TAGIHAN RSIA KENDANGSARI MERR 05 MARET 2021

No NAMA SUPPLIER NO.FAKTUR TANGGAL TANGGAL RINCIAN TOTAL CARA BAYAR

FAKTUR JATUH TEMPO
PT. ANTARMITRA SEMBADA (AMS) 1382 08 Feb 2021/ 1-Mar-21 1,081,592
1 PT. ANTARMITRA SEMBADA (AMS) 1378 08 Feb 2021/ 1-Mar-21 1,254,000 Rp 3,554,942 TRANSFER
PT. ANTARMITRA SEMBADA (AMS) 1799 09 Feb 2021/ 2-Mar-21 1,219,350
PT. AZKEN INDONESIA 189 05 Feb 2021/ 7-Mar-21 4,851,000 TRANSFER
2 Rp 14,692,700
PT. AZKEN INDONESIA 168 01 Feb 2021/ 3-Mar-21 9,841,700
3 CV. ANANDA MEDICAL SURGICAL 2221 02 Feb 2021/ 4-Mar-21 2,200,000 Rp 2,200,000 TRANSFER
4 CV. ARKANA MEDIKA 047 08 Feb 2021/ 3-Mar-21 1,198,600 Rp 1,198,600 TRANSFER
PT. ANUGRAH ARGON MEDICA (AAM) 1054 13 Feb 2021/ 6-Mar-21 1,815,000
PT. ANUGRAH ARGON MEDICA (AAM) 1056 13 Feb 2021/ 6-Mar-21 5,737,875
5 PT. ANUGRAH ARGON MEDICA (AAM) 9186 10 Feb 2021/ 2-Mar-21 974,790 Rp 12,184,988 TRANSFER
PT. ANUGRAH ARGON MEDICA (AAM) 9052 09 Feb 2021/ 2-Mar-21 3,141,395
PT. ANUGRAH ARGON MEDICA (AAM) 8500 08 Feb 2021/ 1-Mar-21 515,928
PT. ANUGERAH PHARMINDO LESTARI (APL) 8559 08 Feb 2021/ 7-Mar-21 7,932,626
PT. ANUGERAH PHARMINDO LESTARI (APL) 8552 06 Feb 2021/ 7-Mar-21 16,071,247
PT. ANUGERAH PHARMINDO LESTARI (APL) 9342 06 Feb 2021/ 8-Mar-21 341,550
PT. ANUGERAH PHARMINDO LESTARI (APL) 8530 05 Feb 2021/ 7-Mar-21 9,961,284
PT. ANUGERAH PHARMINDO LESTARI (APL) 8539 05 Feb 2021/ 7-Mar-21 4,696,485 TRANSFER
6 Rp 74,756,528
PT. ANUGERAH PHARMINDO LESTARI (APL) 8540 05 Feb 2021/ 7-Mar-21 22,592,163
PT. ANUGERAH PHARMINDO LESTARI (APL) 7505 04 Feb 2021/ 6-Mar-21 2,112,000
PT. ANUGERAH PHARMINDO LESTARI (APL) 5081 02 Feb 2021/ 3-Mar-21 895,400
PT. ANUGERAH PHARMINDO LESTARI (APL) 5015 01 Feb 2021/ 3-Mar-21 5,312,706
PT. ANUGERAH PHARMINDO LESTARI (APL) 4977 01 Feb 2021/ 3-Mar-21 4,841,067
7 PT. DOS NI ROHA (DNR) 7256 02 Feb 2021/ 3-Mar-21 3,256,000 Rp 3,256,000 TRANSFER
PT. DAYAANUGERAH DEWATASAKTI (DAD) 9646 17 Feb 2021/ 10-Mar-21 2,970,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 1273 15 Feb 2021/ 8-Mar-21 346,500
PT. DAYAANUGERAH DEWATASAKTI (DAD) 3118 11 Feb 2021/ 4-Mar-21 2,475,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 2374 09 Feb 2021/ 2-Mar-21 924,000
8
PT. DAYAANUGERAH DEWATASAKTI (DAD) 2437 09 Feb 2021/ 2-Mar-21 132,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 1921 08 Feb 2021/ 1-Mar-21 3,234,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 0110 17 Feb 2021/ 10-Mar-21 440,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 9590 16 Feb 2021/ 9-Mar-21 2,326,500 12,848,000 TRANSFER
PT. ENSEVAL PUTERA MEGATRADING 4274 04 Feb 2021/ 6-Mar-21 514,345
PT. ENSEVAL PUTERA MEGATRADING 3747 03 Feb 2021/ 5-Mar-21 1,358,500
9 PT. ENSEVAL PUTERA MEGATRADING 3804 03 Feb 2021/ 5-Mar-21 413,994 Rp 5,362,081 TRANSFER
PT. ENSEVAL PUTERA MEGATRADING 2863 01 Feb 2021/ 3-Mar-21 2,082,300
PT. ENSEVAL PUTERA MEGATRADING 2818 01 Feb 2021/ 3-Mar-21 992,942
10 CV. GRAHA JAYA SUKSES 108 09 Feb 2021/ 6-Mar-21 1,705,000 Rp 1,705,000 TRANSFER
11 PT. INTI BUANA UTAMA 0150 03 Feb 2021/ 5-Mar-21 1,800,007 Rp 1,800,007 TRANSFER
PT. KIMIA FARMA 23192 03 Feb 2021/ 4-Mar-21 1,774,773 TRANSFER
12 Rp 4,230,523
PT. KIMIA FARMA 15796 01 Feb 2021/ 1-Mar-21 2,455,750
PT. KALLISTA PRIMA 7184 08 Feb 2021/ 8-Mar-21 3,696,000
PT. KALLISTA PRIMA 7015 05 Feb 2021/ 7-Mar-21 5,962,000
PT. KALLISTA PRIMA 6986 05 Feb 2021/ 6-Mar-21 291,500
PT. KALLISTA PRIMA 6761 04 Feb 2021/ 6-Mar-21 1,365,650
13 PT. KALLISTA PRIMA 6369 02 Feb 2021/ 4-Mar-21 6,468,000
PT. KALLISTA PRIMA 6200 01 Feb 2021/ 3-Mar-21 3,850,000
PT. KALLISTA PRIMA 6126 01 Feb 2021/ 3-Mar-21 1,100,000
PT. KALLISTA PRIMA 6202 01 Feb 2021/ 3-Mar-21 7,590,000
PT. KALLISTA PRIMA 6121 01 Feb 2021/ 3-Mar-21 189,750 Rp 30,512,900 TRANSFER
14 PT. LAB MEDIKA SEJAHTERA (LMS) 3137 05 Feb 2021/ 7-Mar-21 333,096
PT. LAB MEDIKA SEJAHTERA (LMS) 2544 01 Feb 2021/ 3-Mar-21 2,922,681 Rp 3,255,777 TRANSFER
15 MILLENIUM PHARMACON 8027 13 Feb 2021/ 27-Feb-21 858,000
MILLENIUM PHARMACON 8061 13 Feb 2021/ 27-Feb-21 832,810 Rp 1,690,810 TRANSFER
16 PT. MERAPI UTAMA PHARMA (MUP) 1809 20 Jan 2021/ 6-Mar-21 702,350
PT. MERAPI UTAMA PHARMA (MUP) 1673 20 Jan 2021/ 5-Mar-21 584,320 Rp 1,286,670 TRANSFER
17 MITRA DISTRINDO 244 04 Feb 2021/ 6-Mar-21 2,676,000 Rp 2,676,000 TRANSFER
18 PT. MENSA BINASUKSES (MBS) 3009 05 Feb 2021/ 6-Mar-21 297,000
PT. MENSA BINASUKSES (MBS) 5157 04 Feb 2021/ 5-Mar-21 6,237,000
PT. MENSA BINASUKSES (MBS) 8750 04 Feb 2021/ 6-Mar-21 2,640,000
PT. MENSA BINASUKSES (MBS) 5762 02 Feb 2021/ 3-Mar-21 9,445,700
PT. MENSA BINASUKSES (MBS) 8891 02 Feb 2021/ 4-Mar-21 815,100 Rp 19,434,800 TRANSFER
19 RAJAWALI NUSINDO 1008 01 Feb 2021/ 3-Mar-21 1,504,800
RAJAWALI NUSINDO 1080 02 Feb 2021/ 4-Mar-21 1,588,400 Rp 3,093,200 TRANSFER
20 PT. SRI BUANA LESTARI 9118 05 Feb 2021/ 7-Mar-21 832,722 Rp 832,722 TRANSFER
21 PT. SARANA LINTAS MEDIKA (SLM) 114 05 Feb 2021/ 7-Mar-21 792,000 Rp 792,000 TRANSFER
22 PT. SURGIKA ALKESINDO 579 05 Feb 2021/ 7-Mar-21 4,965,840
PT. SURGIKA ALKESINDO 542 04 Feb 2021/ 5-Mar-21 6,199,985 Rp 11,165,825 TRANSFER
23 CV. SURYA ANUGERAH NUSANTARA 006 26 Jan 2021/ 5-Mar-21 4,474,030 Rp 4,474,030 TRANSFER
24 PT. UNITED DICO CITAS 978 05 Feb 2021/ 26-Feb-21 388,808
PT. UNITED DICO CITAS 804 11 Feb 2021/ 3-Mar-21 1,816,100
PT. UNITED DICO CITAS 434 09 Feb 2021/ 1-Mar-21 550,000 Rp 2,754,908 VA
TOTAL TAGIHAN FARMASI : 219,759,011
25 B-WIND 012 2/25/2021 5-Mar-21 1,088,000 Rp 1,088,000 TRANSFER
26 PT. PRODIA WIDYAHUSADA 700 2/22/2021 8-Mar-21 12,455,000 Rp 12,455,000 TRANSFER
27 CV. AMANDA ALUMINIUM 083 2/25/2021 5-Mar-21 4,134,200 Rp 4,134,200 TRANSFER
28 KEDAI RACHMAH 2/22/2021 5-Mar-21 260,000 Rp 260,000 TRANSFER
29 PT. SURABAYA IDCARD PRINTING 018 1/14/2021 5-Mar-21 3,437,500 Rp 3,437,500 TRANSFER
30 PT. PRIA 1708 2/18/2021 4-Mar-21 1,399,680 Rp 1,399,680 TRANSFER
31 PT. UNILAB PERDANA 1546 2/25/2021 5-Mar-21 731,500 Rp 731,500 TRANSFER
32 WIFORTA ( Cetakan ) 125 2/24/2021 5-Mar-21 1,295,000 Rp 1,295,000 TRANSFER
33 Retribusi kebersihan Feb'21 5-Mar-21 336,000 Rp 336,000 TRANSFER
34 PMI Jan'21 2/23/2021 5-Mar-21 7,440,000 Rp 7,440,000 TRANSFER
CV. ARTHA SATIVA ( PASIEN 15-21 Feb'21 ) 2/21/2021 5-Mar-21 9,226,375
CV. ARTHA SATIVA ( KARY - 01-07 Feb'21 ) 2/7/2021 5-Mar-21 9,896,500
CV. ARTHA SATIVA ( PASIEN - 01-07 Feb'21 ) 2/7/2021 5-Mar-21 12,043,600
35
CV. ARTHA SATIVA ( PASIEN - 08-14 Feb'21 ) 2/14/2021 5-Mar-21 11,971,650
CV. ARTHA SATIVA ( KARY - 08-14 Feb'21 ) 2/14/2021 5-Mar-21 9,118,000
CV. ARTHA SATIVA ( KARY 15-21 Feb'21 ) 2/21/2021 5-Mar-21 8,037,250 Rp 60,293,375 TRANSFER
TOTAL TAGIHAN UMUM : 92,870,255
TOTAL TAGIHAN : 312,629,266

Surabaya, 04 Maret 2021

Diserahkan Oleh, Diketahui Oleh, Diketahui Oleh,

Rini Wahyuningati Dyah Ayu Hanik Nurfitroh

Bendahara Kadiv. Keuangan Wadir Umum & Keuangan
 TAGIHAN RSIA KENDANGSARI MERR 05 MARET 2021

No NAMA SUPPLIER
1 PT. ANTARMITRA SEMBADA (AMS) Rp 3,554,942
2 PT. AZKEN INDONESIA Rp 14,692,700
3 CV. ANANDA MEDICAL SURGICAL Rp 2,200,000
4 CV. ARKANA MEDIKA Rp 1,198,600
5 PT. ANUGRAH ARGON MEDICA (AAM) Rp 12,184,988
6 PT. ANUGERAH PHARMINDO LESTARI (APL) Rp 74,756,528
7 PT. DOS NI ROHA (DNR) Rp 3,256,000
8 PT. DAYAANUGERAH DEWATASAKTI (DAD) 12,848,000
9 PT. ENSEVAL PUTERA MEGATRADING Rp 5,362,081
10 CV. GRAHA JAYA SUKSES Rp 1,705,000
11 PT. INTI BUANA UTAMA Rp 1,800,007
12 PT. KIMIA FARMA Rp 4,230,523
13 PT. KALLISTA PRIMA Rp 30,512,900
14 PT. LAB MEDIKA SEJAHTERA (LMS) Rp 3,255,777
15 MILLENIUM PHARMACON Rp 1,690,810
16 PT. MERAPI UTAMA PHARMA (MUP) Rp 1,286,670
17 MITRA DISTRINDO Rp 2,676,000
18 PT. MENSA BINASUKSES (MBS) Rp 19,434,800
19 RAJAWALI NUSINDO Rp 3,093,200
20 PT. SRI BUANA LESTARI Rp 832,722
21 PT. SARANA LINTAS MEDIKA (SLM) Rp 792,000
22 PT. SURGIKA ALKESINDO Rp 11,165,825
23 CV. SURYA ANUGERAH NUSANTARA Rp 4,474,030
217,004,103
25 B-WIND Rp 1,088,000
26 PT. PRODIA WIDYAHUSADA Rp 12,455,000
27 CV. AMANDA ALUMINIUM Rp 4,134,200
28 KEDAI RACHMAH Rp 260,000
29 PT. SURABAYA IDCARD PRINTING Rp 3,437,500
30 PT. PRIA Rp 1,399,680
31 PT. UNILAB PERDANA Rp 731,500
32 WIFORTA ( Cetakan ) Rp 1,295,000
33 Retribusi kebersihan Feb'21 Rp 336,000
34 PMI Jan'21 Rp 7,440,000
35 CV. ARTHA SATIVA ( PASIEN 15-21 Feb'21 ) Rp 60,293,375
92,870,255
309,874,358

Surabaya, 04 Maret 2021

Diserahkan Oleh,

Rini Wahyuningati
Bendahara
 TAGIHAN RSIA KENDANGSARI MERR 12 MARET 2021

TANGGAL TANGGAL
No NAMA SUPPLIER NO.FAKTUR RINCIAN TOTAL CARA BAYAR
FAKTUR JATUH TEMPO

PT. ANUGRAH ARGON MEDICA (AAM) 2573 22 Feb 2021/ 12-Mar-21 644,090
PT. ANUGRAH ARGON MEDICA (AAM) 4586 22 Feb 2021/ 12-Mar-21 4,712,093
1
PT. ANUGRAH ARGON MEDICA (AAM) 2525 17 Feb 2021/ 9-Mar-21 591,452
PT. ANUGRAH ARGON MEDICA (AAM) 2997 17 Feb 2021/ 10-Mar-21 1,567,500 7,515,135 TRANSFER
PT. ANTARMITRA SEMBADA (AMS) 4137 20 Feb 2021/ 12-Mar-21 484,000
2
PT. ANTARMITRA SEMBADA (AMS) 3455 17 Feb 2021/ 10-Mar-21 1,533,664 2,017,664 TRANSFER
PT. AZKEN INDONESIA 0204 09 Feb 2021/ 11-Mar-21 3,249,400
3 PT. AZKEN INDONESIA 0195 08 Feb 2021/ 10-Mar-21 3,212,000
PT. AZKEN INDONESIA 0214 08 Feb 2021/ 12-Mar-21 3,121,800 9,583,200 TRANSFER
PT. ANUGERAH PHARMINDO LESTARI (APL) 3589 13 Feb 2021/ 13-Mar-21 16,071,247
PT. ANUGERAH PHARMINDO LESTARI (APL) 3612 13 Feb 2021/ 13-Mar-21 7,932,626
PT. ANUGERAH PHARMINDO LESTARI (APL) 3814 13 Feb 2021/ 13-Mar-21 17,853,501
PT. ANUGERAH PHARMINDO LESTARI (APL) 3546 13 Feb 2021/ 13-Mar-21 3,199,110
PT. ANUGERAH PHARMINDO LESTARI (APL) 3548 13 Feb 2021/ 13-Mar-21 11,296,081
PT. ANUGERAH PHARMINDO LESTARI (APL) 3428 11 Feb 2021/ 13-Mar-21 951,055
4 PT. ANUGERAH PHARMINDO LESTARI (APL) 2021 10 Feb 2021/ 12-Mar-21 528,000
PT. ANUGERAH PHARMINDO LESTARI (APL) 1060 09 Feb 2021/ 11-Mar-21 511,500
PT. ANUGERAH PHARMINDO LESTARI (APL) 0613 09 Feb 2021/ 10-Mar-21 26,247,829
PT. ANUGERAH PHARMINDO LESTARI (APL) 0199 08 Feb 2021/ 10-Mar-21 778,250
PT. ANUGERAH PHARMINDO LESTARI (APL) 0145 08 Feb 2021/ 10-Mar-21 11,937,379
PT. ANUGERAH PHARMINDO LESTARI (APL) 0149 08 Feb 2021/ 10-Mar-21 5,228,025
PT. ANUGERAH PHARMINDO LESTARI (APL) 0151 08 Feb 2021/ 10-Mar-21 11,439,668 113,974,271 TRANSFER
5 PT. DAYA MUDA AGUNG (DMA) 4012 10 Feb 2021/ 12-Mar-21 2,090,000 2,090,000 TRANSFER
PT. ENSEVAL PUTERA MEGATRADING 7549 13 Feb 2021/ 15-Mar-21 1,752,408
PT. ENSEVAL PUTERA MEGATRADING 6465 10 Feb 2021/ 12-Mar-21 561,507
6
PT. ENSEVAL PUTERA MEGATRADING 6027 09 Feb 2021/ 11-Mar-21 832,452
PT. ENSEVAL PUTERA MEGATRADING 5549 08 Feb 2021/ 10-Mar-21 2,284,425 5,430,792 TRANSFER
PT. KIMIA FARMA 8839 10 Feb 2021/ 11-Mar-21 1,919,490
7
PT. KIMIA FARMA 6758 13 Feb 2021/ 13-Mar-21 3,009,600 4,929,090 TRANSFER
PT. KALLISTA PRIMA 8205 13 Feb 2021/ 13-Mar-21 1,155,000
PT. KALLISTA PRIMA 8129 11 Feb 2021/ 13-Mar-21 440,000
PT. KALLISTA PRIMA 7884 10 Feb 2021/ 12-Mar-21 2,244,000
8 PT. KALLISTA PRIMA 7769 10 Feb 2021/ 11-Mar-21 1,085,700
PT. KALLISTA PRIMA 7368 09 Feb 2021/ 10-Mar-21 3,389,925
PT. KALLISTA PRIMA 7361 09 Feb 2021/ 10-Mar-21 3,007,125
PT. KALLISTA PRIMA 7638 09 Feb 2021/ 10-Mar-21 291,500 11,613,250 TRANSFER
9 PT. KEBAYORAN PHARMA 265 19 Feb 2021/ 12-Mar-21 4,811,400 4,811,400 TRANSFER
PT. LAB MEDIKA SEJAHTERA (LMS) 3693 10 Feb 2021/ 12-Mar-21 304,567
PT. LAB MEDIKA SEJAHTERA (LMS) 3661 10 Feb 2021/ 12-Mar-21 514,750
10
PT. LAB MEDIKA SEJAHTERA (LMS) 3351 08 Feb 2021/ 10-Mar-21 3,367,490
PT. LAB MEDIKA SEJAHTERA (LMS) 3325 08 Feb 2021/ 10-Mar-21 276,155 4,462,962 TRANSFER
PT. MENSA BINASUKSES (MBS) 3117 13 Feb 2021/ 13-Mar-21 973,500
PT. MENSA BINASUKSES (MBS) 5965 13 Feb 2021/ 15-Mar-21 726,000
PT. MENSA BINASUKSES (MBS) 4148 10 Feb 2021/ 12-Mar-21 2,172,500
11
PT. MENSA BINASUKSES (MBS) 1764 10 Feb 2021/ 11-Mar-21 544,500
PT. MENSA BINASUKSES (MBS) 1764 09 Feb 2021/ 11-Mar-21 1,111,000
PT. MENSA BINASUKSES (MBS) 2426 08 Feb 2021/ 10-Mar-21 644,600 6,172,100 TRANSFER
12 PT. MEGAH MEDIKA PHARMA (MMP) 085 17 Feb 2021/ 10-Mar-21 1,265,000 1,265,000 TRANSFER
13 Pt. Mitra Distrindo Sejati 393 08 Mar 2021/ 12-Mar-21 21,120,000 21,120,000 TRANSFER
PT. PARIT PADANG GLOBAL (PPG) 4856 09 Feb 2021/ 11-Mar-21 2,090,000
14
PT. PARIT PADANG GLOBAL (PPG) 5251 09 Feb 2021/ 10-Mar-21 2,090,000 4,180,000 TRANSFER
PT. RAJAWALI NUSINDO (RNI) 1539 17 Feb 2021/ 19-Mar-21 1,227,875
15
PT. RAJAWALI NUSINDO (RNI) 1499 16 Feb 2021/ 18-Mar-21 4,840,000 6,067,875 TRANSFER
16 PT. SPERO ABADI MEDIKA 066 10 Feb 2021/ 12-Mar-21 1,066,230 1,066,230 TRANSFER
17 PT. SRI BUANA LESTARI 2081 10 Feb 2021/ 11-Mar-21 489,335 489,335 TRANSFER
18 PT. SUMBER BAHAGIA 024 09 Feb 2021/ 11-Mar-21 1,488,000 1,488,000 TRANSFER
19 PT. UNITED DICO CITAS 8880 20 Feb 2021/ 12-Mar-21 357,500 357,500 VA

TOTAL TAGIHAN FARMASI : 208,633,804

21 PT. PRIA 1903 2/25/2021 11-Mar-21 486,000
PT. PRIA 2026 2/26/2021 12-Mar-21 1,730,160
PT. PRIA 1887 2/24/2021 10-Mar-21 1,380,240
PT. PRIA 1745 2/20/2021 6-Mar-21 583,200
PT. PRIA 1788 2/23/2021 9-Mar-21 602,640 4,782,240 TRANSFER
22 LABORATORIUM KEDUNGDORO 3/1/2021 5-Mar-21 1,972,000 1,972,000 TRANSFER
TOTAL TAGIHAN UMUM : 6,754,240
TOTAL TAGIHAN : 215,388,044

Surabaya, 09 Maret 2021

Diserahkan Oleh, Diketahui Oleh, Diketahui Oleh,

Rini Wahyuningati Dyah Ayu Hanik Nurfitroh

Bendahara Kadiv. Keuangan Wadir Umum & Keuangan
 TAGIHAN RSIA KENDANGSARI MERR 12 MARET 2021

No NAMA SUPPLIER
1 PT. ANUGRAH ARGON MEDICA (AAM) 7,515,135
2 PT. ANTARMITRA SEMBADA (AMS) 2,017,664
3 PT. AZKEN INDONESIA 9,583,200
4 PT. ANUGERAH PHARMINDO LESTARI (APL) 113,974,271
5 PT. DAYA MUDA AGUNG (DMA) 2,090,000
6 PT. ENSEVAL PUTERA MEGATRADING 5,430,792
7 PT. KIMIA FARMA 4,929,090
8 PT. KALLISTA PRIMA 11,613,250
9 PT. KEBAYORAN PHARMA 4,811,400
10 PT. LAB MEDIKA SEJAHTERA (LMS) 4,462,962
11 PT. MENSA BINASUKSES (MBS) 6,172,100
12 PT. MEGAH MEDIKA PHARMA (MMP) 1,265,000
13 Pt. Mitra Distrindo Sejati 21,120,000
14 PT. PARIT PADANG GLOBAL (PPG) 4,180,000
15 PT. RAJAWALI NUSINDO (RNI) 6,067,875
16 PT. SPERO ABADI MEDIKA 1,066,230
17 PT. SRI BUANA LESTARI 489,335
18 PT. SUMBER BAHAGIA 1,488,000

208,276,304
21 PT. PRIA 4,782,240
22 LABORATORIUM KEDUNGDORO 1,972,000
6,754,240
215,030,544

Surabaya, 09 Maret 2021

Diserahkan Oleh,

Rini Wahyuningati
Bendahara
 TAGIHAN RSIA KENDANGSARI MERR 19 MARET 2021

No NAMA SUPPLIER NO.FAKTUR TANGGAL TANGGAL RINCIAN TOTAL CARA BAYAR

FAKTUR JATUH TEMPO

PT. AZKEN INDONESIA 0248 17 Feb 2021/ 18-Mar-21 3,534,300

1
PT. AZKEN INDONESIA 0229 15 Feb 2021/ 17-Mar-21 1,999,800 5,534,100 TRANSFER
2 CV. ANANDA MEDICAL SURGICAL 041 18 Feb 2021/ 19-Mar-21 2,100,000 2,100,000 TRANSFER
PT. ANUGRAH ARGON MEDICA (AAM) 8590 27 Feb 2021/ 19-Mar-21 2,214,633
3 PT. ANUGRAH ARGON MEDICA (AAM) 5657 23 Feb 2021/ 15-Mar-21 2,090,495
PT. ANUGRAH ARGON MEDICA (AAM) 5668 23 Feb 2021/ 15-Mar-21 3,795,000 8,100,128 TRANSFER
PT. ANUGERAH PHARMINDO LESTARI (APL) 9991 23 Feb 2021/ 22-Mar-21 22,592,163
PT. ANUGERAH PHARMINDO LESTARI (APL) 0027 23 Feb 2021/ 22-Mar-21 5,595,975
PT. ANUGERAH PHARMINDO LESTARI (APL) 9972 23 Feb 2021/ 22-Mar-21 3,507,042
PT. ANUGERAH PHARMINDO LESTARI (APL) 0051 23 Feb 2021/ 22-Mar-21 5,595,975
PT. ANUGERAH PHARMINDO LESTARI (APL) 9960 23 Feb 2021/ 22-Mar-21 8,018,629
4 PT. ANUGERAH PHARMINDO LESTARI (APL) 9289 20 Feb 2021/ 21-Mar-21 2,743,950
PT. ANUGERAH PHARMINDO LESTARI (APL) 8302 19 Feb 2021/ 20-Mar-21 1,149,500
PT. ANUGERAH PHARMINDO LESTARI (APL) 7661 18 Feb 2021/ 19-Mar-21 1,430,000
PT. ANUGERAH PHARMINDO LESTARI (APL) 7867 18 Feb 2021/ 20-Mar-21 670,890
PT. ANUGERAH PHARMINDO LESTARI (APL) 5828 16 Feb 2021/ 18-Mar-21 951,841
PT. ANUGERAH PHARMINDO LESTARI (APL) 4318 15 Feb 2021/ 15-Mar-21 11,296,081 63,552,046 TRANSFER
PT. DAYAANUGERAH DEWATASAKTI (DAD) 5869 22 Feb 2021/ 15-Mar-21 3,612,400
PT. DAYAANUGERAH DEWATASAKTI (DAD) 4606 17 Feb 2021/ 10-Mar-21 2,970,000
5
PT. DAYAANUGERAH DEWATASAKTI (DAD) 4209 16 Feb 2021/ 9-Mar-21 3,960,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 3735 15 Feb 2021/ 8-Mar-21 346,500 10,888,900 TRANSFER
6 BINTANG SHAFWAN 5239 23 Nov 2021/ 19-Mar-21 732,050 732,050 TRANSFER
PT. ENSEVAL PUTERA MEGATRADING 9598 18 Feb 2021/ 20-Mar-21 348,917
7 PT. ENSEVAL PUTERA MEGATRADING 8417 16 Feb 2021/ 18-Mar-21 1,923,075
PT. ENSEVAL PUTERA MEGATRADING 8560 16 Feb 2021/ 18-Mar-21 3,575,172 5,847,164 TRANSFER
8 PT. INTISUMBER HASILSEMPURNA (IHS) 0611 16 Feb 2021/ 18-Mar-21 531,696 531,696 TRANSFER
PT. KIMIA FARMA 6476 20 Feb 2021/ 20-Mar-21 9,680,000
9
PT. KIMIA FARMA 7963 20 Feb 2021/ 21-Mar-21 899,795 10,579,795 TRANSFER
PT. KALLISTA PRIMA 9594 20 Feb 2021/ 21-Mar-21 429,000
PT. KALLISTA PRIMA 9542 19 Feb 2021/ 21-Mar-21 638,000
PT. KALLISTA PRIMA 9547 19 Feb 2021/ 21-Mar-21 735,680
PT. KALLISTA PRIMA 9285 18 Feb 2021/ 20-Mar-21 1,592,250
10
PT. KALLISTA PRIMA 9053 17 Feb 2021/ 19-Mar-21 1,650,000
PT. KALLISTA PRIMA 9063 17 Feb 2021/ 19-Mar-21 7,014,705
PT. KALLISTA PRIMA 8860 16 Feb 2021/ 18-Mar-21 632,500
PT. KALLISTA PRIMA 8520 15 Feb 2021/ 17-Mar-21 1,376,650 14,068,785 TRANSFER
PT. LAB MEDIKA SEJAHTERA (LMS) 4432 17 Feb 2021/ 19-Mar-21 711,730
11
PT. LAB MEDIKA SEJAHTERA (LMS) 4336 16 Feb 2021/ 18-Mar-21 1,987,314 2,699,044 TRANSFER
PT. MENSA BINASUKSES (MBS) 8576 18 Feb 2021/ 20-Mar-21 495,000
PT. MENSA BINASUKSES (MBS) 8586 18 Feb 2021/ 20-Mar-21 1,485,000
PT. MENSA BINASUKSES (MBS) 2742 17 Feb 2021/ 19-Mar-21 599,500
12
PT. MENSA BINASUKSES (MBS) 8615 17 Feb 2021/ 18-Mar-21 4,479,142
PT. MENSA BINASUKSES (MBS) 5468 16 Feb 2021/ 18-Mar-21 1,595,000
PT. MENSA BINASUKSES (MBS) 9479 15 Feb 2021/ 17-Mar-21 2,860,000 11,513,642 TRANSFER
13 MITRA DISTRINDO 290 16 Feb 2021/ 19-Mar-21 2,452,000 2,452,000 TRANSFER
14 PT. SRI BUANA LESTARI 5377 17 Feb 2021/ 18-Mar-21 1,424,174 1,424,174 TRANSFER

140,023,524
15 MORODADI 3/10/2021 3/19/2021 300,000 300,000 TRANSFER
16 PT. JERINDO JAYA ABADI 6320 2/22/2021 3/19/2021 720,000
PT. JERINDO JAYA ABADI 0120 3/5/2021 3/19/2021 2,107,600 2,827,600 TRANSFER
17 PT. SENTRALSARI PRIMA SENTOSA FEB'21 3/5/2021 3/19/2021 4,580,500 4,580,500 TRANSFER
PT. PRIA 2207 2/27/2021 3/13/2021 1,458,000
PT. PRIA 2267 2/27/2021 3/13/2021 602,640
18
PT. PRIA 2580 3/9/2021 3/23/2021 1,049,760
PT. PRIA 2606 3/9/2021 3/23/2021 1,652,400 4,762,800 TRANSFER
19 PEMBAYARAN ZOOM MEETING - MARET'21 8510 3/14/2021 3/19/2021 173,590 173,590 TRANSFER
20 BIAYA PERBAIKAN TOSSA 3/19/2021 729,000 729,000 TRANSFER
21 CV. WIFORTA 171 3/15/2021 3/19/2021 1,197,500 TRANSFER
CV. WIFORTA 6/18/1900 3/15/2021 3/19/2021 1,000,000 2,197,500
22 MA'RUF SYAH - MARET'21 28 01/03/21 3/19/2021 6,000,000 6,000,000 TRANSFER
23 AMANDA ALUMINIUM 084 3/3/2021 3/19/2021 5,500,000 5,500,000 TRANSFER
24 PT. OTIS ELEVATOR 65588 3/19/2021 4,742,100 4,742,100 TRANSFER
PRAMITA 0672 3/4/2021 3/19/2021 4,320,000
25
PRAMITA 0671 3/4/2021 3/19/2021 2,732,800 7,052,800 TRANSFER
26 PRODIA 0770 3/4/2021 3/19/2021 5,291,700 5,291,700 TRANSFER
27 NAUKEY PROMOTION ( TUMBLER ) 0101 3/19/2021 4,000,000 4,000,000 TRANSFER
28 RAJAWALI PRAWIRA PERKASA 3014 3/1/2021 3/18/2021 11,600,000 11,600,000 TRANSFER
29 PT. INDONESIA PARTNER SOLUTION 310 3/1/2021 3/19/2021 37,017,000 37,017,000 TRANSFER
30 BIAYA PERAWATAN IPAL 3/19/2021 8,805,000 8,805,000 TRANSFER
31 BINTANG NUSANTARA MEDIKA 1047 3/2/2021 3/19/2021 3,000,000 3,000,000 TRANSFER
32 PMI FEB'21 3/9/2021 3/19/2021 4,020,000 4,020,000 TRANSFER
CV. ARTHA SATIVA ( KARY ) TGL. 01-07 MAR'21 3/7/2021 3/19/2021 10,446,000
CV. ARTHA SATIVA ( PASIEN ) TGL. 01-07 MAR'21 3/7/2021 3/19/2021 10,844,900
33
CV. ARTHA SATIVA ( KARY ) TGL. 22-28 FEB'21 2/28/2021 3/19/2021 8,064,250
CV. ARTHA SATIVA ( PASIEN ) TGL. 22-28 FEB'21 2/28/2021 3/19/2021 12,836,350 42,191,500 TRANSFER
34 PT. POLARIS ALKES STARINDO 3/19/2021 72,705,600 72,705,600 TRANSFER
TOTAL TAGIHAN UMUM : 227,496,690
TOTAL TAGIHAN : 367,520,214

Surabaya, 18 Maret 2021

Diserahkan Oleh, Diketahui Oleh, Diketahui Oleh,

Rini Wahyuningati Dyah Ayu Hanik Nurfitroh

Bendahara Kadiv. Keuangan Wadir Umum & Keuangan
 TAGIHAN RSIA KENDANGSARI MERR 19 FEBRUARI 2021

No NAMA SUPPLIER CARA BAYAR

1 PT. ANTARMITRA SEMBADA (AMS) 7,400,404
2 PT. ANUGERAH PHARMINDO LESTARI (APL) 88,825,873
3 CV. ARKANA MEDIKA 2,475,000 TRANSFER
4 CV. ANANDA MEDICAL SURGICAL 1,450,000 TRANSFER
5 PT. ANUGRAH ARGON MEDICA (AAM) 2,731,552
6 PT. DAYAANUGERAH DEWATASAKTI (DAD) 3,883,000
7 PT. DOS NI ROHA (DNR) 2,919,914 TRANSFER
8 PT. ENSEVAL PUTERA MEGATRADING 6,473,457
9 PT. KALLISTA PRIMA 31,497,400
10 PT. KIMIA FARMA 1,677,940 TRANSFER
11 PT. KEBAYORAN PHARMA 5,346,000 TRANSFER
12 PT. LAB MEDIKA SEJAHTERA (LMS) 4,642,195
13 PT. MEGAH MEDIKA PHARMA (MMP) 1,265,000 TRANSFER
14 Pt. Mitra Distrindo Sejati 21,120,000 TRANSFER
15 PT. MERAPI UTAMA PHARMA (MUP) 584,320 TRANSFER
16 PT. MENSA BINASUKSES (MBS) 14,714,700
17 PT. PARIT PADANG GLOBAL (PPG) 3,634,092
18 PT. AZKEN INDONESIA 13,506,900
19 PT. SURGIKA ALKESINDO 1,241,460 TRANSFER
20 PT. SUMBER BAHAGIA 1,945,000
21 PT. SRI BUANA LESTARI 1,016,645 TRANSFER

218,350,852
23 PT. BINTANG NUSANTARA MEDIKA 3,000,000 TRANSFER
24 KEDAI RACHMAH 305,000 TRANSFER
25 PT. CITAS OTIS ELEVATOR 4,742,100 TRANSFER
26 PT. PRAMITA 8,573,000
27 PT. PRODIA WIDYAHUSADA 3,735,200 TRANSFER
28 PARAHITA 13,952,000 TRANSFER
29 LABORATORIUM KLINIK UTAMA KEDUNGDORO 2,480,000 TRANSFER
30 PT. PRIA 5,793,120
31 CV. ARTHA SATIVA (KARY) 30,117,625
72,698,045
291,048,897

Surabaya, 18 Februari 2021

Diserahkan Oleh,

Rini Wahyuningati
Bendahara
 TAGIHAN RSIA KENDANGSARI MERR 26 FEBRUARI 2021

TANGGAL TANGGAL
No NAMA SUPPLIER NO.FAKTUR RINCIAN TOTAL CARA BAYAR
FAKTUR JATUH TEMPO

PT. ANUGRAH ARGON MEDICA (AAM) 6974 04 Feb 2021/ 25-Feb-21 4,988,019
PT. ANUGRAH ARGON MEDICA (AAM) 6608 04 Feb 2021/ 24-Feb-21 577,500
PT. ANUGRAH ARGON MEDICA (AAM) 5957 03 Feb 2021/ 23-Feb-21 550,000
1
PT. ANUGRAH ARGON MEDICA (AAM) 6452 03 Feb 2021/ 24-Feb-21 3,795,000
PT. ANUGRAH ARGON MEDICA (AAM) 5521 02 Feb 2021/ 22-Feb-21 1,032,488
PT. ANUGRAH ARGON MEDICA (AAM) 5293 01 Feb 2021/ 22-Feb-21 6,923,158 17,866,165 TRANSFER
2 PT. ANUGERAH FEVINICA LESTARI SENTOSA (AFLS) 5018 03 Feb 2021/ 24-Feb-21 633,864 633,864 TRANSFER
PT. AZKEN INDONESIA 0149 28 Jan 2021/ 27-Feb-21 2,051,500
3 PT. AZKEN INDONESIA 0144 27 Jan 2021/ 26-Feb-21 2,838,000
PT. AZKEN INDONESIA 0138 26 Jan 2021/ 25-Feb-21 1,975,600 6,865,100 TRANSFER
PT. ANTARMITRA SEMBADA (AMS) 0617 03 Feb 2021/ 24-Feb-21 1,834,800
PT. ANTARMITRA SEMBADA (AMS) 0377 02 Feb 2021/ 23-Feb-21 209,000
4 PT. ANTARMITRA SEMBADA (AMS) 0093 02 Feb 2021/ 22-Feb-21 1,256,200
PT. ANTARMITRA SEMBADA (AMS) 0094 02 Feb 2021/ 22-Feb-21 1,265,000
PT. ANTARMITRA SEMBADA (AMS) 6586 01 Feb 2021/ 20-Feb-21 140,250 4,705,250 TRANSFER
PT. ANUGERAH PHARMINDO LESTARI (APL) 2265 30 Jan 2021/ 28-Feb-21 11,031,322
PT. ANUGERAH PHARMINDO LESTARI (APL) 0945 30 Jan 2021/ 27-Feb-21 17,853,501
PT. ANUGERAH PHARMINDO LESTARI (APL) 1804 30 Jan 2021/ 28-Feb-21 15,185,610
PT. ANUGERAH PHARMINDO LESTARI (APL) 1787 30 Jan 2021/ 28-Feb-21 1,569,513
PT. ANUGERAH PHARMINDO LESTARI (APL) 778 30 Jan 2021/ 27-Feb-21 3,422,656
PT. ANUGERAH PHARMINDO LESTARI (APL) 0533 28 Jan 2021/ 27-Feb-21 106,480
5
PT. ANUGERAH PHARMINDO LESTARI (APL) 9525 28 Jan 2021/ 26-Feb-21 22,062,645
PT. ANUGERAH PHARMINDO LESTARI (APL) 9488 27 Jan 2021/ 26-Feb-21 2,705,923
PT. ANUGERAH PHARMINDO LESTARI (APL) 9285 27 Jan 2021/ 26-Feb-21 5,819,343
PT. ANUGERAH PHARMINDO LESTARI (APL) 9292 27 Jan 2021/ 26-Feb-21 5,636,596
PT. ANUGERAH PHARMINDO LESTARI (APL) 8318 26 Jan 2021/ 25-Feb-21 4,965,150
PT. ANUGERAH PHARMINDO LESTARI (APL) 7503 26 Jan 2021/ 24-Feb-21 864,050 91,222,789 TRANSFER
PT. ANUGRAH ASIA GEMILANG (AAG) 367 22 Jan 2021/ 21-Feb-21 4,101,295
PT. ANUGRAH ASIA GEMILANG (AAG) 244 22 Jan 2021/ 14-Feb-21 1,914,550
PT. ANUGRAH ASIA GEMILANG (AAG) 346 21 Jan 2021/ 20-Feb-21 1,246,318
PT. ANUGRAH ASIA GEMILANG (AAG) 326 21 Jan 2021/ 19-Feb-21 4,048,000
PT. ANUGRAH ASIA GEMILANG (AAG) 300 19 Jan 2021/ 18-Feb-21 4,338,400
PT. ANUGRAH ASIA GEMILANG (AAG) 277 18 Jan 2021/ 17-Feb-21 595,760
PT. ANUGRAH ASIA GEMILANG (AAG) 224 15 Jan 2021/ 13-Feb-21 369,765
PT. ANUGRAH ASIA GEMILANG (AAG) 202 14 Jan 2021/ 12-Feb-21 185,295
PT. ANUGRAH ASIA GEMILANG (AAG) 200 14 Jan 2021/ 12-Feb-21 1,749,000
6 PT. ANUGRAH ASIA GEMILANG (AAG) 176 13 Jan 2021/ 11-Feb-21 830,738
PT. ANUGRAH ASIA GEMILANG (AAG) 151 12 Jan 2021/ 10-Feb-21 2,582,360
PT. ANUGRAH ASIA GEMILANG (AAG) 113 09 Jan 2021/ 7-Feb-21 690,250
PT. ANUGRAH ASIA GEMILANG (AAG) 071 06 Jan 2021/ 5-Feb-21 2,769,993
PT. ANUGRAH ASIA GEMILANG (AAG) 050 06 Jan 2021/ 4-Feb-21 697,679
PT. ANUGRAH ASIA GEMILANG (AAG) 012 05 Jan 2021/ 3-Feb-21 2,233,110
PT. ANUGRAH ASIA GEMILANG (AAG) 017 05 Jan 2021/ 3-Feb-21 220,000
PT. ANUGRAH ASIA GEMILANG (AAG) 475 30 Jan 2021/ 27-Feb-21 2,893,385
PT. ANUGRAH ASIA GEMILANG (AAG) 451 27 Jan 2021/ 26-Feb-21 1,788,325
PT. ANUGRAH ASIA GEMILANG (AAG) 411 25 Jan 2021/ 24-Feb-21 2,096,820 35,351,043 TRANSFER
PT. DAYAANUGERAH DEWATASAKTI (DAD) 9031 30 Jan 2021/ 19-Feb-21 825,000
7 PT. DAYAANUGERAH DEWATASAKTI (DAD) 8613 28 Jan 2021/ 18-Feb-21 1,980,000
PT. DAYAANUGERAH DEWATASAKTI (DAD) 8134 27 Jan 2021/ 17-Feb-21 5,610,000 8,415,000 TRANSFER
8 PT. ENSEVAL PUTERA MEGATRADING 8888 25 Jan 2021/ 24-Feb-21 1,505,350 1,505,350 TRANSFER
PT. KIMIA FARMA 7967 30 Jan 2021/ 27-Feb-21 1,419,818
9
PT. KIMIA FARMA 4432 28 Jan 2021/ 27-Feb-21 1,084,431 2,504,249 TRANSFER
PT. KALLISTA PRIMA 5256 28 Jan 2021/ 26-Feb-21 1,980,000
PT. KALLISTA PRIMA 5322 28 Jan 2021/ 27-Feb-21 3,036,000
PT. KALLISTA PRIMA 5332 28 Jan 2021/ 27-Feb-21 1,227,600
PT. KALLISTA PRIMA 5019 27 Jan 2021/ 26-Feb-21 1,919,500
10 PT. KALLISTA PRIMA 4844 26 Jan 2021/ 25-Feb-21 6,468,000
PT. KALLISTA PRIMA 4803 26 Jan 2021/ 25-Feb-21 1,595,000
PT. KALLISTA PRIMA 4536 25 Jan 2021/ 24-Feb-21 1,512,500
PT. KALLISTA PRIMA 4544 25 Jan 2021/ 24-Feb-21 115,500
PT. KALLISTA PRIMA 4543 25 Jan 2021/ 24-Feb-21 1,127,500 18,981,600 TRANSFER
PT. LAB MEDIKA SEJAHTERA (LMS) 2070 27 Jan 2021/ 26-Feb-21 813,641
11
PT. LAB MEDIKA SEJAHTERA (LMS) 1760 25 Jan 2021/ 24-Feb-21 1,376,446 2,190,087 TRANSFER
PT. MERAPI UTAMA PHARMA (MUP) 4785 15 Jan 2021/ 28-Feb-21 957,880
12
PT. MERAPI UTAMA PHARMA (MUP) 3947 14 Jan 2021/ 27-Feb-21 3,057,094 4,014,974 TRANSFER
13 Pt. Mitra Distrindo Sejati 301 16 Feb 2021/ 23-Feb-21 10,560,000 10,560,000 TRANSFER
PT. MENSA BINASUKSES (MBS) 5956 30 Jan 2021/ 28-Feb-21 7,837,500
PT. MENSA BINASUKSES (MBS) 0616 30 Jan 2021/ 27-Feb-21 18,161,000
PT. MENSA BINASUKSES (MBS) 0598 30 Jan 2021/ 27-Feb-21 16,112,800
14
PT. MENSA BINASUKSES (MBS) 4309 26 Jan 2021/ 25-Feb-21 2,266,000
PT. MENSA BINASUKSES (MBS) 6903 25 Jan 2021/ 24-Feb-21 4,257,000
PT. MENSA BINASUKSES (MBS) 7256 22 Jan 2021/ 21-Feb-21 1,078,000 49,712,300 TRANSFER
15 PT. MILLENNIUM PHARMACON INTERNATIONAL (MPI) 7016 09 Feb 2021/ 22-Feb-21 1,089,000 1,089,000 TRANSFER
16 PT. RAJAWALI NUSINDO (RNI) 0845 27 Jan 2021/ 25-Feb-21 4,008,400 4,008,400 TRANSFER
17 PT. SUMBER BAHAGIA 1620 04 Jan 2021/ 3-Feb-21 1,125,000 1,125,000 TRANSFER
18 CV. SURYA ANUGERAH NUSANTARA 0006 26 Jan 2021/ 25-Feb-21 4,474,030 4,474,030 TRANSFER
PT. SRI BUANA LESTARI 3819 30 Jan 2021/ 28-Feb-21 1,528,835
19 PT. SRI BUANA LESTARI 3263 29 Jan 2021/ 27-Feb-21 466,331
PT. SRI BUANA LESTARI 4623 29 Jan 2021/ 27-Feb-21 520,905 2,516,071 TRANSFER
PT. SURGIKA ALKESINDO 1785 28 Jan 2021/ 26-Feb-21 4,014,054
20 PT. SURGIKA ALKESINDO 1766 27 Jan 2021/ 26-Feb-21 3,310,560
PT. SURGIKA ALKESINDO 1695 25 Jan 2021/ 21-Feb-21 1,931,160 9,255,774 TRANSFER
21 PT. SPERO ABADI MEDIKA 038 27 Jan 2021/ 26-Feb-21 1,066,230 1,066,230 TRANSFER

TOTAL TAGIHAN FARMASI : 278,062,276

22 PT. JERINDO JAYA ABADI 8904 27 Jan 2021/ 2/26/2021 864,000
23 PT. JERINDO JAYA ABADI 1905 2/6/2021 2/26/2021 2,107,600 2,971,600 TRANSFER
24 MA'RUF SYAH - FEB'21 017 2/2/2021 2/26/2021 6,000,000 6,000,000 TRANSFER
25 MAJU INDAH WIRAUSAHA ( Washlap ) 2/15/2021 2/26/2021 861,000 861,000 TRANSFER
WIFORTA 095 1/15/2021 2/26/2021 1,065,000
26
WIFORTA 102 2/15/2021 2/26/2021 2,218,250 3,283,250 TRANSFER
27 NAUKEY PROMOTION 100 2/26/2021 4,000,000 4,000,000 TRANSFER
PT. SAMATOR GAS 385 1/30/2021 2/13/2021 375,000
28 PT. SAMATOR GAS 055 2/5/2021 2/19/2021 425,000
PT. SAMATOR GAS 120 2/11/2021 2/25/2021 535,000 1,335,000 TRANSFER
29 TIKI - JNE 10467 1/31/2021 2/26/2021 1,282,599 1,282,599 VA
30 INDONESIA PARTNER SOLUTION - Jan'21 163 2/1/2021 2/26/2021 37,017,000 37,017,000 TRANSFER
31 CV. KREASI STUDIO SOFT 02 2/15/2021 2/26/2021 1,500,000 1,500,000
32 PEMBAYARAN ZOOM MEETING - FEB'21 170,007 170,007
33 PT. FLEXINDO MANDIRI UTAMA - JAN'21 1/30/2021 2/25/2021 3,476,300 3,476,300
34 ASTINET 2/25/2021 2,832,500 2,832,500 VA
PT. PRIA 1498 2/10/2021 2/24/2021 1,574,640
PT. PRIA 1419 2/9/2021 2/23/2021 1,671,840
35
PT. PRIA 1575 2/13/2021 2/27/2021 1,069,200
PT. PRIA 1590 2/15/2021 3/1/2021 1,749,600 6,065,280
TOTAL TAGIHAN UMUM : 70,794,536
TOTAL TAGIHAN : 348,856,812

Surabaya, 26 Februari 2021

Diserahkan Oleh, Diketahui Oleh, Diketahui Oleh,

Rini Wahyuningati Dyah Ayu Hanik Nurfitroh

Bendahara Kadiv. Keuangan Wadir Umum & Keuangan
TAGIHAN RSIA KENDANGSARI MERR 26 FEBRUARI 2021

No NAMA SUPPLIER
1 PT. ANUGRAH ARGON MEDICA (AAM) 17,866,165
2 PT. ANUGERAH FEVINICA LESTARI SENTOSA (AFLS) 633,864
3 PT. AZKEN INDONESIA 6,865,100
4 PT. ANTARMITRA SEMBADA (AMS) 4,705,250
5 PT. ANUGERAH PHARMINDO LESTARI (APL) 91,222,789
6 PT. ANUGRAH ASIA GEMILANG (AAG) 35,351,043
7 PT. DAYAANUGERAH DEWATASAKTI (DAD) 8,415,000
8 PT. ENSEVAL PUTERA MEGATRADING 1,505,350
9 PT. KIMIA FARMA 2,504,249
10 PT. KALLISTA PRIMA 18,981,600
11 PT. LAB MEDIKA SEJAHTERA (LMS) 2,190,087
12 PT. MERAPI UTAMA PHARMA (MUP) 4,014,974
13 Pt. Mitra Distrindo Sejati 10,560,000
14 PT. MENSA BINASUKSES (MBS) 49,712,300
15 PT. MILLENNIUM PHARMACON INTERNATIONAL (MPI) 1,089,000
16 PT. RAJAWALI NUSINDO (RNI) 4,008,400
17 PT. SUMBER BAHAGIA 1,125,000
18 CV. SURYA ANUGERAH NUSANTARA 4,474,030
19 PT. SRI BUANA LESTARI 2,516,071
20 PT. SURGIKA ALKESINDO 9,255,774
21 PT. SPERO ABADI MEDIKA 1,066,230

278,062,276
22 PT. JERINDO JAYA ABADI 2,971,600
24 MA'RUF SYAH - FEB'21 6,000,000
25 MAJU INDAH WIRAUSAHA ( Washlap ) 861,000
26 WIFORTA 3,283,250
27 NAUKEY PROMOTION 4,000,000
28 PT. SAMATOR GAS 1,335,000
30 INDONESIA PARTNER SOLUTION - Jan'21 37,017,000
31 CV. KREASI STUDIO SOFT 1,500,000
32 PEMBAYARAN ZOOM MEETING - FEB'21 170,007
33 PT. FLEXINDO MANDIRI UTAMA - JAN'21 3,476,300
35 PT. PRIA 6,065,280
66,679,437
344,741,713

Surabaya, 26 Februari 2021

Diserahkan Oleh,

Rini Wahyuningati
Bendahara
 TAGIHAN RSIA KENDANGSARI MERR 29 JANUARI 2021

No NAMA SUPPLIER CARA BAYAR

1 PT. AZKEN INDONESIA 6,516,400 TRANSFER
2 PT. ANUGERAH PHARMINDO LESTARI (APL) 56,886,585
3 PT. ANUGRAH ASIA GEMILANG (AAG) 9,474,080
4 PT. ANTARMITRA SEMBADA (AMS) 7,827,050
5 PT. DOS NI ROHA (DNR) 3,256,000 TRANSFER
6 PT. DAYA ANUGERAH DEWATASAKTI (DAD) 17,187,500
7 PT. ENSEVAL PUTERA MEGATRADING 6,074,534
8 PT. KALLISTA PRIMA 4,862,000
9 PT. KEBAYORAN PHARMA 6,402,000 TRANSFER
10 PT. KIMIA FARMA 3,219,311
11 PT. LAB MEDIKA SEJAHTERA (LMS) 2,517,053 TRANSFER
12 Pt. Mitra Distrindo Sejati 3,725,741 TRANSFER
13 PT. MERAPI UTAMA PHARMA (MUP) 2,281,781
14 PT. MENSA BINASUKSES (MBS) 38,938,900
16 PT. SPERO ABADI MEDIKA 1,066,230 TRANSFER
17 PT. SRI BUANA LESTARI 1,124,989
18 PT. SUMBER BAHAGIA 4,776,000

176,136,154
19 PT. SENTRALSARI PRIMA SENTOSA 4,846,000 TRANSFER
20 WIFORTA 3,795,000
21 PT. SAMATOR GAS 1,729,000
22 CV. ARTHA SATIVA 55,332,275
65,702,275
241,838,429

Surabaya, 28 Januari 2021

Diserahkan Oleh,

Rini Wahyuningati
Bendahara
TAGIHAN RSIA KENDANGSARI MERR 19 MARET 2021

No NAMA SUPPLIER NO.FAKTUR TANGGAL TANGGAL RINCIAN TOTAL

FAKTUR JATUH TEMPO

PT. ANUGRAH ASIA GEMILANG (AAG) 03 Mar 2021/ 1-Apr-21 Rp 5,428,060 Rp 43,745,464
PT. ANUGRAH ASIA GEMILANG (AAG) 03 Mar 2021/ 1-Apr-21 Rp 635,580
PT. ANUGRAH ASIA GEMILANG (AAG) 00971 27 Feb 2021/ 27-Mar-21 Rp 1,497,787
PT. ANUGRAH ASIA GEMILANG (AAG) 00962 27 Feb 2021/ 27-Mar-21 Rp 70,125
PT. ANUGRAH ASIA GEMILANG (AAG) 00900 22 Feb 2021/ 24-Mar-21 Rp 2,630,760
PT. ANUGRAH ASIA GEMILANG (AAG) 00832 18 Feb 2021/ 19-Mar-21 Rp 1,439,130
PT. ANUGRAH ASIA GEMILANG (AAG) 00810 17 Feb 2021/ 18-Mar-21 Rp 2,508,000
PT. ANUGRAH ASIA GEMILANG (AAG) 00779 16 Feb 2021/ 17-Mar-21 Rp 1,062,600
PT. ANUGRAH ASIA GEMILANG (AAG) 00767 13 Feb 2021/ 15-Mar-21 Rp 2,572,955
1
PT. ANUGRAH ASIA GEMILANG (AAG) 00742 11 Feb 2021/ 13-Mar-21 Rp 755,040
PT. ANUGRAH ASIA GEMILANG (AAG) 00692 10 Feb 2021/ 11-Mar-21 Rp 2,101,000
PT. ANUGRAH ASIA GEMILANG (AAG) 00694 10 Feb 2021/ 11-Mar-21 Rp 614,460
PT. ANUGRAH ASIA GEMILANG (AAG) 00714 10 Feb 2021/ 12-Mar-21 Rp 1,676,180
PT. ANUGRAH ASIA GEMILANG (AAG) 00608 05 Feb 2021/ 6-Mar-21 Rp 600,270
PT. ANUGRAH ASIA GEMILANG (AAG) 00631 05 Feb 2021/ 7-Mar-21 Rp 10,377,950
PT. ANUGRAH ASIA GEMILANG (AAG) 00571 03 Feb 2021/ 4-Mar-21 Rp 2,521,535
PT. ANUGRAH ASIA GEMILANG (AAG) 00532 02 Feb 2021/ 3-Mar-21 Rp 5,169,312
PT. ANUGRAH ASIA GEMILANG (AAG) 00535 02 Feb 2021/ 3-Mar-21 Rp 2,084,720
PT. ANUGRAH ARGON MEDICA (AAM) 35648 04 Mar 2021/ 24-Mar-21 Rp 5,856,946 Rp 10,126,135
PT. ANUGRAH ARGON MEDICA (AAM) 35442 04 Mar 2021/ 24-Mar-21 Rp 1,254,000
2 PT. ANUGRAH ARGON MEDICA (AAM) 35649 04 Mar 2021/ 24-Mar-21 Rp 1,570,697
PT. ANUGRAH ARGON MEDICA (AAM) 33941 02 Mar 2021/ 22-Mar-21 Rp 619,492
PT. ANUGRAH ARGON MEDICA (AAM) 34471 02 Mar 2021/ 23-Mar-21 Rp 825,000
PT. ANTARMITRA SEMBADA (AMS) 1349 09 Mar 2021/ 29-Mar-21 Rp 649,440 Rp 8,138,779
PT. ANTARMITRA SEMBADA (AMS) 1230 08 Mar 2021/ 29-Mar-21 Rp 2,046,000
3 PT. ANTARMITRA SEMBADA (AMS) 0992 06 Mar 2021/ 26-Mar-21 Rp 396,000
PT. ANTARMITRA SEMBADA (AMS) 0793 04 Mar 2021/ 25-Mar-21 Rp 508,750
PT. ANTARMITRA SEMBADA (AMS) 0245 02 Mar 2021/ 23-Mar-21 Rp 4,538,589
4 PT. ANUGERAH FEVINICA LESTARI SENTOSA (AFLS) 86810 02 Mar 2021/ 23-Mar-21 Rp 176,825 Rp 176,825
5 PT. AZKEN INDONESIA 0275 22 Feb 2021/ 24-Mar-21 Rp 4,692,600 Rp 4,692,600
PT. ANUGERAH PHARMINDO LESTARI (APL) 654243 25 Feb 2021/ 27-Mar-21 Rp 2,889,351 Rp 48,848,688
PT. ANUGERAH PHARMINDO LESTARI (APL) 651177 23 Feb 2021/ 24-Mar-21 Rp 204,600
PT. ANUGERAH PHARMINDO LESTARI (APL) 655761 23 Feb 2021/ 22-Mar-21 Rp 22,592,163
6
PT. ANUGERAH PHARMINDO LESTARI (APL) 651023 22 Feb 2021/ 24-Mar-21 Rp 7,932,626
PT. ANUGERAH PHARMINDO LESTARI (APL) 651008 22 Feb 2021/ 24-Mar-21 Rp 2,889,351
PT. ANUGERAH PHARMINDO LESTARI (APL) 651077 22 Feb 2021/ 24-Mar-21 Rp 12,340,597
PT. ENSEVAL PUTERA MEGATRADING 21053 22 Feb 2021/ 24-Mar-21 Rp 3,281,712 Rp 5,864,127
7
PT. ENSEVAL PUTERA MEGATRADING 11737 30 Jan 2021/ 30-Mar-21 Rp 2,582,415
PT. KALLISTA PRIMA 09923 22 Feb 2021/ 24-Mar-21 Rp 754,875 Rp 14,284,875
PT. KALLISTA PRIMA 09893 22 Feb 2021/ 24-Mar-21 Rp 1,831,500
PT. KALLISTA PRIMA 09825 22 Feb 2021/ 22-Mar-21 Rp 3,234,000
8
PT. KALLISTA PRIMA 09746 22 Feb 2021/ 22-Mar-21 Rp 3,168,000
PT. KALLISTA PRIMA 10866 27 Feb 2021/ 28-Mar-21 Rp 3,729,000
PT. KALLISTA PRIMA 10147 23 Feb 2021/ 25-Mar-21 Rp 1,567,500
9 PT. KEBAYORAN PHARMA 0364 09 Mar 2021/ 29-Mar-21 Rp 1,056,000 Rp 1,056,000
10 PT. KIMIA FARMA 87633 27 Feb 2021/ 28-Mar-21 Rp 2,340,800 Rp 2,340,800
394912 22 Feb 2021/ Rp 5,881,580
11 PT. LAB MEDIKA SEJAHTERA (LMS) 24-Mar-21 Rp 5,445,980
PT. LAB MEDIKA SEJAHTERA (LMS) 395252 24 Feb 2021/ 26-Mar-21 Rp 435,600
PT. MENSA BINASUKSES (MBS) 14914 27 Feb 2021/ 28-Mar-21 Rp 9,482,000 Rp 22,662,200
PT. MENSA BINASUKSES (MBS) 14901 27 Feb 2021/ 28-Mar-21 Rp 5,604,500
PT. MENSA BINASUKSES (MBS) 90351 23 Feb 2021/ 25-Mar-21 Rp 871,200
12 PT. MENSA BINASUKSES (MBS) 92068 23 Feb 2021/ 25-Mar-21 Rp 451,000
PT. MENSA BINASUKSES (MBS) 85044 22 Feb 2021/ 24-Mar-21 Rp 3,355,000
PT. MENSA BINASUKSES (MBS) 85030 22 Feb 2021/ 24-Mar-21 Rp 2,568,500
PT. MENSA BINASUKSES (MBS) 74948 19 Feb 2021/ 21-Mar-21 Rp 330,000
PT. MERAPI UTAMA PHARMA (MUP) 02685 27 Jan 2021/ 13-Mar-21 Rp 900,322 Rp 3,957,416
13
PT. MERAPI UTAMA PHARMA (MUP) 02587 27 Jan 2021/ 13-Mar-21 Rp 3,057,094
Pt. Mitra Distrindo Sejati A339 23 Feb 2021/ 25-Mar-21 Rp 3,725,741 Rp 11,177,223
14 Pt. Mitra Distrindo Sejati A340 23 Feb 2021/ 25-Mar-21 Rp 3,725,741
Pt. Mitra Distrindo Sejati A341 23 Feb 2021/ 25-Mar-21 Rp 3,725,741
PT. MILLENNIUM PHARMACON INTERNATIONAL (MPI) 12606 08 Mar 2021/ 22-Mar-21 Rp 561,880 Rp 2,079,330
15
PT. MILLENNIUM PHARMACON INTERNATIONAL (MPI) 11555 02 Mar 2021/ 16-Mar-21 Rp 1,517,450
16 PT. SRI BUANA LESTARI 43490 27 Feb 2021/ 28-Mar-21 Rp 282,150 Rp 282,150
PT. SURGIKA ALKESINDO 2372 27 Feb 2021/ 28-Mar-21 Rp 2,118,528 Rp 5,725,659
17
17 PT. SURGIKA ALKESINDO 2240 25 Feb 2021/ 27-Mar-21 Rp 2,896,740
PT. SURGIKA ALKESINDO 2014 23 Feb 2021/ 25-Mar-21 Rp 710,391
18 CV. WIFORTA 132 01 Mar 2021/ 31-Mar-21 Rp 5,625,000 Rp 5,625,000

TOTAL TAGIHAN : Rp 196,664,851

Surabaya, 24 Maret 2021

Diserahkan Oleh, Diketahui Oleh, Diketahui Oleh,

Rini Wahyuningati Dyah Ayu Hanik Nurfitroh

Bendahara Kadiv. Keuangan Wadir Umum & Keuangan
CARA BAYAR

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