LAMPIRAN KEPUTUSAN KEPALA CABANG SOREANG BADAN PENYELENGGARA JAMINAN SOSIAL KESEHATAN [NOMOR: 11 TAHUN 2019 TENTANG PENETAPAN JUMLAH PESERTA "TERDAFTAR OAN BIAYA KAPITASI PADA PUSKESMAS DI WILAVAH KANTOR, [BADAN PENYELENGGARA JAMINAN SOSIAL KESEHATAN CABANG SOREANG ‘BULAN JANUAR! TAHUN 2019 1 | or200000 |PKM CIBIRU HLA [PusKesmas: 7525] 3.210 10745 5700] Rp —_61.246500 "| 10020201 [PKU CICALENGKADTP [puskeswas | seszi| ios] sa. 5550] Ro 290.583.480 3 [ rocana02 [Px NAGREG lpuskeswas | 20516| 5202] 22.07] 700 | Rp 162.688600 “| 10020205 JPR SAWAH LEGA pusxesmas | __21712 2e7] 22.78] ‘5700 | Rp 120.700300 | 10020507 [PRM CINUNUK Puskeswas [12356] 0300] _a1.as] 5550] Rp 120,708.060 | 1o0a0s02 [pnw cuLEUNYI Ipusxesmas | 14250] 7704 22083 5550 Rp 122.398650 7_| 100200" [PRM CIBEUNYING Ipusxeswas | 17282[ 171] 20.485 5700| Rp 116.592 100 | 10020402 [PRM CIMENYAN Ipuskesnas | 10140] soso] 21.208 ‘5550 [ Rp 117704400 [10020507 [PRM RANCAEKEX DTP lpuskeswas | 21.067] iv9s0] aoa] 700 [ Rp _727.008.200 70 | ron20s02 [PRM UNGAR lpuskeswas | 21.160] 2081] 2.0] 15700] Rp 194.12,000 11 | 10120503 PRM NANJUNG MERAR lpuskeswas | ear] 2676] asa 5700] Rp 122.817.800 72 | ron20e0% [PRM OAYEUHKOLOT puskeswas | 11501] 742] 18064 '5700] Rp 108.004 000 13 | son20802 [PRM CANGKUANG lpuskeswas | 1547] 5260] 20.707] ‘5700 Rp 118.028 900 “4 | s002070% [Pk PAMEUNGPEUK [puskeswas | 24osa] e711] aaa 14625] Rp _197.500.125| 15 | 10020702 |PKM BANIARAN NAMBO OTP lpuskeswas | 2n004] 000] ae. 15700] Ro 218.498 100 16 | 10020703 [Px BOJONGSOANG lpusneswas | saaei| 7.180] «0001 18000] Rp 243.966.000 17 | roaz080% |PKaM BANIARAN KOTA lpuskeswas | 2rsvs| aso] aa. 14750| Rp 171.788800 1 | roazoeo2 [Pxaa NAGRAK lpusneswas | 2so7i| _14aa] 27.450] 5880| Rp 152.964 150 19 | 10020003 [Pkit KIANGROKE| Pusneswas | 16.100] 3,162] 19.02 4625 [Rp 09.458750 720_| 10020801 [PRM PANGALENGAN DTP Pusneswas | 33661] 42a] 37.05] 880 [Ro 210.816760 21 | 10020002 [PK CIKALONG Puskeswas | 21772] 228] 23.00] 3325[ Rp 79.497. 500 22 | 10020008 [PRM SUKAMANAH, [pusxesnas | 20603 367] 21.200] 880 [Rp 117.650.000 73 | 10020004 [PKU CIMAUNG [puskesnas | 26264 326] 27202] 15700 | Rp 185 398.400 724 | 10020005 |PKM WARNASARI lpuskeswas | 20782 s«7| 20729] 2560 [Rp 1150045650 ‘25 | 10021001 [PkM CIPARAY OTP lpuskeswas | 37.110] tage] 40s] ‘3580 | Rp 258.860750 726 | 10021002 [PROM PAKUTANDANG [PusKeswas | 24560] 2207] 203778 ‘5.550 Rp 148.606 600 721 | 10021005 [Prod SUMBERSARI lpuskeswas | 22902] 1245] 2422 5550 | Rp 134450050 ‘28 | 10022401 [PROM KATAPANG lpuskeswas | ste] 6194] 20.780 '$700| Rp 118282 100 722 | 10022402 [PHO SANGKANHURIP [Puskeswas | 16965| 2705] 21.750 5205 [ Rp 113643760 "30 | 10022601 [PRM MARGAASIH lPuskeswas | 2146] Sra] 27.7] '5700| Rp 154.296000 | 10022802 [Pro RAHAYU lpuskeswas | 16036] 26s] 17.606] 15700] Rp 100878600 132 | 10022701 [Pr PASEH JPuskeswas | «20zi] $905] 48.0] 5880 Rp 288.493.200 33, | 10022702 [Prat CIPEDES Jpuskeswas [25008] 2280] 28007] 4225 | Ro 129649 25 ‘34 | 10022601 [PRON GUN Puskeswas | 41965] «17a 46.188 15700 Rp 263.100 600 35, | 10022602 [PRM SUOI PUSKESWAS 720] 20841 4750 | Rp 98044750 36 [10022907 [PRM CiKARO puskeswas | 20970 27a] __23e0a] 700 Ro 134 758400 37 | 10022002 [PRM MAIALAYA [puskeswas [28577] e080) 96487] '5700| Rp 208 saa 00 ‘38 | 1002200 [PRM SOLOKAN JERUK Puskeswas | 19.7e| as2s| 20,704] 5700| Rp 136.112800 38 [10022008 [PRM WANGISAGARA, Puskeswas | 16.8 34] 17406] 4750 [Rp 83058 500 | 10022605 [PK PADAMUKTI puskeswas | 15087] 1116] 16.106] '5700| Rp _92:260200 “41 [10023001 [PRM PACET Puskeswas | «2216 2816] 45.195] ‘5205 [Rp 235.690.378 “a2 | 10023002 [PRM PANCA PusKESwas | 29.06] aes| 30071 '5700] Rp 171404 700 43 | 10023101 [Prat SOREANG [puskeswas | 22210| e000] 31.200 '5550| Rp 17321800 “4a [10025102 [PROM KUTAWARINGIN Jpuskeswas | _230s0] 2016] 25057] '5:700| Rp 147.384.500 15 | 10028105 [PRM SUKAIADL lpuskeswas | 10808 e25| 11798 5550] Rp 65.116.160 46 | 10029104 [PRM KOPO. lpuskeswas | 3176s] _2se7| 24.0] '51700] Rp 195,785.00 a7 | 70025201 [PR PASIRIANGU JPuskeswas | _26sa7| _«0sa|__sa.ae] 4750] Rp 154.037750 as_| 025202 [Pk SUGIHMUKTI [puskeswas | 17500 zs] 16.207| 5205] Rp 96.191 575 49 | 10020901 [Pra CDEY lpuskeswas | 20220] _se2e| 23.04 15700] Rp 135.833 600 0 | 10023302 [PRM RAWABOGO. lPuskeswas | _15771 Teo] 16531 5088] Rp #4.1007281002540 [PRM CiKANCUNG [PusKesMas 32697] 5023] st 37600 ‘5100 ap 21486200, 32 | 10023402 [Px CLULUK lpusxeswas | z24s1| 1.28] 23,709 5880 [Ro 132028050 33 | 1002060" [Pk KERTASARI lpusneswas | zo9ri[ 127] sr aaa 14625 | Rp 145 678 250 + | 10020602 [Px SANTOSA lrusresuas | 1686 496] 17312] 5580 [np 08.081 600 55 [10025707 [PKM CLENGKRANG lpusceswas | 15820] ss70] 21099 700 | Ro 120264300 56 | 10020" [Pron ABUL lpuscesuas [11345] _vsa06] 2204 700 | ip 131.008 800 457 | toozsece [Pt MARGARAY SELATAN Puscesias zea] «ase 6.900 8.700 | Rp 30.796 000 28 | 1002010 [Px BALEENOAH pusneswas | 21686] 16748] seaaa 560] Rp 713308700 29 | 10024102 [PK JELEKONG Jpuskeswas | 26262[ 3.764] so. 5700 Rp 171319200 60 | 10026103 [PRM RANCAMANYAR Jpuscesuas | 14700] 5310] 20000 2820 [Rp 111.540.450 61 | Toneeate [PRM ARLASARI lpusneswas | rests] 265] 2179 700 Rp 122994600 62 | 10024401 [Pr RANCABALT puseeswas | 26085] 1023] 27716 880 23 e00| MUAH 713867233] 21 5se| 1800 78 '3550[ Ro @.122000:28