fa; BRJSKesehatan Badan Penyelenggara Jaminan Sosial Nomor 384 /VII-09/0323 Pamekasan, 06 Maret 2023, Lampiran —_: satu berkas Hal Konfirmasi Pembayaran Non Kapitasi Yth. Kepala Dinas Kesehatan dan Keluarga Berencana Kabupaten Sampang di Sampang Pertama-tama kami ucapkan terima kasih atas dukungan dan sinergi yang telah dibangun antara Dinas Kesehatan Kabupaten Sampang dengan BPJS Kesehatan Cabang Pamekasan dalam menyukseskan penyelenggaraan Program JKN-KIS di Kabupaten Sampang. Untuk dapat memonitor pembayaran Non Kapitasi pada Puskesmas di Kabupaten Sampang, maka kami mengirimkan surat konfirmasi pembayaran Kepada Bapak atas pembayaran klaim Non Kapitasi Bulan Februari 2023 sebagaimana terlampir. Demikian surat konfirmasi ini kami sampaikan untuk dapat dipergunakan sebagaimana mestinya, atas perhatian dan kerjasama yang baik selama ini kami ucapkan terima kasih. Kepala Cabang EAewiKU.00 Kantor Cabang Pamekasan JI. Raya Panglegur KM 02 Pamekasan Telp. +62 324 334450 Fax. +62 324 333033, Email : ke-pamekasan@bpjs-kesehatan.go.id www.bpjs-kesehatan.go.idPEMBAYARAN NON KAPITASI SAMPANG FEBRUARI 2023 BANK DJs 02/02/2023 FKTP ST TGL 08/02/2023, i BULAN TAHUN NOREGISTER | KODE PPK NAMA PPK JnSPLYnan | optavanan|peLavanan| PK | MEMORIAL | KLIRING | NETO DINKES SAMPANG T312e012300329 [13351201 | BATULENGER RTP December zona] 71 aa0.000] 1312012300330 [1331201 | BATULENGER RTP [December 2022] 625.000] 1312012300331 [13351201 | BATULENGER ITP December 2022] 1762-700] 1312012300332 [13351201 | BATULENGER ire December 2022] — 40,600.00] —_114447.700 1312012300338 [13350801 J TAMBELANGAN. STP Desember 2022] 4.386.300) 1313012300339 [13350801 JTAMBELANGAN. OTP December 2022] 1.625.000} 1312012300340 [13350801 }TAMBELANGAN’ ITP Deoember 2022] 39,960,000) 1312012300341 [13350801 }TAMBELANGAN’ ITP. December 2022] 32,200,000] 7.171.300) 1312012300344 ]13351002__ [BUNTEN BARAT STP [November 2022] — 700.000} 1312012300345 [13351002 ]BUNTEN BARAT RIP [November 72022{ 3.500.004] 1312012300346 [13351002 [BUNTEN BARAT [Ret [December 20221 6.300.004] 1312012300347 [13351002 ]BUNTEN BARAT RIT? December 2022] —20.700.000) 1312012300348 [13351002 ]BUNTEN BARAT leur December 72022] 2.350.000) 33350.000 1312P012300349 [13350702 [JARANGOAN. reir December 20221 7,560,000] 7.560.000] 1312P012300393 [13350901 [ROBATAL ferre December 20221 —30-s40.004] 1312012300394 [13330901 ]ROBATAL. RIP Decembor 2022) —12.326.c04] 1312012300395 [13350901 |ROBATAL ITP December 2022] 2.125.000] 1312P012300398 [13350901 | ROBATAL ITP. December 2022] —10-s00,000] 75.331, 1312012300364 [13350302 [TANJUNG. RTP December 2022] 1.298.400] 1.298.400) 1312012300350 [02071902 [PULAU MANDANGIN, ITP [December 2022] 14. 700.000} 1312P012300351 [02071902 | PULAU MANDANGIN, RITP [Decembar 2022] 16.020.000] _30-730,000] BANK DIS 06/02/2023 FTP. STTGL 10/02/2023 BULAN | __TAHUN NOREGISTER | KODE PPK NAMA PPK SNSPLYoan | oprayanan[peLavanan| FPK | MEMORIAL | KLIRING | NETO DINKES SAMPANG, TaaPOTIIOONT S301 DANVUANYAR, Rar [Dakar 2023) aor 1312POR300H 13380103 BANYUANYAR. Prom Decanter 3023] — 00.00, 1312POR 3001 3380102 [BANYUANYAR, RIP. [Dezember 2023] a ect. 00h 1312P012300174 fsssoi02[BaNYUANYAR TF [December 2023] 19 00 on, aT 1312P02300145 13350301 |CAMPLONG: RIP, [Dscemer 2023] 26.6000 1312FOR300U6 13380301 |CAMPLONG. fet [December una] 1970.56 1312 FOT230050 13350301 |CAMPLONG. IR December 302i) 74 490.00 312FO1230045 13350301 |CAMPLONG. Te [December 3022] 3825.00 SAB 127012300153 13350501, ENGI comm [December aun] 1875.0EROFECO Tass [REN ar Deseaber Bias] __a sry 1S12FO12300855| 15350501 DRENG: IRI December 3023] 35000 000 S12 F012300856| 13350501 PRENGIK, RI, Desenber 322] 44350 009 3127012500860 13350501 [RENO Ir [November aun] 5010 09 aaa BANK DIS 130272023, KEGIATAN KELOMPOK, BULAN] _TAHUN NOREGISTER | KODE PPK NAMA PPK SNS PLYnan | ppPavanan|PELevanan| FPK | MEMORIAL | KLIRING | NETTO PUSKESMAS BLUD SAMPANG TaigpoIaa00sTS [13350601 JROBATAL IKEGIATAN KELOMPOK [November 2022] 1.090.000} 1312012300524 [13350901 ]ROBATAL IKEGIATAN KELOMPOK _[Doosmbor 2022] 2.180.000} 3.370.000 1312012300517 _]13351001__ |KETAPANG IKEGIATAN KELOMPOK [November 2022] 1.051.000] 1.051006] 1312012300531 [13350102 J BANYUANYAR. IKEGIATAN KELOMPOK [Deoember 2022] 1400-000] 1.400.000 BANK DJS 20/02/2023 KEGIATAN KELOMPOK TAHUN NOREGISTER | KODE PPK NAMA PPK anspLynan | opPavanan|penevanan| FPK | MEMORIAL | KLIRING | NETTO PUSKESMAS BLUD SAMPANG 1129022300035 [13350702 [JARANGOAN IKEGIATAN KELOMPOK [Decenbar 2022] 700-000) 700,000 BANK DJS 23/02/2023 FKTP STTGL. 01/03/2023, BULAN] _TAHUN NOREGISTER | KODE PPK NAMA PPK SNS PLYnan | optavaNan|PELavanan| FPK | MEMORIAL | KLIRING | NETTO PUSKESMAS BLUD SAMPANG Tsiap022500100 [13380701 JKEDUNGDUNG aT Vamnary 2073] _4335,000] 1312022300101 [13350701] KEDUNGDUNG ITP Hanuary 2073] 3925-600] 13120273001 10 [13350701 JKEDUNGDUNG RITP anuary 2023] 47,160,000] 13129022300111 [13350701 ]KEDUNGDUNG RITP- anuary 2023] —18:900.000] __74.340.600] 1312022300121 [13351102 | BRINGKONENG, RITP- Hanuary 2023] — 8.000.000] 1312902230012 [13351102 | BRINGKONENG. ITP Hanuary 2023] —10.011.450] 13129022300123 [13351102] BRINGKONENG. RIP Hana 2023] —11.280.000] 1312902300124 [13351102 J BRINGKONENG. ITP Hanuary 2023] 1.069.900] 30361380] BANK DJS 27/02/2023 FAT? ST-TGL. 02/03/2023, BULAN] __TAHUN NO REGISTER | KODE PPK NAMA PPK anspLynan— optavanan|PELavanan| FPK | MEMORIAL | KLIRING | NETTO [PUSKESMAS BLUD SAMPANG sizpo22s00131 [13380701 JOMBEEN. aT Lam 207s] 1 595.000)i3izp022300152 [13350201 JOMBEN. aT [an Bona] rare. 000] 1312022300133 [13350201 JOMBEN. RIP Hanuary 2023] —49.620.000) 1312022300134 [13350701 JOMBEN. RIP Lanuary 2023] —42.200-000] __95.833.000] 1312022300126 [02070007 _ ]BANJAR ITP Panuary 2023] 2400-000} 1312022300127 —_]02070007 J BANJAR. ITP Hanuary 2023] 4.000.000) 1312022300128 —_]02070007 J BANJAR. ITP Hanuary 2073 1320-000) 1312022300129 [02070007] BANJAR- RIP bs 2023] 28 600-000) 1312022300130 [02070007] BANJAR Promail Panuary 2023] 187.500] ___46.507.500] 1312022300141 [13380702 [JARANGOAN ITP Panay 2023] 3.195.000) 1312022300142 [13380702 [JARANGOAN RIP. [anuary 2023] —32.400-000) 1312022300143 [13350702 [JARANGOAN RIP Hanuary 2073] —15.710-000] 31,308,000] 1312902300125 [13350601 [SRESEH. RIP anuary 2023] —20'30.000) 1312022300135 [13350601 [SRESEH. ITP Hanuary 2023] —18.431.300) 1312027300136 ]13350601 — [SRESEH RIP Sanuary 2023] 41 100-000) 1312022300149 [13350601 [SRESEH. Promatt Hanuary 2023| 340-000] 77.571 300] BANK DIS 27/02/2023 KEGIATAN KELOMPOK NO REGISTER | KODE PPK NAMA PPK INS PLYnan peieranan| FPK | MEMORIAL | KLIRING | NETTO aizpo22s00086 [13381001 | KETAPANG IKEGIATAN KELOMPOK [Deosmbar 2022] 1081,000) ToT