LAMPIRAN REKAPITULASI SURAT PEMBAYARAN HUTANG

OBAT REGULER
INSTALASI FARMASI RSUD H. HANAFIE MUARA BUNGO

Wednesday, October 10, 2012

NO DISTRIBUTOR NO FACT TGL FACT NO.F STDR TAGIHAN PPN PPH SUB TOTAL TOTAL
1 PT. MERAPI UTAMA PHARMA 1119 8/31/2012 00010879 Rp 15,878,231 Rp 1,612,003 Rp 241,800 Rp 17,732,035
2 PT. MERAPI UTAMA PHARMA 1503 9/10/2012 00011255 Rp 2,641,031 Rp 268,125 Rp 40,219 Rp 2,949,375
3 PT. MERAPI UTAMA PHARMA 1562 9/12/2012 00011314 Rp 5,496,103 Rp 557,980 Rp 83,697 Rp 6,137,780
4 PT. MERAPI UTAMA PHARMA 1564 9/12/2012 00011316 Rp 8,597,080 Rp 872,800 Rp 130,920 Rp 9,600,800
5 PT. MERAPI UTAMA PHARMA 1600 9/12/2012 00011351 Rp 3,537,037 Rp 359,090 Rp 53,864 Rp 3,949,990
Rp 36,149,482 Rp 3,669,998 Rp 550,500 Rp 40,369,980
6 PT. ANUGRAH ARGON M 5008 9/11/2012 01118989 Rp 7,611,410 Rp 772,732 Rp 115,910 Rp 8,500,052
7 PT. ANUGRAH ARGON M 5007 9/11/2012 01118988 Rp 6,540,430 Rp 664,003 Rp 99,600 Rp 7,304,033
8 PT. ANUGRAH ARGON M 5010 9/11/2012 01118991 Rp 783,075 Rp 79,500 Rp 11,925 Rp 874,500
9 PT. ANUGRAH ARGON M 5076 9/12/2012 01125342 Rp 11,173,393 Rp 1,134,355 Rp 170,153 Rp 12,477,901
10 PT. ANUGRAH ARGON M 5078 9/12/2012 01125344 Rp 24,099,010 Rp 2,446,600 Rp 366,990 Rp 26,912,600
11 PT. ANUGRAH ARGON M 5075 9/12/2012 01125341 Rp 12,004,688 Rp 1,218,750 Rp 182,813 Rp 13,406,250
12 PT. ANUGRAH ARGON M 5081 9/12/2012 01125347 Rp 3,707,048 Rp 376,350 Rp 56,453 Rp 4,139,850
13 PT. ANUGRAH ARGON M 5080 9/12/2012 01125346 Rp 444,610 Rp 45,138 Rp 6,771 Rp 496,519
14 PT. ANUGRAH ARGON M 5079 9/12/2012 01125345 Rp 20,466,478 Rp 2,077,815 Rp 311,672 Rp 22,855,965
15 PT. ANUGRAH ARGON M 5077 9/12/2012 01125343 Rp 6,818,722 Rp 692,256 Rp 103,838 Rp 7,614,816
16 PT. ANUGRAH ARGON M 5790 9/24/2012 01177465 Rp 1,510,251 Rp 153,325 Rp 22,999 Rp 1,686,575
17 PT. ANUGRAH ARGON M 5791 9/24/2012 01177466 Rp 3,362,189 Rp 341,339 Rp 51,201 Rp 3,754,729
Rp 98,521,303 Rp 10,002,163 Rp 1,500,324 Rp 110,023,790
18 PT. BINA SAN PRIMA 0541 9/6/2012 00025970 Rp 3,987,940 Rp 404,867 Rp 60,730 Rp 4,453,537
19 PT. BINA SAN PRIMA 0553 9/6/2012 00025988 Rp 3,147,902 Rp 319,584 Rp 47,938 Rp 3,515,424
20 PT. BINA SAN PRIMA 0554 9/6/2012 00025989 Rp 2,511,258 Rp 254,950 Rp 38,243 Rp 2,804,450
21 PT. BINA SAN PRIMA 0555 9/6/2012 00025990 Rp 1,504,588 Rp 152,750 Rp 22,913 Rp 1,680,250
22 PT. BINA SAN PRIMA 0556 9/6/2012 00025991 Rp 580,835 Rp 58,968 Rp 8,845 Rp 648,648
23 PT. BINA SAN PRIMA 0557 9/6/2012 00025992 Rp 321,504 Rp 32,640 Rp 4,896 Rp 359,040
24 PT. BINA SAN PRIMA 0558 9/6/2012 00025993 Rp 56,556,326 Rp 5,741,759 Rp 861,264 Rp 63,159,349
25 PT. BINA SAN PRIMA 0978 9/11/2012 00026418 Rp 14,573,824 Rp 1,479,576 Rp 221,936 Rp 16,275,336
26 PT. BINA SAN PRIMA 0979 9/11/2012 00026419 Rp 189,120 Rp 19,200 Rp 2,880 Rp 211,200
27 PT. BINA SAN PRIMA 0982 9/11/2012 00026422 Rp 909,194 Rp 92,304 Rp 13,846 Rp 1,015,344
Rp 84,282,490 Rp 8,556,598 Rp 1,283,490 Rp 94,122,578
28 PT. MILLENIUM PHARMACON I 0256 9/3/2012 00010256 Rp 144,056 Rp 14,625 Rp 2,194 Rp 160,875
29 PT. MILLENIUM PHARMACON I 0460 9/7/2012 00010460 Rp 9,899,250 Rp 1,005,000 Rp 150,750 Rp 11,055,000
30 PT. MILLENIUM PHARMACON I 0352 9/5/2012 00010352 Rp 3,349,000 Rp 340,000 Rp 51,000 Rp 3,740,000
31 PT. MILLENIUM PHARMACON I 0525 9/8/2012 00010525 Rp 1,387,742 Rp 140,888 Rp 21,133 Rp 1,549,763
32 PT. MILLENIUM PHARMACON I 0518 9/8/2012 00010518 Rp 4,186,755 Rp 425,051 Rp 63,758 Rp 4,675,564
33 PT. MILLENIUM PHARMACON I 0542 9/10/2012 00010542 Rp 504,197 Rp 51,188 Rp 7,678 Rp 563,063
34 PT. MILLENIUM PHARMACON I 0543 9/10/2012 00010543 Rp 2,742,831 Rp 278,460 Rp 41,769 Rp 3,063,060
Rp 22,213,832 Rp 2,255,211 Rp 338,282 Rp 24,807,325
35 PT. ENSEVAL PUTERA 8773 9/6/2012 02692053 Rp 22,083,700 Rp 2,242,000 Rp 336,300 Rp 24,662,000
36 PT. ENSEVAL PUTERA 8661 9/5/2012 02678785 Rp 5,570,051 Rp 565,487 Rp 84,823 Rp 6,220,362
37 PT. ENSEVAL PUTERA 9968 9/17/2012 02812754 Rp 411,730 Rp 41,800 Rp 6,270 Rp 459,800
38 PT. ENSEVAL PUTERA 9977 9/17/2012 02812763 Rp 3,087,975 Rp 313,500 Rp 47,025 Rp 3,448,500
39 PT. ENSEVAL PUTERA 0128 9/18/2012 02829703 Rp 6,870,744 Rp 697,537 Rp 104,631 Rp 7,672,912
40 PT. ENSEVAL PUTERA 0253 9/19/2012 02840027 Rp 22,912,775 Rp 2,326,170 Rp 348,926 Rp 25,587,870
41 PT. ENSEVAL PUTERA 1150 9/19/2012 02840143 Rp 2,663,982 Rp 270,455 Rp 40,568 Rp 2,975,005
42 PT. ENSEVAL PUTERA 9673 9/14/2012 02784913 Rp 728,900 Rp 74,000 Rp 11,100 Rp 814,000
43 PT. ENSEVAL PUTERA 9732 9/14/2012 02788588 Rp 4,450,230 Rp 451,800 Rp 67,770 Rp 4,969,800
44 PT. ENSEVAL PUTERA 9767 9/15/2012 02793650 Rp 2,940,127 Rp 298,490 Rp 44,774 Rp 3,283,390
45 PT. ENSEVAL PUTERA 1135 9/15/2012 02800310 Rp 6,347,655 Rp 644,432 Rp 96,665 Rp 7,088,752
46 PT. ENSEVAL PUTERA 1101 9/10/2012 02716570 Rp 479,069 Rp 48,636 Rp 7,295 Rp 535,001
47 PT. ENSEVAL PUTERA 1116 9/11/2012 02743731 Rp 1,723,750 Rp 175,000 Rp 26,250 Rp 1,925,000
48 PT. ENSEVAL PUTERA 1115 9/11/2012 02743730 Rp 1,707,626 Rp 173,363 Rp 26,004 Rp 1,906,994
49 PT. ENSEVAL PUTERA 9350 9/11/2012 02743701 Rp 3,152,000 Rp 320,000 Rp 48,000 Rp 3,520,000
50 PT. ENSEVAL PUTERA 9474 9/12/2012 02758398 Rp 5,101,684 Rp 517,937 Rp 77,691 Rp 5,697,312
51 PT. ENSEVAL PUTERA 1098 9/7/2012 02708659 Rp 537,268 Rp 54,545 Rp 8,182 Rp 599,995
52 PT. ENSEVAL PUTERA 8846 9/7/2012 02708452 Rp 463,196 Rp 47,025 Rp 7,054 Rp 517,275
53 PT. ENSEVAL PUTERA 8904 9/7/2012 02708510 Rp 2,559,276 Rp 259,825 Rp 38,974 Rp 2,858,075
54 PT. ENSEVAL PUTERA 9110 9/10/2012 02724258 Rp 8,604,455 Rp 873,549 Rp 131,032 Rp 9,609,036
55 PT. ENSEVAL PUTERA 9036 9/10/2012 02716545 Rp 5,425,479 Rp 550,810 Rp 82,622 Rp 6,058,910
56 PT. ENSEVAL PUTERA 9010 9/7/2012 02710165 Rp 617,595 Rp 62,700 Rp 9,405 Rp 689,700
57 PT. ENSEVAL PUTERA 9337 9/11/2012 02743688 Rp 21,770,963 Rp 2,210,250 Rp 331,538 Rp 24,312,750
58 PT. ENSEVAL PUTERA 9400 9/12/2012 02752968 Rp 374,300 Rp 38,000 Rp 5,700 Rp 418,000
59 PT. ENSEVAL PUTERA 9609 9/13/2012 02769779 Rp 13,166,003 Rp 1,336,650 Rp 200,498 Rp 14,703,150
Rp 143,750,532 Rp 14,593,963 Rp 2,189,094 Rp 160,533,589
60 PT. TEMPO 3891 9/12/2012 00864133 Rp 13,456,839 Rp 1,366,177 Rp 204,926 Rp 15,027,942
61 PT. TEMPO 3890 9/12/2012 00864134 Rp 16,452,634 Rp 1,670,318 Rp 250,548 Rp 18,373,500
Rp 29,909,473 Rp 3,036,495 Rp 455,474 Rp 33,401,442
62 PT. PARIT PADANG GLOBAL 8005 9/12/2012 00011981 Rp 1,343,176 Rp 136,363 Rp 20,454 Rp 1,499,993
63 PT. PARIT PADANG GLOBAL 8015 9/12/2012 00011984 Rp 394,000 Rp 40,000 Rp 6,000 Rp 440,000
64 PT. PARIT PADANG GLOBAL 8102 9/13/2012 00012014 Rp 2,734,360 Rp 277,600 Rp 41,640 Rp 3,053,600
65 PT. PARIT PADANG GLOBAL 8023 9/12/2012 00011989 Rp 626,756 Rp 63,630 Rp 9,545 Rp 699,930
 Rp 5,098,291 Rp 517,593 Rp 77,639 Rp 5,693,523
66 PT. DOS NI ROHA 7073 8/16/2012 01178382 Rp 7,670,730 Rp 778,754 Rp 116,813 Rp 8,566,298
67 PT. DOS NI ROHA 7901 8/16/2012 01178393 Rp 2,462,500 Rp 250,000 Rp 37,500 Rp 2,750,000
68 PT. DOS NI ROHA 9988 8/21/2012 01184314 Rp 439,556 Rp 44,625 Rp 6,694 Rp 490,875
69 PT. DOS NI ROHA 9550 8/27/2012 01191041 Rp 19,670,450 Rp 1,997,000 Rp 299,550 Rp 21,967,000
70 PT. DOS NI ROHA 9551 8/27/2012 01191042 Rp 3,789,541 Rp 384,725 Rp 57,709 Rp 4,231,975
71 PT. DOS NI ROHA 9552 8/27/2012 01191043 Rp 270,875 Rp 27,500 Rp 4,125 Rp 302,500
72 PT. DOS NI ROHA 0287 8/27/2012 01191056 Rp 1,871,500 Rp 190,000 Rp 28,500 Rp 2,090,000
73 PT. DOS NI ROHA 7932 8/28/2012 01191140 Rp 2,744,604 Rp 278,640 Rp 41,796 Rp 3,065,040
74 PT. DOS NI ROHA 8343 8/28/2012 01191144 Rp 12,286,545 Rp 1,247,365 Rp 187,105 Rp 13,721,015
75 PT. DOS NI ROHA 2830 8/29/2012 01192516 Rp 7,593,414 Rp 770,905 Rp 115,636 Rp 8,479,955
76 PT. DOS NI ROHA 2831 8/29/2012 01192517 Rp 709,200 Rp 72,000 Rp 10,800 Rp 792,000
77 PT. DOS NI ROHA 4441 8/29/2012 01192548 Rp 1,182,000 Rp 120,000 Rp 18,000 Rp 1,320,000
78 PT. DOS NI ROHA 1725 8/30/2012 01204133 Rp 12,224,835 Rp 1,241,100 Rp 186,165 Rp 13,652,100
79 PT. DOS NI ROHA 4224 8/30/2012 01204172 Rp 9,795,825 Rp 994,500 Rp 149,175 Rp 10,939,500
80 PT. DOS NI ROHA 4225 8/30/2012 01204173 Rp 4,235,500 Rp 430,000 Rp 64,500 Rp 4,730,000
Rp 86,947,076 Rp 8,827,114 Rp 1,324,067 Rp 97,098,258
81 PT. INDO FARMA GLOBAL M 5674 8/31/2012 Rp 2,472,360 Rp 251,001 Rp 37,650 Rp 2,761,011
82 PT. INDO FARMA GLOBAL M 5690 8/31/2012 Rp 6,576,530 Rp 667,668 Rp 100,150 Rp 7,344,348
83 PT. INDO FARMA GLOBAL M 5320 8/9/2012 Rp 3,869,070 Rp 392,799 Rp 58,920 Rp 4,320,789
84 PT. INDO FARMA GLOBAL M 5317 8/9/2012 Rp 10,339,085 Rp 1,049,653 Rp 157,448 Rp 11,546,186
85 PT. INDO FARMA GLOBAL M 5234 8/6/2012 Rp 768,938 Rp 78,065 Rp 11,710 Rp 858,713
86 PT. INDO FARMA GLOBAL M 5219 8/6/2012 Rp 2,372,294 Rp 240,842 Rp 36,126 Rp 2,649,262
Rp 26,398,277 Rp 2,680,028 Rp 402,004 Rp 29,480,309
87 PT. UNITED DICO CITAS 6065 8/9/2012 00008584 Rp 1,978,954 Rp 200,909 Rp 30,136 Rp 2,209,999
88 PT. UNITED DICO CITAS 6066 8/9/2012 00008585 Rp 11,138,548 Rp 1,130,817 Rp 169,623 Rp 12,438,988
89 PT. UNITED DICO CITAS 6205 8/13/2012 00008739 Rp 22,215,874 Rp 2,255,419 Rp 338,313 Rp 24,809,606
90 PT. UNITED DICO CITAS 6212 8/30/2012 00008744 Rp 4,511,310 Rp 458,001 Rp 68,700 Rp 5,038,011
91 PT. UNITED DICO CITAS 6286 8/14/2012 00008794 Rp 4,225,650 Rp 429,000 Rp 64,350 Rp 4,719,000
92 PT. UNITED DICO CITAS 6549 8/28/2012 00009067 Rp 12,752,093 Rp 1,294,629 Rp 194,194 Rp 14,240,916
93 PT. UNITED DICO CITAS 6729 8/30/2012 00009213 Rp 8,321,650 Rp 844,838 Rp 126,726 Rp 9,293,213
94 PT. UNITED DICO CITAS 6730 8/30/2012 00009214 Rp 2,310,278 Rp 234,546 Rp 35,182 Rp 2,580,006
Rp 67,454,357 Rp 6,848,158 Rp 1,027,224 Rp 75,329,739
TOTAL Rp 670,860,533 Rp 670,860,533

Mengetahui, Muara Bungo, 10 Oktober 2012

Kepala Instalasi Farmasi Kepala Ruangan

TONI DAFIAPUTRA, S.FARM, APT AYU TRESNAWATI

NIP.19841023 200803 1 001 NIP 19660908 198803 2 002.

LAMPIRAN REKAPITULASI SURAT PEMBAYARAN HUTANG

OBAT REGULER
INSTALASI FARMASI RSUD H. HANAFIE MUARA BUNGO

10/20/2012
NO DISTRIBUTOR NO FACT TGL FACT NO.F STDR TAGIHAN PPN PPH SUB TOTAL TOTAL

1 PT. RAJAWALI NUSINDO 5444 9/10/2012 00005396 Rp 15,240,879 Rp 1,547,297 Rp 232,095 Rp 17,020,271
2 PT. RAJAWALI NUSINDO 5534 9/12/2012 00005397 Rp 16,921,268 Rp 1,717,895 Rp 257,684 Rp 18,896,848
3 PT. RAJAWALI NUSINDO 5538 9/12/2012 00005398 Rp 1,898,706 Rp 192,762 Rp 28,914 Rp 2,120,382
4 PT. RAJAWALI NUSINDO 5566 9/13/2012 00005399 Rp 5,426,834 Rp 550,948 Rp 82,642 Rp 6,060,424
Rp 39,487,687 Rp 4,008,902 Rp 601,335 Rp 44,097,925
5 PT. PENTA VALENT 9659 9/17/2012 00491679 Rp 3,349,000 Rp 340,000 Rp 51,000 Rp 3,740,000
6 PT. PENTA VALENT 9706 9/18/2012 00492709 Rp 2,730,420 Rp 277,200 Rp 41,580 Rp 3,049,200
Rp 6,079,420 Rp 617,200 Rp 92,580 Rp 6,789,200
7 PT. INDO FARMA GLOBAL M 5824 9/6/2012 Rp 193,375 Rp 19,632 Rp 2,945 Rp 215,952
8 PT. INDO FARMA GLOBAL M 5893 9/10/2012 Rp 3,096,065 Rp 314,321 Rp 47,148 Rp 3,457,534
9 PT. INDO FARMA GLOBAL M 5909 9/11/2012 Rp 1,850,165 Rp 187,834 Rp 28,175 Rp 2,066,174
10 PT. INDO FARMA GLOBAL M 6302 9/25/2012 Rp 4,475,427 Rp 454,358 Rp 68,154 Rp 4,997,939
Rp 9,615,032 Rp 976,145 Rp 146,422 Rp 10,737,599
11 PT. ANUGRAH PHARMINDO L 7978 9/25/2012 02082044 Rp 10,029,093 Rp 1,018,182 Rp 152,727 Rp 11,200,002
12 PT. ANUGRAH PHARMINDO L 8089 9/26/2012 02082045 Rp 12,706,522 Rp 1,290,002 Rp 193,500 Rp 14,190,025
13 PT. ANUGRAH PHARMINDO L 8370 9/28/2012 02082047 Rp 1,611,820 Rp 163,637 Rp 24,545 Rp 1,800,002
14 PT. ANUGRAH PHARMINDO L 8375 9/28/2012 02082043 Rp 34,548,875 Rp 3,507,500 Rp 526,125 Rp 38,582,500
15 PT. ANUGRAH PHARMINDO L 8369 9/28/2012 02082046 Rp 42,905,123 Rp 4,355,850 Rp 653,378 Rp 47,914,350
16 PT. ANUGRAH PHARMINDO L 7863 9/24/2012 02082048 Rp 24,772,750 Rp 2,515,000 Rp 377,250 Rp 27,665,000
Rp 126,574,183 Rp 12,850,171 Rp 1,927,526 Rp 141,351,879
17 PT. UNITED DICO CITAS 7676 9/22/2012 00010198 Rp 4,558,031 Rp 462,744 Rp 69,412 Rp 5,090,187
18 PT. UNITED DICO CITAS 7677 9/22/2012 00010199 Rp 6,051,495 Rp 614,365 Rp 92,155 Rp 6,758,015
19 PT. UNITED DICO CITAS 7781 9/25/2012 00010269 Rp 38,611,877 Rp 3,919,988 Rp 587,998 Rp 43,119,863
20 PT. UNITED DICO CITAS 7873 9/26/2012 00010358 Rp 6,274,233 Rp 636,978 Rp 95,547 Rp 7,006,758
21 PT. UNITED DICO CITAS 7305 9/13/2012 00009778 Rp 4,250,659 Rp 431,539 Rp 64,731 Rp 4,746,929
Rp 59,746,296 Rp 6,065,614 Rp 909,842 Rp 66,721,752
22 PT. DOS NI ROHA 7722 9/3/2012 01315857 Rp 5,023,500 Rp 510,000 Rp 76,500 Rp 5,610,000
23 PT. DOS NI ROHA 9563 9/5/2012 01315980 Rp 607,115 Rp 61,636 Rp 9,245 Rp 677,996
24 PT. DOS NI ROHA 5540 9/6/2012 01316003 Rp 472,800 Rp 48,000 Rp 7,200 Rp 528,000
25 PT. DOS NI ROHA 5558 9/6/2012 01316008 Rp 358,185 Rp 36,364 Rp 5,455 Rp 400,004
26 PT. DOS NI ROHA 0841 9/8/2012 01316176 Rp 1,280,502 Rp 130,000 Rp 19,500 Rp 1,430,002
27 PT. DOS NI ROHA 2756 9/10/2012 01316191 Rp 4,553,860 Rp 462,321 Rp 69,348 Rp 5,085,529
28 PT. DOS NI ROHA 2757 9/10/2012 01316192 Rp 2,238,659 Rp 227,275 Rp 34,091 Rp 2,500,025
29 PT. DOS NI ROHA 2758 9/10/2012 01316193 Rp 8,306,013 Rp 843,250 Rp 126,488 Rp 9,275,750
30 PT. DOS NI ROHA 4329 9/10/2012 01316229 Rp 644,734 Rp 65,455 Rp 9,818 Rp 720,007
31 PT. DOS NI ROHA 5123 9/10/2012 01316238 Rp 671,573 Rp 68,180 Rp 10,227 Rp 749,980
32 PT. DOS NI ROHA 1287 9/11/2012 01316283 Rp 1,773,000 Rp 180,000 Rp 27,000 Rp 1,980,000
33 PT. DOS NI ROHA 9009 9/12/2012 01316358 Rp 748,600 Rp 76,000 Rp 11,400 Rp 836,000
34 PT. DOS NI ROHA 9359 9/12/2012 01316365 Rp 195,163 Rp 19,814 Rp 2,972 Rp 217,949
35 PT. DOS NI ROHA 9485 9/12/2012 01316371 Rp 7,953,875 Rp 807,500 Rp 121,125 Rp 8,882,500
36 PT. DOS NI ROHA 9486 9/12/2012 01316372 Rp 698,464 Rp 70,910 Rp 10,637 Rp 780,010
37 PT. DOS NI ROHA 7599 9/13/2012 01316448 Rp 3,022,153 Rp 306,818 Rp 46,023 Rp 3,374,993
38 PT. DOS NI ROHA 7601 9/13/2012 01316449 Rp 5,835,856 Rp 592,473 Rp 88,871 Rp 6,517,200
39 PT. DOS NI ROHA 9862 9/13/2012 01316468 Rp 5,910,000 Rp 600,000 Rp 90,000 Rp 6,600,000
40 PT. DOS NI ROHA 0048 9/13/2012 01316471 Rp 9,426,450 Rp 957,000 Rp 143,550 Rp 10,527,000
41 PT. DOS NI ROHA 0935 9/15/2012 01316581 Rp 414,143 Rp 42,045 Rp 6,307 Rp 462,495
42 PT. DOS NI ROHA 1617 9/15/2012 01316599 Rp 1,735,803 Rp 176,224 Rp 26,434 Rp 1,938,460
43 PT. DOS NI ROHA 4402 9/15/2012 01316627 Rp 402,914 Rp 40,905 Rp 6,136 Rp 449,955
44 PT. DOS NI ROHA 4403 9/15/2012 01316628 Rp 2,216,250 Rp 225,000 Rp 33,750 Rp 2,475,000
45 PT. DOS NI ROHA 4404 9/15/2012 01316629 Rp 4,284,750 Rp 435,000 Rp 65,250 Rp 4,785,000
46 PT. DOS NI ROHA 4405 9/15/2012 01316630 Rp 4,629,500 Rp 470,000 Rp 70,500 Rp 5,170,000
47 PT. DOS NI ROHA 4406 9/15/2012 01316631 Rp 3,693,750 Rp 375,000 Rp 56,250 Rp 4,125,000
48 PT. DOS NI ROHA 4407 9/15/2012 01316632 Rp 6,047,900 Rp 614,000 Rp 92,100 Rp 6,754,000
49 PT. DOS NI ROHA 4408 9/15/2012 01316633 Rp 3,441,984 Rp 349,440 Rp 52,416 Rp 3,843,840
50 PT. DOS NI ROHA 4409 9/15/2012 01316634 Rp 5,910,000 Rp 600,000 Rp 90,000 Rp 6,600,000
51 PT. DOS NI ROHA 4410 9/15/2012 01316635 Rp 242,655 Rp 24,635 Rp 3,695 Rp 270,985
52 PT. DOS NI ROHA 2384 9/27/2012 01344559 Rp 18,613,241 Rp 1,889,669 Rp 283,450 Rp 20,786,361
53 PT. DOS NI ROHA 3129 9/27/2012 01344572 Rp 28,284,275 Rp 2,871,500 Rp 430,725 Rp 31,586,500
54 PT. DOS NI ROHA 9014 9/29/2012 01344739 Rp 10,047,000 Rp 1,020,000 Rp 153,000 Rp 11,220,000
55 PT. DOS NI ROHA 1884 9/29/2012 01344763 Rp 5,931,809 Rp 602,214 Rp 90,332 Rp 6,624,355
56 PT. DOS NI ROHA 1893 9/29/2012 01344769 Rp 2,888,367 Rp 293,235 Rp 43,985 Rp 3,225,587
57 PT. DOS NI ROHA 2724 9/29/2012 01344783 Rp 6,146,400 Rp 624,000 Rp 93,600 Rp 6,864,000
Rp 164,651,242 Rp 16,715,862 Rp 2,507,379 Rp 183,874,483
58 PT. KEBAYORAN PHARMA 9307 9/25/2012 00009431 Rp 581,150 Rp 59,000 Rp 8,850 Rp 649,000
59 PT. KEBAYORAN PHARMA 9479 9/29/2012 00009605 Rp 428,475 Rp 43,500 Rp 6,525 Rp 478,500
60 PT. KEBAYORAN PHARMA 9502 9/29/2012 00009633 Rp 11,475,250 Rp 1,165,000 Rp 174,750 Rp 12,815,000
61 PT. KEBAYORAN PHARMA 9503 9/29/2012 00009634 Rp 7,073,818 Rp 718,154 Rp 107,723 Rp 7,899,695
62 PT. KEBAYORAN PHARMA 9604 9/29/2012 00009738 Rp 13,395,370 Rp 1,359,936 Rp 203,990 Rp 14,959,296
63 PT. KEBAYORAN PHARMA 9606 9/29/2012 00009740 Rp 3,053,500 Rp 310,000 Rp 46,500 Rp 3,410,000
64 PT. KEBAYORAN PHARMA 9274 9/24/2012 00009397 Rp 25,098,509 Rp 2,548,072 Rp 382,211 Rp 28,028,792
65 PT. KEBAYORAN PHARMA 9275 9/24/2012 00009398 Rp 2,435,601 Rp 247,269 Rp 37,090 Rp 2,719,960
66 PT. KEBAYORAN PHARMA 9279 9/24/2012 00009402 Rp 9,367,350 Rp 951,000 Rp 142,650 Rp 10,461,000
67 PT. KEBAYORAN PHARMA 9280 9/24/2012 00009403 Rp 12,293,785 Rp 1,248,100 Rp 187,215 Rp 13,729,100
68 PT. KEBAYORAN PHARMA 9289 9/25/2012 00009412 Rp 6,023,275 Rp 611,500 Rp 91,725 Rp 6,726,500
69 PT. KEBAYORAN PHARMA 9290 9/25/2012 00009413 Rp 7,090,030 Rp 719,800 Rp 107,970 Rp 7,917,800
70 PT. KEBAYORAN PHARMA 9324 9/25/2012 00009448 Rp 1,026,803 Rp 104,244 Rp 15,637 Rp 1,146,684
71 PT. KEBAYORAN PHARMA 9335 9/26/2012 00009459 Rp 9,448,120 Rp 959,200 Rp 143,880 Rp 10,551,200
Rp 108,791,036 Rp 11,044,775 Rp 1,656,716 Rp 121,492,527
72 CV. BHAKTI SEJAHTERA M 287 9/10/2012 00000287 Rp 4,529,030 Rp 459,800 Rp 68,970 Rp 5,057,800
73 CV. BHAKTI SEJAHTERA M 304 9/21/2012 00000304 Rp 8,300,477 Rp 842,688 Rp 126,403 Rp 9,269,568
74 CV. BHAKTI SEJAHTERA M 307 9/27/2012 00000307 Rp 8,101,783 Rp 822,516 Rp 123,377 Rp 9,047,676
Rp 20,931,289 Rp 2,125,004 Rp 318,751 Rp 23,375,044
75 CV. SRI TIRTA JAYA 0955 9/3/2012 00000067 Rp 4,241,016 Rp 430,560 Rp 64,584 Rp 4,736,160
76 CV. SRI TIRTA JAYA 0960 9/5/2012 00000068 Rp 1,699,125 Rp 172,500 Rp 25,875 Rp 1,897,500
77 CV. SRI TIRTA JAYA 0965 9/5/2012 00000070 Rp 886,500 Rp 90,000 Rp 13,500 Rp 990,000
78 CV. SRI TIRTA JAYA 0968 9/6/2012 00000072 Rp 467,875 Rp 47,500 Rp 7,125 Rp 522,500
79 CV. SRI TIRTA JAYA 0972 9/10/2012 00000073 Rp 4,531,000 Rp 460,000 Rp 69,000 Rp 5,060,000
80 CV. SRI TIRTA JAYA 0976 9/11/2012 00000074 Rp 1,255,875 Rp 127,500 Rp 19,125 Rp 1,402,500
81 CV. SRI TIRTA JAYA 0986 9/18/2012 00000076 Rp 2,063,575 Rp 209,500 Rp 31,425 Rp 2,304,500
82 CV. SRI TIRTA JAYA 0992 9/19/2012 00000077 Rp 1,669,575 Rp 169,500 Rp 25,425 Rp 1,864,500
83 CV. SRI TIRTA JAYA 0994 9/20/2012 00000078 Rp 3,289,900 Rp 334,000 Rp 50,100 Rp 3,674,000
84 CV. SRI TIRTA JAYA 1010 9/29/2012 00000081 Rp 2,462,500 Rp 250,000 Rp 37,500 Rp 2,750,000
Rp 22,566,941 Rp 2,291,060 Rp 343,659 Rp 25,201,660
85 PT. TEMPO 4419 9/24/2012 00907236 Rp 3,590,325 Rp 364,500 Rp 54,675 Rp 4,009,500
Rp 4,009,500
86 PT. KIMIA FARMA 8157 7/23/2012 00008146 Rp 1,188,773 Rp 120,688 Rp 18,103 Rp 1,327,564
87 PT. KIMIA FARMA 7834 7/14/2012 00007823 Rp 4,869,622 Rp 494,378 Rp 74,157 Rp 5,438,156
Rp 6,058,395 Rp 615,065 Rp 92,260 Rp 6,765,720
88 PT. PARIT PADANG GLOBAL 8918 9/20/2012 00012307 Rp 271,968 Rp 27,611 Rp 4,142 Rp 303,721
89 PT. PARIT PADANG GLOBAL 8955 9/20/2012 00012321 Rp 591,000 Rp 60,000 Rp 9,000 Rp 660,000
90 PT. PARIT PADANG GLOBAL 9744 9/27/2012 00012578 Rp 2,532,238 Rp 257,080 Rp 38,562 Rp 2,827,880
Rp 3,395,206 Rp 344,691 Rp 51,704 Rp 3,791,601
TOTAL Rp 638,208,890 Rp 638,208,890
 Mengetahui, Muara Bungo, 20 Oktober 2012
Kepala Instalasi Farmasi Kepala Ruangan

TONI DAFIAPUTRA, S.FARM, APT AYU TRESNAWATI

NIP.19841023 200803 1 001 NIP 19660908 198803 2 002

LAMPIRAN REKAPITULASI SURAT PEMBAYARAN HUTANG

OBAT REGULER
INSTALASI FARMASI RSUD H. HANAFIE MUARA BUNGO

10/30/2012
NO DISTRIBUTOR NO FACT TGL FACT NO.F STDR TAGIHAN PPN PPH SUB TOTAL TOTAL

1 PT. MENSA BINA SUKSES 4070 8/27/2012 00881934 Rp 4,969,207 Rp 504,488 Rp 75,673 Rp 5,549,368
2 PT. MENSA BINA SUKSES 2495 8/31/2012 00900166 Rp 10,539,352 Rp 1,069,985 Rp 160,498 Rp 11,769,835
3 PT. MENSA BINA SUKSES 6966 8/31/2012 00904600 Rp 12,146,035 Rp 1,233,100 Rp 184,965 Rp 13,564,100
4 PT. MENSA BINA SUKSES 2498 8/31/2012 00900169 Rp 8,677,958 Rp 881,011 Rp 132,152 Rp 9,691,121
5 PT. MENSA BINA SUKSES 8957 9/11/2012 00946199 Rp 7,696,741 Rp 781,395 Rp 117,209 Rp 8,595,345
6 PT. MENSA BINA SUKSES 8958 9/11/2012 00946200 Rp 26,583,535 Rp 2,698,836 Rp 404,825 Rp 29,687,196
7 PT. MENSA BINA SUKSES 6805 9/13/2012 00953974 Rp 417,578 Rp 42,394 Rp 6,359 Rp 466,331
8 PT. MENSA BINA SUKSES 6808 9/13/2012 00953977 Rp 935,750 Rp 95,000 Rp 14,250 Rp 1,045,000
9 PT. MENSA BINA SUKSES 9302 9/13/2012 00956444 Rp 601,727 Rp 61,089 Rp 9,163 Rp 671,979
10 PT. MENSA BINA SUKSES 9300 9/13/2012 00956442 Rp 3,508,034 Rp 356,146 Rp 53,422 Rp 3,917,601
11 PT. MENSA BINA SUKSES 5102 9/17/2012 00962178 Rp 7,649,756 Rp 776,625 Rp 116,494 Rp 8,542,875
12 PT. MENSA BINA SUKSES 4168 9/26/2012 01000785 Rp 59,997,483 Rp 6,091,115 Rp 913,667 Rp 67,002,265
13 PT. MENSA BINA SUKSES 4172 9/26/2012 01000788 Rp 23,134,547 Rp 2,348,685 Rp 352,303 Rp 25,835,535
14 PT. MENSA BINA SUKSES 4178 9/26/2012 01000794 Rp 2,037,133 Rp 206,816 Rp 31,022 Rp 2,274,971
15 PT. MENSA BINA SUKSES 8513 9/27/2012 01005085 Rp 6,924,550 Rp 703,000 Rp 105,450 Rp 7,733,000
16 PT. MENSA BINA SUKSES 1203 9/27/2012 01007751 Rp 3,510,185 Rp 356,364 Rp 53,455 Rp 3,920,004
17 PT. MENSA BINA SUKSES 8516 9/27/2012 01005088 Rp 3,510,185 Rp 356,364 Rp 53,455 Rp 3,920,004
18 PT. MENSA BINA SUKSES 1206 9/27/2012 01007754 Rp 1,583,757 Rp 160,788 Rp 24,118 Rp 1,768,663
Rp 184,423,514 Rp 18,723,199 Rp 2,808,480 Rp 205,955,193
19 APOTIK CAHAYA SEHAT 0001 9/17/2012 Rp 17,742,114 Rp 1,801,230 Rp 270,184 Rp 19,813,528
Rp 19,813,528
20 PT. ENSEVAL PUTERA 0490 9/21/2012 02861489 Rp 19,817,314 Rp 2,011,910 Rp 301,787 Rp 22,131,010
21 PT. ENSEVAL PUTERA 0497 9/21/2012 02861496 Rp 3,153,478 Rp 320,150 Rp 48,023 Rp 3,521,650
22 PT. ENSEVAL PUTERA 0578 9/21/2012 02874592 Rp 1,038,683 Rp 105,450 Rp 15,818 Rp 1,159,950
23 PT. ENSEVAL PUTERA 0682 9/22/2012 02881280 Rp 39,287,464 Rp 3,988,575 Rp 598,286 Rp 43,874,325
24 PT. ENSEVAL PUTERA 0713 9/24/2012 02894008 Rp 617,595 Rp 62,700 Rp 9,405 Rp 689,700
25 PT. ENSEVAL PUTERA 0875 9/24/2012 02894170 Rp 36,396,464 Rp 3,695,072 Rp 554,261 Rp 40,645,797
26 PT. ENSEVAL PUTERA 1025 9/25/2012 02912756 Rp 8,128,860 Rp 825,265 Rp 123,790 Rp 9,077,915
27 PT. ENSEVAL PUTERA 1157 9/21/2012 02861541 Rp 268,629 Rp 27,272 Rp 4,091 Rp 299,992
28 PT. ENSEVAL PUTERA 1163 9/21/2012 02874599 Rp 738,750 Rp 75,000 Rp 11,250 Rp 825,000
29 PT. ENSEVAL PUTERA 1166 9/22/2012 02881400 Rp 134,315 Rp 13,636 Rp 2,045 Rp 149,996
30 PT. ENSEVAL PUTERA 1169 9/24/2012 02894193 Rp 3,827,907 Rp 388,620 Rp 58,293 Rp 4,274,820
31 PT. ENSEVAL PUTERA 1174 9/24/2012 02894198 Rp 4,781,719 Rp 485,454 Rp 72,818 Rp 5,339,991
32 PT. ENSEVAL PUTERA 1178 9/25/2012 02912797 Rp 658,157 Rp 66,818 Rp 10,023 Rp 734,998
33 PT. ENSEVAL PUTERA 1192 9/27/2012 02942031 Rp 3,510,185 Rp 356,364 Rp 53,455 Rp 3,920,004
34 PT. ENSEVAL PUTERA 1527 9/28/2012 02966715 Rp 24,137,671 Rp 2,450,525 Rp 367,579 Rp 26,955,775
35 PT. ENSEVAL PUTERA 1564 9/29/2012 02966752 Rp 3,396,773 Rp 344,850 Rp 51,728 Rp 3,793,350
36 PT. ENSEVAL PUTERA 1200 9/28/2012 02966824 Rp 1,925,232 Rp 195,455 Rp 29,318 Rp 2,150,005
RETUR Rp. 5.544.000 Rp 151,819,194 Rp 15,413,116 Rp 2,311,967 Rp 169,544,278
37 PT. RAJAWALI NUSINDO 5726 9/20/2012 00005664 Rp 16,252,270 Rp 1,649,977 Rp 247,496 Rp 18,149,743
38 PT. RAJAWALI NUSINDO 5727 9/20/2012 00005665 Rp 644,722 Rp 65,454 Rp 9,818 Rp 719,994
39 PT. RAJAWALI NUSINDO 5769 9/22/2012 00005666 Rp 6,570,275 Rp 667,033 Rp 100,055 Rp 7,337,363
40 PT. RAJAWALI NUSINDO 5772 9/24/2012 00005667 Rp 3,179,698 Rp 322,812 Rp 48,422 Rp 3,550,932
41 PT. RAJAWALI NUSINDO 5785 9/24/2012 00005668 Rp 1,812,302 Rp 183,990 Rp 27,599 Rp 2,023,890
42 PT. RAJAWALI NUSINDO 5791 9/24/2012 00005669 Rp 4,432,500 Rp 450,000 Rp 67,500 Rp 4,950,000
43 PT. RAJAWALI NUSINDO 5904 9/28/2012 00005670 Rp 7,325,540 Rp 743,710 Rp 111,556 Rp 8,180,806
Rp 40,217,306 Rp 4,082,975 Rp 612,446 Rp 44,912,728
44 PT. DOS NI ROHA 1785 8/30/2012 01204148 Rp 2,399,460 Rp 243,600 Rp 36,540 Rp 2,679,600
45 PT. DOS NI ROHA 1786 8/30/2012 01204149 Rp 7,775,347 Rp 789,375 Rp 118,406 Rp 8,683,129
46 PT. DOS NI ROHA 1790 8/30/2012 01204151 Rp 577,703 Rp 58,650 Rp 8,798 Rp 645,150
47 PT. DOS NI ROHA 1791 8/30/2012 01204152 Rp 1,154,275 Rp 117,185 Rp 17,578 Rp 1,289,038
Rp 11,906,785 Rp 1,208,811 Rp 181,322 Rp 13,296,917
48 PT. ANUGRAH ARGON M 4468 8/31/2012 01075804 Rp 12,706,500 Rp 1,290,000 Rp 193,500 Rp 14,190,000
49 PT. ANUGRAH ARGON M 4469 8/31/2012 01075805 Rp 10,812,838 Rp 1,097,750 Rp 164,663 Rp 12,075,250
50 PT. ANUGRAH ARGON M 4465 8/31/2012 01075801 Rp 8,622,155 Rp 875,346 Rp 131,302 Rp 9,628,803
51 PT. ANUGRAH ARGON M 5325 9/17/2012 01142379 Rp 6,252,780 Rp 634,800 Rp 95,220 Rp 6,982,800
52 PT. ANUGRAH ARGON M 5324 9/17/2012 01142378 Rp 2,820,690 Rp 286,364 Rp 42,955 Rp 3,150,009
53 PT. ANUGRAH ARGON M 5356 9/17/2012 01145252 Rp 7,633,750 Rp 775,000 Rp 116,250 Rp 8,525,000
54 PT. ANUGRAH ARGON M 5434 9/18/2012 01151355 Rp 2,825,382 Rp 286,841 Rp 43,026 Rp 3,155,249
55 PT. ANUGRAH ARGON M 5436 9/18/2012 01151357 Rp 1,656,455 Rp 168,168 Rp 25,225 Rp 1,849,848
56 PT. ANUGRAH ARGON M 5433 9/18/2012 01151354 Rp 7,432,828 Rp 754,602 Rp 113,190 Rp 8,300,620
57 PT. ANUGRAH ARGON M 5431 9/18/2012 01151352 Rp 9,094,702 Rp 923,320 Rp 138,498 Rp 10,156,520
58 PT. ANUGRAH ARGON M 5435 9/18/2012 01151356 Rp 5,101,575 Rp 517,926 Rp 77,689 Rp 5,697,190
59 PT. ANUGRAH ARGON M 5432 9/18/2012 01151353 Rp 3,248,044 Rp 329,751 Rp 49,463 Rp 3,627,257
Rp 78,207,698 Rp 7,939,868 Rp 1,190,980 Rp 87,338,546
60 PT. HOTAMA MEDIPHAR 1333 9/28/2012 00001333 Rp 4,141,433 Rp 420,450 Rp 63,068 Rp 4,624,950
61 PT. HOTAMA MEDIPHAR 1334 9/28/2012 00001334 Rp 7,994,384 Rp 811,613 Rp 121,742 Rp 8,927,738
Rp 12,135,816 Rp 1,232,063 Rp 184,809 Rp 13,552,688
62 PT. ULICO PHARMA 0062 9/3/2012 00000062 Rp 4,521,150 Rp 459,000 Rp 68,850 Rp 5,049,000
63 PT. ULICO PHARMA 0063 9/6/2012 00000063 Rp 5,850,900 Rp 594,000 Rp 89,100 Rp 6,534,000
64 PT. ULICO PHARMA 0064 9/10/2012 00000064 Rp 4,077,900 Rp 414,000 Rp 62,100 Rp 4,554,000
65 PT. ULICO PHARMA 0065 9/13/2012 00000065 Rp 4,777,250 Rp 485,000 Rp 72,750 Rp 5,335,000
66 PT. ULICO PHARMA 0066 9/17/2012 00000066 Rp 6,008,500 Rp 610,000 Rp 91,500 Rp 6,710,000
67 PT. ULICO PHARMA 0067 9/20/2012 00000067 Rp 14,479,500 Rp 1,470,000 Rp 220,500 Rp 16,170,000
68 PT. ULICO PHARMA 0068 9/22/2012 00000068 Rp 3,971,520 Rp 403,200 Rp 60,480 Rp 4,435,200
Rp 43,686,720 Rp 4,435,200 Rp 665,280 Rp 48,787,200
69 PT. BINA SAN PRIMA 2970 9/29/2012 00028394 Rp 947,078 Rp 96,150 Rp 14,423 Rp 1,057,650
70 PT. BINA SAN PRIMA 2971 9/29/2012 00028395 Rp 280,725 Rp 28,500 Rp 4,275 Rp 313,500
71 PT. BINA SAN PRIMA 2972 9/29/2012 00028396 Rp 33,770,627 Rp 3,428,490 Rp 514,274 Rp 37,713,390
72 PT. BINA SAN PRIMA 2985 9/29/2012 00028409 Rp 270,136 Rp 27,425 Rp 4,114 Rp 301,675
73 PT. BINA SAN PRIMA 2996 9/29/2012 00028420 Rp 15,793,539 Rp 1,603,405 Rp 240,511 Rp 17,637,455
Rp 51,062,105 Rp 5,183,970 Rp 777,596 Rp 57,023,670
74 PT. MERAPI UTAMA PHARMA 2282 9/28/2012 0012017 Rp 19,264,015 Rp 1,955,738 Rp 293,361 Rp 21,513,113
Rp 21,513,113
75 PT. JUNGER FARMA 0960 9/24/2012 00000960 Rp 679,355 Rp 68,970 Rp 10,346 Rp 758,670
Rp 758,670

TOTAL Rp 682,496,531 Rp 682,496,531

Mengetahui, Muara Bungo, 30 Oktober 2012

Kepala Instalasi Farmasi Kepala Ruangan

TONI DAFIAPUTRA, S.FARM, APT AYU TRESNAWATI

NIP.19841023 200803 1 001 NIP 19660908 198803 2 002
 NO NAMA PERUSAHAAN JUMLAH HUTANG ASKES Rp 62,148,933
bold 1 PT. MERAPI UTAMA PHARMA Rp 40,369,980 UMUM Rp 608,711,600
2 PT. ANUGRAH ARGON M Rp 110,023,790 TOTAL Rp 670,860,533
3 PT. BINA SAN PRIMA Rp 94,122,578
ASKES 4 PT. MILLENIUM PHARMACON I Rp 24,807,325 8/6/2012 MIN
5 PT. ENSEVAL PUTERA Rp 160,533,589 MAX
6 PT. TEMPO Rp 33,401,442
ASKES 7 PT. PARIT PADANG GLOBAL Rp 5,693,523
ASKES 8 PT. DOS NI ROHA Rp 97,098,258
ASKES 9 PT. INDO FARMA GLOBAL M Rp 29,480,309
10 PT. UNITED DICO CITAS Rp 75,329,739

ASKES
ASKES

TOTAL Rp 670,860,533
 NO NAMA PERUSAHAAN JUMLAH HUTANG
1 CV. BHAKTI SEJAHTERA M Rp 23,375,044
2 CV. SRI TIRTA JAYA Rp 25,201,660
3 PT. ANUGRAH PHARMINDO L Rp 141,351,879
4 PT. DOS NI ROHA Rp 183,874,483
5 PT. INDO FARMA GLOBAL M Rp 10,737,599
6 PT. KEBAYORAN PHARMA Rp 121,492,527
7 PT. PARIT PADANG GLOBAL Rp 3,791,601
8 PT. PENTA VALENT Rp 6,789,200
9 PT. RAJAWALI NUSINDO Rp 44,097,925
10 PT. TEMPO Rp 4,009,500
11 PT. UNITED DICO CITAS Rp 66,721,752
PT. KIMIA FARMA Rp 6,765,720

TOTAL Rp 638,208,890
ASKES
AS
 NO NAMA PERUSAHAAN JUMLAH HUTANG
1 PT. MENSA BINA SUKSES Rp 205,955,193
2 APOTIK CAHAYA SEHAT Rp 19,813,528
3 PT. ENSEVAL PUTERA Rp 169,544,278
4 PT. RAJAWALI NUSINDO Rp 44,912,728
5 PT. DOS NI ROHA Rp 13,296,917
6 PT. ANUGRAH ARGON M Rp 87,338,546
7 PT. HOTAMA MEDIPHAR Rp 13,552,688
8 PT. ULICO PHARMA Rp 48,787,200
9 PT. BINA SAN PRIMA Rp 57,023,670
10 PT. MERAPI UTAMA PHARMA Rp 21,513,113
11 PT. JUNGER FARMA Rp 758,670
Rp 682,496,531

ASKES

ASKES
ASKES
 REKAPITULASI HUTANG PBF BULAN OKTOBER 2012
REGULER

NO NAMA PERUSAHAAN JUMLAH HUTANG

1 APOTIK CAHAYA SEHAT Rp 19,813,528
2 CV. BHAKTI SEJAHTERA M Rp 23,375,044
3 CV. SRI TIRTA JAYA Rp 25,201,660
4 PT. ANUGRAH ARGON M Rp 197,362,336
5 PT. ANUGRAH PHARMINDO L Rp 141,351,879
6 PT. BINA SAN PRIMA Rp 151,146,248
7 PT. DOS NI ROHA Rp 294,269,658
8 PT. ENSEVAL PUTERA Rp 330,077,867
9 PT. HOTAMA MEDIPHAR Rp 13,552,688
10 PT. INDO FARMA GLOBAL M Rp 40,217,908
11 PT. JUNGER FARMA Rp 758,670
12 PT. KEBAYORAN PHARMA Rp 121,492,527
13 PT. KIMIA FARMA Rp 6,765,720
14 PT. MENSA BINA SUKSES Rp 205,955,193
15 PT. MERAPI UTAMA PHARMA Rp 61,883,093
16 PT. MILLENIUM PHARMACON I Rp 24,807,325
17 PT. PARIT PADANG GLOBAL Rp 9,485,124
18 PT. PENTA VALENT Rp 6,789,200
19 PT. RAJAWALI NUSINDO Rp 89,010,653
20 PT. TEMPO Rp 37,410,942
21 PT. ULICO PHARMA Rp 48,787,200
22 PT. UNITED DICO CITAS Rp 142,051,491

TOTAL Rp 1,991,565,954
 LAMPIRAN REKAPITULASI SURAT PEMBAYARAN HUTANG
OBHP RUTIN
INSTALASI FARMASI RSUD H. HANAFIE MUARA BUNGO

###
NO DISTRIBUTOR NO FACT TGL FACT NO.F STDR TAGIHAN PPN PPH SUB TOTAL TOTAL
1 PT. HOTAMA MEDIPHAR 1301 8/1/2012 00001301 Rp 7,363,561 Rp 747,570 Rp 112,135 Rp 8,223,266
2 PT. HOTAMA MEDIPHAR 1302 8/1/2012 00001302 Rp 10,027,300 Rp 1,018,000 Rp 152,700 Rp 11,198,000
3 PT. HOTAMA MEDIPHAR 1303 8/2/2012 00001303 Rp 4,849,510 Rp 492,336 Rp 73,850 Rp 5,415,696
4 PT. HOTAMA MEDIPHAR 1304 8/3/2012 00001304 Rp 6,116,850 Rp 621,000 Rp 93,150 Rp 6,831,000
5 PT. HOTAMA MEDIPHAR 1305 8/7/2012 00001305 Rp 9,153,736 Rp 929,313 Rp 139,397 Rp 10,222,446
6 PT. HOTAMA MEDIPHAR 1306 8/8/2012 00001306 Rp 3,860,215 Rp 391,900 Rp 58,785 Rp 4,310,900
7 PT. HOTAMA MEDIPHAR 1307 8/8/2012 00001307 Rp 7,578,590 Rp 769,400 Rp 115,410 Rp 8,463,400
8 PT. HOTAMA MEDIPHAR 1308 8/8/2012 00001308 Rp 13,164,131 Rp 1,336,460 Rp 200,469 Rp 14,701,060
9 PT. HOTAMA MEDIPHAR 1309 8/8/2012 00001309 Rp 11,754,260 Rp 1,193,326 Rp 178,999 Rp 13,126,585
10 PT. HOTAMA MEDIPHAR 1310 8/10/2012 00001310 Rp 30,466,050 Rp 3,093,000 Rp 463,950 Rp 34,023,000
11 PT. HOTAMA MEDIPHAR 1311 8/10/2012 00001311 Rp 3,988,265 Rp 404,900 Rp 60,735 Rp 4,453,900
12 PT. HOTAMA MEDIPHAR 1313 8/13/2012 00001313 Rp 34,179,500 Rp 3,470,000 Rp 520,500 Rp 38,170,000
13 PT. HOTAMA MEDIPHAR 1314 8/13/2012 00001314 Rp 4,728,000 Rp 480,000 Rp 72,000 Rp 5,280,000
14 PT. HOTAMA MEDIPHAR 1315 8/13/2012 00001315 Rp 30,684,720 Rp 3,115,200 Rp 467,280 Rp 34,267,200
15 PT. HOTAMA MEDIPHAR 1316 8/13/2012 00001316 Rp 26,933,840 Rp 2,734,400 Rp 410,160 Rp 30,078,400
16 PT. HOTAMA MEDIPHAR 1317 8/14/2012 00001317 Rp 22,491,277 Rp 2,283,378 Rp 342,507 Rp 25,117,162
17 PT. HOTAMA MEDIPHAR 1318 8/15/2012 00001318 Rp 6,129,667 Rp 622,301 Rp 93,345 Rp 6,845,313
18 PT. HOTAMA MEDIPHAR 1319 8/16/2012 00001319 Rp 4,546,760 Rp 461,600 Rp 69,240 Rp 5,077,600
19 PT. HOTAMA MEDIPHAR 1320 8/16/2012 00001320 Rp 4,728,000 Rp 480,000 Rp 72,000 Rp 5,280,000
20 PT. HOTAMA MEDIPHAR 1321 8/28/2012 00001321 Rp 5,840,065 Rp 592,900 Rp 88,935 Rp 6,521,900
21 PT. HOTAMA MEDIPHAR 1322 8/28/2012 00001322 Rp 7,121,550 Rp 723,000 Rp 108,450 Rp 7,953,000
22 PT. HOTAMA MEDIPHAR 1323 8/28/2012 00001323 Rp 13,735,095 Rp 1,394,426 Rp 209,164 Rp 15,338,685
23 PT. HOTAMA MEDIPHAR 1324 8/28/2012 00001324 Rp 6,501,000 Rp 660,000 Rp 99,000 Rp 7,260,000
24 PT. HOTAMA MEDIPHAR 1325 8/29/2012 00001325 Rp 7,224,975 Rp 733,500 Rp 110,025 Rp 8,068,500
25 PT. HOTAMA MEDIPHAR 1326 8/30/2012 00001326 Rp 34,179,500 Rp 3,470,000 Rp 520,500 Rp 38,170,000
26 PT. HOTAMA MEDIPHAR 1327 8/30/2012 00001327 Rp 4,612,125 Rp 468,236 Rp 70,235 Rp 5,150,596
27 PT. HOTAMA MEDIPHAR 1328 8/30/2012 00001328 Rp 35,425,525 Rp 3,596,500 Rp 539,475 Rp 39,561,500
28 PT. HOTAMA MEDIPHAR 1329 8/30/2012 00001329 Rp 3,417,950 Rp 347,000 Rp 52,050 Rp 3,817,000
29 PT. HOTAMA MEDIPHAR 1330 8/30/2012 00001330 Rp 21,674,925 Rp 2,200,500 Rp 330,075 Rp 24,205,500
30 PT. HOTAMA MEDIPHAR 1331 8/31/2012 00001331 Rp 6,203,227 Rp 629,769 Rp 94,465 Rp 6,927,462
31 PT. HOTAMA MEDIPHAR 1331 8/31/2012 00001332 Rp 14,716,192 Rp 1,494,030 Rp 224,104 Rp 16,434,326
Rp 403,396,360 Rp 40,953,945 Rp 6,143,092 Rp 450,493,397
32 CV. SRI TIRTA JAYA 1009 9/29/2012 00000080 Rp 13,790,000 Rp 1,400,000 Rp 210,000 Rp 15,400,000
33 CV. SRI TIRTA JAYA 0996 9/22/2012 00000079 Rp 5,417,500 Rp 550,000 Rp 82,500 Rp 6,050,000
34 CV. SRI TIRTA JAYA 0980 9/13/2012 00000075 Rp 5,417,500 Rp 550,000 Rp 82,500 Rp 6,050,000
35 CV. SRI TIRTA JAYA 0966 9/5/2012 00000071 Rp 5,417,500 Rp 550,000 Rp 82,500 Rp 6,050,000
36 CV. SRI TIRTA JAYA 0957 9/4/2012 00000068 Rp 46,485,105 Rp 4,719,300 Rp 707,895 Rp 51,912,300
Rp 76,527,605 Rp 7,769,300 Rp 1,165,395 Rp 85,462,300
37 CV. SANTUN Rp 2,462,500 Rp 250,000 Rp 37,500 Rp 2,750,000
Rp 2,750,000

TOTAL Rp 538,705,697 Rp 538,705,697

Mengetahui, Muara Bungo, 31 Oktober 2012

Kepala Instalasi Farmasi Kepala Ruangan

TONI DAFIAPUTRA, S.FARM, APT AYU TRESNAWATI

NIP.19841023 200803 1 001 NIP 19660908 198803 2 002.
 BHP RUTIN SEPTEMBER 2012
OK 1 ITD Rp 85,462,300
OK 2 RADIOLOGI Rp 2,750,000
OK 3 LABOR Rp 249,235,422
OK 4 OK Rp 98,927,184
ASKES 5 ASKES Rp 46,513,491
LABOR 6 RUTIN Rp 55,817,300
ASKES TOTAL Rp 538,705,697
ASKES
ASKES
LABOR
RUTIN
LABOR
LABOR
LABOR
LABOR
OK
OK
OK
RUTIN
RUTIN
OK
OK
LABOR
LABOR
LABOR
LABOR
RUTIN
LABOR
LABOR
OK
LABOR

ITD
ITD
ITD
ITD
ITD

RADIOLOGI
NO NAMA DISTRIBUTOR TGL/ NO FACT. NILAI RETUR SUB TOTAL
1 PT. ENSEVAL PUTERA 5124/ Rp 2,772,000
9/17/2012

2 PT. ENSEVAL PUTERA 5353/ Rp 2,772,000

9/25/2012
TOTAL Rp 5,544,000