No Tanggal Nama pasien Nama obat Jumlah Apotek Nama Obat Jumlah Ppn+margin Keterangan

obat Bpjs obat 30%

1. 31-1-23 Ny Dedeh Lisinopril 20mg 15 table 3.709 Lisinopril 10mg 30 table 29.460
t t
Novomix 2 pen 218.351 Novomix 2 pen 463.050
Metformin 500mg 60 table 4.593 Metformin 500mg 60 table 16.020
t t
Total 226.653 Total 508.530
2. 31-1-23 Ny Susi Amlodipine 5mg 30 table 1.560 Amlodipine 5mg 30 table 8.880
t t
Candesartan 8mg 30 table 6.300 Candesartan 8mg 30 table 193.050
t t
Paracetamol 500mg 10 table Maganol 50mg 10 table 7.200
t t
Neurodex tab 10 table Vitamin b complex 10 table 1.070
t t
Total 7.860 Total 210.200
3 30-1-23 Ny Dedeh sukiah Novomix 5 pen 545.877 Novomix 5 pen 1.157.625
Aptor 100mg 30 table 4.210 Aptor 100mg 30 table
t t
Furosemide 40mg 15 table Farsiretik 40mg 15 table 5.280
t t
Lisinopril 20 mg 15 table 3.709 Lisinopril 10mg 30 table 29.460
t t
Adalat oros 30mg 30 tabe 118.408 Nifedipine 10mg 45 tabe 10.080
t t
Simvastatin 20mg 30 table 4.445 Simvastatin 20mg 30 table 12.900
t t
Total 676.649 Total 1.215.345
4. 7-2-23 Ny NIna Tiamazole 5mg 30 table 20.166 Tyrozol 5mg 30 table 76.080
t t
Propranolol 10mg 30 table 1.678 Propranolol 10mg 30 table 3.510
 t t
Total 21.844 Total 79.590
5. 7-2-23 Ny Tri mursidah Ezelin 1 pen 86.755 Ezelin 1 pen 116.752
Lansoprazole 7 kapsul Dobrizol 7 kapsul 6.524
Sucralfate syr 1 fls Sucralfate syr 1 fls 1710
Simvastatin 20mg 6 tablet Simvastatin 20mg 6 tablet 2.580
Total 86.755 Total 127.566
6. 9-2-23 Ny Tati rohaeti Amlodpin e 5mg 30 table 1.560 Amlodpin e 5mg 30 table 8.070
t t
Candesartan 8mg 30 table 6.300 Candesartan 8mg 30 table 193.050
t t
Paracetamol 500mg 10 table Maganol 500mg 10 table 7200
t t
Total 7.860 Total 208.320
7. 9-2-23 Ny Cicah Candesartan 8mg 30 table 6.300 Candesartan 8mg 30 table 193.050
t t
Amlodipien 5mg 30 table 1.560 Amlodipien 5mg 30 table 8.070
t t
Metformin 500mg 60 table 4.593 Metformin 500mg 60 table 16.020
t t
Total 12.453 Total 217.140
8. 14-2-23 Ny Lina Herlinawati Candesartan 16mg 30 table 9.480 Candesartan 16mg 30 table 281.400
t t
Paracetamol 500mg 10 table Maganol 500mg 10 table 7.200
t t
Neurodex tab 10 table Vitamin b complex t 10 table 1.070
t ab t
Histigo 10 table Histigo 10 table 10.830
t t
Total 9.480 Total 300.500
9. 9-2-23 Ny Iis Suryani Bicnat 10 table Bicnat 10 table
t t
 Novomix 4 pen 463.702 Novomix 5 pen 1.157.625
Amlodipine 5mg 30 table 2.090 Amlodipine 5mg 30 table 17.940
t t
Total 547.967 Total 1.175.565
10. 2-2-13 Ny Mini Tiamazole 5mg 30 table 20.166 Tiamazole 5mg 30 table 76.080
t t
Candesartan 16mg 30 table 9.480 Candesartan 16mg 30 table 281.400
t t
Propranolol 40mg 90 table 7.066 Propranolol 40mg 90 table 16.470
t t
Total 36.712 Total 373.950
11. 16-2-23 M aqbil Asam valproate 500 60 table 84.434 Asam valproate 500 60 table 95.220
mg t mg t
Carbamazepin 200 Bamgetol 20mg 15 44.595
mg tablet
Total 84.434 Total 139.815
12. 13-2-23 Albar Dulfikar Asam valproate 250 60 table 58.821 Asam valproate 250 60 table 95.220
mg t mg t
Total 58.821 Total 95.220
13. 13-2-23 Ny Imasuhaeti Retaphyl SR 15 table Retaphyl SR 15 table
t t
NAC 10 table NAC 10 table 8.060
t t
Symbicort inhaler 1 pcs 146.903 Symbicort inhaler 1 pcs 299.120
Amlodpin 5mg 30 table 1.560 Amlodpin 5mg 30 table 8.880
t t
Cetirizine tab 7 tablet Cetirizine tab 7 tablet 777
Total 148.463 Total 316.837
14. 13-2-23 Ny Cucu septiani Seretide diskus 250 1 pcs 122.546 Seretide diskus 250 1 pcs 381.648
mg mg
Berotec inhaler 1 pcs 84.738 Berotec inhaler 1 pcs 356.721
Total 207.284 Total 738.369
15. 15-2-23 tn Saptono Adalat oros 30mg 30 table 118.408 Nifedipine 10mg 45 table 10.080
t t
Candesartan 16mg 30 table 9.480 Candesartan 16mg 30 table 281.400
t t
Bisoprolol 2,5mg 30 table 3.651 Bisoprolol 2,5mg 30 table 19.320
t t
Spironolakton 25mg 30 table 5.652 Spironolakton 25mg 30 table 20.100
t t
Total 137.191 Total 330.900
16 16-2-23 Ny Cucu Seria Adalat oros 30mg 30 table 118.408 Nifedipin 10mg 45 table 10.080
t t
Candesartan 16mg 30 table 9.480 Candesartan 16mg 30 table 281.400
t t
Bisoprolol 2,5mg 30 table 3.651 Bisoprolol 2,5mg 30 table 19.320
t t
Total 131.593 Total 310.800
17. 22-2-23 Ny Tanti Paracetamol 500mg 10 table Maganol 500mg 10 table 7200
t t
Adalat oros 30mg 30 table 118.408 Nifedipine 10mg 45 table 10.080
t t
Lisinopril 20mg 15 table 3.709 Lisinopril 10mg 30 table 29.460
t t
Glimepirid 1mg 30 table 2.767 Glimepirid 1mg 30 table 15.600
t t
Neurodex tab 10 table Vitamin b complex 10 table 1.070
t t
Total 124.844 Total 63.410
18. 20-2-23 Alpiansyah Carbamazepine 60 11.264 Bamgetol 200mg 60 178.380
200mg tablet tablet
Asam valproate 4 fls 45.679 Asam valproate 4 fls 242.424
Total 56.925 Total 420.804
19 28-2-23 Ny Entin Amlodipine 5mg 30 1.560 Amlodipine 5mg 30 8.880
 tablet tablet
Bisoprolol 2.5 mg 30 3.651 Bisoprolol 2.5 mg 30 19.320
tablet tablet
Lisinopril 20mg 15 3.709 Lisinopril 10mg 30 29.460
tablet tablet
Vitamin b complex 10 Vitamin b complex 10 1.070
tablet tablet
Paracetamol 10 Paracetamol 10 3.720
tablet tablet
Esperion tab 7 tablet Estalex tab 7 tablet 6.643
Total 8.920 Total 69.093
20 28-2-23 Heni Mulyani Seretide diskus 1 pcs 122.546 Seretide diskus 1 pcs 381.648
250mg 250mg
Total 122.546 Total 381.648
21 28-2-23 Ny Dian Herani Symbicort inhaler 1 pcs 146.903 Symbicort inhaler 1 pcs 739.272
Paracetamol 500mg 10 Paracetamol 500mg 10 3.720
tablet tablet
Methylprednisolone 30 3.032 Methylprednisolon 30 9.510
4mg tablet e 4mg tablet
Omeprazole 30 3.827 Lokev 30 15.990
tablet tablet
Retaphyl sr 15 Retaphyl sr 15
tablet tablet
Total 153.762 Total 768.492
22 6-3-23 Tn Tatang Novomix insulin 3 pen 327.526 Novomix insulin 3 pen 694.575
Neurodex tab 10 Vitamin b complex 10 1.070
tablet tablet
Total 327.526 Total 695.645
23 7-3-23 Ny Deliyanah Glimepiride 1mg 30 2.767 Glimepiride 1mg 30 29.910
tablet tablet
Amlodipine 10 mg 30 2.090 Amlodipine 10 mg 30 17.940
tablet tablet
 Candesartan 16mg 30 9.480 Candesartan 16mg 30 281.400
tablet tablet
Bisoprolol2,5mg 30 3.651 Bisoprolol2,5mg 30 19.320
tablet tablet
Paracetamol 500mg 10 Paracetamol 500mg 10 3.720
tablet tablet
Total 17.988 Total 352.290
24 8-3-23 Ny Mini Tiamazole 10mg 30 39.361 Thyrozol 10mg 30 113.010
tablet tablet
Propranolol 10mg 90 5.034 Propranolol 10mg 90 10.530
tablet tablet
Candesartan 16mg 30 9.480 Candesartan 16mg 30 281.400
tablet tablet
Total 53.875 Total 404.940
25 7-3-23 Ano suryadi Neurodex tab 7 tablet Vitamin b complex 7 tablet 749
tab
Paracetamol 500mg 7 tablet Paracetamol 500mg 7 tablet 3.720
Lansoprazole 7 tablet Lansoprazole 7 tablet 12.292
Sucralfate 1 fls Sucralfate 1 fls 17.710
Metformin 500mg 14 Metformin 500mg 14 3.738
tablet tablet
Levemir insulin 2 pen Levemir insulin 2 pen
Novorapid insulin 2 pen Novorapid insulin 2 pen
Total Total 38.209
26 13-3-23 Ny Cicah Amlodpin 5mg 30 1.560 Amlodpin 5mg 30 8.880
tablet tablet
Candesartan 8mg 30 6.300 Candesartan 8mg 30 193.050
tablet tablet
Metformin 50mg 90 6.889 Metformin 50mg 90 24.030
tablet tablet
Total 14.749 Total 225.960
27 13-3-23 Ny imas suhaeti Paracetamol 500mg 10 Paracetamol 500mg 10 3.720
 tablet tablet
Retaphyl sr 15 Retaphyl sr 15
tablet tablet
NAC 10 NAC 10 8.060
tablet tablet
Cetirizine 7 tablet Cetirizine 7 tablet 777
Symbicort 1 pcs 132.158 Symbicort 1 pcs 421.158
turbuhaler turbuhaler
Amlodipine 5mg 30 Amlodipine 5mg 30 8.880
tablet tablet
Total 132.158 Total 42.595
28 13-3-23 Eulis dasa somarlinah Symbicort 1 pcs 132.158 Symbicort 1 pcs 299.120
turbuhaler turbuhaler
Ambrxol syr 1 fls Mucos syr 1 fls 28.810
Cefixime 200mg 10 Cefixime 200mg 10 28.600
kapsul kapsul
Sucralfate syr 1 fls Sucralfate syr 1 fls 17.710
Lansoprazole 7 kapsul Lansoprazole 7 kapsul 12.292
Total 132.158 Total 386.532
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