PENGAJUAN PERJALANAN DINAS RUJUKAN ANTAR JEMPUT PASIEN JAMP

SUMBER DANA DAK NON FISIK TAHUN 2020

BULAN
NO Puskesmas
APRIL MEI JUNI JULI AGUSTUS
1 Siliwangi
2 Karangpawitan
3 Karangmulya 1,030,000 460,000
4 Cempaka 1,100,000 1,010,000 550,000
5 Wanaraja
6 Cimaragas 1,065,000.00 665,000.00
7 Garawangsa
8 Tarogong
9 Cipanas
10 Mekarwangi
11 Kersamenak 3,680,000.00 5,310,000.00 4,780,000.00
12 Pembangunan
13 Sukasenang
14 Bagendit 8,400,000.00
15 Sukaraja
16 Samarang 5,460,000.00
17 Sukakarya
18 Padaawas 4,120,000.00 2,280,000.00
19 Gadog
20 Leles 445,000.00 285,000.00
21 Lembang
22 Kadungora 475,000.00 475,000.00 475,000.00 475,000.00
23 Rancasalak
24 Leuwigoong
25 Karangsari
26 Cibatu 300,000.00
27 Sukamerang
28 Sukawening
29 Maripari
30 Karangtengah ### 6,720,000.00 1,800,000.00 3,000,000.00 2,400,000.00
31 Malangbong
32 Citeras
33 Bayongbong
34 Cilimus 1,945,000.00 3,140,000.00 2,835,000.00
35 Sukahurip 320,000.00 640,000.00
36 Cilawu
37 Bojongloa 3,605,000.00
38 Cisurupan 6,300,000.00
39 Pakuwon

40 Sukamulya
41 Cikajang
42 Singajaya 15,035,000.00 16,975,000.00
43 Cihurip 4,635,000.00 3,270,000.00 5,725,000.00
44 Banjarwangi 3,840,000.00 3,415,000.00 4,375,000.00
45 Peundeuy
46 Pameungpeuk
47 Cisompet
48 Cibalong
49 Maroko
50 Cikelet
51 Bungbulang
52 Mekarmukti 195,000.00
53 Sindangratu
54 Tegal Gede
55 Pamulihan
56 Cisandaan
57 Cisewu
58 Sukarame
59 Talegong
60 Limbangan 455,000.00 980,000.00 910,000.00
61 Selaawi 375,000.00 375,000.00
TOTAL 2,400,000 7,195,000 23,275,000 42,410,000 63,225,000
TAR JEMPUT PASIEN JAMPERSAL TRIWULAN IV
NON FISIK TAHUN 2020

BULAN
TOTAL JALDIN
SEPTEMBER OKTOBER NOVEMBER DESEMBER
530,000 530,000 530,000 1,590,000
370,000 5,020,000 9,810,000 15,200,000 30,400,000
1,010,000 850,000 850,000 1,790,000 5,990,000
1,030,000 515,000 515,000 515,000 5,235,000
1,475,000 415,000 1,910,000 3,450,000 7,250,000
4,750,000.00 4,400,000.00 4,230,000.00 2,650,000.00 17,760,000
3,120,000.00 3,270,000.00 3,185,000.00 4,360,000.00 13,935,000
1,340,000.00 1,675,000.00 1,340,000.00 2,010,000.00 6,365,000
460,000.00 1,280,000.00 1,920,000.00 2,560,000.00 6,220,000
670,000.00 1,535,000.00 600,000.00 635,000.00 3,440,000
2,930,000.00 5,020,000.00 5,200,000.00 5,200,000.00 32,120,000
1,695,000.00 1,480,000.00 2,085,000.00 3,475,000.00 8,735,000
1,980,000.00 1,485,000.00 1,980,000.00 2,475,000.00 7,920,000
1,200,000.00 9,600,000
2,260,000.00 1,655,000.00 990,000.00 1,485,000.00 6,390,000
2,730,000.00 6,240,000.00 4,290,000.00 5,070,000.00 23,790,000
700,000.00 1,050,000.00 1,750,000.00 3,500,000
1,520,000.00 760,000.00 4,560,000.00 2,760,000.00 16,000,000
1,110,000.00 740,000.00 740,000.00 2,590,000
410,000.00 890,000.00 890,000.00 2,920,000
5,385,000.00 3,670,000.00 3,360,000.00 3,255,000.00 15,670,000
475,000.00 475,000.00 950,000.00 950,000.00 4,750,000
390,000.00 1,560,000.00 4,680,000.00 7,020,000.00 13,650,000
335,000.00 935,000.00 125,000.00 335,000.00 1,730,000
2,845,000.00 335,000.00 1,520,000.00 2,845,000.00 7,545,000
335,000.00 335,000.00 335,000.00 1,305,000
2,220,000.00 1,120,000.00 3,300,000.00 6,130,000.00 12,770,000
4,030,000.00 2,800,000.00 6,830,000
1,530,000.00 1,530,000.00 3,060,000
7,850,000.00 7,150,000.00 2,400,000.00 1,800,000.00 35,520,000
- 645,000.00 645,000
 1,000,000.00 2,520,000.00 5,530,000.00 6,030,000.00 15,080,000
3,390,000.00 2,310,000.00 2,490,000.00 3,390,000.00 11,580,000
2,015,000.00 1,195,000.00 2,355,000.00 3,925,000.00 17,410,000
1,120,000.00 1,120,000.00 1,440,000.00 1,600,000.00 6,240,000
5,475,000.00 5,295,000.00 5,295,000.00 5,295,000.00 21,360,000
2,370,000.00 2,795,000.00 3,130,000.00 3,290,000.00 15,190,000
14,360,000.00 13,220,000.00 12,030,000.00 12,335,000.00 58,245,000
6,315,000.00 6,130,000.00 6,635,000.00 19,080,000
2,190,000.00 300,000.00 900,000.00 3,390,000
2,350,000.00 3,080,000.00 2,145,000.00 3,650,000.00 11,225,000
5,630,000.00 4,785,000.00 9,430,000.00 10,485,000.00 62,340,000
5,450,000.00 5,180,000.00 5,450,000.00 7,340,000.00 37,050,000
6,520,000.00 7,270,000.00 7,440,000.00 5,470,000.00 38,330,000
1,065,000.00 3,702,000.00 1,755,000.00 6,522,000
1,850,000.00 1,340,000.00 2,345,000.00 6,380,000.00 11,915,000
2,840,000.00 2,915,000.00 9,065,000.00 14,820,000
875,000.00 875,000.00 1,750,000
2,600,000.00 8,075,000.00 7,125,000.00 17,800,000
1,825,000.00 1,005,000.00 2,830,000
1,915,000.00 2,120,000.00 5,975,000.00 5,975,000.00 15,985,000
11,920,000.00 11,390,000.00 4,915,000.00 8,660,000.00 37,080,000
4,020,000.00 6,440,000.00 13,645,000.00 24,105,000
2,125,000.00 2,500,000.00 2,750,000.00 7,375,000
2,300,000.00 1,650,000.00 3,950,000.00 2,750,000.00 10,650,000
1,725,000.00 2,100,000.00 2,775,000.00 6,600,000
8,685,000.00 9,155,000.00 11,870,000.00 11,745,000.00 41,455,000
6,015,000.00 11,285,000.00 5,235,000.00 5,940,000.00 28,475,000
5,420,000.00 7,375,000.00 4,580,000.00 4,135,000.00 21,510,000
420,000.00 1,365,000.00 910,000.00 1,860,000.00 6,900,000
1,125,000.00 1,125,000.00 3,000,000
138,585,000 173,765,000 199,362,000 240,300,000 890,517,000
 REKAP PERJALANAN DINAS DALAM DAERAH DALAM RANGKA MERUJUK /MENGANTAR /MENJEMPUT PASIEN JAMPERSAL
TRIWULAN IV TAHUN 2020

NO PUSKESMAS NAMA NOMOR REKENING JUMLAH

1 CIHURIP Titi Suryani, S.ST 0173610006492 800,000.00
Susanti, Amd.Keb 0078220449100 2,125,000.00
Restu Atri S, Amd.Keb 0078223197100 2,800,000.00
Leni Herliani R, Amd.Keb 0078205229100 2,725,000.00
Nurlela, S.ST 0078202238100 1,000,000.00
Amas Sumarna, S.Kep 0021079332101 7,780,000.00
Nurdin, Amd.Kep 017310035885 13,170,000.00
BLUD CIHURIP 0059326414001 6,650,000.00

2 SUKARAME YADI RUSTANDI 173200230113 13,615,000.00

SRI HASTUTI 0077756108100 2,875,000.00
RIRIN 0083965088100 1,625,000.00
IIP SAPIRA 0077760482100 1,375,000.00
KEUKEU JUWITA 0009759093100 960,000.00
BLUD PKM SUKARAME (BBM) 0059362658001 8,025,000.00

3 CISEWU SITI QODARIAH 0066091309101 1,280,000.00

NIA TENIA SANTI 0003689591100 2,695,000.00
DEWI ROHILIAH 0010073375100 4,015,000.00
TITA ROSNIAWATI 0067715292100 2,050,000.00
ANDI ARDIAN 0064373005101 6,800,000.00
WAHID DIRMAN 0067715934100 8,225,000.00
BLUD PKM CISEWU (BBM) 0059374109001 16,390,000.00

4 CISOMPET YANI CAHYANI 0002519593100 160,000.00

POPI SOPIDIAWATI 0083947446100 1,980,000.00
ELI ROSITA 0077702903100 1,355,000.00
RIA 0078224584100 1,230,000.00
EEN JAENAH 0002496585100 160,000.00
WULAN 0094577225100 6,675,000.00
BLUD PKM CISOMPET(BBM) 0059316796001 3,260,000.00

5 BAYONGBONG Mimin Karmini 0068323290100 320,000.00

Eros R, Am.Keb 0017013327100 480,000.00
Iceu Kartini 0068516579100 160,000.00
Nyimas Sumiati 0068303648100 1,250,000.00
Mulyani 0068244201100 1,125,000.00
Irma Yunita 0068222214100 750,000.00
Yanti Susanti 0068494702100 375,000.00
Novia Chaerun Nisa 0068516846100 625,000.00
Elis Megalia Am.Keb 0068322839100 625,000.00
Ana Anisa Maroh 0068392233100 1,250,000.00
Saepul Malik 0068248991100 3,500,000.00
BLUD PKM bayongbong 0059349813001 1,120,000.00

6 BANJARWANGI Bidan Rostisah, Str.Keb 0003122921100 2,930,000.00

Bidan Yati Sulastri, SST 0004399277100 690,000.00
Bidan Lia Nurhayati, SST 0005773318100 2,010,000.00
Bidan Lisna Nurdianah 0077653181100 2,625,000.00
Bidan Dina Suciana, Str.Keb 0077560696100 3,250,000.00
Bidan Salwa Rafsanjani 0077657584100 5,600,000.00
Jupri Pringadi 0078825340100 14,450,000.00
Indah Permatasari 0077685235100 425,000.00
Bahan Bakar Minyak (BBM) Puskesmas 0059349775001 6,350,000.00
NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
7 SUKAHURIP Tiny Supartini, SST 0066681890100 1,440,000.00
Ayi Sumiyati, Amd.Keb 0059941836100 1,280,000.00
Liana, SST 0006186246100 960,000.00
Ima S,Logayah, Amd.Keb 0068313872100 1,120,000.00
Zim Zim Indra, S.Kep 0063993603100 1,440,000.00

8 SUKAMERANG Ecin Kuraesin, STr.Keb 0173210000 693 4,140,000.00

Haerlismayanti, AM.Keb 0065398613 100 6,400,000.00
Imas Budianti, AM.Keb 00 19415491101 960,000.00
BLUD SUKAMERANG 0059318391 001 1,270,000.00

9 PADAAWAS Susan Aprianti 0067994922100 5,000,000.00

Nani Herdiantini 0084255841101 4,000,000.00
Yogi Krismansyah 0070871289100 5,000,000.00
BLUD PKM PADAAWAS(BBM) 0059326333001 2,000,000.00

10 TAROGONG Tina Susanti 0004371267100 2,375,000.00

Sandi Romansyah 0093696840100 3,040,000.00
PKM TAROGONG 0059326155001 950,000.00

11 SINGAJAYA RIRIN HERLINA 0068624541100 1,170,000.00

RISKA MEGAYANTI 0078105305100 2,050,000.00
LIA AMELIA S R 0078104848100 2,050,000.00
LINA MARLINA 0078219637100 2,525,000.00
ROSTIKAYATI 0068295785100 960,000.00
N. RINA HIDAYAH 0068382610100 285,000.00
RIKA SRIYANDINARI 0078107936100 2,275,000.00
ERNI RATNAWATI N S 0078106824100 1,925,000.00
LILIM HALIMAH 0083860121100 1,600,000.00
EUIS HASANAH 0173200100680 2,450,000.00
ASTI EKANIA JANUARTI 0078108630100 5,175,000.00
SUPYAN 0016316229100 5,100,000.00
UYUD SUYUD 0077114424100 22,175,000.00
BAHAN BAKAR MINYAK (BBM) 0059349465001 12,600,000.00

12 GARAWANGSA Rini Andriani 0070054061100 750,000.00

Dadan Ramdani 0173200085759 3,200,000.00
In-in Siti Hindun 0010171131100 160,000.00
Septi Mimbar Lestari 0067718569100 1,000,000.00
Suprapti Khoeroh 0068289361100 625,000.00
Elis Sri M 0070054906100 625,000.00
Utang Rohmat 0101699595101 4,480,000.00
Siesca Sundari 0070056003100 375,000.00
Karsini 0068111986101 320,000.00
BLUD PKM Garawangsa 0059326279001 2,400,000.00

13 SUKAKARYA Nuraeni 0057405236100 1,510,000.00

Mumad 0068696348101 1,280,000.00
BLUD PKM (BBM) 0005934951101 230,000.00
Iis Kurniawati 0057405236100 480,000.00

14 MALANGBONG Bd. Nia Dewi Kania, STR.Keb.M.Kes. 0173200119731 210,000.00

Kusnadi Nugraha 0095700896101 210,000.00
BLUD PKM (BBM) 0059349481001 225,000.00

15 LELES Bd HJ Rani 0068926653100 680,000.00

Bd Hj Lina 0057450819100 640,000.00
Bd Hj Rini 0068409985101 360,000.00
Damis Sutandi 0068409985100 750,000.00
NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
BLUD 0059350013001 490,000.00

16 WANARAJA Citra Fitriawati 0069579582100 1,250,000.00

Pujianti Astuti 0069568939100 1,250,000.00
Inten Syakirah 0068774845100 1,625,000.00
Iwan 0069663745100 750,000.00
Dewi Nursetiasih 0081487952101 1,875,000.00
BLUD PKM WANARAJA (BBM) 0059325604001 500,000.00

17 PAMEUNGPEUK ETIN SOPIATI 0027103685101 3,840,000.00

RENI KARTINI QQ AFKHAR 0072671589100 1,510,000.00
IDAM RAHMAN RAKSA 0094539005100 4,615,000.00
BLUD PMPK 0059349201001 1,950,000.00

18 MEKARMUKTI ICAH RADISAH, S.ST 0007368984100 2,550,000.00

YURLITA, S.Tr.Keb 0068758701100 2,900,000.00
ANISA DEWI, Amd.Keb 0068761751100 1,350,000.00
NENG TASMIN, S.ST 0068681987100 4,750,000.00
ASEP NURODIN, S.Kep 0004092317100 14,670,000.00
MEGUS RIANSYAH, SKM 0068732727100 5,370,000.00
BLUD PKM MEKARMUKTI (BBM) 0059361090001 5,490,000.00

19 KARANGSARI Eet Supriatin, S.Tr.Keb 0173100140282 2,720,000.00

Nia Sunia Miharja, Amd 0068659027101 3,875,000.00
BLUD PKM KARANGSARI 0063208612001 950,000.00

20 SUKARAJA Bidan Fahmi fauziah 0067834194100 375,000.00

Asep 0067834178100 2,125,000.00
Bidan Ida 0006971571100 1,280,000.00
Bidan Kicin 0173110027749 1,760,000.00
Bahan Bakar Minyak (BBM) 0059319728001 850,000.00

21 CISANDAAN Fuad Saeful Hasim 0173610004114 2,125,000.00

Heni Rohaeni Despriani 0069934234100 750,000.00
Dede Mulyani 0069936121100 625,000.00
Yusma Yanti 0007446136100 250,000.00
BLUD CISANDAAN 0059370995001 2,850,000.00

22 SELAAWI Bd. Sofi Solihah 0094836301100 630,000.00

SRIWULAN 0083880856100 960,000.00
Supir Kamaludin 0019283534100 960,000.00
BLUD SELAAWI 0059326422001 450,000.00

23 BOJONGLOA Bd. Lina Herlinawati, SST 0002755467100 3,040,000.00

Bd. Iyos Rosyidah , SST 0062288272101 2,400,000.00
Bd. Nurhayat , SST 0173100114436 160,000.00
Bd. Sri Kusyani, SST 0009961909100 1,440,000.00
Bd. Sani Indriani, SST 0055409706100 6,500,000.00
BLUD PKM (BBM) 0059326007001 1,650,000.00

24 SAMARANG HJ. TIKAH ROSYATI, S.ST 0068126606100 6,300,000.00

IKA JULAEHA, S.ST 0003586200100 4,680,000.00
RIZKI GILARNA, S.Farm., Apt 0009408681100 9,760,000.00
BLUD PKM SAMARANG (BBM) 0059349597001 3,050,000.00

25 KARANGTENGAH N. Neni Nuraeni, S.Tr.Keb 0173110288543 19,440,000.00

Sunarlan, S.Kep 0173210224095 10,880,000.00
BAHAN BAKAR MINYAK (BBM) 0059320122001 5,200,000.00
NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
26 PEMBANGUNAN EMA ASGARITTA 0004585437100 660,000.00
RENY HIDAYAT 0069281737100 1,780,000.00
RUDIANA 0068964970100 1,600,000.00
RINA KURNIA 0069792571100 1,480,000.00
NENDEN 0081322705000 1,020,000.00
FITRI DWI 0063777943100 1,120,000.00
DIAN PRAMESTI 0069911382100 825,000.00
BLUD PKM (BBM) 0059326147001 250,000.00

27 RANCASALAK Sarah Raihani,S ST 0002623544100 2,535,000.00

Hj Ani Warnitoh,AmKeb 0173210075762 3,080,000.00
Dede Wangsih,AmKeb 0067855655100 1,760,000.00
H Agus Sobari,S Kep,Ners 0173110299281 4,750,000.00
BLUD PKM RANCASALAK 0059349821001 1,525,000.00

28 CIURUPAN WIDA ADAWIYAH 0068786940100 4,125,000.00

SRI MUNARTI 0014316760101 3,200,000.00
DEDE SUPRIATIN 0063058947101 3,125,000.00
YETI SULASTRI 0075187653100 1,875,000.00
SUMIYATI 0065345511101 7,345,000.00
SENA MARTINA 0075143621100 5,375,000.00
BUDIAWAN 0075143044100 17,500,000.00
WARSANA 0075144423100 5,125,000.00
BLUD CISURUPAN 0059325892001 10,575,000.00

29 CIKELET Intan Sari Pertiwi, Amd.Keb 0060125473100 1,550,000.00

Gege Setiawati, SST 0004273877100 1,280,000.00

30 CILIMUS EUIS SITI SARIPAH 0109081353101 2,850,000.00

ADE YUNARSIH 0068214701100 4,560,000.00
RINA HERLINA 0068288258100 2,350,000.00
NONENG 0068128161100 3,075,000.00
Iwan Hermawan 0173100062293 3,875,000.00
BLUD CILIMUS 0059349945001 700,000.00

31 BAGENDIT ANI,SST 0025478142101. 4,250,000.00

RENI RAHMAWATI, SST 0067724402100. 3,650,000.00
BLUD BAGENDIT 0059326260001 1,700,000.00

32 BUNGBULANG SUTA NIRWANI 0007419945100 6,355,000.00

MUNAWAR 0009555498100 5,870,000.00
BLUD PKM BUNGBULANG(BBM) 0059349600001 3,760,000.00

33 MAROKO Leni Fatmawati Amd.Keb 0060073899100 6,600,000.00

Feny Febrisany Amd.Keb 0078295945101 7,800,000.00
BLUD MAROKO 0059325760001 3,400,000.00

34 KARANGMULYA Rita Siti Patonah 0010209609100 1,835,000.00

Hj.Eli Suryani 0173210224135 720,000.00
Evi Ratna D Amd.keb 0088653551100 1,000,000.00
HJ.Lulut Bawani GS,SST 0173100135945 160,000.00
Komarudin 0067921968101 1,625,000.00
BLUD PKM Karangmulya/BBM 0059349422001 650,000.00

35 CIBATU Rina Umayah Yuliyanti 0069423418100 675,000.00

Darmini 0173100113194 480,000.00
BLUD PKM CIBATU (BBM) 0059325957001 150,000.00

36 SINDANGRATU Siti Kodariah 0084800491101 5,580,000.00

NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
Kokom Juariah 0004440730100 1,120,000.00
Nurul Nur Intani 0078230924100 1,125,000.00
Kiki Kania Rahmadani 0077941169100 1,000,000.00
Dandan Wildan 0007768141100 10,980,000.00
Bahan Bakar Minyak 0059350031001 4,300,000.00

37 TALEGONG RINA PATMAWATI 0010067871100 3,695,000.00

NETI BUDIANI 0076361819100 2,375,000.00
WENI JULIANI 0076385815100 2,850,000.00
AI SEKRIPTIAWATI 0007065663100 2,185,000.00
UJANG KUSNADI 0002282437100 6,680,000.00
BLUD TALEGONG 0059368710001 3,725,000.00

38 CIBALONG Hermawati, Amd. Keb 0069629881100 625,000.00

Iman Rahayu, Amd.Kep 0072045130100 875,000.00
BLUD CIBALONG 0059325833001 250,000.00

39 KARANGPAWITAN NUNUNG YULIASTUTI ,SST 0010208955100 7,640,000.00

RINA HERLINA , SST 0010209307100 5,960,000.00
RUDI HARTONO ,SP 0173610002089 7,250,000.00
ERNA FITRIANA , SST 0016139521101 6,700,000.00
BLUD KARANGPAWITAN 0059326211001 2,850,000.00

40 LEUWIGOONG HJ. KURNIAWATY 0059372106100 160,000.00

EVA PUSPAWIDARI 0068752221100 375,000.00
LINA MARLINA 0173200104599 320,000.00
AGUS MUHARAM 0094521777100 625,000.00
BLUD PKM LEUWIGOONG(BBM) 0059326041001 250,000.00

41 PAKUWON Hj.Yusi Farapmana S.ST 0003720810100 8,000,000.00

Ai Rosmiati Am.Keb 0004371909100 1,760,000.00
Ila Latifah N Am.Keb 0068064988100 1,500,000.00
Imas Siti Salamah Am.Keb 0068816025100 1,875,000.00
Nia Kurniatin Am.Keb 0069570933100 1,625,000.00
Ansori Romdoni S.IP 0022251678102 2,400,000.00
BLUD PKM Pakuwon 0059349971001 1,920,000.00

42 GADOG Yuli Yulianti, SST 0067954386100 160,000.00

Wili Oktavianti, SST 0067954483100 960,000.00
Ajat Hidayat, SKM 0068694019100 1,120,000.00
Bahan Bakar Minyak (BBM) 0059349937001 350,000.00

43 MARIPARI EUIS. K 00173110117722 1,220,000.00

HJ.PONISEM 00173110288554 1,640,000.00
BLUD PKM MARIPARI (BBM) 0059349996001 200,000.00

44 SUKAMULYA ANEU NURHAYATI 0068518202100 625,000.00

ENTIN HAERANI 0173210075948 180,000.00
ANIATI RACHMAWATI 0068522404100 160,000.00
YUNIAR NIRWANTI 0068531799100 500,000.00
LUTHFI NUR FIRMANSYAH 0094427444100 625,000.00
ASEP MOHAMAD ARYANDI 0068521521100 750,000.00
BLUD PKM SUKAMULYA (BBM ) 0059326430001 550,000.00

45 CEMPAKA OLISOH 0173200089562 1,620,000.00

IIM FINAYANI 0015896523100 640,000.00
MINA SRI SHOPIA 0068690072100 500,000.00
NENG TENTEN 0068729270100 375,000.00
YENI NURHASANAH 0173110299192 1,600,000.00
NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
BLUD PKM CEMPAKA (BBM) 0059349831001 500,000.00

46 CIMARAGAS N. ENUR HASANAH 0173100140315 6,310,000.00

AI PIPIN 0004694058100 320,000.00
AI KOMALASARI 0027791727100 640,000.00
AI HARTINI 0004702417100 160,000.00
CUCU PURWANINGSIH 0173200102439 320,000.00
KOKOM KOMALA 0068314951100 375,000.00
EUIS SURYANI 0068393280100 250,000.00
NINA IRNASARI 0068216206100 125,000.00
ERIK RIKI R 0069970249100 6,860,000.00
BLUD PKM CIMARAGAS (BBM) 0059349856001 2,400,000.00

47 CIKAJANG OMAS KOMADIN 0025800087101 3,200,000.00

AAM MARYAMAH, SST 0072914635101 960,000.00
AI EERLINA, AMD.KEB 0018337061100 2,240,000.00
N. TINI SUHARTINI, AMD.KEB 0073037794102 2,240,000.00
BLUD PKM CIKAJANG (BBM) 0059349864001 2,585,000.00

48 SILIWANGI Bidan iseu Setiari 0005817595100 320,000.00

Bidan Dian Fitriani 0014412621100 160,000.00
Bidan Nurlaela 0060538239100 160,000.00
Bidan Leni. K 0010109043100 320,000.00
Ade Rohayat, SKM 0060213437101 480,000.00
BLUD SILIWANGI 0059349708001 150,000.00

49 PAMULIHAN AI MUMIT SYARIPAH 0085281135100 3,950,000.00

HERLINA EFENDI 0085282085100 350,000.00
ANITA RAHMADIAN 0085283219101 350,000.00
SRI RAHAYUWATI 0085360809100 500,000.00
LUTFI MUHAMMAD FAJAR 0109082831100 4,450,000.00
BLUD PAMULIHAN (BBM) 0059364413001 1,050,000.00

50 LEMBANG Popon Karmila, Str.Keb 0173210075919 320,000.00

N. Heni Hendrawati, Str. Keb 0001352423100 640,000.00
Yani Fitriyani, Amd.Keb 0028359438100 500,000.00
Nurillah A, Amd. Keb 0068699355100 875,000.00
Sriyanti Astuti Dewi, Str.Keb 0002320355100 640,000.00
Gusriati, Amd.Keb 0024209342100 125,000.00
Ahmad Rifai'i Amd.Kep 0026781442101 9,920,000.00
BAHAN BAKAR MINYAK (BBM) 0059316801001 2,650,000.00

51 KERSAMENAK Ani Maryani SST 0173200121761 8,640,000.00

Risma Fatimah,AMKeb 0173200108187 3,840,000.00
Puji Sri Fauzi,Amd.Keb 0078297824100 1,790,000.00
Yeni Rachman Khasim,Amd.Keb 0078305932100 2,250,000.00
Wawan Gunawan 0068158941100 13,000,000.00
Bahan Bakar Minyak 0059326384001 2,600,000.00

52 TEGALGEDE EVI NURHAYATI, S.Tr.Keb 0071535835101 3,385,000.00

AGI TRI SHANDI 0095002412100 3,990,000.00

53 PEUNDEUY ADE JUANDA 0002301970100 2,980,000.00

MIMIN MINTARSIH 0003736024100 1,180,000.00
TITA WIDIYANTI 0078234873100 1,355,000.00
BLUD PEUNDEUY 0059349546001 1,007,000.00

54 LIMBANGAN RENI MARDIYANI 0072648791100 1,225,000.00

ELAH NURHAYATI 0173200088805 740,000.00
NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
DIAN MARDIANA 0004270940100 840,000.00
TATIN 0068216052100 630,000.00
YAYAN NURHAYANI 0072649206100 210,000.00
USEP SUKMANTORO 0173200241753 1,680,000.00
ISA MULTENDI 0067916001100 875,000.00
BLUD PKM BL. LIMBANGAN (BBM) 0059349104001 700,000.00

55 SUKASENANG Umi Muminah, A. Md. Keb 0173100227221 1,920,000.00

Nurzah Akmaliyah, S.ST 0010082315100 1,920,000.00

M. Ilham Nurfalah 0094518792100 1,500,000.00

BLUD SUKASENANG 0059325825001 450,000.00

Bd. Siti Nurhayati, SST, M. 0010239060100 2,130,000.00

56 CILAWU HJ SUSI SUSTIKARINI 0009767401100 10,080,000.00

BD EUIS SUMIATI 0062227095101 2,940,000.00

BD NENENG LENDAR 0089910226101 3,620,000.00

BLUD PKM CILAWU.(BBM) 0059349732001 4,720,000.00

57 CITERAS MONDARINI, SST 0173110288539 5,040,000.00

DEDEH JAMILAH,SST 0068174481100 3,450,000.00
JAJANG MUKAROM 0173110117715 5,310,000.00
AI DEDEH K, SST 0021549029101 1,280,000.00

58 CIPANAS Hj, Eneng Cahyawati,Am.Keb 0064690671100 4,200,000.00

H. Heriwanto,Am.Keb. 0173200098812 2,020,000.00

59 MEKARWANGI Lia Andriany,S.ST 0068155789101 1,420,000.00

Siti Lia Nurjamilah,Amd.Keb 0068160480100 660,000.00
Tenitia Istikharoh,Amd.Keb 0068153247100 660,000.00
Ikhsan Nurjaman 0068157218100 500,000.00
BLUD MEKARWANGI 0059326406001 200,000.00

60 KADUNGORA Hj. Ovy Oviyani, S.ST 0093413199101 1,300,000.00

Hj. Tintin Maryati, Str. Keb 0001401440100 900,000.00
Imas Komalasari, S. ST 0012802961101 720,000.00
Eti Siliwatiningsih, Str. Keb 0173200121728 360,000.00
Ayi Muzakir Walad, A.Md. Farm 0173100024824 1,120,000.00
BLUD KADUNGORA 0059400673001 350,000.00

61 SUKAWENING Sri Rahayu, S.Tr.Keb 0010081319100 1,620,000.00

Siti Aminah, SST 0070147874101 160,000.00
Deni Mulyadi 0085682636101 3,700,000.00
BLUD PKM SUKAWENING (BBM) 0059349953001 850,000.00
NIA J 0086524252101 500,000.00

890,517,000.00

Mengetahui: Garut, 23 DESEMBER 2020

Kuasa Pengguna Anggaran Bendahara Pengeluaran Pembantu
Bidang Kesehatan Masyarakat Bidang Kesehatan Masyarakat
NO PUSKESMAS NAMA NOMOR REKENING JUMLAH
dr. H. Tri Cahyo Nugroho Heri Hermawan, SKM
NIP : 19730714 200501 1 007 NIP : 19691203 199503 1003
JUNI-DES 9

14820000 1,015,000.00
1440000
1280000
960000
1120000
1440000

75000
62265000
62340000
775000
12875000
13650000
21175000
7,525,000.00

9
9

3
5
1
5
2
1
1
31

2
29075000
21510000
7565000

9
18

2
2
2
4
14
1

36
2
14
4
5

3
7
6
4
5
18
7

2
4
4
8
3
3
10

LEBIH JALDIN PMPK

20 7,635,000.00
8 90,000.00
20
8

4
7
4
5
28

29
6
13
25

21
5
31
5

8
6
8

6
1
3
1
9
8
5
5

9
9
12
8
3
38

2
2
4

6
6

9
1
1
1
13

22
9
6
10
4
13
10
10
44
31

3
2
2
3

3
3

3
7
3
2
2

10
10

54

63
4
9
63

1
5
3
4
 JAMPERSAL

URAIAN NOMINAL NO REKENING

AMBIL TUNAI MAMIN RTK 11,800,000.00

JASA SEPT OKTTOBER KE BLUD HAURPANGGUNG 4,800,000.00 0059333739001

TOTAL 16,600,000.00

AMBIL TUNAI SEKUNDER

MAMIN PERTEMUAN KIA 36,000,000.00

SPANDUK KIA 300,000.00

TOTAL 36,300,000.00