493.90
PCS 275.00
PCS 42,350.00
PCS 14,760.02
PCS 54,450.00
PCS 774.80
PCS 2,867.70
PCS 847.00
PCS 5,791.50
PCS 43,998.02
224,606.2
PCS 5
PCS 18,150.00
PCS 24,926.00
PCS 493.90
PCS 43,998.02
PCS 653.40
PCS 16,499.97
187,170.0
PCS
6
PCS 23,232.00
PCS 980.10
- 0
PCS 980.10
PCS 292.61
PCS 43,998.02
PCS 2,867.70
PCS 15,014.82
PCS 15,488.00
137,926.4
PCS 0
PCS 275.00
PCS 5,989.50
PCS 922.01
PCS 15,488.00
PCS 778.65
PCS 1,931.16
PCS 76,447.80
PCS 54,450.00
PCS 24,926.00
PCS 5,709.00
PCS 4,157.94
PCS 3,046.65
PCS 4,840.00
PCS 771.54
PCS 390.82
PCS 3,677.22
PCS 2,107.42
PCS 37,755.30
PCS 2,940.30
PCS 5,082.00
224,606.2
PCS
5
PCS 4,198.70
PCS 43,998.02
PCS 24,257.46
PCS 1,385.98
PCS 275.00
PCS 37,755.30

PCS 224,606.2
5
PCS 18,150.00
PCS 43,998.02
PCS 6,897.00
PCS 36,916.35
PCS 23,593.68
PCS 18,150.00
PCS 15,488.00
PCS 653.40
PCS 12,100.00
PCS 2,867.70
PCS 6,425.10
PCS 219.99
PCS 15,488.00
PCS 957.38
PCS 15,488.00
PCS 43,998.02
PCS 1,118.04
PCS 23,958.00
PCS 980.10
PCS 353.49
PCS 15,014.82
PCS 28,182.00
PCS 12,463.00
PCS 922.01
PCS 37,755.30
PCS 877.83
PCS 12,585.10
PCS 2,766.03
PCS 37,389.00
PCS 2,940.30
PCS 4,214.84
PCS 630.27
PCS 1,237.90
PCS 2,766.03
PCS 66,550.00
PCS 7,864.56
PCS 2,103.20
PCS 1,540.00
PCS 3,267.00
PCS 7,744.00
PCS 5,444.34
PCS 43,998.02
PCS 11,529.78
PCS 15,488.00
PCS 7,864.56
PCS 4,900.50
PCS 3,509.00
PCS 5,082.00
PCS 3,146.00
PCS 10,462.50
163,350.0
PCS
0
PCS 2,451.48
PCS 54,999.34
PCS 79,868.58
PCS 8,085.82
PCS 1,051.60
PCS 7,744.00
PCS 10,285.00
PCS 2,417.58
PCS 2,897.46
PCS 1,118.04
PCS 23,593.68
PCS 2,103.20
PCS 33,396.00
PCS 2,103.20
PCS 770.00
PCS 3,267.00
PCS 17,050.00
PCS 3,509.00
PCS 15,729.12
PCS 2,103.20
PCS 17,050.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 1,051.60
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 15,729.12
PCS 1,051.60
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
5,037,208.34
23-12-
1 APT010000I62004496 161569 nn. ANDI INDRI
AMBROXOL
BATARI  199.65 6 219.62
2018 
2 APT010000I62004496 161569 nn. ANDI INDRI
SALBUTAM
BATARI  88.00 6 96.80
3 APT010000I62004496 161569 nn. ANDI INDRI
CANGKANG
BATARI  116.90 6 128.59
4 APT010000I62004496 161569 nn. ANDI INDRI
SANMOL
BATARI 
I 24,202.60 1 26,622.86
5 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 3 7,864.56
6 APT010000I62004497 161572 an. AHMADRANITIDIN
NUR FAUZAN 7,040.00 2 7,744.00
7 APT010000I62004497 161572 an. AHMADDOMPERID
NUR FAUZAN 508.20 3 559.02
8 APT010000I62004497 161572 an. AHMADPROBIO
NUR FAUZAN 
KI 13,354.00 3 14,689.40
9 APT010000I62004497 161572 an. AHMADCAIRAN
NUR FAUZAN 
RL 7,149.60 4 7,864.56
10 APT010000I62004497 161572 an. AHMADHANDSCOEN
NUR FAUZAN 478.00 4 525.80
11 APT010000I62004497 161572 an. AHMADCAIRAN
NUR FAUZAN 
NA15,180.00 2 16,698.00
12 APT010000I62004497 161572 an. AHMADMASKER
NUR FAUZAN 
DI 700.00 1 770.00
13 APT010000I62004497 161572 an. AHMADMETIL
NUR FAUZAN 
PRE 475.79 1 523.37
14 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  AS 9,645.90 3 10,610.49
15 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 4 525.80
16 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  NA15,180.00 2 16,698.00
17 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 1 770.00
18 APT010000I62004476 161475 ny. ANDI MASTURA 
SANMOL I 24,202.60 3 26,622.86
19 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 4 525.80
20 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 2 770.00
21 APT010000I62004476 161475 ny. ANDI MASTURA 
CAIRAN NA15,180.00 2 16,698.00
22 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 3 CC 1,485.00 2 1,633.50
23 APT010000I12000062 139631 tn. IBRAHIMHANDSCOEN
KADIR  478.00 4 525.80
24 APT010000I12000062 139631 tn. IBRAHIMMASKER
KADIR  DI 700.00 2 770.00
25 APT010000I12000062 139631 tn. IBRAHIMSPOIT
KADIR 
5 CC 1,595.00 2 1,754.50
26 APT010000I63003172 161606 ny. ASIH  RANITIDIN 7,040.00 1 7,744.00
27 APT010000I63003172 161606 ny. ASIH  SPOIT 3 CC 1,485.00 1 1,633.50
28 APT010000I63003172 161606 ny. ASIH  CAIRAN RL 7,149.60 1 7,864.56
29 APT010000I62004476 161475 ny. ANDI MASTURA 
ALPRAZOLA 1,915.83 1 2,107.42
30 APT010000I62004505 159634 ny. HJ LOBO 
ONDANSETR7,999.97 3 8,799.97
31 APT010000I62004505 159634 ny. HJ LOBO 
OMEPRAZOL 24,999.70 1 27,499.67
32 APT010000I62004505 159634 ny. HJ LOBO 
CODIPRONT 7,937.60 3 8,731.36
33 APT010000I62004505 159634 ny. HJ LOBO 
KETOROLAC 7,350.75 2 8,085.82
34 APT010000I62004501 115911 ny. WALIDACAPTOPRIL
DG BAJI  199.99 1 219.99
35 APT010000I62004501 115911 ny. WALIDATETRASIKLI
DG BAJI  264.00 1 290.40
36 APT010000I62004501 115911 ny. WALIDAMETRONIDA
DG BAJI  248.18 2 272.99
37 APT010000I62004501 115911 ny. WALIDAAMBROXOL
DG BAJI  199.65 1 219.62
38 APT010000I62004501 115911 ny. WALIDAMETFORMI
DG BAJI  190.00 1 209.00
39 APT010000I62004508 120214 ny. ROSMAWATI 
COMBO PAC 60,500.00 1 66,550.00
40 APT010000I62004508 120214 ny. ROSMAWATI 
CAIRAN RL 7,149.60 1 7,864.56
41 APT010000I62004508 120214 ny. ROSMAWATI 
HANDSCOEN 478.00 4 525.80
42 APT010000I62004508 120214 ny. ROSMAWATI 
SPOIT 3 CC 1,485.00 2 1,633.50
43 APT010000I62004508 120214 ny. ROSMAWATI 
RANITIDIN 7,040.00 1 7,744.00
44 APT010000I62004508 120214 ny. ROSMAWATI 
ONDANSETR5,500.00 1 6,050.00
45 APT010000I62004508 120214 ny. ROSMAWATI 
VERTIGOSA 4,528.33 3 4,981.17
46 APT010000I62004508 120214 ny. ROSMAWATI 
GRATIZIN 4,741.00 2 5,215.10
47 APT010000I62004508 120214 ny. ROSMAWATI 
SANMOL T 297.00 3 326.70
48 APT010000I63003172 161606 ny. ASIH  RANITIDIN 7,040.00 2 7,744.00
49 APT010000I63003172 161606 ny. ASIH  ISOSORBID 102.85 1 113.14
50 APT010000I62004505 159634 ny. HJ LOBO CODIPRONT 7,937.60 3 8,731.36
51 APT010000I62004505 159634 ny. HJ LOBO ONDANSETR5,500.00 3 6,050.00
52 APT010000I62004505 159634 ny. HJ LOBO PUMPITOR 11,330.00 2 12,463.00
53 APT010000I62004505 159634 ny. HJ LOBO KETOROLAC 7,350.75 3 8,085.82
54 APT010000I62004457 76534 tn. SAHABUDDIN 
EPEXOL TA 869.00 3 955.90
55 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 1 847.00
56 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 3 1,930.50
57 APT010000I62004457 76534 tn. SAHABUDDIN 
STREPTOMI 7,700.00 1 7,700.00
58 APT010000I64002929 161294 ny. HASNAH  CEFTAZIDIM23,166.00 2 25,482.60
59 APT010000I64002929 161294 ny. HASNAH  METIL PRE 49,500.00 1 54,450.00
60 APT010000I64002929 161294 ny. HASNAH  OMEPRAZOL 24,999.70 1 27,499.67
61 APT010000I65003098 155366 tn. DUDUNG  CEFTRIAXO19,999.10 2 21,999.01
62 APT010000I65003098 155366 tn. DUDUNG  EPEXOL TA 869.00 3 955.90
63 APT010000I65003098 155366 tn. DUDUNG  COMBIVENT4,549.95 3 5,004.94
64 APT010000I65003098 155366 tn. DUDUNG  SANMOL T 297.00 3 326.70
65 APT010000I65003098 155366 tn. DUDUNG  RANITIDIN 7,040.00 2 7,744.00
66 APT010000I62004494 161562 tn. MUH AGUSALPRAZOLA
BASRI BASTIAN 
1,915.83 2 2,107.42
67 APT010000I62004494 161562 tn. MUH AGUSDOMPERID
BASRI BASTIAN 
508.20 3 559.02
68 APT010000I62004494 161562 tn. MUH AGUSRANITIDIN
BASRI BASTIAN 
7,040.00 2 7,744.00
69 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,330.00 2 12,463.00
70 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
71 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
72 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 2 275.00
73 APT010000I62004471 148491 ny. NURBAENI 
SPORETIK 5,720.50 2 6,292.55
74 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
75 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
76 APT010000I62004453 161309 ny. SURIATIMETAMIZOL4,999.99
DG. SUNGGU   3 5,499.99
77 APT010000I62004490 161536 nn. RISKI INDASARI
CEFADROXI
AMIR 877.80 2 965.58
78 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 
7,040.00 2 7,744.00
79 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 235.95 3 259.55
80 APT010000I62004470 157170 tn. H. HANAFI 
LEVOFLOXA 449.00 1 493.90
81 APT010000I62004470 157170 tn. H. HANAFI 
MELOXICAM 923.23 1 1,015.55

82 APT010000I62004470 157170 tn. H. HANAFI 

N-ACE INJ 38,500.00 3 42,350.00

83 APT010000I62004470 157170 tn. H. HANAFI 

MECOBALAM6,600.00 1 7,260.00
84 APT010000I62004504 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
85 APT010000I62004504 161146 ny. NIRWANA 
KETOROLAC 7,350.75 3 8,085.82
86 APT010000I62004504 161146 ny. NIRWANA 
URDAFALK 5,527.50 2 6,080.25
87 APT010000I62004504 161146 ny. NIRWANA 
CURCUMA 1,098.90 2 1,208.79
88 APT010000I62004504 161146 ny. NIRWANA 
SPORETIK 20,185.00 2 22,203.50
 89 APT010000I62004500 161581 ny. SERI BINTANG 
KETOROLAC 7,350.75 3 8,085.82
90 APT010000I62004500 161581 ny. SERI BINTANG 
RANITIDIN 7,040.00 2 7,744.00
91 APT010000I62004500 161581 ny. SERI BINTANG 
ONDANSETR5,500.00 3 6,050.00
92 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
93 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
94 APT010000I65003086 161248 ny. JUMANIA 
PUMPITOR 11,330.00 2 12,463.00
95 APT010000I65003086 161248 ny. JUMANIA 
LEVOFLOXA 449.00 1 493.90
96 APT010000I65003086 161248 ny. JUMANIA 
SANMOL T 297.00 3 326.70
97 APT010000I64002956 161471 tn. NATHANIEL
CEFTRIAXO19,999.10
SALU  2 21,999.01
98 APT010000I64002956 161471 tn. NATHANIEL
RANITIDIN
SALU  7,040.00 2 7,744.00
99 APT010000I64002956 161471 tn. NATHANIEL
KETOROLAC
SALU  7,350.75 2 8,085.82
100 APT010000I64002956 161471 tn. NATHANIEL
PIRACETAM
SALU  10,670.00 2 11,737.00
101 APT010000I62004472 161449 tn. NUR ROHMAT 
CEFTRIAXO19,999.10 2 21,999.01
102 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 2 7,744.00
103 APT010000I62004472 161449 tn. NUR ROHMAT 
KETOROLAC 7,350.75 3 8,085.82
104 APT010000I62004472 161449 tn. NUR ROHMAT 
CAIRAN RL 7,149.60 2 7,864.56
105 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOEN 478.00 4 525.80
106 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 3 CC 1,485.00 1 1,633.50
107 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 10 C 2,310.00 1 2,541.00
108 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOON 13,613.00 1 14,974.30
109 APT010000I62004472 161449 tn. NUR ROHMAT 
IV CATHETE12,416.00 2 13,657.60
110 APT010000I62004472 161449 tn. NUR ROHMAT 
INFUS SET 7,920.00 1 8,712.00
111 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  629.99 2 692.99
112 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  250.00 1 275.00
113 APT010000I65003101 161497 ny. LILY HAFSAH 
VOLUVEN 621,780.00 1 23,958.00
114 APT010000I65003101 161497 ny. LILY HAFSAH 
SANMOL T 297.00 3 326.70

115 APT010000I65003101 161497 ny. LILY HAFSAH 

METIL PRE 49,500.00 3 54,450.00

116 APT010000I62004486 161525 tn. UMAR M FUROSEMID2,920.50 2 3,212.55

117 APT010000I62004486 161525 tn. UMAR M CAPTOPRIL 199.99 1 219.99
118 APT010000I62004486 161525 tn. UMAR M RANITIDIN 7,040.00 2 7,744.00
119 APT010000I62004486 161525 tn. UMAR M SPIRONOLA 285.75 1 314.33
120 APT010000I62004486 161525 tn. UMAR M DIGOKSIN 107.12 3 117.83
121 APT010000I62004486 161525 tn. UMAR M PREGABAL 5,500.00 2 6,050.00
122 APT010000I62004476 161475 ny. ANDI MASTURA 
LANTUS SO83,950.02 1 92,345.02
123 APT010000I62004476 161475 ny. ANDI MASTURA 
APIDRA 86,999.88 1 95,699.87
124 APT010000I62004476 161475 ny. ANDI MASTURA 
NATRIUM D 195.91 3 215.50
125 APT010000I62004476 161475 ny. ANDI MASTURA 
SANMOL I 24,202.60 3 26,622.86
126 APT010000I62004476 161475 ny. ANDI MASTURA 
KETOROLAC 7,350.75 1 8,085.82
127 APT010000I62004476 161475 ny. ANDI MASTURA 
ALPRAZOLA 1,915.83 1 2,107.42
128 APT010000I12000062 139631 tn. IBRAHIMCOMBIVENT4,549.95
KADIR  3 5,004.94
129 APT010000I12000062 139631 tn. IBRAHIMPULMICORT
KADIR  8,540.00 3 9,394.00
130 APT010000I12000062 139631 tn. IBRAHIMPUMPITOR
KADIR  11,330.00 1 12,463.00
131 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 1 922.01
132 APT010000I62004499 161575 tn. ALIF PRADITYA
SANMOL  I 24,202.60 3 26,622.86
133 APT010000I62004499 161575 tn. ALIF PRADITYA
RANITIDIN
  7,040.00 2 7,744.00
134 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 2 21,999.01
135 APT010000I62004506 161611 tn. ALI NGURAWAN 
KETOROLAC 7,350.75 3 8,085.82
136 APT010000I62004506 161611 tn. ALI NGURAWAN 
ASAM TRAN3,493.88 3 3,843.26
137 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 2 7,744.00
138 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 2 7,744.00
139 APT010000I62004496 161569 nn. ANDI INDRI
CEFTRIAXO19,999.10
BATARI  2 21,999.01
140 APT010000I62004496 161569 nn. ANDI INDRI
METILBATARI 
PRE 49,500.00 1 54,450.00
141 APT010000I62004496 161569 nn. ANDI INDRI
DOMPERID
BATARI  508.20 2 559.02
142 APT010000I62004496 161569 nn. ANDI INDRI
EPEXOL
BATARI 
TA 869.00 3 955.90
143 APT010000I62004496 161569 nn. ANDI INDRI
SANMOL
BATARI 
T 297.00 1 326.70
144 APT010000I65003107 161571 ny. SALFIAHNEW
DG SAYU 
DIAT 557.15 6 612.87
145 APT010000I65003107 161571 ny. SALFIAHRANITIDIN
DG SAYU  7,040.00 2 7,744.00
146 APT010000I65003107 161571 ny. SALFIAHKOTRIMOKS
DG SAYU  254.10 2 279.51
147 APT010000I12000078 161476 ny. SURIYATI 
SANMOL I 24,202.60 3 26,622.86
148 APT010000I12000078 161476 ny. SURIYATI 
CEFTRIAXO19,999.10 2 21,999.01
149 APT010000I62004501 115911 ny. WALIDANEW
DG BAJI 
DIAT 557.15 4 612.87
150 APT010000I62004501 115911 ny. WALIDAMETFORMI
DG BAJI  190.00 2 209.00
151 APT010000I62004501 115911 ny. WALIDAEPEXOL
DG BAJI 
TA 869.00 3 955.90
152 APT010000I62004501 115911 ny. WALIDAGLIMEPIRI
DG BAJI  1,257.80 1 1,383.57
153 APT010000I62004501 115911 ny. WALIDATETRASIKLI
DG BAJI  241.00 3 265.10
154 APT010000I62004497 161572 an. AHMADPROBIO
NUR FAUZAN 
KI 13,354.00 3 14,689.40

155 APT010000I62004497 161572 an. AHMADEPEXOL

NUR FAUZAN 
DR48,400.00 3 53,240.00

156 APT010000I62004497 161572 an. AHMADDOMPERID

NUR FAUZAN 508.20 3 559.02
157 APT010000I62004497 161572 an. AHMADRANITIDIN
NUR FAUZAN 
7,040.00 2 7,744.00
158 APT010000I62004497 161572 an. AHMADCAIRAN
NUR FAUZAN 
RL 7,149.60 3 7,864.56
159 APT010000I12000071 150670 ny. DESTY MELYANI 
CEFTRIAXO19,999.10 2 21,999.01
160 APT010000I12000071 150670 ny. DESTY MELYANI 
KETOROLAC 7,350.75 3 8,085.82
161 APT010000I12000071 150670 ny. DESTY MELYANI 
PREGABAL 5,500.00 2 6,050.00
162 APT010000I62004508 120214 ny. ROSMAWATI 
DIMENHIDR 121.00 2 133.10
163 APT010000I62004508 120214 ny. ROSMAWATI 
NEURODEX 770.00 1 847.00
164 APT010000I62004508 120214 ny. ROSMAWATI 
GRATIZIN 4,741.00 2 5,215.10
165 APT010000I62004508 120214 ny. ROSMAWATI 
RANITIDIN 629.99 2 692.99
166 APT010000I62004508 120214 ny. ROSMAWATI 
AMLODIPIN 475.19 1 522.71
167 APT010000I12000062 139631 tn. IBRAHIMCODIPRONT
KADIR  7,937.60 3 8,731.36
168 APT010000I62004470 157170 tn. H. HANAFI 
MECOBALA 616.00 6 677.60
169 APT010000I62004470 157170 tn. H. HANAFI 
METIL PRE 475.79 6 523.37
170 APT010000I62004470 157170 tn. H. HANAFI 
CANGKANG 116.90 6 128.59
171 APT010000I62004470 157170 tn. H. HANAFI 
OMEPRAZO 704.37 1 774.80
172 APT010000I62004500 161581 ny. SERI BINTANG 
ADONA INJ22,880.00 3 25,168.00
173 APT010000I12000071 150670 ny. DESTY MELYANI 
SANMOL T 297.00 3 326.70
174 APT010000I12000071 150670 ny. DESTY MELYANI 
AKILEN 40 16,698.00 2 18,367.80
175 APT010000I12000071 150670 ny. DESTY MELYANI 
PUMPITOR 11,330.00 2 12,463.00
176 APT010000I62004509 131089 ny. FIRDHAINFUSAN
RESMISARI 
N 6,712.06 2 7,383.27
177 APT010000I62004509 131089 ny. FIRDHANEW
RESMISARI 
DIAT 557.15 4 612.87
178 APT010000I62004509 131089 ny. FIRDHAANTASIDA
RESMISARI  139.99 3 153.98
179 APT010000I62004509 131089 ny. FIRDHASANMOL
RESMISARI 
T 297.00 3 326.70
180 APT010000I12000082 161621 ny. DG NURUNG 
INFUSAN N 6,712.06 2 7,383.27
181 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 7,040.00 2 7,744.00
182 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 3 326.70
183 APT010000I12000082 161621 ny. DG NURUNG 
NEW DIAT 557.15 4 612.87
184 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 5 CC 1,595.00 3 1,754.50
185 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 6 525.80
186 APT010000I12000082 161621 ny. DG NURUNG 
LANTUS SO83,950.02 1 92,345.02
187 APT010000I12000082 161621 ny. DG NURUNG 
NOVO TWIS 2,083.00 1 2,291.30
188 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 3 7,864.56
189 APT010000I62004496 161569 nn. ANDI INDRI
IV CATHETE
BATARI 7,750.00 1 8,525.00
190 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOEN
BATARI  478.00 4 525.80
191 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 2 770.00
192 APT010000I62004508 120214 ny. ROSMAWATI 
CAIRAN RL 7,149.60 4 7,864.56
193 APT010000I62004508 120214 ny. ROSMAWATI 
HANDSCOEN 478.00 4 525.80
194 APT010000I62004508 120214 ny. ROSMAWATI 
MASKER DI 700.00 2 770.00
195 APT010000I12000078 161476 ny. SURIYATI 
CAIRAN AS 9,645.90 5 10,610.49
196 APT010000I12000078 161476 ny. SURIYATI 
HANDSCOON 13,613.00 2 14,974.30
197 APT010000I12000078 161476 ny. SURIYATI 
MASKER DI 700.00 2 770.00
198 APT010000I12000078 161476 ny. SURIYATI 
IV CATHETE 7,750.00 2 8,525.00
199 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
RL 7,149.60 3 7,864.56
200 APT010000I65003107 161571 ny. SALFIAHIVDG
CATHETE
SAYU  7,750.00 1 8,525.00
201 APT010000I65003107 161571 ny. SALFIAHMASKER
DG SAYU DI 700.00 2 770.00
202 APT010000I65003107 161571 ny. SALFIAHHANDSCOEN
DG SAYU  478.00 2 525.80
203 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN RL 7,149.60 5 7,864.56
204 APT010000I65003101 161497 ny. LILY HAFSAH 
MASKER DI 700.00 2 770.00
205 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOEN 478.00 2 525.80
206 APT010000I62004435 161179 ny. HASNAWATY
MASKER H  DI 700.00 2 770.00
207 APT010000I62004435 161179 ny. HASNAWATY
HANDSCOEN
H  478.00 4 525.80
208 APT010000I62004435 161179 ny. HASNAWATY
SPOIT 3H CC 1,485.00 2 1,633.50
209 APT010000I62004501 115911 ny. WALIDACAIRAN
DG BAJI 
NAC6,409.70 3 7,050.67
210 APT010000I62004501 115911 ny. WALIDAMASKER
DG BAJI DI 700.00 3 770.00
211 APT010000I62004501 115911 ny. WALIDAHANDSCOEN
DG BAJI  478.00 10 525.80
212 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
10 C 2,310.00 1 2,541.00
213 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 4 7,864.56
214 APT010000I62004506 161611 tn. ALI NGURAWAN 
IV CATHETE 7,750.00 1 8,525.00
215 APT010000I62004506 161611 tn. ALI NGURAWAN 
HANDSCOEN 478.00 4 525.80
216 APT010000I62004506 161611 tn. ALI NGURAWAN 
HANDSCOON 13,613.00 2 14,974.30
217 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  AS 9,645.90 4 10,610.49
218 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 4 525.80
219 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 2 770.00
220 APT010000I62004497 161572 an. AHMADCAIRAN
NUR FAUZAN 
RL 7,149.60 7 7,864.56
221 APT010000I62004497 161572 an. AHMADHANDSCOEN
NUR FAUZAN 478.00 4 525.80
 222 APT010000I62004497 161572 an. AHMADHANDSCOON
NUR FAUZAN 
12,100.00 1 13,310.00
223 APT010000I62004497 161572 an. AHMADSPOIT
NUR 10
FAUZAN 
C 2,310.00 2 2,541.00
224 APT010000I62004509 131089 ny. FIRDHACAIRAN
RESMISARI 
NAC6,409.70 5 7,050.67
225 APT010000I62004509 131089 ny. FIRDHAIVRESMISARI 
CATHETE 7,750.00 1 8,525.00
226 APT010000I62004509 131089 ny. FIRDHAHANDSCOEN
RESMISARI  478.00 4 525.80
227 APT010000I62004509 131089 ny. FIRDHAMASKER
RESMISARI 
DI 700.00 2 770.00
228 APT010000I62004476 161475 ny. ANDI MASTURA 
CAIRAN AS 9,645.90 3 10,610.49
229 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 4 525.80
230 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 2 770.00
231 APT010000I62004476 161475 ny. ANDI MASTURA 
IV CATHETE 7,750.00 1 8,525.00
232 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 4 525.80
233 APT010000I12000082 161621 ny. DG NURUNG 
MASKER DI 700.00 2 770.00
234 APT010000I12000082 161621 ny. DG NURUNG 
IV CATHETE 7,750.00 1 8,525.00
235 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NAC6,409.70 2 7,050.67
236 APT010000I65003086 161248 ny. JUMANIA 
HANDSCOEN 478.00 2 525.80
237 APT010000I65003086 161248 ny. JUMANIA 
IV CATHETE 7,750.00 1 8,525.00
238 APT010000I65003086 161248 ny. JUMANIA 
CONECTA 13,200.00 1 14,520.00
239 APT010000I65003086 161248 ny. JUMANIA 
SPOIT 3 CC 1,485.00 1 1,633.50
240 APT010000I65003086 161248 ny. JUMANIA 
SPOIT 5 CC 1,595.00 1 1,754.50
241 APT010000I65003086 161248 ny. JUMANIA 
SPOIT 10 C 2,310.00 1 2,541.00
242 APT010000I62004500 161581 ny. SERI BINTANG 
MASKER DI 700.00 2 770.00
243 APT010000I62004500 161581 ny. SERI BINTANG 
HANDSCOEN 478.00 4 525.80
244 APT010000I62004500 161581 ny. SERI BINTANG 
IV CATHETE 7,750.00 1 8,525.00
245 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 5 CC 1,595.00 2 1,754.50
246 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 3 CC 1,485.00 2 1,633.50
247 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN RL 7,149.60 2 7,864.56
248 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  2 525.80
249 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  2 770.00
250 APT010000I62004453 161309 ny. SURIATIIVDG.
CATHETE
SUNGGU 7,750.00
  1 8,525.00
251 APT010000I62004453 161309 ny. SURIATICONECTA
DG. SUNGGU13,200.00
  1 14,520.00
252 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
3 CC 1,485.00
  2 1,633.50
253 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
5 CC 1,595.00
  1 1,754.50
254 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
10 C 2,310.00
  1 2,541.00
255 APT010000I64002956 161471 tn. NATHANIEL
CEFIXIME
SALU  4,950.00 6 5,445.00
256 APT010000I64002956 161471 tn. NATHANIEL
FARGETIX
SALU  407.00 9 447.70
257 APT010000I64002956 161471 tn. NATHANIEL
PIRACETAM
SALU  618.31 9 680.14
258 APT010000I62004503 159886 tn. MUH BASIR
CAIRAN
LALANG 
AM70,188.80 1 94,754.88
259 APT010000I62004503 159886 tn. MUH BASIR
STOLAX
LALANG 
SU 6,710.00 1 8,723.00
260 APT010000I62004493 161561 ny. DINARE CEFTRIAXO19,999.10 2 21,999.01
261 APT010000I62004493 161561 ny. DINARE DIGOKSIN 107.12 1 117.83
262 APT010000I62004493 161561 ny. DINARE ASPILETS 816.20 1 897.82
263 APT010000I62004493 161561 ny. DINARE SIMUCIL 2 1,760.00 3 1,936.00
Sub Total   632
PCS 1,317.72

PCS 580.80
PCS 771.54
PCS 26,622.86
PCS 23,593.68
PCS 15,488.00
PCS 1,677.06
PCS 44,068.20
PCS 31,458.24
PCS 2,103.20
PCS 33,396.00
PCS 770.00
PCS 523.37
PCS 31,831.47
PCS 2,103.20
PCS 33,396.00
PCS 770.00
PCS 79,868.58
PCS 2,103.20
PCS 1,540.00
PCS 33,396.00
PCS 3,267.00
PCS 2,103.20
PCS 1,540.00
PCS 3,509.00
PCS 7,744.00
PCS 1,633.50
PCS 7,864.56
PCS 2,107.42
PCS 26,399.91
PCS 27,499.67
PCS 26,194.08
PCS 16,171.64
PCS 219.99
PCS 290.40
PCS 545.98
PCS 219.62
PCS 209.00
PCS 66,550.00
PCS 7,864.56
PCS 2,103.20
PCS 3,267.00
PCS 7,744.00
PCS 6,050.00
PCS 14,943.51
PCS 10,430.20
PCS 980.10
PCS 15,488.00
PCS 113.14
PCS 26,194.08
PCS 18,150.00
PCS 24,926.00
PCS 24,257.46
PCS 2,867.70
PCS 847.00
PCS 5,791.50
PCS 7,700.00
PCS 50,965.20
PCS 54,450.00
PCS 27,499.67
PCS 43,998.02
PCS 2,867.70
PCS 15,014.82
PCS 980.10
PCS 15,488.00
PCS 4,214.84
PCS 1,677.06
PCS 15,488.00
PCS 24,926.00
PCS 922.01
PCS 5,989.50
PCS 550.00
PCS 12,585.10
PCS 43,998.02
PCS 980.10
PCS 16,499.97
PCS 1,931.16
PCS 15,488.00
PCS 778.65
PCS 493.90
PCS 1,015.55
127,050.0
PCS
0
PCS 7,260.00
PCS 15,488.00
PCS 24,257.46
PCS 12,160.50
PCS 2,417.58
PCS 44,407.00
PCS 24,257.46
PCS 15,488.00
PCS 18,150.00
PCS 43,998.02
PCS 18,150.00
PCS 24,926.00
PCS 493.90
PCS 980.10
PCS 43,998.02
PCS 15,488.00
PCS 16,171.64
PCS 23,474.00
PCS 43,998.02
PCS 15,488.00
PCS 24,257.46
PCS 15,729.12
PCS 2,103.20
PCS 1,633.50
PCS 2,541.00
PCS 14,974.30
PCS 27,315.20
PCS 8,712.00
PCS 1,385.98
PCS 275.00
PCS 23,958.00
PCS 980.10
163,350.0
PCS
0
PCS 6,425.10
PCS 219.99
PCS 15,488.00
PCS 314.33
PCS 353.49
PCS 12,100.00
PCS 92,345.02
PCS 95,699.87
PCS 646.50
PCS 79,868.58
PCS 8,085.82
PCS 2,107.42
PCS 15,014.82
PCS 28,182.00
PCS 12,463.00
PCS 922.01
PCS 79,868.58
PCS 15,488.00
PCS 43,998.02
PCS 24,257.46
PCS 11,529.78
PCS 15,488.00
PCS 15,488.00
PCS 43,998.02
PCS 54,450.00
PCS 1,118.04
PCS 2,867.70
PCS 326.70
PCS 3,677.22
PCS 15,488.00
PCS 559.02
PCS 79,868.58
PCS 43,998.02
PCS 2,451.48
PCS 418.00
PCS 2,867.70
PCS 1,383.57
PCS 795.30
PCS 44,068.20
159,720.0
PCS
0
PCS 1,677.06
PCS 15,488.00
PCS 23,593.68
PCS 43,998.02
PCS 24,257.46
PCS 12,100.00
PCS 266.20
PCS 847.00
PCS 10,430.20
PCS 1,385.98
PCS 522.71
PCS 26,194.08
PCS 4,065.60
PCS 3,140.22
PCS 771.54
PCS 774.80
PCS 75,504.00
PCS 980.10
PCS 36,735.60
PCS 24,926.00
PCS 14,766.54
PCS 2,451.48
PCS 461.94
PCS 980.10
PCS 14,766.54
PCS 15,488.00
PCS 980.10
PCS 2,451.48
PCS 5,263.50
PCS 3,154.80
PCS 92,345.02
PCS 2,291.30
PCS 23,593.68
PCS 8,525.00
PCS 2,103.20
PCS 1,540.00
PCS 31,458.24
PCS 2,103.20
PCS 1,540.00
PCS 53,052.45
PCS 29,948.60
PCS 1,540.00
PCS 17,050.00
PCS 23,593.68
PCS 8,525.00
PCS 1,540.00
PCS 1,051.60
PCS 39,322.80
PCS 1,540.00
PCS 1,051.60
PCS 1,540.00
PCS 2,103.20
PCS 3,267.00
PCS 21,152.01
PCS 2,310.00
PCS 5,258.00
PCS 2,541.00
PCS 31,458.24
PCS 8,525.00
PCS 2,103.20
PCS 29,948.60
PCS 42,441.96
PCS 2,103.20
PCS 1,540.00
PCS 55,051.92
PCS 2,103.20
PCS 13,310.00
PCS 5,082.00
PCS 35,253.35
PCS 8,525.00
PCS 2,103.20
PCS 1,540.00
PCS 31,831.47
PCS 2,103.20
PCS 1,540.00
PCS 8,525.00
PCS 2,103.20
PCS 1,540.00
PCS 8,525.00
PCS 14,101.34
PCS 1,051.60
PCS 8,525.00
PCS 14,520.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 3,509.00
PCS 3,267.00
PCS 15,729.12
PCS 1,051.60
PCS 1,540.00
PCS 8,525.00
PCS 14,520.00
PCS 3,267.00
PCS 1,754.50
PCS 2,541.00
PCS 32,670.00
PCS 4,029.30
PCS 6,121.26
PCS 94,754.88
PCS 8,723.00
PCS 43,998.02
PCS 117.83
PCS 897.82
PCS 5,808.00
4,316,378.33
24-12-
1 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 1 CC 1,920.00 1 2,112.00
2018 
2 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 4 525.80
3 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 1 770.00
4 APT010000I62004504 161146 ny. NIRWANA 
IV DRESSI 4,850.00 1 5,335.00
5 APT010000I62004504 161146 ny. NIRWANA 
INFUS SET 7,920.00 1 8,712.00
6 APT010000I62004504 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
7 APT010000I62004504 161146 ny. NIRWANA 
KETOROLAC 7,350.75 3 8,085.82
8 APT010000I62004504 161146 ny. NIRWANA 
URDAFALK 5,527.50 2 6,080.25
9 APT010000I62004504 161146 ny. NIRWANA 
CURCUMA 1,098.90 2 1,208.79
10 APT010000I62004504 161146 ny. NIRWANA 
CEFIXIME 1,317.02 2 1,448.73
11 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 7,040.00 2 7,744.00
12 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 3 326.70
13 APT010000I12000082 161621 ny. DG NURUNG 
SOTATIC I 3,032.00 3 3,335.20
14 APT010000I62004470 157170 tn. H. HANAFI 
MELOXICAM 923.23 1 1,015.55
15 APT010000I62004470 157170 tn. H. HANAFI 
LEVOFLOXA 449.00 1 493.90
16 APT010000I62004470 157170 tn. H. HANAFI 
PUMPITOR 11,330.00 2 12,463.00
17 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 4 525.80
18 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 1 770.00
19 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 3 CC 1,485.00 3 1,633.50
20 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 5 CC 1,595.00 1 1,754.50
21 APT010000I62004457 76534 tn. SAHABUDDIN 
EPEXOL TA 869.00 3 955.90
22 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 1 847.00
23 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 3 1,930.50
24 APT010000I62004457 76534 tn. SAHABUDDIN 
STREPTOMI 7,700.00 1 7,700.00
25 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 1 CC 1,920.00 1 2,112.00
26 APT010000I62004500 161581 ny. SERI BINTANG 
HANDSCOEN 478.00 2 525.80
27 APT010000I62004500 161581 ny. SERI BINTANG 
MASKER DI 700.00 1 770.00
28 APT010000I62004500 161581 ny. SERI BINTANG 
IV DRESSI 4,850.00 1 5,335.00
29 APT010000I62004500 161581 ny. SERI BINTANG 
INFUS SET 7,920.00 1 8,712.00
30 APT010000I62004500 161581 ny. SERI BINTANG 
KETOROLAC 7,350.75 3 8,085.82
31 APT010000I62004500 161581 ny. SERI BINTANG 
RANITIDIN 7,040.00 2 7,744.00
32 APT010000I62004500 161581 ny. SERI BINTANG 
ONDANSETR5,500.00 3 6,050.00
33 APT010000I62004505 159634 ny. HJ LOBO 
CODIPRONT 7,937.60 3 8,731.36
34 APT010000I62004505 159634 ny. HJ LOBO 
ONDANSETR5,500.00 3 6,050.00
35 APT010000I62004505 159634 ny. HJ LOBO 
PUMPITOR 11,330.00 1 12,463.00
36 APT010000I62004505 159634 ny. HJ LOBO 
KETOROLAC 7,350.75 2 8,085.82
37 APT010000I65003098 155366 tn. DUDUNG CEFTRIAXO19,999.10 2 21,999.01
38 APT010000I65003098 155366 tn. DUDUNG AMBROXOL 199.65 3 219.62
39 APT010000I65003098 155366 tn. DUDUNG SANMOL T 297.00 3 326.70
40 APT010000I65003098 155366 tn. DUDUNG COMBIVENT4,549.95 3 5,004.94
41 APT010000I65003098 155366 tn. DUDUNG RANITIDIN 7,040.00 2 7,744.00
42 APT010000I62004494 161562 tn. MUH AGUS
DOMPERID
BASRI BASTIAN 
508.20 3 559.02
43 APT010000I62004494 161562 tn. MUH AGUS
RANITIDIN
BASRI BASTIAN 
7,040.00 2 7,744.00
44 APT010000I62004494 161562 tn. MUH AGUS
ALPRAZOLA
BASRI BASTIAN 
1,915.83 1 2,107.42
45 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 1 CC
AMIR 
1,920.00 1 2,112.00
46 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 3 CC
AMIR 
1,485.00 1 1,633.50
47 APT010000I62004490 161536 nn. RISKI INDASARI
HANDSCOEN
AMIR 478.00 2 525.80
48 APT010000I62004490 161536 nn. RISKI INDASARI
IV DRESSIAMIR 
4,850.00 1 5,335.00
49 APT010000I62004490 161536 nn. RISKI INDASARI
INFUS SET
AMIR 
7,920.00 1 8,712.00
50 APT010000I62004490 161536 nn. RISKI INDASARI
CONECTAAMIR 
13,200.00 1 14,520.00
51 APT010000I62004490 161536 nn. RISKI INDASARI
IV CATHETE
AMIR 
7,750.00 1 8,525.00
52 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 
7,040.00 2 7,744.00
53 APT010000I62004490 161536 nn. RISKI INDASARI
CEFADROXI
AMIR 877.80 2 965.58
54 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 134.20 1 147.62
55 APT010000I64002929 161294 ny. HASNAH  METIL PRE 49,500.00 1 54,450.00
56 APT010000I64002929 161294 ny. HASNAH  OMEPRAZOL 24,999.70 2 27,499.67
57 APT010000I64002929 161294 ny. HASNAH  CEFTAZIDIM23,166.00 2 25,482.60
58 APT010000I64002929 161294 ny. HASNAH  TRANSFUSI28,050.00 1 30,855.00
59 APT010000I64002929 161294 ny. HASNAH  HANDSCOEN 478.00 2 525.80
60 APT010000I64002929 161294 ny. HASNAH  MASKER DI 700.00 1 770.00
61 APT010000I64002929 161294 ny. HASNAH  SPOIT 10 C 2,310.00 2 2,541.00
62 APT010000I64002929 161294 ny. HASNAH  SPOIT 5 CC 1,595.00 1 1,754.50
63 APT010000I63003172 161606 ny. ASIH  SPOIT 3 CC 1,485.00 2 1,633.50
64 APT010000I63003172 161606 ny. ASIH  HANDSCOEN 478.00 4 525.80
65 APT010000I63003172 161606 ny. ASIH  MASKER DI 700.00 2 770.00
66 APT010000I63003172 161606 ny. ASIH  NASAL CA 11,550.07 1 12,705.07
67 APT010000I63003172 161606 ny. ASIH  RANITIDIN 7,040.00 2 7,744.00
68 APT010000I63003172 161606 ny. ASIH  ISOSORBID 102.85 1 113.14

69 APT010000I62004453 161309 ny. SURIATIMETRONIDA

DG. SUNGGU
56,718.20
  3 62,390.02

70 APT010000I62004453 161309 ny. SURIATISANTAGESIK4,949.40

DG. SUNGGU   3 5,444.34
71 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU7,040.00
  3 7,744.00
72 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
73 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
74 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  2 770.00
75 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
76 APT010000I62004453 161309 ny. SURIATIIVDG.
CATHETE
SUNGGU7,750.00
  1 8,525.00
77 APT010000I62004453 161309 ny. SURIATIINFUS
DG. SUNGGU
SET 7,920.00
  2 8,712.00
78 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
10 C 2,310.00
  2 2,541.00
79 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
3 CC 1,485.00
  2 1,633.50
80 APT010000I65003086 161248 ny. JUMANIA 
SANMOL I 24,202.60 3 26,622.86
81 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
82 APT010000I65003086 161248 ny. JUMANIA 
PUMPITOR 11,330.00 2 12,463.00
83 APT010000I65003086 161248 ny. JUMANIA 
LEVOFLOXA 449.00 1 493.90
84 APT010000I62004509 131089 ny. FIRDHANEW
RESMISARI 
DIAT 557.15 6 612.87
85 APT010000I62004509 131089 ny. FIRDHAANTASIDA
RESMISARI  139.99 3 153.98
86 APT010000I62004509 131089 ny. FIRDHASANMOL
RESMISARI 
T 297.00 3 326.70
87 APT010000I62004476 161475 ny. ANDI MASTURA 
NATRIUM D 195.91 2 215.50
88 APT010000I65003107 161571 ny. SALFIAHDOMPERID
DG SAYU  508.20 3 559.02
 89 APT010000I65003107 161571 ny. SALFIAHRANITIDIN
DG SAYU  7,040.00 2 7,744.00
90 APT010000I65003107 161571 ny. SALFIAHSANMOL
DG SAYU 
T 297.00 3 326.70
91 APT010000I65003107 161571 ny. SALFIAHNEW
DG SAYU 
DIAT 557.15 6 612.87
92 APT010000I65003107 161571 ny. SALFIAHKOTRIMOKS
DG SAYU  254.10 4 279.51
93 APT010000I62004486 161525 tn. UMAR M FUROSEMID2,920.50 2 3,212.55
94 APT010000I62004486 161525 tn. UMAR M CAPTOPRIL 199.99 2 219.99
95 APT010000I62004486 161525 tn. UMAR M RANITIDIN 7,040.00 2 7,744.00
96 APT010000I62004486 161525 tn. UMAR M DIGOKSIN 107.12 3 117.83
97 APT010000I64002956 161471 tn. NATHANIEL
CEFIXIME
SALU  4,950.00 6 5,445.00
98 APT010000I64002956 161471 tn. NATHANIEL
FARGETIX
SALU  407.00 9 447.70
99 APT010000I64002956 161471 tn. NATHANIEL
PIRACETAM
SALU  618.31 9 680.14
100 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  923.23 1 1,015.55
101 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  629.99 2 692.99
102 APT010000I12000078 161476 ny. SURIYATI 
SANMOL I 24,202.60 3 26,622.86
103 APT010000I12000078 161476 ny. SURIYATI 
SOTATIC I 3,032.00 3 3,335.20
104 APT010000I12000078 161476 ny. SURIYATI 
CEFTRIAXO19,999.10 2 21,999.01
105 APT010000I12000078 161476 ny. SURIYATI 
LODIA TAB 1,045.00 3 1,149.50
106 APT010000I12000078 161476 ny. SURIYATI 
PREDNISON 224.99 5 247.49
107 APT010000I12000078 161476 ny. SURIYATI 
AMOXICILL 462.46 3 508.71
108 APT010000I12000078 161476 ny. SURIYATI 
CANGKANG 75.00 10 82.50
109 APT010000I12000078 161476 ny. SURIYATI 
CEFTRIAXO19,999.10 2 21,999.01
110 APT010000I12000078 161476 ny. SURIYATI 
LODIA TAB 1,045.00 3 1,149.50
111 APT010000I12000071 150670 ny. DESTY MELYANI 
SANMOL T 297.00 9 326.70
112 APT010000I12000071 150670 ny. DESTY MELYANI 
OFLOKSASI 1,549.00 6 1,703.90
113 APT010000I12000071 150670 ny. DESTY MELYANI 
PREGABAL 5,500.00 6 6,050.00
114 APT010000I62004499 161575 tn. ALIF PRADITYA
PROBIO  KI 13,354.00 3 14,689.40
115 APT010000I62004499 161575 tn. ALIF PRADITYA
EPEXOL  TA 869.00 3 955.90
116 APT010000I62004499 161575 tn. ALIF PRADITYA
ONDANSETR5,500.00
  3 6,050.00
117 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 2 21,999.01
118 APT010000I62004506 161611 tn. ALI NGURAWAN 
KETOROLAC 7,350.75 3 8,085.82
119 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 2 7,744.00
120 APT010000I62004506 161611 tn. ALI NGURAWAN 
ASAM TRAN3,493.88 3 3,843.26
121 APT010000I62004499 161575 tn. ALIF PRADITYA
RANITIDIN
  7,040.00 2 7,744.00
122 APT010000I62004499 161575 tn. ALIF PRADITYA
SANMOL  I 24,202.60 3 26,622.86

123 APT010000I65003101 161497 ny. LILY HAFSAH 

METIL PRE 49,500.00 3 54,450.00

124 APT010000I65003101 161497 ny. LILY HAFSAH 

PUMPITOR 11,330.00 2 12,463.00
125 APT010000I65003101 161497 ny. LILY HAFSAH 
SANMOL T 297.00 3 326.70
126 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN GE88,300.30 1 97,130.33
127 APT010000I12000062 139631 tn. IBRAHIMCODIPRONT
KADIR  7,937.60 9 8,731.36
128 APT010000I12000062 139631 tn. IBRAHIMOMEPRAZO
KADIR  704.37 3 774.80
129 APT010000I12000062 139631 tn. IBRAHIMAMLODIPIN
KADIR  838.19 3 922.01
130 APT010000I12000062 139631 tn. IBRAHIMAZITROMYC
KADIR  1,777.99 3 1,955.79
131 APT010000I62004501 115911 ny. WALIDATETRASIKLI
DG BAJI  264.00 3 290.40
132 APT010000I62004501 115911 ny. WALIDAMETRONIDA
DG BAJI  248.18 3 272.99
133 APT010000I62004501 115911 ny. WALIDAGLIMEPIRI
DG BAJI  1,257.80 3 1,383.57
134 APT010000I62004501 115911 ny. WALIDAMETFORMI
DG BAJI  190.00 2 209.00
135 APT010000I62004501 115911 ny. WALIDAEPEXOL
DG BAJI 
TA 869.00 3 955.90
136 APT010000I62004501 115911 ny. WALIDANEW
DG BAJI 
DIAT 557.15 3 612.87
137 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 4 7,864.56
138 APT010000I62004511 161613 an. MUHAMMAD
SANMOL TAQWA 
I 24,202.60 3 26,622.86
139 APT010000I62004511 161613 an. MUHAMMAD
ONDANSETR5,500.00
TAQWA  1 6,050.00
140 APT010000I62004508 120214 ny. ROSMAWATI 
DIMENHIDR 121.00 2 133.10
141 APT010000I62004508 120214 ny. ROSMAWATI 
NEURODEX 770.00 1 847.00
142 APT010000I62004508 120214 ny. ROSMAWATI 
SANMOL T 297.00 3 326.70
143 APT010000I62004496 161569 nn. ANDI INDRI
AMBROXOL
BATARI  199.65 3 219.62
144 APT010000I62004496 161569 nn. ANDI INDRI
CEFTRIAXO19,999.10
BATARI  2 21,999.01
145 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 2 7,744.00
146 APT010000I62004496 161569 nn. ANDI INDRI
DOMPERID
BATARI  508.20 2 559.02
147 APT010000I62004496 161569 nn. ANDI INDRI
CIPROFLOX
BATARI  770.00 6 847.00
148 APT010000I62004470 157170 tn. H. HANAFI 
CODIPRONT 7,937.60 9 8,731.36
149 APT010000I62004503 159886 tn. MUH BASIR
NEUROSANB5,324.00
LALANG  1 6,921.20
104,181.0 135,435.3
150 APT010000I62004503 159886 tn. MUH BASIR
FLEETLALANG 
ENE 1
0 0
151 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
152 APT010000I62004503 159886 tn. MUH BASIR
SPOITLALANG 
1 CC 1,920.00 1 2,784.00
153 APT010000I62004503 159886 tn. MUH BASIR
SPOITLALANG 
10 C 2,310.00 1 3,118.50
154 APT010000I62004503 159886 tn. MUH BASIR
HANDSCOEN
LALANG  478.00 2 645.30
155 APT010000I62004503 159886 tn. MUH BASIR
MASKER
LALANG 
DI 700.00 1 910.00
156 APT010000I62004501 115911 ny. WALIDACODIPRONT
DG BAJI  7,937.60 3 8,731.36
157 APT010000I62004501 115911 ny. WALIDAANALSIK
DG BAJI  1,556.50 3 1,712.15
158 APT010000I62004506 161611 tn. ALI NGURAWAN 
FOLEY CAT 20,735.00 1 22,808.50
159 APT010000I32000269 152599 nn. NURAENI
METIL
MUSPRE
  819.00 2 900.90
160 APT010000I32000269 152599 nn. NURAENI
SPORETIK
MUS   5,720.50 2 6,292.55
161 APT010000I32000269 152599 nn. NURAENI
NEURODEX
MUS   770.00 1 847.00
162 APT010000I32000269 152599 nn. NURAENI
PUMPITOR
MUS   11,330.00 2 12,463.00
163 APT010000I62004470 157170 tn. H. HANAFI 
MELOXICAM 923.23 2 1,015.55
164 APT010000I62004470 157170 tn. H. HANAFI 
LEVOFLOXA 449.00 2 493.90
165 APT010000I62004470 157170 tn. H. HANAFI 
PUMPITOR 11,330.00 4 12,463.00
166 APT010000I62004486 161525 tn. UMAR M 
FUROSEMID 190.99 3 210.09
167 APT010000I62004486 161525 tn. UMAR M 
CAPTOPRIL 199.99 3 219.99
168 APT010000I62004486 161525 tn. UMAR M 
SIMVASTAT 359.10 2 395.01
169 APT010000I62004486 161525 tn. UMAR M 
RANITIDIN 629.99 4 692.99

170 APT010000I62004506 161611 tn. ALI NGURAWAN 

FOLEY CAT 79,200.00 2 87,120.00

171 APT010000I62004512 161657 ny. HASNAH KETOROLAC

TAHA  7,350.75 1 8,085.82
172 APT010000I62004512 161657 ny. HASNAH SPOIT
TAHA 
3 CC 1,485.00 1 1,633.50
173 APT010000I12000078 161476 ny. SURIYATI 
CEFADROXI 877.80 6 965.58
174 APT010000I65003107 161571 ny. SALFIAHFLAMAR
DG SAYU 
50 1,908.50 2 2,099.35
175 APT010000I65003107 161571 ny. SALFIAHMETFORMI
DG SAYU  190.00 3 209.00
176 APT010000I65003107 161571 ny. SALFIAHLANTUS
DG SAYU SO83,950.02 1 92,345.02
177 APT010000I65003107 161571 ny. SALFIAHNOVO
DG SAYU 
TWIS 2,083.00 1 2,291.30
178 APT010000I62004472 161449 tn. NUR ROHMAT 
CEFIXIME 4,950.00 10 5,445.00
179 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 629.99 10 692.99
180 APT010000I62004472 161449 tn. NUR ROHMAT 
MELOXICAM 923.23 10 1,015.55
181 APT010000I62004472 161449 tn. NUR ROHMAT 
PREDNISON 224.99 34 247.49
182 APT010000I62004472 161449 tn. NUR ROHMAT 
MEGABAL 1,730.00 3 1,903.00
183 APT010000I62004472 161449 tn. NUR ROHMAT 
PIRACETAM 347.27 6 382.00
184 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 2 2,099.35
185 APT010000I62004494 161562 tn. MUH AGUS
ALPRAZOL
BASRI BASTIAN 
1,023.66 2 1,126.03
186 APT010000I62004494 161562 tn. MUH AGUS
EPISAN
BASRI
SU BASTIAN 
51,150.00 1 56,265.00
187 APT010000I62004494 161562 tn. MUH AGUS
BUSCOPAN
BASRI BASTIAN 
4,327.40 6 4,760.14
188 APT010000I62004494 161562 tn. MUH AGUS
DOMPERID
BASRI BASTIAN 
508.20 6 559.02
189 APT010000I62004494 161562 tn. MUH AGUS
CANGKANG
BASRI BASTIAN 
116.90 6 128.59
190 APT010000I62004494 161562 tn. MUH AGUS
PUMPITOR
BASRI BASTIAN 
11,330.00 6 12,463.00
191 APT010000I62004476 161475 ny. ANDI MASTURA 
CAIRAN AS 9,645.90 3 10,610.49
192 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 3 770.00
193 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 6 525.80
194 APT010000I62004476 161475 ny. ANDI MASTURA 
CONECTA 13,200.00 1 14,520.00
195 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOON 12,100.00 1 13,310.00
196 APT010000I62004501 115911 ny. WALIDACAIRAN
DG BAJI 
NAC6,409.70 3 7,050.67
197 APT010000I62004501 115911 ny. WALIDAMASKER
DG BAJI DI 700.00 2 770.00
198 APT010000I62004501 115911 ny. WALIDAHANDSCOEN
DG BAJI  478.00 4 525.80
199 APT010000I62004501 115911 ny. WALIDAHANDSCOON
DG BAJI  12,100.00 1 13,310.00
200 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  AS 9,645.90 4 10,610.49
201 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 2 770.00
202 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 4 525.80
203 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
RL 7,149.60 3 7,864.56
204 APT010000I65003107 161571 ny. SALFIAHMASKER
DG SAYU DI 700.00 3 770.00
205 APT010000I65003107 161571 ny. SALFIAHHANDSCOEN
DG SAYU  478.00 4 525.80
206 APT010000I65003107 161571 ny. SALFIAHCONECTA
DG SAYU 13,200.00 1 14,520.00
207 APT010000I65003107 161571 ny. SALFIAHHANDSCOON
DG SAYU 12,100.00 1 13,310.00
208 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN NAC6,409.70 5 7,050.67
209 APT010000I65003101 161497 ny. LILY HAFSAH 
MASKER DI 700.00 2 770.00
210 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOEN 478.00 4 525.80
211 APT010000I65003101 161497 ny. LILY HAFSAH 
IV CATHETE 7,750.00 1 8,525.00
212 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOON 12,100.00 1 13,310.00
213 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 7 7,864.56
214 APT010000I62004511 161613 an. MUHAMMAD
CONECTATAQWA 
13,200.00 1 14,520.00
215 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 2 770.00
216 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA  478.00 4 525.80
217 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOON
TAQWA 
12,100.00 1 13,310.00
218 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 3 7,864.56
219 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOEN
BATARI  478.00 4 525.80
220 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 2 770.00
221 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
3 CC 1,485.00 2 1,633.50
222 APT010000I62004496 161569 nn. ANDI INDRI
IV CATHETE
BATARI 7,750.00 1 8,525.00
223 APT010000I62004497 161572 an. AHMADCAIRAN
NUR FAUZAN 
RL 7,149.60 6 7,864.56
224 APT010000I62004497 161572 an. AHMADMASKER
NUR FAUZAN 
DI 700.00 2 770.00
225 APT010000I62004497 161572 an. AHMADHANDSCOEN
NUR FAUZAN 478.00 4 525.80
226 APT010000I62004509 131089 ny. FIRDHACAIRAN
RESMISARI 
NAC6,409.70 5 7,050.67
227 APT010000I62004509 131089 ny. FIRDHAHANDSCOEN
RESMISARI  478.00 4 525.80
228 APT010000I62004509 131089 ny. FIRDHAMASKER
RESMISARI 
DI 700.00 2 770.00
229 APT010000I62004509 131089 ny. FIRDHAIVRESMISARI 
CATHETE 7,750.00 1 8,525.00
230 APT010000I62004509 131089 ny. FIRDHAHANDSCOON
RESMISARI 12,100.00 1 13,310.00
231 APT010000I12000071 150670 ny. DESTY MELYANI 
PREGABAL 5,500.00 2 6,050.00
232 APT010000I12000071 150670 ny. DESTY MELYANI 
OFLOKSASI 1,549.00 3 1,703.90
233 APT010000I66000437 161676 ny. HJ ERNAWATY 
FEEDING T 42,800.00 1 47,080.00
234 APT010000I66000437 161676 ny. HJ ERNAWATY 
MECOBALAM6,600.00 1 7,260.00
235 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 27,505.00 2 30,255.50
236 APT010000I66000437 161676 ny. HJ ERNAWATY 
CAIRAN MA39,499.90 1 43,449.89
237 APT010000I66000437 161676 ny. HJ ERNAWATY 
CAIRAN NAC6,409.70 1 7,050.67
238 APT010000I66000437 161676 ny. HJ ERNAWATY 
ELEKTRODA 4,000.00 5 4,400.00
239 APT010000I66000437 161676 ny. HJ ERNAWATY 
CONECTA 25,000.00 1 27,500.00
240 APT010000I66000437 161676 ny. HJ ERNAWATY 
SUNGKUP 44,750.00 1 49,225.00
241 APT010000I66000437 161676 ny. HJ ERNAWATY 
MASKER DI 700.00 1 770.00
242 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 4 525.80
243 APT010000I65003086 161248 ny. JUMANIA MASKER DI 700.00 2 770.00
244 APT010000I65003086 161248 ny. JUMANIA HANDSCOEN 478.00 4 525.80
245 APT010000I65003086 161248 ny. JUMANIA SPOIT 10 C 2,310.00 2 2,541.00
246 APT010000I65003086 161248 ny. JUMANIA SPOIT 3 CC 1,485.00 2 1,633.50
247 APT010000I65003086 161248 ny. JUMANIA IV CATHETE 7,750.00 2 8,525.00
248 APT010000I65003086 161248 ny. JUMANIA CONECTA 13,200.00 1 14,520.00
249 APT010000I65003086 161248 ny. JUMANIA SUNGKUP 44,750.00 1 49,225.00
250 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01
251 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
252 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
AQ 2,860.00
  2 3,146.00
253 APT010000I62004490 161536 nn. RISKI INDASARI
CAIRAN RL
AMIR 
7,149.60 2 7,864.56
254 APT010000I62004490 161536 nn. RISKI INDASARI
MASKER AMIR 
DI 700.00 2 770.00
255 APT010000I62004490 161536 nn. RISKI INDASARI
HANDSCOEN
AMIR 478.00 4 525.80
256 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 10AMIR 
C 2,310.00 2 2,541.00
257 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 3 CC
AMIR 
1,485.00 2 1,633.50
258 APT010000I62004490 161536 nn. RISKI INDASARI
IV DRESSIAMIR 
4,850.00 1 5,335.00
259 APT010000I62004490 161536 nn. RISKI INDASARI
IV CATHETE
AMIR 
7,750.00 1 8,525.00
260 APT010000I62004490 161536 nn. RISKI INDASARI
INFUS SET
AMIR 
7,920.00 1 8,712.00
261 APT010000I62004490 161536 nn. RISKI INDASARI
SUNGKUPAMIR 
44,750.00 1 49,225.00
262 APT010000I62004490 161536 nn. RISKI INDASARI
FOLEY CAT
AMIR 
33,000.00 1 36,300.00
263 APT010000I62004512 161657 ny. HASNAH CAIRAN
TAHA RL 7,149.60 2 7,864.56
264 APT010000I62004512 161657 ny. HASNAH IVTAHA 
CATHETE 7,750.00 1 8,525.00
265 APT010000I62004512 161657 ny. HASNAH HANDSCOEN
TAHA  478.00 2 525.80
266 APT010000I62004512 161657 ny. HASNAHMASKER
TAHA  DI 700.00 1 770.00
267 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
1 CC 1,920.00 1 2,112.00
268 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
3 CC 1,485.00 1 1,633.50
269 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
10 C 2,310.00 1 2,541.00
270 APT010000I62004512 161657 ny. HASNAHCAIRAN
TAHA AQ 2,860.00 2 3,146.00
271 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN NAC6,409.70 2 7,050.67
272 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN NA15,180.00 1 16,698.00
273 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
274 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 1 CC 1,920.00 1 2,112.00
275 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
276 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
277 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 10 C 2,310.00 1 2,541.00
278 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 2 525.80
279 APT010000I62004505 159634 ny. HJ LOBO 
MASKER DI 700.00 1 770.00
280 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN AQ 2,860.00 2 3,146.00
281 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN NAC6,409.70 2 7,050.67
282 APT010000I62004457 76534 tn. SAHABUDDIN 
IV CATHETE 7,750.00 1 8,525.00
283 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 1 CC 1,920.00 1 2,112.00
284 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 3 CC 1,485.00 1 1,633.50
285 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 5 CC 1,595.00 1 1,754.50
286 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 10 C 2,310.00 1 2,541.00
287 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 2 525.80
288 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 1 770.00
289 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
RL 7,149.60
E  2 7,864.56
290 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
1 CC 1,920.00
E  1 2,112.00
291 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
3 CC 1,485.00
E  1 1,633.50
292 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
5 CC 1,595.00
E  1 1,754.50
293 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
10 C 2,310.00
E  1 2,541.00
294 APT010000I62004513 114199 tn. SOFYANHANDSCOEN
FIRMANSYAH478.00
E  2 525.80
295 APT010000I62004513 114199 tn. SOFYANMASKER
FIRMANSYAH
DI 700.00
E  1 770.00
296 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
AQ 2,860.00
E  1 3,146.00
297 APT010000I64002929 161294 ny. HASNAH 
CAIRAN NAC6,409.70 1 7,050.67
298 APT010000I64002929 161294 ny. HASNAH 
HANDSCOEN 478.00 4 525.80
299 APT010000I64002929 161294 ny. HASNAH 
MASKER DI 700.00 1 770.00
300 APT010000I64002929 161294 ny. HASNAH 
SPOIT 10 C 2,310.00 2 2,541.00
301 APT010000I64002929 161294 ny. HASNAH 
SPOIT 5 CC 1,595.00 2 1,754.50
302 APT010000I64002929 161294 ny. HASNAH 
SPOIT 3 CC 1,485.00 2 1,633.50
303 APT010000I64002929 161294 ny. HASNAH 
IV DRESSI 4,850.00 1 5,335.00
304 APT010000I64002929 161294 ny. HASNAH 
IV CATHETE 7,750.00 1 8,525.00
305 APT010000I64002929 161294 ny. HASNAH 
CONECTA 13,200.00 1 14,520.00
306 APT010000I64002929 161294 ny. HASNAH 
CAIRAN AQ 2,860.00 2 3,146.00
307 APT010000I65003098 155366 tn. DUDUNG 
CAIRAN RL 7,149.60 3 7,864.56
308 APT010000I65003098 155366 tn. DUDUNG 
HANDSCOEN 478.00 4 525.80
309 APT010000I65003098 155366 tn. DUDUNG 
MASKER DI 700.00 1 770.00
310 APT010000I65003098 155366 tn. DUDUNG 
CONECTA 13,200.00 2 14,520.00
311 APT010000I65003098 155366 tn. DUDUNG IV DRESSI 4,850.00 1 5,335.00
312 APT010000I65003098 155366 tn. DUDUNG CAIRAN NA15,180.00 1 16,698.00
313 APT010000I65003098 155366 tn. DUDUNG INFUS SET 7,920.00 1 8,712.00
314 APT010000I65003098 155366 tn. DUDUNG CAIRAN AQ 2,860.00 2 3,146.00
315 APT010000I65003098 155366 tn. DUDUNG SPOIT 3 CC 1,485.00 2 1,633.50
316 APT010000I65003098 155366 tn. DUDUNG SPOIT 10 C 2,310.00 2 2,541.00
317 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
NAC6,409.70
  3 7,050.67
318 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
319 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  1 770.00
320 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
5 CC 1,595.00
  2 1,754.50
321 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
10 C 2,310.00
  2 2,541.00
322 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
3 CC 1,485.00
  2 1,633.50
323 APT010000I62004453 161309 ny. SURIATIIVDG.
CATHETE
SUNGGU 7,750.00
  1 8,525.00
324 APT010000I62004494 161562 tn. MUH AGUS
CAIRAN
BASRIRL BASTIAN 
7,149.60 3 7,864.56
325 APT010000I62004494 161562 tn. MUH AGUS
MASKER
BASRI DIBASTIAN 
700.00 1 770.00
326 APT010000I62004494 161562 tn. MUH AGUS
HANDSCOEN
BASRI BASTIAN 
478.00 4 525.80
327 APT010000I62004494 161562 tn. MUH AGUS
IV CATHETE
BASRI BASTIAN 
7,750.00 2 8,525.00
328 APT010000I62004494 161562 tn. MUH AGUS
IV DRESSI
BASRI BASTIAN 
4,850.00 2 5,335.00
329 APT010000I62004494 161562 tn. MUH AGUS
CAIRAN
BASRINA15,180.00
BASTIAN  1 16,698.00
330 APT010000I62004494 161562 tn. MUH AGUS
CAIRAN
BASRIAQBASTIAN 
2,860.00 2 3,146.00
331 APT010000I62004500 161581 ny. SERI BINTANG 
MASKER DI 700.00 2 770.00
332 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN NAC6,409.70 2 7,050.67
333 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 10 C 2,310.00 2 2,541.00
334 APT010000I62004500 161581 ny. SERI BINTANG 
HANDSCOEN 478.00 4 525.80
335 APT010000I62004500 161581 ny. SERI BINTANG 
IV CATHETE 7,750.00 1 8,525.00
336 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 1 CC 1,920.00 2 2,112.00
337 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN AQ 2,860.00 2 3,146.00
338 APT010000I66000437 161676 ny. HJ ERNAWATY 
SUNGKUP 44,750.00 1 49,225.00
339 APT010000I66000437 161676 ny. HJ ERNAWATY 
KETOROLAC 7,350.75 1 8,085.82
340 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 3 21,999.01
341 APT010000I62004506 161611 tn. ALI NGURAWAN 
KETOROLAC 7,350.75 3 8,085.82
342 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 2 7,744.00
343 APT010000I62004506 161611 tn. ALI NGURAWAN 
VITAMIN K 7,920.00 3 8,712.00

344 APT010000I62004506 161611 tn. ALI NGURAWAN 

DICYNONE 4I 7,740.00 3 52,514.00

345 APT010000I62004506 161611 tn. ALI NGURAWAN 

VITAMIN C 5,665.80 3 6,232.38
346 APT010000I62004506 161611 tn. ALI NGURAWAN 
PLASMINEX13,002.00 3 14,302.20

347 APT010000I62004506 161611 tn. ALI NGURAWAN 

CAIRAN NAC6,409.70 20 7,050.67

348 APT010000I62004506 161611 tn. ALI NGURAWAN 

CAIRAN RL 7,149.60 2 7,864.56
349 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 10 C 2,310.00 2 2,541.00
350 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 5 CC 1,595.00 2 1,754.50
351 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 3 CC 1,485.00 2 1,633.50
352 APT010000I62004506 161611 tn. ALI NGURAWAN 
SANTAGESIK4,949.40 3 5,444.34
353 APT010000I62004472 161449 tn. NUR ROHMAT 
CITICOLIN 10,011.38 2 11,012.51
 354 APT010000I62004472 161449 tn. NUR ROHMAT 
MECOBALAM6,600.00 1 7,260.00
355 APT010000I62004472 161449 tn. NUR ROHMAT 
PREDNISON 224.99 12 247.49
356 APT010000I62004472 161449 tn. NUR ROHMAT 
CAIRAN RL 7,149.60 2 7,864.56
357 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOEN 478.00 4 525.80
358 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOON 13,613.00 1 14,974.30
359 APT010000I62004472 161449 tn. NUR ROHMAT 
MASKER DI 700.00 2 770.00
360 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 3 CC 1,485.00 2 1,633.50
361 APT010000I62004472 161449 tn. NUR ROHMAT 
SPOIT 10 C 2,310.00 1 2,541.00
362 APT010000I62004472 161449 tn. NUR ROHMAT 
IV CATHETE 7,750.00 1 8,525.00
363 APT010000I62004472 161449 tn. NUR ROHMAT 
INFUS SET 7,920.00 1 8,712.00
364 APT010000I62004472 161449 tn. NUR ROHMAT 
CEFTRIAXO19,999.10 2 21,999.01
365 APT010000I62004472 161449 tn. NUR ROHMAT 
KETOROLAC 7,350.75 2 8,085.82
366 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 2 7,744.00
Sub Total   939
PCS 2,112.00

PCS 2,103.20
PCS 770.00
PCS 5,335.00
PCS 8,712.00
PCS 15,488.00
PCS 24,257.46
PCS 12,160.50
PCS 2,417.58
PCS 2,897.46
PCS 15,488.00
PCS 980.10
PCS 10,005.60
PCS 1,015.55
PCS 493.90
PCS 24,926.00
PCS 2,103.20
PCS 770.00
PCS 4,900.50
PCS 1,754.50
PCS 2,867.70
PCS 847.00
PCS 5,791.50
PCS 7,700.00
PCS 2,112.00
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 8,712.00
PCS 24,257.46
PCS 15,488.00
PCS 18,150.00
PCS 26,194.08
PCS 18,150.00
PCS 12,463.00
PCS 16,171.64
PCS 43,998.02
PCS 658.86
PCS 980.10
PCS 15,014.82
PCS 15,488.00
PCS 1,677.06
PCS 15,488.00
PCS 2,107.42
PCS 2,112.00
PCS 1,633.50
PCS 1,051.60
PCS 5,335.00
PCS 8,712.00
PCS 14,520.00
PCS 8,525.00
PCS 15,488.00
PCS 1,931.16
PCS 147.62
PCS 54,450.00
PCS 54,999.34
PCS 50,965.20
PCS 30,855.00
PCS 1,051.60
PCS 770.00
PCS 5,082.00
PCS 1,754.50
PCS 3,267.00
PCS 2,103.20
PCS 1,540.00
PCS 12,705.07
PCS 15,488.00
PCS 113.14

PCS 187,170.0
6
PCS 16,333.02
PCS 23,232.00
PCS 43,998.02
PCS 980.10
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 17,424.00
PCS 5,082.00
PCS 3,267.00
PCS 79,868.58
PCS 18,150.00
PCS 24,926.00
PCS 493.90
PCS 3,677.22
PCS 461.94
PCS 980.10
PCS 431.00
PCS 1,677.06
PCS 15,488.00
PCS 980.10
PCS 3,677.22
PCS 1,118.04
PCS 6,425.10
PCS 439.98
PCS 15,488.00
PCS 353.49
PCS 32,670.00
PCS 4,029.30
PCS 6,121.26
PCS 1,015.55
PCS 1,385.98
PCS 79,868.58
PCS 10,005.60
PCS 43,998.02
PCS 3,448.50
PCS 1,237.45
PCS 1,526.13
PCS 825.00
PCS 43,998.02
PCS 3,448.50
PCS 2,940.30
PCS 10,223.40
PCS 36,300.00
PCS 44,068.20
PCS 2,867.70
PCS 18,150.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 11,529.78
PCS 15,488.00
PCS 79,868.58
163,350.0
PCS
0
PCS 24,926.00
PCS 980.10
PCS 97,130.33
PCS 78,582.24
PCS 2,324.40
PCS 2,766.03
PCS 5,867.37
PCS 871.20
PCS 818.97
PCS 4,150.71
PCS 418.00
PCS 2,867.70
PCS 1,838.61
PCS 31,458.24
PCS 79,868.58
PCS 6,050.00
PCS 266.20
PCS 847.00
PCS 980.10
PCS 658.86
PCS 43,998.02
PCS 15,488.00
PCS 1,118.04
PCS 5,082.00
PCS 78,582.24
PCS 6,921.20
135,435.3
PCS
0
PCS 53,997.56
PCS 2,784.00
PCS 3,118.50
PCS 1,290.60
PCS 910.00
PCS 26,194.08
PCS 5,136.45
PCS 22,808.50
PCS 1,801.80
PCS 12,585.10
PCS 847.00
PCS 24,926.00
PCS 2,031.10
PCS 987.80
PCS 49,852.00
PCS 630.27
PCS 659.97
PCS 790.02
PCS 2,771.96
174,240.0
PCS 0
PCS 8,085.82
PCS 1,633.50
PCS 5,793.48
PCS 4,198.70
PCS 627.00
PCS 92,345.02
PCS 2,291.30
PCS 54,450.00
PCS 6,929.90
PCS 10,155.50
PCS 8,414.66
PCS 5,709.00
PCS 2,292.00
PCS 4,198.70
PCS 2,252.06
PCS 56,265.00
PCS 28,560.84
PCS 3,354.12
PCS 771.54
PCS 74,778.00
PCS 31,831.47
PCS 2,310.00
PCS 3,154.80
PCS 14,520.00
PCS 13,310.00
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 13,310.00
PCS 42,441.96
PCS 1,540.00
PCS 2,103.20
PCS 23,593.68
PCS 2,310.00
PCS 2,103.20
PCS 14,520.00
PCS 13,310.00
PCS 35,253.35
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 13,310.00
PCS 55,051.92
PCS 14,520.00
PCS 1,540.00
PCS 2,103.20
PCS 13,310.00
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 3,267.00
PCS 8,525.00
PCS 47,187.36
PCS 1,540.00
PCS 2,103.20
PCS 35,253.35
PCS 2,103.20
PCS 1,540.00
PCS 8,525.00
PCS 13,310.00
PCS 12,100.00
PCS 5,111.70
PCS 47,080.00
PCS 7,260.00
PCS 60,511.00
PCS 43,449.89
PCS 7,050.67
PCS 22,000.00
PCS 27,500.00
PCS 49,225.00
PCS 770.00
PCS 2,103.20
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,267.00
PCS 17,050.00
PCS 14,520.00
PCS 49,225.00
PCS 43,998.02
PCS 980.10
PCS 6,292.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,267.00
PCS 5,335.00
PCS 8,525.00
PCS 8,712.00
PCS 49,225.00
PCS 36,300.00
PCS 15,729.12
PCS 8,525.00
PCS 1,051.60
PCS 770.00
PCS 2,112.00
PCS 1,633.50
PCS 2,541.00
PCS 6,292.00
PCS 14,101.34
PCS 16,698.00
PCS 8,525.00
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 6,292.00
PCS 14,101.34
PCS 8,525.00
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 15,729.12
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 3,146.00
PCS 7,050.67
PCS 2,103.20
PCS 770.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 5,335.00
PCS 8,525.00
PCS 14,520.00
PCS 6,292.00
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 29,040.00
PCS 5,335.00
PCS 16,698.00
PCS 8,712.00
PCS 6,292.00
PCS 3,267.00
PCS 5,082.00
PCS 21,152.01
PCS 2,103.20
PCS 770.00
PCS 3,509.00
PCS 5,082.00
PCS 3,267.00
PCS 8,525.00
PCS 23,593.68
PCS 770.00
PCS 2,103.20
PCS 17,050.00
PCS 10,670.00
PCS 16,698.00
PCS 6,292.00
PCS 1,540.00
PCS 14,101.34
PCS 5,082.00
PCS 2,103.20
PCS 8,525.00
PCS 4,224.00
PCS 6,292.00
PCS 49,225.00
PCS 8,085.82
PCS 65,997.03
PCS 24,257.46
PCS 15,488.00
PCS 26,136.00
157,542.0
PCS
0
PCS 18,697.14
PCS 42,906.60
141,013.4
PCS
0
PCS 15,729.12
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 16,333.02
PCS 22,025.02
PCS 7,260.00
PCS 2,969.88
PCS 15,729.12
PCS 2,103.20
PCS 14,974.30
PCS 1,540.00
PCS 3,267.00
PCS 2,541.00
PCS 8,525.00
PCS 8,712.00
PCS 43,998.02
PCS 16,171.64
PCS 15,488.00
5,574,695.74
25-12-
1 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN RL 7,149.60 2 7,864.56
2018 
2 APT010000I12000082 161621 ny. DG NURUNG 
IV CATHETE 7,750.00 1 8,525.00
3 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 1 CC 1,920.00 1 2,112.00
4 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
5 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 10 C 2,310.00 1 2,541.00
6 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 2 525.80
7 APT010000I12000082 161621 ny. DG NURUNG 
MASKER DI 700.00 1 770.00
8 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN AQ 2,860.00 2 3,146.00
9 APT010000I12000082 161621 ny. DG NURUNG 
METOCLOPR5,500.00 2 6,050.00
10 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 3 326.70
11 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 7,040.00 2 7,744.00
12 APT010000I62004506 161611 tn. ALI NGURAWAN 
ADONA INJ22,880.00 1 25,168.00
13 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 1 7,864.56
14 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN NAC6,409.70 10 7,050.67
15 APT010000I62004511 161613 an. MUHAMMAD
ZINK OKSI
TAQWA  604.00 1 664.40
16 APT010000I62004511 161613 an. MUHAMMAD
SANMOL TAQWA 
I 24,202.60 2 26,622.86
17 APT010000I62004511 161613 an. MUHAMMAD
ONDANSETR5,500.00
TAQWA  2 6,050.00
18 APT010000I62004509 131089 ny. FIRDHAANTASIDA
RESMISARI  139.99 3 153.98
19 APT010000I62004509 131089 ny. FIRDHASANMOL
RESMISARI 
T 297.00 3 326.70
20 APT010000I62004509 131089 ny. FIRDHANEW
RESMISARI 
DIAT 557.15 6 612.87
21 APT010000I62004476 161475 ny. ANDI MASTURA 
SANMOL I 24,202.60 3 26,622.86
22 APT010000I62004476 161475 ny. ANDI MASTURA 
NATRIUM D 195.91 2 215.50
23 APT010000I62004499 161575 tn. ALIF PRADITYA
RANITIDIN
  7,040.00 2 7,744.00
24 APT010000I62004499 161575 tn. ALIF PRADITYA
SANMOL  I 24,202.60 2 26,622.86
25 APT010000I62004499 161575 tn. ALIF PRADITYA
CEFTRIAXO19,999.10
  2 21,999.01

26 APT010000I65003101 161497 ny. LILY HAFSAH 

METIL PRE 49,500.00 2 54,450.00

27 APT010000I65003101 161497 ny. LILY HAFSAH 

PUMPITOR 11,330.00 2 12,463.00
28 APT010000I65003101 161497 ny. LILY HAFSAH 
VOLUVEN 621,780.00 1 23,958.00
29 APT010000I65003101 161497 ny. LILY HAFSAH 
CETIRIZIN 266.01 3 292.61
30 APT010000I65003101 161497 ny. LILY HAFSAH 
NATRIUM D 195.91 3 215.50
31 APT010000I62004501 115911 ny. WALIDACODIPRONT
DG BAJI  7,937.60 3 8,731.36
32 APT010000I62004501 115911 ny. WALIDAANALSIK
DG BAJI  1,556.50 3 1,712.15
33 APT010000I62004501 115911 ny. WALIDA- DG BAJI  0 0 0
34 APT010000I62004501 115911 ny. WALIDAINFUSAN
DG BAJI N 6,712.06 3 7,383.27
35 APT010000I62004501 115911 ny. WALIDATETRASIKLI
DG BAJI  264.00 3 290.40
36 APT010000I62004501 115911 ny. WALIDAMETRONIDA
DG BAJI  248.18 3 272.99
37 APT010000I62004501 115911 ny. WALIDAMETFORMI
DG BAJI  190.00 2 209.00
38 APT010000I62004501 115911 ny. WALIDAEPEXOL
DG BAJI 
TA 869.00 3 955.90
39 APT010000I62004501 115911 ny. WALIDANEW
DG BAJI 
DIAT 557.15 3 612.87
40 APT010000I65003107 161571 ny. SALFIAHKOTRIMOKS
DG SAYU  254.10 4 279.51
41 APT010000I65003107 161571 ny. SALFIAHMETFORMI
DG SAYU  190.00 2 209.00
42 APT010000I65003107 161571 ny. SALFIAHCAIRAN
DG SAYU 
RL 7,149.60 3 7,864.56
43 APT010000I65003107 161571 ny. SALFIAHNATRIUM
DG SAYU D 195.91 2 215.50
44 APT010000I65003107 161571 ny. SALFIAHRANITIDIN
DG SAYU  7,040.00 2 7,744.00
45 APT010000I65003107 161571 ny. SALFIAHMETIL
DG SAYU 
PRE 475.79 3 523.37
46 APT010000I62004514 160906 tn. KIDJO SUKARYO 
COMBIVENT4,549.95 3 5,004.94
47 APT010000I62004514 160906 tn. KIDJO SUKARYO 
FUROSEMID2,920.50 3 3,212.55
48 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SALBUTAM 102.85 1 113.14
49 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CETIRIZIN 266.01 1 292.61
50 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 3 7,864.56
51 APT010000I62004514 160906 tn. KIDJO SUKARYO 
NEBULIZE 40,535.00 1 44,588.50
52 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CODEIN 10 605.00 3 665.50
53 APT010000I62004435 161179 ny. HASNAWATY
RANITIDIN
H  629.99 6 692.99
54 APT010000I62004435 161179 ny. HASNAWATY
MELOXICAM
H  923.23 3 1,015.55
55 APT010000I62004508 120214 ny. ROSMAWATI 
DIMENHIDR 121.00 2 133.10
56 APT010000I62004508 120214 ny. ROSMAWATI 
NEURODEX 770.00 1 847.00
57 APT010000I62004508 120214 ny. ROSMAWATI 
SANMOL T 297.00 3 326.70
58 APT010000I62004496 161569 nn. ANDI INDRI
DOMPERID
BATARI  508.20 2 559.02
59 APT010000I62004496 161569 nn. ANDI INDRI
CIPROFLOX
BATARI  770.00 2 847.00
60 APT010000I62004496 161569 nn. ANDI INDRI
SANMOL
BATARI 
I 24,202.60 3 26,622.86
61 APT010000I62004496 161569 nn. ANDI INDRI
COMBIVENT4,549.95
BATARI  2 5,004.94
62 APT010000I62004496 161569 nn. ANDI INDRI
NEBULIZE
BATARI 40,535.00 1 44,588.50
63 APT010000I62004496 161569 nn. ANDI INDRI
IV CATHETE
BATARI 12,416.00 1 13,657.60
64 APT010000I62004496 161569 nn. ANDI INDRI
CONECTA
BATARI 13,200.00 1 14,520.00
65 APT010000I62004496 161569 nn. ANDI INDRI
INFUSBATARI 
SET 7,920.00 1 8,712.00
66 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
3 CC 1,485.00 1 1,633.50
67 APT010000I62004496 161569 nn. ANDI INDRI
LIDOCAINE
BATARI 1,287.00 1 1,415.70
68 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
50 12,367.00 2 13,603.70
69 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 1 21,999.01
70 APT010000I62004506 161611 tn. ALI NGURAWAN 
METAMIZOL4,999.99 2 5,499.99
71 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 3 7,744.00
72 APT010000I62004506 161611 tn. ALI NGURAWAN 
ASAM TRAN3,493.88 1 3,843.26
73 APT010000I62004506 161611 tn. ALI NGURAWAN 
VITAMIN K 7,920.00 1 8,712.00
74 APT010000I62004506 161611 tn. ALI NGURAWAN 
VITAMIN C 5,665.80 1 6,232.38
75 APT010000I62004506 161611 tn. ALI NGURAWAN 
DICYNONE 4I 7,740.00 1 52,514.00
76 APT010000I62004506 161611 tn. ALI NGURAWAN 
ADONA INJ22,880.00 1 25,168.00
77 APT010000I62004506 161611 tn. ALI NGURAWAN 
INFUSAN N 6,712.06 10 7,383.27
78 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN AQ 2,860.00 1 3,146.00
79 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 10,011.38 4 11,012.51
80 APT010000I66000437 161676 ny. HJ ERNAWATY 
MECOBALAM6,600.00 1 7,260.00
81 APT010000I66000437 161676 ny. HJ ERNAWATY 
RANITIDIN 7,040.00 2 7,744.00
82 APT010000I66000437 161676 ny. HJ ERNAWATY 
INFUSAN N 6,712.06 3 7,383.27
83 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 5 CC 1,595.00 3 1,754.50
84 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 10 C 2,310.00 1 2,541.00
85 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 3 CC 1,485.00 2 1,633.50
86 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 20 525.80
87 APT010000I66000437 161676 ny. HJ ERNAWATY 
MASKER DI 700.00 10 770.00
88 APT010000I62004503 159886 tn. MUH BASIR
NEUROSANB5,324.00
LALANG  1 6,921.20
 89 APT010000I62004503 159886 tn. MUH BASIR
RANITIDIN
LALANG 7,040.00 2 10,700.80
90 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
91 APT010000I62004503 159886 tn. MUH BASIR
CAIRAN
LALANG 
AM70,188.80 1 94,754.88
92 APT010000I62004505 159634 ny. HJ LOBO ONDANSETR5,500.00 3 6,050.00
93 APT010000I62004505 159634 ny. HJ LOBO PUMPITOR 11,330.00 1 12,463.00
94 APT010000I62004505 159634 ny. HJ LOBO CODIPRONT 7,937.60 3 8,731.36
95 APT010000I64002929 161294 ny. HASNAH  CEFTAZIDIM23,166.00 2 25,482.60
96 APT010000I64002929 161294 ny. HASNAH  METIL PRE 49,500.00 1 54,450.00
97 APT010000I64002929 161294 ny. HASNAH  PUMPITOR 11,330.00 2 12,463.00
98 APT010000I62004500 161581 ny. SERI BINTANG 
CODEIN 10 605.00 3 665.50
99 APT010000I62004513 114199 tn. SOFYANCEFTRIAXO19,999.10
FIRMANSYAH E  2 21,999.01
100 APT010000I62004513 114199 tn. SOFYANRANITIDIN
FIRMANSYAH7,040.00
E  2 7,744.00
101 APT010000I62004513 114199 tn. SOFYANDOMPERID
FIRMANSYAH508.20
E  3 559.02
102 APT010000I62004513 114199 tn. SOFYANDEKSAMETA1,801.80
FIRMANSYAH E  2 1,981.98
103 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 
7,040.00 2 7,744.00
104 APT010000I62004490 161536 nn. RISKI INDASARI
CEFADROXI
AMIR 877.80 2 965.58
105 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 235.95 3 259.55
106 APT010000I62004472 161449 tn. NUR ROHMAT 
MECOBALAM6,600.00 1 7,260.00
107 APT010000I62004472 161449 tn. NUR ROHMAT 
PREDNISON 224.99 12 247.49

108 APT010000I62004472 161449 tn. NUR ROHMAT 

PIRACETAM77,000.00 2 84,700.00

109 APT010000I62004472 161449 tn. NUR ROHMAT 

MELOXICAM 923.23 1 1,015.55
110 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 629.99 2 692.99
111 APT010000I62004472 161449 tn. NUR ROHMAT 
SPORETIK 5,720.50 2 6,292.55
112 APT010000I63003172 161606 ny. ASIH  RANITIDIN 7,040.00 2 7,744.00
113 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
114 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,330.00 2 12,463.00
115 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
116 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 2 275.00
117 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
118 APT010000I62004500 161581 ny. SERI BINTANG 
KETOROLAC 7,350.75 3 8,085.82
119 APT010000I62004500 161581 ny. SERI BINTANG 
RANITIDIN 7,040.00 2 7,744.00
120 APT010000I62004500 161581 ny. SERI BINTANG 
ONDANSETR5,500.00 3 6,050.00
121 APT010000I62004500 161581 ny. SERI BINTANG 
CARBAZOC11,145.20 3 12,259.72
122 APT010000I65003098 155366 tn. DUDUNG CEFTRIAXO19,999.10 2 21,999.01
123 APT010000I65003098 155366 tn. DUDUNG AMBROXOL 199.65 3 219.62
124 APT010000I65003098 155366 tn. DUDUNG SANMOL T 297.00 3 326.70
125 APT010000I65003098 155366 tn. DUDUNG COMBIVENT4,549.95 3 5,004.94
126 APT010000I65003098 155366 tn. DUDUNG RANITIDIN 7,040.00 2 7,744.00
127 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 7,040.00 2 7,744.00
128 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 3 326.70
129 APT010000I12000082 161621 ny. DG NURUNG 
SOTATIC I 3,032.00 3 3,335.20
130 APT010000I62004515 161675 tn. ANDI MAY
CEFTRIAXO19,999.10
WELLO M, SE  2 21,999.01
131 APT010000I62004515 161675 tn. ANDI MAY
RANITIDIN
WELLO M,
7,040.00
SE  2 7,744.00
132 APT010000I62004515 161675 tn. ANDI MAY
DOMPERID
WELLO M, 508.20
SE  6 559.02
133 APT010000I62004515 161675 tn. ANDI MAY
CETIRIZIN
WELLO M, 266.01
SE  1 292.61
134 APT010000I62004515 161675 tn. ANDI MAY
AMBROXOL
WELLO M, 199.65
SE  9 219.62
135 APT010000I62004515 161675 tn. ANDI MAY
SALBUTAM
WELLO M, SE 
88.00 9 96.80
136 APT010000I62004515 161675 tn. ANDI MAY
METIL
WELLO
PRE M, 475.79
SE  9 523.37
137 APT010000I62004515 161675 tn. ANDI MAY
CANGKANG
WELLO M, SE 
75.00 9 82.50
138 APT010000I62004453 161309 ny. SURIATICEFTRIAXO19,999.10
DG. SUNGGU   2 21,999.01

139 APT010000I62004453 161309 ny. SURIATIMETRONIDA

DG. SUNGGU
56,718.20
  3 62,390.02

140 APT010000I62004453 161309 ny. SURIATIRANITIDIN

DG. SUNGGU7,040.00
  3 7,744.00
141 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  3 326.70
142 APT010000I62004453 161309 ny. SURIATISANTAGESIK4,949.40
DG. SUNGGU   3 5,444.34
143 APT010000I62004457 76534 tn. SAHABUDDIN 
EPEXOL TA 869.00 3 955.90
144 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 1 847.00
145 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 3 1,930.50
146 APT010000I62004457 76534 tn. SAHABUDDIN 
STREPTOMI 7,700.00 1 7,700.00
147 APT010000I65003086 161248 ny. JUMANIA 
CEFTRIAXO19,999.10 2 21,999.01
148 APT010000I65003086 161248 ny. JUMANIA 
PUMPITOR 11,330.00 1 12,463.00
149 APT010000I65003086 161248 ny. JUMANIA 
LEVOFLOXA 449.00 1 493.90
150 APT010000I65003086 161248 ny. JUMANIA 
ONDANSETR5,500.00 3 6,050.00
151 APT010000I65003086 161248 ny. JUMANIA 
SANMOL I 24,202.60 3 26,622.86
152 APT010000I62004504 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
153 APT010000I62004504 161146 ny. NIRWANA 
INFUSAN N 6,712.06 1 7,383.27
154 APT010000I62004504 161146 ny. NIRWANA 
METAMIZOL4,999.99 1 5,499.99
155 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 1 CC 1,920.00 1 2,112.00
156 APT010000I62004504 161146 ny. NIRWANA 
URDAFALK 5,527.50 2 6,080.25
157 APT010000I64002973 123863 ny. MULIATI
COMBO
DG NGAI 
PAC
60,500.00 1 66,550.00
158 APT010000I64002973 123863 ny. MULIATI
NATRIUM
DG NGAI D 195.91 1 215.50
159 APT010000I64002973 123863 ny. MULIATI
SPOIT
DG NGAI 
3 CC 1,485.00 2 1,633.50
160 APT010000I64002973 123863 ny. MULIATI
RANITIDIN
DG NGAI  7,040.00 1 7,744.00
161 APT010000I64002973 123863 ny. MULIATI
NEUROSANB5,324.00
DG NGAI  1 5,856.40
162 APT010000I64002973 123863 ny. MULIATI
HANDSCOEN
DG NGAI  478.00 2 525.80
163 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN DE18,920.00 1 20,812.00
164 APT010000I62004517 161692 ny. DJANGKI 
COMBO PAC 60,500.00 1 66,550.00
165 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN RL 7,149.60 1 7,864.56
166 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 1 21,999.01
167 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
168 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
169 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 1 CC 1,920.00 1 2,112.00
170 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 3 CC 1,485.00 3 1,633.50
171 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 5 CC 1,595.00 1 1,754.50
172 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 10 C 2,310.00 1 2,541.00
173 APT010000I66000437 161676 ny. HJ ERNAWATY 
IV CATHETE 7,750.00 1 8,525.00
174 APT010000I66000437 161676 ny. HJ ERNAWATY 
INFUSAN N 6,712.06 1 7,383.27
175 APT010000I66000437 161676 ny. HJ ERNAWATY 
NASAL CA 11,550.07 1 12,705.07
176 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 50 C 10,000.09 1 11,000.10
 177 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 20 525.80
178 APT010000I64002973 123863 ny. MULIATI ALLOPURIN
DG NGAI  248.02 1 272.83
179 APT010000I64002973 123863 ny. MULIATI AMLODIPIN
DG NGAI  475.19 1 522.71
180 APT010000I64002973 123863 ny. MULIATI METFORMI
DG NGAI  190.00 2 209.00
181 APT010000I64002973 123863 ny. MULIATI CAIRAN
DG NGAI 
RL 7,149.60 2 7,864.56
182 APT010000I64002973 123863 ny. MULIATI OMEPRAZOL
DG NGAI 24,999.70 1 27,499.67
183 APT010000I64002973 123863 ny. MULIATI ONDANSETR5,500.00
DG NGAI  3 6,050.00
184 APT010000I64002973 123863 ny. MULIATI SIMVASTAT
DG NGAI  751.94 1 827.13
185 APT010000I62004506 161611 tn. ALI NGURAWAN 
DEKSAMETA1,801.80 2 1,981.98
186 APT010000I62004500 161581 ny. SERI BINTANG 
CODIPRON10,502.80 2 11,553.08
187 APT010000I62004505 159634 ny. HJ LOBO CODIPRON10,502.80 2 11,553.08
188 APT010000I62004490 161536 nn. RISKI INDASARI
CODIPRON10,502.80
AMIR  2 11,553.08
189 APT010000I66000437 161676 ny. HJ ERNAWATY 
CAIRAN AQ 2,860.00 2 3,146.00
190 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 10 C 2,310.00 1 2,541.00
191 APT010000I62004517 161692 ny. DJANGKI CEFTRIAXO19,999.10 2 21,999.01
192 APT010000I62004517 161692 ny. DJANGKI NEUROSANB5,324.00 1 5,856.40
193 APT010000I62004517 161692 ny. DJANGKI OMEPRAZOL 24,999.70 1 27,499.67
194 APT010000I62004517 161692 ny. DJANGKI CURCUMA 1,098.90 3 1,208.79
195 APT010000I62004476 161475 ny. ANDI MASTURA 
CETIRIZIN 266.01 3 292.61
196 APT010000I62004476 161475 ny. ANDI MASTURA 
KETOROLAC 7,350.75 3 8,085.82
197 APT010000I62004519 154288 tn. ANDI MUIS 
VALISANBE 236.50 1 260.15
Sub Total   490

Total 3514
PCS 15,729.12

PCS 8,525.00
PCS 2,112.00
PCS 1,633.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 6,292.00
PCS 12,100.00
PCS 980.10
PCS 15,488.00
PCS 25,168.00
PCS 7,864.56
PCS 70,506.70
PCS 664.40
PCS 53,245.72
PCS 12,100.00
PCS 461.94
PCS 980.10
PCS 3,677.22
PCS 79,868.58
PCS 431.00
PCS 15,488.00
PCS 53,245.72
PCS 43,998.02
108,900.0
PCS
0
PCS 24,926.00
PCS 23,958.00
PCS 877.83
PCS 646.50
PCS 26,194.08
PCS 5,136.45
- 0
PCS 22,149.81
PCS 871.20
PCS 818.97
PCS 418.00
PCS 2,867.70
PCS 1,838.61
PCS 1,118.04
PCS 418.00
PCS 23,593.68
PCS 431.00
PCS 15,488.00
PCS 1,570.11
PCS 15,014.82
PCS 9,637.65
PCS 113.14
PCS 292.61
PCS 23,593.68
PCS 44,588.50
PCS 1,996.50
PCS 4,157.94
PCS 3,046.65
PCS 266.20
PCS 847.00
PCS 980.10
PCS 1,118.04
PCS 1,694.00
PCS 79,868.58
PCS 10,009.88
PCS 44,588.50
PCS 13,657.60
PCS 14,520.00
PCS 8,712.00
PCS 1,633.50
PCS 1,415.70
PCS 27,207.40
PCS 21,999.01
PCS 10,999.98
PCS 23,232.00
PCS 3,843.26
PCS 8,712.00
PCS 6,232.38
PCS 52,514.00
PCS 25,168.00
PCS 73,832.70
PCS 3,146.00
PCS 44,050.04
PCS 7,260.00
PCS 15,488.00
PCS 22,149.81
PCS 5,263.50
PCS 2,541.00
PCS 3,267.00
PCS 10,516.00
PCS 7,700.00
PCS 6,921.20
PCS 21,401.60
PCS 53,997.56
PCS 94,754.88
PCS 18,150.00
PCS 12,463.00
PCS 26,194.08
PCS 50,965.20
PCS 54,450.00
PCS 24,926.00
PCS 1,996.50
PCS 43,998.02
PCS 15,488.00
PCS 1,677.06
PCS 3,963.96
PCS 15,488.00
PCS 1,931.16
PCS 778.65
PCS 7,260.00
PCS 2,969.88
169,400.0
PCS 0
PCS 1,015.55
PCS 1,385.98
PCS 12,585.10
PCS 15,488.00
PCS 5,989.50
PCS 24,926.00
PCS 922.01
PCS 550.00
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 18,150.00
PCS 36,779.16
PCS 43,998.02
PCS 658.86
PCS 980.10
PCS 15,014.82
PCS 15,488.00
PCS 15,488.00
PCS 980.10
PCS 10,005.60
PCS 43,998.02
PCS 15,488.00
PCS 3,354.12
PCS 292.61
PCS 1,976.58
PCS 871.20
PCS 4,710.33
PCS 742.50
PCS 43,998.02
187,170.0
PCS
6
PCS 23,232.00
PCS 980.10
PCS 16,333.02
PCS 2,867.70
PCS 847.00
PCS 5,791.50
PCS 7,700.00
PCS 43,998.02
PCS 12,463.00
PCS 493.90
PCS 18,150.00
PCS 79,868.58
PCS 43,998.02
PCS 7,383.27
PCS 5,499.99
PCS 2,112.00
PCS 12,160.50
PCS 66,550.00
PCS 215.50
PCS 3,267.00
PCS 7,744.00
PCS 5,856.40
PCS 1,051.60
PCS 20,812.00
PCS 66,550.00
PCS 7,864.56
PCS 21,999.01
PCS 5,856.40
PCS 3,626.37
PCS 2,112.00
PCS 4,900.50
PCS 1,754.50
PCS 2,541.00
PCS 8,525.00
PCS 7,383.27
PCS 12,705.07
PCS 11,000.10
PCS 10,516.00
PCS 272.83
PCS 522.71
PCS 418.00
PCS 15,729.12
PCS 27,499.67
PCS 18,150.00
PCS 827.13
PCS 3,963.96
PCS 23,106.16
PCS 23,106.16
PCS 23,106.16
PCS 6,292.00
PCS 2,541.00
PCS 43,998.02
PCS 5,856.40
PCS 27,499.67
PCS 3,626.37
PCS 877.83
PCS 24,257.46
PCS 260.15
3,398,563.08
 22,807,1
53.30
26-12-
1 APT010000I62004517 161692 ny. DJANGKI 
MASKER DI 700.00 1 770.00
2018 
2 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 2 525.80
3 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN RL 7,149.60 3 7,864.56
4 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN DE18,920.00 2 20,812.00
5 APT010000I62004517 161692 ny. DJANGKI 
IV CATHETE 7,750.00 1 8,525.00
6 APT010000I62004517 161692 ny. DJANGKI 
IV DRESSI 4,850.00 1 5,335.00
7 APT010000I62004519 154288 tn. ANDI MUIS 
CAIRAN RL 7,149.60 6 7,864.56
8 APT010000I62004519 154288 tn. ANDI MUIS 
MASKER DI 700.00 1 770.00
9 APT010000I62004519 154288 tn. ANDI MUIS 
HANDSCOEN 478.00 2 525.80
10 APT010000I62004519 154288 tn. ANDI MUIS 
SPOIT 10 C 2,310.00 1 2,541.00
11 APT010000I62004519 154288 tn. ANDI MUIS 
SPOIT 1 CC 1,920.00 1 2,112.00
12 APT010000I62004519 154288 tn. ANDI MUIS 
IV CATHETE 7,750.00 1 8,525.00
13 APT010000I62004519 154288 tn. ANDI MUIS 
IV DRESSI 4,850.00 1 5,335.00
14 APT010000I62004519 154288 tn. ANDI MUIS 
CONECTA 13,200.00 1 14,520.00
15 APT010000I62004499 161575 tn. ALIF PRADITYA
INFUSAN  R 9,645.50 4 10,610.05
16 APT010000I62004499 161575 tn. ALIF PRADITYA
IV DRESSI
  4,850.00 1 5,335.00
17 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 1 770.00
18 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 2 525.80
19 APT010000I62004499 161575 tn. ALIF PRADITYA
IV CATHETE
  7,750.00 1 8,525.00
20 APT010000I62004499 161575 tn. ALIF PRADITYA
CONECTA  13,200.00 1 14,520.00
21 APT010000I62004476 161475 ny. ANDI MASTURA 
INFUSAN R 9,645.50 3 10,610.05
22 APT010000I62004476 161475 ny. ANDI MASTURA 
IV CATHETE 7,750.00 1 8,525.00
23 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 1 770.00
24 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 2 525.80
25 APT010000I62004476 161475 ny. ANDI MASTURA 
CAIRAN AQ 2,860.00 1 3,146.00
26 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 10 C 2,310.00 1 2,541.00
27 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 3 CC 1,485.00 1 1,633.50
28 APT010000I62004476 161475 ny. ANDI MASTURA 
IV DRESSI 4,850.00 1 5,335.00
29 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 3 7,864.56
30 APT010000I62004506 161611 tn. ALI NGURAWAN 
MASKER DI 700.00 1 770.00
31 APT010000I62004506 161611 tn. ALI NGURAWAN 
HANDSCOEN 478.00 2 525.80
32 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 10 C 2,310.00 1 2,541.00
33 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 5 CC 1,595.00 1 1,754.50
34 APT010000I62004506 161611 tn. ALI NGURAWAN 
IV CATHETE 7,750.00 1 8,525.00
35 APT010000I62004506 161611 tn. ALI NGURAWAN 
TRANSFUSI28,050.00 1 30,855.00
36 APT010000I62004506 161611 tn. ALI NGURAWAN 
CONECTA 13,200.00 1 14,520.00
37 APT010000I62004501 115911 ny. WALIDAINFUSAN
DG BAJI N 6,712.06 3 7,383.27
38 APT010000I62004501 115911 ny. WALIDAMASKER
DG BAJI DI 700.00 1 770.00
39 APT010000I62004501 115911 ny. WALIDAHANDSCOEN
DG BAJI  478.00 2 525.80
40 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
10 C 2,310.00 1 2,541.00
41 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
5 CC 1,595.00 1 1,754.50
42 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
3 CC 1,485.00 1 1,633.50
43 APT010000I62004501 115911 ny. WALIDAIVDGDRESSI
BAJI  4,850.00 1 5,335.00
44 APT010000I62004501 115911 ny. WALIDACONECTA
DG BAJI  13,200.00 1 14,520.00
45 APT010000I62004501 115911 ny. WALIDATRANSFUSI28,050.00
DG BAJI  1 30,855.00
46 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 4 7,864.56
47 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 1 770.00
48 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOEN
BATARI  478.00 2 525.80
49 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
10 C 2,310.00 1 2,541.00
50 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
5 CC 1,595.00 1 1,754.50
51 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
3 CC 1,485.00 1 1,633.50
52 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
AQ 2,860.00 1 3,146.00
53 APT010000I62004496 161569 nn. ANDI INDRI
INFUSBATARI 
SET 7,920.00 1 8,712.00
54 APT010000I62004496 161569 nn. ANDI INDRI
IV CATHETE
BATARI 7,750.00 1 8,525.00
55 APT010000I65003101 161497 ny. LILY HAFSAH 
INFUSAN N 6,712.06 6 7,383.27
56 APT010000I65003101 161497 ny. LILY HAFSAH 
MASKER DI 700.00 1 770.00
57 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOEN 478.00 2 525.80
58 APT010000I65003101 161497 ny. LILY HAFSAH 
SPOIT 3 CC 1,485.00 1 1,633.50
59 APT010000I65003101 161497 ny. LILY HAFSAH 
SPOIT 5 CC 1,595.00 1 1,754.50
60 APT010000I65003101 161497 ny. LILY HAFSAH 
IV CATHETE 7,750.00 1 8,525.00
61 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN AQ 2,860.00 1 3,146.00
62 APT010000I65003101 161497 ny. LILY HAFSAH 
INFUS SET 7,920.00 1 8,712.00
63 APT010000I64002973 123863 ny. MULIATINOVO
DG NGAI 
TWIS 2,083.00 1 2,291.30
64 APT010000I64002973 123863 ny. MULIATICAIRAN
DG NGAI 
RL 7,149.60 3 7,864.56
65 APT010000I64002973 123863 ny. MULIATIMASKER
DG NGAI 
DI 700.00 2 770.00
66 APT010000I64002973 123863 ny. MULIATIHANDSCOEN
DG NGAI  478.00 4 525.80
67 APT010000I64002973 123863 ny. MULIATIINFUS
DG NGAI 
SET 7,920.00 1 8,712.00
68 APT010000I64002973 123863 ny. MULIATICONECTA
DG NGAI 13,200.00 1 14,520.00
69 APT010000I64002973 123863 ny. MULIATIIVDG
DRESSI
NGAI  4,850.00 1 5,335.00
70 APT010000I64002973 123863 ny. MULIATISPOIT
DG NGAI 
10 C 2,310.00 2 2,541.00
71 APT010000I64002973 123863 ny. MULIATISPOIT
DG NGAI 
5 CC 1,595.00 2 1,754.50
72 APT010000I64002973 123863 ny. MULIATISPOIT
DG NGAI 
3 CC 1,485.00 2 1,633.50
73 APT010000I62004509 131089 ny. FIRDHAINFUSAN
RESMISARI 
N 6,712.06 5 7,383.27
74 APT010000I62004509 131089 ny. FIRDHAMASKER
RESMISARI 
DI 700.00 2 770.00
75 APT010000I62004509 131089 ny. FIRDHAHANDSCOEN
RESMISARI  478.00 4 525.80
76 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 6 7,864.56
77 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 1 770.00
78 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA  478.00 2 525.80
79 APT010000I62004511 161613 an. MUHAMMAD
IV CATHETE
TAQWA 
7,750.00 1 8,525.00
80 APT010000I62004511 161613 an. MUHAMMAD
CONECTATAQWA 
13,200.00 1 14,520.00
81 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
AQ 2,860.00 1 3,146.00
82 APT010000I65003107 161571 ny. SALFIAHINFUSAN
DG SAYU N 6,712.06 3 7,383.27
83 APT010000I65003107 161571 ny. SALFIAHINFUS
DG SAYU 
SET 7,920.00 1 8,712.00
84 APT010000I65003107 161571 ny. SALFIAHCONECTA
DG SAYU 13,200.00 1 14,520.00
85 APT010000I65003107 161571 ny. SALFIAHIVDG
CATHETE
SAYU  7,750.00 1 8,525.00
86 APT010000I65003107 161571 ny. SALFIAHIVDG
DRESSI
SAYU  4,850.00 1 5,335.00
87 APT010000I65003107 161571 ny. SALFIAHMASKER
DG SAYU 
DI 700.00 2 770.00
88 APT010000I65003107 161571 ny. SALFIAHHANDSCOEN
DG SAYU  478.00 4 525.80
89 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 3 7,864.56
 90 APT010000I62004514 160906 tn. KIDJO SUKARYO 
MASKER DI 700.00 1 770.00
91 APT010000I62004514 160906 tn. KIDJO SUKARYO 
HANDSCOEN 478.00 2 525.80
92 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 10 C 2,310.00 1 2,541.00
93 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 3 CC 1,485.00 1 1,633.50
94 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 5 CC 1,595.00 1 1,754.50
95 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV CATHETE 7,750.00 1 8,525.00
96 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN AQ 2,860.00 2 3,146.00
97 APT010000I62004515 161675 tn. ANDI MAYCAIRAN
WELLO
RL M,
7,149.60
SE  3 7,864.56
98 APT010000I62004515 161675 tn. ANDI MAYHANDSCOEN
WELLO M, 478.00
SE  4 525.80
99 APT010000I62004515 161675 tn. ANDI MAYMASKER
WELLODIM, 700.00
SE  1 770.00
100 APT010000I62004515 161675 tn. ANDI MAYSPOIT
WELLO
5 CC M,
1,595.00
SE  2 1,754.50
101 APT010000I62004515 161675 tn. ANDI MAYSPOIT
WELLO
3 CC M,
1,485.00
SE  2 1,633.50
102 APT010000I62004515 161675 tn. ANDI MAYCAIRAN
WELLO
AQM,2,860.00
SE  1 3,146.00
103 APT010000I62004515 161675 tn. ANDI MAYCAIRAN
WELLO
NA15,180.00
M, SE  1 16,698.00
104 APT010000I62004504 161146 ny. NIRWANA HANDSCOEN 478.00 6 525.80
105 APT010000I62004504 161146 ny. NIRWANA MASKER DI 700.00 3 770.00
106 APT010000I62004504 161146 ny. NIRWANA SPOIT 10 C 2,310.00 2 2,541.00
107 APT010000I62004504 161146 ny. NIRWANA SPOIT 5 CC 1,595.00 2 1,754.50
108 APT010000I62004504 161146 ny. NIRWANA SPOIT 3 CC 1,485.00 2 1,633.50
109 APT010000I62004504 161146 ny. NIRWANA IV CATHETE 7,750.00 2 8,525.00
110 APT010000I62004504 161146 ny. NIRWANA INFUSAN N 6,712.06 3 7,383.27
111 APT010000I62004504 161146 ny. NIRWANA CAIRAN AQ 2,860.00 2 3,146.00
112 APT010000I63003172 161606 ny. ASIH  INFUSAN N 6,712.06 3 7,383.27
113 APT010000I63003172 161606 ny. ASIH  SPOIT 10 C 2,310.00 2 2,541.00
114 APT010000I63003172 161606 ny. ASIH  SPOIT 5 CC 1,595.00 2 1,754.50
115 APT010000I63003172 161606 ny. ASIH  SPOIT 3 CC 1,485.00 2 1,633.50
116 APT010000I63003172 161606 ny. ASIH  IV CATHETE 7,750.00 2 8,525.00
117 APT010000I63003172 161606 ny. ASIH  HANDSCOEN 478.00 4 525.80
118 APT010000I63003172 161606 ny. ASIH  MASKER DI 700.00 2 770.00
119 APT010000I63003172 161606 ny. ASIH  CAIRAN AQ 2,860.00 2 3,146.00
120 APT010000I63003172 161606 ny. ASIH  CAIRAN NA15,180.00 2 16,698.00
121 APT010000I62004490 161536 nn. RISKI INDASARI
INFUSANAMIR 
N 6,712.06 3 7,383.27
122 APT010000I62004490 161536 nn. RISKI INDASARI
IV CATHETE
AMIR 
7,750.00 2 8,525.00
123 APT010000I62004490 161536 nn. RISKI INDASARI
HANDSCOEN
AMIR 478.00 6 525.80
124 APT010000I62004490 161536 nn. RISKI INDASARI
MASKER AMIR 
DI 700.00 3 770.00
125 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 10AMIR 
C 2,310.00 2 2,541.00
126 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 5 CC
AMIR 
1,595.00 2 1,754.50
127 APT010000I62004490 161536 nn. RISKI INDASARI
CAIRAN AQ
AMIR 
2,860.00 2 3,146.00
128 APT010000I62004490 161536 nn. RISKI INDASARI
CAIRAN NA15,180.00
AMIR  2 16,698.00
129 APT010000I62004513 114199 tn. SOFYANINFUSAN
FIRMANSYAH
N 6,712.06
E  3 7,383.27
130 APT010000I62004513 114199 tn. SOFYANHANDSCOEN
FIRMANSYAH478.00
E  6 525.80
131 APT010000I62004513 114199 tn. SOFYANMASKER
FIRMANSYAH
DI 700.00
E  3 770.00
132 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
10 C 2,310.00
E  2 2,541.00
133 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
5 CC 1,595.00
E  2 1,754.50
134 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
3 CC 1,485.00
E  2 1,633.50
135 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
AQ 2,860.00
E  2 3,146.00
136 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
NA15,180.00
E  2 16,698.00
137 APT010000I64002929 161294 ny. HASNAH 
INFUSAN N 6,712.06 2 7,383.27
138 APT010000I64002929 161294 ny. HASNAH 
HANDSCOEN 478.00 4 525.80
139 APT010000I64002929 161294 ny. HASNAH 
MASKER DI 700.00 1 770.00
140 APT010000I64002929 161294 ny. HASNAH 
CAIRAN NA15,180.00 1 16,698.00
141 APT010000I64002929 161294 ny. HASNAH 
CAIRAN AQ 2,860.00 2 3,146.00
142 APT010000I62004453 161309 ny. SURIATIINFUSAN
DG. SUNGGU
N 6,712.06
  3 7,383.27
143 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
144 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  1 770.00
145 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
5 CC 1,595.00
  2 1,754.50
146 APT010000I62004453 161309 ny. SURIATIIVDG.
CATHETE
SUNGGU7,750.00
  2 8,525.00
147 APT010000I62004453 161309 ny. SURIATIIVDG.
DRESSI
SUNGGU4,850.00
  1 5,335.00
148 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
AQ 2,860.00
  1 3,146.00
149 APT010000I62004512 161657 ny. HASNAHINFUSAN
TAHA  N 6,712.06 2 7,383.27
150 APT010000I62004512 161657 ny. HASNAHIVTAHA 
CATHETE 7,750.00 1 8,525.00
151 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
5 CC 1,595.00 1 1,754.50
152 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
10 C 2,310.00 1 2,541.00
153 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
3 CC 1,485.00 1 1,633.50
154 APT010000I62004512 161657 ny. HASNAHHANDSCOEN
TAHA  478.00 4 525.80
155 APT010000I62004512 161657 ny. HASNAHMASKER
TAHA  DI 700.00 1 770.00
156 APT010000I62004512 161657 ny. HASNAHIVTAHA 
DRESSI 4,850.00 1 5,335.00
157 APT010000I62004512 161657 ny. HASNAHCAIRAN
TAHA AQ 2,860.00 1 3,146.00
158 APT010000I62004512 161657 ny. HASNAHCAIRAN
TAHA NA15,180.00 1 16,698.00
159 APT010000I12000082 161621 ny. DG NURUNG 
SUNGKUP 44,750.00 1 49,225.00
160 APT010000I12000082 161621 ny. DG NURUNG 
INFUSAN N 6,712.06 2 7,383.27
161 APT010000I12000082 161621 ny. DG NURUNG 
IV CATHETE 7,750.00 1 8,525.00
162 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
163 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 5 CC 1,595.00 1 1,754.50
164 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 10 C 2,310.00 1 2,541.00
165 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 2 525.80
166 APT010000I12000082 161621 ny. DG NURUNG 
MASKER DI 700.00 1 770.00
167 APT010000I12000082 161621 ny. DG NURUNG 
INFUS SET 7,920.00 1 8,712.00
168 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NA15,180.00 1 16,698.00
169 APT010000I62004505 159634 ny. HJ LOBO 
INFUSAN N 6,712.06 2 7,383.27
170 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
171 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
172 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
173 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 10 C 2,310.00 1 2,541.00
174 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 2 525.80
175 APT010000I62004505 159634 ny. HJ LOBO 
MASKER DI 700.00 1 770.00
176 APT010000I65003098 155366 tn. DUDUNG 
INFUSAN N 6,712.06 2 7,383.27
177 APT010000I65003098 155366 tn. DUDUNG 
IV CATHETE 7,750.00 1 8,525.00
178 APT010000I65003098 155366 tn. DUDUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
179 APT010000I65003098 155366 tn. DUDUNG 
SPOIT 5 CC 1,595.00 1 1,754.50
180 APT010000I65003098 155366 tn. DUDUNG SPOIT 10 C 2,310.00 1 2,541.00
181 APT010000I65003098 155366 tn. DUDUNG IV DRESSI 4,850.00 1 5,335.00
182 APT010000I65003098 155366 tn. DUDUNG CAIRAN AQ 2,860.00 2 3,146.00
183 APT010000I65003098 155366 tn. DUDUNG HANDSCOEN 478.00 2 525.80
184 APT010000I65003098 155366 tn. DUDUNG MASKER DI 700.00 1 770.00
185 APT010000I65003098 155366 tn. DUDUNG CAIRAN NA15,180.00 1 16,698.00
186 APT010000I62004457 76534 tn. SAHABUDDIN 
INFUSAN N 6,712.06 2 7,383.27
187 APT010000I62004457 76534 tn. SAHABUDDIN 
IV CATHETE 7,750.00 1 8,525.00
188 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 3 CC 1,485.00 1 1,633.50
189 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 5 CC 1,595.00 1 1,754.50
190 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 10 C 2,310.00 1 2,541.00
191 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 2 525.80
192 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 1 770.00
193 APT010000I62004457 76534 tn. SAHABUDDIN 
SUNGKUP 44,750.00 1 49,225.00
194 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN AQ 2,860.00 2 3,146.00
195 APT010000I62004500 161581 ny. SERI BINTANG 
INFUSAN N 6,712.06 3 7,383.27
196 APT010000I62004500 161581 ny. SERI BINTANG 
HANDSCOEN 478.00 6 525.80
197 APT010000I62004500 161581 ny. SERI BINTANG 
MASKER DI 700.00 3 770.00
198 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 10 C 2,310.00 2 2,541.00
199 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 5 CC 1,595.00 2 1,754.50
200 APT010000I62004500 161581 ny. SERI BINTANG 
IV CATHETE 7,750.00 2 8,525.00
201 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN AQ 2,860.00 2 3,146.00
202 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN NA15,180.00 2 16,698.00
203 APT010000I62004508 120214 ny. ROSMAWATI 
DIMENHIDR 121.00 6 133.10
204 APT010000I62004508 120214 ny. ROSMAWATI 
NEURODEX 770.00 3 847.00
205 APT010000I62004508 120214 ny. ROSMAWATI 
SANMOL T 297.00 9 326.70
206 APT010000I62004508 120214 ny. ROSMAWATI 
AMLODIPIN 475.19 3 522.71
207 APT010000I62004508 120214 ny. ROSMAWATI 
SIMVASTAT 359.10 3 395.01
208 APT010000I62004508 120214 ny. ROSMAWATI 
GLIMEPIRI 1,257.80 3 1,383.57
209 APT010000I62004508 120214 ny. ROSMAWATI 
PREGABAL 5,500.00 6 6,050.00
210 APT010000I62004509 131089 ny. FIRDHANEW
RESMISARI 
DIAT 557.15 4 612.87
211 APT010000I62004509 131089 ny. FIRDHAONDANSET
RESMISARI 1,355.20 9 1,490.72
212 APT010000I65003098 155366 tn. DUDUNG SPORETIK 5,720.50 6 6,292.55
213 APT010000I65003098 155366 tn. DUDUNG AMBROXOL 199.65 9 219.62
214 APT010000I65003098 155366 tn. DUDUNG METIL PRE 702.00 6 772.20
215 APT010000I65003098 155366 tn. DUDUNG CETIRIZIN 266.01 3 292.61

216 APT010000I62004500 161581 ny. SERI BINTANG 

CODIPRON10,502.80 9 11,553.08

217 APT010000I65003086 161248 ny. JUMANIA 

LEVOFLOXA 449.00 3 493.90
218 APT010000I65003086 161248 ny. JUMANIA 
LANSOPRAZ 851.29 6 936.42
219 APT010000I65003086 161248 ny. JUMANIA 
METIL PRE 819.00 12 900.90
220 APT010000I64002929 161294 ny. HASNAH 
METIL PRE 819.00 12 900.90
221 APT010000I64002929 161294 ny. HASNAH 
LANSOPRAZ 851.29 6 936.42
222 APT010000I64002929 161294 ny. HASNAH 
SPORETIK 5,720.50 6 6,292.55
223 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 6 847.00
224 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 6 1,930.50
225 APT010000I62004453 161309 ny. SURIATISPORETIK
DG. SUNGGU5,720.50
  6 6,292.55
226 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU629.99
  6 692.99
227 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  9 326.70
228 APT010000I62004453 161309 ny. SURIATITRICHODAZ
DG. SUNGGU1,738.00
  9 1,911.80
229 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 629.99 6 692.99
230 APT010000I62004490 161536 nn. RISKI INDASARI
EPISAN SU
AMIR 
51,150.00 1 56,265.00
231 APT010000I62004490 161536 nn. RISKI INDASARI
CEFADROXI
AMIR 877.80 6 965.58
232 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 235.95 9 259.55
233 APT010000I62004515 161675 tn. ANDI MAYAZITROMYC
WELLO M,1,777.99
SE  1 1,955.79
234 APT010000I62004515 161675 tn. ANDI MAYINTERHIST
WELLO M, 768.08
SE  2 844.88
235 APT010000I62004504 161146 ny. NIRWANA CEFTRIAXO19,999.10 2 21,999.01
236 APT010000I62004504 161146 ny. NIRWANA URDAFALK 5,527.50 2 6,080.25
237 APT010000I62004504 161146 ny. NIRWANA NEUROSANB5,324.00 1 5,856.40
238 APT010000I63003172 161606 ny. ASIH  CAIRAN NAC6,409.70 2 7,050.67
239 APT010000I63003172 161606 ny. ASIH  RANITIDIN 7,040.00 2 7,744.00
240 APT010000I63003172 161606 ny. ASIH  ISOSORBID 102.85 1 113.14
241 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NAC6,409.70 1 7,050.67
242 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 7,040.00 2 7,744.00
243 APT010000I12000082 161621 ny. DG NURUNG 
NEW DIAT 557.15 3 612.87
244 APT010000I12000082 161621 ny. DG NURUNG 
METOCLOPR5,500.00 3 6,050.00
245 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 3 326.70
246 APT010000I12000082 161621 ny. DG NURUNG 
NEURODEX 770.00 2 847.00
247 APT010000I62004512 161657 ny. HASNAH KETOROLAC
TAHA  7,350.75 3 8,085.82
248 APT010000I62004513 114199 tn. SOFYANCEFTRIAXO19,999.10
FIRMANSYAH E  2 21,999.01
249 APT010000I62004513 114199 tn. SOFYANDEKSAMETA1,801.80
FIRMANSYAH E  2 1,981.98
250 APT010000I62004513 114199 tn. SOFYANVOSEDON
FIRMANSYAH
T 2,431.00
E  3 2,674.10
251 APT010000I62004513 114199 tn. SOFYANSANMOL
FIRMANSYAH
T 297.00
E  3 326.70
252 APT010000I62004513 114199 tn. SOFYANRANITIDIN
FIRMANSYAH 7,040.00
E  2 7,744.00
253 APT010000I62004505 159634 ny. HJ LOBO IV CATHETE12,416.00 1 13,657.60
254 APT010000I62004505 159634 ny. HJ LOBO TRANSFUSI28,050.00 1 30,855.00
255 APT010000I62004505 159634 ny. HJ LOBO CONECTA 13,200.00 1 14,520.00
256 APT010000I62004505 159634 ny. HJ LOBO LIDOCAINE 1,287.00 3 1,415.70
257 APT010000I62004505 159634 ny. HJ LOBO SPOIT 5 CC 1,595.00 1 1,754.50
258 APT010000I62004505 159634 ny. HJ LOBO ONDANSET 2,151.00 3 2,366.10
259 APT010000I62004505 159634 ny. HJ LOBO PUMPITOR 11,330.00 1 12,463.00
260 APT010000I62004493 161561 ny. DINARE COMBIVENT4,549.95 2 5,004.94
261 APT010000I62004493 161561 ny. DINARE CEFTRIAXO19,999.10 2 21,999.01

262 APT010000I62004500 161581 ny. SERI BINTANG 

VOMETRON18,150.00 9 19,965.00

263 APT010000I62004500 161581 ny. SERI BINTANG 

PUMPITOR 11,330.00 3 12,463.00
264 APT010000I62004503 159886 tn. MUH BASIR
RANITIDIN
LALANG 7,040.00 2 10,700.80
265 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
266 APT010000I62004503 159886 tn. MUH BASIR
NEUROSANB5,324.00
LALANG  1 6,921.20
267 APT010000I62004503 159886 tn. MUH BASIR
CAIRAN
LALANG 
AM70,188.80 1 94,754.88
268 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 20 C 5,600.00 2 6,160.00
269 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOON 12,100.00 1 13,310.00
270 APT010000I62004514 160906 tn. KIDJO SUKARYO 
AMBROXOL 199.65 3 219.62
271 APT010000I62004514 160906 tn. KIDJO SUKARYO 
COMBIVENT4,549.95 3 5,004.94
272 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPORETIK 5,720.50 3 6,292.55
273 APT010000I62004517 161692 ny. DJANGKI 
PUMPITOR 11,330.00 1 12,463.00
274 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
275 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 2 21,999.01
276 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
277 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 10,011.38 4 11,012.51
278 APT010000I66000437 161676 ny. HJ ERNAWATY 
MECOBALAM6,600.00 2 7,260.00
279 APT010000I66000437 161676 ny. HJ ERNAWATY 
RANITIDIN 7,040.00 2 7,744.00
280 APT010000I66000437 161676 ny. HJ ERNAWATY 
INFUSAN N 6,712.06 2 7,383.27
281 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 20 525.80
282 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 2 2,099.35
283 APT010000I62004476 161475 ny. ANDI MASTURA 
CETIRIZIN 266.01 3 292.61
284 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 2 21,999.01
285 APT010000I62004506 161611 tn. ALI NGURAWAN 
KETOROLAC 7,350.75 3 8,085.82
286 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 2 7,744.00
287 APT010000I62004501 115911 ny. WALIDATETRASANB
DG BAJI  506.00 9 556.60
288 APT010000I62004501 115911 ny. WALIDATRICHODAZ
DG BAJI  1,738.00 9 1,911.80
289 APT010000I62004501 115911 ny. WALIDAMETFORMI
DG BAJI  190.00 6 209.00
290 APT010000I62004501 115911 ny. WALIDAAMBROXOL
DG BAJI  199.65 9 219.62
291 APT010000I62004501 115911 ny. WALIDAGLIMEPIRI
DG BAJI  1,257.80 3 1,383.57
292 APT010000I62004496 161569 nn. ANDI INDRI
COMBIVENT4,549.95
BATARI  2 5,004.94
293 APT010000I62004496 161569 nn. ANDI INDRI
CEFTRIAXO19,999.10
BATARI  2 21,999.01
294 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 2 7,744.00
295 APT010000I62004496 161569 nn. ANDI INDRI
VOSEDON
BATARI 
T 2,431.00 3 2,674.10
296 APT010000I65003101 161497 ny. LILY HAFSAH 
PUMPITOR 11,330.00 2 12,463.00
297 APT010000I65003101 161497 ny. LILY HAFSAH 
VOLUVEN 621,780.00 1 23,958.00

298 APT010000I65003101 161497 ny. LILY HAFSAH 

METIL PRE 49,500.00 2 54,450.00

299 APT010000I64002973 123863 ny. MULIATI

CAIRAN
DG NGAI 
NAC6,409.70 1 7,050.67
300 APT010000I64002973 123863 ny. MULIATI
ONDANSETR5,500.00
DG NGAI  3 6,050.00
301 APT010000I64002973 123863 ny. MULIATI
METFORMI
DG NGAI  190.00 2 209.00
302 APT010000I64002973 123863 ny. MULIATI
AMLODIPIN
DG NGAI  475.19 1 522.71
303 APT010000I64002973 123863 ny. MULIATI
ALLOPURIN
DG NGAI  248.02 1 272.83
304 APT010000I64002973 123863 ny. MULIATI
SIMVASTAT
DG NGAI  751.94 1 827.13

305 APT010000I62004511 161613 an. MUHAMMAD

PARACETA
TAQWA 
68,062.50 3 74,868.75

306 APT010000I62004511 161613 an. MUHAMMAD

ONDANSETR5,500.00
TAQWA  2 6,050.00
307 APT010000I65003107 161571 ny. SALFIAHFLAMAR
DG SAYU 50 1,908.50 2 2,099.35
308 APT010000I65003107 161571 ny. SALFIAHMETFORMI
DG SAYU  190.00 3 209.00
309 APT010000I62004499 161575 tn. ALIF PRADITYA
CEFTRIAXO19,999.10
  2 21,999.01
310 APT010000I62004523 107296 ny. HJ BAHARIA 
CAIRAN RL 7,149.60 2 7,864.56
311 APT010000I62004520 138788 nn. NUR TESSA
CEFTRIAXO19,999.10
AMELIA  2 21,999.01
312 APT010000I62004520 138788 nn. NUR TESSA
CAIRAN
AMELIA 
NA15,180.00 1 16,698.00
313 APT010000I62004520 138788 nn. NUR TESSA
RANITIDIN
AMELIA 7,040.00 2 7,744.00
314 APT010000I62004520 138788 nn. NUR TESSA
ONDANSETR5,500.00
AMELIA  2 6,050.00
315 APT010000I62004520 138788 nn. NUR TESSA
EPISAN
AMELIA 
SU 51,150.00 1 56,265.00
316 APT010000I62004521 146576 tn. SAHARUDDIN
COMBIVENT4,549.95
HAMID  3 5,004.94
317 APT010000I62004521 146576 tn. SAHARUDDIN
AMBROXOL
HAMID 199.65 3 219.62

318 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   3 54,450.00

319 APT010000I65003111 39079 ny. ELIK SULISTIYO

MECOBALAM
PURBAWATI
6,600.00   1 7,260.00
320 APT010000I65003111 39079 ny. ELIK SULISTIYO
RANITIDIN
PURBAWATI
7,040.00   2 7,744.00
321 APT010000I65003111 39079 ny. ELIK SULISTIYO
BECLOV PURBAWATI
INJ13,418.20   4 14,760.02
322 APT010000I62004525 83291 tn. SADIR,S.AG 
RANITIDIN 7,040.00 1 7,744.00
323 APT010000I62004525 83291 tn. SADIR,S.AG 
NEW DIAT 557.15 4 612.87
324 APT010000I62004525 83291 tn. SADIR,S.AG 
SANPRIMA 902.00 9 992.20
325 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN RL 7,149.60 1 7,864.56
326 APT010000I62004518 161696 ny. A. AYU NEUROSANB5,324.00
ANDANI  1 6,921.20
327 APT010000I62004518 161696 ny. A. AYU RANITIDIN
ANDANI  7,040.00 3 10,700.80
328 APT010000I62004518 161696 ny. A. AYU SANMOL
ANDANI  T 297.00 2 386.10

329 APT010000I62004512 161657 ny. HASNAH

BAQUINOR
TAHA  14,564.00 9 16,020.40

330 APT010000I62004512 161657 ny. HASNAH

FARGETIX
TAHA  407.00 9 447.70
331 APT010000I62004524 161724 tn. MOCH SADDAM
CEFTRIAXO19,999.10
HUSAIN MO'O  2 21,999.01
332 APT010000I62004524 161724 tn. MOCH SADDAM
RANITIDINHUSAIN
7,040.00
MO'O  2 7,744.00
333 APT010000I62004524 161724 tn. MOCH SADDAM
SANMOL HUSAIN
T 297.00
MO'O  3 326.70
334 APT010000I62004524 161724 tn. MOCH SADDAM
NEW DIATHUSAIN
557.15
MO'O  6 612.87

335 APT010000I62004523 107296 ny. HJ BAHARIA 

CAIRAN FU41,388.90 3 45,527.79

336 APT010000I62004523 107296 ny. HJ BAHARIA 

KOTRIMOKS 254.10 4 279.51
337 APT010000I62004523 107296 ny. HJ BAHARIA 
RANITIDIN 7,040.00 2 7,744.00
338 APT010000I62004472 161449 tn. NUR ROHMAT 
DEKSAMETA1,801.80 3 1,981.98
339 APT010000I62004521 146576 tn. SAHARUDDIN
NEBULIZE
HAMID 40,535.00 1 44,588.50
340 APT010000I62004496 161569 nn. ANDI INDRI
NEBULIZE
BATARI  40,535.00 1 44,588.50
341 APT010000I62004496 161569 nn. ANDI INDRI
AZITROMYC
BATARI 1,777.99 1 1,955.79
342 APT010000I62004496 161569 nn. ANDI INDRI
KETOROLAC
BATARI 7,350.75 2 8,085.82
343 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI  629.99 2 692.99
344 APT010000I62004496 161569 nn. ANDI INDRI
EPEXOL
BATARI 
TA 869.00 3 955.90
345 APT010000I62004496 161569 nn. ANDI INDRI
FLAMAR
BATARI 
50 1,908.50 2 2,099.35
346 APT010000I62004496 161569 nn. ANDI INDRI
CURCUMA
BATARI 1,098.90 3 1,208.79
347 APT010000I62004499 161575 tn. ALIF PRADITYA
RANITIDIN
  7,040.00 2 7,744.00
348 APT010000I64002973 123863 ny. MULIATICONCOR
DG NGAI 2. 597.00 2 656.70
349 APT010000I64002973 123863 ny. MULIATICETIRIZIN
DG NGAI  266.01 3 292.61
350 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 1 7,864.56
351 APT010000I65003112 161744 tn. BAKRI WAHID 
PARACETA 68,062.50 1 74,868.75
352 APT010000I65003112 161744 tn. BAKRI WAHID 
RANITIDIN 7,040.00 1 7,744.00
 353 APT010000I65003112 161744 tn. BAKRI WAHID 
NEUROSANB5,324.00 1 5,856.40
354 APT010000I65003112 161744 tn. BAKRI WAHID 
DIPENHYDR 7,700.00 1 8,470.00
355 APT010000I65003112 161744 tn. BAKRI WAHID 
DEKSAMETA1,801.80 1 1,981.98
356 APT010000I62004527 161427 ny. BAYA  CAIRAN RL 7,149.60 1 7,864.56
357 APT010000I62004527 161427 ny. BAYA  COMBO PAC 60,500.00 1 66,550.00
358 APT010000I62004527 161427 ny. BAYA  CONECTA 13,200.00 1 14,520.00
359 APT010000I62004517 161692 ny. DJANGKI 
ZINK OKSI 604.00 1 664.40
360 APT010000I62004517 161692 ny. DJANGKI 
VITAMIN B 146.99 6 161.69
361 APT010000I62004527 161427 ny. BAYA  CEFTRIAXO19,999.10 2 21,999.01
362 APT010000I62004528 161750 tn. H LABAKKANG 
KETOROLAC 7,350.75 1 8,085.82
363 APT010000I62004528 161750 tn. H LABAKKANG 
SPOIT 3 CC 1,485.00 2 1,633.50
364 APT010000I62004528 161750 tn. H LABAKKANG 
RANITIDIN 7,040.00 1 7,744.00
365 APT010000I62004515 161675 tn. ANDI MAY
CODIPRONT
WELLO M,7,937.60
SE  10 8,731.36
366 APT010000I62004515 161675 tn. ANDI MAY
SPORETIK
WELLO M,5,720.50
SE  10 6,292.55
Sub Total   918
PCS 770.00

PCS 1,051.60
PCS 23,593.68
PCS 41,624.00
PCS 8,525.00
PCS 5,335.00
PCS 47,187.36
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 2,112.00
PCS 8,525.00
PCS 5,335.00
PCS 14,520.00
PCS 42,440.20
PCS 5,335.00
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 14,520.00
PCS 31,830.15
PCS 8,525.00
PCS 770.00
PCS 1,051.60
PCS 3,146.00
PCS 2,541.00
PCS 1,633.50
PCS 5,335.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 8,525.00
PCS 30,855.00
PCS 14,520.00
PCS 22,149.81
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 5,335.00
PCS 14,520.00
PCS 30,855.00
PCS 31,458.24
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 3,146.00
PCS 8,712.00
PCS 8,525.00
PCS 44,299.62
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 3,146.00
PCS 8,712.00
PCS 2,291.30
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 8,712.00
PCS 14,520.00
PCS 5,335.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 36,916.35
PCS 1,540.00
PCS 2,103.20
PCS 47,187.36
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 14,520.00
PCS 3,146.00
PCS 22,149.81
PCS 8,712.00
PCS 14,520.00
PCS 8,525.00
PCS 5,335.00
PCS 1,540.00
PCS 2,103.20
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 6,292.00
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 3,509.00
PCS 3,267.00
PCS 3,146.00
PCS 16,698.00
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 17,050.00
PCS 22,149.81
PCS 6,292.00
PCS 22,149.81
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 17,050.00
PCS 2,103.20
PCS 1,540.00
PCS 6,292.00
PCS 33,396.00
PCS 22,149.81
PCS 17,050.00
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 6,292.00
PCS 33,396.00
PCS 22,149.81
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 6,292.00
PCS 33,396.00
PCS 14,766.54
PCS 2,103.20
PCS 770.00
PCS 16,698.00
PCS 6,292.00
PCS 22,149.81
PCS 2,103.20
PCS 770.00
PCS 3,509.00
PCS 17,050.00
PCS 5,335.00
PCS 3,146.00
PCS 14,766.54
PCS 8,525.00
PCS 1,754.50
PCS 2,541.00
PCS 1,633.50
PCS 2,103.20
PCS 770.00
PCS 5,335.00
PCS 3,146.00
PCS 16,698.00
PCS 49,225.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 16,698.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 5,335.00
PCS 6,292.00
PCS 1,051.60
PCS 770.00
PCS 16,698.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 49,225.00
PCS 6,292.00
PCS 22,149.81
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 17,050.00
PCS 6,292.00
PCS 33,396.00
PCS 798.60
PCS 2,541.00
PCS 2,940.30
PCS 1,568.13
PCS 1,185.03
PCS 4,150.71
PCS 36,300.00
PCS 2,451.48
PCS 13,416.48
PCS 37,755.30
PCS 1,976.58
PCS 4,633.20
PCS 877.83
103,977.7
PCS
2
PCS 1,481.70
PCS 5,618.52
PCS 10,810.80
PCS 10,810.80
PCS 5,618.52
PCS 37,755.30
PCS 5,082.00
PCS 11,583.00
PCS 37,755.30
PCS 4,157.94
PCS 2,940.30
PCS 17,206.20
PCS 4,157.94
PCS 56,265.00
PCS 5,793.48
PCS 2,335.95
PCS 1,955.79
PCS 1,689.76
PCS 43,998.02
PCS 12,160.50
PCS 5,856.40
PCS 14,101.34
PCS 15,488.00
PCS 113.14
PCS 7,050.67
PCS 15,488.00
PCS 1,838.61
PCS 18,150.00
PCS 980.10
PCS 1,694.00
PCS 24,257.46
PCS 43,998.02
PCS 3,963.96
PCS 8,022.30
PCS 980.10
PCS 15,488.00
PCS 13,657.60
PCS 30,855.00
PCS 14,520.00
PCS 4,247.10
PCS 1,754.50
PCS 7,098.30
PCS 12,463.00
PCS 10,009.88
PCS 43,998.02
179,685.0
PCS 0
PCS 37,389.00
PCS 21,401.60
PCS 53,997.56
PCS 6,921.20
PCS 94,754.88
PCS 12,320.00
PCS 13,310.00
PCS 658.86
PCS 15,014.82
PCS 18,877.65
PCS 12,463.00
PCS 5,856.40
PCS 43,998.02
PCS 3,626.37
PCS 44,050.04
PCS 14,520.00
PCS 15,488.00
PCS 14,766.54
PCS 10,516.00
PCS 4,198.70
PCS 877.83
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 5,009.40
PCS 17,206.20
PCS 1,254.00
PCS 1,976.58
PCS 4,150.71
PCS 10,009.88
PCS 43,998.02
PCS 15,488.00
PCS 8,022.30
PCS 24,926.00
PCS 23,958.00
108,900.0
PCS
0
PCS 7,050.67
PCS 18,150.00
PCS 418.00
PCS 522.71
PCS 272.83
PCS 827.13
224,606.2
PCS 5
PCS 12,100.00
PCS 4,198.70
PCS 627.00
PCS 43,998.02
PCS 15,729.12
PCS 43,998.02
PCS 16,698.00
PCS 15,488.00
PCS 12,100.00
PCS 56,265.00
PCS 15,014.82
PCS 658.86

PCS 163,350.0
0
PCS 7,260.00
PCS 15,488.00
PCS 59,040.08
PCS 7,744.00
PCS 2,451.48
PCS 8,929.80
PCS 7,864.56
PCS 6,921.20
PCS 32,102.40
PCS 772.20
144,183.6
PCS 0
PCS 4,029.30
PCS 43,998.02
PCS 15,488.00
PCS 980.10
PCS 3,677.22
136,583.3
PCS
7
PCS 1,118.04
PCS 15,488.00
PCS 5,945.94
PCS 44,588.50
PCS 44,588.50
PCS 1,955.79
PCS 16,171.64
PCS 1,385.98
PCS 2,867.70
PCS 4,198.70
PCS 3,626.37
PCS 15,488.00
PCS 1,313.40
PCS 877.83
PCS 7,864.56
PCS 74,868.75
PCS 7,744.00
PCS 5,856.40
PCS 8,470.00
PCS 1,981.98
PCS 7,864.56
PCS 66,550.00
PCS 14,520.00
PCS 664.40
PCS 970.14
PCS 43,998.02
PCS 8,085.82
PCS 3,267.00
PCS 7,744.00
PCS 87,313.60
PCS 62,925.50
5,291,875.20
27-12-
1 APT010000I31000563 161752 ny. RISMAWATI 
COMBIVENT4,549.95 1 5,004.94
2018 
2 APT010000I31000563 161752 ny. RISMAWATI 
NEBULIZE 40,535.00 1 44,588.50
3 APT010000I62004520 138788 nn. NUR TESSA
HANDSCOEN
AMELIA  478.00 4 525.80
4 APT010000I62004520 138788 nn. NUR TESSA
MASKER
AMELIA 
DI 700.00 2 770.00
5 APT010000I62004520 138788 nn. NUR TESSA
INFUSAN
AMELIA 
N 6,712.06 2 7,383.27
6 APT010000I62004520 138788 nn. NUR TESSA
IV DRESSI
AMELIA 4,850.00 1 5,335.00
7 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
5 CC 1,595.00 2 1,754.50
8 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
3 CC 1,485.00 2 1,633.50
9 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
RL 7,149.60 2 7,864.56
10 APT010000I62004521 146576 tn. SAHARUDDIN
HANDSCOEN
HAMID 478.00 4 525.80
11 APT010000I62004521 146576 tn. SAHARUDDIN
MASKER HAMID 
DI 700.00 2 770.00
12 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
NA15,180.00 2 16,698.00
13 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 5HAMID 
CC 1,595.00 2 1,754.50
14 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 3HAMID 
CC 1,485.00 2 1,633.50
15 APT010000I62004521 146576 tn. SAHARUDDIN
IV DRESSI
HAMID 
4,850.00 1 5,335.00
16 APT010000I62004471 148491 ny. NURBAENI 
INFUSAN N 6,712.06 3 7,383.27
17 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
18 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
19 APT010000I62004471 148491 ny. NURBAENI 
IV DRESSI 4,850.00 1 5,335.00
20 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 3 CC 1,485.00 2 1,633.50
21 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 5 CC 1,595.00 2 1,754.50
22 APT010000I62004515 161675 tn. ANDI MAY
CAIRAN
WELLO
RL M,
7,149.60
SE  3 7,864.56
23 APT010000I62004515 161675 tn. ANDI MAY
HANDSCOEN
WELLO M, 478.00
SE  6 525.80
24 APT010000I62004515 161675 tn. ANDI MAY
MASKER
WELLODIM, 700.00
SE  3 770.00
25 APT010000I62004515 161675 tn. ANDI MAY
CAIRAN
WELLO
AQM,2,860.00
SE  1 3,146.00
26 APT010000I62004515 161675 tn. ANDI MAY
SPOIT
WELLO
5 CC M,
1,595.00
SE  2 1,754.50
27 APT010000I62004515 161675 tn. ANDI MAY
SPOIT
WELLO
3 CC M,
1,485.00
SE  2 1,633.50
28 APT010000I62004515 161675 tn. ANDI MAY
CAIRAN
WELLO
NA15,180.00
M, SE  1 16,698.00
29 APT010000I62004515 161675 tn. ANDI MAY
IV DRESSI
WELLO M,4,850.00
SE  2 5,335.00
30 APT010000I62004505 159634 ny. HJ LOBO 
MASKER DI 700.00 2 770.00
31 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 4 525.80
32 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
33 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
34 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
35 APT010000I62004505 159634 ny. HJ LOBO 
IV DRESSI 4,850.00 1 5,335.00
36 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN NA15,180.00 1 16,698.00
37 APT010000I12000082 161621 ny. DG NURUNG 
MASKER DI 700.00 2 770.00
38 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOON 13,613.00 1 14,974.30
39 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 4 525.80
40 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NA15,180.00 1 16,698.00
41 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 5 CC 1,595.00 1 1,754.50
42 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
43 APT010000I12000082 161621 ny. DG NURUNG 
IV CATHETE 7,750.00 1 8,525.00
44 APT010000I12000082 161621 ny. DG NURUNG 
INFUS SET 7,920.00 1 8,712.00
45 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 3 7,864.56
46 APT010000I65003112 161744 tn. BAKRI WAHID 
TRANSFUSI28,050.00 1 30,855.00
47 APT010000I65003112 161744 tn. BAKRI WAHID 
IV CATHETE 7,750.00 1 8,525.00
48 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 3 CC 1,485.00 1 1,633.50
49 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 5 CC 1,595.00 1 1,754.50
50 APT010000I65003112 161744 tn. BAKRI WAHID 
MASKER DI 700.00 2 770.00
51 APT010000I65003112 161744 tn. BAKRI WAHID 
HANDSCOEN 478.00 4 525.80
52 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN RL 7,149.60 2 7,864.56
53 APT010000I62004504 161146 ny. NIRWANA 
IV CATHETE 7,750.00 1 8,525.00
54 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 3 CC 1,485.00 1 1,633.50
55 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 5 CC 1,595.00 1 1,754.50
56 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 10 C 2,310.00 1 2,541.00
57 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 4 525.80
58 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOON 13,613.00 1 14,974.30
59 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 2 770.00
60 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN NA15,180.00 2 16,698.00
61 APT010000I63003172 161606 ny. ASIH  IV CATHETE 7,750.00 1 8,525.00
62 APT010000I63003172 161606 ny. ASIH  CONECTA 13,200.00 1 14,520.00
63 APT010000I63003172 161606 ny. ASIH  SPOIT 3 CC 1,485.00 1 1,633.50
64 APT010000I63003172 161606 ny. ASIH  SPOIT 5 CC 1,595.00 1 1,754.50
65 APT010000I63003172 161606 ny. ASIH  SPOIT 10 C 2,310.00 1 2,541.00
66 APT010000I63003172 161606 ny. ASIH  MASKER DI 700.00 2 770.00
67 APT010000I63003172 161606 ny. ASIH  HANDSCOEN 478.00 4 525.80
68 APT010000I62004493 161561 ny. DINARE INFUSAN N 6,712.06 2 7,383.27
69 APT010000I62004493 161561 ny. DINARE CAIRAN NA15,180.00 1 16,698.00
70 APT010000I62004493 161561 ny. DINARE SPOIT 10 C 2,310.00 1 2,541.00
71 APT010000I62004493 161561 ny. DINARE SPOIT 3 CC 1,485.00 2 1,633.50
72 APT010000I62004493 161561 ny. DINARE SPOIT 5 CC 1,595.00 1 1,754.50
73 APT010000I62004493 161561 ny. DINARE MASKER DI 700.00 2 770.00
74 APT010000I62004493 161561 ny. DINARE HANDSCOEN 478.00 4 525.80
75 APT010000I62004493 161561 ny. DINARE NASAL CA 11,550.07 1 12,705.07
76 APT010000I62004493 161561 ny. DINARE NEBULIZE 40,535.00 1 44,588.50
77 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA 
RL 7,149.60 3 7,864.56
78 APT010000I62004526 161746 ny. YOSPINAMASKER
KAMMA DI 700.00 2 770.00
79 APT010000I62004526 161746 ny. YOSPINAHANDSCOON
KAMMA 13,613.00 1 14,974.30
80 APT010000I62004526 161746 ny. YOSPINAHANDSCOEN
KAMMA  478.00 4 525.80
81 APT010000I62004526 161746 ny. YOSPINASPOIT
KAMMA 
5 CC 1,595.00 1 1,754.50
82 APT010000I62004526 161746 ny. YOSPINASPOIT
KAMMA 
3 CC 1,485.00 1 1,633.50
83 APT010000I62004526 161746 ny. YOSPINAIV KAMMA 
CATHETE 7,750.00 1 8,525.00
84 APT010000I62004526 161746 ny. YOSPINAIV KAMMA 
DRESSI 4,850.00 1 5,335.00
85 APT010000I65003111 39079 ny. ELIK SULISTIYO
INFUSANPURBAWATI
N 6,712.06   3 7,383.27
86 APT010000I65003111 39079 ny. ELIK SULISTIYO
MASKERPURBAWATI
DI 700.00   2 770.00
87 APT010000I65003111 39079 ny. ELIK SULISTIYO
HANDSCOEN
PURBAWATI
478.00   4 525.80
88 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 3 CC
PURBAWATI
1,485.00   1 1,633.50
89 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 5 CC
PURBAWATI
1,595.00   1 1,754.50
 90 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV CATHETE
PURBAWATI
7,750.00   1 8,525.00
91 APT010000I65003111 39079 ny. ELIK SULISTIYO
INFUS SETPURBAWATI
7,920.00   1 8,712.00
92 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV DRESSIPURBAWATI
4,850.00   1 5,335.00
93 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
RL 7,149.60
E  2 7,864.56
94 APT010000I62004513 114199 tn. SOFYANMASKER
FIRMANSYAH
DI 700.00
E  2 770.00
95 APT010000I62004513 114199 tn. SOFYANHANDSCOEN
FIRMANSYAH478.00
E  4 525.80
96 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
10 C 2,310.00
E  1 2,541.00
97 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
3 CC 1,485.00
E  2 1,633.50
98 APT010000I62004513 114199 tn. SOFYANINFUS
FIRMANSYAH
SET 7,920.00
E  1 8,712.00
99 APT010000I62004513 114199 tn. SOFYANIVFIRMANSYAH
CATHETE 7,750.00
E  1 8,525.00
100 APT010000I62004513 114199 tn. SOFYANIVFIRMANSYAH
CATHETE 7,750.00
E  1 8,525.00
101 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
102 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,330.00 2 12,463.00
103 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 2 275.00
104 APT010000I62004471 148491 ny. NURBAENI 
CAIRAN NA15,180.00 1 16,698.00
105 APT010000I62004521 146576 tn. SAHARUDDIN
EPEXOLHAMID 
TA 869.00 3 955.90
106 APT010000I62004521 146576 tn. SAHARUDDIN
SANMOL HAMID 
T 297.00 3 326.70
107 APT010000I64002973 123863 ny. MULIATIINFUSAN
DG NGAI N 6,712.06 2 7,383.27
108 APT010000I64002973 123863 ny. MULIATITRANSFUSI28,050.00
DG NGAI  1 30,855.00
109 APT010000I64002973 123863 ny. MULIATICONECTA
DG NGAI 13,200.00 1 14,520.00
110 APT010000I64002973 123863 ny. MULIATIIVDG
CATHETE
NGAI 12,416.00 1 13,657.60
111 APT010000I64002973 123863 ny. MULIATIIVDG
DRESSI
NGAI  4,850.00 1 5,335.00

112 APT010000I62004523 107296 ny. HJ BAHARIA 

CAIRAN FU41,388.90 3 45,527.79

113 APT010000I62004523 107296 ny. HJ BAHARIA 

MASKER DI 700.00 2 770.00
114 APT010000I62004523 107296 ny. HJ BAHARIA 
HANDSCOEN 478.00 4 525.80
115 APT010000I62004523 107296 ny. HJ BAHARIA 
SPOIT 10 C 2,310.00 2 2,541.00
116 APT010000I62004523 107296 ny. HJ BAHARIA 
SPOIT 5 CC 1,595.00 2 1,754.50
117 APT010000I62004523 107296 ny. HJ BAHARIA 
SPOIT 3 CC 1,485.00 2 1,633.50
118 APT010000I62004523 107296 ny. HJ BAHARIA 
INFUS SET 7,920.00 1 8,712.00
119 APT010000I62004524 161724 tn. MOCH SADDAM
CAIRAN RLHUSAIN
7,149.60
MO'O  3 7,864.56
120 APT010000I62004524 161724 tn. MOCH SADDAM
MASKER DIHUSAIN
700.00
MO'O  2 770.00
121 APT010000I62004524 161724 tn. MOCH SADDAM
INFUS SETHUSAIN
7,920.00
MO'O  1 8,712.00
122 APT010000I62004524 161724 tn. MOCH SADDAM
HANDSCOENHUSAIN
478.00
MO'O  4 525.80
123 APT010000I62004524 161724 tn. MOCH SADDAM
CONECTAHUSAIN
13,200.00
MO'O  1 14,520.00
124 APT010000I62004524 161724 tn. MOCH SADDAM
IV DRESSIHUSAIN
4,850.00
MO'O  1 5,335.00
125 APT010000I62004524 161724 tn. MOCH SADDAM
IV CATHETE
HUSAIN
7,750.00
MO'O  1 8,525.00
126 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN RL 7,149.60 3 7,864.56
127 APT010000I62004525 83291 tn. SADIR,S.AG 
SPOIT 10 C 2,310.00 1 2,541.00
128 APT010000I62004525 83291 tn. SADIR,S.AG 
MASKER DI 700.00 1 770.00
129 APT010000I62004525 83291 tn. SADIR,S.AG 
HANDSCOEN 478.00 2 525.80
130 APT010000I62004525 83291 tn. SADIR,S.AG 
CONECTA 13,200.00 1 14,520.00
131 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN NA15,180.00 1 16,698.00
132 APT010000I62004525 83291 tn. SADIR,S.AG 
TRANSFUSI28,050.00 1 30,855.00
133 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 3 7,864.56
134 APT010000I62004514 160906 tn. KIDJO SUKARYO 
MASKER DI 700.00 1 770.00
135 APT010000I62004514 160906 tn. KIDJO SUKARYO 
HANDSCOEN 478.00 2 525.80
136 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV DRESSI 4,850.00 1 5,335.00
137 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN AQ 2,860.00 1 3,146.00
138 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 5 CC 1,595.00 1 1,754.50
139 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 4 7,864.56
PCS 5,004.94

PCS 44,588.50
PCS 2,103.20
PCS 1,540.00
PCS 14,766.54
PCS 5,335.00
PCS 3,509.00
PCS 3,267.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 33,396.00
PCS 3,509.00
PCS 3,267.00
PCS 5,335.00
PCS 22,149.81
PCS 2,103.20
PCS 1,540.00
PCS 5,335.00
PCS 3,267.00
PCS 3,509.00
PCS 23,593.68
PCS 3,154.80
PCS 2,310.00
PCS 3,146.00
PCS 3,509.00
PCS 3,267.00
PCS 16,698.00
PCS 10,670.00
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 5,335.00
PCS 16,698.00
PCS 1,540.00
PCS 14,974.30
PCS 2,103.20
PCS 16,698.00
PCS 1,754.50
PCS 1,633.50
PCS 8,525.00
PCS 8,712.00
PCS 23,593.68
PCS 30,855.00
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 1,540.00
PCS 2,103.20
PCS 15,729.12
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 2,103.20
PCS 14,974.30
PCS 1,540.00
PCS 33,396.00
PCS 8,525.00
PCS 14,520.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,540.00
PCS 2,103.20
PCS 14,766.54
PCS 16,698.00
PCS 2,541.00
PCS 3,267.00
PCS 1,754.50
PCS 1,540.00
PCS 2,103.20
PCS 12,705.07
PCS 44,588.50
PCS 23,593.68
PCS 1,540.00
PCS 14,974.30
PCS 2,103.20
PCS 1,754.50
PCS 1,633.50
PCS 8,525.00
PCS 5,335.00
PCS 22,149.81
PCS 1,540.00
PCS 2,103.20
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 8,712.00
PCS 5,335.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 3,267.00
PCS 8,712.00
PCS 8,525.00
PCS 8,525.00
PCS 43,998.02
PCS 24,926.00
PCS 550.00
PCS 16,698.00
PCS 2,867.70
PCS 980.10
PCS 14,766.54
PCS 30,855.00
PCS 14,520.00
PCS 13,657.60
PCS 5,335.00
136,583.3
PCS
7
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 8,712.00
PCS 23,593.68
PCS 1,540.00
PCS 8,712.00
PCS 2,103.20
PCS 14,520.00
PCS 5,335.00
PCS 8,525.00
PCS 23,593.68
PCS 2,541.00
PCS 770.00
PCS 1,051.60
PCS 14,520.00
PCS 16,698.00
PCS 30,855.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 3,146.00
PCS 1,754.50
PCS 31,458.24
26-12-
1 APT010000I62004517 161692 ny. DJANGKI 
MASKER DI 700.00 1 770.00
2018 
2 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 2 525.80
3 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN RL 7,149.60 3 7,864.56
4 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN DE18,920.00 2 20,812.00
5 APT010000I62004517 161692 ny. DJANGKI 
IV CATHETE 7,750.00 1 8,525.00
6 APT010000I62004517 161692 ny. DJANGKI 
IV DRESSI 4,850.00 1 5,335.00
7 APT010000I62004519 154288 tn. ANDI MUIS 
CAIRAN RL 7,149.60 6 7,864.56
8 APT010000I62004519 154288 tn. ANDI MUIS 
MASKER DI 700.00 1 770.00
9 APT010000I62004519 154288 tn. ANDI MUIS 
HANDSCOEN 478.00 2 525.80
10 APT010000I62004519 154288 tn. ANDI MUIS 
SPOIT 10 C 2,310.00 1 2,541.00
11 APT010000I62004519 154288 tn. ANDI MUIS 
SPOIT 1 CC 1,920.00 1 2,112.00
12 APT010000I62004519 154288 tn. ANDI MUIS 
IV CATHETE 7,750.00 1 8,525.00
13 APT010000I62004519 154288 tn. ANDI MUIS 
IV DRESSI 4,850.00 1 5,335.00
14 APT010000I62004519 154288 tn. ANDI MUIS 
CONECTA 13,200.00 1 14,520.00
15 APT010000I62004499 161575 tn. ALIF PRADITYA
INFUSAN  R 9,645.50 4 10,610.05
16 APT010000I62004499 161575 tn. ALIF PRADITYA
IV DRESSI
  4,850.00 1 5,335.00
17 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 1 770.00
18 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 2 525.80
19 APT010000I62004499 161575 tn. ALIF PRADITYA
IV CATHETE
  7,750.00 1 8,525.00
20 APT010000I62004499 161575 tn. ALIF PRADITYA
CONECTA  13,200.00 1 14,520.00
21 APT010000I62004476 161475 ny. ANDI MASTURA 
INFUSAN R 9,645.50 3 10,610.05
22 APT010000I62004476 161475 ny. ANDI MASTURA 
IV CATHETE 7,750.00 1 8,525.00
23 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 1 770.00
24 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 2 525.80
25 APT010000I62004476 161475 ny. ANDI MASTURA 
CAIRAN AQ 2,860.00 1 3,146.00
26 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 10 C 2,310.00 1 2,541.00
27 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 3 CC 1,485.00 1 1,633.50
28 APT010000I62004476 161475 ny. ANDI MASTURA 
IV DRESSI 4,850.00 1 5,335.00
29 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 3 7,864.56
30 APT010000I62004506 161611 tn. ALI NGURAWAN 
MASKER DI 700.00 1 770.00
31 APT010000I62004506 161611 tn. ALI NGURAWAN 
HANDSCOEN 478.00 2 525.80
32 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 10 C 2,310.00 1 2,541.00
33 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 5 CC 1,595.00 1 1,754.50
34 APT010000I62004506 161611 tn. ALI NGURAWAN 
IV CATHETE 7,750.00 1 8,525.00
35 APT010000I62004506 161611 tn. ALI NGURAWAN 
TRANSFUSI28,050.00 1 30,855.00
36 APT010000I62004506 161611 tn. ALI NGURAWAN 
CONECTA 13,200.00 1 14,520.00
37 APT010000I62004501 115911 ny. WALIDAINFUSAN
DG BAJI N 6,712.06 3 7,383.27
38 APT010000I62004501 115911 ny. WALIDAMASKER
DG BAJI DI 700.00 1 770.00
39 APT010000I62004501 115911 ny. WALIDAHANDSCOEN
DG BAJI  478.00 2 525.80
40 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
10 C 2,310.00 1 2,541.00
41 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
5 CC 1,595.00 1 1,754.50
42 APT010000I62004501 115911 ny. WALIDASPOIT
DG BAJI 
3 CC 1,485.00 1 1,633.50
43 APT010000I62004501 115911 ny. WALIDAIVDGDRESSI
BAJI  4,850.00 1 5,335.00
44 APT010000I62004501 115911 ny. WALIDACONECTA
DG BAJI  13,200.00 1 14,520.00
45 APT010000I62004501 115911 ny. WALIDATRANSFUSI28,050.00
DG BAJI  1 30,855.00
46 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 4 7,864.56
47 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 1 770.00
48 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOEN
BATARI  478.00 2 525.80
49 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
10 C 2,310.00 1 2,541.00
50 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
5 CC 1,595.00 1 1,754.50
51 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
3 CC 1,485.00 1 1,633.50
52 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
AQ 2,860.00 1 3,146.00
53 APT010000I62004496 161569 nn. ANDI INDRI
INFUSBATARI 
SET 7,920.00 1 8,712.00
54 APT010000I62004496 161569 nn. ANDI INDRI
IV CATHETE
BATARI 7,750.00 1 8,525.00
55 APT010000I65003101 161497 ny. LILY HAFSAH 
INFUSAN N 6,712.06 6 7,383.27
56 APT010000I65003101 161497 ny. LILY HAFSAH 
MASKER DI 700.00 1 770.00
57 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOEN 478.00 2 525.80
58 APT010000I65003101 161497 ny. LILY HAFSAH 
SPOIT 3 CC 1,485.00 1 1,633.50
59 APT010000I65003101 161497 ny. LILY HAFSAH 
SPOIT 5 CC 1,595.00 1 1,754.50
60 APT010000I65003101 161497 ny. LILY HAFSAH 
IV CATHETE 7,750.00 1 8,525.00
61 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN AQ 2,860.00 1 3,146.00
62 APT010000I65003101 161497 ny. LILY HAFSAH 
INFUS SET 7,920.00 1 8,712.00
63 APT010000I64002973 123863 ny. MULIATINOVO
DG NGAI 
TWIS 2,083.00 1 2,291.30
64 APT010000I64002973 123863 ny. MULIATICAIRAN
DG NGAI 
RL 7,149.60 3 7,864.56
65 APT010000I64002973 123863 ny. MULIATIMASKER
DG NGAI 
DI 700.00 2 770.00
66 APT010000I64002973 123863 ny. MULIATIHANDSCOEN
DG NGAI  478.00 4 525.80
67 APT010000I64002973 123863 ny. MULIATIINFUS
DG NGAI 
SET 7,920.00 1 8,712.00
68 APT010000I64002973 123863 ny. MULIATICONECTA
DG NGAI 13,200.00 1 14,520.00
69 APT010000I64002973 123863 ny. MULIATIIVDG
DRESSI
NGAI  4,850.00 1 5,335.00
70 APT010000I64002973 123863 ny. MULIATISPOIT
DG NGAI 
10 C 2,310.00 2 2,541.00
71 APT010000I64002973 123863 ny. MULIATISPOIT
DG NGAI 
5 CC 1,595.00 2 1,754.50
72 APT010000I64002973 123863 ny. MULIATISPOIT
DG NGAI 
3 CC 1,485.00 2 1,633.50
73 APT010000I62004509 131089 ny. FIRDHAINFUSAN
RESMISARI 
N 6,712.06 5 7,383.27
74 APT010000I62004509 131089 ny. FIRDHAMASKER
RESMISARI 
DI 700.00 2 770.00
75 APT010000I62004509 131089 ny. FIRDHAHANDSCOEN
RESMISARI  478.00 4 525.80
76 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 6 7,864.56
77 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 1 770.00
78 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA  478.00 2 525.80
79 APT010000I62004511 161613 an. MUHAMMAD
IV CATHETE
TAQWA 
7,750.00 1 8,525.00
80 APT010000I62004511 161613 an. MUHAMMAD
CONECTATAQWA 
13,200.00 1 14,520.00
81 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
AQ 2,860.00 1 3,146.00
82 APT010000I65003107 161571 ny. SALFIAHINFUSAN
DG SAYU N 6,712.06 3 7,383.27
83 APT010000I65003107 161571 ny. SALFIAHINFUS
DG SAYU 
SET 7,920.00 1 8,712.00
84 APT010000I65003107 161571 ny. SALFIAHCONECTA
DG SAYU 13,200.00 1 14,520.00
85 APT010000I65003107 161571 ny. SALFIAHIVDG
CATHETE
SAYU  7,750.00 1 8,525.00
86 APT010000I65003107 161571 ny. SALFIAHIVDG
DRESSI
SAYU  4,850.00 1 5,335.00
87 APT010000I65003107 161571 ny. SALFIAHMASKER
DG SAYU 
DI 700.00 2 770.00
88 APT010000I65003107 161571 ny. SALFIAHHANDSCOEN
DG SAYU  478.00 4 525.80
89 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 3 7,864.56
 90 APT010000I62004514 160906 tn. KIDJO SUKARYO 
MASKER DI 700.00 1 770.00
91 APT010000I62004514 160906 tn. KIDJO SUKARYO 
HANDSCOEN 478.00 2 525.80
92 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 10 C 2,310.00 1 2,541.00
93 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 3 CC 1,485.00 1 1,633.50
94 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 5 CC 1,595.00 1 1,754.50
95 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV CATHETE 7,750.00 1 8,525.00
96 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN AQ 2,860.00 2 3,146.00
97 APT010000I62004515 161675 tn. ANDI MAYCAIRAN
WELLO
RL M,
7,149.60
SE  3 7,864.56
98 APT010000I62004515 161675 tn. ANDI MAYHANDSCOEN
WELLO M, 478.00
SE  4 525.80
99 APT010000I62004515 161675 tn. ANDI MAYMASKER
WELLODIM, 700.00
SE  1 770.00
100 APT010000I62004515 161675 tn. ANDI MAYSPOIT
WELLO
5 CC M,
1,595.00
SE  2 1,754.50
101 APT010000I62004515 161675 tn. ANDI MAYSPOIT
WELLO
3 CC M,
1,485.00
SE  2 1,633.50
102 APT010000I62004515 161675 tn. ANDI MAYCAIRAN
WELLO
AQM,2,860.00
SE  1 3,146.00
103 APT010000I62004515 161675 tn. ANDI MAYCAIRAN
WELLO
NA15,180.00
M, SE  1 16,698.00
104 APT010000I62004504 161146 ny. NIRWANA HANDSCOEN 478.00 6 525.80
105 APT010000I62004504 161146 ny. NIRWANA MASKER DI 700.00 3 770.00
106 APT010000I62004504 161146 ny. NIRWANA SPOIT 10 C 2,310.00 2 2,541.00
107 APT010000I62004504 161146 ny. NIRWANA SPOIT 5 CC 1,595.00 2 1,754.50
108 APT010000I62004504 161146 ny. NIRWANA SPOIT 3 CC 1,485.00 2 1,633.50
109 APT010000I62004504 161146 ny. NIRWANA IV CATHETE 7,750.00 2 8,525.00
110 APT010000I62004504 161146 ny. NIRWANA INFUSAN N 6,712.06 3 7,383.27
111 APT010000I62004504 161146 ny. NIRWANA CAIRAN AQ 2,860.00 2 3,146.00
112 APT010000I63003172 161606 ny. ASIH  INFUSAN N 6,712.06 3 7,383.27
113 APT010000I63003172 161606 ny. ASIH  SPOIT 10 C 2,310.00 2 2,541.00
114 APT010000I63003172 161606 ny. ASIH  SPOIT 5 CC 1,595.00 2 1,754.50
115 APT010000I63003172 161606 ny. ASIH  SPOIT 3 CC 1,485.00 2 1,633.50
116 APT010000I63003172 161606 ny. ASIH  IV CATHETE 7,750.00 2 8,525.00
117 APT010000I63003172 161606 ny. ASIH  HANDSCOEN 478.00 4 525.80
118 APT010000I63003172 161606 ny. ASIH  MASKER DI 700.00 2 770.00
119 APT010000I63003172 161606 ny. ASIH  CAIRAN AQ 2,860.00 2 3,146.00
120 APT010000I63003172 161606 ny. ASIH  CAIRAN NA15,180.00 2 16,698.00
121 APT010000I62004490 161536 nn. RISKI INDASARI
INFUSANAMIR 
N 6,712.06 3 7,383.27
122 APT010000I62004490 161536 nn. RISKI INDASARI
IV CATHETE
AMIR 
7,750.00 2 8,525.00
123 APT010000I62004490 161536 nn. RISKI INDASARI
HANDSCOEN
AMIR 478.00 6 525.80
124 APT010000I62004490 161536 nn. RISKI INDASARI
MASKER AMIR 
DI 700.00 3 770.00
125 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 10AMIR 
C 2,310.00 2 2,541.00
126 APT010000I62004490 161536 nn. RISKI INDASARI
SPOIT 5 CC
AMIR 
1,595.00 2 1,754.50
127 APT010000I62004490 161536 nn. RISKI INDASARI
CAIRAN AQ
AMIR 
2,860.00 2 3,146.00
128 APT010000I62004490 161536 nn. RISKI INDASARI
CAIRAN NA15,180.00
AMIR  2 16,698.00
129 APT010000I62004513 114199 tn. SOFYANINFUSAN
FIRMANSYAH
N 6,712.06
E  3 7,383.27
130 APT010000I62004513 114199 tn. SOFYANHANDSCOEN
FIRMANSYAH478.00
E  6 525.80
131 APT010000I62004513 114199 tn. SOFYANMASKER
FIRMANSYAH
DI 700.00
E  3 770.00
132 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
10 C 2,310.00
E  2 2,541.00
133 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
5 CC 1,595.00
E  2 1,754.50
134 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
3 CC 1,485.00
E  2 1,633.50
135 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
AQ 2,860.00
E  2 3,146.00
136 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
NA15,180.00
E  2 16,698.00
137 APT010000I64002929 161294 ny. HASNAH 
INFUSAN N 6,712.06 2 7,383.27
138 APT010000I64002929 161294 ny. HASNAH 
HANDSCOEN 478.00 4 525.80
139 APT010000I64002929 161294 ny. HASNAH 
MASKER DI 700.00 1 770.00
140 APT010000I64002929 161294 ny. HASNAH 
CAIRAN NA15,180.00 1 16,698.00
141 APT010000I64002929 161294 ny. HASNAH 
CAIRAN AQ 2,860.00 2 3,146.00
142 APT010000I62004453 161309 ny. SURIATIINFUSAN
DG. SUNGGU
N 6,712.06
  3 7,383.27
143 APT010000I62004453 161309 ny. SURIATIHANDSCOEN
DG. SUNGGU478.00
  4 525.80
144 APT010000I62004453 161309 ny. SURIATIMASKER
DG. SUNGGU
DI 700.00
  1 770.00
145 APT010000I62004453 161309 ny. SURIATISPOIT
DG. SUNGGU
5 CC 1,595.00
  2 1,754.50
146 APT010000I62004453 161309 ny. SURIATIIVDG.
CATHETE
SUNGGU7,750.00
  2 8,525.00
147 APT010000I62004453 161309 ny. SURIATIIVDG.
DRESSI
SUNGGU4,850.00
  1 5,335.00
148 APT010000I62004453 161309 ny. SURIATICAIRAN
DG. SUNGGU
AQ 2,860.00
  1 3,146.00
149 APT010000I62004512 161657 ny. HASNAHINFUSAN
TAHA  N 6,712.06 2 7,383.27
150 APT010000I62004512 161657 ny. HASNAHIVTAHA 
CATHETE 7,750.00 1 8,525.00
151 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
5 CC 1,595.00 1 1,754.50
152 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
10 C 2,310.00 1 2,541.00
153 APT010000I62004512 161657 ny. HASNAHSPOIT
TAHA 
3 CC 1,485.00 1 1,633.50
154 APT010000I62004512 161657 ny. HASNAHHANDSCOEN
TAHA  478.00 4 525.80
155 APT010000I62004512 161657 ny. HASNAHMASKER
TAHA  DI 700.00 1 770.00
156 APT010000I62004512 161657 ny. HASNAHIVTAHA 
DRESSI 4,850.00 1 5,335.00
157 APT010000I62004512 161657 ny. HASNAHCAIRAN
TAHA AQ 2,860.00 1 3,146.00
158 APT010000I62004512 161657 ny. HASNAHCAIRAN
TAHA NA15,180.00 1 16,698.00
159 APT010000I12000082 161621 ny. DG NURUNG 
SUNGKUP 44,750.00 1 49,225.00
160 APT010000I12000082 161621 ny. DG NURUNG 
INFUSAN N 6,712.06 2 7,383.27
161 APT010000I12000082 161621 ny. DG NURUNG 
IV CATHETE 7,750.00 1 8,525.00
162 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
163 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 5 CC 1,595.00 1 1,754.50
164 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 10 C 2,310.00 1 2,541.00
165 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 2 525.80
166 APT010000I12000082 161621 ny. DG NURUNG 
MASKER DI 700.00 1 770.00
167 APT010000I12000082 161621 ny. DG NURUNG 
INFUS SET 7,920.00 1 8,712.00
168 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NA15,180.00 1 16,698.00
169 APT010000I62004505 159634 ny. HJ LOBO 
INFUSAN N 6,712.06 2 7,383.27
170 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
171 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
172 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
173 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 10 C 2,310.00 1 2,541.00
174 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 2 525.80
175 APT010000I62004505 159634 ny. HJ LOBO 
MASKER DI 700.00 1 770.00
176 APT010000I65003098 155366 tn. DUDUNG 
INFUSAN N 6,712.06 2 7,383.27
177 APT010000I65003098 155366 tn. DUDUNG 
IV CATHETE 7,750.00 1 8,525.00
178 APT010000I65003098 155366 tn. DUDUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
179 APT010000I65003098 155366 tn. DUDUNG 
SPOIT 5 CC 1,595.00 1 1,754.50
180 APT010000I65003098 155366 tn. DUDUNG SPOIT 10 C 2,310.00 1 2,541.00
181 APT010000I65003098 155366 tn. DUDUNG IV DRESSI 4,850.00 1 5,335.00
182 APT010000I65003098 155366 tn. DUDUNG CAIRAN AQ 2,860.00 2 3,146.00
183 APT010000I65003098 155366 tn. DUDUNG HANDSCOEN 478.00 2 525.80
184 APT010000I65003098 155366 tn. DUDUNG MASKER DI 700.00 1 770.00
185 APT010000I65003098 155366 tn. DUDUNG CAIRAN NA15,180.00 1 16,698.00
186 APT010000I62004457 76534 tn. SAHABUDDIN 
INFUSAN N 6,712.06 2 7,383.27
187 APT010000I62004457 76534 tn. SAHABUDDIN 
IV CATHETE 7,750.00 1 8,525.00
188 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 3 CC 1,485.00 1 1,633.50
189 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 5 CC 1,595.00 1 1,754.50
190 APT010000I62004457 76534 tn. SAHABUDDIN 
SPOIT 10 C 2,310.00 1 2,541.00
191 APT010000I62004457 76534 tn. SAHABUDDIN 
HANDSCOEN 478.00 2 525.80
192 APT010000I62004457 76534 tn. SAHABUDDIN 
MASKER DI 700.00 1 770.00
193 APT010000I62004457 76534 tn. SAHABUDDIN 
SUNGKUP 44,750.00 1 49,225.00
194 APT010000I62004457 76534 tn. SAHABUDDIN 
CAIRAN AQ 2,860.00 2 3,146.00
195 APT010000I62004500 161581 ny. SERI BINTANG 
INFUSAN N 6,712.06 3 7,383.27
196 APT010000I62004500 161581 ny. SERI BINTANG 
HANDSCOEN 478.00 6 525.80
197 APT010000I62004500 161581 ny. SERI BINTANG 
MASKER DI 700.00 3 770.00
198 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 10 C 2,310.00 2 2,541.00
199 APT010000I62004500 161581 ny. SERI BINTANG 
SPOIT 5 CC 1,595.00 2 1,754.50
200 APT010000I62004500 161581 ny. SERI BINTANG 
IV CATHETE 7,750.00 2 8,525.00
201 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN AQ 2,860.00 2 3,146.00
202 APT010000I62004500 161581 ny. SERI BINTANG 
CAIRAN NA15,180.00 2 16,698.00
203 APT010000I62004508 120214 ny. ROSMAWATI 
DIMENHIDR 121.00 6 133.10
204 APT010000I62004508 120214 ny. ROSMAWATI 
NEURODEX 770.00 3 847.00
205 APT010000I62004508 120214 ny. ROSMAWATI 
SANMOL T 297.00 9 326.70
206 APT010000I62004508 120214 ny. ROSMAWATI 
AMLODIPIN 475.19 3 522.71
207 APT010000I62004508 120214 ny. ROSMAWATI 
SIMVASTAT 359.10 3 395.01
208 APT010000I62004508 120214 ny. ROSMAWATI 
GLIMEPIRI 1,257.80 3 1,383.57
209 APT010000I62004508 120214 ny. ROSMAWATI 
PREGABAL 5,500.00 6 6,050.00
210 APT010000I62004509 131089 ny. FIRDHANEW
RESMISARI 
DIAT 557.15 4 612.87
211 APT010000I62004509 131089 ny. FIRDHAONDANSET
RESMISARI 1,355.20 9 1,490.72
212 APT010000I65003098 155366 tn. DUDUNG SPORETIK 5,720.50 6 6,292.55
213 APT010000I65003098 155366 tn. DUDUNG AMBROXOL 199.65 9 219.62
214 APT010000I65003098 155366 tn. DUDUNG METIL PRE 702.00 6 772.20
215 APT010000I65003098 155366 tn. DUDUNG CETIRIZIN 266.01 3 292.61

216 APT010000I62004500 161581 ny. SERI BINTANG 

CODIPRON10,502.80 9 11,553.08

217 APT010000I65003086 161248 ny. JUMANIA 

LEVOFLOXA 449.00 3 493.90
218 APT010000I65003086 161248 ny. JUMANIA 
LANSOPRAZ 851.29 6 936.42
219 APT010000I65003086 161248 ny. JUMANIA 
METIL PRE 819.00 12 900.90
220 APT010000I64002929 161294 ny. HASNAH 
METIL PRE 819.00 12 900.90
221 APT010000I64002929 161294 ny. HASNAH 
LANSOPRAZ 851.29 6 936.42
222 APT010000I64002929 161294 ny. HASNAH 
SPORETIK 5,720.50 6 6,292.55
223 APT010000I62004457 76534 tn. SAHABUDDIN 
NEURODEX 770.00 6 847.00
224 APT010000I62004457 76534 tn. SAHABUDDIN 
KSR 600 M 1,755.00 6 1,930.50
225 APT010000I62004453 161309 ny. SURIATISPORETIK
DG. SUNGGU5,720.50
  6 6,292.55
226 APT010000I62004453 161309 ny. SURIATIRANITIDIN
DG. SUNGGU629.99
  6 692.99
227 APT010000I62004453 161309 ny. SURIATISANMOL
DG. SUNGGU
T 297.00
  9 326.70
228 APT010000I62004453 161309 ny. SURIATITRICHODAZ
DG. SUNGGU1,738.00
  9 1,911.80
229 APT010000I62004490 161536 nn. RISKI INDASARI
RANITIDIN
AMIR 629.99 6 692.99
230 APT010000I62004490 161536 nn. RISKI INDASARI
EPISAN SU
AMIR 
51,150.00 1 56,265.00
231 APT010000I62004490 161536 nn. RISKI INDASARI
CEFADROXI
AMIR 877.80 6 965.58
232 APT010000I62004490 161536 nn. RISKI INDASARI
IBUPROFEN
AMIR 235.95 9 259.55
233 APT010000I62004515 161675 tn. ANDI MAYAZITROMYC
WELLO M,1,777.99
SE  1 1,955.79
234 APT010000I62004515 161675 tn. ANDI MAYINTERHIST
WELLO M, 768.08
SE  2 844.88
235 APT010000I62004504 161146 ny. NIRWANA CEFTRIAXO19,999.10 2 21,999.01
236 APT010000I62004504 161146 ny. NIRWANA URDAFALK 5,527.50 2 6,080.25
237 APT010000I62004504 161146 ny. NIRWANA NEUROSANB5,324.00 1 5,856.40
238 APT010000I63003172 161606 ny. ASIH  CAIRAN NAC6,409.70 2 7,050.67
239 APT010000I63003172 161606 ny. ASIH  RANITIDIN 7,040.00 2 7,744.00
240 APT010000I63003172 161606 ny. ASIH  ISOSORBID 102.85 1 113.14
241 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NAC6,409.70 1 7,050.67
242 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 7,040.00 2 7,744.00
243 APT010000I12000082 161621 ny. DG NURUNG 
NEW DIAT 557.15 3 612.87
244 APT010000I12000082 161621 ny. DG NURUNG 
METOCLOPR5,500.00 3 6,050.00
245 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 3 326.70
246 APT010000I12000082 161621 ny. DG NURUNG 
NEURODEX 770.00 2 847.00
247 APT010000I62004512 161657 ny. HASNAH KETOROLAC
TAHA  7,350.75 3 8,085.82
248 APT010000I62004513 114199 tn. SOFYANCEFTRIAXO19,999.10
FIRMANSYAH E  2 21,999.01
249 APT010000I62004513 114199 tn. SOFYANDEKSAMETA1,801.80
FIRMANSYAH E  2 1,981.98
250 APT010000I62004513 114199 tn. SOFYANVOSEDON
FIRMANSYAH
T 2,431.00
E  3 2,674.10
251 APT010000I62004513 114199 tn. SOFYANSANMOL
FIRMANSYAH
T 297.00
E  3 326.70
252 APT010000I62004513 114199 tn. SOFYANRANITIDIN
FIRMANSYAH 7,040.00
E  2 7,744.00
253 APT010000I62004505 159634 ny. HJ LOBO IV CATHETE12,416.00 1 13,657.60
254 APT010000I62004505 159634 ny. HJ LOBO TRANSFUSI28,050.00 1 30,855.00
255 APT010000I62004505 159634 ny. HJ LOBO CONECTA 13,200.00 1 14,520.00
256 APT010000I62004505 159634 ny. HJ LOBO LIDOCAINE 1,287.00 3 1,415.70
257 APT010000I62004505 159634 ny. HJ LOBO SPOIT 5 CC 1,595.00 1 1,754.50
258 APT010000I62004505 159634 ny. HJ LOBO ONDANSET 2,151.00 3 2,366.10
259 APT010000I62004505 159634 ny. HJ LOBO PUMPITOR 11,330.00 1 12,463.00
260 APT010000I62004493 161561 ny. DINARE COMBIVENT4,549.95 2 5,004.94
261 APT010000I62004493 161561 ny. DINARE CEFTRIAXO19,999.10 2 21,999.01

262 APT010000I62004500 161581 ny. SERI BINTANG 

VOMETRON18,150.00 9 19,965.00

263 APT010000I62004500 161581 ny. SERI BINTANG 

PUMPITOR 11,330.00 3 12,463.00
264 APT010000I62004503 159886 tn. MUH BASIR
RANITIDIN
LALANG 7,040.00 2 10,700.80
265 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
266 APT010000I62004503 159886 tn. MUH BASIR
NEUROSANB5,324.00
LALANG  1 6,921.20
267 APT010000I62004503 159886 tn. MUH BASIR
CAIRAN
LALANG 
AM70,188.80 1 94,754.88
268 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 20 C 5,600.00 2 6,160.00
269 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOON 12,100.00 1 13,310.00
270 APT010000I62004514 160906 tn. KIDJO SUKARYO 
AMBROXOL 199.65 3 219.62
271 APT010000I62004514 160906 tn. KIDJO SUKARYO 
COMBIVENT4,549.95 3 5,004.94
272 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPORETIK 5,720.50 3 6,292.55
273 APT010000I62004517 161692 ny. DJANGKI 
PUMPITOR 11,330.00 1 12,463.00
274 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
275 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 2 21,999.01
276 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
277 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 10,011.38 4 11,012.51
278 APT010000I66000437 161676 ny. HJ ERNAWATY 
MECOBALAM6,600.00 2 7,260.00
279 APT010000I66000437 161676 ny. HJ ERNAWATY 
RANITIDIN 7,040.00 2 7,744.00
280 APT010000I66000437 161676 ny. HJ ERNAWATY 
INFUSAN N 6,712.06 2 7,383.27
281 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 20 525.80
282 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 2 2,099.35
283 APT010000I62004476 161475 ny. ANDI MASTURA 
CETIRIZIN 266.01 3 292.61
284 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFTRIAXO19,999.10 2 21,999.01
285 APT010000I62004506 161611 tn. ALI NGURAWAN 
KETOROLAC 7,350.75 3 8,085.82
286 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 2 7,744.00
287 APT010000I62004501 115911 ny. WALIDATETRASANB
DG BAJI  506.00 9 556.60
288 APT010000I62004501 115911 ny. WALIDATRICHODAZ
DG BAJI  1,738.00 9 1,911.80
289 APT010000I62004501 115911 ny. WALIDAMETFORMI
DG BAJI  190.00 6 209.00
290 APT010000I62004501 115911 ny. WALIDAAMBROXOL
DG BAJI  199.65 9 219.62
291 APT010000I62004501 115911 ny. WALIDAGLIMEPIRI
DG BAJI  1,257.80 3 1,383.57
292 APT010000I62004496 161569 nn. ANDI INDRI
COMBIVENT4,549.95
BATARI  2 5,004.94
293 APT010000I62004496 161569 nn. ANDI INDRI
CEFTRIAXO19,999.10
BATARI  2 21,999.01
294 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI 7,040.00 2 7,744.00
295 APT010000I62004496 161569 nn. ANDI INDRI
VOSEDON
BATARI 
T 2,431.00 3 2,674.10
296 APT010000I65003101 161497 ny. LILY HAFSAH 
PUMPITOR 11,330.00 2 12,463.00
297 APT010000I65003101 161497 ny. LILY HAFSAH 
VOLUVEN 621,780.00 1 23,958.00

298 APT010000I65003101 161497 ny. LILY HAFSAH 

METIL PRE 49,500.00 2 54,450.00

299 APT010000I64002973 123863 ny. MULIATI

CAIRAN
DG NGAI 
NAC6,409.70 1 7,050.67
300 APT010000I64002973 123863 ny. MULIATI
ONDANSETR5,500.00
DG NGAI  3 6,050.00
301 APT010000I64002973 123863 ny. MULIATI
METFORMI
DG NGAI  190.00 2 209.00
302 APT010000I64002973 123863 ny. MULIATI
AMLODIPIN
DG NGAI  475.19 1 522.71
303 APT010000I64002973 123863 ny. MULIATI
ALLOPURIN
DG NGAI  248.02 1 272.83
304 APT010000I64002973 123863 ny. MULIATI
SIMVASTAT
DG NGAI  751.94 1 827.13

305 APT010000I62004511 161613 an. MUHAMMAD

PARACETA
TAQWA 
68,062.50 3 74,868.75

306 APT010000I62004511 161613 an. MUHAMMAD

ONDANSETR5,500.00
TAQWA  2 6,050.00
307 APT010000I65003107 161571 ny. SALFIAHFLAMAR
DG SAYU 50 1,908.50 2 2,099.35
308 APT010000I65003107 161571 ny. SALFIAHMETFORMI
DG SAYU  190.00 3 209.00
309 APT010000I62004499 161575 tn. ALIF PRADITYA
CEFTRIAXO19,999.10
  2 21,999.01
310 APT010000I62004523 107296 ny. HJ BAHARIA 
CAIRAN RL 7,149.60 2 7,864.56
311 APT010000I62004520 138788 nn. NUR TESSA
CEFTRIAXO19,999.10
AMELIA  2 21,999.01
312 APT010000I62004520 138788 nn. NUR TESSA
CAIRAN
AMELIA 
NA15,180.00 1 16,698.00
313 APT010000I62004520 138788 nn. NUR TESSA
RANITIDIN
AMELIA 7,040.00 2 7,744.00
314 APT010000I62004520 138788 nn. NUR TESSA
ONDANSETR5,500.00
AMELIA  2 6,050.00
315 APT010000I62004520 138788 nn. NUR TESSA
EPISAN
AMELIA 
SU 51,150.00 1 56,265.00
316 APT010000I62004521 146576 tn. SAHARUDDIN
COMBIVENT4,549.95
HAMID  3 5,004.94
317 APT010000I62004521 146576 tn. SAHARUDDIN
AMBROXOL
HAMID 199.65 3 219.62

318 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   3 54,450.00

319 APT010000I65003111 39079 ny. ELIK SULISTIYO

MECOBALAM
PURBAWATI
6,600.00   1 7,260.00
320 APT010000I65003111 39079 ny. ELIK SULISTIYO
RANITIDIN
PURBAWATI
7,040.00   2 7,744.00
321 APT010000I65003111 39079 ny. ELIK SULISTIYO
BECLOV PURBAWATI
INJ13,418.20   4 14,760.02
322 APT010000I62004525 83291 tn. SADIR,S.AG 
RANITIDIN 7,040.00 1 7,744.00
323 APT010000I62004525 83291 tn. SADIR,S.AG 
NEW DIAT 557.15 4 612.87
324 APT010000I62004525 83291 tn. SADIR,S.AG 
SANPRIMA 902.00 9 992.20
325 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN RL 7,149.60 1 7,864.56
326 APT010000I62004518 161696 ny. A. AYU NEUROSANB5,324.00
ANDANI  1 6,921.20
327 APT010000I62004518 161696 ny. A. AYU RANITIDIN
ANDANI  7,040.00 3 10,700.80
328 APT010000I62004518 161696 ny. A. AYU SANMOL
ANDANI  T 297.00 2 386.10

329 APT010000I62004512 161657 ny. HASNAH

BAQUINOR
TAHA  14,564.00 9 16,020.40

330 APT010000I62004512 161657 ny. HASNAH

FARGETIX
TAHA  407.00 9 447.70
331 APT010000I62004524 161724 tn. MOCH SADDAM
CEFTRIAXO19,999.10
HUSAIN MO'O  2 21,999.01
332 APT010000I62004524 161724 tn. MOCH SADDAM
RANITIDINHUSAIN
7,040.00
MO'O  2 7,744.00
333 APT010000I62004524 161724 tn. MOCH SADDAM
SANMOL HUSAIN
T 297.00
MO'O  3 326.70
334 APT010000I62004524 161724 tn. MOCH SADDAM
NEW DIATHUSAIN
557.15
MO'O  6 612.87

335 APT010000I62004523 107296 ny. HJ BAHARIA 

CAIRAN FU41,388.90 3 45,527.79

336 APT010000I62004523 107296 ny. HJ BAHARIA 

KOTRIMOKS 254.10 4 279.51
337 APT010000I62004523 107296 ny. HJ BAHARIA 
RANITIDIN 7,040.00 2 7,744.00
338 APT010000I62004472 161449 tn. NUR ROHMAT 
DEKSAMETA1,801.80 3 1,981.98
339 APT010000I62004521 146576 tn. SAHARUDDIN
NEBULIZE
HAMID 40,535.00 1 44,588.50
340 APT010000I62004496 161569 nn. ANDI INDRI
NEBULIZE
BATARI  40,535.00 1 44,588.50
341 APT010000I62004496 161569 nn. ANDI INDRI
AZITROMYC
BATARI 1,777.99 1 1,955.79
342 APT010000I62004496 161569 nn. ANDI INDRI
KETOROLAC
BATARI 7,350.75 2 8,085.82
343 APT010000I62004496 161569 nn. ANDI INDRI
RANITIDIN
BATARI  629.99 2 692.99
344 APT010000I62004496 161569 nn. ANDI INDRI
EPEXOL
BATARI 
TA 869.00 3 955.90
345 APT010000I62004496 161569 nn. ANDI INDRI
FLAMAR
BATARI 
50 1,908.50 2 2,099.35
346 APT010000I62004496 161569 nn. ANDI INDRI
CURCUMA
BATARI 1,098.90 3 1,208.79
347 APT010000I62004499 161575 tn. ALIF PRADITYA
RANITIDIN
  7,040.00 2 7,744.00
348 APT010000I64002973 123863 ny. MULIATICONCOR
DG NGAI 2. 597.00 2 656.70
349 APT010000I64002973 123863 ny. MULIATICETIRIZIN
DG NGAI  266.01 3 292.61
350 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 1 7,864.56
351 APT010000I65003112 161744 tn. BAKRI WAHID 
PARACETA 68,062.50 1 74,868.75
352 APT010000I65003112 161744 tn. BAKRI WAHID 
RANITIDIN 7,040.00 1 7,744.00
 353 APT010000I65003112 161744 tn. BAKRI WAHID 
NEUROSANB5,324.00 1 5,856.40
354 APT010000I65003112 161744 tn. BAKRI WAHID 
DIPENHYDR 7,700.00 1 8,470.00
355 APT010000I65003112 161744 tn. BAKRI WAHID 
DEKSAMETA1,801.80 1 1,981.98
356 APT010000I62004527 161427 ny. BAYA  CAIRAN RL 7,149.60 1 7,864.56
357 APT010000I62004527 161427 ny. BAYA  COMBO PAC 60,500.00 1 66,550.00
358 APT010000I62004527 161427 ny. BAYA  CONECTA 13,200.00 1 14,520.00
359 APT010000I62004517 161692 ny. DJANGKI 
ZINK OKSI 604.00 1 664.40
360 APT010000I62004517 161692 ny. DJANGKI 
VITAMIN B 146.99 6 161.69
361 APT010000I62004527 161427 ny. BAYA  CEFTRIAXO19,999.10 2 21,999.01
362 APT010000I62004528 161750 tn. H LABAKKANG 
KETOROLAC 7,350.75 1 8,085.82
363 APT010000I62004528 161750 tn. H LABAKKANG 
SPOIT 3 CC 1,485.00 2 1,633.50
364 APT010000I62004528 161750 tn. H LABAKKANG 
RANITIDIN 7,040.00 1 7,744.00
365 APT010000I62004515 161675 tn. ANDI MAY
CODIPRONT
WELLO M,7,937.60
SE  10 8,731.36
366 APT010000I62004515 161675 tn. ANDI MAY
SPORETIK
WELLO M,5,720.50
SE  10 6,292.55
Sub Total   918
27-12-
1 APT010000I31000563 161752 ny. RISMAWATI 
COMBIVENT4,549.95 1 5,004.94
2018 
2 APT010000I31000563 161752 ny. RISMAWATI 
NEBULIZE 40,535.00 1 44,588.50
3 APT010000I62004520 138788 nn. NUR TESSA
HANDSCOEN
AMELIA  478.00 4 525.80
4 APT010000I62004520 138788 nn. NUR TESSA
MASKER
AMELIA 
DI 700.00 2 770.00
5 APT010000I62004520 138788 nn. NUR TESSA
INFUSAN
AMELIA 
N 6,712.06 2 7,383.27
6 APT010000I62004520 138788 nn. NUR TESSA
IV DRESSI
AMELIA 4,850.00 1 5,335.00
7 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
5 CC 1,595.00 2 1,754.50
8 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
3 CC 1,485.00 2 1,633.50
9 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
RL 7,149.60 2 7,864.56
10 APT010000I62004521 146576 tn. SAHARUDDIN
HANDSCOEN
HAMID 478.00 4 525.80
11 APT010000I62004521 146576 tn. SAHARUDDIN
MASKER HAMID 
DI 700.00 2 770.00
12 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
NA15,180.00 2 16,698.00
13 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 5HAMID 
CC 1,595.00 2 1,754.50
14 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 3HAMID 
CC 1,485.00 2 1,633.50
15 APT010000I62004521 146576 tn. SAHARUDDIN
IV DRESSI
HAMID 
4,850.00 1 5,335.00
16 APT010000I62004471 148491 ny. NURBAENI 
INFUSAN N 6,712.06 3 7,383.27
17 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
18 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
19 APT010000I62004471 148491 ny. NURBAENI 
IV DRESSI 4,850.00 1 5,335.00
20 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 3 CC 1,485.00 2 1,633.50
21 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 5 CC 1,595.00 2 1,754.50
22 APT010000I62004515 161675 tn. ANDI MAY
CAIRAN
WELLO
RL M,
7,149.60
SE  3 7,864.56
23 APT010000I62004515 161675 tn. ANDI MAY
HANDSCOEN
WELLO M, 478.00
SE  6 525.80
24 APT010000I62004515 161675 tn. ANDI MAY
MASKER
WELLODIM, 700.00
SE  3 770.00
25 APT010000I62004515 161675 tn. ANDI MAY
CAIRAN
WELLO
AQM,2,860.00
SE  1 3,146.00
26 APT010000I62004515 161675 tn. ANDI MAY
SPOIT
WELLO
5 CC M,
1,595.00
SE  2 1,754.50
27 APT010000I62004515 161675 tn. ANDI MAY
SPOIT
WELLO
3 CC M,
1,485.00
SE  2 1,633.50
28 APT010000I62004515 161675 tn. ANDI MAY
CAIRAN
WELLO
NA15,180.00
M, SE  1 16,698.00
29 APT010000I62004515 161675 tn. ANDI MAY
IV DRESSI
WELLO M,4,850.00
SE  2 5,335.00
30 APT010000I62004505 159634 ny. HJ LOBO 
MASKER DI 700.00 2 770.00
31 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 4 525.80
32 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
33 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
34 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
35 APT010000I62004505 159634 ny. HJ LOBO 
IV DRESSI 4,850.00 1 5,335.00
36 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN NA15,180.00 1 16,698.00
37 APT010000I12000082 161621 ny. DG NURUNG 
MASKER DI 700.00 2 770.00
38 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOON 13,613.00 1 14,974.30
39 APT010000I12000082 161621 ny. DG NURUNG 
HANDSCOEN 478.00 4 525.80
40 APT010000I12000082 161621 ny. DG NURUNG 
CAIRAN NA15,180.00 1 16,698.00
41 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 5 CC 1,595.00 1 1,754.50
42 APT010000I12000082 161621 ny. DG NURUNG 
SPOIT 3 CC 1,485.00 1 1,633.50
43 APT010000I12000082 161621 ny. DG NURUNG 
IV CATHETE 7,750.00 1 8,525.00
44 APT010000I12000082 161621 ny. DG NURUNG 
INFUS SET 7,920.00 1 8,712.00
45 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 3 7,864.56
46 APT010000I65003112 161744 tn. BAKRI WAHID 
TRANSFUSI28,050.00 1 30,855.00
47 APT010000I65003112 161744 tn. BAKRI WAHID 
IV CATHETE 7,750.00 1 8,525.00
48 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 3 CC 1,485.00 1 1,633.50
49 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 5 CC 1,595.00 1 1,754.50
50 APT010000I65003112 161744 tn. BAKRI WAHID 
MASKER DI 700.00 2 770.00
51 APT010000I65003112 161744 tn. BAKRI WAHID 
HANDSCOEN 478.00 4 525.80
52 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN RL 7,149.60 2 7,864.56
53 APT010000I62004504 161146 ny. NIRWANA 
IV CATHETE 7,750.00 1 8,525.00
54 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 3 CC 1,485.00 1 1,633.50
55 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 5 CC 1,595.00 1 1,754.50
56 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 10 C 2,310.00 1 2,541.00
57 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 4 525.80
58 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOON 13,613.00 1 14,974.30
59 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 2 770.00
60 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN NA15,180.00 2 16,698.00
61 APT010000I63003172 161606 ny. ASIH  IV CATHETE 7,750.00 1 8,525.00
62 APT010000I63003172 161606 ny. ASIH  CONECTA 13,200.00 1 14,520.00
63 APT010000I63003172 161606 ny. ASIH  SPOIT 3 CC 1,485.00 1 1,633.50
64 APT010000I63003172 161606 ny. ASIH  SPOIT 5 CC 1,595.00 1 1,754.50
65 APT010000I63003172 161606 ny. ASIH  SPOIT 10 C 2,310.00 1 2,541.00
66 APT010000I63003172 161606 ny. ASIH  MASKER DI 700.00 2 770.00
67 APT010000I63003172 161606 ny. ASIH  HANDSCOEN 478.00 4 525.80
68 APT010000I62004493 161561 ny. DINARE INFUSAN N 6,712.06 2 7,383.27
69 APT010000I62004493 161561 ny. DINARE CAIRAN NA15,180.00 1 16,698.00
70 APT010000I62004493 161561 ny. DINARE SPOIT 10 C 2,310.00 1 2,541.00
71 APT010000I62004493 161561 ny. DINARE SPOIT 3 CC 1,485.00 2 1,633.50
72 APT010000I62004493 161561 ny. DINARE SPOIT 5 CC 1,595.00 1 1,754.50
73 APT010000I62004493 161561 ny. DINARE MASKER DI 700.00 2 770.00
74 APT010000I62004493 161561 ny. DINARE HANDSCOEN 478.00 4 525.80
 75 APT010000I62004493 161561 ny. DINARE NASAL CA 11,550.07 1 12,705.07
76 APT010000I62004493 161561 ny. DINARE NEBULIZE 40,535.00 1 44,588.50
77 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA RL 7,149.60 3 7,864.56
78 APT010000I62004526 161746 ny. YOSPINAMASKER
KAMMA  DI 700.00 2 770.00
79 APT010000I62004526 161746 ny. YOSPINAHANDSCOON
KAMMA 13,613.00 1 14,974.30
80 APT010000I62004526 161746 ny. YOSPINAHANDSCOEN
KAMMA  478.00 4 525.80
81 APT010000I62004526 161746 ny. YOSPINASPOIT
KAMMA 
5 CC 1,595.00 1 1,754.50
82 APT010000I62004526 161746 ny. YOSPINASPOIT
KAMMA 
3 CC 1,485.00 1 1,633.50
83 APT010000I62004526 161746 ny. YOSPINAIV KAMMA 
CATHETE 7,750.00 1 8,525.00
84 APT010000I62004526 161746 ny. YOSPINAIV KAMMA 
DRESSI 4,850.00 1 5,335.00
85 APT010000I65003111 39079 ny. ELIK SULISTIYO
INFUSANPURBAWATI
N 6,712.06   3 7,383.27
86 APT010000I65003111 39079 ny. ELIK SULISTIYO
MASKERPURBAWATI
DI 700.00   2 770.00
87 APT010000I65003111 39079 ny. ELIK SULISTIYO
HANDSCOENPURBAWATI
478.00   4 525.80
88 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 3 CC
PURBAWATI
1,485.00   1 1,633.50
89 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 5 CC
PURBAWATI
1,595.00   1 1,754.50
90 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV CATHETE
PURBAWATI
7,750.00   1 8,525.00
91 APT010000I65003111 39079 ny. ELIK SULISTIYO
INFUS SETPURBAWATI
7,920.00   1 8,712.00
92 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV DRESSIPURBAWATI
4,850.00   1 5,335.00
93 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
RL 7,149.60
E  2 7,864.56
94 APT010000I62004513 114199 tn. SOFYANMASKER
FIRMANSYAH
DI 700.00
E  2 770.00
95 APT010000I62004513 114199 tn. SOFYANHANDSCOEN
FIRMANSYAH478.00
E  4 525.80
96 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
10 C 2,310.00
E  1 2,541.00
97 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
3 CC 1,485.00
E  2 1,633.50
98 APT010000I62004513 114199 tn. SOFYANINFUS
FIRMANSYAH
SET 7,920.00
E  1 8,712.00
99 APT010000I62004513 114199 tn. SOFYANIVFIRMANSYAH
CATHETE 7,750.00
E  1 8,525.00
100 APT010000I62004513 114199 tn. SOFYANIVFIRMANSYAH
CATHETE 7,750.00
E  1 8,525.00
101 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
102 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,330.00 2 12,463.00
103 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 2 275.00
104 APT010000I62004471 148491 ny. NURBAENI 
CAIRAN NA15,180.00 1 16,698.00
105 APT010000I62004521 146576 tn. SAHARUDDIN
EPEXOLHAMID 
TA 869.00 3 955.90
106 APT010000I62004521 146576 tn. SAHARUDDIN
SANMOL HAMID 
T 297.00 3 326.70
107 APT010000I64002973 123863 ny. MULIATIINFUSAN
DG NGAI N 6,712.06 2 7,383.27
108 APT010000I64002973 123863 ny. MULIATITRANSFUSI28,050.00
DG NGAI  1 30,855.00
109 APT010000I64002973 123863 ny. MULIATICONECTA
DG NGAI 13,200.00 1 14,520.00
110 APT010000I64002973 123863 ny. MULIATIIVDG
CATHETE
NGAI 12,416.00 1 13,657.60
111 APT010000I64002973 123863 ny. MULIATIIVDG
DRESSI
NGAI  4,850.00 1 5,335.00

112 APT010000I62004523 107296 ny. HJ BAHARIA 

CAIRAN FU41,388.90 3 45,527.79

113 APT010000I62004523 107296 ny. HJ BAHARIA 

MASKER DI 700.00 2 770.00
114 APT010000I62004523 107296 ny. HJ BAHARIA 
HANDSCOEN 478.00 4 525.80
115 APT010000I62004523 107296 ny. HJ BAHARIA 
SPOIT 10 C 2,310.00 2 2,541.00
116 APT010000I62004523 107296 ny. HJ BAHARIA 
SPOIT 5 CC 1,595.00 2 1,754.50
117 APT010000I62004523 107296 ny. HJ BAHARIA 
SPOIT 3 CC 1,485.00 2 1,633.50
118 APT010000I62004523 107296 ny. HJ BAHARIA 
INFUS SET 7,920.00 1 8,712.00
119 APT010000I62004524 161724 tn. MOCH SADDAM
CAIRAN RL HUSAIN
7,149.60
MO'O  3 7,864.56
120 APT010000I62004524 161724 tn. MOCH SADDAM
MASKER DI HUSAIN
700.00
MO'O  2 770.00
121 APT010000I62004524 161724 tn. MOCH SADDAM
INFUS SETHUSAIN
7,920.00
MO'O  1 8,712.00
122 APT010000I62004524 161724 tn. MOCH SADDAM
HANDSCOEN HUSAIN
478.00
MO'O  4 525.80
123 APT010000I62004524 161724 tn. MOCH SADDAM
CONECTAHUSAIN
13,200.00
MO'O  1 14,520.00
124 APT010000I62004524 161724 tn. MOCH SADDAM
IV DRESSIHUSAIN
4,850.00
MO'O  1 5,335.00
125 APT010000I62004524 161724 tn. MOCH SADDAM
IV CATHETEHUSAIN
7,750.00
MO'O  1 8,525.00
126 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN RL 7,149.60 3 7,864.56
127 APT010000I62004525 83291 tn. SADIR,S.AG 
SPOIT 10 C 2,310.00 1 2,541.00
128 APT010000I62004525 83291 tn. SADIR,S.AG 
MASKER DI 700.00 1 770.00
129 APT010000I62004525 83291 tn. SADIR,S.AG 
HANDSCOEN 478.00 2 525.80
130 APT010000I62004525 83291 tn. SADIR,S.AG 
CONECTA 13,200.00 1 14,520.00
131 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN NA15,180.00 1 16,698.00
132 APT010000I62004525 83291 tn. SADIR,S.AG 
TRANSFUSI28,050.00 1 30,855.00
133 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 3 7,864.56
134 APT010000I62004514 160906 tn. KIDJO SUKARYO 
MASKER DI 700.00 1 770.00
135 APT010000I62004514 160906 tn. KIDJO SUKARYO 
HANDSCOEN 478.00 2 525.80
136 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV DRESSI 4,850.00 1 5,335.00
137 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN AQ 2,860.00 1 3,146.00
138 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 5 CC 1,595.00 1 1,754.50
139 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 4 7,864.56
140 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 1 770.00
141 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOEN
BATARI  478.00 2 525.80
142 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
5 CC 1,595.00 1 1,754.50
143 APT010000I62004496 161569 nn. ANDI INDRI
IV DRESSI
BATARI 4,850.00 1 5,335.00
144 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
AQ 2,860.00 1 3,146.00
145 APT010000I62004499 161575 tn. ALIF PRADITYA
INFUSAN  R 9,645.50 4 10,610.05
146 APT010000I62004499 161575 tn. ALIF PRADITYA
IV CATHETE
  7,750.00 1 8,525.00
147 APT010000I62004499 161575 tn. ALIF PRADITYA
CONECTA   13,200.00 1 14,520.00
148 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 1 770.00
149 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 2 525.80
150 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 3 7,864.56
151 APT010000I62004506 161611 tn. ALI NGURAWAN 
MASKER DI 700.00 1 770.00
152 APT010000I62004506 161611 tn. ALI NGURAWAN 
HANDSCOEN 478.00 2 525.80
153 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 10 C 2,310.00 1 2,541.00
154 APT010000I62004506 161611 tn. ALI NGURAWAN 
IV CATHETE 7,750.00 1 8,525.00
155 APT010000I62004519 154288 tn. ANDI MUIS 
CAIRAN RL 7,149.60 3 7,864.56
156 APT010000I62004519 154288 tn. ANDI MUIS 
MASKER DI 700.00 1 770.00
157 APT010000I62004519 154288 tn. ANDI MUIS 
HANDSCOEN 478.00 2 525.80
158 APT010000I62004519 154288 tn. ANDI MUIS 
IV DRESSI 4,850.00 1 5,335.00
159 APT010000I62004519 154288 tn. ANDI MUIS 
IV CATHETE 7,750.00 1 8,525.00
160 APT010000I62004519 154288 tn. ANDI MUIS 
SPOIT 5 CC 1,595.00 1 1,754.50
161 APT010000I62004519 154288 tn. ANDI MUIS 
CAIRAN NA15,180.00 1 16,698.00
162 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 3 7,864.56
163 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 1 770.00
164 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA 478.00 2 525.80
165 APT010000I62004511 161613 an. MUHAMMAD
SPOIT 10
TAQWA 
C 2,310.00 1 2,541.00
166 APT010000I62004511 161613 an. MUHAMMAD
CONECTATAQWA 
13,200.00 1 14,520.00
167 APT010000I62004511 161613 an. MUHAMMAD
IV DRESSI
TAQWA 
4,850.00 1 5,335.00
168 APT010000I65003101 161497 ny. LILY HAFSAH 
CAIRAN NA15,180.00 1 16,698.00
169 APT010000I65003101 161497 ny. LILY HAFSAH 
MASKER DI 700.00 1 770.00
170 APT010000I65003101 161497 ny. LILY HAFSAH 
HANDSCOEN 478.00 2 525.80
171 APT010000I65003101 161497 ny. LILY HAFSAH 
INFUSAN N 6,712.06 3 7,383.27
172 APT010000I65003101 161497 ny. LILY HAFSAH 
SPOIT 5 CC 1,595.00 1 1,754.50
173 APT010000I65003101 161497 ny. LILY HAFSAH 
CONECTA 13,200.00 1 14,520.00
174 APT010000I65003101 161497 ny. LILY HAFSAH 
VOLUVEN 621,780.00 1 23,958.00

175 APT010000I62004517 161692 ny. DJANGKI 

CAIRAN DE18,920.00 6 20,812.00

176 APT010000I62004517 161692 ny. DJANGKI 

MASKER DI 700.00 1 770.00
177 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 2 525.80
178 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 10 C 2,310.00 1 2,541.00
179 APT010000I62004517 161692 ny. DJANGKI 
IV CATHETE 7,750.00 1 8,525.00
180 APT010000I62004517 161692 ny. DJANGKI 
IV DRESSI 4,850.00 1 5,335.00
181 APT010000I62004528 161750 tn. H LABAKKANG 
INFUSAN N 6,712.06 3 7,383.27

182 APT010000I62004528 161750 tn. H LABAKKANG 

CAIRAN AM70,188.80 2 77,207.68

183 APT010000I62004528 161750 tn. H LABAKKANG 

OMEPRAZOL 24,999.70 2 27,499.67
184 APT010000I62004528 161750 tn. H LABAKKANG 
HANDSCOEN 478.00 4 525.80
185 APT010000I62004528 161750 tn. H LABAKKANG 
MASKER DI 700.00 2 770.00
186 APT010000I62004476 161475 ny. ANDI MASTURA 
CETIRIZIN 266.01 1 292.61
187 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 1 2,099.35
188 APT010000I31000563 161752 ny. RISMAWATI 
INFUSAN N 6,712.06 1 7,383.27
189 APT010000I31000563 161752 ny. RISMAWATI 
RANITIDIN 7,040.00 2 7,744.00
190 APT010000I31000563 161752 ny. RISMAWATI 
SOTATIC I 3,032.00 3 3,335.20
191 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 3 CC 1,485.00 2 1,633.50
192 APT010000I31000563 161752 ny. RISMAWATI 
AMLODIPIN 838.19 1 922.01
193 APT010000I62004526 161746 ny. YOSPINA
APIDRA
KAMMA 86,999.88 1 95,699.87
194 APT010000I62004526 161746 ny. YOSPINA
LANTUS
KAMMA SO83,950.02 1 92,345.02
195 APT010000I62004526 161746 ny. YOSPINA
NOVO
KAMMA 
TWIS 2,083.00 2 2,291.30
196 APT010000I62004528 161750 tn. H LABAKKANG 
INFUSAN N 6,712.06 3 7,383.27

197 APT010000I62004528 161750 tn. H LABAKKANG 

CAIRAN AM70,188.80 2 77,207.68

198 APT010000I62004528 161750 tn. H LABAKKANG 

OMEPRAZOL24,999.70 2 27,499.67
199 APT010000I62004528 161750 tn. H LABAKKANG 
HANDSCOEN 478.00 4 525.80
200 APT010000I62004528 161750 tn. H LABAKKANG 
MASKER DI 700.00 2 770.00
201 APT010000I31000563 161752 ny. RISMAWATI 
ISOSORBID 102.85 3 113.14
202 APT010000I31000563 161752 ny. RISMAWATI 
AMLODIPIN 838.19 1 922.01
203 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,330.00 2 12,463.00
204 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
205 APT010000I62004471 148491 ny. NURBAENI 
MICARDIS 5,408.95 1 5,949.85
206 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 2 275.00
207 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
208 APT010000I65003112 161744 tn. BAKRI WAHID 
SANMOL I 24,202.60 3 26,622.86
209 APT010000I65003112 161744 tn. BAKRI WAHID 
RANITIDIN 7,040.00 3 7,744.00
210 APT010000I65003112 161744 tn. BAKRI WAHID 
DIPENHYDR 7,700.00 2 8,470.00
211 APT010000I65003112 161744 tn. BAKRI WAHID 
DEKSAMETA1,801.80 2 1,981.98
212 APT010000I65003111 39079 ny. ELIK SULISTIYO
FUROSEMID
PURBAWATI
190.99   1 210.09
213 APT010000I65003111 39079 ny. ELIK SULISTIYO
DIGOKSINPURBAWATI
107.12   1 117.83
214 APT010000I65003111 39079 ny. ELIK SULISTIYO
SIMARC PURBAWATI
TA 975.98   1 1,073.58
215 APT010000I65003111 39079 ny. ELIK SULISTIYO
GLIMEPIRI
PURBAWATI
1,257.80   1 1,383.57
216 APT010000I65003111 39079 ny. ELIK SULISTIYO
CITICOLIN
PURBAWATI
27,505.00   2 30,255.50
217 APT010000I65003111 39079 ny. ELIK SULISTIYO
MECOBALAM
PURBAWATI
6,600.00   1 7,260.00

218 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   3 54,450.00

219 APT010000I65003111 39079 ny. ELIK SULISTIYO

RANITIDIN
PURBAWATI
7,040.00   2 7,744.00
220 APT010000I62004515 161675 tn. ANDI MAY
CEFTRIAXO19,999.10
WELLO M, SE  2 21,999.01
221 APT010000I62004515 161675 tn. ANDI MAY
RANITIDIN
WELLO M, 7,040.00
SE  2 7,744.00
222 APT010000I62004515 161675 tn. ANDI MAY
DOMPERID
WELLO M, 508.20
SE  2 559.02
223 APT010000I62004515 161675 tn. ANDI MAY
CETIRIZIN
WELLO M, 266.01
SE  1 292.61
224 APT010000I62004515 161675 tn. ANDI MAY
CEFIXIME
WELLO M, 4,950.00
SE  2 5,445.00
225 APT010000I62004504 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
226 APT010000I62004504 161146 ny. NIRWANA 
URDAFALK 5,527.50 2 6,080.25
227 APT010000I62004504 161146 ny. NIRWANA 
SOTATIC I 3,032.00 2 3,335.20
228 APT010000I62004520 138788 nn. NUR TESSA
CEFTRIAXO19,999.10
AMELIA  2 21,999.01
229 APT010000I62004520 138788 nn. NUR TESSA
RANITIDIN
AMELIA 7,040.00 2 7,744.00
230 APT010000I62004520 138788 nn. NUR TESSA
ONDANSETR5,500.00
AMELIA  2 6,050.00
231 APT010000I62004520 138788 nn. NUR TESSA
EPISAN
AMELIA 
SU 51,150.00 1 56,265.00
232 APT010000I62004493 161561 ny. DINARE DIGOKSIN 107.12 1 117.83
233 APT010000I62004493 161561 ny. DINARE ASPILETS 816.20 1 897.82
234 APT010000I62004493 161561 ny. DINARE CEFTRIAXO19,999.10 2 21,999.01
235 APT010000I62004493 161561 ny. DINARE COMBIVENT4,549.95 2 5,004.94
236 APT010000I62004505 159634 ny. HJ LOBO 
PUMPITOR 11,330.00 1 12,463.00
237 APT010000I62004505 159634 ny. HJ LOBO 
ONDANSET 2,151.00 3 2,366.10
238 APT010000I62004528 161750 tn. H LABAKKANG 
CAIRAN AM70,188.80 1 77,207.68

239 APT010000I62004528 161750 tn. H LABAKKANG 

PUMPITOR 62,693.82 2 68,963.20

240 APT010000I62004513 114199 tn. SOFYANCEFTRIAXO19,999.10

FIRMANSYAH E  2 21,999.01
241 APT010000I62004513 114199 tn. SOFYANRANITIDIN
FIRMANSYAH7,040.00
E  2 7,744.00
242 APT010000I62004513 114199 tn. SOFYANDEKSAMETA1,801.80
FIRMANSYAH E  2 1,981.98
243 APT010000I62004513 114199 tn. SOFYANDOMPERID
FIRMANSYAH508.20
E  3 559.02
244 APT010000I62004526 161746 ny. YOSPINA
CEFTRIAXO19,999.10
KAMMA  2 21,999.01
245 APT010000I62004521 146576 tn. SAHARUDDIN
CEFTRIAXO19,999.10
HAMID  2 21,999.01
246 APT010000I62004521 146576 tn. SAHARUDDIN
SANMOLHAMID 
I 24,202.60 1 26,622.86
247 APT010000I62004521 146576 tn. SAHARUDDIN
AMBROXOL
HAMID 199.65 3 219.62
248 APT010000I62004521 146576 tn. SAHARUDDIN
RANITIDIN
HAMID 
7,040.00 2 7,744.00
249 APT010000I62004521 146576 tn. SAHARUDDIN
COMBIVENT4,549.95
HAMID  3 5,004.94
250 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
251 APT010000I62004503 159886 tn. MUH BASIR
NEUROSANB5,324.00
LALANG  1 6,921.20
252 APT010000I62004503 159886 tn. MUH BASIR
RANITIDIN
LALANG 7,040.00 2 10,700.80
253 APT010000I62004499 161575 tn. ALIF PRADITYA
METIL PRE
  702.00 3 772.20
254 APT010000I62004499 161575 tn. ALIF PRADITYA
CEFTRIAXO19,999.10
  2 21,999.01
255 APT010000I62004514 160906 tn. KIDJO SUKARYO 
AMBROXOL 199.65 3 219.62
256 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CEFIXIME 4,950.00 2 5,445.00
257 APT010000I62004496 161569 nn. ANDI INDRI
AZITROMYC
BATARI 1,777.99 1 1,955.79
258 APT010000I62004519 154288 tn. ANDI MUIS 
LEVACID T 2,351.25 3 2,586.38
259 APT010000I62004519 154288 tn. ANDI MUIS 
AMLODIPIN 475.19 3 522.71
260 APT010000I62004519 154288 tn. ANDI MUIS 
TRIHEXIPH 220.00 6 242.00
261 APT010000I62004519 154288 tn. ANDI MUIS 
VALISANBE 236.50 3 260.15
262 APT010000I64002973 123863 ny. MULIATICONCOR
DG NGAI 2. 597.00 1 656.70
263 APT010000I64002973 123863 ny. MULIATIFARSORBID
DG NGAI  569.18 3 626.10
264 APT010000I64002973 123863 ny. MULIATIMETFORMI
DG NGAI  190.00 3 209.00
265 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 1 21,999.01
266 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
267 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
268 APT010000I62004517 161692 ny. DJANGKI 
NOVA B C 150.01 3 165.01
269 APT010000I62004517 161692 ny. DJANGKI 
ZINK OKSI 604.00 1 664.40
270 APT010000I62004517 161692 ny. DJANGKI 
PUMPITOR 62,693.82 1 68,963.20
271 APT010000I62004506 161611 tn. ALI NGURAWAN 
RANITIDIN 7,040.00 1 7,744.00
272 APT010000I62004525 83291 tn. SADIR,S.AG 
NEW DIAT 557.15 6 612.87
273 APT010000I62004525 83291 tn. SADIR,S.AG 
KOTRIMOKS 254.10 4 279.51
274 APT010000I62004476 161475 ny. ANDI MASTURA 
NATRIUM D 195.91 3 215.50
275 APT010000I62004476 161475 ny. ANDI MASTURA 
CETIRIZIN 266.01 3 292.61
276 APT010000I62004511 161613 an. MUHAMMAD
SANMOL TAQWA 
I 24,202.60 3 26,622.86
277 APT010000I63003172 161606 ny. ASIH  FARGETIX 407.00 9 447.70
278 APT010000I63003172 161606 ny. ASIH  RANITIDIN 629.99 6 692.99
279 APT010000I12000082 161621 ny. DG NURUNG 
VOSEDON T 2,431.00 9 2,674.10
280 APT010000I12000082 161621 ny. DG NURUNG 
SANMOL T 297.00 9 326.70
281 APT010000I12000082 161621 ny. DG NURUNG 
NEURODEX 770.00 6 847.00
282 APT010000I12000082 161621 ny. DG NURUNG 
RANITIDIN 629.99 6 692.99
283 APT010000I12000082 161621 ny. DG NURUNG 
EPEXOL TA 869.00 9 955.90
284 APT010000I65003101 161497 ny. LILY HAFSAH 
CURCUMA 1,098.90 9 1,208.79
285 APT010000I65003101 161497 ny. LILY HAFSAH 
FLAMAR 50 1,908.50 9 2,099.35
286 APT010000I65003107 161571 ny. SALFIAHMETFORMI
DG SAYU  190.00 9 209.00
287 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 10,011.38 4 11,012.51
288 APT010000I66000437 161676 ny. HJ ERNAWATY 
MECOBALAM6,600.00 1 7,260.00
289 APT010000I66000437 161676 ny. HJ ERNAWATY 
RANITIDIN 7,040.00 2 7,744.00
290 APT010000I66000437 161676 ny. HJ ERNAWATY 
IV CATHETE 7,750.00 2 8,525.00
291 APT010000I66000437 161676 ny. HJ ERNAWATY 
INFUSAN N 6,712.06 3 7,383.27
292 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 3 CC 1,485.00 3 1,633.50
293 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 20 525.80
294 APT010000I66000437 161676 ny. HJ ERNAWATY 
MASKER DI 700.00 5 770.00
295 APT010000I62004503 159886 tn. MUH BASIR
MELOXICAM
LALANG  250.00 10 462.50
296 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID 190.99 1 210.09
297 APT010000I62004523 107296 ny. HJ BAHARIA 
KOTRIMOKS 254.10 4 279.51
298 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFIXIME 1,317.02 12 1,448.73
299 APT010000I62004506 161611 tn. ALI NGURAWAN 
SANMOL T 297.00 9 326.70
300 APT010000I62004506 161611 tn. ALI NGURAWAN 
NEURODEX 770.00 6 847.00
301 APT010000I62004531 161761 ny. SUNARTI 
LANTUS SO83,950.02 1 92,345.02
302 APT010000I62004531 161761 ny. SUNARTI 
METFORMI 190.00 3 209.00
303 APT010000I62004531 161761 ny. SUNARTI 
SOTATIC I 3,032.00 2 3,335.20
304 APT010000I62004531 161761 ny. SUNARTI 
RANITIDIN 7,040.00 2 7,744.00
305 APT010000I65003112 161744 tn. BAKRI WAHID 
CETIRIZIN 266.01 1 292.61
306 APT010000I66000437 161676 ny. HJ ERNAWATY 
SUCTION C10,313.00 1 11,344.30
307 APT010000I66000437 161676 ny. HJ ERNAWATY 
GUDEL DEW28,125.00 1 30,937.50
308 APT010000I66000437 161676 ny. HJ ERNAWATY 
CAIRAN NAC6,409.70 3 7,050.67
309 APT010000I62004533 99897 an. MUH. AIDIL
COMBOFITRAH
PAC
60,500.00
B  1 66,550.00
310 APT010000I62004533 99897 an. MUH. AIDIL
INFUSAN
FITRAH
R 9,645.50
B  1 10,610.05
311 APT010000I62004533 99897 an. MUH. AIDIL
HANDSCOEN
FITRAH B 478.00 4 525.80
312 APT010000I62004533 99897 an. MUH. AIDIL
CONECTA
FITRAH13,200.00
B  1 14,520.00
313 APT010000I62004533 99897 an. MUH. AIDIL
PARACETA
FITRAH68,062.50
B  1 74,868.75
314 APT010000I62004533 99897 an. MUH. AIDIL
SPOITFITRAH
10 C 2,310.00
B  1 2,541.00
315 APT010000I62004533 99897 an. MUH. AIDIL
MASKER
FITRAH
DI B 700.00 2 770.00
316 APT010000I62004533 99897 an. MUH. AIDIL
INFUSFITRAH
SET 7,920.00
B  1 8,712.00
317 APT010000I62004472 161449 tn. NUR ROHMAT 
PIRACETAM 1,293.60 2 1,422.96
318 APT010000I62004472 161449 tn. NUR ROHMAT 
MEGABAL 1,730.00 1 1,903.00
319 APT010000I62004472 161449 tn. NUR ROHMAT 
DEKSAMETA1,801.80 3 1,981.98
320 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID2,920.50 1 3,212.55
321 APT010000I31000563 161752 ny. RISMAWATI 
FOLEY CAT 33,000.00 1 36,300.00
322 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 5 CC 1,595.00 1 1,754.50
323 APT010000I31000563 161752 ny. RISMAWATI 
GUDEL DEW28,125.00 1 30,937.50
324 APT010000I31000563 161752 ny. RISMAWATI 
HANDSCOEN 478.00 6 525.80
325 APT010000I31000563 161752 ny. RISMAWATI 
MASKER DI 700.00 3 770.00
326 APT010000I31000563 161752 ny. RISMAWATI 
ELEKTRODA 4,000.00 5 4,400.00
327 APT010000I31000563 161752 ny. RISMAWATI 
CEDOCARD31,000.00 2 34,100.00
328 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID2,920.50 10 3,212.55
329 APT010000I31000563 161752 ny. RISMAWATI 
CONECTA 13,200.00 1 14,520.00
330 APT010000I31000563 161752 ny. RISMAWATI 
PERFUSSOR21,000.00 1 23,100.00
331 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 10 C 2,310.00 2 2,541.00
332 APT010000I31000563 161752 ny. RISMAWATI 
SUNGKUP 44,750.00 1 49,225.00
333 APT010000I62004533 99897 an. MUH. AIDIL
EPEXOL
FITRAH
SY 17,930.00
B  1 19,723.00
334 APT010000I62004526 161746 ny. YOSPINA
CEFTRIAXO19,999.10
KAMMA  2 21,999.01
335 APT010000I62004526 161746 ny. YOSPINA
KETOROLAC
KAMMA  7,350.75 3 8,085.82
336 APT010000I62004526 161746 ny. YOSPINA
OMEPRAZOL
KAMMA 24,999.70 2 27,499.67
337 APT010000I62004526 161746 ny. YOSPINA
DEKSAMETA1,801.80
KAMMA  1 1,981.98
338 APT010000I62004526 161746 ny. YOSPINA
SPOIT
KAMMA 
10 C 2,310.00 2 2,541.00
 339 APT010000I62004526 161746 ny. YOSPINA
SPOIT
KAMMA 
3 CC 1,485.00 2 1,633.50
340 APT010000I62004526 161746 ny. YOSPINA
CAIRAN
KAMMA RL 7,149.60 2 7,864.56
341 APT010000I62004526 161746 ny. YOSPINA
CAIRAN
KAMMA DE18,920.00 1 20,812.00
342 APT010000I62004526 161746 ny. YOSPINA
HANDSCOEN
KAMMA  478.00 20 525.80
343 APT010000I62004526 161746 ny. YOSPINA
PERFUSSOR
KAMMA 21,000.00 1 23,100.00
344 APT010000I62004526 161746 ny. YOSPINA
SPOIT
KAMMA 
50 12,367.00 1 13,603.70

345 APT010000I62004526 161746 ny. YOSPINA

FENTANYL
KAMMA 041,599.80 6 45,759.78

346 APT010000I64002984 161794 tn. RICHARD

KETOROLAC
LEONARD 7,350.75 1 8,085.82
347 APT010000I64002984 161794 tn. RICHARD
ONDANSETR5,500.00
LEONARD  1 6,050.00
348 APT010000I64002984 161794 tn. RICHARD
RANITIDIN
LEONARD 7,040.00 1 7,744.00
349 APT010000I64002984 161794 tn. RICHARD
AMLODIPIN
LEONARD  838.19 1 922.01
350 APT010000I64002984 161794 tn. RICHARD
NASAL
LEONARD 
CA 11,550.07 1 12,705.07
351 APT010000I64002984 161794 tn. RICHARD
COMBO
LEONARD 
PAC60,500.00 1 66,550.00
352 APT010000I64002984 161794 tn. RICHARD
CAIRAN
LEONARD 
RL 7,149.60 1 7,864.56
353 APT010000I64002984 161794 tn. RICHARD
SPOIT
LEONARD 
3 CC 1,485.00 2 1,633.50
354 APT010000I65003120 158007 ny. JUMIATI 
CONECTA 13,200.00 1 14,520.00
355 APT010000I65003120 158007 ny. JUMIATI 
INFUS SET 7,920.00 1 8,712.00
356 APT010000I62004536 161792 nn. ANDI SALMA
COMBO AQIB 
KAT60,500.00 1 66,550.00
357 APT010000I62004536 161792 nn. ANDI SALMA
FEEDING
AQIB 
T 42,800.00 1 47,080.00
358 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
10 C 2,310.00 1 2,541.00
359 APT010000I62004536 161792 nn. ANDI SALMA
CAIRANAQIB 
RL 7,149.60 1 7,864.56
360 APT010000I62004526 161746 ny. YOSPINA
CAIRAN
KAMMA 
RL 7,149.60 1 7,864.56
361 APT010000I62004526 161746 ny. YOSPINA
INFUSAN
KAMMA  N 6,712.06 1 7,383.27
362 APT010000I62004526 161746 ny. YOSPINA
NASAL
KAMMA 
CA 11,550.07 1 12,705.07
363 APT010000I62004534 161785 nn. NURHADI
CAIRAN
HATIKA 
RL 7,149.60 4 7,864.56
364 APT010000I62004534 161785 nn. NURHADI
RANITIDIN
HATIKA  7,040.00 2 7,744.00
365 APT010000I62004534 161785 nn. NURHADI
SOTATIC
HATIKA 
I 3,032.00 3 3,335.20
366 APT010000I62004534 161785 nn. NURHADI
ALPRAZOLA
HATIKA  1,915.83 1 2,107.42
Sub Total   820
28-12-
1 APT010000I62004496 161569 nn. ANDI INDRI
CAIRAN
BATARI 
RL 7,149.60 4 7,864.56
2018 
2 APT010000I62004496 161569 nn. ANDI INDRI
MASKER
BATARI 
DI 700.00 2 770.00
3 APT010000I62004496 161569 nn. ANDI INDRI
HANDSCOEN
BATARI  478.00 4 525.80
4 APT010000I62004496 161569 nn. ANDI INDRI
SPOITBATARI 
10 C 2,310.00 1 2,541.00
5 APT010000I62004525 83291 tn. SADIR,S.AG 
CAIRAN RL 7,149.60 3 7,864.56
6 APT010000I62004525 83291 tn. SADIR,S.AG 
MASKER DI 700.00 2 770.00
7 APT010000I62004525 83291 tn. SADIR,S.AG 
HANDSCOEN 478.00 4 525.80
8 APT010000I62004525 83291 tn. SADIR,S.AG 
SPOIT 10 C 2,310.00 1 2,541.00
9 APT010000I62004527 161427 ny. BAYA  CAIRAN RL 7,149.60 3 7,864.56
10 APT010000I62004527 161427 ny. BAYA  MASKER DI 700.00 2 770.00
11 APT010000I62004527 161427 ny. BAYA  HANDSCOEN 478.00 4 525.80
12 APT010000I62004527 161427 ny. BAYA  SPOIT 10 C 2,310.00 1 2,541.00
13 APT010000I64002973 123863 ny. MULIATIMASKER
DG NGAI 
DI 700.00 2 770.00
14 APT010000I64002973 123863 ny. MULIATICAIRAN
DG NGAI 
NAC6,409.70 2 7,050.67
15 APT010000I64002973 123863 ny. MULIATICONECTA
DG NGAI 13,200.00 1 14,520.00
16 APT010000I64002973 123863 ny. MULIATIHANDSCOEN
DG NGAI  478.00 4 525.80
17 APT010000I64002973 123863 ny. MULIATIINFUS
DG NGAI 
SET 7,920.00 1 8,712.00
18 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 2 7,864.56
19 APT010000I62004514 160906 tn. KIDJO SUKARYO 
MASKER DI 700.00 2 770.00
20 APT010000I62004514 160906 tn. KIDJO SUKARYO 
HANDSCOEN 478.00 4 525.80
21 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 5 CC 1,595.00 1 1,754.50
22 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 3 CC 1,485.00 1 1,633.50
23 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 10 C 2,310.00 1 2,541.00
24 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SUNGKUP 19,520.00 1 21,472.00
25 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV CATHETE 7,750.00 1 8,525.00
26 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CONECTA 13,200.00 1 14,520.00
27 APT010000I62004506 161611 tn. ALI NGURAWAN 
MASKER DI 700.00 2 770.00
28 APT010000I62004506 161611 tn. ALI NGURAWAN 
CONECTA 13,200.00 1 14,520.00
29 APT010000I62004506 161611 tn. ALI NGURAWAN 
SPOIT 3 CC 1,485.00 2 1,633.50
30 APT010000I62004506 161611 tn. ALI NGURAWAN 
HANDSCOEN 478.00 4 525.80
31 APT010000I62004506 161611 tn. ALI NGURAWAN 
IV CATHETE 7,750.00 1 8,525.00
32 APT010000I62004506 161611 tn. ALI NGURAWAN 
CAIRAN RL 7,149.60 3 7,864.56
33 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 3 7,864.56
34 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA  478.00 4 525.80
35 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 2 770.00
36 APT010000I62004511 161613 an. MUHAMMAD
SPOIT 3TAQWA 
CC 1,485.00 2 1,633.50
37 APT010000I62004511 161613 an. MUHAMMAD
INFUS SET
TAQWA 7,920.00 1 8,712.00
38 APT010000I62004511 161613 an. MUHAMMAD
IV CATHETE
TAQWA 7,750.00 1 8,525.00
39 APT010000I62004511 161613 an. MUHAMMAD
CONECTATAQWA 
13,200.00 1 14,520.00
40 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN
  478.00 4 525.80
41 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 2 770.00
42 APT010000I62004499 161575 tn. ALIF PRADITYA
INFUSAN  R 9,645.50 2 10,610.05
43 APT010000I62004499 161575 tn. ALIF PRADITYA
CONECTA   13,200.00 1 14,520.00
44 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 3 CC 1,485.00 2 1,633.50
45 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN NAC6,409.70 3 7,050.67
46 APT010000I62004517 161692 ny. DJANGKI 
MASKER DI 700.00 2 770.00
47 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 4 525.80
48 APT010000I62004517 161692 ny. DJANGKI 
CONECTA 13,200.00 1 14,520.00
49 APT010000I62004524 161724 tn. MOCH SADDAM
MASKER DI HUSAIN
700.00
MO'O  2 770.00
50 APT010000I62004524 161724 tn. MOCH SADDAM
HANDSCOEN HUSAIN
478.00
MO'O  4 525.80
51 APT010000I62004524 161724 tn. MOCH SADDAM
CAIRAN RL HUSAIN
7,149.60
MO'O  3 7,864.56
52 APT010000I62004524 161724 tn. MOCH SADDAM
SPOIT 5 CCHUSAIN
1,595.00
MO'O  1 1,754.50
53 APT010000I62004524 161724 tn. MOCH SADDAM
SPOIT 3 CCHUSAIN
1,485.00
MO'O  2 1,633.50
54 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 2 770.00
55 APT010000I62004476 161475 ny. ANDI MASTURA 
INFUSAN R 9,645.50 3 10,610.05
56 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 6 525.80
57 APT010000I62004476 161475 ny. ANDI MASTURA 
IV CATHETE 7,750.00 1 8,525.00
58 APT010000I62004476 161475 ny. ANDI MASTURA 
CONECTA 13,200.00 1 14,520.00
59 APT010000I62004476 161475 ny. ANDI MASTURA 
INFUS SET 7,920.00 1 8,712.00
 60 APT010000I62004531 161761 ny. SUNARTI 
NOVO TWIS 2,083.00 1 2,291.30
61 APT010000I62004531 161761 ny. SUNARTI 
CAIRAN NAC6,409.70 3 7,050.67
62 APT010000I62004531 161761 ny. SUNARTI 
HANDSCOEN 478.00 4 525.80
63 APT010000I62004531 161761 ny. SUNARTI 
MASKER DI 700.00 2 770.00
64 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 3 CC 1,485.00 2 1,633.50
65 APT010000I62004531 161761 ny. SUNARTI 
INFUS SET 7,920.00 1 8,712.00
66 APT010000I62004531 161761 ny. SUNARTI 
IV CATHETE 7,750.00 1 8,525.00
67 APT010000I62004531 161761 ny. SUNARTI 
CONECTA 13,200.00 1 14,520.00
68 APT010000I65003120 158007 ny. JUMIATI 
RANITIDIN 7,040.00 2 7,744.00
69 APT010000I65003120 158007 ny. JUMIATI 
SANMOL T 297.00 3 326.70
70 APT010000I65003120 158007 ny. JUMIATI 
VOSEDON T 2,431.00 3 2,674.10
71 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 1 770.00
72 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
73 APT010000I62004471 148491 ny. NURBAENI 
CAIRAN NA15,180.00 1 16,698.00
74 APT010000I62004471 148491 ny. NURBAENI 
IV CATHETE 7,750.00 1 8,525.00
75 APT010000I62004471 148491 ny. NURBAENI 
IV DRESSI 4,850.00 1 5,335.00
76 APT010000I62004471 148491 ny. NURBAENI 
TRANSFUSI28,050.00 1 30,855.00
77 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 1 2,541.00
78 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 5 CC 1,595.00 1 1,754.50
79 APT010000I62004520 138788 nn. NUR TESSA
MASKER
AMELIA 
DI 700.00 1 770.00
80 APT010000I62004520 138788 nn. NUR TESSA
HANDSCOEN
AMELIA  478.00 4 525.80
81 APT010000I62004520 138788 nn. NUR TESSA
CAIRAN
AMELIA 
RL 7,149.60 3 7,864.56
82 APT010000I62004520 138788 nn. NUR TESSA
IV CATHETE
AMELIA 7,750.00 1 8,525.00
83 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
10 C 2,310.00 1 2,541.00
84 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
5 CC 1,595.00 1 1,754.50
85 APT010000I62004520 138788 nn. NUR TESSA
SPOITAMELIA 
3 CC 1,485.00 1 1,633.50
86 APT010000I62004520 138788 nn. NUR TESSA
IV DRESSI
AMELIA 4,850.00 1 5,335.00
87 APT010000I65003111 39079 ny. ELIK SULISTIYO
MASKERPURBAWATI
DI 700.00   1 770.00
88 APT010000I65003111 39079 ny. ELIK SULISTIYO
HANDSCOEN
PURBAWATI
478.00   4 525.80
89 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV CATHETE
PURBAWATI
7,750.00   1 8,525.00
90 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 5 CC
PURBAWATI
1,595.00   1 1,754.50
91 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 3 CC
PURBAWATI
1,485.00   1 1,633.50
92 APT010000I65003111 39079 ny. ELIK SULISTIYO
CAIRAN PURBAWATI
NA15,180.00   1 16,698.00
93 APT010000I65003111 39079 ny. ELIK SULISTIYO
CAIRAN PURBAWATI
RL 7,149.60   2 7,864.56
94 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV DRESSI
PURBAWATI
4,850.00   1 5,335.00
95 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
NAC6,409.70 2 7,050.67
96 APT010000I62004521 146576 tn. SAHARUDDIN
MASKER HAMID 
DI 700.00 1 770.00
97 APT010000I62004521 146576 tn. SAHARUDDIN
HANDSCOEN
HAMID 478.00 4 525.80
98 APT010000I62004521 146576 tn. SAHARUDDIN
INFUS SET
HAMID 
7,920.00 1 8,712.00
99 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 10
HAMID 
C 2,310.00 1 2,541.00
100 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 3HAMID 
CC 1,485.00 1 1,633.50
101 APT010000I62004521 146576 tn. SAHARUDDIN
IV CATHETE
HAMID 
7,750.00 1 8,525.00
102 APT010000I62004521 146576 tn. SAHARUDDIN
CONECTAHAMID 
13,200.00 1 14,520.00
103 APT010000I62004521 146576 tn. SAHARUDDIN
IV DRESSI
HAMID 
4,850.00 1 5,335.00
104 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 3 7,864.56
105 APT010000I65003112 161744 tn. BAKRI WAHID 
NASAL CA 11,550.07 1 12,705.07
106 APT010000I65003112 161744 tn. BAKRI WAHID 
HANDSCOEN 478.00 4 525.80
107 APT010000I65003112 161744 tn. BAKRI WAHID 
MASKER DI 700.00 1 770.00
108 APT010000I65003112 161744 tn. BAKRI WAHID 
IV DRESSI 4,850.00 1 5,335.00
109 APT010000I65003112 161744 tn. BAKRI WAHID 
IV CATHETE12,416.00 1 13,657.60
110 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 3 CC 1,485.00 3 1,633.50
111 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 5 CC 1,595.00 1 1,754.50
112 APT010000I65003112 161744 tn. BAKRI WAHID 
CONECTA 13,200.00 1 14,520.00
113 APT010000I62004472 161449 tn. NUR ROHMAT 
CAIRAN NAC6,409.70 1 7,050.67
114 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOEN 478.00 4 525.80
115 APT010000I62004472 161449 tn. NUR ROHMAT 
HANDSCOON 12,100.00 1 13,310.00
116 APT010000I62004472 161449 tn. NUR ROHMAT 
MASKER DI 700.00 1 770.00
117 APT010000I66000437 161676 ny. HJ ERNAWATY 
CAIRAN NAC6,409.70 2 7,050.67
118 APT010000I66000437 161676 ny. HJ ERNAWATY 
IV CATHETE 7,750.00 1 8,525.00
119 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 3 CC 1,485.00 1 1,633.50
120 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 5 CC 1,595.00 1 1,754.50
121 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 4 525.80
122 APT010000I66000437 161676 ny. HJ ERNAWATY 
MASKER DI 700.00 1 770.00
123 APT010000I62004533 99897 an. MUH. AIDIL
CAIRANFITRAH
DE18,920.00
B  2 20,812.00
124 APT010000I62004533 99897 an. MUH. AIDIL
IV CATHETE
FITRAH16,720.00
B  1 18,392.00
125 APT010000I62004533 99897 an. MUH. AIDIL
SPOITFITRAH
3 CC 1,485.00
B  1 1,633.50
126 APT010000I62004533 99897 an. MUH. AIDIL
SPOITFITRAH
5 CC 1,595.00
B  1 1,754.50
127 APT010000I62004533 99897 an. MUH. AIDIL
MASKERFITRAH
DI B 700.00 1 770.00
128 APT010000I62004533 99897 an. MUH. AIDIL
HANDSCOEN
FITRAH B 478.00 2 525.80
129 APT010000I62004533 99897 an. MUH. AIDIL
INFUSFITRAH
SET 7,920.00
B  1 8,712.00
130 APT010000I62004505 159634 ny. HJ LOBO 
CAIRAN NAC6,409.70 2 7,050.67
131 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 5 CC 1,595.00 1 1,754.50
132 APT010000I62004505 159634 ny. HJ LOBO 
SPOIT 3 CC 1,485.00 1 1,633.50
133 APT010000I62004505 159634 ny. HJ LOBO 
IV CATHETE 7,750.00 1 8,525.00
134 APT010000I62004505 159634 ny. HJ LOBO 
HANDSCOEN 478.00 4 525.80
135 APT010000I62004505 159634 ny. HJ LOBO 
MASKER DI 700.00 1 770.00
136 APT010000I62004505 159634 ny. HJ LOBO 
ALKOHOL S 300.00 2 330.00
137 APT010000I62004493 161561 ny. DINARE CAIRAN NAC6,409.70 2 7,050.67
138 APT010000I62004493 161561 ny. DINARE SPOIT 5 CC 1,595.00 2 1,754.50
139 APT010000I62004493 161561 ny. DINARE IV CATHETE 7,750.00 1 8,525.00
140 APT010000I62004493 161561 ny. DINARE MASKER DI 700.00 1 770.00
141 APT010000I62004493 161561 ny. DINARE HANDSCOEN 478.00 4 525.80
142 APT010000I62004493 161561 ny. DINARE INFUS SET 7,920.00 1 8,712.00
143 APT010000I62004493 161561 ny. DINARE CONECTA 13,200.00 1 14,520.00
144 APT010000I62004493 161561 ny. DINARE CAIRAN NA15,180.00 1 16,698.00
145 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN RL 7,149.60 2 7,864.56
146 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 5 CC 1,595.00 2 1,754.50
147 APT010000I62004504 161146 ny. NIRWANA 
IV CATHETE 7,750.00 1 8,525.00
148 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 1 770.00
149 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOON 13,613.00 2 14,974.30
150 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN NA15,180.00 2 16,698.00
151 APT010000I62004513 114199 tn. SOFYANCAIRAN
FIRMANSYAH
RL 7,149.60
E  2 7,864.56
152 APT010000I62004513 114199 tn. SOFYANMASKER
FIRMANSYAH
DI 700.00
E  1 770.00
153 APT010000I62004513 114199 tn. SOFYANHANDSCOEN
FIRMANSYAH478.00
E  4 525.80
154 APT010000I62004513 114199 tn. SOFYANIVFIRMANSYAH
CATHETE 7,750.00
E  1 8,525.00
155 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
10 C 2,310.00
E  1 2,541.00
156 APT010000I62004513 114199 tn. SOFYANSPOIT
FIRMANSYAH
5 CC 1,595.00
E  2 1,754.50
157 APT010000I62004513 114199 tn. SOFYANALKOHOL
FIRMANSYAH
S 300.00
E  1 330.00
158 APT010000I62004506 161611 tn. ALI NGURAWAN 
CEFIXIME 4,950.00 2 5,445.00
159 APT010000I62004506 161611 tn. ALI NGURAWAN 
SANMOL T 297.00 3 326.70
160 APT010000I62004506 161611 tn. ALI NGURAWAN 
NEURODEX 770.00 2 847.00
161 APT010000I62004503 159886 tn. MUH BASIR
CAIRAN
LALANG 
SAL27,830.00 1 37,570.50
162 APT010000I62004503 159886 tn. MUH BASIR
LANSOPRAZ
LALANG  851.29 2 1,600.43
163 APT010000I62004503 159886 tn. MUH BASIR
RANITIDIN
LALANG 7,040.00 2 10,700.80
164 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
165 APT010000I65003112 161744 tn. BAKRI WAHID 
DIPENHYDR 7,700.00 1 8,470.00
166 APT010000I65003112 161744 tn. BAKRI WAHID 
CETIRIZIN 266.01 1 292.61
167 APT010000I65003112 161744 tn. BAKRI WAHID 
RANITIDIN 7,040.00 2 7,744.00
168 APT010000I65003112 161744 tn. BAKRI WAHID 
SANMOL I 24,202.60 2 26,622.86
169 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 7,332.97 2 8,066.26
170 APT010000I66000437 161676 ny. HJ ERNAWATY 
MEGABAL 1,730.00 1 1,903.00
171 APT010000I62004504 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
172 APT010000I62004504 161146 ny. NIRWANA 
SOTATIC I 3,032.00 3 3,335.20
173 APT010000I62004504 161146 ny. NIRWANA 
URDAFALK 5,527.50 2 6,080.25
174 APT010000I62004504 161146 ny. NIRWANA 
SANTAGESIK4,949.40 3 5,444.34
175 APT010000I62004533 99897 an. MUH. AIDIL
SANMOL
FITRAH
I 24,202.60
B  1 26,622.86

176 APT010000I65003111 39079 ny. ELIK SULISTIYO

CITICOLIN
PURBAWATI
27,505.00   4 30,255.50

177 APT010000I65003111 39079 ny. ELIK SULISTIYO

MECOBALAM
PURBAWATI
6,600.00   1 7,260.00

178 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   3 54,450.00

179 APT010000I65003111 39079 ny. ELIK SULISTIYO

RANITIDIN
PURBAWATI
7,040.00   2 7,744.00
180 APT010000I65003111 39079 ny. ELIK SULISTIYO
FUROSEMID
PURBAWATI
190.99   1 210.09
181 APT010000I65003111 39079 ny. ELIK SULISTIYO
DIGOKSINPURBAWATI
107.12   1 117.83
182 APT010000I65003111 39079 ny. ELIK SULISTIYO
SIMARC PURBAWATI
TA 975.98   1 1,073.58
183 APT010000I65003111 39079 ny. ELIK SULISTIYO
LANTUS PURBAWATI
SO83,950.02   1 92,345.02
184 APT010000I65003111 39079 ny. ELIK SULISTIYO
APIDRA PURBAWATI
86,999.88   1 95,699.87
185 APT010000I65003111 39079 ny. ELIK SULISTIYO
NOVO TWIS
PURBAWATI
2,083.00   2 2,291.30
186 APT010000I62004521 146576 tn. SAHARUDDIN
CEFTRIAXO19,999.10
HAMID  2 21,999.01
187 APT010000I62004521 146576 tn. SAHARUDDIN
SANMOLHAMID 
I 24,202.60 3 26,622.86
188 APT010000I62004521 146576 tn. SAHARUDDIN
EPEXOLHAMID 
TA 869.00 3 955.90
189 APT010000I62004521 146576 tn. SAHARUDDIN
COMBIVENT4,549.95
HAMID  3 5,004.94
190 APT010000I62004521 146576 tn. SAHARUDDIN
RANITIDIN
HAMID 7,040.00 2 7,744.00
191 APT010000I62004520 138788 nn. NUR TESSA
CEFTRIAXO19,999.10
AMELIA  2 21,999.01
192 APT010000I62004520 138788 nn. NUR TESSA
RANITIDIN
AMELIA 7,040.00 2 7,744.00
193 APT010000I62004517 161692 ny. DJANGKI 
VITAMIN B 146.99 6 161.69
194 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
195 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 2 21,999.01
196 APT010000I62004517 161692 ny. DJANGKI 
OMEPRAZOL24,999.70 1 27,499.67
197 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
198 APT010000I62004514 160906 tn. KIDJO SUKARYO 
EPEXOL TA 869.00 3 955.90
199 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CEFIXIME 4,950.00 2 5,445.00

200 APT010000I62004505 159634 ny. HJ LOBO 

CODIPRON10,502.80 9 11,553.08

201 APT010000I62004505 159634 ny. HJ LOBO 

MST CONTI15,620.00 9 17,182.00

202 APT010000I62004531 161761 ny. SUNARTI 

METFORMI 190.00 3 209.00
203 APT010000I62004531 161761 ny. SUNARTI 
METOCLOPR5,500.00 1 6,050.00
204 APT010000I62004531 161761 ny. SUNARTI 
RANITIDIN 7,040.00 2 7,744.00
205 APT010000I62004531 161761 ny. SUNARTI 
NEURODEX 770.00 2 847.00
206 APT010000I62004524 161724 tn. MOCH SADDAM
CEFTRIAXO19,999.10
HUSAIN MO'O  2 21,999.01
207 APT010000I62004524 161724 tn. MOCH SADDAM
RANITIDINHUSAIN
7,040.00
MO'O  2 7,744.00
208 APT010000I62004524 161724 tn. MOCH SADDAM
METOCLOPR5,500.00
HUSAIN MO'O  3 6,050.00
209 APT010000I62004524 161724 tn. MOCH SADDAM
SANMOL HUSAIN
T 297.00MO'O  3 326.70
210 APT010000I62004524 161724 tn. MOCH SADDAM
NEW DIATHUSAIN557.15
MO'O  2 612.87
211 APT010000I62004525 83291 tn. SADIR,S.AG 
RANITIDIN 7,040.00 2 7,744.00
212 APT010000I62004525 83291 tn. SADIR,S.AG 
SOTATIC I 3,032.00 3 3,335.20
213 APT010000I62004525 83291 tn. SADIR,S.AG 
NEW DIAT 557.15 3 612.87
214 APT010000I62004525 83291 tn. SADIR,S.AG 
KOTRIMOKS 254.10 4 279.51
215 APT010000I64002984 161794 tn. RICHARDBETAHISTI
LEONARD  733.33 2 806.67
216 APT010000I64002984 161794 tn. RICHARDVERTIGOSA
LEONARD 4,528.33 1 4,981.17
217 APT010000I64002984 161794 tn. RICHARDMICARDIS
LEONARD 5,408.95 1 5,949.85
218 APT010000I64002984 161794 tn. RICHARDAMLODIPIN
LEONARD  838.19 1 922.01
219 APT010000I62004535 161791 tn. ANDI DZULFAHMI
RANITIDIN IMRAN
7,040.00
H  2 7,744.00
220 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SANMOL I IMRAN
24,202.60
H  2 26,622.86
221 APT010000I62004527 161427 ny. BAYA  CEFTRIAXO19,999.10 2 21,999.01
222 APT010000I62004527 161427 ny. BAYA  KETOROLAC 7,350.75 3 8,085.82
223 APT010000I62004527 161427 ny. BAYA  RANITIDIN 7,040.00 2 7,744.00
224 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 2 2,099.35
225 APT010000I64002973 123863 ny. MULIATIASPILETS
DG NGAI  816.20 1 897.82
226 APT010000I64002973 123863 ny. MULIATIFARSORBID
DG NGAI  569.18 3 626.10
227 APT010000I64002973 123863 ny. MULIATICONCOR
DG NGAI 
2. 597.00 1 656.70
228 APT010000I65003120 158007 ny. JUMIATI 
NEURODEX 770.00 2 847.00
229 APT010000I62004496 161569 nn. ANDI INDRI
CEFIXIME
BATARI 4,950.00 6 5,445.00
230 APT010000I62004496 161569 nn. ANDI INDRI
AZITROMYC
BATARI 1,777.99 3 1,955.79
231 APT010000I62004499 161575 tn. ALIF PRADITYA
CEFIXIME
  4,950.00 2 5,445.00
232 APT010000I62004499 161575 tn. ALIF PRADITYA
METIL PRE
  475.79 3 523.37
233 APT010000I62004499 161575 tn. ALIF PRADITYA
PUMPITOR
  11,330.00 1 12,463.00
234 APT010000I62004499 161575 tn. ALIF PRADITYA
SANMOL  T 297.00 3 326.70
235 APT010000I62004505 159634 ny. HJ LOBO 
PUMPITOR 11,330.00 3 12,463.00
236 APT010000I62004505 159634 ny. HJ LOBO 
ONDANSET 1,355.20 9 1,490.72
237 APT010000I62004513 114199 tn. SOFYANCEFIXIME
FIRMANSYAH 4,950.00
E  6 5,445.00
238 APT010000I62004513 114199 tn. SOFYANRANITIDIN
FIRMANSYAH629.99
E  6 692.99
239 APT010000I62004513 114199 tn. SOFYANSANMOL
FIRMANSYAH
T 297.00
E  9 326.70
240 APT010000I62004513 114199 tn. SOFYANVOSEDON
FIRMANSYAH
T 2,431.00
E  6 2,674.10
241 APT010000I62004513 114199 tn. SOFYANEPEXOL
FIRMANSYAH
TA 869.00
E  9 955.90
242 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID2,920.50 10 3,212.55
243 APT010000I31000563 161752 ny. RISMAWATI 
CEDOCARD31,000.00 1 34,100.00
244 APT010000I31000563 161752 ny. RISMAWATI 
RANITIDIN 7,040.00 2 7,744.00
245 APT010000I31000563 161752 ny. RISMAWATI 
AMLODIPIN 838.19 1 922.01
246 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA 
RL 7,149.60 2 7,864.56
247 APT010000I62004526 161746 ny. YOSPINACEFTRIAXO19,999.10
KAMMA  2 21,999.01
248 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA 
KA11,314.00 2 12,445.40
249 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA 
VA73,700.00 1 81,070.00
250 APT010000I62004526 161746 ny. YOSPINASANTAGESIK4,949.40
KAMMA  2 5,444.34
251 APT010000I62004526 161746 ny. YOSPINAHANDSCOEN
KAMMA  478.00 20 525.80
252 APT010000I62004526 161746 ny. YOSPINAMASKER
KAMMA DI 700.00 5 770.00
253 APT010000I62004526 161746 ny. YOSPINAINFUS
KAMMA 
SET 7,920.00 2 8,712.00
254 APT010000I62004524 161724 tn. MOCH SADDAM
CEFIXIMEHUSAIN
4,950.00
MO'O  6 5,445.00
255 APT010000I62004524 161724 tn. MOCH SADDAM
SANMOL HUSAIN
T 297.00 MO'O  9 326.70
256 APT010000I62004524 161724 tn. MOCH SADDAM
NEW DIATHUSAIN557.15
MO'O  9 612.87
257 APT010000I62004526 161746 ny. YOSPINAOMEPRAZOL
KAMMA 24,999.70 1 27,499.67
258 APT010000I62004526 161746 ny. YOSPINAIV KAMMA 
CATHETE12,416.00 1 13,657.60
259 APT010000I62004526 161746 ny. YOSPINACONECTA
KAMMA 13,200.00 1 14,520.00
260 APT010000I62004536 161792 nn. ANDI SALMA
PROPILTIO
AQIB  499.00 8 548.90
261 APT010000I62004536 161792 nn. ANDI SALMA
NEURODEX
AQIB  770.00 3 847.00
262 APT010000I62004536 161792 nn. ANDI SALMA
NEUROSAN
AQIB  1,168.50 1 1,285.35
263 APT010000I62004536 161792 nn. ANDI SALMA
PROPANOLO
AQIB  75.90 6 83.49
264 APT010000I62004525 83291 tn. SADIR,S.AG 
KOTRIMOKS 254.10 8 279.51
265 APT010000I62004525 83291 tn. SADIR,S.AG 
NEW DIAT 557.15 6 612.87
266 APT010000I62004531 161761 ny. SUNARTI 
BUSCOPAN 4,327.40 2 4,760.14
267 APT010000I62004531 161761 ny. SUNARTI 
GLUCODEX 478.50 1 526.35
268 APT010000I62004531 161761 ny. SUNARTI 
ALPRAZOLA 1,915.83 1 2,107.42
269 APT010000I64002973 123863 ny. MULIATICETIRIZIN
DG NGAI  266.01 1 292.61

270 APT010000I62004526 161746 ny. YOSPINA

FENTANYL
KAMMA 041,599.80 5 45,759.78

271 APT010000I62004472 161449 tn. NUR ROHMAT 

PIRACETAM 1,293.60 2 1,422.96
272 APT010000I62004472 161449 tn. NUR ROHMAT 
MEGABAL 1,730.00 1 1,903.00
273 APT010000I62004472 161449 tn. NUR ROHMAT 
DEKSAMETA1,801.80 2 1,981.98
274 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 2 7,744.00
275 APT010000I62004520 138788 nn. NUR TESSA
CEFIXIME
AMELIA 4,950.00 6 5,445.00
276 APT010000I62004520 138788 nn. NUR TESSA
OMEPRAZO
AMELIA  704.37 6 774.80
277 APT010000I62004520 138788 nn. NUR TESSA
EPISAN
AMELIA 
SU 51,150.00 1 56,265.00
278 APT010000I62004520 138788 nn. NUR TESSA
NEURODEX
AMELIA  770.00 3 847.00
279 APT010000I12000083 161681 tn. H KULAU 
CAIRAN NAC6,409.70 1 8,332.61
280 APT010000I12000083 161681 tn. H KULAU 
ACETYLCYS 1,100.00 3 1,705.00

281 APT010000I12000083 161681 tn. H KULAU 

FENTANYL 041,599.80 5 54,079.74

282 APT010000I62004538 15737 ny. SRI KABDARIN

COMBODJUHARINI 
PAC
60,500.00 1 66,550.00
283 APT010000I62004538 15737 ny. SRI KABDARIN
CAIRANDJUHARINI 
RL 7,149.60 1 7,864.56
284 APT010000I62004538 15737 ny. SRI KABDARIN
HANDSCOENDJUHARINI 
478.00 2 525.80
285 APT010000I62004538 15737 ny. SRI KABDARIN
METAMIZOL4,999.99
DJUHARINI  1 5,499.99
286 APT010000I62004538 15737 ny. SRI KABDARIN
RANITIDINDJUHARINI 
7,040.00 1 7,744.00
287 APT010000I62004538 15737 ny. SRI KABDARIN
DEKSAMETA1,801.80
DJUHARINI  1 1,981.98
288 APT010000I62004538 15737 ny. SRI KABDARIN
SPOIT 3DJUHARINI 
CC 1,485.00 3 1,633.50
289 APT010000I62004533 99897 an. MUH. AIDIL
EPEXOLFITRAH
TA B 869.00 3 955.90
290 APT010000I62004533 99897 an. MUH. AIDIL
CTM FITRAH
TAB 1,249.00
B  5 1,373.90
291 APT010000I62004533 99897 an. MUH. AIDIL
CORTIDEX
FITRAH B 286.00 9 314.60
292 APT010000I62004533 99897 an. MUH. AIDIL
KERTASFITRAH
PU B 613.00 9 674.30
293 APT010000I62004533 99897 an. MUH. AIDIL
CAIRANFITRAH
NAC6,409.70
B  1 7,050.67
294 APT010000I62004533 99897 an. MUH. AIDIL
NEBULIZER40,535.00
FITRAH B  1 44,588.50
295 APT010000I62004540 112479 tn. REZKI H CAIRAN RL 7,149.60 1 7,864.56
296 APT010000I62004542 125603 nn. AYU PUTRI
COMBORACHMAN 
PAC
60,500.00 1 66,550.00
297 APT010000I62004542 125603 nn. AYU PUTRI
CAIRAN
RACHMAN 
RL 7,149.60 1 7,864.56
298 APT010000I62004542 125603 nn. AYU PUTRI
HANDSCOEN
RACHMAN  478.00 8 525.80
299 APT010000I62004542 125603 nn. AYU PUTRI
SPOITRACHMAN 
3 CC 1,485.00 2 1,633.50
300 APT010000I62004542 125603 nn. AYU PUTRI
RANITIDIN
RACHMAN 7,040.00 1 7,744.00
301 APT010000I62004542 125603 nn. AYU PUTRI
NEUROSANB5,324.00
RACHMAN  1 5,856.40
302 APT010000I62004538 15737 ny. SRI KABDARIN
SANMOL DJUHARINI 
T 297.00 2 326.70
303 APT010000I62004538 15737 ny. SRI KABDARIN
METOCLOPR5,500.00
DJUHARINI  2 6,050.00
304 APT010000I65003112 161744 tn. BAKRI WAHID 
HANDSCOEN 478.00 4 525.80
305 APT010000I65003112 161744 tn. BAKRI WAHID 
MASKER DI 700.00 2 770.00
306 APT010000I65003112 161744 tn. BAKRI WAHID 
CONECTA 13,200.00 1 14,520.00
307 APT010000I65003112 161744 tn. BAKRI WAHID 
INFUS SET 7,920.00 1 8,712.00
308 APT010000I65003112 161744 tn. BAKRI WAHID 
IV CATHETE 7,750.00 1 8,525.00
309 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 3 7,864.56
310 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
RL 7,149.60 3 7,864.56
311 APT010000I62004521 146576 tn. SAHARUDDIN
MASKER HAMID 
DI 700.00 2 770.00
312 APT010000I62004521 146576 tn. SAHARUDDIN
CONECTA HAMID 
13,200.00 1 14,520.00
313 APT010000I62004521 146576 tn. SAHARUDDIN
INFUS SET
HAMID 
7,920.00 1 8,712.00
314 APT010000I62004521 146576 tn. SAHARUDDIN
IV CATHETE
HAMID 
7,750.00 1 8,525.00
315 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN RL 7,149.60 2 7,864.56
316 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 4 525.80
317 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 2 770.00
318 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 10 C 2,310.00 2 2,541.00
319 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 5 CC 1,595.00 2 1,754.50
320 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 3 CC 1,485.00 2 1,633.50
321 APT010000I62004504 161146 ny. NIRWANA 
CONECTA 13,200.00 1 14,520.00
322 APT010000I62004504 161146 ny. NIRWANA 
INFUS SET 7,920.00 1 8,712.00
323 APT010000I62004504 161146 ny. NIRWANA 
IV CATHETE 7,750.00 1 8,525.00
324 APT010000I62004533 99897 an. MUH. AIDIL
SPOITFITRAH
10 C 2,310.00
B  2 2,541.00
325 APT010000I62004533 99897 an. MUH. AIDIL
MASKERFITRAH
DI B 700.00 2 770.00
326 APT010000I62004533 99897 an. MUH. AIDIL
HANDSCOEN
FITRAH B 478.00 4 525.80
327 APT010000I62004533 99897 an. MUH. AIDIL
INFUSFITRAH
SET 7,920.00
B  1 8,712.00
328 APT010000I62004533 99897 an. MUH. AIDIL
CONECTA
FITRAH13,200.00
B  1 14,520.00
329 APT010000I62004533 99897 an. MUH. AIDIL
IV CATHETE
FITRAH16,720.00
B  1 18,392.00
330 APT010000I62004533 99897 an. MUH. AIDIL
SPOITFITRAH
5 CC 1,595.00
B  2 1,754.50
331 APT010000I62004533 99897 an. MUH. AIDIL
CAIRANFITRAH
DE18,920.00
B  2 20,812.00
332 APT010000I62004541 161827 tn. JOHAMZAH 
- 0 0 0
333 APT010000I62004541 161827 tn. JOHAMZAH 
CAIRAN RL 7,149.60 3 7,864.56
334 APT010000I62004541 161827 tn. JOHAMZAH 
MASKER DI 700.00 2 770.00
335 APT010000I62004541 161827 tn. JOHAMZAH 
HANDSCOEN 478.00 4 525.80
336 APT010000I62004541 161827 tn. JOHAMZAH 
SPOIT 10 C 2,310.00 1 2,541.00
337 APT010000I62004541 161827 tn. JOHAMZAH 
SPOIT 5 CC 1,595.00 2 1,754.50
338 APT010000I62004541 161827 tn. JOHAMZAH 
SPOIT 3 CC 1,485.00 2 1,633.50
339 APT010000I62004541 161827 tn. JOHAMZAH 
IV CATHETE 7,750.00 1 8,525.00
340 APT010000I62004541 161827 tn. JOHAMZAH 
CONECTA 13,200.00 1 14,520.00
341 APT010000I62004541 161827 tn. JOHAMZAH 
INFUS SET 7,920.00 1 8,712.00
342 APT010000I65003111 39079 ny. ELIK SULISTIYO
CAIRAN PURBAWATI
RL 7,149.60   3 7,864.56
343 APT010000I65003111 39079 ny. ELIK SULISTIYO
HANDSCOEN PURBAWATI
478.00   4 525.80
344 APT010000I65003111 39079 ny. ELIK SULISTIYO
MASKERPURBAWATI
DI 700.00   2 770.00
345 APT010000I65003111 39079 ny. ELIK SULISTIYO
CONECTA PURBAWATI
13,200.00   1 14,520.00
346 APT010000I65003111 39079 ny. ELIK SULISTIYO
INFUS SET PURBAWATI
7,920.00   1 8,712.00
347 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV CATHETEPURBAWATI
7,750.00   1 8,525.00
348 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 10PURBAWATI
C 2,310.00   2 2,541.00
349 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 5 CCPURBAWATI
1,595.00   2 1,754.50
350 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 3 CCPURBAWATI
1,485.00   1 1,633.50
351 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  RL 7,149.60 3 7,864.56
352 APT010000I62004499 161575 tn. ALIF PRADITYA
HANDSCOEN  478.00 4 525.80
353 APT010000I62004499 161575 tn. ALIF PRADITYA
MASKER  DI 700.00 1 770.00
354 APT010000I62004499 161575 tn. ALIF PRADITYA
CONECTA   13,200.00 1 14,520.00
355 APT010000I62004499 161575 tn. ALIF PRADITYA
CAIRAN  NA15,180.00 2 16,698.00
356 APT010000I62004499 161575 tn. ALIF PRADITYA
IV CATHETE
  16,720.00 1 18,392.00
357 APT010000I62004499 161575 tn. ALIF PRADITYA
IV DRESSI  4,850.00 1 5,335.00
358 APT010000I62004499 161575 tn. ALIF PRADITYA
SPOIT 10  C 2,310.00 2 2,541.00
359 APT010000I62004499 161575 tn. ALIF PRADITYA
SPOIT 3  CC 1,485.00 2 1,633.50
360 APT010000I62004537 161805 ny. ZURIATICAIRAN
N. TANIYO 
RL 7,149.60 3 7,864.56
361 APT010000I62004537 161805 ny. ZURIATICAIRAN
N. TANIYO 
NA15,180.00 2 16,698.00
362 APT010000I62004537 161805 ny. ZURIATICONECTA
N. TANIYO  13,200.00 1 14,520.00
363 APT010000I62004537 161805 ny. ZURIATIIVN.DRESSI
TANIYO 4,850.00 1 5,335.00
364 APT010000I62004537 161805 ny. ZURIATIMASKER
N. TANIYO 
DI 700.00 1 770.00
365 APT010000I62004537 161805 ny. ZURIATIHANDSCOEN
N. TANIYO  478.00 4 525.80
366 APT010000I62004537 161805 ny. ZURIATIIVN.CATHETE
TANIYO 7,750.00 1 8,525.00
367 APT010000I62004537 161805 ny. ZURIATISPOIT
N. TANIYO 
5 CC 1,595.00 2 1,754.50
368 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CAIRAN RL IMRAN
7,149.60
H  4 7,864.56
369 APT010000I62004535 161791 tn. ANDI DZULFAHMI
HANDSCOON IMRAN
12,100.00
H  2 13,310.00
370 APT010000I62004535 161791 tn. ANDI DZULFAHMI
MASKER DIIMRAN700.00
H  1 770.00
371 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SPOIT 10 C IMRAN
2,310.00
H  2 2,541.00
372 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SPOIT 5 CCIMRAN
1,595.00
H  2 1,754.50
373 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CAIRAN NA15,180.00
IMRAN H  2 16,698.00
374 APT010000I62004535 161791 tn. ANDI DZULFAHMI
IV CATHETEIMRAN
16,720.00
H  1 18,392.00
375 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CONECTA IMRAN
13,200.00
H  1 14,520.00
376 APT010000I62004535 161791 tn. ANDI DZULFAHMI
IV DRESSI IMRAN
4,850.00
H  1 5,335.00
377 APT010000I65003120 158007 ny. JUMIATI 
MASKER DI 700.00 1 770.00
378 APT010000I65003120 158007 ny. JUMIATI 
HANDSCOEN 478.00 4 525.80
379 APT010000I65003120 158007 ny. JUMIATI 
CAIRAN RL 7,149.60 3 7,864.56
380 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 3 CC 1,485.00 2 1,633.50
381 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 5 CC 1,595.00 1 1,754.50
382 APT010000I65003120 158007 ny. JUMIATI 
IV DRESSI 4,850.00 1 5,335.00
383 APT010000I65003120 158007 ny. JUMIATI 
IV CATHETE 7,750.00 1 8,525.00
384 APT010000I62004476 161475 ny. ANDI MASTURA 
MASKER DI 700.00 1 770.00
385 APT010000I62004476 161475 ny. ANDI MASTURA 
HANDSCOEN 478.00 4 525.80
386 APT010000I62004476 161475 ny. ANDI MASTURA 
IV CATHETE 7,750.00 1 8,525.00
387 APT010000I62004476 161475 ny. ANDI MASTURA 
IV DRESSI 4,850.00 1 5,335.00
388 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 3 CC 1,485.00 2 1,633.50
389 APT010000I62004476 161475 ny. ANDI MASTURA 
SPOIT 5 CC 1,595.00 2 1,754.50
390 APT010000I62004476 161475 ny. ANDI MASTURA 
CAIRAN NAC6,409.70 3 7,050.67
391 APT010000I62004476 161475 ny. ANDI MASTURA 
INFUS SET 7,920.00 1 8,712.00
392 APT010000I62004476 161475 ny. ANDI MASTURA 
CONECTA 13,200.00 1 14,520.00
393 APT010000I62004517 161692 ny. DJANGKI 
INFUSAN R 9,645.50 3 10,610.05
394 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 4 525.80
395 APT010000I62004517 161692 ny. DJANGKI 
MASKER DI 700.00 1 770.00
396 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 3 CC 1,485.00 1 1,633.50
397 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 5 CC 1,595.00 1 1,754.50
398 APT010000I62004517 161692 ny. DJANGKI 
IV DRESSI 4,850.00 1 5,335.00
399 APT010000I62004517 161692 ny. DJANGKI 
INFUS SET 7,920.00 1 8,712.00
400 APT010000I62004517 161692 ny. DJANGKI 
IV CATHETE 7,750.00 1 8,525.00
401 APT010000I62004517 161692 ny. DJANGKI 
CONECTA 13,200.00 1 14,520.00
402 APT010000I62004536 161792 nn. ANDI SALMA
CAIRANAQIB 
RL 7,149.60 3 7,864.56
403 APT010000I62004536 161792 nn. ANDI SALMA
IV DRESSI
AQIB  4,850.00 1 5,335.00
404 APT010000I62004536 161792 nn. ANDI SALMA
IV CATHETE
AQIB  7,750.00 1 8,525.00
405 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
3 CC 1,485.00 2 1,633.50
406 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
5 CC 1,595.00 2 1,754.50
407 APT010000I62004536 161792 nn. ANDI SALMA
CONECTA
AQIB 13,200.00 1 14,520.00
408 APT010000I62004536 161792 nn. ANDI SALMA
MASKERAQIB 
DI 700.00 1 770.00
409 APT010000I62004536 161792 nn. ANDI SALMA
HANDSCOEN
AQIB  478.00 4 525.80
410 APT010000I62004536 161792 nn. ANDI SALMA
INFUS AQIB 
SET 7,920.00 1 8,712.00
411 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 3 7,864.56
412 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA  478.00 4 525.80
413 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 1 770.00
414 APT010000I62004511 161613 an. MUHAMMAD
IV CATHETE
TAQWA 
7,750.00 1 8,525.00
415 APT010000I62004511 161613 an. MUHAMMAD
INFUS SET
TAQWA 
7,920.00 1 8,712.00
416 APT010000I62004511 161613 an. MUHAMMAD
SPOIT 3TAQWA 
CC 1,485.00 2 1,633.50
417 APT010000I62004511 161613 an. MUHAMMAD
SPOIT 5TAQWA 
CC 1,595.00 1 1,754.50
418 APT010000I62004511 161613 an. MUHAMMAD
CONECTA TAQWA 
13,200.00 1 14,520.00
419 APT010000I64002984 161794 tn. RICHARD
CAIRAN
LEONARD 
RL 7,149.60 2 7,864.56
420 APT010000I64002984 161794 tn. RICHARD
MASKER
LEONARD 
DI 700.00 1 770.00
421 APT010000I64002984 161794 tn. RICHARD
HANDSCOEN
LEONARD  478.00 4 525.80
422 APT010000I64002984 161794 tn. RICHARD
SPOIT
LEONARD 
5 CC 1,595.00 2 1,754.50
423 APT010000I64002984 161794 tn. RICHARD
SPOIT
LEONARD 
10 C 2,310.00 1 2,541.00
424 APT010000I64002984 161794 tn. RICHARD
INFUS
LEONARD 
SET 7,920.00 1 8,712.00
425 APT010000I64002984 161794 tn. RICHARD
CONECTA
LEONARD  13,200.00 1 14,520.00
426 APT010000I64002984 161794 tn. RICHARD
IV LEONARD 
DRESSI 4,850.00 1 5,335.00
427 APT010000I62004531 161761 ny. SUNARTI 
CAIRAN NAC6,409.70 3 7,050.67
428 APT010000I62004531 161761 ny. SUNARTI 
MASKER DI 700.00 1 770.00
429 APT010000I62004531 161761 ny. SUNARTI 
HANDSCOEN 478.00 2 525.80
430 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 3 CC 1,485.00 1 1,633.50
431 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 5 CC 1,595.00 1 1,754.50
432 APT010000I62004531 161761 ny. SUNARTI 
INFUS SET 7,920.00 1 8,712.00
433 APT010000I62004531 161761 ny. SUNARTI 
CONECTA 13,200.00 1 14,520.00
434 APT010000I62004531 161761 ny. SUNARTI 
IV CATHETE 7,750.00 1 8,525.00
435 APT010000I62004531 161761 ny. SUNARTI 
IV DRESSI 4,850.00 1 5,335.00
436 APT010000I62004531 161761 ny. SUNARTI 
NOVO TWIS 2,083.00 1 2,291.30
437 APT010000I62004527 161427 ny. BAYA  CAIRAN RL 7,149.60 2 7,864.56
438 APT010000I62004527 161427 ny. BAYA  CAIRAN NA15,180.00 2 16,698.00
439 APT010000I62004527 161427 ny. BAYA  SPOIT 10 C 2,310.00 2 2,541.00
440 APT010000I62004527 161427 ny. BAYA  SPOIT 5 CC 1,595.00 2 1,754.50
441 APT010000I62004527 161427 ny. BAYA  IV CATHETE 7,750.00 1 8,525.00
442 APT010000I62004527 161427 ny. BAYA  IV DRESSI 4,850.00 1 5,335.00
443 APT010000I62004527 161427 ny. BAYA  HANDSCOEN 478.00 4 525.80
444 APT010000I62004527 161427 ny. BAYA  CONECTA 13,200.00 1 14,520.00
445 APT010000I62004527 161427 ny. BAYA  MASKER DI 700.00 1 770.00
446 APT010000I62004524 161724 tn. MOCH SADDAM
CAIRAN RL HUSAIN
7,149.60
MO'O  3 7,864.56
447 APT010000I62004524 161724 tn. MOCH SADDAM
MASKER DI HUSAIN
700.00
MO'O  1 770.00
448 APT010000I62004524 161724 tn. MOCH SADDAM
SPOIT 3 CCHUSAIN
1,485.00
MO'O  2 1,633.50
449 APT010000I62004524 161724 tn. MOCH SADDAM
IV CATHETEHUSAIN
7,750.00
MO'O  1 8,525.00
450 APT010000I62004524 161724 tn. MOCH SADDAM
HANDSCOEN HUSAIN
478.00
MO'O  4 525.80
451 APT010000I62004524 161724 tn. MOCH SADDAM
CONECTAHUSAIN
13,200.00
MO'O  1 14,520.00
452 APT010000I64002973 123863 ny. MULIATI
CAIRAN
DG NGAI 
NAC6,409.70 2 7,050.67
453 APT010000I64002973 123863 ny. MULIATI
SPOIT
DG NGAI 
10 C 2,310.00 1 2,541.00
454 APT010000I64002973 123863 ny. MULIATI
IVDG
CATHETE
NGAI  7,750.00 1 8,525.00
455 APT010000I64002973 123863 ny. MULIATI
SPOIT
DG NGAI 
5 CC 1,595.00 2 1,754.50
456 APT010000I64002973 123863 ny. MULIATI
HANDSCOON
DG NGAI 13,613.00 1 14,974.30
457 APT010000I64002973 123863 ny. MULIATI
MASKER
DG NGAI DI 700.00 1 770.00
458 APT010000I64002973 123863 ny. MULIATI
IVDG
DRESSI
NGAI  4,850.00 1 5,335.00
 459 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CAIRAN RL 7,149.60 2 7,864.56
460 APT010000I62004514 160906 tn. KIDJO SUKARYO 
MASKER DI 700.00 1 770.00
461 APT010000I62004514 160906 tn. KIDJO SUKARYO 
HANDSCOEN 478.00 4 525.80
462 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 10 C 2,310.00 1 2,541.00
463 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPOIT 3 CC 1,485.00 1 1,633.50
464 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV CATHETE 7,750.00 1 8,525.00
465 APT010000I62004514 160906 tn. KIDJO SUKARYO 
CONECTA 13,200.00 1 14,520.00
466 APT010000I62004514 160906 tn. KIDJO SUKARYO 
IV DRESSI 4,850.00 1 5,335.00

467 APT010000I62004526 161746 ny. YOSPINA

FENTANYL
KAMMA 041,599.80 5 45,759.78

468 APT010000I31000563 161752 ny. RISMAWATI 

IV CATHETE 7,750.00 1 8,525.00
469 APT010000I31000563 161752 ny. RISMAWATI 
CONECTA 13,200.00 2 14,520.00
470 APT010000I31000563 161752 ny. RISMAWATI 
MASKER DI 700.00 5 770.00
471 APT010000I31000563 161752 ny. RISMAWATI 
CEDOCARD31,000.00 1 34,100.00
472 APT010000I62004534 161785 nn. NURHADI
RANITIDIN
HATIKA  7,040.00 2 7,744.00
473 APT010000I62004534 161785 nn. NURHADI
SOTATIC
HATIKA 
I 3,032.00 3 3,335.20
474 APT010000I62004534 161785 nn. NURHADI
ALPRAZOLA
HATIKA  1,915.83 1 2,107.42
475 APT010000I62004534 161785 nn. NURHADI
CAIRAN
HATIKA 
RL 7,149.60 4 7,864.56
Sub Total   1031
29-12-
2018  1 APT010000I62004526 161746 ny. YOSPINA
METRONIDA
KAMMA 56,718.20 2 62,390.02

2 APT010000I62004542 125603 nn. AYU PUTRI

SANMOL
RACHMAN 
T 297.00 2 326.70
3 APT010000I62004542 125603 nn. AYU PUTRI
SIMUCIL
RACHMAN 
2 1,760.00 2 1,936.00
4 APT010000I62004536 161792 nn. ANDI SALMA
PROPILTIO
AQIB  499.00 8 548.90
5 APT010000I62004543 161832 ny. HARTATI
CAIRAN
NGANRO RL 7,149.60 3 7,864.56
6 APT010000I62004543 161832 ny. HARTATI
NEW
NGANRO 
DIAT 557.15 4 612.87
7 APT010000I62004524 161724 tn. MOCH SADDAM
SPORETIKHUSAIN
5,720.50
MO'O  6 6,292.55
8 APT010000I62004524 161724 tn. MOCH SADDAM
NEW DIATHUSAIN 557.15
MO'O  5 612.87
9 APT010000I64002984 161794 tn. RICHARD
VERTIGOSA
LEONARD 4,528.33 2 4,981.17
10 APT010000I64002984 161794 tn. RICHARD
GRATIZIN
LEONARD 4,741.00 1 5,215.10
11 APT010000I64002984 161794 tn. RICHARD
TELMISART
LEONARD 5,445.00 1 5,989.50
12 APT010000I64002984 161794 tn. RICHARD
AMLODIPIN
LEONARD  838.19 1 922.01
13 APT010000I62004511 161613 an. MUHAMMAD
SANMOL TAQWA 
I 24,202.60 3 26,622.86
14 APT010000I62004511 161613 an. MUHAMMAD
ONDANSETR5,500.00
TAQWA  1 6,050.00
15 APT010000I62004511 161613 an. MUHAMMAD
AMBROXOLTAQWA  199.65 3 219.62
16 APT010000I62004503 159886 tn. MUH BASIR
CEFTRIAXO19,999.10
LALANG  2 26,998.78
17 APT010000I62004503 159886 tn. MUH BASIR
RANITIDIN
LALANG 7,040.00 2 10,700.80
18 APT010000I62004517 161692 ny. DJANGKI 
ZINK OKSI 604.00 1 664.40
19 APT010000I62004517 161692 ny. DJANGKI 
B COMPLEK 76.34 3 83.97
20 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
21 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 2 21,999.01
22 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
23 APT010000I64002973 123863 ny. MULIATI
ONDANSETR5,500.00
DG NGAI  2 6,050.00
24 APT010000I64002973 123863 ny. MULIATI
ASPILETS
DG NGAI  816.20 1 897.82
25 APT010000I64002973 123863 ny. MULIATI
FARSORBID
DG NGAI  569.18 3 626.10
26 APT010000I64002973 123863 ny. MULIATICONCOR
DG NGAI  2. 597.00 1 656.70
27 APT010000I62004537 161805 ny. ZURIATICEFTRIAXO19,999.10
N. TANIYO  2 21,999.01
28 APT010000I62004537 161805 ny. ZURIATIKETOROLAC
N. TANIYO 7,350.75 3 8,085.82
29 APT010000I62004537 161805 ny. ZURIATIRANITIDIN
N. TANIYO 7,040.00 3 7,744.00
30 APT010000I62004476 161475 ny. ANDI MASTURA 
FLAMAR 50 1,908.50 2 2,099.35
31 APT010000I62004476 161475 ny. ANDI MASTURA 
PREGABAL 5,500.00 2 6,050.00
32 APT010000I62004536 161792 nn. ANDI SALMA
NEUROSANB5,324.00
AQIB  1 5,856.40
33 APT010000I62004536 161792 nn. ANDI SALMA
NEUROSAN
AQIB  1,168.50 3 1,285.35
34 APT010000I62004540 112479 tn. REZKI H NEW DIAT 557.15 3 612.87
35 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SPORETIK 5,720.50 6 6,292.55
36 APT010000I62004499 161575 tn. ALIF PRADITYA
CEFIXIME  4,950.00 6 5,445.00
37 APT010000I62004499 161575 tn. ALIF PRADITYA
METIL PRE
  475.79 9 523.37
38 APT010000I62004499 161575 tn. ALIF PRADITYA
PUMPITOR  11,330.00 3 12,463.00
39 APT010000I62004527 161427 ny. BAYA  SPORETIK 5,720.50 6 6,292.55
40 APT010000I62004527 161427 ny. BAYA  IBUPROFEN 235.95 6 259.55
41 APT010000I62004527 161427 ny. BAYA  NEURODEX 770.00 6 847.00
42 APT010000I65003120 158007 ny. JUMIATI 
RANITIDIN 7,040.00 2 7,744.00
43 APT010000I65003120 158007 ny. JUMIATI 
SANMOL T 297.00 3 326.70
44 APT010000I65003120 158007 ny. JUMIATI 
VOSEDON T 2,431.00 3 2,674.10
45 APT010000I65003120 158007 ny. JUMIATI 
NEURODEX 770.00 1 847.00
46 APT010000I65003120 158007 ny. JUMIATI 
GRATIZIN 4,741.00 1 5,215.10
47 APT010000I65003120 158007 ny. JUMIATI 
ALPRAZOLA 1,915.83 1 2,107.42
48 APT010000I62004535 161791 tn. ANDI DZULFAHMI
RANITIDIN IMRAN
7,040.00
H  2 7,744.00
49 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SANMOL I IMRAN
24,202.60
H  2 26,622.86
50 APT010000I62004535 161791 tn. ANDI DZULFAHMI
NEW DIAT IMRAN 557.15
H  4 612.87
51 APT010000I62004531 161761 ny. SUNARTI 
METFORMI 190.00 3 209.00
52 APT010000I62004531 161761 ny. SUNARTI 
SOTATIC T 394.90 1 434.39
53 APT010000I62004531 161761 ny. SUNARTI 
RANITIDIN 7,040.00 2 7,744.00
54 APT010000I62004531 161761 ny. SUNARTI 
NEURODEX 770.00 2 847.00
55 APT010000I62004531 161761 ny. SUNARTI 
PREGABAL 5,500.00 2 6,050.00
56 APT010000I62004531 161761 ny. SUNARTI 
BUSCOPAN 4,327.40 2 4,760.14
57 APT010000I62004531 161761 ny. SUNARTI 
GLUCODEX 478.50 1 526.35
58 APT010000I62004531 161761 ny. SUNARTI 
ALPRAZOLA 1,915.83 1 2,107.42
59 APT010000I65003111 39079 ny. ELIK SULISTIYO
PUMPITOR PURBAWATI
11,616.00   2 12,777.60
60 APT010000I65003111 39079 ny. ELIK SULISTIYO
AMLODIPINPURBAWATI
838.19   1 922.01
61 APT010000I65003111 39079 ny. ELIK SULISTIYO
MELOXICAMPURBAWATI
250.00   2 275.00
62 APT010000I65003111 39079 ny. ELIK SULISTIYO
CEFTRIAXO19,999.10
PURBAWATI   2 21,999.01
63 APT010000I65003111 39079 ny. ELIK SULISTIYO
TELMISARTPURBAWATI
5,445.00   1 5,989.50
64 APT010000I65003111 39079 ny. ELIK SULISTIYO
SIMARC PURBAWATI
TA 975.98   1 1,073.58
65 APT010000I65003111 39079 ny. ELIK SULISTIYO
DIGOKSIN PURBAWATI
107.12   1 117.83
66 APT010000I65003111 39079 ny. ELIK SULISTIYO
FUROSEMIDPURBAWATI
190.99   1 210.09

67 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   2 54,450.00

68 APT010000I65003111 39079 ny. ELIK SULISTIYO

MECOBALAM
PURBAWATI
6,600.00   1 7,260.00
69 APT010000I65003111 39079 ny. ELIK SULISTIYO
RANITIDIN
PURBAWATI
7,040.00   2 7,744.00
 70 APT010000I65003111 39079 ny. ELIK SULISTIYO
CITICOLIN
PURBAWATI
10,011.38   2 11,012.51
71 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 7,332.97 2 8,066.26
72 APT010000I66000437 161676 ny. HJ ERNAWATY 
MEGABAL 1,730.00 1 1,903.00
73 APT010000I66000437 161676 ny. HJ ERNAWATY 
AMLODIPIN 475.19 1 522.71
74 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,616.00 2 12,777.60
75 APT010000I62004471 148491 ny. NURBAENI 
EPISAN SU 51,150.00 1 56,265.00
76 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
77 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
78 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 1 275.00
79 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
80 APT010000I62004544 161844 nn. ANNISACAIRAN
AULIA  RL 7,149.60 1 7,864.56
81 APT010000I62004544 161844 nn. ANNISACOMBO
AULIA  PAC60,500.00 1 66,550.00
82 APT010000I62004544 161844 nn. ANNISAHANDSCOEN
AULIA  478.00 2 525.80
83 APT010000I62004544 161844 nn. ANNISASANMOL
AULIA  T 297.00 1 326.70
84 APT010000I62004544 161844 nn. ANNISARANITIDIN
AULIA  7,040.00 1 7,744.00
85 APT010000I62004544 161844 nn. ANNISASPOIT
AULIA 
3 CC 1,485.00 1 1,633.50
86 APT010000I62004544 161844 nn. ANNISAMASKER
AULIA  DI 700.00 2 770.00
87 APT010000I62004504 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
88 APT010000I62004504 161146 ny. NIRWANA 
SANTAGESIK4,949.40 3 5,444.34
89 APT010000I62004504 161146 ny. NIRWANA 
METOCLOPR5,500.00 3 6,050.00
90 APT010000I62004504 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
91 APT010000I62004504 161146 ny. NIRWANA 
URSODEOX 4,158.00 2 4,573.80
92 APT010000I62004538 15737 ny. SRI KABDARIN
SANMOL DJUHARINI 
T 297.00 3 326.70
93 APT010000I62004538 15737 ny. SRI KABDARIN
METOCLOPR5,500.00
DJUHARINI  2 6,050.00
94 APT010000I62004542 125603 nn. AYU PUTRI
SANMOL
RACHMAN 
T 297.00 3 326.70
95 APT010000I62004542 125603 nn. AYU PUTRI
ACETYLCYS
RACHMAN 1,100.00 3 1,210.00
96 APT010000I62004533 99897 an. MUH. AIDIL
SANPICILLI
FITRAH16,764.00
B  4 18,440.40
97 APT010000I62004521 146576 tn. SAHARUDDIN
CEFTRIAXO19,999.10
HAMID  2 21,999.01
98 APT010000I62004521 146576 tn. SAHARUDDIN
COMBIVENT4,549.95
HAMID  3 5,004.94
99 APT010000I62004521 146576 tn. SAHARUDDIN
RANITIDIN
HAMID 
7,040.00 2 7,744.00
100 APT010000I62004521 146576 tn. SAHARUDDIN
NEURODEX
HAMID 770.00 2 847.00
101 APT010000I62004521 146576 tn. SAHARUDDIN
NYSTATIN
HAMID 
24,200.00 1 26,620.00
102 APT010000I62004521 146576 tn. SAHARUDDIN
FLAMAR HAMID 
50 1,908.50 3 2,099.35
103 APT010000I65003112 161744 tn. BAKRI WAHID 
CETIRIZIN 266.01 1 292.61
104 APT010000I65003112 161744 tn. BAKRI WAHID 
SANMOL T 297.00 3 326.70
105 APT010000I62004541 161827 tn. JOHAMZAH 
CITICOLIN 10,011.38 4 11,012.51
106 APT010000I62004541 161827 tn. JOHAMZAH 
NEURODEX 770.00 1 847.00
107 APT010000I12000083 161681 tn. H KULAU 
CAIRAN RL 7,149.60 3 9,294.49
108 APT010000I12000083 161681 tn. H KULAU 
CAIRAN DE18,920.00 2 24,596.00
109 APT010000I12000083 161681 tn. H KULAU 
CEFTRIAXO19,999.10 2 26,998.78
112,869.2
110 APT010000I12000083 161681 tn. H KULAU 
METRONIDA
56,718.20 2 2
111 APT010000I12000083 161681 tn. H KULAU 
KETOROLAC 7,350.75 3 9,555.98
112 APT010000I12000083 161681 tn. H KULAU 
MASKER DI 700.00 10 910.00
113 APT010000I12000083 161681 tn. H KULAU 
HANDSCOEN 478.00 20 645.30
114 APT010000I12000083 161681 tn. H KULAU 
SPOIT 10 C 2,310.00 1 3,118.50
115 APT010000I12000083 161681 tn. H KULAU 
SPOIT 5 CC 1,595.00 1 2,153.25
116 APT010000I62004514 160906 tn. KIDJO SUKARYO 
SALBUTAM 88.00 9 96.80
117 APT010000I62004514 160906 tn. KIDJO SUKARYO 
NEW DIAT 557.15 9 612.87
118 APT010000I62004472 161449 tn. NUR ROHMAT 
DEKSAMETA1,801.80 1 1,981.98
119 APT010000I62004472 161449 tn. NUR ROHMAT 
RANITIDIN 7,040.00 2 7,744.00
120 APT010000I62004472 161449 tn. NUR ROHMAT 
MEGABAL 1,730.00 1 1,903.00
121 APT010000I62004472 161449 tn. NUR ROHMAT 
PIRACETAM 1,293.60 2 1,422.96
122 APT010000I62004472 161449 tn. NUR ROHMAT 
CEFIXIME 4,950.00 2 5,445.00
123 APT010000I62004472 161449 tn. NUR ROHMAT 
MELOXICAM 923.23 1 1,015.55
124 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID2,920.50 4 3,212.55
125 APT010000I31000563 161752 ny. RISMAWATI 
RANITIDIN 7,040.00 2 7,744.00
126 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA KA11,314.00 1 12,445.40
127 APT010000I62004526 161746 ny. YOSPINACAIRAN
KAMMA VA73,700.00 1 81,070.00
128 APT010000I62004526 161746 ny. YOSPINACEFTRIAXO19,999.10
KAMMA  2 21,999.01
129 APT010000I62004526 161746 ny. YOSPINASANTAGESIK4,949.40
KAMMA  3 5,444.34
130 APT010000I62004526 161746 ny. YOSPINAOMEPRAZOL
KAMMA 24,999.70 2 27,499.67

131 APT010000I62004526 161746 ny. YOSPINA

METRONIDA
KAMMA 56,718.20 3 62,390.02

132 APT010000I62004526 161746 ny. YOSPINA

HANDSCOEN
KAMMA  478.00 10 525.80
133 APT010000I62004526 161746 ny. YOSPINA
MASKER
KAMMA 
DI 700.00 5 770.00
134 APT010000I12000083 161681 tn. H KULAU 
OMEPRAZOL24,999.70 1 33,749.60
135 APT010000I12000083 161681 tn. H KULAU 
METAMIZOL4,999.99 3 6,749.99

136 APT010000I12000083 MEROPENE240,240.0

161681 tn. H KULAU  2 408,408.0
0 0
137 APT010000I12000083 161681 tn. H KULAU 
RANITIDIN 7,040.00 2 10,700.80

138 APT010000I12000083 161681 tn. H KULAU 

FENTANYL 041,599.80 5 54,079.74

139 APT010000I65003112 161744 tn. BAKRI WAHID 

NEFROSTER49,599.00 1 54,558.90
140 APT010000I65003112 161744 tn. BAKRI WAHID 
KSR 600 M 1,755.00 1 1,930.50
141 APT010000I65003112 161744 tn. BAKRI WAHID 
EPISAN SU 51,150.00 1 56,265.00
142 APT010000I62004542 125603 nn. AYU PUTRI
ALPRAZOLA
RACHMAN 
1,915.83 3 2,107.42
143 APT010000I62004538 15737 ny. SRI KABDARIN
ALPRAZOLA
DJUHARINI 
1,915.83 3 2,107.42
144 APT010000I62004544 161844 nn. ANNISACAIRAN
AULIA  RL 7,149.60 3 7,864.56
145 APT010000I62004544 161844 nn. ANNISAMASKER
AULIA  DI 700.00 2 770.00
146 APT010000I62004538 15737 ny. SRI KABDARIN
CAIRANDJUHARINI 
RL 7,149.60 4 7,864.56
147 APT010000I62004538 15737 ny. SRI KABDARIN
MASKERDJUHARINI 
DI 700.00 1 770.00
148 APT010000I62004538 15737 ny. SRI KABDARIN
HANDSCOEN
DJUHARINI 
478.00 2 525.80
149 APT010000I62004543 161832 ny. HARTATICAIRAN
NGANRO 
RL 7,149.60 4 7,864.56
150 APT010000I62004543 161832 ny. HARTATIMASKER
NGANRO DI 700.00 2 770.00
151 APT010000I12000083 161681 tn. H KULAU 
CAIRAN KA11,314.00 2 14,708.20
152 APT010000I65003130 161850 ny. NOTOPA CEFTRIAXO19,999.10
DG SUNGGU  2 21,999.01
153 APT010000I65003130 161850 ny. NOTOPA SANMOL
DG SUNGGU 
T 297.00 3 326.70
154 APT010000I65003130 161850 ny. NOTOPA AMLODIPIN
DG SUNGGU 838.19 1 922.01
155 APT010000I65003130 161850 ny. NOTOPA NEUROSANB5,324.00
DG SUNGGU  1 5,856.40
156 APT010000I65003130 161850 ny. NOTOPACAIRAN
DG SUNGGU 
RL 7,149.60 3 7,864.56
157 APT010000I65003130 161850 ny. NOTOPAMASKER
DG SUNGGU 
DI 700.00 2 770.00
158 APT010000I65003130 161850 ny. NOTOPAHANDSCOEN
DG SUNGGU 478.00 4 525.80
159 APT010000I65003130 161850 ny. NOTOPASPOIT
DG SUNGGU 
5 CC 1,595.00 1 1,754.50
160 APT010000I65003130 161850 ny. NOTOPACONECTA
DG SUNGGU 
13,200.00 1 14,520.00
161 APT010000I65003130 161850 ny. NOTOPASPOIT
DG SUNGGU 
3 CC 1,485.00 2 1,633.50
162 APT010000I65003130 161850 ny. NOTOPAINFUS
DG SUNGGU 
SET 7,920.00 1 8,712.00
163 APT010000I65003130 161850 ny. NOTOPASPOIT
DG SUNGGU 
10 C 2,310.00 2 2,541.00
164 APT010000I62004543 161832 ny. HARTATI
INFUS
NGANRO 
SET 7,920.00 1 8,712.00
165 APT010000I62004543 161832 ny. HARTATI
CONECTA
NGANRO 13,200.00 1 14,520.00
166 APT010000I62004543 161832 ny. HARTATI
SPOIT
NGANRO 
3 CC 1,485.00 1 1,633.50
167 APT010000I62004543 161832 ny. HARTATI
SPOIT
NGANRO 
5 CC 1,595.00 1 1,754.50
168 APT010000I62004543 161832 ny. HARTATI
SPOIT
NGANRO 
1 CC 1,920.00 1 2,112.00
169 APT010000I62004543 161832 ny. HARTATI
HANDSCOEN
NGANRO  478.00 2 525.80
170 APT010000I62004543 161832 ny. HARTATI
MASKER
NGANRO DI 700.00 1 770.00
171 APT010000I62004543 161832 ny. HARTATI
NASAL
NGANRO 
CA 11,550.07 1 12,705.07
172 APT010000I62004543 161832 ny. HARTATI
GUDEL
NGANRO 
DEW28,125.00 1 30,937.50
173 APT010000I31000563 161752 ny. RISMAWATI 
CAIRAN NAC6,409.70 2 7,050.67
174 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 10 C 2,310.00 2 2,541.00
175 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 5 CC 1,595.00 2 1,754.50
176 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 3 CC 1,485.00 2 1,633.50
177 APT010000I31000563 161752 ny. RISMAWATI 
HANDSCOEN 478.00 4 525.80
178 APT010000I31000563 161752 ny. RISMAWATI 
MASKER DI 700.00 2 770.00
179 APT010000I31000563 161752 ny. RISMAWATI 
CONECTA 13,200.00 1 14,520.00
180 APT010000I62004526 161746 ny. YOSPINA
CAIRAN
KAMMA RL 7,149.60 3 7,864.56
181 APT010000I62004526 161746 ny. YOSPINA
MASKER
KAMMA  DI 700.00 2 770.00
182 APT010000I62004526 161746 ny. YOSPINA
HANDSCOEN
KAMMA  478.00 4 525.80
183 APT010000I62004526 161746 ny. YOSPINA
SPOIT
KAMMA 
10 C 2,310.00 2 2,541.00
184 APT010000I62004526 161746 ny. YOSPINA
SPOIT
KAMMA 
5 CC 1,595.00 2 1,754.50
185 APT010000I62004526 161746 ny. YOSPINA
SPOIT
KAMMA 
3 CC 1,485.00 2 1,633.50
186 APT010000I62004526 161746 ny. YOSPINA
CONECTA
KAMMA 13,200.00 1 14,520.00
187 APT010000I62004526 161746 ny. YOSPINA
INFUS
KAMMA 
SET 7,920.00 1 8,712.00
188 APT010000I62004544 161844 nn. ANNISACAIRAN
AULIA  RL 7,149.60 3 7,864.56
189 APT010000I62004544 161844 nn. ANNISAMASKER
AULIA  DI 700.00 2 770.00
190 APT010000I62004544 161844 nn. ANNISAHANDSCOEN
AULIA  478.00 4 525.80
191 APT010000I62004544 161844 nn. ANNISASPOIT
AULIA 
10 C 2,310.00 2 2,541.00
192 APT010000I62004544 161844 nn. ANNISASPOIT
AULIA 
5 CC 1,595.00 2 1,754.50
193 APT010000I62004544 161844 nn. ANNISASPOIT
AULIA 
3 CC 1,485.00 2 1,633.50
194 APT010000I62004544 161844 nn. ANNISAINFUS
AULIA 
SET 7,920.00 1 8,712.00
195 APT010000I62004544 161844 nn. ANNISACONECTA
AULIA  13,200.00 1 14,520.00
196 APT010000I62004542 125603 nn. AYU PUTRI
INFUS
RACHMAN 
SET 7,920.00 1 8,712.00
197 APT010000I62004542 125603 nn. AYU PUTRI
SPOIT
RACHMAN 
1 CC 1,920.00 1 2,112.00
198 APT010000I62004542 125603 nn. AYU PUTRI
SPOIT
RACHMAN 
5 CC 1,595.00 1 1,754.50
199 APT010000I62004542 125603 nn. AYU PUTRI
SPOIT
RACHMAN 
3 CC 1,485.00 1 1,633.50
200 APT010000I62004542 125603 nn. AYU PUTRI
SPOIT
RACHMAN 
10 C 2,310.00 1 2,541.00
201 APT010000I62004542 125603 nn. AYU PUTRI
HANDSCOEN
RACHMAN  478.00 2 525.80
202 APT010000I62004542 125603 nn. AYU PUTRI
MASKER
RACHMAN 
DI 700.00 1 770.00
203 APT010000I62004542 125603 nn. AYU PUTRI
CAIRAN
RACHMAN 
AQ 2,860.00 1 3,146.00
204 APT010000I62004542 125603 nn. AYU PUTRI
CAIRAN
RACHMAN 
NA15,180.00 1 16,698.00
205 APT010000I62004541 161827 tn. JOHAMZAH 
CAIRAN RL 7,149.60 2 7,864.56
206 APT010000I62004541 161827 tn. JOHAMZAH 
SPOIT 3 CC 1,485.00 1 1,633.50
207 APT010000I62004541 161827 tn. JOHAMZAH 
SUNGKUP 44,750.00 1 49,225.00
208 APT010000I62004541 161827 tn. JOHAMZAH 
SPOIT 5 CC 1,595.00 1 1,754.50
209 APT010000I62004541 161827 tn. JOHAMZAH 
SPOIT 10 C 2,310.00 1 2,541.00
210 APT010000I62004541 161827 tn. JOHAMZAH 
NEBULIZE 40,535.00 1 44,588.50
211 APT010000I62004541 161827 tn. JOHAMZAH 
IV DRESSI 4,850.00 1 5,335.00
212 APT010000I62004541 161827 tn. JOHAMZAH 
HANDSCOEN 478.00 2 525.80
213 APT010000I62004541 161827 tn. JOHAMZAH 
MASKER DI 700.00 1 770.00
214 APT010000I62004541 161827 tn. JOHAMZAH 
CAIRAN NA15,180.00 1 16,698.00
215 APT010000I62004538 15737 ny. SRI KABDARIN
CAIRANDJUHARINI 
RL 7,149.60 2 7,864.56
216 APT010000I62004538 15737 ny. SRI KABDARIN
SPOIT 1DJUHARINI 
CC 1,920.00 1 2,112.00
217 APT010000I62004538 15737 ny. SRI KABDARIN
SPOIT 3DJUHARINI 
CC 1,485.00 1 1,633.50
218 APT010000I62004538 15737 ny. SRI KABDARIN
SPOIT 5DJUHARINI 
CC 1,595.00 1 1,754.50
219 APT010000I62004538 15737 ny. SRI KABDARIN
SPOIT 10
DJUHARINI 
C 2,310.00 1 2,541.00
220 APT010000I62004538 15737 ny. SRI KABDARIN
HANDSCOEN
DJUHARINI 
478.00 2 525.80
221 APT010000I62004538 15737 ny. SRI KABDARIN
MASKERDJUHARINI 
DI 700.00 1 770.00
222 APT010000I62004538 15737 ny. SRI KABDARIN
IV DRESSI
DJUHARINI 
4,850.00 1 5,335.00
223 APT010000I62004538 15737 ny. SRI KABDARIN
CAIRANDJUHARINI 
AQ 2,860.00 1 3,146.00
224 APT010000I62004538 15737 ny. SRI KABDARIN
NEBULIZE
DJUHARINI 
40,535.00 1 44,588.50
225 APT010000I66000437 161676 ny. HJ ERNAWATY 
CAIRAN RL 7,149.60 1 7,864.56
226 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 1 CC 1,920.00 1 2,112.00
227 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 3 CC 1,485.00 1 1,633.50
228 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 5 CC 1,595.00 1 1,754.50
229 APT010000I66000437 161676 ny. HJ ERNAWATY 
SPOIT 10 C 2,310.00 1 2,541.00
230 APT010000I66000437 161676 ny. HJ ERNAWATY 
HANDSCOEN 478.00 2 525.80
231 APT010000I66000437 161676 ny. HJ ERNAWATY 
MASKER DI 700.00 1 770.00
232 APT010000I66000437 161676 ny. HJ ERNAWATY 
IV DRESSI 4,850.00 1 5,335.00
233 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN RL 7,149.60 2 7,864.56
234 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 1 CC 1,920.00 1 2,112.00
235 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 3 CC 1,485.00 1 1,633.50
236 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 5 CC 1,595.00 1 1,754.50
237 APT010000I62004504 161146 ny. NIRWANA 
SPOIT 10 C 2,310.00 1 2,541.00
238 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 2 525.80
239 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 1 770.00
240 APT010000I62004504 161146 ny. NIRWANA 
IV DRESSI 4,850.00 1 5,335.00
241 APT010000I62004504 161146 ny. NIRWANA 
CAIRAN AQ 2,860.00 1 3,146.00
242 APT010000I64002973 123863 ny. MULIATICAIRAN
DG NGAI 
NAC6,409.70 3 7,050.67
243 APT010000I64002973 123863 ny. MULIATIIVDG
CATHETE
NGAI  7,750.00 1 8,525.00
244 APT010000I64002973 123863 ny. MULIATICONECTA
DG NGAI 13,200.00 1 14,520.00
245 APT010000I64002973 123863 ny. MULIATIIVDG
DRESSI
NGAI  4,850.00 1 5,335.00
246 APT010000I64002973 123863 ny. MULIATI
MASKER
DG NGAI DI 700.00 2 770.00
247 APT010000I64002973 123863 ny. MULIATI
HANDSCOEN
DG NGAI  478.00 4 525.80
248 APT010000I64002973 123863 ny. MULIATI
CAIRAN
DG NGAI 
NA15,180.00 1 16,698.00
249 APT010000I64002973 123863 ny. MULIATI
INFUS
DG NGAI 
SET 7,920.00 1 8,712.00
250 APT010000I64002973 123863 ny. MULIATI
TRANSFUSI28,050.00
DG NGAI  1 30,855.00
251 APT010000I64002973 123863 ny. MULIATI
SPOIT
DG NGAI 
3 CC 1,485.00 1 1,633.50
252 APT010000I64002973 123863 ny. MULIATI
SPOIT
DG NGAI 
5 CC 1,595.00 1 1,754.50
253 APT010000I64002973 123863 ny. MULIATI
SPOIT
DG NGAI 
10 C 2,310.00 1 2,541.00
254 APT010000I62004534 161785 nn. NURHADI
CAIRAN
HATIKA 
RL 7,149.60 4 7,864.56
255 APT010000I62004534 161785 nn. NURHADI
IV CATHETE
HATIKA  7,750.00 1 8,525.00
256 APT010000I62004534 161785 nn. NURHADI
CONECTA
HATIKA 13,200.00 1 14,520.00
257 APT010000I62004534 161785 nn. NURHADI
MASKER
HATIKA 
DI 700.00 2 770.00
258 APT010000I62004534 161785 nn. NURHADI
HANDSCOEN
HATIKA  478.00 4 525.80
259 APT010000I62004534 161785 nn. NURHADI
IV DRESSI
HATIKA  4,850.00 1 5,335.00
260 APT010000I62004534 161785 nn. NURHADI
CAIRAN
HATIKA 
NA15,180.00 1 16,698.00
261 APT010000I62004534 161785 nn. NURHADI
INFUSHATIKA 
SET 7,920.00 1 8,712.00
262 APT010000I62004534 161785 nn. NURHADI
SPOITHATIKA 
3 CC 1,485.00 1 1,633.50
263 APT010000I62004534 161785 nn. NURHADI
SPOITHATIKA 
5 CC 1,595.00 1 1,754.50
264 APT010000I62004534 161785 nn. NURHADI
SPOITHATIKA 
10 C 2,310.00 1 2,541.00
265 APT010000I62004537 161805 ny. ZURIATICAIRAN
N. TANIYO 
RL 7,149.60 3 7,864.56
266 APT010000I62004537 161805 ny. ZURIATIHANDSCOON
N. TANIYO 13,613.00 2 14,974.30
267 APT010000I62004537 161805 ny. ZURIATIMASKER
N. TANIYO 
DI 700.00 1 770.00
268 APT010000I62004537 161805 ny. ZURIATIIVN.DRESSI
TANIYO 4,850.00 1 5,335.00
269 APT010000I62004537 161805 ny. ZURIATICAIRAN
N. TANIYO 
NA15,180.00 2 16,698.00
270 APT010000I62004537 161805 ny. ZURIATIIVN.CATHETE
TANIYO 16,720.00 2 18,392.00
271 APT010000I62004537 161805 ny. ZURIATISPOIT
N. TANIYO 
5 CC 1,595.00 2 1,754.50
272 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CAIRAN RL IMRAN
7,149.60
H  3 7,864.56
273 APT010000I62004535 161791 tn. ANDI DZULFAHMI
MASKER DIIMRAN 700.00
H  1 770.00
274 APT010000I62004535 161791 tn. ANDI DZULFAHMI
IV DRESSI IMRAN
4,850.00
H  1 5,335.00
275 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CONECTA IMRAN13,200.00
H  2 14,520.00
276 APT010000I62004535 161791 tn. ANDI DZULFAHMI
INFUS SET IMRAN
7,920.00
H  1 8,712.00
277 APT010000I62004535 161791 tn. ANDI DZULFAHMI
IV CATHETEIMRAN
16,720.00
H  2 18,392.00
278 APT010000I64002984 161794 tn. RICHARD
CAIRAN
LEONARD 
RL 7,149.60 3 7,864.56
279 APT010000I64002984 161794 tn. RICHARD
IV LEONARD 
CATHETE 7,750.00 1 8,525.00
280 APT010000I64002984 161794 tn. RICHARD
HANDSCOEN
LEONARD  478.00 4 525.80
281 APT010000I64002984 161794 tn. RICHARD
SPOIT
LEONARD 
5 CC 1,595.00 2 1,754.50
282 APT010000I64002984 161794 tn. RICHARD
MASKER
LEONARD 
DI 700.00 1 770.00
283 APT010000I64002984 161794 tn. RICHARD
IV LEONARD 
DRESSI 4,850.00 1 5,335.00
284 APT010000I64002984 161794 tn. RICHARD
CAIRAN
LEONARD 
NA15,180.00 1 16,698.00
285 APT010000I62004536 161792 nn. ANDI SALMA
CAIRAN AQIB 
RL 7,149.60 2 7,864.56
286 APT010000I62004536 161792 nn. ANDI SALMA
MASKER AQIB 
DI 700.00 1 770.00
287 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
10 C 2,310.00 2 2,541.00
288 APT010000I62004536 161792 nn. ANDI SALMA
HANDSCOEN
AQIB  478.00 4 525.80
289 APT010000I62004536 161792 nn. ANDI SALMA
IV CATHETE
AQIB  7,750.00 1 8,525.00
290 APT010000I62004536 161792 nn. ANDI SALMA
CAIRAN AQIB 
NA15,180.00 1 16,698.00
291 APT010000I62004536 161792 nn. ANDI SALMA
IV DRESSI
AQIB  4,850.00 1 5,335.00
292 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
RL 7,149.60 4 7,864.56
293 APT010000I62004511 161613 an. MUHAMMAD
HANDSCOEN
TAQWA  478.00 4 525.80
294 APT010000I62004511 161613 an. MUHAMMAD
MASKER TAQWA 
DI 700.00 1 770.00
295 APT010000I62004511 161613 an. MUHAMMAD
SPOIT 3TAQWA 
CC 1,485.00 2 1,633.50
296 APT010000I62004511 161613 an. MUHAMMAD
IV CATHETE
TAQWA 
16,720.00 1 18,392.00
297 APT010000I62004511 161613 an. MUHAMMAD
IV DRESSI
TAQWA 
4,850.00 1 5,335.00
298 APT010000I62004511 161613 an. MUHAMMAD
CAIRANTAQWA 
NA15,180.00 1 16,698.00
299 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN NAC6,409.70 3 7,050.67
300 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 4 525.80
301 APT010000I62004517 161692 ny. DJANGKI 
IV CATHETE 7,750.00 1 8,525.00
302 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 3 CC 1,485.00 1 1,633.50
303 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 5 CC 1,595.00 1 1,754.50
304 APT010000I62004517 161692 ny. DJANGKI 
CONECTA 13,200.00 1 14,520.00
305 APT010000I62004517 161692 ny. DJANGKI 
IV DRESSI 4,850.00 1 5,335.00
306 APT010000I62004517 161692 ny. DJANGKI 
MASKER DI 700.00 2 770.00
307 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN NA15,180.00 2 16,698.00
308 APT010000I65003120 158007 ny. JUMIATI 
CAIRAN RL 7,149.60 3 7,864.56
309 APT010000I65003120 158007 ny. JUMIATI 
IV CATHETE 7,750.00 1 8,525.00
310 APT010000I65003120 158007 ny. JUMIATI 
CAIRAN NA15,180.00 2 16,698.00
311 APT010000I65003120 158007 ny. JUMIATI 
HANDSCOEN 478.00 4 525.80
312 APT010000I65003120 158007 ny. JUMIATI 
IV DRESSI 4,850.00 1 5,335.00
313 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 5 CC 1,595.00 1 1,754.50
314 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 10 C 2,310.00 1 2,541.00
315 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 3 CC 1,485.00 1 1,633.50
316 APT010000I65003120 158007 ny. JUMIATI 
CONECTA 13,200.00 1 14,520.00
317 APT010000I62004539 161825 tn. JARI  CAIRAN RL 7,149.60 3 7,864.56
318 APT010000I62004539 161825 tn. JARI  IV CATHETE 7,750.00 2 8,525.00
319 APT010000I62004539 161825 tn. JARI  IV DRESSI 4,850.00 1 5,335.00
320 APT010000I62004539 161825 tn. JARI  CONECTA 13,200.00 1 14,520.00
321 APT010000I62004539 161825 tn. JARI  HANDSCOEN 478.00 4 525.80
322 APT010000I62004539 161825 tn. JARI  MASKER DI 700.00 2 770.00
323 APT010000I62004539 161825 tn. JARI  SPOIT 10 C 2,310.00 1 2,541.00
324 APT010000I62004539 161825 tn. JARI  SPOIT 3 CC 1,485.00 1 1,633.50
325 APT010000I62004539 161825 tn. JARI  SPOIT 5 CC 1,595.00 1 1,754.50
326 APT010000I62004539 161825 tn. JARI  CAIRAN NA15,180.00 1 16,698.00
327 APT010000I62004531 161761 ny. SUNARTI 
CAIRAN NAC6,409.70 3 7,050.67
328 APT010000I62004531 161761 ny. SUNARTI 
IV CATHETE 7,750.00 1 8,525.00
329 APT010000I62004531 161761 ny. SUNARTI 
HANDSCOEN 478.00 4 525.80
330 APT010000I62004531 161761 ny. SUNARTI 
IV DRESSI 4,850.00 1 5,335.00
331 APT010000I62004531 161761 ny. SUNARTI 
INFUS SET 7,920.00 1 8,712.00
332 APT010000I62004531 161761 ny. SUNARTI 
MASKER DI 700.00 2 770.00
333 APT010000I62004531 161761 ny. SUNARTI 
CONECTA 13,200.00 1 14,520.00
334 APT010000I62004531 161761 ny. SUNARTI 
CAIRAN NA15,180.00 1 16,698.00
335 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 3 CC 1,485.00 1 1,633.50
 336 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 5 CC 1,595.00 1 1,754.50
337 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 10 C 2,310.00 1 2,541.00
338 APT010000I62004540 112479 tn. REZKI H CAIRAN RL 7,149.60 4 7,864.56
339 APT010000I62004540 112479 tn. REZKI H CONECTA 13,200.00 2 14,520.00
340 APT010000I62004540 112479 tn. REZKI H IV DRESSI 4,850.00 2 5,335.00
341 APT010000I62004540 112479 tn. REZKI H HANDSCOEN 478.00 4 525.80
342 APT010000I62004540 112479 tn. REZKI H MASKER DI 700.00 1 770.00
343 APT010000I62004540 112479 tn. REZKI H SPOIT 5 CC 1,595.00 2 1,754.50
344 APT010000I62004540 112479 tn. REZKI H CAIRAN NA15,180.00 2 16,698.00
345 APT010000I62004534 161785 nn. NURHADIRANITIDIN
HATIKA  7,040.00 2 7,744.00
346 APT010000I62004534 161785 nn. NURHADISOTATIC
HATIKA 
I 3,032.00 2 3,335.20
347 APT010000I62004534 161785 nn. NURHADIALPRAZOLA
HATIKA  1,915.83 1 2,107.42
348 APT010000I62004534 161785 nn. NURHADIAMBROXOL
HATIKA  199.65 3 219.62
Sub Total   717
30-12-
2018  1 APT010000I62004547 155788 tn. DRS. AHMAD
NASALMUSLIMIN
CA 11,550.07
  1 12,705.07

2 APT010000I62004547 155788 tn. DRS. AHMAD

COMBO MUSLIMIN
PAC
60,500.00
  1 66,550.00
3 APT010000I62004547 155788 tn. DRS. AHMAD
SPOIT MUSLIMIN
5 CC 1,595.00
  1 1,754.50
4 APT010000I62004547 155788 tn. DRS. AHMAD
FUROSEMID2,920.50
MUSLIMIN   2 3,212.55
5 APT010000I62004547 155788 tn. DRS. AHMAD
CAIRANMUSLIMIN
NAC6,409.70
  1 7,050.67
6 APT010000I62004547 155788 tn. DRS. AHMAD
HANDSCOEN
MUSLIMIN478.00
  4 525.80
7 APT010000I64002984 161794 tn. RICHARDGRATIZIN
LEONARD 4,741.00 1 5,215.10
8 APT010000I62004545 150008 nn. NOVITARANITIDIN
EKA SAFITRI 
7,040.00 2 7,744.00
9 APT010000I62004545 150008 nn. NOVITAVOSEDON
EKA SAFITRI 
T 2,431.00 3 2,674.10
10 APT010000I62004526 161746 ny. YOSPINACEFTRIAXO19,999.10
KAMMA  2 21,999.01
11 APT010000I62004526 161746 ny. YOSPINAKETOROLAC
KAMMA  7,350.75 3 8,085.82
12 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID2,920.50 4 3,212.55
13 APT010000I31000563 161752 ny. RISMAWATI 
RANITIDIN 7,040.00 2 7,744.00
14 APT010000I62004543 161832 ny. HARTATINEW
NGANRO 
DIAT 557.15 6 612.87
15 APT010000I62004543 161832 ny. HARTATIRANITIDIN
NGANRO  7,040.00 2 7,744.00
16 APT010000I62004543 161832 ny. HARTATIONDANSETR5,500.00
NGANRO  2 6,050.00

17 APT010000I62004544 161844 nn. ANNISAPARACETA

AULIA  68,062.50 3 74,868.75

18 APT010000I62004544 161844 nn. ANNISARANITIDIN

AULIA  7,040.00 2 7,744.00
19 APT010000I62004542 125603 nn. AYU PUTRI
SANMOL
RACHMAN 
T 297.00 9 326.70
20 APT010000I62004542 125603 nn. AYU PUTRI
LAPRAZ
RACHMAN 
30 12,232.00 6 13,455.20
21 APT010000I62004541 161827 tn. JOHAMZAH 
RANITIDIN 7,040.00 2 7,744.00
22 APT010000I62004541 161827 tn. JOHAMZAH 
CITICOLIN 10,011.38 4 11,012.51
23 APT010000I62004541 161827 tn. JOHAMZAH 
NEURODEX 770.00 1 847.00
24 APT010000I62004541 161827 tn. JOHAMZAH 
ASPILETS 816.20 3 897.82
25 APT010000I62004541 161827 tn. JOHAMZAH 
PIRACETAM10,670.00 2 11,737.00
26 APT010000I62004538 15737 ny. SRI KABDARIN
SANMOL DJUHARINI 
T 297.00 3 326.70
27 APT010000I62004538 15737 ny. SRI KABDARIN
SOTATICDJUHARINI 
I 3,032.00 2 3,335.20
28 APT010000I66000437 161676 ny. HJ ERNAWATY 
CITICOLIN 7,332.97 6 8,066.26
29 APT010000I66000437 161676 ny. HJ ERNAWATY 
ASPILETS 816.20 3 897.82
30 APT010000I66000437 161676 ny. HJ ERNAWATY 
NEURODEX 770.00 3 847.00
31 APT010000I66000437 161676 ny. HJ ERNAWATY 
RANITIDIN 629.99 6 692.99
32 APT010000I66000437 161676 ny. HJ ERNAWATY 
AMLODIPIN 475.19 3 522.71
33 APT010000I62004504 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
34 APT010000I62004504 161146 ny. NIRWANA 
SANTAGESIK4,949.40 3 5,444.34
35 APT010000I62004504 161146 ny. NIRWANA 
RANITIDIN 7,040.00 2 7,744.00
36 APT010000I62004504 161146 ny. NIRWANA 
URSODEOX 4,158.00 2 4,573.80
37 APT010000I62004504 161146 ny. NIRWANA 
SOTATIC I 3,032.00 3 3,335.20
38 APT010000I62004504 161146 ny. NIRWANA 
VITAMIN K 7,920.00 1 8,712.00

39 APT010000I62004533 99897 an. MUH. AIDIL

PARACETA
FITRAH68,062.50
B  3 74,868.75

40 APT010000I62004533 99897 an. MUH. AIDIL

SANPICILLI
FITRAH16,764.00
B  4 18,440.40
41 APT010000I62004521 146576 tn. SAHARUDDIN
EPEXOLHAMID 
TA 869.00 3 955.90

42 APT010000I62004521 146576 tn. SAHARUDDIN

PARACETA
HAMID 
68,062.50 3 74,868.75

43 APT010000I62004521 146576 tn. SAHARUDDIN

COMBIVENT4,549.95
HAMID  3 5,004.94
44 APT010000I62004521 146576 tn. SAHARUDDIN
RANITIDIN
HAMID 
7,040.00 2 7,744.00
45 APT010000I62004521 146576 tn. SAHARUDDIN
CEFTRIAXO19,999.10
HAMID  2 21,999.01
46 APT010000I62004521 146576 tn. SAHARUDDIN
NEURODEX
HAMID 770.00 2 847.00
47 APT010000I65003111 39079 ny. ELIK SULISTIYO
- PURBAWATI0   0 0
48 APT010000I65003111 39079 ny. ELIK SULISTIYO
FUROSEMID
PURBAWATI
190.99   1 210.09

49 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   3 54,450.00

50 APT010000I65003111 39079 ny. ELIK SULISTIYO

MECOBALAM
PURBAWATI
6,600.00   1 7,260.00
51 APT010000I65003111 39079 ny. ELIK SULISTIYO
RANITIDIN
PURBAWATI
7,040.00   2 7,744.00
52 APT010000I65003111 39079 ny. ELIK SULISTIYO
CITICOLIN
PURBAWATI
10,011.38   4 11,012.51
53 APT010000I65003111 39079 ny. ELIK SULISTIYO
DIGOKSINPURBAWATI
107.12   1 117.83
54 APT010000I65003111 39079 ny. ELIK SULISTIYO
SIMARC PURBAWATI
TA 975.98   1 1,073.58
55 APT010000I62004471 148491 ny. NURBAENI 
PUMPITOR 11,616.00 3 12,777.60
56 APT010000I62004471 148491 ny. NURBAENI 
AMLODIPIN 838.19 1 922.01
57 APT010000I62004471 148491 ny. NURBAENI 
TELMISART 5,445.00 1 5,989.50
58 APT010000I62004471 148491 ny. NURBAENI 
MELOXICAM 250.00 1 275.00
59 APT010000I62004471 148491 ny. NURBAENI 
CEFTRIAXO19,999.10 2 21,999.01
60 APT010000I65003130 161850 ny. NOTOPA CEFTRIAXO19,999.10
DG SUNGGU  2 21,999.01
61 APT010000I65003130 161850 ny. NOTOPA SANMOL
DG SUNGGU 
T 297.00 3 326.70
62 APT010000I65003130 161850 ny. NOTOPA AMLODIPIN
DG SUNGGU 838.19 1 922.01
63 APT010000I65003130 161850 ny. NOTOPA NEUROSANB5,324.00
DG SUNGGU  1 5,856.40
64 APT010000I62004545 150008 nn. NOVITARANITIDIN
EKA SAFITRI 
7,040.00 2 7,744.00
65 APT010000I62004545 150008 nn. NOVITAVOSEDON
EKA SAFITRI 
T 2,431.00 3 2,674.10
66 APT010000I65003112 161744 tn. BAKRI WAHID 
RANITIDIN 7,040.00 2 7,744.00
67 APT010000I65003112 161744 tn. BAKRI WAHID 
NEFROSTER49,599.00 1 54,558.90
68 APT010000I65003112 161744 tn. BAKRI WAHID 
CETIRIZIN 266.01 1 292.61
69 APT010000I65003112 161744 tn. BAKRI WAHID 
KSR 600 M 1,755.00 1 1,930.50
70 APT010000I62004511 161613 an. MUHAMMAD
B COMPLEK
TAQWA 76.34 6 83.97
71 APT010000I64002973 123863 ny. MULIATIPUMPITOR
DG NGAI 11,616.00 6 12,777.60
 72 APT010000I64002973 123863 ny. MULIATI
FUROSEMID
DG NGAI  190.99 9 210.09
73 APT010000I64002973 123863 ny. MULIATI
CONCOR
DG NGAI 
2. 597.00 3 656.70
74 APT010000I62004536 161792 nn. ANDI SALMA
PROPILTIO
AQIB  499.00 8 548.90
75 APT010000I62004536 161792 nn. ANDI SALMA
PROPANOLO
AQIB  119.79 3 131.77
76 APT010000I62004536 161792 nn. ANDI SALMA
NEURODEX
AQIB  770.00 3 847.00
77 APT010000I62004536 161792 nn. ANDI SALMA
NEUROSANB5,324.00
AQIB  1 5,856.40
78 APT010000I62004546 75663 ny. SYAMSIAH
DIMENHIDR
DG MAU  121.00 2 133.10
79 APT010000I62004546 75663 ny. SYAMSIAH
SANMOL
DG MAU 
T 297.00 3 326.70
80 APT010000I62004546 75663 ny. SYAMSIAH
NEURODEX
DG MAU  770.00 1 847.00
81 APT010000I62004531 161761 ny. SUNARTI 
METFORMI 190.00 3 209.00
82 APT010000I62004531 161761 ny. SUNARTI 
SOTATIC I 3,032.00 2 3,335.20
83 APT010000I62004531 161761 ny. SUNARTI 
RANITIDIN 7,040.00 2 7,744.00
84 APT010000I62004531 161761 ny. SUNARTI 
PREGABAL 5,500.00 2 6,050.00
85 APT010000I62004531 161761 ny. SUNARTI 
NEURODEX 770.00 1 847.00
86 APT010000I62004531 161761 ny. SUNARTI 
GLUCODEX 478.50 1 526.35
87 APT010000I62004531 161761 ny. SUNARTI 
ALPRAZOLA 1,915.83 1 2,107.42
88 APT010000I64002984 161794 tn. RICHARD
VERTIGOSA
LEONARD 4,528.33 2 4,981.17
89 APT010000I64002984 161794 tn. RICHARD
GRATIZIN
LEONARD 4,741.00 2 5,215.10
90 APT010000I64002984 161794 tn. RICHARD
TELMISART
LEONARD 5,445.00 1 5,989.50
91 APT010000I64002984 161794 tn. RICHARD
AMLODIPIN
LEONARD  475.19 1 522.71
92 APT010000I64002984 161794 tn. RICHARD
ASPILETS
LEONARD  816.20 1 897.82
93 APT010000I64002984 161794 tn. RICHARD
PREGABAL
LEONARD 5,500.00 1 6,050.00
94 APT010000I62004534 161785 nn. NURHADI
RANITIDIN
HATIKA  7,040.00 2 7,744.00
95 APT010000I62004534 161785 nn. NURHADI
SOTATIC
HATIKA 
I 3,032.00 2 3,335.20
96 APT010000I62004534 161785 nn. NURHADI
EPEXOL
HATIKA 
TA 869.00 3 955.90
97 APT010000I62004534 161785 nn. NURHADI
ALPRAZOLA
HATIKA  1,915.83 1 2,107.42
98 APT010000I65003120 158007 ny. JUMIATI 
RANITIDIN 7,040.00 2 7,744.00
99 APT010000I65003120 158007 ny. JUMIATI 
SANMOL T 297.00 3 326.70
100 APT010000I65003120 158007 ny. JUMIATI 
VOSEDON T 2,431.00 3 2,674.10
101 APT010000I65003120 158007 ny. JUMIATI 
NEURODEX 770.00 2 847.00
102 APT010000I65003120 158007 ny. JUMIATI 
GRATIZIN 4,741.00 1 5,215.10
103 APT010000I62004537 161805 ny. ZURIATISANMOL
N. TANIYO 
T 297.00 3 326.70
104 APT010000I62004537 161805 ny. ZURIATIBAQUINOR
N. TANIYO 
14,564.00 3 16,020.40
105 APT010000I62004537 161805 ny. ZURIATIPREGABAL
N. TANIYO 5,500.00 2 6,050.00
106 APT010000I62004517 161692 ny. DJANGKI 
ZINK OKSI 604.00 1 664.40
107 APT010000I62004517 161692 ny. DJANGKI 
B COMPLEK 76.34 6 83.97
108 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
109 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
110 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 2 21,999.01
111 APT010000I62004517 161692 ny. DJANGKI 
OMEPRAZOL 24,999.70 1 27,499.67
112 APT010000I62004535 161791 tn. ANDI DZULFAHMI
RANITIDIN IMRAN
7,040.00
H  2 7,744.00

113 APT010000I62004535 161791 tn. ANDI DZULFAHMI

PARACETA IMRAN
68,062.50
H  3 74,868.75

114 APT010000I12000083 161681 tn. H KULAU 

RANITIDIN 7,040.00 2 10,700.80
 112,869.2
115 APT010000I12000083 161681 tn. H KULAU 
METRONIDA
56,718.20 2
2

116 APT010000I12000083 MEROPENE240,240.0

161681 tn. H KULAU  2 408,408.0
0 0

117 APT010000I12000083 161681 tn. H KULAU 

CODIPRONT 7,937.60 10 10,715.76

118 APT010000I12000083 161681 tn. H KULAU 

SANTAGESIK4,949.40 3 8,760.44

119 APT010000I12000083 161681 tn. H KULAU 

FENTANYL 041,599.80 2 54,079.74

120 APT010000I62004540 112479 tn. REZKI H NEW DIAT 557.15 9 612.87

121 APT010000I62004547 155788 tn. DRS. AHMAD
INFUSAN
MUSLIMIN
N 6,712.06
  2 7,383.27
122 APT010000I62004547 155788 tn. DRS. AHMAD
FUROSEMID2,920.50
MUSLIMIN   4 3,212.55
123 APT010000I62004549 161877 tn. SAMSIR RANITIDIN 7,040.00 1 7,744.00
124 APT010000I62004549 161877 tn. SAMSIR ONDANSETR5,500.00 1 6,050.00
125 APT010000I62004549 161877 tn. SAMSIR FUROSEMID2,920.50 1 3,212.55
126 APT010000I62004549 161877 tn. SAMSIR SPOIT 3 CC 1,485.00 3 1,633.50
127 APT010000I62004549 161877 tn. SAMSIR CAIRAN AS 9,645.90 1 10,610.49
128 APT010000I62004549 161877 tn. SAMSIR COMBO PAC 60,500.00 1 66,550.00
129 APT010000I62004549 161877 tn. SAMSIR HANDSCOEN 478.00 4 525.80
130 APT010000I62004533 99897 an. MUH. AIDIL
CEFADROXI
FITRAH9,091.50
B  1 10,000.65
131 APT010000I62004533 99897 an. MUH. AIDIL
AMBROXOL
FITRAH B 199.65 3 219.62
132 APT010000I62004533 99897 an. MUH. AIDIL
CTM FITRAH
TAB 1,249.00
B  5 1,373.90
133 APT010000I62004533 99897 an. MUH. AIDIL
DEKSAMETA
FITRAH B 149.07 10 163.98
134 APT010000I62004533 99897 an. MUH. AIDIL
KERTAS
FITRAH
PU B 613.00 9 674.30
135 APT010000I62004549 161877 tn. SAMSIR CAIRAN NAC6,409.70 2 7,050.67
136 APT010000I62004549 161877 tn. SAMSIR NEFROSTER49,599.00 1 54,558.90
137 APT010000I62004549 161877 tn. SAMSIR SOTATIC I 3,032.00 3 3,335.20
138 APT010000I62004549 161877 tn. SAMSIR LANSOPRAZ 851.29 1 936.42
139 APT010000I62004549 161877 tn. SAMSIR VALSARTAN 2,420.00 1 2,662.00
140 APT010000I62004549 161877 tn. SAMSIR AMLODIPIN 838.19 1 922.01
141 APT010000I62004549 161877 tn. SAMSIR ISOSORBID 102.85 3 113.14
142 APT010000I62004504 161146 ny. NIRWANA 
DULCOLAX 2,247.81 2 2,472.59
143 APT010000I62004504 161146 ny. NIRWANA 
DULCOLAX 23,571.24 2 25,928.36
144 APT010000I62004504 161146 ny. NIRWANA 
SANTAGESIK4,949.40 1 5,444.34
145 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
COMBO PAC 60,500.00 1 66,550.00
146 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
CAIRAN RL 7,149.60 1 7,864.56
147 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
SPOIT 3 CC 1,485.00 2 1,633.50
148 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
RANITIDIN 7,040.00 1 7,744.00
149 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
KETOROLAC 7,350.75 1 8,085.82
150 APT010000I12000083 161681 tn. H KULAU 
OMEPRAZOL 24,999.70 1 33,749.60
151 APT010000I65003120 158007 ny. JUMIATI 
CAIRAN RL 7,149.60 2 7,864.56
152 APT010000I65003120 158007 ny. JUMIATI 
MASKER DI 700.00 1 770.00
153 APT010000I65003120 158007 ny. JUMIATI 
HANDSCOEN 478.00 4 525.80
154 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 3 CC 1,485.00 1 1,633.50
155 APT010000I65003120 158007 ny. JUMIATI 
SPOIT 10 C 2,310.00 1 2,541.00
156 APT010000I65003120 158007 ny. JUMIATI 
IV CATHETE 7,750.00 1 8,525.00
157 APT010000I65003120 158007 ny. JUMIATI 
IV CATHETE12,416.00 1 13,657.60
158 APT010000I62004537 161805 ny. ZURIATICAIRAN
N. TANIYO 
RL 7,149.60 3 7,864.56
159 APT010000I62004537 161805 ny. ZURIATICAIRAN
N. TANIYO 
NA15,180.00 2 16,698.00
160 APT010000I62004537 161805 ny. ZURIATIMASKER
N. TANIYO 
DI 700.00 2 770.00
161 APT010000I62004537 161805 ny. ZURIATIHANDSCOON
N. TANIYO 13,613.00 2 14,974.30
162 APT010000I62004537 161805 ny. ZURIATIIVN.DRESSI
TANIYO 4,850.00 1 5,335.00
163 APT010000I62004537 161805 ny. ZURIATIIVN.CATHETE
TANIYO 16,720.00 2 18,392.00
164 APT010000I62004537 161805 ny. ZURIATISPOIT
N. TANIYO 
3 CC 1,485.00 2 1,633.50
165 APT010000I62004539 161825 tn. JARI  CAIRAN NAC6,409.70 3 7,050.67
166 APT010000I62004539 161825 tn. JARI  MASKER DI 700.00 2 770.00
167 APT010000I62004539 161825 tn. JARI  HANDSCOEN 478.00 4 525.80
168 APT010000I62004539 161825 tn. JARI  TRANSFUSI28,050.00 1 30,855.00
169 APT010000I62004539 161825 tn. JARI  IV CATHETE12,416.00 1 13,657.60
170 APT010000I62004539 161825 tn. JARI  CONECTA 25,000.00 1 27,500.00
171 APT010000I62004539 161825 tn. JARI  SPOIT 10 C 2,310.00 2 2,541.00
172 APT010000I62004539 161825 tn. JARI  SPOIT 5 CC 1,595.00 2 1,754.50
173 APT010000I62004539 161825 tn. JARI  SPOIT 3 CC 1,485.00 2 1,633.50
174 APT010000I62004546 75663 ny. SYAMSIAH
MASKERDG MAU 
DI 700.00 2 770.00
175 APT010000I62004546 75663 ny. SYAMSIAH
HANDSCOEN
DG MAU  478.00 4 525.80
176 APT010000I62004546 75663 ny. SYAMSIAH
CAIRANDG MAU 
RL 7,149.60 3 7,864.56
177 APT010000I62004546 75663 ny. SYAMSIAH
INFUS DGSET
MAU 7,920.00 1 8,712.00
178 APT010000I62004546 75663 ny. SYAMSIAH
CONECTA
DG MAU 25,000.00 1 27,500.00
179 APT010000I62004546 75663 ny. SYAMSIAH
IV CATHETE
DG MAU 7,750.00 1 8,525.00
180 APT010000I62004546 75663 ny. SYAMSIAH
IV DRESSI
DG MAU 4,850.00 1 5,335.00
181 APT010000I62004517 161692 ny. DJANGKI 
CAIRAN RL 7,149.60 2 7,864.56
182 APT010000I62004517 161692 ny. DJANGKI 
MASKER DI 700.00 1 770.00
183 APT010000I62004517 161692 ny. DJANGKI 
HANDSCOEN 478.00 4 525.80
184 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 1 CC 1,920.00 1 2,112.00
185 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 3 CC 1,485.00 1 1,633.50
186 APT010000I62004517 161692 ny. DJANGKI 
SPOIT 5 CC 1,595.00 1 1,754.50
187 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CAIRAN RL IMRAN
7,149.60
H  3 7,864.56
188 APT010000I62004535 161791 tn. ANDI DZULFAHMI
HANDSCOEN IMRAN
478.00
H  4 525.80
189 APT010000I62004535 161791 tn. ANDI DZULFAHMI
CAIRAN NA15,180.00
IMRAN H  2 16,698.00
190 APT010000I62004535 161791 tn. ANDI DZULFAHMI
MASKER DIIMRAN 700.00
H  1 770.00
191 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SPOIT 5 CCIMRAN
1,595.00
H  2 1,754.50
192 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SPOIT 3 CCIMRAN
1,485.00
H  2 1,633.50
193 APT010000I62004535 161791 tn. ANDI DZULFAHMI
IV DRESSI IMRAN
4,850.00
H  1 5,335.00
194 APT010000I31000567 159753 an. AINURRAFIQAH 
CAIRAN RL 7,149.60 3 7,864.56
195 APT010000I31000567 159753 an. AINURRAFIQAH 
IV DRESSI 4,850.00 1 5,335.00
196 APT010000I31000567 159753 an. AINURRAFIQAH 
HANDSCOEN 478.00 4 525.80
197 APT010000I31000567 159753 an. AINURRAFIQAH 
TRANSFUSI28,050.00 1 30,855.00
198 APT010000I31000567 159753 an. AINURRAFIQAH 
SPOIT 10 C 2,310.00 2 2,541.00
199 APT010000I31000567 159753 an. AINURRAFIQAH 
SPOIT 5 CC 1,595.00 2 1,754.50
200 APT010000I62004531 161761 ny. SUNARTI 
HANDSCOEN 478.00 2 525.80
201 APT010000I62004531 161761 ny. SUNARTI 
MASKER DI 700.00 1 770.00
202 APT010000I62004531 161761 ny. SUNARTI 
CAIRAN NAC6,409.70 2 7,050.67
203 APT010000I62004531 161761 ny. SUNARTI 
SPOIT 3 CC 1,485.00 1 1,633.50
204 APT010000I62004531 161761 ny. SUNARTI 
IV CATHETE 7,750.00 1 8,525.00
205 APT010000I62004534 161785 nn. NURHADICAIRAN
HATIKA 
RL 7,149.60 4 7,864.56
206 APT010000I62004534 161785 nn. NURHADIHANDSCOEN
HATIKA  478.00 2 525.80
207 APT010000I62004534 161785 nn. NURHADIMASKER
HATIKA 
DI 700.00 1 770.00
208 APT010000I62004534 161785 nn. NURHADISPOIT
HATIKA 
3 CC 1,485.00 1 1,633.50
209 APT010000I64002984 161794 tn. RICHARDMASKER
LEONARD 
DI 700.00 2 770.00
210 APT010000I64002984 161794 tn. RICHARDHANDSCOEN
LEONARD  478.00 4 525.80
211 APT010000I64002984 161794 tn. RICHARDSUNGKUP
LEONARD  44,750.00 1 49,225.00
212 APT010000I62004536 161792 nn. ANDI SALMA
NEURODEX
AQIB  770.00 2 847.00
213 APT010000I62004536 161792 nn. ANDI SALMA
PROPANOLO
AQIB  75.90 4 83.49
214 APT010000I62004536 161792 nn. ANDI SALMA
HANDSCOEN
AQIB  478.00 4 525.80
215 APT010000I62004536 161792 nn. ANDI SALMA
MASKER AQIB 
DI 700.00 1 770.00
216 APT010000I62004536 161792 nn. ANDI SALMA
CAIRAN AQIB 
NAC6,409.70 2 7,050.67
217 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
3 CC 1,485.00 1 1,633.50
218 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
10 C 2,310.00 1 2,541.00
219 APT010000I62004536 161792 nn. ANDI SALMA
IV CATHETE
AQIB  7,750.00 1 8,525.00
220 APT010000I62004536 161792 nn. ANDI SALMA
IV CATHETE
AQIB  7,750.00 1 8,525.00
221 APT010000I62004504 161146 ny. NIRWANA 
DULCOLAX 23,571.24 2 25,928.36
222 APT010000I62004504 161146 ny. NIRWANA 
HANDSCOEN 478.00 2 525.80
223 APT010000I62004504 161146 ny. NIRWANA 
MASKER DI 700.00 1 770.00
224 APT010000I65003111 39079 ny. ELIK SULISTIYO
CAIRAN PURBAWATI
RL 7,149.60   2 7,864.56
225 APT010000I65003111 39079 ny. ELIK SULISTIYO
MASKERPURBAWATI
DI 700.00   2 770.00
226 APT010000I65003111 39079 ny. ELIK SULISTIYO
HANDSCOENPURBAWATI
478.00   4 525.80
227 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 3 CC
PURBAWATI
1,485.00   2 1,633.50
228 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 10PURBAWATI
C 2,310.00   2 2,541.00
229 APT010000I65003111 39079 ny. ELIK SULISTIYO
SPOIT 5 CC
PURBAWATI
1,595.00   2 1,754.50
230 APT010000I65003111 39079 ny. ELIK SULISTIYO
IV CATHETE
PURBAWATI
7,750.00   1 8,525.00
231 APT010000I65003111 39079 ny. ELIK SULISTIYO
INFUS SETPURBAWATI
7,920.00   1 8,712.00
232 APT010000I65003130 161850 ny. NOTOPA CAIRAN
DG SUNGGU 
RL 7,149.60 2 7,864.56
233 APT010000I65003130 161850 ny. NOTOPA MASKER
DG SUNGGU 
DI 700.00 2 770.00
234 APT010000I65003130 161850 ny. NOTOPA HANDSCOEN
DG SUNGGU 478.00 4 525.80
235 APT010000I65003130 161850 ny. NOTOPA SPOIT
DG SUNGGU 
5 CC 1,595.00 2 1,754.50
236 APT010000I65003130 161850 ny. NOTOPA SPOIT
DG SUNGGU 
10 C 2,310.00 2 2,541.00
237 APT010000I65003130 161850 ny. NOTOPA IV DG
CATHETE
SUNGGU 7,750.00 1 8,525.00
238 APT010000I65003130 161850 ny. NOTOPA CONECTA
DG SUNGGU 
25,000.00 1 27,500.00
239 APT010000I65003130 161850 ny. NOTOPA TRANSFUSI28,050.00
DG SUNGGU  1 30,855.00
240 APT010000I62004545 150008 nn. NOVITACAIRAN
EKA SAFITRI 
RL 7,149.60 2 7,864.56
241 APT010000I62004545 150008 nn. NOVITAHANDSCOEN
EKA SAFITRI  478.00 4 525.80
242 APT010000I62004545 150008 nn. NOVITAMASKER
EKA SAFITRI 
DI 700.00 2 770.00
243 APT010000I62004545 150008 nn. NOVITASPOIT
EKA SAFITRI 
10 C 2,310.00 2 2,541.00
244 APT010000I62004545 150008 nn. NOVITASPOIT
EKA SAFITRI 
5 CC 1,595.00 2 1,754.50
245 APT010000I62004545 150008 nn. NOVITACONECTA
EKA SAFITRI 
25,000.00 1 27,500.00
246 APT010000I62004545 150008 nn. NOVITAIVEKA
CATHETE
SAFITRI 
7,750.00 1 8,525.00
247 APT010000I62004545 150008 nn. NOVITATRANSFUSI28,050.00
EKA SAFITRI  1 30,855.00
248 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 3HAMID 
CC 1,485.00 2 1,633.50
249 APT010000I62004521 146576 tn. SAHARUDDIN
SPOIT 5HAMID 
CC 1,595.00 2 1,754.50
250 APT010000I62004521 146576 tn. SAHARUDDIN
IV CATHETE
HAMID 
7,750.00 1 8,525.00
251 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
RL 7,149.60 2 7,864.56
252 APT010000I62004521 146576 tn. SAHARUDDIN
HANDSCOEN
HAMID 478.00 4 525.80
253 APT010000I62004521 146576 tn. SAHARUDDIN
MASKER HAMID 
DI 700.00 1 770.00
254 APT010000I62004521 146576 tn. SAHARUDDIN
CAIRANHAMID 
AQ 2,860.00 1 3,146.00
255 APT010000I62004547 155788 tn. DRS. AHMAD
SPOIT MUSLIMIN
3 CC 1,485.00
  1 1,633.50
256 APT010000I62004547 155788 tn. DRS. AHMAD
SPOIT MUSLIMIN
5 CC 1,595.00
  1 1,754.50
257 APT010000I62004547 155788 tn. DRS. AHMAD
SPOIT MUSLIMIN
10 C 2,310.00
  1 2,541.00
258 APT010000I62004547 155788 tn. DRS. AHMAD
CAIRANMUSLIMIN
NAC6,409.70
  2 7,050.67
259 APT010000I62004547 155788 tn. DRS. AHMAD
HANDSCOEN
MUSLIMIN 478.00
  2 525.80
260 APT010000I62004547 155788 tn. DRS. AHMAD
MASKERMUSLIMIN
DI 700.00  1 770.00
261 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 3 CC 1,485.00 1 1,633.50
262 APT010000I65003112 161744 tn. BAKRI WAHID 
SPOIT 5 CC 1,595.00 1 1,754.50
263 APT010000I65003112 161744 tn. BAKRI WAHID 
IV CATHETE 7,750.00 1 8,525.00
264 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN RL 7,149.60 2 7,864.56
265 APT010000I65003112 161744 tn. BAKRI WAHID 
HANDSCOEN 478.00 2 525.80
266 APT010000I65003112 161744 tn. BAKRI WAHID 
MASKER DI 700.00 1 770.00
267 APT010000I65003112 161744 tn. BAKRI WAHID 
CAIRAN AQ 2,860.00 1 3,146.00
268 APT010000I62004549 161877 tn. SAMSIR SPOIT 5 CC 1,595.00 1 1,754.50
269 APT010000I62004549 161877 tn. SAMSIR SPOIT 3 CC 1,485.00 1 1,633.50
270 APT010000I62004549 161877 tn. SAMSIR SPOIT 10 C 2,310.00 1 2,541.00
271 APT010000I62004549 161877 tn. SAMSIR CAIRAN RL 7,149.60 2 7,864.56
272 APT010000I62004549 161877 tn. SAMSIR HANDSCOEN 478.00 2 525.80
273 APT010000I62004549 161877 tn. SAMSIR MASKER DI 700.00 1 770.00
274 APT010000I31000563 161752 ny. RISMAWATI 
CAIRAN RL 7,149.60 2 7,864.56
275 APT010000I31000563 161752 ny. RISMAWATI 
HANDSCOEN 478.00 4 525.80
276 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 10 C 2,310.00 2 2,541.00
277 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 5 CC 1,595.00 2 1,754.50
278 APT010000I31000563 161752 ny. RISMAWATI 
IV CATHETE 7,750.00 1 8,525.00
279 APT010000I31000563 161752 ny. RISMAWATI 
MASKER DI 700.00 2 770.00
280 APT010000I31000563 161752 ny. RISMAWATI 
SPOIT 3 CC 1,485.00 2 1,633.50
281 APT010000I31000563 161752 ny. RISMAWATI 
CONECTA 25,000.00 1 27,500.00
282 APT010000I31000563 161752 ny. RISMAWATI 
INFUS SET 7,920.00 1 8,712.00
283 APT010000I62004471 148491 ny. NURBAENI 
MASKER DI 700.00 2 770.00
284 APT010000I62004471 148491 ny. NURBAENI 
CAIRAN NA15,180.00 2 16,698.00
285 APT010000I62004471 148491 ny. NURBAENI 
HANDSCOEN 478.00 4 525.80
286 APT010000I62004471 148491 ny. NURBAENI 
CONECTA 25,000.00 1 27,500.00
287 APT010000I62004471 148491 ny. NURBAENI 
IV CATHETE 7,750.00 1 8,525.00
288 APT010000I62004471 148491 ny. NURBAENI 
SPOIT 10 C 2,310.00 1 2,541.00
289 APT010000I62004471 148491 ny. NURBAENI 
SUNGKUP 44,750.00 1 49,225.00
290 APT010000I62004471 148491 ny. NURBAENI 
FOLEY CAT 33,000.00 1 36,300.00
 291 APT010000I62004471 148491 ny. NURBAENI 
URINE BAG 8,835.00 1 9,718.50
292 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
SPOIT 5 CC 1,595.00 1 1,754.50
293 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
SPOIT 3 CC 1,485.00 1 1,633.50
294 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
CAIRAN NAC6,409.70 2 7,050.67
295 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
IV CATHETE 7,750.00 1 8,525.00
296 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
HANDSCOEN 478.00 1 525.80
297 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
MASKER DI 700.00 1 770.00
298 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
CIPROFLOX 770.00 2 847.00
299 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
VALISANBE 236.50 3 260.15
Sub Total   644
31-12-
1 APT010000I62004551 161895 tn. SAHAMAD 
RANITIDIN 7,040.00 2 7,744.00
2018 
2 APT010000I62004551 161895 tn. SAHAMAD 
VOSEDON T 2,431.00 3 2,674.10
3 APT010000I62004551 161895 tn. SAHAMAD 
VALSARTAN 2,420.00 1 2,662.00
4 APT010000I62004551 161895 tn. SAHAMAD 
AMLODIPIN 838.19 1 922.01
5 APT010000I62004552 161897 tn. AWAL ANUGRAH
CAIRAN RL  7,149.60 1 7,864.56
6 APT010000I62004552 161897 tn. AWAL ANUGRAH
SANMOL T  297.00 3 326.70
7 APT010000I62004552 161897 tn. AWAL ANUGRAH
RANITIDIN  7,040.00 2 7,744.00
8 APT010000I62004521 146576 tn. SAHARUDDIN
RANITIDIN
HAMID 
7,040.00 2 7,744.00

9 APT010000I62004521 146576 tn. SAHARUDDIN

PARACETA
HAMID 
68,062.50 3 74,868.75

10 APT010000I12000083 161681 tn. H KULAU 

CAIRAN AM70,188.80 1 94,754.88
11 APT010000I12000083 161681 tn. H KULAU 
ACETYLCYS 1,100.00 3 1,705.00
12 APT010000I12000083 161681 tn. H KULAU 
RANITIDIN 7,040.00 2 10,700.80
13 APT010000I12000083 161681 tn. H KULAU 
FUROSEMID 190.99 1 257.84

14 APT010000I12000083 MEROPENE240,240.0
161681 tn. H KULAU  2 408,408.0
0 0
15 APT010000I12000083 161681 tn. H KULAU 
METAMIZOL4,999.99 3 6,749.99
16 APT010000I12000083 161681 tn. H KULAU 
OMEPRAZOL
24,999.70 1 33,749.60

17 APT010000I12000083 161681 tn. H KULAU 

CODIPRONT 7,937.60 10 10,715.76

18 APT010000I62004545 150008 nn. NOVITARANITIDIN

EKA SAFITRI 
7,040.00 2 7,744.00
19 APT010000I62004545 150008 nn. NOVITAMELOXICAM
EKA SAFITRI  923.23 1 1,015.55
20 APT010000I62004544 161844 nn. ANNISACEFTRIAXO19,999.10
AULIA  3 21,999.01
21 APT010000I62004544 161844 nn. ANNISARANITIDIN
AULIA  7,040.00 2 7,744.00
22 APT010000I62004544 161844 nn. ANNISASANMOL
AULIA  T 297.00 3 326.70
23 APT010000I65003130 161850 ny. NOTOPACEFTRIAXO19,999.10
DG SUNGGU  2 21,999.01
24 APT010000I65003130 161850 ny. NOTOPAAMLODIPIN
DG SUNGGU 838.19 1 922.01
25 APT010000I65003130 161850 ny. NOTOPANEUROSANB5,324.00
DG SUNGGU  1 5,856.40
26 APT010000I65003112 161744 tn. BAKRI WAHID 
CETIRIZIN 266.01 1 292.61
27 APT010000I65003112 161744 tn. BAKRI WAHID 
SANMOL T 297.00 3 326.70
28 APT010000I65003112 161744 tn. BAKRI WAHID 
NEFROSTER49,599.00 1 54,558.90
29 APT010000I65003112 161744 tn. BAKRI WAHID 
KSR 600 M 1,755.00 1 1,930.50
30 APT010000I62004549 161877 tn. SAMSIR NEFROSTER49,599.00 1 54,558.90
31 APT010000I62004549 161877 tn. SAMSIR AMLODIPIN 838.19 1 922.01
32 APT010000I62004549 161877 tn. SAMSIR ONDANSETR5,500.00 3 6,050.00
33 APT010000I62004549 161877 tn. SAMSIR DIOVAN 8012,432.04 1 13,675.25
34 APT010000I62004526 161746 ny. YOSPINACEFTRIAXO19,999.10
KAMMA  2 21,999.01
35 APT010000I62004526 161746 ny. YOSPINAKETOROLAC
KAMMA  7,350.75 3 8,085.82
36 APT010000I62004526 161746 ny. YOSPINAZINK
KAMMA 
OKSI 604.00 1 664.40
37 APT010000I62004526 161746 ny. YOSPINAB COMPLEK
KAMMA  76.34 6 83.97
38 APT010000I62004553 110199 tn. LUTHFI CITICOLIN 10,011.38 4 11,012.51
39 APT010000I62004553 110199 tn. LUTHFI ASPILETS 816.20 2 897.82
40 APT010000I62004553 110199 tn. LUTHFI NEURODEX 770.00 1 847.00
41 APT010000I62004553 110199 tn. LUTHFI RANITIDIN 7,040.00 2 7,744.00
42 APT010000I31000563 161752 ny. RISMAWATI 
FUROSEMID 190.99 6 210.09
43 APT010000I31000563 161752 ny. RISMAWATI 
PUMPITOR 11,616.00 6 12,777.60
44 APT010000I31000563 161752 ny. RISMAWATI 
AMLODIPIN 838.19 3 922.01
45 APT010000I31000563 161752 ny. RISMAWATI 
CETIRIZIN 266.01 6 292.61
46 APT010000I62004543 161832 ny. HARTATILAPRAZ
NGANRO 
30 12,232.00 6 13,455.20
47 APT010000I62004543 161832 ny. HARTATINEURODEX
NGANRO  770.00 3 847.00
48 APT010000I62004543 161832 ny. HARTATINEW
NGANRO 
DIAT 557.15 9 612.87
49 APT010000I62004538 15737 ny. SRI KABDARIN
ALPRAZOLDJUHARINI 
1,023.66 5 1,126.03
50 APT010000I62004538 15737 ny. SRI KABDARIN
BUSCOPANDJUHARINI 
4,327.40 9 4,760.14
51 APT010000I62004538 15737 ny. SRI KABDARIN
SOTATICDJUHARINI 
T 394.90 9 434.39
52 APT010000I62004538 15737 ny. SRI KABDARIN
CEFIXIMEDJUHARINI 
1,317.02 6 1,448.73
53 APT010000I62004538 15737 ny. SRI KABDARIN
CANGKANGDJUHARINI 
116.90 9 128.59
54 APT010000I65003111 39079 ny. ELIK SULISTIYO
FUROSEMID
PURBAWATI
190.99   1 210.09
55 APT010000I65003111 39079 ny. ELIK SULISTIYO
DIGOKSINPURBAWATI
107.12   1 117.83
56 APT010000I65003111 39079 ny. ELIK SULISTIYO
SIMARC PURBAWATI
TA 975.98   1 1,073.58
57 APT010000I65003111 39079 ny. ELIK SULISTIYO
CITICOLIN
PURBAWATI
10,011.38   4 11,012.51
58 APT010000I65003111 39079 ny. ELIK SULISTIYO
MECOBALAM
PURBAWATI
6,600.00   1 7,260.00
59 APT010000I65003111 39079 ny. ELIK SULISTIYO
RANITIDIN
PURBAWATI
7,040.00   2 7,744.00

60 APT010000I65003111 39079 ny. ELIK SULISTIYO

METIL PRE
PURBAWATI
49,500.00   2 54,450.00

61 APT010000I65003111 39079 ny. ELIK SULISTIYO

OBH SYRUP
PURBAWATI
7,700.00   1 8,470.00
62 APT010000I62004541 161827 tn. JOHAMZAH 
CITICOLIN 7,332.97 2 8,066.26
63 APT010000I62004541 161827 tn. JOHAMZAH 
ASPILETS 816.20 1 897.82
64 APT010000I62004541 161827 tn. JOHAMZAH 
NEURODEX 770.00 1 847.00
65 APT010000I62004547 155788 tn. DRS. AHMAD
CEFTRIAXO19,999.10
MUSLIMIN   2 21,999.01
66 APT010000I62004547 155788 tn. DRS. AHMAD
COMBIVENT4,549.95
MUSLIMIN   2 5,004.94
67 APT010000I62004504 161146 ny. NIRWANA 
CEFTRIAXO19,999.10 2 21,999.01
68 APT010000I62004504 161146 ny. NIRWANA 
URSODEOX 4,158.00 2 4,573.80
69 APT010000I62004504 161146 ny. NIRWANA 
VITAMIN K 7,920.00 1 8,712.00
70 APT010000I62004504 161146 ny. NIRWANA 
SANTAGESIK4,949.40 1 5,444.34
71 APT010000I62004546 75663 ny. SYAMSIAH
DIMENHIDR
DG MAU  121.00 6 133.10
72 APT010000I62004546 75663 ny. SYAMSIAH
SANMOL
DG MAU 
T 297.00 9 326.70
73 APT010000I62004546 75663 ny. SYAMSIAH
NEURODEX
DG MAU  770.00 3 847.00
74 APT010000I62004534 161785 nn. NURHADIALPRAZOLA
HATIKA  1,915.83 3 2,107.42
75 APT010000I62004534 161785 nn. NURHADISOTATIC
HATIKA 
T 394.90 9 434.39
 76 APT010000I62004534 161785 nn. NURHADI
AMBROXOL
HATIKA  199.65 9 219.62
77 APT010000I62004537 161805 ny. ZURIATISANMOL
N. TANIYO 
T 297.00 9 326.70

78 APT010000I62004537 161805 ny. ZURIATIBAQUINOR

N. TANIYO 
14,564.00 9 16,020.40

79 APT010000I62004531 161761 ny. SUNARTI 

GLUCODEX 478.50 3 526.35
80 APT010000I62004531 161761 ny. SUNARTI 
METFORMI 190.00 3 209.00
81 APT010000I62004531 161761 ny. SUNARTI 
NEURODEX 770.00 3 847.00
82 APT010000I62004531 161761 ny. SUNARTI 
ALPRAZOLA 1,915.83 3 2,107.42
83 APT010000I64002984 161794 tn. RICHARDVERTIGOSA
LEONARD 4,528.33 2 4,981.17
84 APT010000I64002984 161794 tn. RICHARDGRATIZIN
LEONARD 4,741.00 1 5,215.10
85 APT010000I64002984 161794 tn. RICHARDTELMISART
LEONARD 5,445.00 1 5,989.50
86 APT010000I64002984 161794 tn. RICHARDAMLODIPIN
LEONARD  838.19 1 922.01
87 APT010000I64002984 161794 tn. RICHARDASPILETS
LEONARD  816.20 1 897.82
88 APT010000I64002984 161794 tn. RICHARDPIRACETAM
LEONARD  618.31 2 680.14
89 APT010000I62004535 161791 tn. ANDI DZULFAHMI
SANMOL T IMRAN297.00
H  9 326.70
90 APT010000I62004535 161791 tn. ANDI DZULFAHMI
NEW DIAT IMRAN557.15
H  9 612.87
91 APT010000I62004535 161791 tn. ANDI DZULFAHMI
BAQUINORIMRAN
14,564.00
H  3 16,020.40
92 APT010000I31000567 159753 an. AINURRAFIQAH 
CEFTRIAXO19,999.10 2 21,999.01
93 APT010000I62004517 161692 ny. DJANGKI 
NEUROSANB5,324.00 1 5,856.40
94 APT010000I62004517 161692 ny. DJANGKI 
CEFTRIAXO19,999.10 1 21,999.01
95 APT010000I62004517 161692 ny. DJANGKI 
ZINK OKSI 604.00 1 664.40
96 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
97 APT010000I62004517 161692 ny. DJANGKI 
B COMPLEK 76.34 6 83.97
98 APT010000I65003120 158007 ny. JUMIATI 
NEURODEX 770.00 6 847.00
99 APT010000I65003120 158007 ny. JUMIATI 
SANMOL T 297.00 9 326.70
100 APT010000I65003120 158007 ny. JUMIATI 
AMLODIPIN 838.19 3 922.01
101 APT010000I62004536 161792 nn. ANDI SALMA
PROPILTIO
AQIB  499.00 8 548.90
102 APT010000I62004536 161792 nn. ANDI SALMA
SANMOLAQIB 
I 24,202.60 2 26,622.86
103 APT010000I62004536 161792 nn. ANDI SALMA
PROPANOLO
AQIB  75.90 6 83.49
104 APT010000I62004536 161792 nn. ANDI SALMA
NEURODEX
AQIB  770.00 1 847.00
105 APT010000I62004536 161792 nn. ANDI SALMA
ALPRAZOLA
AQIB  1,915.83 1 2,107.42
106 APT010000I62004539 161825 tn. JARI  BIOSANBE 1,017.50 3 1,119.25
107 APT010000I62004556 161917 tn. MUHAMMAD
CAIRANAKIB
RL RAUF
7,149.60
  1 7,864.56
108 APT010000I62004556 161917 tn. MUHAMMAD
COMBOAKIB
PAC6RAUF
0,500.00
  1 66,550.00
109 APT010000I62004556 161917 tn. MUHAMMAD
HANDSCOEN
AKIB RAUF
478.00
  2 525.80
110 APT010000I62004556 161917 tn. MUHAMMAD
COMBIVENT4,549.95
AKIB RAUF   1 5,004.94
111 APT010000I62004554 161904 tn. ALAM BRURY
CAIRAN  RL 7,149.60 3 7,864.56
112 APT010000I62004554 161904 tn. ALAM BRURY
RANITIDIN
  7,040.00 2 7,744.00
113 APT010000I62004554 161904 tn. ALAM BRURY
ONDANSETR5,500.00
  1 6,050.00
114 APT010000I62004554 161904 tn. ALAM BRURY
SANMOL  I 24,202.60 3 26,622.86
115 APT010000I62004554 161904 tn. ALAM BRURY
KOTRIMOKS
  254.10 4 279.51
116 APT010000I62004554 161904 tn. ALAM BRURY
NEW DIAT
  557.15 6 612.87
117 APT010000I65003111 39079 ny. ELIK SULISTIYO
NOVO TWIS
PURBAWATI
2,083.00   2 2,291.30
118 APT010000I65003112 161744 tn. BAKRI WAHID 
CETIRIZIN 266.01 3 292.61
119 APT010000I65003112 161744 tn. BAKRI WAHID 
SANMOL T 297.00 9 326.70
120 APT010000I62004526 161746 ny. YOSPINAZINK
KAMMA 
OKSI 604.00 1 664.40
121 APT010000I62004526 161746 ny. YOSPINAB COMPLEK
KAMMA  76.34 6 83.97
122 APT010000I62004545 150008 nn. NOVITAEPISAN
EKA SAFITRI 
SU 51,150.00 1 56,265.00
123 APT010000I62004555 161909 tn. ARIS RUDIANTO 
SANMOL I 24,202.60 3 26,622.86
124 APT010000I62004517 161692 ny. DJANGKI 
CEFIXIME 1,317.02 6 1,448.73
125 APT010000I62004517 161692 ny. DJANGKI 
CURCUMA 1,098.90 3 1,208.79
126 APT010000I62004517 161692 ny. DJANGKI 
NEURODEX 770.00 3 847.00
127 APT010000I62004517 161692 ny. DJANGKI 
PREGABAL 5,500.00 6 6,050.00
128 APT010000I62004557 160401 tn. ABD RAUF.S. 
NASAL CA 11,550.07 1 12,705.07
129 APT010000I62004557 160401 tn. ABD RAUF.S. 
CAIRAN RL 7,149.60 1 7,864.56
130 APT010000I62004557 160401 tn. ABD RAUF.S. 
HANDSCOEN 478.00 4 525.80
131 APT010000I62004557 160401 tn. ABD RAUF.S. 
TRANSFUSI28,050.00 1 30,855.00
132 APT010000I62004557 160401 tn. ABD RAUF.S. 
IV CATHETE 7,750.00 1 8,525.00
133 APT010000I62004557 160401 tn. ABD RAUF.S. 
IV DRESSI 4,850.00 1 5,335.00
134 APT010000I62004557 160401 tn. ABD RAUF.S. 
KAPAS AL 300.00 1 330.00
135 APT010000I62004541 161827 tn. JOHAMZAH 
CITICOLIN 10,011.38 4 11,012.51
136 APT010000I62004550 136634 ny. CITRAWATI,S.SI 
STOLAX SU 6,710.00 1 7,381.00
137 APT010000I62004558 84134 tn. ISKANDAR
NEUROSANB5,324.00
MAGGA  1 5,856.40
138 APT010000I62004558 84134 tn. ISKANDAR
CAIRAN
MAGGA 
RL 7,149.60 3 7,864.56
139 APT010000I62004557 160401 tn. ABD RAUF.S. 
MASKER DI 700.00 2 770.00
140 APT010000I62004557 160401 tn. ABD RAUF.S. 
HANDSCOEN 478.00 4 525.80
141 APT010000I62004557 160401 tn. ABD RAUF.S. 
SPOIT 3 CC 1,485.00 1 1,633.50
142 APT010000I62004557 160401 tn. ABD RAUF.S. 
CONECTA 13,200.00 1 14,520.00
143 APT010000I62004557 160401 tn. ABD RAUF.S. 
CAIRAN NAC6,409.70 2 7,050.67
144 APT010000I62004557 160401 tn. ABD RAUF.S. 
CEFTRIAXO19,999.10 2 21,999.01
145 APT010000I62004557 160401 tn. ABD RAUF.S. 
LANTUS SO83,950.02 1 92,345.02
146 APT010000I62004557 160401 tn. ABD RAUF.S. 
NOVORAPID 87,000.00 1 95,700.00
147 APT010000I62004557 160401 tn. ABD RAUF.S. 
NOVO TWIS 2,083.00 2 2,291.30
148 APT010000I62004556 161917 tn. MUHAMMAD
CAIRANAKIB
NAC6,409.70
RAUF   2 7,050.67
149 APT010000I62004556 161917 tn. MUHAMMAD
RANITIDIN
AKIB RAUF
7,040.00
  2 7,744.00
150 APT010000I62004556 161917 tn. MUHAMMAD
ASPILETS
AKIB RAUF
816.20
  1 897.82
151 APT010000I62004556 161917 tn. MUHAMMAD
MASKER AKIB
DI RAUF
700.00
  2 770.00
152 APT010000I62004556 161917 tn. MUHAMMAD
HANDSCOEN
AKIB RAUF
478.00
  4 525.80
153 APT010000I62004556 161917 tn. MUHAMMAD
IV CATHETE
AKIB RAUF
7,750.00
  1 8,525.00
154 APT010000I62004556 161917 tn. MUHAMMAD
SPOIT 10
AKIB
C RAUF
2,310.00
  1 2,541.00
155 APT010000I62004556 161917 tn. MUHAMMAD
SPOIT 1AKIB
CC RAUF
1,920.00
  1 2,112.00
156 APT010000I64002984 161794 tn. RICHARDMASKER
LEONARD 
DI 700.00 2 770.00
157 APT010000I64002984 161794 tn. RICHARDHANDSCOEN
LEONARD  478.00 4 525.80
158 APT010000I64002984 161794 tn. RICHARDCONECTA
LEONARD 13,200.00 1 14,520.00
159 APT010000I64002984 161794 tn. RICHARDSPOIT
LEONARD 
3 CC 1,485.00 1 1,633.50
160 APT010000I62004536 161792 nn. ANDI SALMA
CAIRANAQIB 
RL 7,149.60 4 7,864.56
161 APT010000I62004536 161792 nn. ANDI SALMA
MASKERAQIB 
DI 700.00 4 770.00
162 APT010000I62004536 161792 nn. ANDI SALMA
IV DRESSI
AQIB  4,850.00 1 5,335.00
163 APT010000I62004536 161792 nn. ANDI SALMA
SPOIT AQIB 
3 CC 1,485.00 1 1,633.50
164 APT010000I31000567 159753 an. AINURRAFIQAH 
CAIRAN RL 7,149.60 3 7,864.56
 165 APT010000I31000567 159753 an. AINURRAFIQAH 
IV CATHETE 7,750.00 1 8,525.00
166 APT010000I31000567 159753 an. AINURRAFIQAH 
MASKER DI 700.00 1 770.00
167 APT010000I31000567 159753 an. AINURRAFIQAH 
HANDSCOEN 478.00 4 525.80
168 APT010000I31000567 159753 an. AINURRAFIQAH 
CONECTA 13,200.00 1 14,520.00
169 APT010000I31000567 159753 an. AINURRAFIQAH 
CAIRAN NA15,180.00 1 16,698.00
170 APT010000I62004539 161825 tn. JARI  CAIRAN NAC6,409.70 3 7,050.67
171 APT010000I62004539 161825 tn. JARI  MASKER DI 700.00 2 770.00
172 APT010000I62004539 161825 tn. JARI  HANDSCOEN 478.00 4 525.80
173 APT010000I62004539 161825 tn. JARI  CAIRAN NA15,180.00 1 16,698.00
174 APT010000I62004539 161825 tn. JARI  SPOIT 3 CC 1,485.00 2 1,633.50
Sub Total   501

Total 4631
PCS 770.00

PCS 1,051.60
PCS 23,593.68
PCS 41,624.00
PCS 8,525.00
PCS 5,335.00
PCS 47,187.36
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 2,112.00
PCS 8,525.00
PCS 5,335.00
PCS 14,520.00
PCS 42,440.20
PCS 5,335.00
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 14,520.00
PCS 31,830.15
PCS 8,525.00
PCS 770.00
PCS 1,051.60
PCS 3,146.00
PCS 2,541.00
PCS 1,633.50
PCS 5,335.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 8,525.00
PCS 30,855.00
PCS 14,520.00
PCS 22,149.81
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 5,335.00
PCS 14,520.00
PCS 30,855.00
PCS 31,458.24
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 3,146.00
PCS 8,712.00
PCS 8,525.00
PCS 44,299.62
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 3,146.00
PCS 8,712.00
PCS 2,291.30
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 8,712.00
PCS 14,520.00
PCS 5,335.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 36,916.35
PCS 1,540.00
PCS 2,103.20
PCS 47,187.36
PCS 770.00
PCS 1,051.60
PCS 8,525.00
PCS 14,520.00
PCS 3,146.00
PCS 22,149.81
PCS 8,712.00
PCS 14,520.00
PCS 8,525.00
PCS 5,335.00
PCS 1,540.00
PCS 2,103.20
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 6,292.00
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 3,509.00
PCS 3,267.00
PCS 3,146.00
PCS 16,698.00
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 17,050.00
PCS 22,149.81
PCS 6,292.00
PCS 22,149.81
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 17,050.00
PCS 2,103.20
PCS 1,540.00
PCS 6,292.00
PCS 33,396.00
PCS 22,149.81
PCS 17,050.00
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 6,292.00
PCS 33,396.00
PCS 22,149.81
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 6,292.00
PCS 33,396.00
PCS 14,766.54
PCS 2,103.20
PCS 770.00
PCS 16,698.00
PCS 6,292.00
PCS 22,149.81
PCS 2,103.20
PCS 770.00
PCS 3,509.00
PCS 17,050.00
PCS 5,335.00
PCS 3,146.00
PCS 14,766.54
PCS 8,525.00
PCS 1,754.50
PCS 2,541.00
PCS 1,633.50
PCS 2,103.20
PCS 770.00
PCS 5,335.00
PCS 3,146.00
PCS 16,698.00
PCS 49,225.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 8,712.00
PCS 16,698.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 5,335.00
PCS 6,292.00
PCS 1,051.60
PCS 770.00
PCS 16,698.00
PCS 14,766.54
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 49,225.00
PCS 6,292.00
PCS 22,149.81
PCS 3,154.80
PCS 2,310.00
PCS 5,082.00
PCS 3,509.00
PCS 17,050.00
PCS 6,292.00
PCS 33,396.00
PCS 798.60
PCS 2,541.00
PCS 2,940.30
PCS 1,568.13
PCS 1,185.03
PCS 4,150.71
PCS 36,300.00
PCS 2,451.48
PCS 13,416.48
PCS 37,755.30
PCS 1,976.58
PCS 4,633.20
PCS 877.83
103,977.7
PCS
2
PCS 1,481.70
PCS 5,618.52
PCS 10,810.80
PCS 10,810.80
PCS 5,618.52
PCS 37,755.30
PCS 5,082.00
PCS 11,583.00
PCS 37,755.30
PCS 4,157.94
PCS 2,940.30
PCS 17,206.20
PCS 4,157.94
PCS 56,265.00
PCS 5,793.48
PCS 2,335.95
PCS 1,955.79
PCS 1,689.76
PCS 43,998.02
PCS 12,160.50
PCS 5,856.40
PCS 14,101.34
PCS 15,488.00
PCS 113.14
PCS 7,050.67
PCS 15,488.00
PCS 1,838.61
PCS 18,150.00
PCS 980.10
PCS 1,694.00
PCS 24,257.46
PCS 43,998.02
PCS 3,963.96
PCS 8,022.30
PCS 980.10
PCS 15,488.00
PCS 13,657.60
PCS 30,855.00
PCS 14,520.00
PCS 4,247.10
PCS 1,754.50
PCS 7,098.30
PCS 12,463.00
PCS 10,009.88
PCS 43,998.02
179,685.0
PCS 0
PCS 37,389.00
PCS 21,401.60
PCS 53,997.56
PCS 6,921.20
PCS 94,754.88
PCS 12,320.00
PCS 13,310.00
PCS 658.86
PCS 15,014.82
PCS 18,877.65
PCS 12,463.00
PCS 5,856.40
PCS 43,998.02
PCS 3,626.37
PCS 44,050.04
PCS 14,520.00
PCS 15,488.00
PCS 14,766.54
PCS 10,516.00
PCS 4,198.70
PCS 877.83
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 5,009.40
PCS 17,206.20
PCS 1,254.00
PCS 1,976.58
PCS 4,150.71
PCS 10,009.88
PCS 43,998.02
PCS 15,488.00
PCS 8,022.30
PCS 24,926.00
PCS 23,958.00
108,900.0
PCS
0
PCS 7,050.67
PCS 18,150.00
PCS 418.00
PCS 522.71
PCS 272.83
PCS 827.13
224,606.2
PCS 5
PCS 12,100.00
PCS 4,198.70
PCS 627.00
PCS 43,998.02
PCS 15,729.12
PCS 43,998.02
PCS 16,698.00
PCS 15,488.00
PCS 12,100.00
PCS 56,265.00
PCS 15,014.82
PCS 658.86

PCS 163,350.0
0
PCS 7,260.00
PCS 15,488.00
PCS 59,040.08
PCS 7,744.00
PCS 2,451.48
PCS 8,929.80
PCS 7,864.56
PCS 6,921.20
PCS 32,102.40
PCS 772.20
144,183.6
PCS 0
PCS 4,029.30
PCS 43,998.02
PCS 15,488.00
PCS 980.10
PCS 3,677.22
136,583.3
PCS
7
PCS 1,118.04
PCS 15,488.00
PCS 5,945.94
PCS 44,588.50
PCS 44,588.50
PCS 1,955.79
PCS 16,171.64
PCS 1,385.98
PCS 2,867.70
PCS 4,198.70
PCS 3,626.37
PCS 15,488.00
PCS 1,313.40
PCS 877.83
PCS 7,864.56
PCS 74,868.75
PCS 7,744.00
PCS 5,856.40
PCS 8,470.00
PCS 1,981.98
PCS 7,864.56
PCS 66,550.00
PCS 14,520.00
PCS 664.40
PCS 970.14
PCS 43,998.02
PCS 8,085.82
PCS 3,267.00
PCS 7,744.00
PCS 87,313.60
PCS 62,925.50
5,291,875.20

PCS 5,004.94

PCS 44,588.50
PCS 2,103.20
PCS 1,540.00
PCS 14,766.54
PCS 5,335.00
PCS 3,509.00
PCS 3,267.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 33,396.00
PCS 3,509.00
PCS 3,267.00
PCS 5,335.00
PCS 22,149.81
PCS 2,103.20
PCS 1,540.00
PCS 5,335.00
PCS 3,267.00
PCS 3,509.00
PCS 23,593.68
PCS 3,154.80
PCS 2,310.00
PCS 3,146.00
PCS 3,509.00
PCS 3,267.00
PCS 16,698.00
PCS 10,670.00
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 5,335.00
PCS 16,698.00
PCS 1,540.00
PCS 14,974.30
PCS 2,103.20
PCS 16,698.00
PCS 1,754.50
PCS 1,633.50
PCS 8,525.00
PCS 8,712.00
PCS 23,593.68
PCS 30,855.00
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 1,540.00
PCS 2,103.20
PCS 15,729.12
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 2,103.20
PCS 14,974.30
PCS 1,540.00
PCS 33,396.00
PCS 8,525.00
PCS 14,520.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,540.00
PCS 2,103.20
PCS 14,766.54
PCS 16,698.00
PCS 2,541.00
PCS 3,267.00
PCS 1,754.50
PCS 1,540.00
PCS 2,103.20
PCS 12,705.07
PCS 44,588.50
PCS 23,593.68
PCS 1,540.00
PCS 14,974.30
PCS 2,103.20
PCS 1,754.50
PCS 1,633.50
PCS 8,525.00
PCS 5,335.00
PCS 22,149.81
PCS 1,540.00
PCS 2,103.20
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 8,712.00
PCS 5,335.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 3,267.00
PCS 8,712.00
PCS 8,525.00
PCS 8,525.00
PCS 43,998.02
PCS 24,926.00
PCS 550.00
PCS 16,698.00
PCS 2,867.70
PCS 980.10
PCS 14,766.54
PCS 30,855.00
PCS 14,520.00
PCS 13,657.60
PCS 5,335.00
136,583.3
PCS
7
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 8,712.00
PCS 23,593.68
PCS 1,540.00
PCS 8,712.00
PCS 2,103.20
PCS 14,520.00
PCS 5,335.00
PCS 8,525.00
PCS 23,593.68
PCS 2,541.00
PCS 770.00
PCS 1,051.60
PCS 14,520.00
PCS 16,698.00
PCS 30,855.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 3,146.00
PCS 1,754.50
PCS 31,458.24
PCS 770.00
PCS 1,051.60
PCS 1,754.50
PCS 5,335.00
PCS 3,146.00
PCS 42,440.20
PCS 8,525.00
PCS 14,520.00
PCS 770.00
PCS 1,051.60
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 8,525.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 5,335.00
PCS 8,525.00
PCS 1,754.50
PCS 16,698.00
PCS 23,593.68
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 14,520.00
PCS 5,335.00
PCS 16,698.00
PCS 770.00
PCS 1,051.60
PCS 22,149.81
PCS 1,754.50
PCS 14,520.00
PCS 23,958.00
124,872.0
PCS 0
PCS 770.00
PCS 1,051.60
PCS 2,541.00
PCS 8,525.00
PCS 5,335.00
PCS 22,149.81
154,415.3
PCS 6
PCS 54,999.34
PCS 2,103.20
PCS 1,540.00
PCS 292.61
PCS 2,099.35
PCS 7,383.27
PCS 15,488.00
PCS 10,005.60
PCS 3,267.00
PCS 922.01
PCS 95,699.87
PCS 92,345.02
PCS 4,582.60
PCS 22,149.81
154,415.3
PCS
6
PCS 54,999.34
PCS 2,103.20
PCS 1,540.00
PCS 339.42
PCS 922.01
PCS 24,926.00
PCS 922.01
PCS 5,949.85
PCS 550.00
PCS 43,998.02
PCS 79,868.58
PCS 23,232.00
PCS 16,940.00
PCS 3,963.96
PCS 210.09
PCS 117.83
PCS 1,073.58
PCS 1,383.57
PCS 60,511.00
PCS 7,260.00
163,350.0
PCS 0
PCS 15,488.00
PCS 43,998.02
PCS 15,488.00
PCS 1,118.04
PCS 292.61
PCS 10,890.00
PCS 43,998.02
PCS 12,160.50
PCS 6,670.40
PCS 43,998.02
PCS 15,488.00
PCS 12,100.00
PCS 56,265.00
PCS 117.83
PCS 897.82
PCS 43,998.02
PCS 10,009.88
PCS 12,463.00
PCS 7,098.30
PCS 77,207.68
137,926.4
PCS
0
PCS 43,998.02
PCS 15,488.00
PCS 3,963.96
PCS 1,677.06
PCS 43,998.02
PCS 43,998.02
PCS 26,622.86
PCS 658.86
PCS 15,488.00
PCS 15,014.82
PCS 53,997.56
PCS 6,921.20
PCS 21,401.60
PCS 2,316.60
PCS 43,998.02
PCS 658.86
PCS 10,890.00
PCS 1,955.79
PCS 7,759.14
PCS 1,568.13
PCS 1,452.00
PCS 780.45
PCS 656.70
PCS 1,878.30
PCS 627.00
PCS 21,999.01
PCS 5,856.40
PCS 3,626.37
PCS 495.03
PCS 664.40
PCS 68,963.20
PCS 7,744.00
PCS 3,677.22
PCS 1,118.04
PCS 646.50
PCS 877.83
PCS 79,868.58
PCS 4,029.30
PCS 4,157.94
PCS 24,066.90
PCS 2,940.30
PCS 5,082.00
PCS 4,157.94
PCS 8,603.10
PCS 10,879.11
PCS 18,894.15
PCS 1,881.00
PCS 44,050.04
PCS 7,260.00
PCS 15,488.00
PCS 17,050.00
PCS 22,149.81
PCS 4,900.50
PCS 10,516.00
PCS 3,850.00
PCS 4,625.00
PCS 210.09
PCS 1,118.04
PCS 17,384.76
PCS 2,940.30
PCS 5,082.00
PCS 92,345.02
PCS 627.00
PCS 6,670.40
PCS 15,488.00
PCS 292.61
PCS 11,344.30
PCS 30,937.50
PCS 21,152.01
PCS 66,550.00
PCS 10,610.05
PCS 2,103.20
PCS 14,520.00
PCS 74,868.75
PCS 2,541.00
PCS 1,540.00
PCS 8,712.00
PCS 2,845.92
PCS 1,903.00
PCS 5,945.94
PCS 3,212.55
PCS 36,300.00
PCS 1,754.50
PCS 30,937.50
PCS 3,154.80
PCS 2,310.00
PCS 22,000.00
PCS 68,200.00
PCS 32,125.50
PCS 14,520.00
PCS 23,100.00
PCS 5,082.00
PCS 49,225.00
PCS 19,723.00
PCS 43,998.02
PCS 24,257.46
PCS 54,999.34
PCS 1,981.98
PCS 5,082.00
PCS 3,267.00
PCS 15,729.12
PCS 20,812.00
PCS 10,516.00
PCS 23,100.00
PCS 13,603.70
274,558.6
PCS
8
PCS 8,085.82
PCS 6,050.00
PCS 7,744.00
PCS 922.01
PCS 12,705.07
PCS 66,550.00
PCS 7,864.56
PCS 3,267.00
PCS 14,520.00
PCS 8,712.00
PCS 66,550.00
PCS 47,080.00
PCS 2,541.00
PCS 7,864.56
PCS 7,864.56
PCS 7,383.27
PCS 12,705.07
PCS 31,458.24
PCS 15,488.00
PCS 10,005.60
PCS 2,107.42
5,818,840.24

PCS 31,458.24

PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 1,540.00
PCS 14,101.34
PCS 14,520.00
PCS 2,103.20
PCS 8,712.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 1,754.50
PCS 1,633.50
PCS 2,541.00
PCS 21,472.00
PCS 8,525.00
PCS 14,520.00
PCS 1,540.00
PCS 14,520.00
PCS 3,267.00
PCS 2,103.20
PCS 8,525.00
PCS 23,593.68
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 3,267.00
PCS 8,712.00
PCS 8,525.00
PCS 14,520.00
PCS 2,103.20
PCS 1,540.00
PCS 21,220.10
PCS 14,520.00
PCS 3,267.00
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 14,520.00
PCS 1,540.00
PCS 2,103.20
PCS 23,593.68
PCS 1,754.50
PCS 3,267.00
PCS 1,540.00
PCS 31,830.15
PCS 3,154.80
PCS 8,525.00
PCS 14,520.00
PCS 8,712.00
PCS 2,291.30
PCS 21,152.01
PCS 2,103.20
PCS 1,540.00
PCS 3,267.00
PCS 8,712.00
PCS 8,525.00
PCS 14,520.00
PCS 15,488.00
PCS 980.10
PCS 8,022.30
PCS 770.00
PCS 2,103.20
PCS 16,698.00
PCS 8,525.00
PCS 5,335.00
PCS 30,855.00
PCS 2,541.00
PCS 1,754.50
PCS 770.00
PCS 2,103.20
PCS 23,593.68
PCS 8,525.00
PCS 2,541.00
PCS 1,754.50
PCS 1,633.50
PCS 5,335.00
PCS 770.00
PCS 2,103.20
PCS 8,525.00
PCS 1,754.50
PCS 1,633.50
PCS 16,698.00
PCS 15,729.12
PCS 5,335.00
PCS 14,101.34
PCS 770.00
PCS 2,103.20
PCS 8,712.00
PCS 2,541.00
PCS 1,633.50
PCS 8,525.00
PCS 14,520.00
PCS 5,335.00
PCS 23,593.68
PCS 12,705.07
PCS 2,103.20
PCS 770.00
PCS 5,335.00
PCS 13,657.60
PCS 4,900.50
PCS 1,754.50
PCS 14,520.00
PCS 7,050.67
PCS 2,103.20
PCS 13,310.00
PCS 770.00
PCS 14,101.34
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 2,103.20
PCS 770.00
PCS 41,624.00
PCS 18,392.00
PCS 1,633.50
PCS 1,754.50
PCS 770.00
PCS 1,051.60
PCS 8,712.00
PCS 14,101.34
PCS 1,754.50
PCS 1,633.50
PCS 8,525.00
PCS 2,103.20
PCS 770.00
PCS 660.00
PCS 14,101.34
PCS 3,509.00
PCS 8,525.00
PCS 770.00
PCS 2,103.20
PCS 8,712.00
PCS 14,520.00
PCS 16,698.00
PCS 15,729.12
PCS 3,509.00
PCS 8,525.00
PCS 770.00
PCS 29,948.60
PCS 33,396.00
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 8,525.00
PCS 2,541.00
PCS 3,509.00
PCS 330.00
PCS 10,890.00
PCS 980.10
PCS 1,694.00
PCS 37,570.50
PCS 3,200.86
PCS 21,401.60
PCS 53,997.56
PCS 8,470.00
PCS 292.61
PCS 15,488.00
PCS 53,245.72
PCS 16,132.52
PCS 1,903.00
PCS 43,998.02
PCS 10,005.60
PCS 12,160.50
PCS 16,333.02
PCS 26,622.86
121,022.0
PCS
0
PCS 7,260.00

PCS 163,350.0
0
PCS 15,488.00
PCS 210.09
PCS 117.83
PCS 1,073.58
PCS 92,345.02
PCS 95,699.87
PCS 4,582.60
PCS 43,998.02
PCS 79,868.58
PCS 2,867.70
PCS 15,014.82
PCS 15,488.00
PCS 43,998.02
PCS 15,488.00
PCS 970.14
PCS 3,626.37
PCS 43,998.02
PCS 27,499.67
PCS 5,856.40
PCS 2,867.70
PCS 10,890.00

PCS 103,977.7
2
154,638.0
PCS
0
PCS 627.00
PCS 6,050.00
PCS 15,488.00
PCS 1,694.00
PCS 43,998.02
PCS 15,488.00
PCS 18,150.00
PCS 980.10
PCS 1,225.74
PCS 15,488.00
PCS 10,005.60
PCS 1,838.61
PCS 1,118.04
PCS 1,613.34
PCS 4,981.17
PCS 5,949.85
PCS 922.01
PCS 15,488.00
PCS 53,245.72
PCS 43,998.02
PCS 24,257.46
PCS 15,488.00
PCS 4,198.70
PCS 897.82
PCS 1,878.30
PCS 656.70
PCS 1,694.00
PCS 32,670.00
PCS 5,867.37
PCS 10,890.00
PCS 1,570.11
PCS 12,463.00
PCS 980.10
PCS 37,389.00
PCS 13,416.48
PCS 32,670.00
PCS 4,157.94
PCS 2,940.30
PCS 16,044.60
PCS 8,603.10
PCS 32,125.50
PCS 34,100.00
PCS 15,488.00
PCS 922.01
PCS 15,729.12
PCS 43,998.02
PCS 24,890.80
PCS 81,070.00
PCS 10,888.68
PCS 10,516.00
PCS 3,850.00
PCS 17,424.00
PCS 32,670.00
PCS 2,940.30
PCS 5,515.83
PCS 27,499.67
PCS 13,657.60
PCS 14,520.00
PCS 4,391.20
PCS 2,541.00
PCS 1,285.35
PCS 500.94
PCS 2,236.08
PCS 3,677.22
PCS 9,520.28
PCS 526.35
PCS 2,107.42
PCS 292.61
228,798.9
PCS
0
PCS 2,845.92
PCS 1,903.00
PCS 3,963.96
PCS 15,488.00
PCS 32,670.00
PCS 4,648.80
PCS 56,265.00
PCS 2,541.00
PCS 8,332.61
PCS 5,115.00

PCS 270,398.7
0
PCS 66,550.00
PCS 7,864.56
PCS 1,051.60
PCS 5,499.99
PCS 7,744.00
PCS 1,981.98
PCS 4,900.50
PCS 2,867.70
PCS 6,869.50
PCS 2,831.40
PCS 6,068.70
PCS 7,050.67
PCS 44,588.50
PCS 7,864.56
PCS 66,550.00
PCS 7,864.56
PCS 4,206.40
PCS 3,267.00
PCS 7,744.00
PCS 5,856.40
PCS 653.40
PCS 12,100.00
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 8,712.00
PCS 8,525.00
PCS 23,593.68
PCS 23,593.68
PCS 1,540.00
PCS 14,520.00
PCS 8,712.00
PCS 8,525.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 14,520.00
PCS 8,712.00
PCS 8,525.00
PCS 5,082.00
PCS 1,540.00
PCS 2,103.20
PCS 8,712.00
PCS 14,520.00
PCS 18,392.00
PCS 3,509.00
PCS 41,624.00
- 0
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 2,541.00
PCS 3,509.00
PCS 3,267.00
PCS 8,525.00
PCS 14,520.00
PCS 8,712.00
PCS 23,593.68
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 8,712.00
PCS 8,525.00
PCS 5,082.00
PCS 3,509.00
PCS 1,633.50
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 14,520.00
PCS 33,396.00
PCS 18,392.00
PCS 5,335.00
PCS 5,082.00
PCS 3,267.00
PCS 23,593.68
PCS 33,396.00
PCS 14,520.00
PCS 5,335.00
PCS 770.00
PCS 2,103.20
PCS 8,525.00
PCS 3,509.00
PCS 31,458.24
PCS 26,620.00
PCS 770.00
PCS 5,082.00
PCS 3,509.00
PCS 33,396.00
PCS 18,392.00
PCS 14,520.00
PCS 5,335.00
PCS 770.00
PCS 2,103.20
PCS 23,593.68
PCS 3,267.00
PCS 1,754.50
PCS 5,335.00
PCS 8,525.00
PCS 770.00
PCS 2,103.20
PCS 8,525.00
PCS 5,335.00
PCS 3,267.00
PCS 3,509.00
PCS 21,152.01
PCS 8,712.00
PCS 14,520.00
PCS 31,830.15
PCS 2,103.20
PCS 770.00
PCS 1,633.50
PCS 1,754.50
PCS 5,335.00
PCS 8,712.00
PCS 8,525.00
PCS 14,520.00
PCS 23,593.68
PCS 5,335.00
PCS 8,525.00
PCS 3,267.00
PCS 3,509.00
PCS 14,520.00
PCS 770.00
PCS 2,103.20
PCS 8,712.00
PCS 23,593.68
PCS 2,103.20
PCS 770.00
PCS 8,525.00
PCS 8,712.00
PCS 3,267.00
PCS 1,754.50
PCS 14,520.00
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 3,509.00
PCS 2,541.00
PCS 8,712.00
PCS 14,520.00
PCS 5,335.00
PCS 21,152.01
PCS 770.00
PCS 1,051.60
PCS 1,633.50
PCS 1,754.50
PCS 8,712.00
PCS 14,520.00
PCS 8,525.00
PCS 5,335.00
PCS 2,291.30
PCS 15,729.12
PCS 33,396.00
PCS 5,082.00
PCS 3,509.00
PCS 8,525.00
PCS 5,335.00
PCS 2,103.20
PCS 14,520.00
PCS 770.00
PCS 23,593.68
PCS 770.00
PCS 3,267.00
PCS 8,525.00
PCS 2,103.20
PCS 14,520.00
PCS 14,101.34
PCS 2,541.00
PCS 8,525.00
PCS 3,509.00
PCS 14,974.30
PCS 770.00
PCS 5,335.00
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 2,541.00
PCS 1,633.50
PCS 8,525.00
PCS 14,520.00
PCS 5,335.00

PCS 228,798.9
0
PCS 8,525.00
PCS 29,040.00
PCS 3,850.00
PCS 34,100.00
PCS 15,488.00
PCS 10,005.60
PCS 2,107.42
PCS 31,458.24
6,267,480.89
124,780.0
PCS 4
PCS 653.40
PCS 3,872.00
PCS 4,391.20
PCS 23,593.68
PCS 2,451.48
PCS 37,755.30
PCS 3,064.35
PCS 9,962.34
PCS 5,215.10
PCS 5,989.50
PCS 922.01
PCS 79,868.58
PCS 6,050.00
PCS 658.86
PCS 53,997.56
PCS 21,401.60
PCS 664.40
PCS 251.91
PCS 3,626.37
PCS 43,998.02
PCS 5,856.40
PCS 12,100.00
PCS 897.82
PCS 1,878.30
PCS 656.70
PCS 43,998.02
PCS 24,257.46
PCS 23,232.00
PCS 4,198.70
PCS 12,100.00
PCS 5,856.40
PCS 3,856.05
PCS 1,838.61
PCS 37,755.30
PCS 32,670.00
PCS 4,710.33
PCS 37,389.00
PCS 37,755.30
PCS 1,557.30
PCS 5,082.00
PCS 15,488.00
PCS 980.10
PCS 8,022.30
PCS 847.00
PCS 5,215.10
PCS 2,107.42
PCS 15,488.00
PCS 53,245.72
PCS 2,451.48
PCS 627.00
PCS 434.39
PCS 15,488.00
PCS 1,694.00
PCS 12,100.00
PCS 9,520.28
PCS 526.35
PCS 2,107.42
PCS 25,555.20
PCS 922.01
PCS 550.00
PCS 43,998.02
PCS 5,989.50
PCS 1,073.58
PCS 117.83
PCS 210.09
108,900.0
PCS
0
PCS 7,260.00
PCS 15,488.00
PCS 22,025.02
PCS 16,132.52
PCS 1,903.00
PCS 522.71
PCS 25,555.20
PCS 56,265.00
PCS 922.01
PCS 5,989.50
PCS 275.00
PCS 43,998.02
PCS 7,864.56
PCS 66,550.00
PCS 1,051.60
PCS 326.70
PCS 7,744.00
PCS 1,633.50
PCS 1,540.00
PCS 43,998.02
PCS 16,333.02
PCS 18,150.00
PCS 15,488.00
PCS 9,147.60
PCS 980.10
PCS 12,100.00
PCS 980.10
PCS 3,630.00
PCS 73,761.60
PCS 43,998.02
PCS 15,014.82
PCS 15,488.00
PCS 1,694.00
PCS 26,620.00
PCS 6,298.05
PCS 292.61
PCS 980.10
PCS 44,050.04
PCS 847.00
PCS 27,883.47
PCS 49,192.00
PCS 53,997.56
225,738.4
PCS 4
PCS 28,667.94
PCS 9,100.00
PCS 12,906.00
PCS 3,118.50
PCS 2,153.25
PCS 871.20
PCS 5,515.83
PCS 1,981.98
PCS 15,488.00
PCS 1,903.00
PCS 2,845.92
PCS 10,890.00
PCS 1,015.55
PCS 12,850.20
PCS 15,488.00
PCS 12,445.40
PCS 81,070.00
PCS 43,998.02
PCS 16,333.02
PCS 54,999.34
187,170.0
PCS
6
PCS 5,258.00
PCS 3,850.00
PCS 33,749.60
PCS 20,249.97

PCS 816,816.0
0
PCS 21,401.60
270,398.7
PCS
0
PCS 54,558.90
PCS 1,930.50
PCS 56,265.00
PCS 6,322.26
PCS 6,322.26
PCS 23,593.68
PCS 1,540.00
PCS 31,458.24
PCS 770.00
PCS 1,051.60
PCS 31,458.24
PCS 1,540.00
PCS 29,416.40
PCS 43,998.02
PCS 980.10
PCS 922.01
PCS 5,856.40
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 1,754.50
PCS 14,520.00
PCS 3,267.00
PCS 8,712.00
PCS 5,082.00
PCS 8,712.00
PCS 14,520.00
PCS 1,633.50
PCS 1,754.50
PCS 2,112.00
PCS 1,051.60
PCS 770.00
PCS 12,705.07
PCS 30,937.50
PCS 14,101.34
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 2,103.20
PCS 1,540.00
PCS 14,520.00
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 14,520.00
PCS 8,712.00
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 8,712.00
PCS 14,520.00
PCS 8,712.00
PCS 2,112.00
PCS 1,754.50
PCS 1,633.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 3,146.00
PCS 16,698.00
PCS 15,729.12
PCS 1,633.50
PCS 49,225.00
PCS 1,754.50
PCS 2,541.00
PCS 44,588.50
PCS 5,335.00
PCS 1,051.60
PCS 770.00
PCS 16,698.00
PCS 15,729.12
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 3,146.00
PCS 44,588.50
PCS 7,864.56
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 15,729.12
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 1,051.60
PCS 770.00
PCS 5,335.00
PCS 3,146.00
PCS 21,152.01
PCS 8,525.00
PCS 14,520.00
PCS 5,335.00
PCS 1,540.00
PCS 2,103.20
PCS 16,698.00
PCS 8,712.00
PCS 30,855.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 31,458.24
PCS 8,525.00
PCS 14,520.00
PCS 1,540.00
PCS 2,103.20
PCS 5,335.00
PCS 16,698.00
PCS 8,712.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 23,593.68
PCS 29,948.60
PCS 770.00
PCS 5,335.00
PCS 33,396.00
PCS 36,784.00
PCS 3,509.00
PCS 23,593.68
PCS 770.00
PCS 5,335.00
PCS 29,040.00
PCS 8,712.00
PCS 36,784.00
PCS 23,593.68
PCS 8,525.00
PCS 2,103.20
PCS 3,509.00
PCS 770.00
PCS 5,335.00
PCS 16,698.00
PCS 15,729.12
PCS 770.00
PCS 5,082.00
PCS 2,103.20
PCS 8,525.00
PCS 16,698.00
PCS 5,335.00
PCS 31,458.24
PCS 2,103.20
PCS 770.00
PCS 3,267.00
PCS 18,392.00
PCS 5,335.00
PCS 16,698.00
PCS 21,152.01
PCS 2,103.20
PCS 8,525.00
PCS 1,633.50
PCS 1,754.50
PCS 14,520.00
PCS 5,335.00
PCS 1,540.00
PCS 33,396.00
PCS 23,593.68
PCS 8,525.00
PCS 33,396.00
PCS 2,103.20
PCS 5,335.00
PCS 1,754.50
PCS 2,541.00
PCS 1,633.50
PCS 14,520.00
PCS 23,593.68
PCS 17,050.00
PCS 5,335.00
PCS 14,520.00
PCS 2,103.20
PCS 1,540.00
PCS 2,541.00
PCS 1,633.50
PCS 1,754.50
PCS 16,698.00
PCS 21,152.01
PCS 8,525.00
PCS 2,103.20
PCS 5,335.00
PCS 8,712.00
PCS 1,540.00
PCS 14,520.00
PCS 16,698.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 31,458.24
PCS 29,040.00
PCS 10,670.00
PCS 2,103.20
PCS 770.00
PCS 3,509.00
PCS 33,396.00
PCS 15,488.00
PCS 6,670.40
PCS 2,107.42
PCS 658.86
5,792,861.08

PCS 12,705.07

PCS 66,550.00
PCS 1,754.50
PCS 6,425.10
PCS 7,050.67
PCS 2,103.20
PCS 5,215.10
PCS 15,488.00
PCS 8,022.30
PCS 43,998.02
PCS 24,257.46
PCS 12,850.20
PCS 15,488.00
PCS 3,677.22
PCS 15,488.00
PCS 12,100.00
224,606.2
PCS
5
PCS 15,488.00
PCS 2,940.30
PCS 80,731.20
PCS 15,488.00
PCS 44,050.04
PCS 847.00
PCS 2,693.46
PCS 23,474.00
PCS 980.10
PCS 6,670.40
PCS 48,397.56
PCS 2,693.46
PCS 2,541.00
PCS 4,157.94
PCS 1,568.13
PCS 43,998.02
PCS 16,333.02
PCS 15,488.00
PCS 9,147.60
PCS 10,005.60
PCS 8,712.00
224,606.2
PCS
5
PCS 73,761.60
PCS 2,867.70
224,606.2
PCS
5
PCS 15,014.82
PCS 15,488.00
PCS 43,998.02
PCS 1,694.00
- 0
PCS 210.09
163,350.0
PCS
0
PCS 7,260.00
PCS 15,488.00
PCS 44,050.04
PCS 117.83
PCS 1,073.58
PCS 38,332.80
PCS 922.01
PCS 5,989.50
PCS 275.00
PCS 43,998.02
PCS 43,998.02
PCS 980.10
PCS 922.01
PCS 5,856.40
PCS 15,488.00
PCS 8,022.30
PCS 15,488.00
PCS 54,558.90
PCS 292.61
PCS 1,930.50
PCS 503.82
PCS 76,665.60
PCS 1,890.81
PCS 1,970.10
PCS 4,391.20
PCS 395.31
PCS 2,541.00
PCS 5,856.40
PCS 266.20
PCS 980.10
PCS 847.00
PCS 627.00
PCS 6,670.40
PCS 15,488.00
PCS 12,100.00
PCS 847.00
PCS 526.35
PCS 2,107.42
PCS 9,962.34
PCS 10,430.20
PCS 5,989.50
PCS 522.71
PCS 897.82
PCS 6,050.00
PCS 15,488.00
PCS 6,670.40
PCS 2,867.70
PCS 2,107.42
PCS 15,488.00
PCS 980.10
PCS 8,022.30
PCS 1,694.00
PCS 5,215.10
PCS 980.10
PCS 48,061.20
PCS 12,100.00
PCS 664.40
PCS 503.82
PCS 3,626.37
PCS 5,856.40
PCS 43,998.02
PCS 27,499.67
PCS 15,488.00
224,606.2
PCS
5
PCS 21,401.60
 225,738.4
PCS
4

PCS 816,816.0
0
107,157.6
PCS
0
PCS 26,281.32

PCS 108,159.4
8
PCS 5,515.83
PCS 14,766.54
PCS 12,850.20
PCS 7,744.00
PCS 6,050.00
PCS 3,212.55
PCS 4,900.50
PCS 10,610.49
PCS 66,550.00
PCS 2,103.20
PCS 10,000.65
PCS 658.86
PCS 6,869.50
PCS 1,639.80
PCS 6,068.70
PCS 14,101.34
PCS 54,558.90
PCS 10,005.60
PCS 936.42
PCS 2,662.00
PCS 922.01
PCS 339.42
PCS 4,945.18
PCS 51,856.72
PCS 5,444.34
PCS 66,550.00
PCS 7,864.56
PCS 3,267.00
PCS 7,744.00
PCS 8,085.82
PCS 33,749.60
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 1,633.50
PCS 2,541.00
PCS 8,525.00
PCS 13,657.60
PCS 23,593.68
PCS 33,396.00
PCS 1,540.00
PCS 29,948.60
PCS 5,335.00
PCS 36,784.00
PCS 3,267.00
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 30,855.00
PCS 13,657.60
PCS 27,500.00
PCS 5,082.00
PCS 3,509.00
PCS 3,267.00
PCS 1,540.00
PCS 2,103.20
PCS 23,593.68
PCS 8,712.00
PCS 27,500.00
PCS 8,525.00
PCS 5,335.00
PCS 15,729.12
PCS 770.00
PCS 2,103.20
PCS 2,112.00
PCS 1,633.50
PCS 1,754.50
PCS 23,593.68
PCS 2,103.20
PCS 33,396.00
PCS 770.00
PCS 3,509.00
PCS 3,267.00
PCS 5,335.00
PCS 23,593.68
PCS 5,335.00
PCS 2,103.20
PCS 30,855.00
PCS 5,082.00
PCS 3,509.00
PCS 1,051.60
PCS 770.00
PCS 14,101.34
PCS 1,633.50
PCS 8,525.00
PCS 31,458.24
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 1,540.00
PCS 2,103.20
PCS 49,225.00
PCS 1,694.00
PCS 333.96
PCS 2,103.20
PCS 770.00
PCS 14,101.34
PCS 1,633.50
PCS 2,541.00
PCS 8,525.00
PCS 8,525.00
PCS 51,856.72
PCS 1,051.60
PCS 770.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 3,267.00
PCS 5,082.00
PCS 3,509.00
PCS 8,525.00
PCS 8,712.00
PCS 15,729.12
PCS 1,540.00
PCS 2,103.20
PCS 3,509.00
PCS 5,082.00
PCS 8,525.00
PCS 27,500.00
PCS 30,855.00
PCS 15,729.12
PCS 2,103.20
PCS 1,540.00
PCS 5,082.00
PCS 3,509.00
PCS 27,500.00
PCS 8,525.00
PCS 30,855.00
PCS 3,267.00
PCS 3,509.00
PCS 8,525.00
PCS 15,729.12
PCS 2,103.20
PCS 770.00
PCS 3,146.00
PCS 1,633.50
PCS 1,754.50
PCS 2,541.00
PCS 14,101.34
PCS 1,051.60
PCS 770.00
PCS 1,633.50
PCS 1,754.50
PCS 8,525.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 3,146.00
PCS 1,754.50
PCS 1,633.50
PCS 2,541.00
PCS 15,729.12
PCS 1,051.60
PCS 770.00
PCS 15,729.12
PCS 2,103.20
PCS 5,082.00
PCS 3,509.00
PCS 8,525.00
PCS 1,540.00
PCS 3,267.00
PCS 27,500.00
PCS 8,712.00
PCS 1,540.00
PCS 33,396.00
PCS 2,103.20
PCS 27,500.00
PCS 8,525.00
PCS 2,541.00
PCS 49,225.00
PCS 36,300.00
PCS 9,718.50
PCS 1,754.50
PCS 1,633.50
PCS 14,101.34
PCS 8,525.00
PCS 525.80
PCS 770.00
PCS 1,694.00
PCS 780.45
5,622,262.01

PCS 15,488.00

PCS 8,022.30
PCS 2,662.00
PCS 922.01
PCS 7,864.56
PCS 980.10
PCS 15,488.00
PCS 15,488.00
224,606.2
PCS 5
PCS 94,754.88
PCS 5,115.00
PCS 21,401.60
PCS 257.84

PCS 816,816.0
0
PCS 20,249.97
PCS 33,749.60

PCS 107,157.6
0
PCS 15,488.00
PCS 1,015.55
PCS 65,997.03
PCS 15,488.00
PCS 980.10
PCS 43,998.02
PCS 922.01
PCS 5,856.40
PCS 292.61
PCS 980.10
PCS 54,558.90
PCS 1,930.50
PCS 54,558.90
PCS 922.01
PCS 18,150.00
PCS 13,675.25
PCS 43,998.02
PCS 24,257.46
PCS 664.40
PCS 503.82
PCS 44,050.04
PCS 1,795.64
PCS 847.00
PCS 15,488.00
PCS 1,260.54
PCS 76,665.60
PCS 2,766.03
PCS 1,755.66
PCS 80,731.20
PCS 2,541.00
PCS 5,515.83
PCS 5,630.15
PCS 42,841.26
PCS 3,909.51
PCS 8,692.38
PCS 1,157.31
PCS 210.09
PCS 117.83
PCS 1,073.58
PCS 44,050.04
PCS 7,260.00
PCS 15,488.00
108,900.0
PCS
0
PCS 8,470.00
PCS 16,132.52
PCS 897.82
PCS 847.00
PCS 43,998.02
PCS 10,009.88
PCS 43,998.02
PCS 9,147.60
PCS 8,712.00
PCS 5,444.34
PCS 798.60
PCS 2,940.30
PCS 2,541.00
PCS 6,322.26
PCS 3,909.51
PCS 1,976.58
PCS 2,940.30

PCS 144,183.6
0
PCS 1,579.05
PCS 627.00
PCS 2,541.00
PCS 6,322.26
PCS 9,962.34
PCS 5,215.10
PCS 5,989.50
PCS 922.01
PCS 897.82
PCS 1,360.28
PCS 2,940.30
PCS 5,515.83
PCS 48,061.20
PCS 43,998.02
PCS 5,856.40
PCS 21,999.01
PCS 664.40
PCS 3,626.37
PCS 503.82
PCS 5,082.00
PCS 2,940.30
PCS 2,766.03
PCS 4,391.20
PCS 53,245.72
PCS 500.94
PCS 847.00
PCS 2,107.42
PCS 3,357.75
PCS 7,864.56
PCS 66,550.00
PCS 1,051.60
PCS 5,004.94
PCS 23,593.68
PCS 15,488.00
PCS 6,050.00
PCS 79,868.58
PCS 1,118.04
PCS 3,677.22
PCS 4,582.60
PCS 877.83
PCS 2,940.30
PCS 664.40
PCS 503.82
PCS 56,265.00
PCS 79,868.58
PCS 8,692.38
PCS 3,626.37
PCS 2,541.00
PCS 36,300.00
PCS 12,705.07
PCS 7,864.56
PCS 2,103.20
PCS 30,855.00
PCS 8,525.00
PCS 5,335.00
PCS 330.00
PCS 44,050.04
PCS 7,381.00
PCS 5,856.40
PCS 23,593.68
PCS 1,540.00
PCS 2,103.20
PCS 1,633.50
PCS 14,520.00
PCS 14,101.34
PCS 43,998.02
PCS 92,345.02
PCS 95,700.00
PCS 4,582.60
PCS 14,101.34
PCS 15,488.00
PCS 897.82
PCS 1,540.00
PCS 2,103.20
PCS 8,525.00
PCS 2,541.00
PCS 2,112.00
PCS 1,540.00
PCS 2,103.20
PCS 14,520.00
PCS 1,633.50
PCS 31,458.24
PCS 3,080.00
PCS 5,335.00
PCS 1,633.50
PCS 23,593.68
PCS 8,525.00
PCS 770.00
PCS 2,103.20
PCS 14,520.00
PCS 16,698.00
PCS 21,152.01
PCS 1,540.00
PCS 2,103.20
PCS 16,698.00
PCS 3,267.00
3,830,930.32
 32,624,2
49.74
06-12-
1 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
CAIRAN RL 7,149.60 1
2018 
2 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
INFUS SET 17,000.00 1
3 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
IV CATHETE 7,750.00 1
4 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
HANDSCOEN 478.00 2
5 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
IV DRESSI 4,850.00 1
6 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
SOTATIC I 3,032.00 2
7 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
CAIRAN RL 7,149.60 3
8 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
SPOIT 10 C 2,310.00 1
9 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
SPOIT 3 CC 1,485.00 1
10 APT010000I62004381 160797 tn. ISHAK  RANITIDIN 3,000.00 2
11 APT010000I62004381 160797 tn. ISHAK  PARACETA 220.72 3
Sub Total   18
07-12-
1 APT010000I62004381 160797 tn. ISHAK  SANMOL T 297.00 3
2018 
2 APT010000I62004381 160797 tn. ISHAK  RANITIDIN 3,000.00 2
3 APT010000I62004381 160797 tn. ISHAK  METIL PRE 54,054.00 1
Sub Total   6
08-12-
1 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
CAIRAN RL 7,149.60 2
2018 
2 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
RANITIDIN 7,687.68 2
Sub Total   4
10-12-
1 APT010000I62004393 130394 tn. ANDI SURYATMAN EKA JAYA 
RANITIDIN 629.99 6
2018 
Sub Total   6
19-12- 1 APT010000I64002934 161233 tn. SYARIFUDDIN  CAPTOPRIL 199.99 1
2018 
2 APT010000I64002934 161233 tn. SYARIFUDDIN  SPIRONOLA 285.75 1
3 APT010000I64002934 161233 tn. SYARIFUDDIN  FUROSEMID2,920.50 4
4 APT010000I64002934 161233 tn. SYARIFUDDIN  RANITIDIN 7,040.00 2
5 APT010000I64002934 161233 tn. SYARIFUDDIN  CLOPIDOGR 2,722.50 1
6 APT010000I64002934 161233 tn. SYARIFUDDIN  ASPILETS 816.20 1
7 APT010000I64002934 161233 tn. SYARIFUDDIN  DIGOKSIN 107.12 4
8 APT010000I62004466 161346 ny. RABI  DOMPERID 508.20 10
9 APT010000I62004466 161346 ny. RABI  SANMOL T 297.00 10
10 APT010000I62004466 161346 ny. RABI  VALISANBE 396.00 2
11 APT010000I62004466 161346 ny. RABI  NEURODEX 770.00 10
Sub Total   46
22-12-
2018  1 APT010000I62004503 159886 tn. MUH BASIR LALANG  IV CATHETE 7,750.00 1

Sub Total   1
23-12-
1 APT010000I62004503 159886 tn. MUH BASIR LALANG  CAIRAN AM70,188.80 1
2018 
2 APT010000I62004503 159886 tn. MUH BASIR LALANG  STOLAX SU 6,710.00 1
Sub Total   2
24-12-
1 APT010000I62004503 159886 tn. MUH BASIR LALANG  NEUROSANB5,324.00 1
2018 

2 APT010000I62004503 159886 tn. MUH BASIR LALANG  FLEET ENE 104,181.0 1

0
3 APT010000I62004503 159886 tn. MUH BASIR LALANG  CEFTRIAXO19,999.10 2
4 APT010000I62004503 159886 tn. MUH BASIR LALANG  SPOIT 1 CC 1,920.00 1
5 APT010000I62004503 159886 tn. MUH BASIR LALANG  SPOIT 10 C 2,310.00 1
6 APT010000I62004503 159886 tn. MUH BASIR LALANG  HANDSCOEN 478.00 2
7 APT010000I62004503 159886 tn. MUH BASIR LALANG  MASKER DI 700.00 1
Sub Total   9
25-12-
1 APT010000I62004503 159886 tn. MUH BASIR LALANG  NEUROSANB5,324.00 1
2018 
2 APT010000I62004503 159886 tn. MUH BASIR LALANG  RANITIDIN 7,040.00 2
3 APT010000I62004503 159886 tn. MUH BASIR LALANG  CEFTRIAXO19,999.10 2
4 APT010000I62004503 159886 tn. MUH BASIR LALANG  CAIRAN AM70,188.80 1
Sub Total   6
26-12-
1 APT010000I62004503 159886 tn. MUH BASIR LALANG  RANITIDIN 7,040.00 2
2018 
2 APT010000I62004503 159886 tn. MUH BASIR LALANG  CEFTRIAXO19,999.10 2
3 APT010000I62004503 159886 tn. MUH BASIR LALANG  NEUROSANB5,324.00 1
4 APT010000I62004503 159886 tn. MUH BASIR LALANG  CAIRAN AM70,188.80 1
5 APT010000I62004518 161696 ny. A. AYU ANDANI  NEUROSANB5,324.00 1
6 APT010000I62004518 161696 ny. A. AYU ANDANI  RANITIDIN 7,040.00 3
7 APT010000I62004518 161696 ny. A. AYU ANDANI  SANMOL T 297.00 2
Sub Total   12
27-12- 1 APT010000I62004503 159886 tn. MUH BASIR LALANG  CEFTRIAXO19,999.10 2
2018 
2 APT010000I62004503 159886 tn. MUH BASIR LALANG  NEUROSANB5,324.00 1
3 APT010000I62004503 159886 tn. MUH BASIR LALANG  RANITIDIN 7,040.00 2
4 APT010000I62004503 159886 tn. MUH BASIR LALANG  MELOXICAM 250.00 10
Sub Total   15
28-12-
1 APT010000I62004503 159886 tn. MUH BASIR LALANG  CAIRAN SAL27,830.00 1
2018 
2 APT010000I62004503 159886 tn. MUH BASIR LALANG  LANSOPRAZ 851.29 2
3 APT010000I62004503 159886 tn. MUH BASIR LALANG  RANITIDIN 7,040.00 2
4 APT010000I62004503 159886 tn. MUH BASIR LALANG  CEFTRIAXO19,999.10 2
5 APT010000I12000083 161681 tn. H KULAU  CAIRAN NAC6,409.70 1
6 APT010000I12000083 161681 tn. H KULAU  ACETYLCYS 1,100.00 3

7 APT010000I12000083 161681 tn. H KULAU  FENTANYL 041,599.80 5

Sub Total   16
29-12-
1 APT010000I62004503 159886 tn. MUH BASIR LALANG  CEFTRIAXO19,999.10 2
2018 
2 APT010000I62004503 159886 tn. MUH BASIR LALANG  RANITIDIN 7,040.00 2
3 APT010000I12000083 161681 tn. H KULAU  CAIRAN RL 7,149.60 3
 4 APT010000I12000083 161681 tn. H KULAU  CAIRAN DE18,920.00 2
5 APT010000I12000083 161681 tn. H KULAU  CEFTRIAXO19,999.10 2

6 APT010000I12000083 161681 tn. H KULAU  METRONIDA

56,718.20 2

7 APT010000I12000083 161681 tn. H KULAU  KETOROLAC 7,350.75 3

8 APT010000I12000083 161681 tn. H KULAU  MASKER DI 700.00 10
9 APT010000I12000083 161681 tn. H KULAU  HANDSCOEN 478.00 20
10 APT010000I12000083 161681 tn. H KULAU  SPOIT 10 C 2,310.00 1
11 APT010000I12000083 161681 tn. H KULAU  SPOIT 5 CC 1,595.00 1
12 APT010000I12000083 161681 tn. H KULAU  OMEPRAZOL 24,999.70 1
13 APT010000I12000083 161681 tn. H KULAU  METAMIZOL4,999.99 3
240,240.0
14 APT010000I12000083 161681 tn. H KULAU  MEROPENE 0 2

15 APT010000I12000083 161681 tn. H KULAU  RANITIDIN 7,040.00 2

16 APT010000I12000083 161681 tn. H KULAU  FENTANYL 041,599.80 5

17 APT010000I12000083 161681 tn. H KULAU  CAIRAN KA11,314.00 2

Sub Total   63
30-12-
1 APT010000I12000083 161681 tn. H KULAU  RANITIDIN 7,040.00 2
2018 

2 APT010000I12000083 161681 tn. H KULAU  METRONIDA

56,718.20 2

240,240.0
3 APT010000I12000083 161681 tn. H KULAU  MEROPENE 2
0

4 APT010000I12000083 161681 tn. H KULAU  CODIPRONT 7,937.60 10

5 APT010000I12000083 161681 tn. H KULAU  SANTAGESIK4,949.40 3

6 APT010000I12000083 161681 tn. H KULAU  FENTANYL 041,599.80 2

7 APT010000I12000083 161681 tn. H KULAU  OMEPRAZOL

24,999.70 1
Sub Total   22
31-12-
1 APT010000I12000083 161681 tn. H KULAU  CAIRAN AM70,188.80 1
2018 
2 APT010000I12000083 161681 tn. H KULAU  ACETYLCYS 1,100.00 3
3 APT010000I12000083 161681 tn. H KULAU  RANITIDIN 7,040.00 2
4 APT010000I12000083 161681 tn. H KULAU  FUROSEMID 190.99 1
240,240.0
5 APT010000I12000083 161681 tn. H KULAU  MEROPENE 2
0
6 APT010000I12000083 161681 tn. H KULAU  METAMIZOL4,999.99 3
7 APT010000I12000083 161681 tn. H KULAU  OMEPRAZOL
24,999.70 1

8 APT010000I12000083 161681 tn. H KULAU  CODIPRONT 7,937.60 10

Sub Total   23

Total 249
12-12-
1 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH IV CATHETE 7,750.00 1
2018 
2 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH INFUS SET 7,920.00 1
3 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH IV DRESSI 4,850.00 1
4 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH HANDSCOEN 478.00 2
5 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH MASKER DI 700.00 2
6 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH CAIRAN RL 7,149.60 1
7 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH RANITIDIN 7,040.00 1
8 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH KETOROLAC 7,350.75 1
Sub Total   10
13-12-
2018  1 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH KETOROLAC 7,350.75 3

2 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH RANITIDIN 7,040.00 2

3 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH CAIRAN RL 7,149.60 3
Sub Total   8
14-12- 1 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH RANITIDIN 7,040.00 2
2018 
2 APT010000I62004434 151459 tn. MUH EQI FARDIANSYAH KETOROLAC 7,350.75 1
Sub Total   3
19-12- 1 APT010000I64002956 161471 tn. NATHANIEL SALU  CAIRAN RL 7,149.60 3
2018 
Sub Total   3
20-12-
2018  1 APT010000I62004472 161449 tn. NUR ROHMAT  CAIRAN AQ 2,860.00 2

2 APT010000I62004472 161449 tn. NUR ROHMAT  CEFTRIAXO19,999.10 1

3 APT010000I62004472 161449 tn. NUR ROHMAT  KETOROLAC 7,350.75 1
4 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 1
5 APT010000I62004472 161449 tn. NUR ROHMAT  CAIRAN RL 7,149.60 2
6 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 10 C 2,310.00 3
7 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 3 CC 1,485.00 3
8 APT010000I64002956 161471 tn. NATHANIEL SALU  CEFTRIAXO19,999.10 2
9 APT010000I64002956 161471 tn. NATHANIEL SALU  PIRACETAM10,670.00 2
10 APT010000I64002956 161471 tn. NATHANIEL SALU  KETOROLAC 7,350.75 2
11 APT010000I64002956 161471 tn. NATHANIEL SALU  RANITIDIN 7,040.00 1
Sub Total   20
21-12-
1 APT010000I64002956 161471 tn. NATHANIEL SALU  CEFTRIAXO19,999.10 2
2018 
2 APT010000I64002956 161471 tn. NATHANIEL SALU  RANITIDIN 7,040.00 2
3 APT010000I64002956 161471 tn. NATHANIEL SALU  KETOROLAC 7,350.75 2
4 APT010000I64002956 161471 tn. NATHANIEL SALU  PIRACETAM10,670.00 2
5 APT010000I64002956 161471 tn. NATHANIEL SALU  CAIRAN NAC6,409.70 3
6 APT010000I64002956 161471 tn. NATHANIEL SALU  HANDSCOEN 478.00 4
7 APT010000I64002956 161471 tn. NATHANIEL SALU  CONECTA 13,200.00 2
8 APT010000I64002956 161471 tn. NATHANIEL SALU  IV CATHETE 7,750.00 1
9 APT010000I62004472 161449 tn. NUR ROHMAT  CEFTRIAXO19,999.10 2
10 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 2
11 APT010000I62004472 161449 tn. NUR ROHMAT  KETOROLAC 7,350.75 3
12 APT010000I62004472 161449 tn. NUR ROHMAT  KETOROLAC 7,350.75 3
13 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 2
14 APT010000I62004472 161449 tn. NUR ROHMAT  CAIRAN RL 7,149.60 2
15 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOEN 478.00 2
16 APT010000I62004472 161449 tn. NUR ROHMAT  MASKER DI 700.00 1
17 APT010000I62004472 161449 tn. NUR ROHMAT  IV DRESSI 4,850.00 1
18 APT010000I62004472 161449 tn. NUR ROHMAT  TRANSFUSI28,050.00 1
19 APT010000I62004472 161449 tn. NUR ROHMAT  KETOROLAC 7,350.75 1
20 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 1
21 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 3 CC 1,485.00 2
Sub Total   41
23-12- 1 APT010000I64002956 161471 tn. NATHANIEL SALU  CEFTRIAXO19,999.10 2
2018 
2 APT010000I64002956 161471 tn. NATHANIEL SALU  RANITIDIN 7,040.00 2
3 APT010000I64002956 161471 tn. NATHANIEL SALU  KETOROLAC 7,350.75 2
4 APT010000I64002956 161471 tn. NATHANIEL SALU  PIRACETAM10,670.00 2
5 APT010000I62004472 161449 tn. NUR ROHMAT  CEFTRIAXO19,999.10 2
6 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 2
7 APT010000I62004472 161449 tn. NUR ROHMAT  KETOROLAC 7,350.75 3
8 APT010000I62004472 161449 tn. NUR ROHMAT  CAIRAN RL 7,149.60 2
9 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOEN 478.00 4
10 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 3 CC 1,485.00 1
11 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 10 C 2,310.00 1
12 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOON 13,613.00 1
13 APT010000I62004472 161449 tn. NUR ROHMAT  IV CATHETE12,416.00 2
14 APT010000I62004472 161449 tn. NUR ROHMAT  INFUS SET 7,920.00 1
15 APT010000I64002956 161471 tn. NATHANIEL SALU  CEFIXIME 4,950.00 6
16 APT010000I64002956 161471 tn. NATHANIEL SALU  FARGETIX 407.00 9
17 APT010000I64002956 161471 tn. NATHANIEL SALU  PIRACETAM 618.31 9
Sub Total   51
24-12-
1 APT010000I64002956 161471 tn. NATHANIEL SALU  CEFIXIME 4,950.00 6
2018 
2 APT010000I64002956 161471 tn. NATHANIEL SALU  FARGETIX 407.00 9
 3 APT010000I64002956 161471 tn. NATHANIEL SALU  PIRACETAM 618.31 9
4 APT010000I62004472 161449 tn. NUR ROHMAT  CEFIXIME 4,950.00 10
5 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 629.99 10
6 APT010000I62004472 161449 tn. NUR ROHMAT  MELOXICAM 923.23 10
7 APT010000I62004472 161449 tn. NUR ROHMAT  PREDNISON 224.99 34
8 APT010000I62004472 161449 tn. NUR ROHMAT  MEGABAL 1,730.00 3
9 APT010000I62004472 161449 tn. NUR ROHMAT  PIRACETAM 347.27 6
10 APT010000I62004472 161449 tn. NUR ROHMAT  CITICOLIN 10,011.38 2
11 APT010000I62004472 161449 tn. NUR ROHMAT  MECOBALAM6,600.00 1
12 APT010000I62004472 161449 tn. NUR ROHMAT  PREDNISON 224.99 12
13 APT010000I62004472 161449 tn. NUR ROHMAT  CAIRAN RL 7,149.60 2
14 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOEN 478.00 4
15 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOON 13,613.00 1
16 APT010000I62004472 161449 tn. NUR ROHMAT  MASKER DI 700.00 2
17 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 3 CC 1,485.00 2
18 APT010000I62004472 161449 tn. NUR ROHMAT  SPOIT 10 C 2,310.00 1
19 APT010000I62004472 161449 tn. NUR ROHMAT  IV CATHETE 7,750.00 1
20 APT010000I62004472 161449 tn. NUR ROHMAT  INFUS SET 7,920.00 1
21 APT010000I62004472 161449 tn. NUR ROHMAT  CEFTRIAXO19,999.10 2
22 APT010000I62004472 161449 tn. NUR ROHMAT  KETOROLAC 7,350.75 2
23 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 2
Sub Total   132
25-12-
1 APT010000I62004472 161449 tn. NUR ROHMAT  MECOBALAM6,600.00 1
2018 
2 APT010000I62004472 161449 tn. NUR ROHMAT  PREDNISON 224.99 12

3 APT010000I62004472 161449 tn. NUR ROHMAT  PIRACETAM77,000.00 2

4 APT010000I62004472 161449 tn. NUR ROHMAT  MELOXICAM 923.23 1

5 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 629.99 2
6 APT010000I62004472 161449 tn. NUR ROHMAT  SPORETIK 5,720.50 2
Sub Total   20
26-12-
1 APT010000I62004472 161449 tn. NUR ROHMAT  DEKSAMETA1,801.80 3
2018 
Sub Total   3
27-12-
1 APT010000I62004472 161449 tn. NUR ROHMAT  PIRACETAM 1,293.60 2
2018 
2 APT010000I62004472 161449 tn. NUR ROHMAT  MEGABAL 1,730.00 1
3 APT010000I62004472 161449 tn. NUR ROHMAT  DEKSAMETA1,801.80 3
Sub Total   6
28-12-
1 APT010000I62004472 161449 tn. NUR ROHMAT  CAIRAN NAC6,409.70 1
2018 
2 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOEN 478.00 4
3 APT010000I62004472 161449 tn. NUR ROHMAT  HANDSCOON12,100.00 1
4 APT010000I62004472 161449 tn. NUR ROHMAT  MASKER DI 700.00 1
5 APT010000I62004472 161449 tn. NUR ROHMAT  PIRACETAM 1,293.60 2
 6 APT010000I62004472 161449 tn. NUR ROHMAT  MEGABAL 1,730.00 1
7 APT010000I62004472 161449 tn. NUR ROHMAT  DEKSAMETA1,801.80 2
8 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 2
Sub Total   14
29-12-
1 APT010000I62004472 161449 tn. NUR ROHMAT  DEKSAMETA1,801.80 1
2018 
2 APT010000I62004472 161449 tn. NUR ROHMAT  RANITIDIN 7,040.00 2
3 APT010000I62004472 161449 tn. NUR ROHMAT  MEGABAL 1,730.00 1
4 APT010000I62004472 161449 tn. NUR ROHMAT  PIRACETAM 1,293.60 2
5 APT010000I62004472 161449 tn. NUR ROHMAT  CEFIXIME 4,950.00 2
6 APT010000I62004472 161449 tn. NUR ROHMAT  MELOXICAM 923.23 1
Sub Total   9

Total 320
 9,294.49 PCS 9,294.49

22,100.00 PCS 22,100.00

10,462.50 PCS 10,462.50
645.30 PCS 1,290.60
6,790.00 PCS 6,790.00
5,154.40 PCS 10,308.80
9,294.49 PCS 27,883.47
3,118.50 PCS 3,118.50
2,004.75 PCS 2,004.75
4,560.00 PCS 9,120.00
297.97 PCS 893.91
103,267.02

386.10 PCS 1,158.30

4,560.00 PCS 9,120.00

89,189.10 PCS 89,189.10
99,467.40

9,294.49 PCS 18,588.98

11,685.27 PCS 23,370.54

41,959.52

818.99 PCS 4,913.94

4,913.94

269.99 PCS 269.99

394.34 PCS 394.34

3,796.65 PCS 15,186.60
10,700.80 PCS 21,401.60
3,675.38 PCS 3,675.38
1,061.06 PCS 1,061.06
166.04 PCS 664.16
660.66 PCS 6,606.60
386.10 PCS 3,861.00
534.60 PCS 1,069.20
1,255.10 PCS 12,551.00
66,740.93

10,462.50 PCS 10,462.50

10,462.50

94,754.88 PCS 94,754.88

8,723.00 PCS 8,723.00

103,477.88
 6,921.20 PCS 6,921.20

135,435.3 PCS 135,435.3

0 0
26,998.78 PCS 53,997.56
2,784.00 PCS 2,784.00
3,118.50 PCS 3,118.50
645.30 PCS 1,290.60
910.00 PCS 910.00
204,457.16

6,921.20 PCS 6,921.20

10,700.80 PCS 21,401.60

26,998.78 PCS 53,997.56
94,754.88 PCS 94,754.88
177,075.24

10,700.80 PCS 21,401.60

26,998.78 PCS 53,997.56

6,921.20 PCS 6,921.20
94,754.88 PCS 94,754.88
6,921.20 PCS 6,921.20
10,700.80 PCS 32,102.40
386.10 PCS 772.20
216,871.04

26,998.78 PCS 53,997.56

6,921.20 PCS 6,921.20

10,700.80 PCS 21,401.60
462.50 PCS 4,625.00
86,945.36

37,570.50 PCS 37,570.50

1,600.43 PCS 3,200.86

10,700.80 PCS 21,401.60
26,998.78 PCS 53,997.56
8,332.61 PCS 8,332.61
1,705.00 PCS 5,115.00
270,398.7
54,079.74 PCS 0
400,016.83

26,998.78 PCS 53,997.56

10,700.80 PCS 21,401.60

9,294.49 PCS 27,883.47
24,596.00 PCS 49,192.00
26,998.78 PCS 53,997.56
112,869.2 PCS 225,738.4
2 4
9,555.98 PCS 28,667.94
910.00 PCS 9,100.00
645.30 PCS 12,906.00
3,118.50 PCS 3,118.50
2,153.25 PCS 2,153.25
33,749.60 PCS 33,749.60
6,749.99 PCS 20,249.97
408,408.0 816,816.0
0 PCS 0
10,700.80 PCS 21,401.60
270,398.7
54,079.74 PCS 0
14,708.20 PCS 29,416.40
1,680,188.59

10,700.80 PCS 21,401.60

112,869.2 225,738.4
2 PCS 4
408,408.0 816,816.0
PCS
0 0

10,715.76 PCS 107,157.6

0
8,760.44 PCS 26,281.32
108,159.4
54,079.74 PCS
8
33,749.60 PCS 33,749.60
1,339,304.04

94,754.88 PCS 94,754.88

1,705.00 PCS 5,115.00

10,700.80 PCS 21,401.60
257.84 PCS 257.84
408,408.0 816,816.0
0 PCS 0
6,749.99 PCS 20,249.97
33,749.60 PCS 33,749.60
107,157.6
10,715.76 PCS 0
1,099,502.49
 5,634,64
9.94
 8,525.00 PCS 8,525.00

8,712.00 PCS 8,712.00

5,335.00 PCS 5,335.00
525.80 PCS 1,051.60
770.00 PCS 1,540.00
7,864.56 PCS 7,864.56
7,744.00 PCS 7,744.00
8,085.82 PCS 8,085.82
48,857.98

8,085.82 PCS 24,257.46

7,744.00 PCS 15,488.00

7,864.56 PCS 23,593.68
63,339.14

7,744.00 PCS 15,488.00

8,085.82 PCS 8,085.82

23,573.82

7,864.56 PCS 23,593.68

23,593.68

3,146.00 PCS 6,292.00

21,999.01 PCS 21,999.01

8,085.82 PCS 8,085.82
7,744.00 PCS 7,744.00
7,864.56 PCS 15,729.12
2,541.00 PCS 7,623.00
1,633.50 PCS 4,900.50
21,999.01 PCS 43,998.02
11,737.00 PCS 23,474.00
8,085.82 PCS 16,171.64
7,744.00 PCS 7,744.00
163,761.11
21,999.01 PCS 43,998.02

7,744.00 PCS 15,488.00

8,085.82 PCS 16,171.64
11,737.00 PCS 23,474.00
7,050.67 PCS 21,152.01
525.80 PCS 2,103.20
14,520.00 PCS 29,040.00
8,525.00 PCS 8,525.00
21,999.01 PCS 43,998.02
7,744.00 PCS 15,488.00
8,085.82 PCS 24,257.46
8,085.82 PCS 24,257.46
7,744.00 PCS 15,488.00
7,864.56 PCS 15,729.12
525.80 PCS 1,051.60
770.00 PCS 770.00
5,335.00 PCS 5,335.00
30,855.00 PCS 30,855.00
8,085.82 PCS 8,085.82
7,744.00 PCS 7,744.00
1,633.50 PCS 3,267.00
356,278.35

21,999.01 PCS 43,998.02

7,744.00 PCS 15,488.00

8,085.82 PCS 16,171.64
11,737.00 PCS 23,474.00
21,999.01 PCS 43,998.02
7,744.00 PCS 15,488.00
8,085.82 PCS 24,257.46
7,864.56 PCS 15,729.12
525.80 PCS 2,103.20
1,633.50 PCS 1,633.50
2,541.00 PCS 2,541.00
14,974.30 PCS 14,974.30
13,657.60 PCS 27,315.20
8,712.00 PCS 8,712.00
5,445.00 PCS 32,670.00
447.70 PCS 4,029.30
680.14 PCS 6,121.26
298,704.02

5,445.00 PCS 32,670.00

447.70 PCS 4,029.30

 680.14 PCS 6,121.26
5,445.00 PCS 54,450.00
692.99 PCS 6,929.90
1,015.55 PCS 10,155.50
247.49 PCS 8,414.66
1,903.00 PCS 5,709.00
382.00 PCS 2,292.00
11,012.51 PCS 22,025.02
7,260.00 PCS 7,260.00
247.49 PCS 2,969.88
7,864.56 PCS 15,729.12
525.80 PCS 2,103.20
14,974.30 PCS 14,974.30
770.00 PCS 1,540.00
1,633.50 PCS 3,267.00
2,541.00 PCS 2,541.00
8,525.00 PCS 8,525.00
8,712.00 PCS 8,712.00
21,999.01 PCS 43,998.02
8,085.82 PCS 16,171.64
7,744.00 PCS 15,488.00
296,075.80

7,260.00 PCS 7,260.00

247.49 PCS 2,969.88

84,700.00 PCS 169,400.0

0
1,015.55 PCS 1,015.55
692.99 PCS 1,385.98
6,292.55 PCS 12,585.10
194,616.51

1,981.98 PCS 5,945.94

5,945.94

1,422.96 PCS 2,845.92

1,903.00 PCS 1,903.00

1,981.98 PCS 5,945.94
10,694.86

7,050.67 PCS 7,050.67

525.80 PCS 2,103.20

13,310.00 PCS 13,310.00
770.00 PCS 770.00
1,422.96 PCS 2,845.92
1,903.00 PCS 1,903.00
1,981.98 PCS 3,963.96
7,744.00 PCS 15,488.00
47,434.75

1,981.98 PCS 1,981.98

7,744.00 PCS 15,488.00

1,903.00 PCS 1,903.00
1,422.96 PCS 2,845.92
5,445.00 PCS 10,890.00
1,015.55 PCS 1,015.55
34,124.45
 1,567,00
0.41