PT.

ASURANSI JIWA INHEALTH INDONESIA

LAMPIRAN PENGAJUAN TAGIHAN (DATA YANG SUDAH DIVERIF)

NAMA PROVIDER : APOTEK KIMIA FARMA 199 (1801A022)

TINGKAT PELAYANAN : ORJTL

NOMOR REGISTER : 1801O112100076
NOMOR FPK : 1801A0221121004
NOMOR INVOICE PROVIDER : 123

NO TGL PELAYANAN NOSJP / REF SJP NORESEP NOKA PESERTA NAMA PESERTA KODE BU
2 29 Sep 2021 1801A0220921X000013 | 1801R0210921X000070 070 1011431491626 DENTAUFA 03420115 PT CHAROEN POKPHAND INDONESIA Tbk
03420115 PT CHAROEN POKPHAND INDONESIA Tbk
03420115 PT CHAROEN POKPHAND INDONESIA Tbk
03420115 PT CHAROEN POKPHAND INDONESIA Tbk
03420115 PT CHAROEN POKPHAND INDONESIA Tbk

1 12 Oct 2021 1801A0221021X000010 | 1801R0491021X000032 032 1011556545985 ANATHASIA NINING KURNIASIH 01950050 PT PJB SERVICES
01950050 PT PJB SERVICES
3 18 Oct 2021 1801A0221121X000014 | 1801R0221021X000197 197 1001001194572 ILYAS SE 03420018 PT BANK SULSELBAR

4 23 Oct 2021 1801A0221121X000015 | 0201K02225421215 215 1001006091527 MOUDY PITOY, SE 03420114 PT PELINDO IV (PERSERO)
03420114 PT PELINDO IV (PERSERO)
03420114 PT PELINDO IV (PERSERO)
03420114 PT PELINDO IV (PERSERO)
4 04 Sep 2021 1801A0221121X000002 | 1801K0250921X000005 02 1001444386353 H. MUHAMMAD AZIS, M.PD 03420042 KALLA GROUP
03420042 KALLA GROUP

03420042 KALLA GROUP

1 12 Oct 2021 1801A0221021X000009 | 1801K0691021X000006 006 1001601449561 ARAS TUSDIN 03420018 PT BANK SULSELBAR

03420018 PT BANK SULSELBAR

03420018 PT BANK SULSELBAR

03420018 PT BANK SULSELBAR
03420018 PT BANK SULSELBAR
03420018 PT BANK SULSELBAR
03420018 PT BANK SULSELBAR

2 12 Oct 2021 1801A0221121X000012 | 1801U0351021X000008 008 1001463683747 KARTINI AMIR 01140264 PT PENSIUNAN LPND BULOG
01140264 PT PENSIUNAN LPND BULOG
3 12 Oct 2021 1801A0221121X000013 | 1801U0351021X000009 009 1011463683748 MUH.NUR SALEH 01140264 PT PENSIUNAN LPND BULOG

01140264 PT PENSIUNAN LPND BULOG