Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie [631024]

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 1 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
1 40119773669416717883 123 NGRFBW 14558 663492 75.30 27.76 6/1/2017 ROM 0.00 27.76 0.00 0.00 0.00
2 40247126509153838235 10 NGRFBW 14587 663492 138.75 69.25 6/3/2017 ROM 44.50 24.75 0.00 0.00 0.00
3 40131809663723389298 19 NGRFBW 14546 663492 115.63 43.70 6/3/2017 ROM 7.60 36.10 0.00 0.00 0.00
4 40653580851719107061 70 NGRFBW 14450 663492 66.38 33.41 6/5/2017 ROM 14.56 18.85 0.00 0.00 0.00
5 40133280522278340242 86 NGRFAW 6239 663484 54.29 41.54 6/5/2017 ROM 10.60 7.52 23.42 0.00 0.00
6 40165999946273855016 10 NGRFBF 1175 B06035 138.84 86.82 6/6/2017 ROM 16.38 70.44 0.00 0.00 0.00
7 40145635187920679537 11 NGRFBF 1176 B06035 33.19 24.21 6/6/2017 ROM 24.21 0.00 0.00 0.00 0.00
8 [anonimizat] 12 TABIIIC 7104312 B06035 4.17 3.17 6/6/2017 ROM 3.17 0.00 0.00 0.00 0.00
9 40311629847887182476 26 NGRFBW 14627 663492 66.95 27.44 6/6/2017 ROM 14.34 13.10 0.00 0.00 0.00
10 40126511660547201457 35 NGRFBW 14642 663492 161.57 25.99 6/6/2017 ROM 9.69 15.10 0.00 0.00 1.20
11 40154480462109736647 75 NGRFBW 14641 663492 10.50 10.50 6/6/2017 ROM 10.50 0.00 0.00 0.00 0.00
12 40473981479159435295 79 NGRFBF 1184 B06035 33.42 22.39 6/6/2017 ROM 22.39 0.00 0.00 0.00 0.00
13 40727881237710002338 98 NGRFBW 14639 663492 115.77 48.20 6/6/2017 ROM 13.34 34.86 0.00 0.00 0.00
14 40176220019870735146 33 NGRFBF 1192 B06035 87.63 50.84 6/7/2017 ROM 39.23 11.61 0.00 0.00 0.00
15 40663864377773702879 41 NGRFBF 1179 B06035 27.13 12.01 6/7/2017 ROM 12.01 0.00 0.00 0.00 0.00
16 40620370203696767659 43 NGRFBF 1178 B06035 157.10 94.47 6/7/2017 ROM 0.00 31.04 63.43 0.00 0.00
17 40133842125083238879 49 NGRFBW 14664 663492 72.88 34.84 6/7/2017 ROM 15.99 18.85 0.00 0.00 0.00
18 40117312721522017439 52 NGRFBW 14663 663492 21.60 10.33 6/7/2017 ROM 7.60 2.73 0.00 0.00 0.00
19 40311569784045749701 54 NGRFBF 1189 B06035 33.00 16.57 6/7/2017 ROM 16.57 0.00 0.00 0.00 0.00
20 40109770874517331130 56 NGRFBF 1190 B06035 58.05 46.00 6/7/2017 ROM 21.90 24.10 0.00 0.00 0.00
21 40120728151924327239 67 NGRFAW 6324 663484 237.89 191.50 6/7/2017 ROM 118.83 0.00 72.67 0.00 0.00
22 40128378233338981331 11 NGRFBF 1201 B06035 53.27 32.19 6/8/2017 ROM 23.01 9.18 0.00 0.00 0.00
23 40101413564485215635 13 NGRFBW 14681 663492 9.62 8.66 6/8/2017 ROM 8.66 0.00 0.00 0.00 0.00
TOTAL PAGINA: 1772.93 961.79 455.08 345.99 159.52 0.00
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 1.20

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 2 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
24 40165999946273855016 18 NGRFBF 1202 B06035 29.31 15.09 6/8/2017 ROM 15.09 0.00 0.00 0.00 0.00
25 40157120823676919418 19 NGRFBF 1195 B06035 54.76 10.95 6/8/2017 ROM 0.00 0.00 0.00 0.00 10.95
26 40655783720944726282 37 NGRFBW 14690 663492 39.87 13.01 6/8/2017 ROM 0.00 13.01 0.00 0.00 0.00
27 40102629408019355238 48 NGRFBW 14634 663492 318.82 170.20 6/8/2017 ROM 28.37 141.83 0.00 0.00 0.00
28 40142909143816435585 54 NGRFAW 6300 663484 134.18 66.25 6/8/2017 ROM 66.25 0.00 0.00 0.00 0.00
29 40133842125083238879 78 NGRFBW 14665 663492 32.76 19.24 6/8/2017 ROM 9.24 10.00 0.00 0.00 0.00
30 40855136506139553821 7 NGRFAW 6404 663484 98.80 51.34 6/9/2017 ROM 23.36 27.98 0.00 0.00 0.00
31 40123794441373737644 12 NGRFBW 14696 663492 18.78 11.18 6/9/2017 ROM 4.04 7.14 0.00 0.00 0.00
32 40109197166022795788 13 NGRFBF 1213 B06035 112.61 63.48 6/9/2017 ROM 37.02 26.46 0.00 0.00 0.00
33 40127334485685310960 17 NGRFBF 1215 B06035 15.84 14.26 6/9/2017 ROM 14.26 0.00 0.00 0.00 0.00
34 40127334485685310960 18 NGRFBF 1214 B06035 40.39 18.01 6/9/2017 ROM 0.70 17.31 0.00 0.00 0.00
35 40864281394197522617 24 NGRFBW 14653 663492 40.46 33.16 6/9/2017 ROM 33.16 0.00 0.00 0.00 0.00
36 40118955787836279650 44 NGRFBW 18525 099033 35.04 13.01 6/9/2017 ROM 0.00 13.01 0.00 0.00 0.00
37 40904059420506325706 47 NGRFBW 18524 099033 232.63 109.29 6/9/2017 ROM 11.55 97.74 0.00 0.00 0.00
38 40112162642385065212 62 NGRFBW 18585 099033 97.69 53.46 6/9/2017 ROM 28.61 22.28 2.57 0.00 0.00
39 40436640746428876389 63 NGRFBW 14700 663492 68.11 35.84 6/10/2017 ROM 15.63 20.21 0.00 0.00 0.00
40 40836506694514199300 110 NGRFBF 1209 B06035 93.15 93.15 6/10/2017 ROM 18.20 19.05 0.00 55.90 0.00
41 40152231010901929857 118 NGRFBF 1203 B06035 475.00 185.78 6/10/2017 ROM 22.80 67.83 95.15 0.00 0.00
42 40774092123770685941 123 NGRFBW 14527 663492 405.82 205.31 6/10/2017 ROM 41.95 163.36 0.00 0.00 0.00
43 40605027809474729753 124 NGRFBW 2479 145264 92.14 79.91 6/10/2017 ROM 0.00 74.66 0.00 5.25 0.00
44 40120937679873486706 125 NGRFAW 6411 663484 117.36 62.19 6/10/2017 ROM 26.87 35.32 0.00 0.00 0.00
45 2500331521603 126 TABIIIC 5732242 663484 5.96 3.56 6/10/2017 ROM 3.56 0.00 0.00 0.00 0.00
46 40152791058848010775 67 NGRFBF 1207 B06035 46.87 23.38 6/10/2017 ROM 3.35 20.03 0.00 0.00 0.00
TOTAL PAGINA: 2606.35 1351.05 404.01 777.22 97.72 61.15
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 10.95

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 3 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
47 40254094896343673262 14 NGRFBF 1219 B06035 33.76 33.76 6/12/2017 ROM 0.00 0.00 0.00 33.76 0.00
48 40152791058848010775 25 NGRFBF 1208 B06035 59.28 22.72 6/12/2017 ROM 0.00 22.72 0.00 0.00 0.00
49 40448401672412342766 42 NGRFBF 1221 B06035 13.34 13.34 6/12/2017 ROM 0.00 13.34 0.00 0.00 0.00
50 40144267134798709767 15 NGRFBF 1217 B06035 102.90 102.90 6/13/2017 ROM 0.00 0.00 102.90 0.00 0.00
51 40402560025543279878 16 NGRFBF 1216 B06035 23.86 10.87 6/13/2017 ROM 0.00 10.87 0.00 0.00 0.00
52 40111789331054714923 21 NGRFBF 1223 B06035 47.52 23.88 6/13/2017 ROM 23.88 0.00 0.00 0.00 0.00
53 40575906467141105273 37 NGRFAW 6430 663484 230.97 101.99 6/13/2017 ROM 20.89 81.10 0.00 0.00 0.00
54 40145960153217597614 15 NGRFBF 1225 B06035 10.39 5.19 6/14/2017 ROM 0.00 5.19 0.00 0.00 0.00
55 40180253820414570115 16 NGRFBF 1224 B06035 56.14 28.07 6/14/2017 ROM 0.00 28.07 0.00 0.00 0.00
56 40159508676501209608 19 NGRFBF 1222 B06035 80.21 59.83 6/14/2017 ROM 53.57 0.00 0.00 0.00 6.26
57 40550015888030817360 9 NGRFBF 1228 B06035 16.15 7.60 6/15/2017 ROM 7.60 0.00 0.00 0.00 0.00
58 40254206447731534781 19 NGRFBF 1229 B06035 69.74 45.69 6/15/2017 ROM 45.69 0.00 0.00 0.00 0.00
59 40088253725325449604 7 NGRFBF 1234 B06035 83.30 83.30 6/16/2017 ROM 0.00 35.92 0.00 47.38 0.00
60 40875182433415964543 8 NGRFBW 14794 663492 139.72 61.05 6/16/2017 ROM 12.28 48.77 0.00 0.00 0.00
61 40142087311221235087 66 NGRFBF 1231 B06035 16.15 7.60 6/16/2017 ROM 7.60 0.00 0.00 0.00 0.00
62 40868064018510046033 2 NGRFAW 6461 663484 77.68 28.04 6/17/2017 ROM 8.03 15.19 0.00 0.00 4.82
63 40104007751059818742 9 NGRFAW 6477 663484 113.48 67.38 6/17/2017 ROM 43.40 23.98 0.00 0.00 0.00
64 40104249507998453497 11 NGRFAW 6478 663484 86.33 53.31 6/17/2017 ROM 11.72 41.59 0.00 0.00 0.00
65 40335937128453111634 23 NGRFBF 1237 B06035 126.77 121.05 6/17/2017 ROM 0.00 87.29 0.00 33.76 0.00
66 40235752669140313784 36 NGRFBF 1236 B06035 95.00 42.72 6/17/2017 ROM 4.73 34.83 0.00 0.00 3.16
67 40121199611124797924 39 NGRFBW 14638 663492 79.71 37.60 6/17/2017 ROM 14.96 22.64 0.00 0.00 0.00
68 40938263376554508882 56 NGRFBW 14733 663492 57.22 19.70 6/17/2017 ROM 14.12 5.58 0.00 0.00 0.00
69 40306926070182801577 66 NGRFBF 1232 B06035 47.38 47.38 6/17/2017 ROM 0.00 0.00 0.00 47.38 0.00
TOTAL PAGINA: 1667.00 1024.97 268.47 477.08 102.90 162.28
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 14.24

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 4 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
70 40327366551898301802 67 NGRFBF 1235 B06035 48.63 23.92 6/17/2017 ROM 16.38 7.08 0.00 0.00 0.46
71 40334148536824643814 68 NGRFBF 1200 B06035 204.20 57.66 6/17/2017 ROM 12.01 45.65 0.00 0.00 0.00
72 40590673733783816523 70 NGRFBW 14640 663492 127.03 81.62 6/17/2017 ROM 33.86 47.76 0.00 0.00 0.00
73 40171081732047136262 74 NGRFBW 14689 663492 340.85 302.26 6/17/2017 ROM 157.46 0.00 144.80 0.00 0.00
74 40172243563217542116 75 NGRFBW 14695 663492 92.01 31.74 6/17/2017 ROM 20.61 11.13 0.00 0.00 0.00
75 40437198197225406588 76 NGRFBW 14680 663492 105.55 38.27 6/17/2017 ROM 14.11 24.16 0.00 0.00 0.00
76 40183625909019849989 79 NGRFBF 1210 B06035 47.31 20.34 6/17/2017 ROM 4.41 15.93 0.00 0.00 0.00
77 40569542529499407076 112 NGRFAW 6229 663484 98.81 32.60 6/17/2017 ROM 27.78 0.00 0.00 0.00 4.82
78 40637625782425322097 125 NGRFBW 2574 145264 98.19 38.52 6/17/2017 ROM 18.76 19.76 0.00 0.00 0.00
79 40275233610625786562 57 NGRFBF 1158 B06035 11.23 2.21 6/18/2017 ROM 2.21 0.00 0.00 0.00 0.00
80 40611444838602831715 9 NGRFBF 1240 B06035 18.02 18.02 6/20/2017 ROM 18.02 0.00 0.00 0.00 0.00
81 40267917301409079350 23 NGRFBF 1147 B06035 23.22 11.61 6/20/2017 ROM 0.00 11.61 0.00 0.00 0.00
82 40165975043549650158 24 NGRFBW 14880 663492 52.71 20.97 6/20/2017 ROM 2.94 18.03 0.00 0.00 0.00
83 40586576280516220703 26 NGRFBF 1239 B06035 45.83 24.78 6/20/2017 ROM 24.78 0.00 0.00 0.00 0.00
84 40120728875574656320 58 NGRFBF 1246 B06035 20.54 20.54 6/20/2017 ROM 0.00 0.00 0.00 20.54 0.00
85 40155597455914511546 60 NGRFBW 1210 099033 111.80 59.02 6/20/2017 ROM 32.71 26.31 0.00 0.00 0.00
86 40110488452200446941 61 NGRFAW 6545 663484 150.98 44.34 6/20/2017 ROM 27.91 11.03 0.00 0.00 5.40
87 40143476971416003024 68 NGRFBW 14792 663492 113.33 54.22 6/20/2017 ROM 37.52 11.88 0.00 0.00 4.82
88 40660168801424466649 4 NGRFAW 6529 663484 92.98 37.42 6/21/2017 ROM 26.45 10.97 0.00 0.00 0.00
89 40136795023083513097 11 NGRFBW 14655 663492 54.20 30.64 6/21/2017 ROM 14.79 15.85 0.00 0.00 0.00
90 40664862767802535069 19 NGRFBF 1211 B06035 60.81 23.19 6/21/2017 ROM 18.37 0.00 0.00 0.00 4.82
91 40416945269403811917 24 NGRFBW 14873 663492 115.63 43.70 6/21/2017 ROM 7.60 36.10 0.00 0.00 0.00
92 40110822228783047327 26 NGRFBW 14907 663492 20.85 15.92 6/21/2017 ROM 9.00 0.00 0.00 6.92 0.00
TOTAL PAGINA: 2054.71 1033.51 527.68 313.25 144.80 27.46
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 20.32

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 5 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
93 40179271411931771921 55 NGRFAW 6466 663484 224.55 110.05 6/21/2017 ROM 0.00 110.05 0.00 0.00 0.00
94 40398455165283092328 83 NGRFBF 1247 B06035 98.18 33.72 6/21/2017 ROM 13.86 19.86 0.00 0.00 0.00
95 40491548571468191390 1 NGRFAW 6497 663484 163.79 75.32 6/22/2017 ROM 0.00 75.32 0.00 0.00 0.00
96 40108950863352828647 61 NGRFBF 1248 B06035 35.61 17.68 6/22/2017 ROM 17.68 0.00 0.00 0.00 0.00
97 40140760593916246948 16 NGRFBW 14940 663492 65.71 32.68 6/23/2017 ROM 14.56 18.12 0.00 0.00 0.00
98 40102103875676228850 29 NGRFBW 14707 663492 109.15 49.31 6/23/2017 ROM 16.41 32.90 0.00 0.00 0.00
99 40159471208384000962 30 NGRFBW 14705 663492 99.68 27.32 6/23/2017 ROM 3.60 22.12 0.00 0.00 1.60
100 40856346309695830128 57 NGRFAW 6551 663484 41.40 25.19 6/23/2017 ROM 25.19 0.00 0.00 0.00 0.00
101 40192639329123213743 58 NGRFAW 6523 663484 37.93 27.54 6/23/2017 ROM 0.00 0.00 27.54 0.00 0.00
102 40167397224962781683 32 NGRFAW 6588 663484 148.81 64.19 6/24/2017 ROM 25.39 38.80 0.00 0.00 0.00
103 40125984647803653717 101 NGRFBF 1258 B06035 38.48 23.58 6/24/2017 ROM 23.58 0.00 0.00 0.00 0.00
104 40164134023181912923 103 NGRFBF 1250 B06035 299.76 299.76 6/24/2017 ROM 0.00 299.76 0.00 0.00 0.00
105 40130288236494387491 104 NGRFBF 1255 B06035 76.38 76.38 6/24/2017 ROM 0.00 35.92 0.00 40.46 0.00
106 40167070810502365979 105 NGRFBF 1254 B06035 49.09 20.44 6/24/2017 ROM 11.08 9.36 0.00 0.00 0.00
107 40113862021696803930 14 NGRFBW 14950 663492 93.32 58.02 6/26/2017 ROM 36.28 21.74 0.00 0.00 0.00
108 40752629447769151981 5 NGRFBF 1259 B06035 76.75 20.75 6/27/2017 ROM 15.93 0.00 0.00 0.00 4.82
109 40494211840282711541 11 NGRFBW 14972 663492 87.78 38.55 6/27/2017 ROM 33.15 0.00 0.00 0.00 5.40
110 40134210469096666749 20 NGRFBF 1262 B06035 212.32 147.64 6/27/2017 ROM 93.34 54.30 0.00 0.00 0.00
111 40180789841672106610 35 NGRFBW 2724 145264 39.95 35.03 6/27/2017 ROM 22.53 0.00 0.00 0.00 12.50
112 40515427925084435925 50 NGRFAW 6452 663484 83.96 28.26 6/27/2017 ROM 11.62 16.64 0.00 0.00 0.00
113 40836506694514199300 87 NGRFBF 1243 B06035 27.38 27.38 6/27/2017 ROM 0.00 0.00 0.00 27.38 0.00
114 40145757977141235377 89 NGRFBW 14897 663492 132.73 55.58 6/27/2017 ROM 32.46 23.12 0.00 0.00 0.00
115 40132259369074959506 90 NGRFBW 14898 663492 84.79 29.49 6/27/2017 ROM 21.78 7.71 0.00 0.00 0.00
TOTAL PAGINA: 2327.50 1323.86 418.44 785.72 27.54 67.84
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 24.32

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 6 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
116 40691184270106356465 10 NGRFBW 14990 663492 79.61 45.28 6/28/2017 ROM 39.80 5.48 0.00 0.00 0.00
117 40184225556325383057 14 NGRFBW 15000 663492 111.85 35.75 6/28/2017 ROM 15.35 20.40 0.00 0.00 0.00
118 40960490875678154788 15 NGRFAW 6400 663484 32.66 32.61 6/28/2017 ROM 0.00 0.00 32.61 0.00 0.00
119 40902058591400225617 35 NGRFBF 1263 B06035 89.20 28.42 6/28/2017 ROM 7.60 20.82 0.00 0.00 0.00
120 40107748407231237039 37 NGREAY 4350 800104 126.10 99.46 6/29/2017 ROM 18.78 53.84 0.00 26.84 0.00
121 40149540786787475300 64 NGRFBF 1264 B06035 216.66 70.87 6/29/2017 ROM 7.60 52.47 0.00 0.00 10.80
122 40437198718137710107 66 NGRFBF 1265 B06035 114.08 26.31 6/29/2017 ROM 10.54 0.00 0.00 0.00 15.77
123 40103840997474082503 17 NGRFAW 6683 663484 159.08 33.84 6/30/2017 ROM 0.00 33.84 0.00 0.00 0.00
124 40844994462533138933 26 NGRFBF 1274 B06035 47.21 47.21 6/30/2017 ROM 0.00 20.37 0.00 26.84 0.00
125 40699040315184348698 71 NGRFBW 15025 663492 275.45 133.81 6/30/2017 ROM 62.23 54.30 0.00 0.00 17.28
126 40109037504773116971 84 NGRFAW 6645 663484 85.30 37.37 6/30/2017 ROM 27.10 5.45 0.00 0.00 4.82
127 40143702003312222856 86 NGRFBW 14910 663492 69.65 50.73 6/30/2017 ROM 10.62 40.11 0.00 0.00 0.00
128 40134212654338764657 88 NGRFBW 14864 663492 116.75 100.68 6/30/2017 ROM 29.14 71.54 0.00 0.00 0.00
129 40723920639584394377 89 NGRFAW 6504 663484 155.54 84.49 6/30/2017 ROM 53.09 31.40 0.00 0.00 0.00
130 40363950455362818830 92 NGRFAW 6505 663484 275.59 246.26 6/30/2017 ROM 91.36 15.24 139.66 0.00 0.00
131 40164652826558661952 93 NGREBE 8187 D25480 224.20 224.20 6/30/2017 ROM 0.00 0.00 224.20 0.00 0.00
132 40104672806275752807 94 NGREBE 8186 D25480 111.57 111.57 6/30/2017 ROM 0.00 0.00 111.57 0.00 0.00
133 40103095683267949172 96 NGRFAW 6522 663484 64.13 21.60 6/30/2017 ROM 10.54 11.06 0.00 0.00 0.00
134 40156704844957796274 98 NGRFBW 18538 099033 111.61 111.61 6/30/2017 ROM 0.00 0.00 111.61 0.00 0.00
135 40598524610115330839 99 NGRFBF 1273 B06035 65.36 27.54 6/30/2017 ROM 7.60 19.94 0.00 0.00 0.00
136 40106235991274148948 100 NGRFBF 1204 B06035 114.44 82.29 6/30/2017 ROM 82.29 0.00 0.00 0.00 0.00
137 40110901286368060031 101 NGRFBF 1205 B06035 86.91 51.10 6/30/2017 ROM 51.10 0.00 0.00 0.00 0.00
138 40128916003737591874 102 NGRFBF 1206 B06035 241.25 190.31 6/30/2017 ROM 36.37 62.31 45.47 0.00 46.16
TOTAL PAGINA: 2974.20 1893.31 561.11 518.57 665.12 53.68
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 94.83

Nr. Crt Serie si nr. prescriptie Cod parafa medic Valoare prescriptie
CNP / CID Asigurat Aplicatia informatica : Pharma
Aviz nr. 566/ 17 septembrie 2001
Valoare compensare din care: 7 7 / Pag. 1.1. Borderou centralizator medicamente compensate si gratuite in tratamentul ambulatoriu pentru luna IUNIE anul 2017 care insoteste factura seria
RIVGR-C numar 69 / 30-06-2017
Nr. Bon fiscal
Data
1Nr. card european
22.2. 2.1 Nr. si serie pasaport
3 4 5 6 7Tip formular european/ document
8Tip document
9Tara
10 11 12 Sublista A Sublista B
13 14 Sublista C Sublista C1 Sublista C Sublista C3
15 16 Societatea farmaceutica: SC RIV COM SRL Numar: 69/30-06-2017 Farmacia: – Adresa: Cartojani Nr. contract: 361 incheiat cu CJAS GIURGIU
Valoare factura = 7592.77 leiANEXA NR. 2
Anexa 8-a la Ordinul nr. 452/2016
Sublista D
17
139 1430317521592 103 TABIIIC 7105327 663484 3.24 2.14 6/30/2017 ROM 2.14 0.00 0.00 0.00 0.00
140 2641118521591 104 TABIIIC 5732241 663484 6.66 2.14 6/30/2017 ROM 2.14 0.00 0.00 0.00 0.00
Semnatura Reprezentant legal, Radu Valentin TOTAL GENERAL: 13412.59 7592.77
Raspundem de exactitatea si corectitudinea datelor 2639.07 3217.83 1197.60 372.41 165.86
SUBTOTAL 1 – valoare compensata aferenta retetelor prescrise de medicul de familie ca urmare a scrisor ii medicului
de la medicina muncii (coloanele 11-17 sunt egale c u totalul de la col. 10 – 16 din tabelul 1.2 din pr ezenta anexa) 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SUBTOTAL 2 – valoare compensata aferenta retetelor eliberate pentru titularii de card european (coloan ele 11 – 17 sunt egale
cu totalul de la col. 8 – 14 din tabelul 1.3 din pr ezenta anexa) 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SUBTOTAL 3 – valoare compensata aferenta retetelor eliberate pentru pacientii din statele cu care Roma nia
a incheiat acorduri, intelegeri, conventii sau prot ocoale internationale cu prevederi in domeniul sana tatii 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SUBTOTAL 4 – aferent retetelor eliberate pentru tit ularii de formulare europene (coloanele 11 – 17 sun t egale cu
totalul de la col. 9 – 15 din tabelul 1.5 din preze nta anexa) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 (coloanele 11 – 17 sunt egale cu totalul de la col. 9 – 15 din tabelul 1.4 din prezenta anexa)
SUBTOTAL 5 – valoare compensata aferenta DCI-urilor notate cu (**)1 potrivit anexei la Hotararea Guver nului nr. 720/2008
pentru aprobarea Listei cuprinzand denumirile comun e internationale corespunzatoare medicamentelor de care 0.00 0.00 0.00 0.00 0.00 0.00 0.00
beneficiaza asiguratii, cu sau fara contributie per sonala, pe baza de prescriptie medicala, in sistemu l de asigurari sociale
de sanatate, precum si denumirile comune internatio nale corespunzatoare medicamentelor care se acorda in cadrul
programelor nationale de sanatate, cu modificarile si completarile ulterioare (coloanele 11-17 sunt eg ale cu totalul
de la coloanele 11-17 din tabelul 1.6 din prezenta anexa)
TOTAL PAGINA: 9.90 4.28 4.28 0.00 0.00 0.00
de catre RADU VALENTIN cu certificatul numarul 2005 0624500155C5252ACDE92B936181 din data 07/07/2016 em is de DigiSign S.A.. Acest document a fost generat si semnat electronic conform prevederilor Legii nr. 455/2001 si ale Hota rarii Guvernului nr. 1259/2001
Acest document a fost imprimat folosind aplicatia P HARMA ORIGINAL a WinSoft Group. 0.00