BALAI KESEHATAN MATA MASYARAKAT CIKAMPEK

Jl. Ir. H. Djuanda No. 10 Cikampek

KABUPATEN KARAWANG Kode Pos - Telp. (0264) 316710

LAPORAN PENJUALAN BARANG DETAIL

Periode : 01 Mei 2020 s/d 31 Mei 2020

No.Pendaftaran Nama pasien Jenis Kelas Tgl. PelayananNama Barang Harga satuan Service Biaya Total Tangg.Rs Total Ruangan Pasien
No No Cm Pasien R/ke Qty Admin bayar Dokter

1 2005050012 000105 Tarisem Binti Sarkum BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

2 2005050012 000105 Tarisem Binti Sarkum BPJS NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

3 2005050003 024862 Engkay Binti Walam BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
4 2005050003 024862 Engkay Binti Walam BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

5 2005050004 012570
Karsono Bin Harjo MartonoBPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

6 2005050004 012570
Karsono Bin Harjo MartonoBPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

7 2005050015 024961 Iyah Binti Warsa BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

8 2005050015 024961 Iyah Binti Warsa BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

9 2005050015 024961 Iyah Binti Warsa BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
10 2005050021 026213Nardilah Binti Moch Hariri BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

11 2005050021 026213Nardilah Binti Moch Hariri BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

12 2005050030 026216Ahmad Muhidin Bin YayaUMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

13 2005050030 026216Ahmad Muhidin Bin YayaUMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

14 2005050029 026215Nur Fadilah Binti KomenUMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
15 2005050029 026215Nur Fadilah Binti KomenUMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

16 2005050025 024570 Nugraha Bin Undi BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

17 2005050025 024570 Nugraha Bin Undi BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

18 2005060018 016300 I Wayan Terima UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

19 2005060018 016300 I Wayan Terima UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00
20 2005060018 016300 I Wayan Terima UMUM NON KELAS ### 3 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

21 2005060007 026117 Nursih Binti Kastum UMUM NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

22 2005060007 026117 Nursih Binti Kastum UMUM NON KELAS ### 2 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

23 2005060007 026117 Nursih Binti Kastum UMUM NON KELAS ### 1 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

24 2005060011 026219
Yuyu Wahyudin Bin Usman
UMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

25 2005060011 026219
Yuyu Wahyudin Bin Usman
UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00
26 2005060008 026217
Toto Toihah Bin Komaludin
UMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

27 2005060008 026217
Toto Toihah Bin Komaludin
UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

28 2005060009 026218 Suharmi Binti Mitro UMUM NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

29 2005060009 026218 Suharmi Binti Mitro UMUM NON KELAS ### 1 Tobroson MD 1 40000 0 0 40,000.00 0 40,000.00

30 2005060009 026218 Suharmi Binti Mitro UMUM NON KELAS ### 3 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00
31 2005060022 012578 Hambawi Bin Warsan BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

32 2005060022 012578 Hambawi Bin Warsan BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

33 2005060006 026096 Onih Binti Risan BPJS NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

34 2005060006 026096 Onih Binti Risan BPJS NON KELAS ### 1 P Pred MD 1 55000 0 0 55,000.00 0 55,000.00

35 2005060006 026096 Onih Binti Risan BPJS NON KELAS ### 4 Matoflam 6 8785 0 0 52,710.00 0 52,710.00
36 2005060006 026096 Onih Binti Risan BPJS NON KELAS ### Metil
2 Prednisolon 16 20 1385 0 0 27,700.00 0 27,700.00

37 2005060020 026224 Sruwet Binti Watno BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

38 2005060020 026224 Sruwet Binti Watno BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

39 2005060040 026239Jati Siswadi Bin Sudarto UMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

40 2005060040 026239Jati Siswadi Bin Sudarto UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

41 2005060033 015482
Budiman Sagara Bin Wiryanto
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
42 2005060033 015482
Budiman Sagara Bin Wiryanto
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

43 2005060029 026230
Tati Supriatin Binti M YasinBPJS NON KELAS ### 2 Catarlent MD 1 27500 0 0 27,500.00 0 27,500.00

44 2005060029 026230
Tati Supriatin Binti M YasinBPJS NON KELAS ### 1 Noncort MD 1 58125 0 0 58,125.00 0 58,125.00

45 2005060021 026147 Ida Binti Rosid BPJS NON KELAS ### 2 P Pred MD 1 55000 0 0 55,000.00 0 55,000.00

46 2005060021 026147 Ida Binti Rosid BPJS NON KELAS ### 4 Aspar K 3 0 0 0 0.00 0 0.00
47 2005060021 026147 Ida Binti Rosid BPJS NON KELAS ### 3 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

48 2005060021 026147 Ida Binti Rosid BPJS NON KELAS ### Metil
1 Prednisolon 16 20 1385 0 0 27,700.00 0 27,700.00

49 2005060038 009381
Mohamad Irzal Bin Bikmansyah
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

50 2005060038 009381
Mohamad Irzal Bin Bikmansyah
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

51 2005060016 026222 Rahmat Bin Domo UMUM NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
52 2005060016 026222 Rahmat Bin Domo UMUM NON KELAS ### 1 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

53 2005060016 026222 Rahmat Bin Domo UMUM NON KELAS ### 3 Cendo Vital Tab 1 4125 0 0 4,125.00 0 4,125.00

54 2005110038 026259 Karta Bin Tatang UMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

55 2005110038 026259 Karta Bin Tatang UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

56 2005110023 026197 Suma Bin Saja UMUM NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

57 2005110023 026197 Suma Bin Saja UMUM NON KELAS ### 1 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00
58 2005110023 026197 Suma Bin Saja UMUM NON KELAS ### 3 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

59 2005110041 026261 Titi Maryati Binti Ihing UMUM NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

60 2005110041 026261 Titi Maryati Binti Ihing UMUM NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

61 2005110041 026261 Titi Maryati Binti Ihing UMUM NON KELAS ### 3 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

62 2005110040 026260
Mutiara Alifia H Binti Yusak
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
63 2005110040 026260
Mutiara Alifia H Binti Yusak
UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

64 2005110042 026262 Adi Bin Kastam BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

65 2005110042 026262 Adi Bin Kastam BPJS NON KELAS ### 1 Neurodex 10 756 0 0 7,560.00 0 7,560.00

66 2005110028 008330 Wardiah Binti Namin BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

67 2005110028 008330 Wardiah Binti Namin BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
68 2005110045 026264 Aan Binti Data BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

69 2005110045 026264 Aan Binti Data BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

70 2005110046 026265 Samjih Bin Sartiman BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

71 2005110046 026265 Samjih Bin Sartiman BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

72 2005110034 019996 Ruhendi Bin Saican BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

73 2005110034 019996 Ruhendi Bin Saican BPJS NON KELAS ### 1 Neurodex 10 756 0 0 7,560.00 0 7,560.00
74 2005110021 026252
Abdul Aziz Bin Acep TobroniBPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

75 2005110021 026252
Abdul Aziz Bin Acep TobroniBPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

76 2005110029 Euis
026255
Cahyawati Binti S Ganda Sumiarsa
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

77 2005110029 Euis
026255
Cahyawati Binti S Ganda Sumiarsa
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

78 2005110020 026251Warno Bin Parto Paimin BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
79 2005110020 026251Warno Bin Parto Paimin BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

80 2005110035 Risfhi
013098 Rashifah Hayati Bin Ridwan
UMUM
Arifin NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

81 2005110035 Risfhi
013098 Rashifah Hayati Bin Ridwan
UMUM
Arifin NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

82 2005110054 026272
Lutfi Adityatna Bin DadengBPJS NON KELAS ### 1 Mycos EO 1 36250 0 0 36,250.00 0 36,250.00

83 2005110052 026270 Erna Wati Binti Nasudi UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00
84 2005110052 026270 Erna Wati Binti Nasudi UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

85 2005110052 026270 Erna Wati Binti Nasudi UMUM NON KELAS ### 3 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

86 2005110049 026267Yayan Ruhyana Bin EminUMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

87 2005110049 026267Yayan Ruhyana Bin EminUMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

88 2005110048 026266 Komida Binti Kinang UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

89 2005110048 026266 Komida Binti Kinang UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00
90 2005110050 026268 Sajim Bin Idong BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

91 2005110050 026268 Sajim Bin Idong BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

92 2005110053 026271 Siti Aisah Binti Nusin UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

93 2005110053 026271 Siti Aisah Binti Nusin UMUM NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

94 2005110053 026271 Siti Aisah Binti Nusin UMUM NON KELAS ### 3 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00
95 2005120009 026274
Siti Nurazizah Binti Rustayim
BPJS NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

96 2005120009 026274
Siti Nurazizah Binti Rustayim
BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

97 2005120009 026274
Siti Nurazizah Binti Rustayim
BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

98 2005120014 002031
Entju Suzianah Binti Sudirman
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

99 2005120014 002031
Entju Suzianah Binti Sudirman
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
100 2005120010 002529
Nati Susilawati Binti NamunBPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

101 2005120010 002529

Nati Susilawati Binti NamunBPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

102 2005120013 026275 Nuraini Binti Calim BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

103 2005120013 026275 Nuraini Binti Calim BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

104 2005120006 003267 Evi Murliana Munandar BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

105 2005120006 003267 Evi Murliana Munandar BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
106 2005120007 000838 Darmadi Bin Gunadi BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

107 2005120007 000838 Darmadi Bin Gunadi BPJS NON KELAS ### 3 Aspar K 3 0 0 0 0.00 0 0.00

108 2005120007 000838 Darmadi Bin Gunadi BPJS NON KELAS ### 2 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

109 2005120007 000838 Darmadi Bin Gunadi BPJS NON KELAS ### 4 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

110 2005120008 026273

Ng Karso Raharjo Be Bin Wiryareja
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
111 2005120008 026273
Ng Karso Raharjo Be Bin Wiryareja
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

112 2005120004 023053 Haris Rizal Bin Amir BPJS NON KELAS ### Metil
1 Prednisolon 16 20 1385 0 0 27,700.00 0 27,700.00

113 2005120004 023053 Haris Rizal Bin Amir BPJS NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

114 2005120004 023053 Haris Rizal Bin Amir BPJS NON KELAS ### 2 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

115 2005120003 020918 Dariah Binti Sahri BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00
116 2005120003 020918 Dariah Binti Sahri BPJS NON KELAS ### 3 Neurodex 10 756 0 0 7,560.00 0 7,560.00

117 2005120003 020918 Dariah Binti Sahri BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

118 2005120002 025672 Ipah Binti Radam BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

119 2005120002 025672 Ipah Binti Radam BPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

120 2005120002 025672 Ipah Binti Radam BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

121 2005120005 025457 Sopiah Binti Yahya BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
122 2005120005 025457 Sopiah Binti Yahya BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

123 2005120001 023616 Een Binti Mista BPJS NON KELAS ### 2 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

124 2005120001 023616 Een Binti Mista BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

125 2005120001 023616 Een Binti Mista BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

126 2005120017 000736Djudju Djuarsa Bin Djaria BPJS NON KELAS ### 1 Glaoplus MD 1 132500 0 0 132,500.00 0 132,500.00
127 2005120017 000736Djudju Djuarsa Bin Djaria BPJS NON KELAS ### 2 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

128 2005120017 000736Djudju Djuarsa Bin Djaria BPJS NON KELAS ### 3 Aspar K 3 0 0 0 0.00 0 0.00

129 2005120018 020834 Tati Binti Cartim BPJS NON KELAS ### 4 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

130 2005120018 020834 Tati Binti Cartim BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

131 2005120018 020834 Tati Binti Cartim BPJS NON KELAS ### 3 Aspar K 3 0 0 0 0.00 0 0.00
132 2005120018 020834 Tati Binti Cartim BPJS NON KELAS ### 2 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

133 2005120012 007377 Darsih Binti Ita BPJS NON KELAS ### 4 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

134 2005120012 007377 Darsih Binti Ita BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

135 2005120012 007377 Darsih Binti Ita BPJS NON KELAS ### 3 Aspar K 3 0 0 0 0.00 0 0.00

136 2005120012 007377 Darsih Binti Ita BPJS NON KELAS ### 2 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

137 2005120011 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00
138 2005120011 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 3 Aspar K 3 0 0 0 0.00 0 0.00

139 2005120011 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 2 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

140 2005120011 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 4 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

141 2005120015 014619

Yeti Supriyati Binti Ahmad Jakaria
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

142 2005120015 014619

Yeti Supriyati Binti Ahmad Jakaria
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
143 2005120016 Dimas
026276
Candra Prasetya Bin Eko Supriyono
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

144 2005120016 Dimas

026276
Candra Prasetya Bin Eko Supriyono
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

145 2005120020 026278 Rudi Bin Uneb BPJS NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

146 2005120020 026278 Rudi Bin Uneb BPJS NON KELAS ### 2 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

147 2005120019 026277Ratu Natalina Binti Alex BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
148 2005120019 026277Ratu Natalina Binti Alex BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

149 2005120021 026279 Nermah Binti Yahya UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

150 2005120021 026279 Nermah Binti Yahya UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

151 2005120021 026279 Nermah Binti Yahya UMUM NON KELAS ### 3 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

152 2005120022 026280 Rahmat Bin Ahmid BPJS NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

153 2005120022 026280 Rahmat Bin Ahmid BPJS NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00
154 2005120022 026280 Rahmat Bin Ahmid BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

155 2005140004 006125

Nizam Dwi Cahya Bin Waim
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

156 2005140004 006125

Nizam Dwi Cahya Bin Waim
UMUM NON KELAS ### 2Berry Vision Disp. 10 2681 0 0 26,810.00 0 26,810.00

157 2005140013 026300

Dian Edi Purnomo Bin Suratman
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

158 2005140013 026300

Dian Edi Purnomo Bin Suratman
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
159 2005140015 026302 Tajudin Bin Tabrani BPJS NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

160 2005140015 026302 Tajudin Bin Tabrani BPJS NON KELAS ### 2 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

161 2005140014 026301

Wawan Setiawan Bin Rohanda
UMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

162 2005140014 026301

Wawan Setiawan Bin Rohanda
UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

163 2005140018 003658 Kurniasih Binti Caiman BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
164 2005140018 003658 Kurniasih Binti Caiman BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

165 2005140016 026303

Tanti Nurhayati Binti Uhi Suardi
BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

166 2005140016 026303

Tanti Nurhayati Binti Uhi Suardi
BPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

167 2005140016 026303

Tanti Nurhayati Binti Uhi Suardi
BPJS NON KELAS ### 3 Neurodex 10 756 0 0 7,560.00 0 7,560.00

168 2005140017 026304

Luthfianti Fadilah Binti Sahroni
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

169 2005140017 026304

Luthfianti Fadilah Binti Sahroni
UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00
170 2005150010 017003 Herman Bin Arsa UMUM NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

171 2005150010 017003 Herman Bin Arsa UMUM NON KELAS ### 1 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

172 2005150010 017003 Herman Bin Arsa UMUM NON KELAS ### 3 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

173 2005150023 001192

E Tri Wahyuni Binti Endang
UMUM NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

174 2005150023 001192

E Tri Wahyuni Binti Endang
UMUM NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
175 2005150023 001192
E Tri Wahyuni Binti Endang
UMUM NON KELAS ### 3 Nutriflam Neo 2 8663 0 0 17,326.00 0 17,326.00

176 2005150023 001192

E Tri Wahyuni Binti Endang
UMUM NON KELAS ### 1 Nutriflam Neo 4 8663 0 0 34,652.00 0 34,652.00

177 2005150003 026306 Wiwin Binti Musa UMUM NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

178 2005150003 026306 Wiwin Binti Musa UMUM NON KELAS ### 2 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

179 2005150003 026306 Wiwin Binti Musa UMUM NON KELAS ### 1 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00
180 2005150012 026310 Siti Supami Binti Sapii UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

181 2005150012 026310 Siti Supami Binti Sapii UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

182 2005150016 026312 Anah Binti Udin UMUM NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

183 2005150016 026312 Anah Binti Udin UMUM NON KELAS ### 2 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

184 2005150016 026312 Anah Binti Udin UMUM NON KELAS ### 1 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

185 2005150019 017168 Rukiyah Binti Ranta BPJS NON KELAS ### 1 Prednison 5 20 0 0 0 0.00 0 0.00
186 2005150019 017168 Rukiyah Binti Ranta BPJS NON KELAS ### 2Timol 0.5 % MD 1 36000 0 0 36,000.00 0 36,000.00

187 2005150019 017168 Rukiyah Binti Ranta BPJS NON KELAS ### 5 Tobroson MD 1 40000 0 0 40,000.00 0 40,000.00

188 2005150019 017168 Rukiyah Binti Ranta BPJS NON KELAS ### 4 Aspar K 6 0 0 0 0.00 0 0.00

189 2005150019 017168 Rukiyah Binti Ranta BPJS NON KELAS ### 3 Glauseta 250 12 5783 0 0 69,396.00 0 69,396.00

190 2005150022 024501 Damo Bin Saikan BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
191 2005150022 024501 Damo Bin Saikan BPJS NON KELAS ### 1Timol 0.5 % MD 1 36000 0 0 36,000.00 0 36,000.00

192 2005150022 024501 Damo Bin Saikan BPJS NON KELAS ### 4 Aspar K 6 0 0 0 0.00 0 0.00

193 2005150022 024501 Damo Bin Saikan BPJS NON KELAS ### 3 Glauseta 250 12 5783 0 0 69,396.00 0 69,396.00

194 2005150007 025718

Salam Purwanto Bin SanrajiBPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

195 2005150007 025718

Salam Purwanto Bin SanrajiBPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00
196 2005150007 025718
Salam Purwanto Bin SanrajiBPJS NON KELAS ### 3 Neurodex 10 756 0 0 7,560.00 0 7,560.00

197 2005150013 025997 Darja Bin Sura BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

198 2005150013 025997 Darja Bin Sura BPJS NON KELAS ### 1 Neurodex 10 756 0 0 7,560.00 0 7,560.00

199 2005150002 023034 Suherman Bin M Jana BPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

200 2005150002 023034 Suherman Bin M Jana BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

201 2005150009 025815 Saman Bin Atut BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
202 2005150009 025815 Saman Bin Atut BPJS NON KELAS ### 1Timol 0.5 % MD 1 36000 0 0 36,000.00 0 36,000.00

203 2005150009 025815 Saman Bin Atut BPJS NON KELAS ### 4 Aspar K 6 0 0 0 0.00 0 0.00

204 2005150009 025815 Saman Bin Atut BPJS NON KELAS ### 3 Glauseta 250 12 5783 0 0 69,396.00 0 69,396.00

205 2005150005 026308

Budi Eka Ramadhan Bin Wawan
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

206 2005150005 026308

Budi Eka Ramadhan Bin Wawan
BPJS NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00
207 2005150011 011058 Inda Bin Taim BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

208 2005150011 011058 Inda Bin Taim BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

209 2005150015 026311

Ade Kusmiati Binti Acmad Sanusi
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

210 2005150015 026311

Ade Kusmiati Binti Acmad Sanusi
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

211 2005150004 026307Ade Fahrudin Bin Soding BPJS NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00
212 2005150004 026307Ade Fahrudin Bin Soding BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

213 2005190022 026350 Nuryati Binti Karwi BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

214 2005190013 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 1 Posop MD 1 72188 0 0 72,188.00 0 72,188.00

215 2005190013 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 2 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

216 2005190013 007880Dedi Perwadi Bin Paidjo BPJS NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

217 2005190014 005774 Annisaa Azhaar Arifin UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
218 2005190014 005774 Annisaa Azhaar Arifin UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

219 2005190024 005176 Kirno Bin Joyo Kadis BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

220 2005190024 005176 Kirno Bin Joyo Kadis BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

221 2005190025 006996

Nurfahta Joyo Nugroho Bin Kirno
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

222 2005190026 026351 Tri Wawan Bin Siki UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
223 2005190018 026140
Al Haidar Fauzy Bin Shandy Utomo
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

224 2005190018 026140

Al Haidar Fauzy Bin Shandy Utomo
BPJS NON KELAS ### 2Berry Vision Disp. 10 2681 0 0 26,810.00 0 26,810.00

225 2005190001 010276

Taty Rukmyati Binti M Usman
BPJS NON KELAS ### 3 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

226 2005190001 010276

Taty Rukmyati Binti M Usman
BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

227 2005190001 010276

Taty Rukmyati Binti M Usman
BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00
228 2005190001 010276
Taty Rukmyati Binti M Usman
BPJS NON KELAS ### 4 Aspar K 3 0 0 0 0.00 0 0.00

229 2005190002 025907

Nani Maryani Binti AtmanaBPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

230 2005190002 025907

Nani Maryani Binti AtmanaBPJS NON KELAS ### 2 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

231 2005190002 025907

Nani Maryani Binti AtmanaBPJS NON KELAS ### 4 Aspar K 3 0 0 0 0.00 0 0.00

232 2005190002 025907

Nani Maryani Binti AtmanaBPJS NON KELAS ### 3 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

233 2005200025 026363

Elsa Junita Binti Endang Witarsawan
UMUM NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00
234 2005200025 026363
Elsa Junita Binti Endang Witarsawan
UMUM NON KELAS ### 2 Dextafen 1 1719 0 0 1,719.00 0 1,719.00

235 2005200013 026356 Sujarwo Bin Djahuri BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

236 2005200013 026356 Sujarwo Bin Djahuri BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

237 2005200009 Riana

026354
Fitriani Br Ginting Binti JahtraBPJS
Ginting NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

238 2005200009 Riana

026354
Fitriani Br Ginting Binti JahtraBPJS
Ginting NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
239 2005200002 024342 Cawi Binti Tasim BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

240 2005200002 024342 Cawi Binti Tasim BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

241 2005200019 Reyhan

026360 Putra Adriana Bin Ade Hidayat
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

242 2005200019 Reyhan

026360 Putra Adriana Bin Ade Hidayat
UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

243 2005200003 008196 Rudy Kapantow UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
244 2005200003 008196 Rudy Kapantow UMUM NON KELAS ### 3 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

245 2005200003 008196 Rudy Kapantow UMUM NON KELAS ### 2 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

246 2005200012 012578 Hambawi Bin Warsan BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

247 2005200012 012578 Hambawi Bin Warsan BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

248 2005200017 026358

Diaz Hadiansyah Bin H R Sucipto
BPJS NON KELAS ### 1 Mycos EO 1 36250 0 0 36,250.00 0 36,250.00

249 2005200005 026096 Onih Binti Risan BPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00
250 2005200005 026096 Onih Binti Risan BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

251 2005200005 026096 Onih Binti Risan BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

252 2005200024 026362

Bella Saadah Binti SuciptoBPJS NON KELAS ### 1 Mycos EO 1 36250 0 0 36,250.00 0 36,250.00

253 2005200024 026362

Bella Saadah Binti SuciptoBPJS NON KELAS ### 2 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

254 2005200016 026357 Pipit Binti Adang BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
255 2005200016 026357 Pipit Binti Adang BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

256 2005200023 000061Yayah Asiah Binti Marzuki BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

257 2005200023 000061Yayah Asiah Binti Marzuki BPJS NON KELAS ### 3 Aspar K 3 0 0 0 0.00 0 0.00

258 2005200023 000061Yayah Asiah Binti Marzuki BPJS NON KELAS ### 4 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

259 2005200023 000061Yayah Asiah Binti Marzuki BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
260 2005200020 026147 Ida Binti Rosid BPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

261 2005200020 026147 Ida Binti Rosid BPJS NON KELAS ### 3 Tropin 1 % ED 1 17188 0 0 17,188.00 0 17,188.00

262 2005200020 026147 Ida Binti Rosid BPJS NON KELAS ### 2
Metil Prednisolon 8 6 769 0 0 4,614.00 0 4,614.00

263 2005200018 026359

Elang Seka Nurpanca Bin Nurali
BPJS NON KELAS ### 3 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

264 2005200018 026359

Elang Seka Nurpanca Bin Nurali
BPJS NON KELAS ### 2 Tobroson MD 1 40000 0 0 40,000.00 0 40,000.00

265 2005200018 026359

Elang Seka Nurpanca Bin Nurali
BPJS NON KELAS ### 1 Prednison 5 20 0 0 0 0.00 0 0.00
266 2005270015 026382
Muhammad Rosip Bin Alfian
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

267 2005270015 026382

Muhammad Rosip Bin Alfian
UMUM NON KELAS ### 2 optihealth 10 0 0 0 0.00 0 0.00

268 2005270012 026168 Alfian Bin Nawawi UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

269 2005270012 026168 Alfian Bin Nawawi UMUM NON KELAS ### 2 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

270 2005270012 026168 Alfian Bin Nawawi UMUM NON KELAS ### 3 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00
271 2005270016 026383
Andi Apriandi Bin E Koeswadi
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

272 2005270016 026383

Andi Apriandi Bin E Koeswadi
BPJS NON KELAS ### 2 Cendo Vital Tab 10 5706 0 0 57,060.00 0 57,060.00

273 2005270017 026384 Kim Keunsoo UMUM NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

274 2005270017 026384 Kim Keunsoo UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

275 2005270035 016843

Muhammad Syahrudin Bin Kartono
BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
276 2005270035 016843
Muhammad Syahrudin Bin Kartono
BPJS NON KELAS ### 1 Vernacel MD 1 28750 0 0 28,750.00 0 28,750.00

277 2005270035 016843

Muhammad Syahrudin Bin Kartono
BPJS NON KELAS ### 3 Dextafen 1 1719 0 0 1,719.00 0 1,719.00

278 2005270032 003063 Nuroh Binti Idis BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

279 2005270032 003063 Nuroh Binti Idis BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

280 2005270037 023557

Siti Rochimah Binti Wonodiwiryo
BPJS NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

281 2005270037 023557

Siti Rochimah Binti Wonodiwiryo
BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00
282 2005270037 023557
Siti Rochimah Binti Wonodiwiryo
BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

283 2005270038 026395 Nurhaeti Binti Usup BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

284 2005270038 026395 Nurhaeti Binti Usup BPJS NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

285 2005270038 026395 Nurhaeti Binti Usup BPJS NON KELAS ### 3 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

286 2005270005 024119 Jumaroh Binti Sije BPJS NON KELAS ### 2 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
287 2005270005 024119 Jumaroh Binti Sije BPJS NON KELAS ### 1 Timol 0.5 % ED 1 65750 0 0 65,750.00 0 65,750.00

288 2005270005 024119 Jumaroh Binti Sije BPJS NON KELAS ### 4 Aspar K 3 0 0 0 0.00 0 0.00

289 2005270005 024119 Jumaroh Binti Sije BPJS NON KELAS ### 3 Glauseta 250 9 5783 0 0 52,047.00 0 52,047.00

290 2005270034 026394

Nova Puspitasari Binti Sukirno
BPJS NON KELAS ### 1 Mycos EO 1 36250 0 0 36,250.00 0 36,250.00

291 2005270034 026394

Nova Puspitasari Binti Sukirno
BPJS NON KELAS ### 2 Matoflam 6 8785 0 0 52,710.00 0 52,710.00
292 2005290009 026427 Emid Hamid Bin Ihya BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

293 2005290009 026427 Emid Hamid Bin Ihya BPJS NON KELAS ### 2 Matoflam 6 8785 0 0 52,710.00 0 52,710.00

294 2005290014 026431Ira Gunawati Binti Saleh BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

295 2005290014 026431Ira Gunawati Binti Saleh BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

296 2005290003 026221 Sahim Bin Marin BPJS NON KELAS ### 1 Floxa MD 1 36875 0 0 36,875.00 0 36,875.00

297 2005290003 026221 Sahim Bin Marin BPJS NON KELAS ### 2 Matoflam 6 8785 0 0 52,710.00 0 52,710.00
298 2005290011 026429 Toat Bin Onon BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

299 2005290011 026429 Toat Bin Onon BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

300 2005290015 026432

Hafiz Syakur Munif Bin Misbachul
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

301 2005290016 005382Rosmawati Binti Marham BPJS NON KELAS ### 2 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

302 2005290016 005382Rosmawati Binti Marham BPJS NON KELAS ### 3 P Pred MD 1 55000 0 0 55,000.00 0 55,000.00
303 2005290016 005382Rosmawati Binti Marham BPJS NON KELAS ### 1 Tropin 1 % ED 1 17188 0 0 17,188.00 0 17,188.00

304 2005290016 005382Rosmawati Binti Marham BPJS NON KELAS ### Metil
4 Prednisolon 16 30 1385 0 0 41,550.00 0 41,550.00

305 2005290040 026442

Krisdhina Ambarsari Binti Karim
UMUM NON KELAS ### 1 Polynel MD 1 24625 0 0 24,625.00 0 24,625.00

306 2005290040 026442

Krisdhina Ambarsari Binti Karim
UMUM NON KELAS ### 2 Nutriflam Neo 6 8663 0 0 51,978.00 0 51,978.00

307 2005290035 026440Yuliadi Rahmat Bin Arifin BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
308 2005290035 026440Yuliadi Rahmat Bin Arifin BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

309 2005290037 026441 Ikeu Sri Ratna Dewi BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

310 2005290037 026441 Ikeu Sri Ratna Dewi BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

311 2005290041 026443

Chika Syaras Dewi Binti Asril Syam
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

312 2005290039 004942

Anita Eka Pratiwi Binti Firman Sasetyo
BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

313 2005290039 004942

Anita Eka Pratiwi Binti Firman Sasetyo
BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00
314 2005290032 Nabilla
017521
Azizah Nugraha Binti Esa Husyz
UMUMNugraha NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

315 2005290032 Nabilla

017521
Azizah Nugraha Binti Esa Husyz
UMUMNugraha NON KELAS ### 2 optihealth 10 0 0 0 0.00 0 0.00

316 2005290031 010002

Nisa Almalia Nugraha Binti Esa
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

317 2005290031 010002

Nisa Almalia Nugraha Binti Esa
UMUM NON KELAS ### 2 optihealth 10 0 0 0 0.00 0 0.00

318 2005290042 026444 Mustadi Bin Zaenudin UMUM NON KELAS ### 3 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
319 2005290042 026444 Mustadi Bin Zaenudin UMUM NON KELAS ### 2 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

320 2005290042 026444 Mustadi Bin Zaenudin UMUM NON KELAS ### 1 Cendo Vital Tab 10 4125 0 0 41,250.00 0 41,250.00

321 2005290027 026124 Endun Binti Amat BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

322 2005290027 026124 Endun Binti Amat BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

323 2005290010 026428 Wartini Binti Bahreni BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
324 2005290010 026428 Wartini Binti Bahreni BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

325 2005290024 026436

Cucu Sri Nurlaelasari Binti Karna
UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

326 2005290024 026436

Cucu Sri Nurlaelasari Binti Karna
UMUM NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

327 2005290020 026433

Widia Ningsih Binti SugimanBPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

328 2005290020 026433

Widia Ningsih Binti SugimanBPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

329 2005290018 020258 Kacem Binti Umin UMUM NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
330 2005290018 020258 Kacem Binti Umin UMUM NON KELAS ### 2 Vitrolenta ED 1 45000 0 0 45,000.00 0 45,000.00

331 2005290018 020258 Kacem Binti Umin UMUM NON KELAS ### 3 optihealth 10 0 0 0 0.00 0 0.00

332 2005290044 026446 Yanti Binti Tasir BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00

333 2005290044 026446 Yanti Binti Tasir BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

334 2005290043 026445 Suta Bin Komban BPJS NON KELAS ### 1 Lyteers MD 1 26875 0 0 26,875.00 0 26,875.00
 335 2005290043 026445 Suta Bin Komban BPJS NON KELAS ### 2 Neurodex 10 756 0 0 7,560.00 0 7,560.00

Jumlah Qty 1494

Jumlah Total ###
Jumlah Total Bayar ###

Total Nama Barang

Aspar K 48
Berry Vision 20
Catarlent MD 1
Cendo Vital 211
Dextafen 2
Floxa MD 14
Glaoplus MD 1
Glauseta 250 126
Lyteers MD 111
Matoflam 90
Metil Prednis 90
Metil Prednis 6
Mycos EO 4
Neurodex 550
Noncort MD 1
Nutriflam Ne 84
optihealth 40
P Pred MD 3
Polynel MD 18
Posop MD 1
Prednison 5 40
Timol 0.5 % 13
Timol 0.5 % 3
Tobroson MD 3
Tropin 1 % E 2
Vernacel MD 1
Vitrolenta ED 11
Total 1494

Apotik Rawat Jalan

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