KODE JENIS BULAN PAJAK /

DISETOR
NO. NAMA PPK JUMLAH KOMPENSASI
PPK PELAYANAN PELAYANAN
TRENGGALEK
28 13150601 TUGU AMBULAN Mar-18 1,300,000 1,300,000
29 13150601 TUGU KB Mar-18 1,245,000 1,245,000
TOTAL TUGU 2,545,000 - 2,545,000
30 13150402 BARUHARJO AMBULAN Mar-18 4,540,000 4,540,000
31 13150402 BARUHARJO PERSALINAN Mar-18 700,000 700,000
TOTAL BARUHARJO 5,240,000 - 5,240,000
32 13150401 DURENAN PERSALINAN Mar-18 700,000 700,000
33 13150401 DURENAN KB Mar-18 420,000 420,000
34 13150401 DURENAN AMBULAN Mar-18 1,680,000 1,680,000
TOTAL DURENAN 2,800,000 - 2,800,000
35 13150101 TRENGGALEK KB Mar-18 665,000 665,000
36 13150301 POGALAN AMBULAN Mar-18 400,000 400,000
 JENIS
NO. NAMA PPK INSTRUKTUR SENAM BULAN PELAYANAN JUMLAH
PELAYANAN
TRENGGALEK
10 SURUH ATIK DAN DRG. PUJI AJI SENAM Saturday, March 31, 2018 350,000
11 BODAG INDRATNI DAN DRG. VENDRA SENAM Monday, March 05, 2018 460,000
12 PANGGUL DYAH, DRG. RIDHO DAN DR. MEYRINA SENAM 28,29 MAR 2018 1,000,000
13 NGULANKULON NING DAN CHRIS SENAM Friday, March 23, 2018 575,000
14 KARANGAN YUNIARTI DAN DR. YENI SENAM 02,09,16,23 MAR 18 1,600,000
15 PANDEAN PUTUT DAN YETI RUHANA SENAM Thursday, March 15, 2018 500,000
PPH 21 PPH 23 DISETOR

4,500 - 345,500
9,000 - 451,000
18,000 - 982,000
9,000 - 566,000
18,000 - 1,582,000
9,000 8,000 483,000
 KODE JENIS BULAN PAJAK /
DISETOR
NO. NAMA PPK JUMLAH KOMPENSASI
PPK PELAYANAN PELAYANAN
TRENGGALEK
10 13150902 KARANGANYAR LAB PROLANIS Mar-18 1,085,000 1,085,000
11 13150401 DURENAN LAB PROLANIS Mar-18 320,000 320,000
12 13151001 WATULIMO LAB PROLANIS Mar-18 110,000 110,000
13 13150101 TRENGGALEK LAB PROLANIS Mar-18 390,000 390,000
14 13151102 BODAG IVA Mar-18 100,000 100,000
15 13151201 DONGKO LAB PROLANIS Mar-18 110,000 110,000
16 13151002 SLAWE LAB PROLANIS Mar-18 385,000 385,000
17 13151101 PANGGUL IVA Mar-18 50,000 50,000
18 13150602 PUCANGANAK LAB PROLANIS Mar-18 310,000 310,000
19 13150201 BENDUNGAN LAB PROLANIS Mar-18 130,000 130,000
 KODE JENIS BULAN PAJAK /
DISETOR
NO. NAMA PPK JUMLAH KOMPENSASI
PPK PELAYANAN PELAYANAN
TRENGGALEK
38 13150602 PUCANGANAK AMBULAN Mar-18 1,440,000 1,440,000
39 13150602 PUCANGANAK KB Mar-18 390,000 390,000
40 13150602 PUCANGANAK RITP Mar-18 18,360,000 18,360,000
TOTAL PUCANGANAK 20,190,000 - 20,190,000
41 13150701 PULE KB Mar-18 1,105,000 1,105,000
42 13150701 PULE PERSALINAN Mar-18 8,400,000 8,400,000
43 13150701 PULE AMBULAN Mar-18 6,600,000 6,600,000
44 13150701 PULE RITP Mar-18 52,920,000 52,920,000
TOTAL PULE 69,025,000 - 69,025,000
45 13151101 PANGGUL KB Mar-18 895,000 895,000
46 13151101 PANGGUL PRA RUJUKAN Mar-18 2,125,000 2,125,000
47 13151101 PANGGUL AMBULAN Mar-18 11,200,000 11,200,000
48 13151101 PANGGUL PERSALINAN Mar-18 4,200,000 4,200,000
49 13151101 PANGGUL RITP Mar-18 29,880,000 29,880,000
TOTAL PANGGUL 48,300,000 - 48,300,000
50 13150102 REJOWINANGUN KB Mar-18 615,000 615,000
51 13150102 REJOWINANGUN PERSALINAN Mar-18 700,000 700,000
TOTAL REJOWINANGUN 1,315,000 - 1,315,000
52 13151001 WATULIMO RITP Mar-18 23,760,000 23,760,000
53 13151001 WATULIMO AMBULAN Mar-18 3,170,000 3,170,000
TOTAL WATULIMO 26,930,000 - 26,930,000
54 13151002 SLAWE PERSALINAN Mar-18 700,000 700,000
55 13151002 SLAWE AMBULAN Mar-18 6,475,000 6,475,000
TOTAL SLAWE 7,175,000 - 7,175,000
56 13150902 KARANGANYAR RITP Mar-18 40,500,000 40,500,000
57 13150902 KARANGANYAR AMBULAN Mar-18 720,000 720,000
58 13150902 KARANGANYAR KB Mar-18 220,000 220,000
TOTAL KARANGANYAR 41,440,000 - 41,440,000
59 13150501 KARANGAN RITP Mar-18 36,720,000 36,720,000
60 13150501 KARANGAN LAB PROLANIS Mar-18 380,000 380,000
61 13150501 KARANGAN AMBULAN Mar-18 700,000 700,000
62 13150501 KARANGAN KB Mar-18 735,000 735,000
TOTAL KARANGAN 38,535,000 - 38,535,000
63 13150801 KAMPAK PERSALINAN Mar-18 4,900,000 4,900,000
64 13150801 KAMPAK PRA RUJUKAN Mar-18 1,000,000 1,000,000
65 13150801 KAMPAK KB Mar-18 500,000 500,000
66 13150801 KAMPAK AMBULAN Mar-18 2,340,000 2,340,000
67 13150801 KAMPAK RITP Mar-18 37,800,000 37,800,000
TOTAL KAMPAK 46,540,000 - 46,540,000
68 13150901 GANDUSARI RITP Mar-18 19,440,000 19,440,000
69 13150901 GANDUSARI AMBULAN Mar-18 1,560,000 1,560,000
70 13150901 GANDUSARI PERSALINAN Mar-18 4,200,000 4,200,000
71 13150901 GANDUSARI KB Mar-18 270,000 270,000
TOTAL GANDUSARI 25,470,000 - 25,470,000
72 13151201 DONGKO PERSALINAN Mar-18 2,100,000 2,100,000
73 13151201 DONGKO RITP Mar-18 59,940,000 59,940,000
74 13151201 DONGKO KB Mar-18 390,000 390,000
75 13151201 DONGKO AMBULAN Mar-18 4,400,000 4,400,000
76 13151201 DONGKO PRA RUJUKAN Mar-18 1,500,000 1,500,000
TOTAL DONGKO 68,330,000 - 68,330,000
77 13151102 BODAG AMBULAN Mar-18 5,200,000 5,200,000
78 13151102 BODAG PRA RUJUKAN Mar-18 500,000 500,000
79 13151102 BODAG KB Mar-18 335,000 335,000
80 13151102 BODAG PERSALINAN Mar-18 6,300,000 6,300,000
81 13151102 BODAG RITP Mar-18 21,960,000 21,960,000
82 13151102 BODAG ANC Mar-18 800,000 800,000
TOTAL BODAG 35,095,000 - 35,095,000
83 13150301 POGALAN PERSALINAN Mar-18 1,400,000 1,400,000
84 13151202 PANDEAN KB Mar-18 220,000 220,000
85 13150502 SURUH RITP Mar-18 30,420,000 30,420,000
86 13150601 TUGU RITP Mar-18 26,100,000 26,100,000
87 13150402 BARUHARJO RITP Mar-18 20,160,000 20,160,000
88 13150201 BENDUNGAN PERSALINAN Mar-18 2,100,000 2,100,000
89 13150401 DURENAN RITP Mar-18 17,640,000 17,640,000
 FORMULIR PERSETUJUAN PEMBAYARAN
DAFTAR TRANSFER KLAIM KOLEKTIF
BPJS KESEHATAN CABANG TULUNGAGUNG

KODE JENIS BULAN PAJAK /

DISETOR
NO. NAMA PPK JUMLAH KOMPENSASI
PPK PELAYANAN PELAYANAN
TRENGGALEK

1 13160502 SURUH AMBULAN Mar-18 4,160,000 4,160,000

2 13160502 SURUH LAB PROLANIS Mar-18 20,000 20,000
TOTAL SURUH 4,180,000 - 4,180,000

3 13150302 NGULANKULON AMBULAN Mar-18 200,000 200,000

4 13150302 NGULANKULON KB Mar-18 365,000 365,000
TOTAL NGULANKULON 565,000 - 565,000

5 13151202 PANDEAN RITP Mar-18 30,960,000 30,960,000

JUMLAH 35,705,000 - 35,705,000
 KAPITASI PUSKESMAS BULAN MEI 2018

KABUPATEN TRENGGALEK

JUMLAH JUMLAH
NO. NAMA PUSKESMAS PESERTA PESERTA JUMLAH TARIF JUMLAH NON PBI JUMLAH PBI TOTAL
NON PBI PBI
TRENGGALEK 6,000
1 10087 5067 15,154 60,522,000 30,402,000 90,924,000
REJOWINANGUN 5,700
2 4234 8410 12,644 24,133,800 47,937,000 72,070,800
BENDUNGAN 5,225
3 958 19308 20,266 5,005,550 100,884,300 105,889,850
POGALAN 5,700
4 4279 12384 16,663 24,390,300 70,588,800 94,979,100
NGULANKULON 5,088
5 1547 6243 7,790 7,871,136 31,764,384 39,635,520
DURENAN 6,000
6 3966 7208 11,174 23,796,000 43,248,000 67,044,000
BARUHARJO 5,700
7 1859 8516 10,375 10,596,300 48,541,200 59,137,500
KARANGAN 5,700
8 5007 16409 21,416 28,539,900 93,531,300 122,071,200
SURUH 5,700
9 1338 14152 15,490 7,626,600 80,666,400 88,293,000
TUGU 6,000
10 3538 18463 22,001 21,228,000 110,778,000 132,006,000
PUCANGANAK 5,225
11 1020 9620 10,640 5,329,500 50,264,500 55,594,000
PULE 6,000
12 1767 30282 32,049 10,602,000 181,692,000 192,294,000
KAMPAK 5,700
13 1837 18957 20,794 10,470,900 108,054,900 118,525,800
GANDUSARI 5,700
14 3548 9605 13,153 20,223,600 54,748,500 74,972,100
KARANGANYAR 5,700
15 1366 10647 12,013 7,786,200 60,687,900 68,474,100
WATULIMO 5,700
16 2514 6827 9,341 14,329,800 38,913,900 53,243,700
SLAWE 5,700
17 1602 9672 11,274 9,131,400 55,130,400 64,261,800
PANGGUL 5,700
18 3273 25282 28,555 18,656,100 144,107,400 162,763,500
BODAG 5,700
19 679 21219 21,898 3,870,300 120,948,300 124,818,600
DONGKO 5,500
20 1867 22256 24,123 10,268,500 122,408,000 132,676,500
PANDEAN 5,700
21 355 21396 21,751 2,023,500 121,957,200 123,980,700
MUNJUNGAN 5,550
22 2310 25951 28,261 12,820,500 144,028,050 156,848,550

JUMLAH 58,951 327,874 386,825 124,688 339,221,886 1,861,282,434 2,200,504,320

 KAPITASI PUSKESMAS BULAN MEI 2018
KABUPATEN TRENGGALEK

SUSULAN SUSULAN JUMLAH KOMPENSASI KOMPENSASI KOMPENSASI KAPITASI

NO. NAMA PUSKESMAS KAPITASI MEI
FEBRUARI APRIL KAPITASI FEBRUARI MARET APRIL DIBAYAR

1 TRENGGALEK - 534,000 90,924,000 91,458,000 (30,000) (30,000) (30,000) 91,368,000

2 REJOWINANGUN - 262,200 72,070,800 72,333,000 (51,300) (51,300) (51,300) 72,179,100

3 BENDUNGAN - 52,250 105,889,850 105,942,100 (159,600) (153,900) (141,075) 105,487,525

4 POGALAN - 347,700 94,979,100 95,326,800 (34,200) (34,200) (34,200) 95,224,200

5 NGULANKULON 10,450 254,400 39,635,520 39,900,370 (47,025) (47,025) (45,792) 39,760,528

6 DURENAN - 384,000 67,044,000 67,428,000 (84,000) (84,000) (84,000) 67,176,000

7 BARUHARJO - 712,500 59,137,500 59,850,000 (28,500) (28,500) (28,500) 59,764,500

8 KARANGAN 22,800 832,200 122,071,200 122,926,200 (85,500) (85,500) (85,500) 122,669,700

9 SURUH - 216,600 88,293,000 88,509,600 (77,700) (77,700) (79,800) 88,274,400

10 TUGU 17,100 384,000 132,006,000 132,407,100 (74,100) (74,100) (78,000) 132,180,900

11 PUCANGANAK - 172,425 55,594,000 55,766,425 (11,400) (11,400) (10,450) 55,733,175

12 PULE - 168,000 192,294,000 192,462,000 (125,400) (119,700) (126,000) 192,090,900

13 KAMPAK 11,400 176,700 118,525,800 118,713,900 (125,400) (125,400) (125,400) 118,337,700

14 GANDUSARI 5,700 342,000 74,972,100 75,319,800 (68,400) (68,400) (62,700) 75,120,300

15 KARANGANYAR - 142,500 68,474,100 68,616,600 (74,100) (74,100) (74,100) 68,394,300

16 WATULIMO - 250,800 53,243,700 53,494,500 (79,800) (79,800) (79,800) 53,255,100

17 SLAWE - 102,600 64,261,800 64,364,400 - - - 64,364,400

18 PANGGUL - 456,000 162,763,500 163,219,500 (96,900) (96,900) (96,900) 162,928,800

19 BODAG - 51,300 124,818,600 124,869,900 (28,500) (28,500) (28,500) 124,784,400

20 DONGKO - 418,000 132,676,500 133,094,500 (88,000) (88,000) (88,000) 132,830,500

21 PANDEAN - 153,900 123,980,700 124,134,600 (198,000) (186,000) (176,700) 123,573,900

22 MUNJUNGAN - 299,700 156,848,550 157,148,250 (70,771) (70,771) (94,350) 156,912,358

JUMLAH 67,450 6,713,775 2,200,504,320 2,207,285,545 (1,638,596) (1,615,196) (1,621,067) 2,202,410,686