TAGIHAN PENGAMBILAN OBAT-OBATAN PEGAWAI/KELUARGA

TIRTA INVESTAMA R/SUBANG

KAMP.SALAM DS.DARMAGA KEC.CISALAK SUBANG
TANGGAL: 01/APRIL/2021 SAMPAI 30/APRIL/2021

No No. Transaksi No. Resep Waktu NO. NPP Karyawan Nama Nama Obat Qty Harga/Obat Harga Obat Total Harga Penyakit No. Kwitansi
Pasien

BECOM-ZET KAPL @ 100 20 2,934 58,680

1 T11YXY01150895964 7398887/1/23032021/094449278 4/30/2021 13680 Tatok Budi Tatok FITUNO KAPLET-BLISTER 3X10 KAPLET 9 6,120 55,080 475,970 ANTIVIRUS C14020210510586536-A/IV/2021
AZITHROMYCIN 500 MG (DUS 20 TAB) 5 7,762 38,810
OSELTAMIVIR @100 KPS 14 23,100 323,400
BECOM-ZET KAPL @ 100 20 2,934 58,680
FITUNO KAPLET-BLISTER 3X10 KAPLET 9 6,120 55,080
2 T11YXY0115088090R 7398887/1/23032021/093501289 4/30/2021 13680 Tatok Budi Rini AZITHROMYCIN 500 MG (DUS 20 TAB) 10 7,762 77,620 536,802 ANTIVIRUS C14020210510586536-A/IV/2021
OSELTAMIVIR @100 KPS 14 23,100 323,400
SANADRYL EXP SYR 120ML 1 22,022 22,022
BECOM-ZET KAPL @ 100 20 2,934 58,680
NUTRIMAX VITAMIN D3 400 IU SYRUP 1 133,001 133,001
3 T11YXY01150858566 7398887/1/23032021/091913907 4/30/2021 13680 Tatok Budi Nazwa 120ML 553,891 ANTIVIRUS C14020210510586536-A/IV/2021
AZITHROMYCIN 500 MG (DUS 20 TAB) 5 7,762 38,810
OSELTAMIVIR @100 KPS 14 23,100 323,400
BECOM-ZET KAPL @ 100 20 2,934 58,680
NUTRIMAX VITAMIN D3 400 IU SYRUP 1 133,001 133,001
4 T11YXY0115083712M 7398887/1/23032021/091646396 4/30/2021 13680 Tatok Budi Siti Aisyah 120ML 553,891 ANTIVIRUS C14020210510586536-A/IV/2021
AZITHROMYCIN 500 MG (DUS 20 TAB) 5 7,762 38,810
OSELTAMIVIR @100 KPS 14 23,100 323,400
5 T11YXY0120640739K 11956/1/30042021/213741496 4/30/2021 07815 Yeyep Yeyep YASMIN TAB@21 2 299,036 598,072 598,072 HORMON C14020210510586536-A/IV/2021
ZEGAVIT KPL@50 30 5,544 166,320
NATUR-E NR CAP 300IU@32 20 2,720 54,400
6 T11YXY0120511512I 7950526/1/30042021/092043071 4/30/2021 02410 Triati TRIATI 316,970 VITAMIN C14020210510586536-A/IV/2021
CALNIC PLUS KPL@30 10 5,390 53,900
D-VIT FT TAB@30 10 4,235 42,350
ZEGAVIT KPL@50 30 5,544 166,320
CALNIC PLUS KPL@30 10 5,390 53,900
7 T11YXY0120511185D 7950526/1/30042021/091845731 4/30/2021 02410 Triati Daffa 316,970 VITAMIN C14020210510586536-A/IV/2021
D-VIT FT TAB@30 10 4,235 42,350
NATUR-E NR CAP 300IU@32 20 2,720 54,400
8 T11YXY0120511006L 7950526/1/30042021/091632936 4/30/2021 06258 Atis S Atis S YASMIN TAB@21 2 299,036 598,072 598,072 HORMON C14020210510586536-A/IV/2021
9 T11YXY0120509060L 7950526/1/30042021/090711516 4/30/2021 13438 Dika I Dika I VENTOLIN INHALER 1 176,658 176,658 176,658 ASMA C14020210510586536-A/IV/2021
saeful MAXCEF 125MG SYR 60ML 1 63,525 63,525
10 T11YXY0120455844M 11956/1/29042021/193338089 4/29/2021 9714 Saeful 112,035 FLU, BATUK C14020210510586536-A/IV/2021
anwar ANADEX SYR 60ML 1 48,510 48,510
DEPAKENE SYR 120ML 2 241,318 482,636
11 T11YXY0120145639M 7911862/1/27042021/180604814 4/27/2021 8869 Bambang BambanG 561,407 EPILEPSI C14020210510586536-A/IV/2021
ELKANA CL SYR 120ML 1 78,771 78,771
12 T11YXY0120145430G 7911862/1/27042021/180401353 4/27/2021 8869 Bambang BambanG YASMIN TAB@21 2 299,036 598,072 598,072 HORMON C14020210510586536-A/IV/2021
13 T11YXY01200965403 7906755/1/27042021/130540027 4/27/2021 7728 Aang A aang a YASMIN TAB@21 2 299,036 598,072 598,072 HORMON C14020210510586536-A/IV/2021
OSELTAMIVIR @100 KPS 10 23,100 231,000
WELLNESS EXCELL-C 500MG@60 1 235,200 235,200
14 T11YXY0120096109P 7906755/1/27042021/125232546 4/27/2021 17386 Suryana SuryanA NATUR E SOFT CAPS @ 16 16 1,457 23,312 510,612 ANTIVIRUS C14020210510586536-A/IV/2021
ZINK DISPERSIBEL (DUS 100 TAB) 10 724 7,240
INTUNAL FORTE TABLET 25X4 S 12 1,155 13,860
WELLNESS EXCELL-C 500MG@60 1 235,200 235,200
15 T11YXY0120095744K 7906755/1/27042021/124916025 4/27/2021 17772 Roka RokA 273,700 VITAMIN C14020210510586536-A/IV/2021
PROVE D3-1000 TAB@30 10 3,850 38,500
 LACTACYD BABY 250 ML NEW 1 134,197 134,197
shonie
16 T11YXY0120095378H 7906755/1/27042021/124629083 4/27/2021 9422 Shonie
hermana ATOPICLAIR CREAM 100ML 1 492,800 492,800 655,487 DERMATITIS C14020210510586536-A/IV/2021
KLODERMA GEL 5GR 1 28,490 28,490
ZINK DISPERSIBEL (DUS 100 TAB) 14 724 10,136
Asep WELLNESS EXCELL-C 500MG@60 1 235,200 235,200
17 T11YXY0120088623P 7906755/1/27042021/124417773 4/27/2021 12737 Asep Hendra 322,548 VITAMIN C14020210510586536-A/IV/2021
Sumpena PROVE D3-1000 TAB@30 14 3,850 53,900
NATUR E SOFT CAPS @ 16 16 1,457 23,312
18 T11YXY01199239818 11956/1/26042021/101350904 4/26/2021 13395 Deden Y Deden Y DIANE 35 TAB@21 2 190,607 381,214 381,214 HORMON C14020210510586536-A/IV/2021
LOVEQUIN 500 MG-STRIP 2X10 TABLET 5 54,670 273,350
TORI LEVOFLOXACIN 500 MG (DUS 50 TAB) 5 1,615 8,075
19 T11YXY01197912739 11956/1/25042021/093836499 4/25/2021 17359 Tori R RAHAYU CEFIXIME 200MG CAP@100 GDX 403,305 INFEKSI C14020210510586536-A/IV/2021
20 5,647 112,940
CORTIDEX 0.5MG TAB@100 20 447 8,940
20 T11YXY01193936717 7850322/1/22042021/133013425 4/22/2021 6206 Yayat yayat PROPEPSA SUSP 200ML 1 130,900 130,900 130,900 LAMBUNG C14020210510586536-A/IV/2021
21 T11YXY0119233683F 11956/1/21042021/110054136 4/21/2021 13738 Arif arif YASMIN TAB@21 2 299,036 598,072 598,072 HORMON C14020210510586536-A/IV/2021
FLAGYL FORTE 500MG TAB@100 10 11,304 113,040
22 T11YXY01191879513 11956/1/20042021/205835455 4/20/2021 7857 Nani Y Arian N 136,530 NYERI C14020210510586536-A/IV/2021
ANALSIK KPL@100 10 2,349 23,490
CINOLON N CR 5GR 1 18,480 18,480
23 T11YXY01191765936 7834052/1/20042021/200718524 4/20/2021 13740 Abdul G Gias 68,915 DERMATITIS C14020210510586536-A/IV/2021
CURVIT SYR 120 ML 1 50,435 50,435
24 T11YXY0119124479A 7826642/1/20042021/151823804 4/20/2021 6210 Sumarno SumarNO CALCIUM D REDOXON EFF@10 4 55,756 223,024 223,024 VITAMIN C14020210510586536-A/IV/2021
CESTER KPL@30 30 6,314 189,420
PROVE D3-1000 TAB@30 15 3,850 57,750
25 T11YXY01191239692 7826642/1/20042021/151628794 4/20/2021 6210 Sumarno SumarNO NATUR E SOFT CAPS @ 16 16 1,457 23,312 349,332 VITAMIN C14020210510586536-A/IV/2021
ZINK DISPERSIBEL (DUS 100 TAB) 10 724 7,240
IMBOOST TAB@50 15 4,774 71,610
CESTER KPL@30 30 6,314 189,420
PROVE D3-1000 TAB@30 15 3,850 57,750
26 T11YXY0119123573L 7826642/1/20042021/151249496 4/20/2021 17772 Roka RokA NATUR E SOFT CAPS @ 16 16 1,457 23,312 349,332 VITAMIN C14020210510586536-A/IV/2021
ZINK DISPERSIBEL (DUS 100 TAB) 10 724 7,240
IMBOOST TAB@50 15 4,774 71,610
27 T11YXY01191191109 7826642/1/20042021/144659423 4/20/2021 15022 Dwi Sofina CEPEZET 100 MG TAB(MERSI) 1 693 693 693 ANTIPSIKOTIK C14020210510586536-A/IV/2021
CESTER KPL@30 12 6,314 75,768
28 T11YXY0119118542N 7826642/1/20042021/144424513 4/20/2021 13768 Masripah Masripah NATUR E SOFT CAPS @ 16 16 1,457 23,312 106,320 VITAMIN C14020210510586536-A/IV/2021
ZINK DISPERSIBEL (DUS 100 TAB) 10 724 7,240
OREZINC SYR 60ML 1 49,606 49,606
29 T11YXY0119118100B 7826642/1/20042021/143955464 4/20/2021 7760 Muslim Alika BIOLYSIN SYR 100ML 1 23,100 23,100 169,726 VITAMIN C14020210510586536-A/IV/2021
IMUNOS SYR 60ML 1 97,020 97,020
30 T11YXY0117962788N 7706472/1/12042021/112421589 4/12/2021 14983 M Patoni Bilal LACTULAX SYR 120ML 1 95,480 95,480 95,480 KONSTIPASI C14020210510586536-A/IV/2021

31 T11YXY01178467654 7697433/1/11042021/135313930 4/11/2021 6258 Atis S Atis Sutisna ALERGINE 10 MG TABLET SALUT 10 5,760 57,600 57,600 ALERGI C14020210510586536-A/IV/2021
SELAPUT
32 T11YXY0117822621Q 7697489/1/11042021/101903172 4/11/2021 9698 Abdul M Abdul M DIANE 35 TAB@21 2 190,607 381,214 381,214 HORMON C14020210510586536-A/IV/2021
33 T11YXY0117813491O 7697489/1/11042021/090021039 4/11/2021 7796 Maryati Maryati DIANE 35 TAB@21 2 190,607 381,214 381,214 HORMON C14020210510586536-A/IV/2021
34 T11YXY01178130708 7697489/1/11042021/085511706 4/11/2021 8084 Ade S Ade S YASMIN TAB@21 2 299,036 598,072 598,072 HORMON C14020210510586536-A/IV/2021
LAPICEF FORTE SYR 60ML 1 111,650 111,650
35 T11YXY01177124314 11956/1/10042021/131651404 4/10/2021 10255 Yayan S Jihan 160,160 FLU, BATUK C14020210510586536-A/IV/2021
ANADEX SYR 60ML 1 48,510 48,510
TOTAL 12,350,332

TERBILANG: DUA BELAS JUTA TIGA RATUS LIMA PULUH RIBU TIGA RATUS TIGA PULUH DUA RUPIAH

PT.Kimia Farma Apotek

Dian Hardiyansyah,S.Ak
KTU
 KWITANSI

No. Kwitansi : C14020210510586536-A/IV/2021

Sudah terima dari : PT. TIRTA INVESTAMA

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Untuk pembayaran : Pembelian obat - obatan

Bandung, 10 Mei 2021

PT. Kimia Farma Apotek
Jumlah Kwitansi : Rp. 12,350,332

Apotek : KF 405
Obat : - Dian Hardiyansyah,S.Ak
Dokter : - KTU
No. : C14020210510586536-A/IV/2021 Bandung, 10 Mei 2021
Lamp. : 1 Set kuitansi
Hal. : Permohonan Transfer

Kepada Yth,
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Di Tempat

Dengan hormat,

Bersama ini kami sampaikan klaim tagihan pembelian obat - obatan

dengan perincian sebagai berikut :

Kwitansi No. C14020210510586536-A/IV/2021 Rp. 12,350,332

Mohon proses pembayarannya di transfer melalui bank: .

Bank Mandiri Kacab. Alun - alun Jl.Asia Afrika Bandung
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Dian Hardiyansyah,S.Ak
KTU