Page 1
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
01/04/2021
03/04/2021
03/04/2021
03/04/2021
03/04/2021
03/04/2021
03/04/2021
03/04/2021
03/04/2021
04/04/2021
04/04/2021
04/04/2021
04/04/2021
04/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
2021-1186585
2021-1025983
2021-1186760
2021-1186978
2021-1188408
2021-1188552
2021-1188569
2021-1189822
2021-1189829
2021-1190339
2021-1190478
2021-1190727
2021-1191337
2021-1191773
2021-1192079
2021-1192305
2021-1024479
2021-1024659
2021-1025167
2021-1025389
2021-1025828
2021-1025834
2021-1186700
2021-1195197
2021-1195627
2021-1195650
2021-1027013
2021-1196253
2021-1196462
2021-1026615
2021-1196160
2021-1197315
2021-1197340
2021-1198006
2021-1197396
2021-1197362
2021-1201151
2021-1031839
2021-1201404
2021-1203443
ROBLES TORRES, ANTONIO
ARRIETA DUDAMEL, PRISBELIS ABIGA
NUÑEZ CONTRERAS, SEVERINA
NATERA URBAEZ, HADIEL JOSIAS
CASILLA QUEZADA, SHANTAL
CASTILLO CEDANO, STEPHANIE MAIR
NUÑEZ CASTILLO, ABRAHAM JONABE
GUERRERO PLACENCIA, CELIDA
MORALES GUERRERO, MARIANNY
CASTILLO DOROTEO, JULISSA
CASTRO JIMENEZ, DAVID ESTEBAN
SANCHEZ AVILA, AURELIO
SANTANA CASTILLO, HAMELY
DE LOS SANTOS CEDEÑO, DAYMOND
DE LA CRUZ HOLGUIN, KENAN JAVIE
CARPIO , EUSEBIO
NUÑEZ ROSARIO, JULIO CESAR
GUERRERO SANTANA, CRUZ MARIA
HERNANDEZ ESPIRITUSANTO, YALEIN
DRIJA MANCILLA, RUTH SIMONE
CALDERON MEJIA, NATANAEL
CASTILLO , CECILIA
MEDINA PEREZ, FRANK ALEXANDER
CASTILLO GUERRERO, DALIA ARIANN
SANCHEZ CEDANO, CARLOS LIVIO
PLATA , MARILENIS
DE GRACIA NUÑEZ, CARMEN MERCED
FRIAS GUZMAN, ANLLY STEPHANIE
SANCHEZ NIN, JOSE MARIA
PION MARTINEZ DE GARCIA, MARGAR
FREDIMON VALDEZ, ALEXANDRA
GUERRERO SOLIVEI, ALEXIS
SANCHEZ NIN, JOSE MARIA
SEVERINO , RAMON ANGEL
LUCIANO SORIANO, GINA MARIEL
CEDANO MARMOLEJOS, ARIANNY MIC
DE LOS SANTOS ESPIRITUSANTO, LU
RODRIGUEZ OZUNA, MARTIN
RICHIEZ RODRIGUEZ, MELANIE
DIAZ CABRERA, WANDRY DANIEL
399.00 904.00 735.00 549.50 542.50 556.50 549.50 1,340.50 1,071.00 1,137.50 1,330.70 752.50 290.50 763.00 710.50 987.00 1,840.00 1,780.00 332.00 900.00 3,000.00 1,220.00 2,359.00 1,767.50 3,976.00 812.00 1,160.00 378.00 595.00 1,692.00 336.00 308.00 472.50 1,109.50 1,008.00 6,275.50 189.00 3,056.00 518.00 651.00
570.00 1,130.00 1,050.00 785.00 775.00 795.00 785.00 1,915.00 1,530.00 1,625.00 1,901.00 1,075.00 415.00 1,090.00 1,015.00 1,410.00 2,300.00 2,225.00 415.00 1,125.00 4,772.00 1,525.00 3,370.00 2,525.00 5,680.00 1,160.00 1,450.00 540.00 850.00 2,115.00 480.00 440.00 675.00 1,585.00 1,440.00 8,965.00 270.00 3,820.00 740.00 930.00
AMBUL
AMBUL
AMBUL
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AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
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05/05/2021
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05/05/2021
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05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
379.05 858.80 698.25 522.02 515.37 528.67 522.02 1,273.47 1,017.45 1,080.62 1,264.16 714.87 275.97 724.85 674.97 937.65 1,748.00 1,691.00 315.40 855.00 2,850.00 1,159.00 2,241.05 1,679.12 3,777.20 771.40 1,102.00 359.10 565.25 1,607.40 319.20 292.60 448.87 1,054.02 957.60 5,961.72 179.55 2,903.20 492.10 618.45
B0101308304
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B0101308304
B0101308304
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B0101308304
B0101308304
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B0101308304
B0101308304
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B0101308304
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B0101308304
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Page 2
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
05/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
06/04/2021
2021-1203503
2021-1203628
2021-1204719
2021-1205321
2021-1206836
2021-1207411
2021-1208489
2021-1213453
2021-1213519
2021-1213609
2021-1030018
2021-1031147
2021-1201295
2021-1216302
2021-1037659
2021-1217026
2021-1218068
2021-1219424
2021-1219650
2021-1220792
2021-1221095
2021-1221132
2021-1221806
2021-1222055
2021-1222822
2021-1223344
2021-1225337
2021-1225402
2021-1225493
2021-1226469
2021-1226570
2021-1226769
2021-1228450
2021-1228647
2021-1228649
2021-1229280
2021-1229437
2021-1230090
2021-1035666
2021-1216984
DIAZ CABRERA, WANDRY DANIEL
LOPEZ , OLGA LIDIA
SOLANO ORTEGA, FRANKLIN
MERCEDES HERRERA, FELIX ANTONI
DEL ROSARIO DONASTORG, JULEIDY
MARCHI MARTINEZ, CAROLINA
MEDINA RODRIGUEZ, KEILA
VILLEGAS MORLA, JULIO CESAR
MORENO CASTILLO, MARIELY
GUERRERO CEDEÑO, MARIA ANTONI
ESPIRITUSANTO CASTILLO, YOMAIRA
PILIER SANTILLAN, LUCRECIA
RIVERA SANTOS, RAYMOND LUIS
CARMONA BRITO, BRIANNA DISLENI
GONZALEZ GALVEZ, BARBARA
RODRIGUEZ , OLGA
MARTINEZ PEREZ, BIENVENIDA
REYES FIGUEREO, LAURIS MARIA
POLANCO FRANCISCO, MABEL
CALDERON RAMIREZ, DADY ALEXAND
DE GRACIA RIJO, GREGORIA
DE GRACIA RIJO, GREGORIA
CARPIO NU¿EZ, TOMAS
MONI VILORIO, ROSENDO
PEGUERO FORNE, ROSAURA
BERROA PEGUERO, DARIANA
ALCANTARA ENCARNACION, ERIKA
REYES DOLISCA, ELIFETE
FRANCO MERCEDES, JUDERLYS
RODRIGUEZ MARTINEZ, ISAEL
MELENDEZ AMANCIO, YALINNA MARIE
VILLAVICENCIO , REYNA
CARPIO , AMBAR
MERCEDES CONCEPCION, JULIANNY
MERCEDES PEGUERO, MARTIRES
CAYETANO BAUTISTA, JULIO ANGEL
CARPIO CEDENO DE RONDON, ANA
ENCARNACION CEDANO, KYLIE
KURZO , VERENA MARIA
CASTRO GUZMAN, CECILIA
210.00 570.50 864.50 1,067.50 1,067.50 570.50 367.50 246.40 2,205.00 378.00 920.00 1,440.00 490.00 1,256.50 153.60 1,729.00 1,708.00 220.50 395.50 1,877.40 490.00 892.50 4,935.00 857.50 2,205.00 570.50 1,305.50 682.50 1,642.20 2,478.00 427.00 1,470.00 822.50 427.00 1,732.50 1,260.00 500.50 570.50 1,440.00 1,064.00
300.00 815.00 1,235.00 1,525.00 1,525.00 815.00 525.00 352.00 3,150.00 540.00 1,700.00 1,800.00 700.00 1,795.00 192.00 2,470.00 2,440.00 315.00 565.00 2,682.00 700.00 1,275.00 7,050.00 1,225.00 3,150.00 815.00 1,865.00 975.00 2,346.00 3,540.00 610.00 2,100.00 1,175.00 610.00 2,475.00 1,800.00 715.00 815.00 1,800.00 1,520.00
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
199.50 541.97 821.27 1,014.12 1,014.12 541.97 349.12 234.08 2,094.75 359.10 874.00 1,368.00 465.50 1,193.67 145.92 1,642.55 1,622.60 209.47 375.72 1,783.53 465.50 847.87 4,688.25 814.62 2,094.75 541.97 1,240.22 648.37 1,560.09 2,354.10 405.65 1,396.50 781.37 405.65 1,645.87 1,197.00 475.47 541.97 1,368.00 1,010.80
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Page 3
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
07/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
2021-1233602
2021-1043458
2021-1236153
2021-1236625
2021-1236687
2021-1237606
2021-1239803
2021-1240455
2021-1240469
2021-1242038
2021-1242095
2021-1243787
2021-1244182
2021-1244702
2021-1244858
2021-1245378
2021-1245601
2021-1246350
2021-1039671
2021-1039862
2021-1041984
2021-1041994
2021-1042715
2021-1043026
2021-1043439
2021-1235279
2021-1249441
2021-1049647
2021-1251759
2021-1253853
2021-1254514
2021-1255622
2021-1255692
2021-1256272
2021-1256710
2021-1257944
2021-1259920
2021-1260099
2021-1260140
2021-1260274
BLA , KAROLAYN
RIJO JACQUES, YINEDRY
SANTOS SANTANA, DEMETRIA DE LO
CALDERON CASTILLO, SIMEONA
CALDERON CASTILLO, SIMEONA
PRENCIVIL , GUIDO ANTONIO
RAMOS PEGUERO, RAMONA
DE LA CRUZ ROJAS, SAMUEL DAVID
GOMEZ LAUREANO, ARISLEIDY
CARABALLO RODRIGUEZ, DOMINGA
CASTILLO BRATINI, NOELSY
MARTINEZ , YOLANDA
RIJO , FRANCHESCA
DURAN GARCIA, ERICA
MORENO CASTILLO, MARIELY
LANTIGUA LOPEZ, ROSA ISABEL
SANTANA SANTANA, ESMERLIN DILEIS
CEDENO , DIVIANNY
GUERRERO , EDDY ANTONIO
MARTINEZ MONTERO, ANYELY MASSI
CESPEDES DEL ROSARIO, KARELIN M
CUEVAS FELIZ, SANTA MARIA
CEDANO RODRIGUEZ, MARCIA CONS
HERNANDEZ CASTILLO, JONATHAN A
CARMONA BRITO, BRIANNA DISLENI
ORTEGAS MARTINEZ, MARILYN
LUNA MARTINEZ, FREISI CHAMIL
ZORRILLA GERMAN, WANNA BEATRI
RAMOS PALACIO, JUAN JULIO
CEBALLOS CARPIO, ALEXANDER
RIVERA ACOSTA, YOSAIRA ORQUIDEA
CARTY SOTO, BAYRON MANUEL
PEREZ GARCIA, SARA MARIA
RIJO , MATIAS
RAPOSO RODRIGUEZ, YANELIS
MEDINA OGANDO, MAYELIN
MESA MALDONADO, MIRNA
NUÑEZ ROSA, ANGELA MARIA
DEL ORDEN NUÑEZ, GUEMELIN ORLE
CASTILLO ALFONSO, ZOILA
2,481.50 1,080.00 770.00 1,106.00 105.00 1,260.00 1,855.00 805.00 539.00 609.00 546.00 2,429.00 385.00 3,315.50 1,522.50 1,260.00 1,029.00 420.00 860.00 441.60 792.00 1,872.00 648.00 276.00 1,000.00 1,795.50 504.00 3,216.00 595.00 934.50 1,029.00 1,134.00 311.50 1,557.50 1,067.50 920.50 315.00 756.70 304.50 626.50
3,545.00 1,350.00 1,100.00 1,580.00 150.00 1,800.00 2,650.00 1,150.00 770.00 870.00 780.00 3,470.00 550.00 4,490.00 2,175.00 1,800.00 1,470.00 600.00 1,075.00 552.00 990.00 2,560.00 810.00 345.00 1,250.00 2,565.00 720.00 4,020.00 850.00 1,335.00 1,470.00 1,620.00 445.00 2,225.00 1,525.00 1,315.00 450.00 1,081.00 435.00 895.00
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
2,357.42 1,026.00 731.50 1,050.70 99.75
1,197.00 1,762.25 764.75 512.05 578.55 518.70 2,307.55 365.75 3,149.72 1,446.37 1,197.00 977.55 399.00 817.00 419.52 752.40 1,778.40 615.60 262.20 950.00 1,705.72 478.80 3,055.20 565.25 887.77 977.55 1,077.30 295.92 1,479.62 1,014.12 874.47 299.25 718.86 289.27 595.17
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 4
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
08/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
09/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
2021-1260572
2021-1261297
2021-1261383
2021-1261675
2021-1261723
2021-1262327
2021-1262604
2021-1262679
2021-1262750
2021-1263016
2021-1046567
2021-1048577
2021-1049104
2021-1249585
2021-1265044
2021-1055376
2021-1268666
2021-1269778
2021-1271081
2021-1273407
2021-1274610
2021-1275123
2021-1275609
2021-1278081
2021-1278640
2021-1279381
2021-1279538
2021-1279759
2021-1279910
2021-1050646
2021-1051428
2021-1051635
2021-1051665
2021-1053970
2021-1266981
2021-1282861
2021-1282957
2021-1283493
2021-1286538
2021-1288448
CASTILLO CEDENO, ATANACIO
ORTIZ , LUIS MANUEL
MARCIAL RODRIGUEZ, ESTEFANY
CEDANO CARABALLO, HEIDY
MORLA BARELA, ADRIEL ALEXANDE
MEDINA JESURUN, LUZ ERICA
DE JESUS GIL, ANDREINA
DURAN GARCIA, ERICA
LUCIANO CASTILLO, ANALIA
VELEZ , LEIRY LAURA
CORPORAN CASTILLO, STARLINA
DE LA CRUZ MEJIA, MERCEDES
FEIJOO , JUAN ROBERTO
CEDENO GONZALEZ, LUIS
LEBRON VILLANUEVA, RUTH DELANI
GARCIA SIGOLLEN, VERENICE
MOTA DOMINGUEZ, RAMON
SIMPLE , YOLANDA
RODRIGUEZ , MARIA INOCENCIA
CARABALLO MERCEDES, DIONYS ANE
DE JESUS CUESTA, LUIS ARIEL
CASILLA ROA, BETHANIA
ORTEGAS MARTINEZ, MARILYN
SANTANA ASTACIO, PORFIRIO ANTON
ROBLES PACHE, FERNANDO
SANTANA FELIZ, DIANA KATIANA
SANTANA DE LA ROSA, MAURELYS
ROBLES MERCEDES, MIQUEAS
GUERRERO LAUREANO, OLGA LIDIA
REYNOSO , ANTONIA
RIVERA DE GARCIA, SILVIA GLADIS
RAMIREZ MERCEDES, TERESA
GARCIA HERNANDEZ, PILAR
DE LOS SANTOS , ANDREA
SANTANA SANTANA, ALTAGRACIA
PEREZ SOTO, JONAS ANDRIEL
POUERIET CASTILLO, JONATHAN REY
ARIAS HIDALGO, RADYVERKA
SILVESTRE DOMINGUEZ, ELIZABETH
ENCARNACION PACHE, JORDY JAVIE
976.50 1,382.50 1,641.50 1,207.50 322.00 1,505.00 1,470.00 863.00 731.50 374.50 4,252.00 820.00 1,064.00 1,557.50 724.50 653.30 246.40 553.00 1,078.00 1,330.00 1,302.00 1,358.00 3,010.00 3,080.00 2,625.00 875.00 1,606.50 1,284.50 1,323.00 648.00 900.00 3,000.00 720.00 576.00 801.00 1,298.50 294.00 752.50 1,942.50 105.00
1,395.00 1,975.00 2,345.00 1,725.00 460.00 2,150.00 2,100.00 1,190.00 1,045.00 535.00 5,315.00 1,025.00 1,330.00 2,225.00 1,035.00 970.00 352.00 790.00 1,540.00 1,900.00 1,860.00 2,030.00 4,300.00 4,400.00 3,750.00 1,250.00 2,295.00 1,835.00 1,890.00 810.00 1,125.00 4,055.00 1,425.00 720.00 1,070.00 1,855.00 420.00 1,075.00 2,775.00 150.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
927.67 1,313.37 1,559.42 1,147.12 305.90 1,429.75 1,396.50 819.85 694.92 355.77 4,039.40 779.00 1,010.80 1,479.62 688.27 620.63 234.08 525.35 1,024.10 1,263.50 1,236.90 1,290.10 2,859.50 2,926.00 2,493.75 831.25 1,526.17 1,220.27 1,256.85 615.60 855.00 2,850.00 684.00 547.20 760.95 1,233.57 279.30 714.87 1,845.37 99.75
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 5
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
10/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
10/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
11/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
12/04/2021
2021-1289058
2021-1057049
2021-1289298
2021-1289310
2021-1289566
2021-1289581
2021-1056027
2021-1056869
2021-1289130
2021-1290908
2021-1291198
2021-1291411
2021-1291584
2021-1291777
2021-1058216
2021-1292180
2021-1292181
2021-1057894
2021-1057964
2021-1291973
2021-1295677
2021-1064110
2021-1301967
2021-1303464
2021-1303834
2021-1303895
2021-1305306
2021-1305727
2021-1307199
2021-1307912
2021-1309373
2021-1309614
2021-1309697
2021-1059804
2021-1060156
2021-1062570
2021-1063082
2021-1063166
2021-1064107
2021-1296009
ASENCIO ESPIRITUSANTO, JUAN ISID
CASTILLO SANCHEZ, PERLA MASSIE
ESTRELLA SANTANA, YULIANA
ESTRELLA SANTANA, YULIANA
GUILLERMO TAVERAS, BELKIS ALTAG
MARTINEZ RIVERA, MASSIEL
PEREZ RODRIGUEZ, YAILIN ISABEL
BASTARDO CHALAS, FELIX ANTONIO
DALMASI PALMERO, IRSA ANGELICA
TAVAREZ , GERTRUDIS
ROJAS , YASMELYN
PEÑA CEDANO, DIOSLENNY WALESC
MEDINA RODRIGUEZ, KEILA
CASTRO MOTA, ROSMARY ARIANNA
IBERT SANCHEZ, FRANCHESCA
RIJO VANTERPOOL, KENNETH
SANTANA CEDANO, SEVERO
PACHE , AGUEDA
GUERRERO CARPIO, HILDA MARIA
SORIANO ORTEGA, ALAIA ELENA
DE LOS SANTOS CASTILLO, ROSANLL
ARIAS , SHARY LISBETH
ZORRILLA MERCEDES, JOYCE BELIZ
CASTILLO SANTANA, SURMEDYS EBE
ALMONTE PAVILIS, ALMA ELIZABETH
ALMONTE PAVILIS, ALMA ELIZABETH
DOVAL MEJIA, BIVIANA ARISLEIDI
NUNEZ PENA, GERYANSY
CUEVAS , DULCIGELYS
NUNEZ DE LOS SANTOS, ARISLEYDY
MELO CORONADO, ELIAS
VALDEZ REYES, ZACARIAS
VALERA REYES, CLAUDIA MARGARIT
PUJOLS RIVERA, JAFREISY JACKELIN
KING , DIOMEDES
CEDANO RODRIGUEZ, MARCIA CONS
LOPEZ GUERRERO, JULIA
DEL ROSARIO GUILLERMO, YASMIN
ARIAS , RAMONA
JIMENEZ SANTANA, MARINO BIENVEN
2,027.90 1,424.00 325.50 729.40 1,837.50 840.00 1,344.00 352.00 217.00 1,172.50 2,922.50 644.00 297.50 693.00 3,000.00 553.00 820.00 512.00 1,191.20 196.00 525.00 1,320.00 465.50 1,225.00 983.50 570.50 2,390.50 1,067.50 273.00 1,340.50 1,491.00 763.00 332.50 976.00 976.00 372.00 1,984.00 1,144.00 1,488.00 787.50
2,897.00 1,780.00 465.00 1,042.00 2,625.00 1,200.00 1,680.00 440.00 310.00 1,675.00 4,175.00 920.00 425.00 990.00 5,100.00 790.00 1,025.00 640.00 1,489.00 280.00 750.00 1,650.00 665.00 1,750.00 1,405.00 815.00 3,415.00 1,525.00 390.00 1,915.00 2,130.00 1,090.00 475.00 1,220.00 1,410.00 1,300.00 2,480.00 1,430.00 1,860.00 1,125.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
1,926.50 1,352.80 309.22 692.93 1,745.62 798.00 1,276.80 334.40 206.15 1,113.87 2,776.37 611.80 282.62 658.35 2,850.00 525.35 779.00 486.40 1,131.64 186.20 498.75 1,254.00 442.22 1,163.75 934.32 541.97 2,270.97 1,014.12 259.35 1,273.47 1,416.45 724.85 315.87 927.20 927.20 353.40 1,884.80 1,086.80 1,413.60 748.12
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 6
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
13/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
2021-1313933
2021-1069278
2021-1314940
2021-1315178
2021-1315505
2021-1315680
2021-1315831
2021-1316275
2021-1316967
2021-1317623
2021-1317750
2021-1317966
2021-1318885
2021-1319411
2021-1319818
2021-1320885
2021-1320943
2021-1322693
2021-1323644
2021-1323877
2021-1325084
2021-1326028
2021-1327084
2021-1327192
2021-1064975
2021-1065143
2021-1065889
2021-1068587
2021-1069261
2021-1314070
2021-1332541
2021-1075770
2021-1335826
2021-1335845
2021-1337047
2021-1338324
2021-1339214
2021-1339330
2021-1339497
2021-1339532
GUERRERO REYES, ESTEBANIA
MEDINA GARRIDO, STEVEN
CARPIO CARPIO, JACQUELINE
SYLKA GAVRILYUK, ANNA
MERCEDES MARIANO, ONANCY VIRGI
PEREZ BELTRE, MARISOL
MOTA CONCEPCION, DHAYANNA
DIAZ CALDERON, ELIEZER TOMAS
TIREN , JUAN
RODRIGUEZ CASTILLO, FELICIA
MERCEDES RAMOS, DULCE MARIA
RODRIGUEZ ABREU, ANGIE
TORRES MATEO, DAIRY DARIANA
GONZALEZ LUGO, AWILDA MADELIN
DE LOS SANTOS ESPIRITUSANTO, LU
RIJO , ROSA VIRGINIA
CASTRO ARAUJO, SIXTA
GARRIDO CEDANO, BERALISIS
CASIMIRO , DAYNA SOFIA
BELTRE BERAS, GLORIDANIA ALTAGR
JONES POOL, JESUS
LACHE RIJO, GENOVEVA
GUTIERREZ JIMENEZ, AURORA
REYES LIRIANO DE ABAD, JULIANA
CABRERA , YEWRY
CARABALLO MAÑANA, RAFAEL
SARMIENTO MERCEDES, JUAN MATTE
PACHE VILORIO, ROXANNE ELIANA
DE PAULA MERCEDES, CANDIDA
MARTINEZ RIJO, RAISA
CESPEDES LEDESMA, CARMEN MARIE
CACERES CARABALLO, MARTHA MAR
PRADO GUERRERO, ALEXANDER
DEL RIO , ROSAIRA
MEJIA , CEFERINO
ROBLES SOLANO, BRIANNY
MEJIA UBIERA, PORFIRIA
SANTANA FLORENTINO, OSLYN FRAN
MERCEDES ENCARNACION, EAN JHAS
PRENSIBIL HIDALGO, ROSANIRIS
2,632.00 2,120.00 2,297.50 1,207.50 2,254.00 1,015.00 1,144.50 276.50 511.00 1,291.50 1,050.00 3,209.50 119.00 1,596.00 2,716.00 870.80 717.50 1,235.50 794.50 605.50 1,239.00 1,050.00 168.00 1,911.00 1,500.00 728.00 244.00 504.00 932.00 1,428.00 1,424.50 2,240.00 1,484.00 626.50 1,879.50 2,142.00 504.00 308.00 658.00 542.50
3,760.00 2,650.00 3,050.00 1,725.00 3,220.00 1,450.00 1,635.00 395.00 730.00 1,845.00 1,500.00 4,585.00 170.00 2,280.00 3,880.00 1,244.00 1,025.00 1,765.00 1,135.00 865.00 1,770.00 1,500.00 240.00 2,730.00 1,875.00 910.00 305.00 630.00 1,350.00 2,040.00 2,035.00 3,818.00 2,120.00 895.00 2,685.00 3,060.00 720.00 440.00 940.00 775.00
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
2,500.40 2,014.00 2,182.62 1,147.12 2,141.30 964.25 1,087.27 262.67 485.45 1,226.92 997.50 3,049.02 113.05 1,516.20 2,580.20 827.26 681.62 1,173.72 754.77 575.22 1,177.05 997.50 159.60 1,815.45 1,425.00 691.60 231.80 478.80 885.40 1,356.60 1,353.27 2,128.00 1,409.80 595.17 1,785.52 2,034.90 478.80 292.60 625.10 515.37
B0101308304
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B0101308304
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B0101308304
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Page 7
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
14/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
2021-1340484
2021-1342363
2021-1342681
2021-1346812
2021-1347447
2021-1071198
2021-1071681
2021-1074152
2021-1074282
2021-1074291
2021-1075625
2021-1075652
2021-1075672
2021-1075705
2021-1334955
2021-1351534
2021-1080480
2021-1353227
2021-1353914
2021-1354625
2021-1355506
2021-1356488
2021-1357555
2021-1358918
2021-1359124
2021-1359169
2021-1359285
2021-1359727
2021-1361224
2021-1361991
2021-1363120
2021-1363600
2021-1363908
2021-1364111
2021-1364331
2021-1364355
2021-1364665
2021-1364827
2021-1077855
2021-1079023
CASTILLO CEDENO, ATANACIO
MEJIA , MARIA ALTAGRACIA
GUERRERO DE LA CRUZ, ODILEINNY
MARTINEZ DE PAYANO, KARIN
SIMPLE GARCIA, LUIS NORIEL
RIVERA DE GARCIA, SILVIA GLADIS
GUERRERO PACHE, MERCEDES
RAMIREZ RIVERA, ESTEFANI KASAND
ROSADO SANTANA, DOLORES
ROSADO SANTANA, DOLORES
MEJIA RIJO, ESTHER
SIMPLE GARCIA, LUIS ANGEL
ARIAS , RAMONA
ALMONTE FERNANDEZ, JAVIER
SANCHEZ MOTA, YORLENNY CAROLIN
GUERRERO JIMENEZ, YUDERKIS
DEL ROSARIO MEJIA, CRISTINA
DE LA ROSA MATOS, ENDER
GUERRERO MORLA, LUIS XAVIEL
SANTANA MORETA, TOMAS GABRIEL
DE LA ROSA RODRIGUEZ, ANDIA ORL
CASTILLO DE MOTA, WANYELI
ARIAS ESPIRITUSANTO, KARINA
DEL ROSARIO, RAMONA
ESPIRITUSANTO RIJO, LEIMY MARIEL
REYES , STEPHANIE
LOPEZ RODRIGUEZ, YULEISY
CEDANO ENCARNACION, LIDIA MARIA
RODRIGUEZ DE LOS SANTOS, LUCIND
BERROA GUERRERO, ANGEL EMILIO
DEL CARMEN TORRES, ROSANGELA
SANCHEZ MEJIA, DARIANY
ARREDONDO PEREZ, INDIRA
DE LOS SANTOS TORRES, MANUEL EN
DELGADO SARMIENTO, DANIEL
DE LA ROSA , MARIA GREGORIA
CEDEÑO VENTURA, JUAN CARLOS
SANCHEZ RIVERA, OSCAR DAVID
GRATINI NATERA, CESAR ANDRES
PEÑA CEDANO, JAVIER AUGUSTO
245.00 1,085.00 343.00 910.00 1,148.00 720.00 1,002.72 344.00 1,572.00 340.00 2,280.00 348.00 392.00 780.00 1,039.00 997.50 1,452.00 668.50 882.00 1,736.00 542.50 448.00 1,330.00 927.50 1,732.50 371.00 479.50 861.00 1,071.00 1,645.00 448.00 1,288.00 479.50 437.50 3,097.50 605.50 805.00 1,011.50 1,820.00 368.00
350.00 1,550.00 490.00 1,300.00 1,640.00 1,350.00 2,275.00 430.00 1,965.00 425.00 2,850.00 435.00 490.00 975.00 1,390.00 1,425.00 1,815.00 955.00 1,260.00 2,480.00 775.00 640.00 1,900.00 1,325.00 2,475.00 530.00 685.00 1,230.00 1,530.00 2,350.00 640.00 1,840.00 685.00 625.00 4,425.00 865.00 1,150.00 1,445.00 2,275.00 460.00
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
232.75 1,030.75 325.85 864.50 1,090.60 684.00 952.58 326.80 1,493.40 323.00 2,166.00 330.60 372.40 741.00 987.05 947.62 1,379.40 635.07 837.90 1,649.20 515.37 425.60 1,263.50 881.12 1,645.87 352.45 455.52 817.95 1,017.45 1,562.75 425.60 1,223.60 455.52 415.62 2,942.62 575.22 764.75 960.92 1,729.00 349.60
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B0101308304
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B0101308304
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B0101308304
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Page 8
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
15/04/2021
15/04/2021
15/04/2021
15/04/2021
15/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
2021-1079147
2021-1079180
2021-1079191
2021-1079953
2021-1352770
2021-1367606
2021-1368235
2021-1369072
2021-1369679
2021-1370273
2021-1370651
2021-1371160
2021-1373480
2021-1374163
2021-1374623
2021-1374855
2021-1375133
2021-1375899
2021-1375940
2021-1376166
2021-1376765
2021-1377238
2021-1377473
2021-1378704
2021-1378990
2021-1379047
2021-1379059
2021-1379184
2021-1379185
2021-1379295
2021-1379322
2021-1379392
2021-1379985
2021-1380214
2021-1380691
2021-1380775
2021-1380799
2021-1380824
2021-1381067
2021-1381075
MIRAS RAMOS, MANUEL
VILLAVICENCIO CASTILLO, JUANA
VILLAVICENCIO CASTILLO, JUANA
RIJO RIJO, BENITA
CIRIACO SANTIAGO, MONICA
RINCON , CAROLIN AIME
FULGENCIO , JOSEFA
ORTEGA MATOS, MODESTO
SILFA SANCHEZ, SONIA
ROBLES CASTILLO, LOIDA
SOLANO ORTEGA, FRANKLIN
FELIZ CORPORAN, GRISENIA MERCED
DE LOS SANTOS ROSA, TOMASINA
DE JESUS RODRIGUEZ, AMAL LUCIA
JIMENEZ MOTA, NASHLY MIROLAND
PEÑA MONTERO, AYLIN ANDREA
CALDERON CEDENO, JOAN FELIX
MERCEDES SANTANA, BRYAN JOSE
BOCIO DE LOS SANTOS, TATIANA
SANTA DE LEON, YOEL
CARPIO SANTANA, RIKELVIN SNAIDE
SANTANA POUERIET, DEIBY
HERNANDEZ CANDELARIA, ROSA ANY
RIJO DE LOS SANTOS, CINTHIA JANE
GONZALEZ GONZALEZ, JENNY
GARCIA , SANDRO EMILIO
LEBRON DE JESUS, RAYLENIS
RAMOS PEGUERO, RAMONA
CORONADO RESTITUYO, MARTA ALTA
MELO RIVERA, MARIA ALTAGRACIA
SANTANA SANCHEZ, YERALDIN
GOMEZ DE JESUS, PATRIA
ESPINOSA ADAMES, JERSON JOSE
DOMINGUEZ MOREL, YOBANY
MORETA OGANDO, CAROLINA
SANTANA GONZALEZ, KEISY ALEXAND
SANTANA GONZALEZ, KEISY ALEXAND
DEL ROSARIO RODRIGUEZ, EUSEBIA
PACHE SILVESTRE, RODRIGO CAMIL
PACHE SILVESTRE, RODRIGO CAMIL
1,584.00 1,340.00 1,420.00 2,016.00 427.00 2,075.50 682.50 822.50 805.00 651.00 805.00 689.50 2,138.50 497.00 808.50 612.50 2,166.50 434.00 570.50 3,703.00 357.00 616.00 665.00 542.50 1,197.00 4,797.50 1,029.00 2,284.50 3,458.00 4,182.50 1,197.00 210.00 1,834.00 2,586.50 490.00 1,218.00 469.00 785.38 1,969.50 1,444.50
1,980.00 1,675.00 1,775.00 2,520.00 610.00 2,965.00 975.00 1,175.00 1,150.00 930.00 1,150.00 985.00 3,055.00 710.00 1,155.00 875.00 3,095.00 620.00 815.00 5,290.00 510.00 880.00 950.00 775.00 1,710.00 6,265.00 1,470.00 3,265.00 4,940.00 5,975.00 1,710.00 300.00 2,620.00 3,695.00 700.00 1,740.00 670.00 2,275.00 2,660.00 1,885.00
AMBUL
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AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
1,504.80 1,273.00 1,349.00 1,915.20 405.65 1,971.72 648.37 781.37 764.75 618.45 764.75 655.02 2,031.57 472.15 768.07 581.87 2,058.17 412.30 541.97 3,517.85 339.15 585.20 631.75 515.37 1,137.15 4,557.62 977.55 2,170.27 3,285.10 3,973.37 1,137.15 199.50 1,742.30 2,457.17 465.50 1,157.10 445.55 746.11 1,871.02 1,372.27
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Page 9
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
16/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
17/04/2021
18/04/2021
18/04/2021
18/04/2021
18/04/2021
18/04/2021
18/04/2021
18/04/2021
18/04/2021
18/04/2021
2021-1082867
2021-1082972
2021-1083068
2021-1084113
2021-1084301
2021-1084771
2021-1085577
2021-1086132
2021-1086326
2021-1086730
2021-1086925
2021-1086986
2021-1087133
2021-1383063
2021-1089573
2021-1383751
2021-1384276
2021-1385285
2021-1385420
2021-1385469
2021-1385532
2021-1385815
2021-1387511
2021-1387833
2021-1387899
2021-1388255
2021-1087866
2021-1088459
2021-1089213
2021-1089287
2021-1383633
2021-1389392
2021-1389685
2021-1390107
2021-1390509
2021-1090303
2021-1390756
2021-1089904
2021-1090300
2021-1390530
MEDINA CASTILLO, JUSTINO
CALDERON CAMPECHANO, JUNIOR
ACOSTA DE CEDEÑO, TOMASA
PILIER SANTILLAN, LUCRECIA
GUERRERO RIJO, ROSARIO
CASTRO CASTRO, SILVERINA
SANTANA DE LOS SANTOS, KATHERIN
CEDEÑO CEDEÑO, JUANA MERCEDE
SARMIENTO , JUAN
PACHE , ANA HILDA
GARCIA CEDANO, DANNY APOLINAR
LOPEZ GUERRERO, JULIA
GUERRERO LAUREANO, OLGA LIDIA
LACHE RIJO, GENOVEVA
LOPEZ CONTRERAS, ISAAC
MOIS FELIX, BERNABEL
MEDINA OGANDO, DANNY
CASTILLO , MARGARITA
CASTILLO , MARGARITA
FRISEN EDUA, JHOENLY
MARTINEZ MARTINEZ, DANNY
PAULINO DE JESUS, CORNELIA
MARTINEZ MARTINEZ, SEVERA
ESPIRITUSANTO PEGUERO, CHRYSTA
BAUTISTA PEREZ, BELGICA
CLOTE MIGUEL, MASSO
PACHE , REYNA ISABEL
MERCEDES MORALES, CANDIDA
MEDINA CEDENO, ROSAINNY
CONTRERAS MELENDEZ, JOSE DANIE
TURBI MADE, BIENVENIDO
GIL CASTAÑOS, RUTH DIVINA
MINAYA DE LOS SANTOS, YURIANNY
ARIAS , MILAGROS
MARTINEZ PACHE, JOANNA
CEDE¥O SOLER, LILLIAM
HODGE GUERRERO, MICHAEL JOSU
JIMENEZ REYES, ROSILIS
CEDE¥O SOLER, LILLIAM
SOLER , CLEOTILDE
769.60 1,980.00 2,000.00 1,560.00 1,028.00 980.00 3,000.00 252.00 1,912.00 1,844.00 1,661.80 1,104.00 960.00 521.50 492.00 462.00 473.20 2,765.00 294.00 178.50 3,031.00 2,016.00 588.00 437.50 752.50 913.50 920.00 1,220.00 752.00 332.00 392.00 1,032.50 1,088.50 191.54 1,736.00 428.00 276.50 512.00 2,564.00 626.50
962.00 2,475.00 2,500.00 3,225.00 1,285.00 1,225.00 3,850.00 315.00 2,390.00 2,305.00 2,374.00 1,380.00 1,200.00 745.00 615.00 660.00 654.00 3,950.00 420.00 255.00 4,330.00 2,880.00 840.00 625.00 1,075.00 1,305.00 1,375.00 1,525.00 940.00 415.00 560.00 1,475.00 1,555.00 955.00 2,480.00 535.00 395.00 640.00 3,205.00 895.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
731.12 1,881.00 1,900.00 1,482.00 976.60 931.00 2,850.00 239.40 1,816.40 1,751.80 1,578.71 1,048.80 912.00 495.42 467.40 438.90 449.54 2,626.75 279.30 169.57 2,879.45 1,915.20 558.60 415.62 714.87 867.82 874.00 1,159.00 714.40 315.40 372.40 980.87 1,034.07 181.96 1,649.20 406.60 262.67 486.40 2,435.80 595.17
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Page 10
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
19/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
2021-1395576
2021-1093361
2021-1397891
2021-1398556
2021-1399458
2021-1400212
2021-1401268
2021-1401452
2021-1402305
2021-1402875
2021-1406434
2021-1406713
2021-1407830
2021-1407941
2021-1408541
2021-1408631
2021-1408907
2021-1091122
2021-1091301
2021-1091339
2021-1396680
2021-1411954
2021-1102054
2021-1415615
2021-1416745
2021-1418049
2021-1418115
2021-1418794
2021-1419739
2021-1420113
2021-1420881
2021-1420934
2021-1421363
2021-1421553
2021-1421612
2021-1421847
2021-1422221
2021-1423566
2021-1423611
2021-1423730
FLORIAN DE LA CRUZ, IDELSA
RODRIGUEZ , YELAINE CAMILA
RIJO GUERRERO, GLORIA
VICENTE , ANDRES
SANCHEZ , ELIANNY LIZBETH
PIMENTEL CORONADO, JUANA DOMI
JIMENEZ MOTA, NASHLY MIROLAND
CABRERA HERNANDEZ, ANA CRISTIN
MARTINEZ DEL RIO, EUSEBIO
FELIZ FELIZ, MILEDYS
GUERRERO REYES, BASILISA
MARTINEZ RODRIGUEZ, CARMEN
MERCEDES MIESES, ISIS MARY
HERNANDEZ RODRIGUEZ, MARIEN SC
EUSTAQUIO CEDEÑO, YOSSELIN
RODRIGUEZ NOLACO, RONIELD AARA
CABRERA JIMENEZ, CLARIBEL
SANTANA , CHANTAL
PEÑA RUBEN, JUAN RAFAEL
CARVAJAL RAMIREZ, ELIA MARIA
DE LA ROSA , MARIA GREGORIA
ORTIZ NICASIO, ESTEBAN
DEL ROSARIO MEJIA, CRISTINA
ENCARNACION PEREZ, YONELIS
MELO BAEZ, DERLIN MIGUEL
LEBRON DE JESUS, ROIS
MOTA MERCEDES, JACQUELYN
RODRIGUEZ , REGELIO
PANIAGUA CASTILLO, MARIA ALTAGR
GONZALEZ PIMENTEL, ARLEN MARIA
CARRASCO SANTANA, MERCHI KARIN
FIGUEREO RIJO, BILSON GUELYN
JEAN MEGUI, DAMARIS
MEJIA VILLARES, LAURIANNY
CASTILLO DEL ROSARIO, RAMONA
CASTILLO CASTILLO, VENERADA
GARCIA MUÑOZ, DINORAH
HIDALGO JIMENEZ, MARISOL
CESPEDES CABRAL, JHAJAIRA
RUIZ CASTILLO, BIERKA ANAHAY
399.00 1,643.99 1,106.00 224.00 1,347.50 1,277.50 322.00 353.50 2,397.50 1,022.00 262.60 1,067.50 724.50 920.50 1,760.00 483.00 1,099.00 1,864.00 2,724.00 1,920.00 542.50 980.00 1,548.00 787.50 413.00 448.00 1,687.00 441.00 3,202.50 225.40 1,214.50 737.10 1,547.00 504.00 822.50 910.00 1,291.50 1,382.50 434.00 1,435.00
570.00 2,195.00 1,580.00 320.00 1,925.00 1,825.00 460.00 505.00 3,425.00 1,460.00 1,375.00 1,525.00 1,035.00 1,315.00 2,400.00 690.00 1,570.00 2,330.00 3,405.00 2,400.00 775.00 1,400.00 2,070.00 1,125.00 590.00 640.00 2,410.00 630.00 4,575.00 322.00 1,735.00 1,053.00 2,210.00 720.00 1,175.00 1,300.00 1,845.00 1,975.00 620.00 2,050.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
379.05 1,561.79 1,050.70 212.80 1,280.12 1,213.62 305.90 335.82 2,277.62 970.90 249.47 1,014.12 688.27 874.47 1,672.00 458.85 1,044.05 1,770.80 2,587.80 1,824.00 515.37 931.00 1,470.60 748.12 392.35 425.60 1,602.65 418.95 3,042.37 214.13 1,153.77 700.24 1,469.65 478.80 781.37 864.50 1,226.92 1,313.37 412.30 1,363.25
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Page 11
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
20/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
2021-1423903
2021-1425622
2021-1425830
2021-1426362
2021-1426411
2021-1426575
2021-1097270
2021-1097676
2021-1097704
2021-1100204
2021-1100454
2021-1100473
2021-1100761
2021-1100781
2021-1100903
2021-1101238
2021-1414166
2021-1429967
2021-1107619
2021-1431522
2021-1432080
2021-1432406
2021-1432532
2021-1433002
2021-1433188
2021-1433281
2021-1434668
2021-1434868
2021-1435100
2021-1435846
2021-1436296
2021-1436405
2021-1436701
2021-1437296
2021-1438920
2021-1439040
2021-1441823
2021-1442531
2021-1442613
2021-1442644
TORRES PEREZ , WALMER STARLYN
CARPIO CEDENO DE RONDON, ANA
SANCHEZ , ROSA AMELIA
TAVAREZ ABREU, YIREISY
RODRIGUEZ GUERRERO, JOSE OSCA
DE GRACIA DE LOS SANTOS, KARINA
GONZALEZ TAVAREZ, WILBERTH ALFR
PLACENCIO MONTANO, ELIZABETH
PLACENCIO MONTANO, ELIZABETH
CANELA ROSARIO, JULIANA
BRITO POLANCO, MARINO DE JESUS
CASTILLO , MARIA CRISTINA
CAMPUSANO PEGUERO, EVARISTO
CAMPUSANO SANTANA, YUREIMY LIS
BATISTA RODRIGUEZ, JOERLIN JESU
SANTANA CEDANO, MARIORKA
GARCIA CEDANO, WANDRY
ARISTY ESPINAL, DELLANIRA CONSU
RODRIGUEZ HENRIQUEZ, ONABEL
DIAZ LIRIANO, RAMONA
MATOS MONTERO , FRAYLIN
ANGELES RIJO, JUAN ANDRES
SALICHE GUERRERO, JULIA LUCY
GUERRERO , JOSEFINA
CORPORAN ZORRILLA, BENTURA
CORPORAN ZORRILLA, BENTURA
VARGAS VENTURA, ESCARLIS PAOL
LEBRON DE JESUS, ROIS
DE LA ROSA , EDUVIGES
CARABALLO LIZARDO, JOHANSEL
AVILA DE LA CRUZ, LUCIA ALIJANSA
CALDERON , JUANA ROSALI
BELIAR FIGUEROA, ANGELICA JAREIS
BASTARDO RODRIGUEZ, ELIZABETH M
CASTILLO CADETE, JORDAN EMMANU
RUIZ MEJIA, VERONICA VINELLYS
DALMASI PALMERO, IRSA ANGELICA
RODRIGUEZ HERRERA, WILKIN BIENV
CEPEDA SANCHEZ, JACOB JESUS
PACHE CASTILLO, JOLEISIS
1,942.50 2,327.50 1,421.00 1,120.00 1,281.00 367.50 324.00 556.00 360.00 1,884.00 320.00 512.00 3,000.00 1,032.00 432.00 2,044.00 1,729.00 654.50 508.00 1,190.00 2,028.60 199.50 1,575.00 560.00 857.50 1,218.00 1,120.00 220.50 2,968.00 378.00 1,731.50 5,267.50 1,022.00 483.00 441.00 1,253.00 325.50 945.00 1,008.00 570.50
2,775.00 3,325.00 2,030.00 1,600.00 1,830.00 525.00 405.00 695.00 450.00 2,355.00 400.00 640.00 6,375.00 1,290.00 540.00 2,555.00 2,470.00 935.00 635.00 1,700.00 2,842.00 285.00 2,250.00 800.00 1,225.00 1,740.00 1,600.00 315.00 4,240.00 540.00 2,625.00 7,525.00 1,460.00 690.00 630.00 1,790.00 465.00 1,350.00 1,440.00 815.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
1,845.37 2,211.12 1,349.95 1,064.00 1,216.95 349.12 307.80 528.20 342.00 1,789.80 304.00 486.40 2,850.00 980.40 410.40 1,941.80 1,642.55 621.77 482.60 1,130.50 1,927.17 189.52 1,496.25 532.00 814.62 1,157.10 1,064.00 209.47 2,819.60 359.10 1,644.92 5,004.12 970.90 458.85 418.95 1,190.35 309.22 897.75 957.60 541.97
B0101308304
B0101308304
B0101308304
B0101308304
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B0101308304
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0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 12
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
21/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
22/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
2021-1103973
2021-1104642
2021-1105078
2021-1105411
2021-1106649
2021-1106691
2021-1107258
2021-1429989
2021-1447583
2021-1113318
2021-1448018
2021-1455311
2021-1456371
2021-1458037
2021-1458476
2021-1458735
2021-1458828
2021-1459724
2021-1459820
2021-1460259
2021-1108737
2021-1110227
2021-1110552
2021-1111272
2021-1111755
2021-1111771
2021-1112841
2021-1113239
2021-1447676
2021-1463548
2021-1115547
2021-1465886
2021-1466989
2021-1467648
2021-1467843
2021-1468009
2021-1468107
2021-1469094
2021-1469715
2021-1470617
LEON GUERRERO, MARGARITA DE
GUERRERO REYES, MIGUELINA
MENSIA RODRIGUEZ, MARISOL
ROJAS ESPINAL, VALENTINA ESTHE
CEDANO CASTILLO, MARTIRES
LOPEZ GUERRERO, JULIA
GARCIA RODRIGUEZ, MANUEL ANTO
PACHE , TOMASA
FELIX DIAZ, MARLENY
MONTILLA CORPORAN, EMILIA
BALBUENA , TRINIDAD
CASTILLO DOROTEO, JULISSA
GARRIDO CEDANO, PEDRO
HERRERA , MARLENE
PICHARDO CORDONES, ANA GREGOR
STEPAN , MILLY
AVILA DUARTE, VIRAUDY IVON
JIMENEZ CARPIO, CRISTIAN GLENYS
AVILA MONTILLA, MARLENE
OSCAR AQUINO, DAFNE SAMARA
ESTEVEZ CEDANO, RAFAELA ALTAGR
SANCHEZ , MARIA ORLANDA
CONTRERAS CASTILLO, JONATHAN
WILLIAMS JIMENEZ, BENJAMIN
DE JESUS CASTILLO, JUANA
POUERIET NUÑEZ, CANDIDA
ECHAVARRIA HIDALGO, VICENTE
GARCIA HERNANDEZ, MERCEDES
GOMEZ MELENDEZ, JONAS
LOPEZ GERMAN, JOSEPH DAVID
GUERRERO MORLA, CATALINA
SANCHEZ , YUDELKA ALTAGRACIA
CORPORAN RIJO, YESENIA
DE LOS SANTOS TORRES, MANUEL EN
FISELI CANDELARIO, DARIANNY ROBE
RIJO SANTANA, FRANCIA
JAPAY ORTIZ, MIGUELINA
SANCHEZ , JOHANA IVELISES
SANCHEZ , JOHANA IVELISES
ALBURQUERQUE URQUERQUE , JUAN
312.00 3,920.00 2,112.00 1,796.69 3,420.00 480.00 940.00 1,295.00 4,008.20 1,020.00 2,583.00 525.00 63.00
1,456.00 3,124.00 731.50 1,578.50 1,326.50 1,463.00 1,239.00 1,300.00 264.00 584.00 440.00 1,468.00 680.00 3,000.00 5,000.00 360.50 2,170.00 552.00 1,277.50 805.00 1,939.00 1,890.00 479.50 3,545.50 2,877.00 668.50 273.00
390.00 4,900.00 2,640.00 2,737.00 4,275.00 1,095.00 1,175.00 1,850.00 5,726.00 1,275.00 3,690.00 750.00 90.00
2,080.00 4,100.00 1,045.00 2,255.00 2,425.00 2,090.00 1,770.00 1,625.00 330.00 730.00 550.00 1,835.00 850.00 4,845.00 6,495.00 515.00 3,100.00 690.00 1,825.00 1,150.00 2,770.00 2,700.00 685.00 4,530.00 4,110.00 955.00 390.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
296.40 3,724.00 2,006.40 1,706.86 3,249.00 456.00 893.00 1,230.25 3,807.79 969.00 2,453.85 498.75 59.85
1,383.20 2,967.80 694.92 1,499.57 1,260.17 1,389.85 1,177.05 1,235.00 250.80 554.80 418.00 1,394.60 646.00 2,850.00 4,750.00 342.47 2,061.50 524.40 1,213.62 764.75 1,842.05 1,795.50 455.52 3,368.22 2,733.15 635.07 259.35
B0101308304
B0101308304
B0101308304
B0101308304
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B0101308304
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B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Page 13
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
23/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
24/04/2021
2021-1471314
2021-1471860
2021-1472731
2021-1472869
2021-1474107
2021-1474214
2021-1474448
2021-1474552
2021-1475004
2021-1475168
2021-1463773
2021-1477824
2021-1120865
2021-1478418
2021-1478495
2021-1478972
2021-1479080
2021-1479395
2021-1479439
2021-1480484
2021-1480500
2021-1480726
2021-1480887
2021-1480980
2021-1481001
2021-1481100
2021-1481402
2021-1481485
2021-1481494
2021-1481588
2021-1481606
2021-1481619
2021-1481727
2021-1481747
2021-1119496
2021-1119570
2021-1120030
2021-1120661
2021-1120662
2021-1478375
LOPEZ GUERRERO, BIENVENIDO
CORONADO MARTINEZ, NERCY CARO
DE LA ROSA MERAN, MARIA ALTAGRA
PEREZ LOPEZ, MATILDE
RIJO RAMIREZ, CARLIXTA
REYES LINARES, FANNY CAROLINA
MANZANILLO POLANCO, YOHANNA M
ASTACIO CASTRO, FLORENTINA
FELIX , RAFAEL ENRIQUEZ
GARCIA ROSARIO, JOEL OSEAS
DE LA CRUZ QUEZADA, MIURBI MIGUE
ORTIZ BENITEZ, YULEISY
UBIERA , MARIA ALTAGRACIA
CARPIO , EUSEBIO
NUÑEZ CONTRERAS, SEVERINA
MERCEDES MORENO, SOPHY MARIA
JOSE LESDEL, LINDA
MARTINEZ VILLA, MARTINA
MARTINEZ VILLA, MARTINA
ORTIZ JIMENEZ, YEIMI
RAMIREZ REYES, ARISLEYDDY ELIZAB
ARECHE GUERRERO, ROCIO PAMEL
SEVERINO , RAMON ANGEL
HERRAND MOTA, ANYI RAFAELA
RIJO MARTINEZ, MASSIEL MIGUELIN
CUELLO FRANCISCO, GEURY SAMUE
CASTILLO CACERES, BELEN
RINCON , CAROLIN AIME
CEDEÑO TRONCOSO, RUBELIS
POLANCO CRUZ, MEREDITH ELIZABET
DE LOS SANTOS OSCAR, TAHIRA IKER
DE LOS SANTOS OSCAR, TAHIRA IKER
MERCEDES ROMEN, LUIS ALBERTO
NUÑEZ GUERRERO, BOLIVIA
SANTANA CARABALLO, SANTA
LOPEZ MERCEDES, AMAURIS
CASTILLO VARGAS, ALVARO RAFAEL
DEL ROSARIO MARIANO, HEIDI MARIA
CASTILLO ENCARNACION, ANGEL LUI
MEDINA ABREU, MIREYA ALTAGRACI
378.00 297.50 1,232.00 486.50 661.50 2,558.50 332.50 1,155.00 475.00 2,310.00 255.50 1,130.50 3,000.00 987.00 1,393.00 497.00 308.00 6,231.50 812.50 262.50 353.50 3,097.50 665.00 1,855.00 1,445.50 2,558.50 570.50 1,134.70 217.00 770.00 966.00 353.50 1,985.20 465.50 760.00 1,960.00 2,892.90 1,880.00 988.00 1,466.50
540.00 425.00 1,760.00 695.00 945.00 3,655.00 475.00 1,650.00 2,150.00 3,300.00 365.00 1,615.00 4,732.00 1,410.00 1,990.00 710.00 440.00 8,045.00 3,275.00 375.00 505.00 4,425.00 950.00 2,650.00 2,065.00 3,655.00 815.00 1,621.00 310.00 1,100.00 1,380.00 505.00 2,836.00 665.00 950.00 2,450.00 6,200.00 2,350.00 1,235.00 2,095.00
AMBUL
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AMBUL
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AMBUL
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AMBUL
AMBUL
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AMBUL
AMBUL
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
359.10 282.62 1,170.40 462.17 628.42 2,430.57 315.87 1,097.25 451.25 2,194.50 242.72 1,073.97 2,850.00 937.65 1,323.35 472.15 292.60 5,919.92 771.87 249.37 335.82 2,942.62 631.75 1,762.25 1,373.22 2,430.57 541.97 1,077.96 206.15 731.50 917.70 335.82 1,885.94 442.22 722.00 1,862.00 2,748.25 1,786.00 938.60 1,393.17
B0101308304
B0101308304
B0101308304
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B0101308304
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B0101308304
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Page 14
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
25/04/2021
25/04/2021
25/04/2021
25/04/2021
25/04/2021
25/04/2021
25/04/2021
25/04/2021
25/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
26/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
2021-1482894
2021-1482901
2021-1482909
2021-1483235
2021-1483433
2021-1483326
2021-1483330
2021-1483357
2021-1483310
2021-1491940
2021-1127212
2021-1492740
2021-1493233
2021-1494356
2021-1498294
2021-1498739
2021-1499402
2021-1499574
2021-1500425
2021-1500670
2021-1122733
2021-1124629
2021-1125268
2021-1126467
2021-1126639
2021-1492613
2021-1504634
2021-1132983
2021-1508130
2021-1510238
2021-1510922
2021-1510969
2021-1511671
2021-1512318
2021-1512755
2021-1514304
2021-1514398
2021-1514921
2021-1515001
2021-1516033
CEDENO MERCEDES DE SANCHEZ, BE
NUÑEZ PILIER, JACOBA
GARCIA NUNEZ, JOANNA CAROLINA
CASTILLO CRUZADO, ANNY PATRICI
UBIERA , CARLOS DAVID
RAMIREZ MORALES, MATILDE
RAMIREZ MORALES, MATILDE
CHARLES LOUIS, FAIDRA CATALEYA
JIMENEZ COLON, RAMONA
CARABALLO JIMENEZ, SANTOS
SANCHEZ GUERRERO, NULFA JOSEF
SANTANA ESPIRITUSANTO, JISSELL
VARGAS ROSARIO, MILVIO DARIEL
MARTE MARTINEZ, MARTINA
MARTE MARTINEZ, MARTINA
MEDINA OGANDO, DANNY
BAEZ BRITO, NAIROBY YAMILET
MARTINEZ NUÑEZ, JACK CAIRO
BAILON PONCEANO, ROBERTO
DEL ROSARIO, WILSON
RAMEAU , ANECE
ROSADO SANTANA, DOLORES
MEDINA DOMINGUEZ, YENNIFER CAR
MINYETTY CUSTODIO, YENNY JULIZ
GONZALEZ TAVAREZ, WILBERTH ALFR
ESPIRITUSANTO , MARIA ANTONIA
PENA Y ROSA, TERESA
BATISTA BURGOS, JUAN DE JESUS
ALCANTARA ENCARNACION, ERIKA
DE MORLA CARABALLO, FABIA
CORONADO RESTITUYO, MARTA ALTA
CLOTE MIGUEL, MASSO
REYES CALDERON, YERLIN
RIJO RICHIEZ, IVAN
GARRIDO , ISABEL
ARIAS DE LA CRUZ, SERGIDA
GUERRERO , RAFAELA
DE JESUS GARCIA, ANA JOHANNY
ROSARIO LUNA, FRANCISCO
CASTILLO DEL ROSARIO, RAMONA
962.50 521.50 840.00 749.00 84.00 637.00 726.30 448.00 987.00 514.50 1,636.00 378.00 112.00 294.00 686.00 728.00 2,152.50 1,480.50 344.40 1,319.50 1,224.00 938.40 3,000.00 3,000.00 1,068.00 973.00 766.50 1,300.00 276.50 1,158.50 1,988.00 675.50 646.80 962.50 1,031.10 1,645.00 1,736.00 1,389.50 2,502.50 1,540.00
1,375.00 745.00 1,200.00 1,070.00 120.00 910.00 2,295.00 640.00 1,410.00 735.00 2,045.00 540.00 160.00 420.00 980.00 1,040.00 3,075.00 2,115.00 492.00 1,885.00 1,530.00 1,650.00 4,450.00 4,592.00 1,335.00 1,390.00 1,095.00 1,625.00 395.00 1,655.00 2,840.00 965.00 924.00 1,375.00 1,473.00 2,350.00 2,480.00 1,985.00 3,575.00 2,200.00
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
914.37 495.42 798.00 711.55 79.80 605.15 689.98 425.60 937.65 488.77 1,554.20 359.10 106.40 279.30 651.70 691.60 2,044.87 1,406.47 327.18 1,253.52 1,162.80 891.48 2,850.00 2,850.00 1,014.60 924.35 728.17 1,235.00 262.67 1,100.57 1,888.60 641.72 614.46 914.37 979.54 1,562.75 1,649.20 1,320.02 2,377.37 1,463.00
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
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B0101308304
B0101308304
B0101308304
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B0101308304
B0101308304
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B0101308304
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B0101308304
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Page 15
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
27/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
28/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
2021-1516136
2021-1516978
2021-1517645
2021-1517917
2021-1518146
2021-1128407
2021-1128443
2021-1128721
2021-1129073
2021-1130581
2021-1131043
2021-1131489
2021-1132205
2021-1505057
2021-1522398
2021-1135684
2021-1525382
2021-1525407
2021-1526470
2021-1527422
2021-1529031
2021-1529231
2021-1532747
2021-1532912
2021-1533103
2021-1533450
2021-1533983
2021-1534264
2021-1534878
2021-1534921
2021-1135574
2021-1524623
2021-1538389
2021-1143891
2021-1541045
2021-1541200
2021-1541722
2021-1541911
2021-1543186
2021-1543319
HERRERA SANCHEZ, VANESSA PAOLA
ESTEVEZ ESPIRITUSANTO, YOAMNY
CASTILLO MELO, ARINZA YASMIN
ROBLES CORNIELL, LAIA GABRIELA
CEDE¥O SOLER, LILLIAM
DEL ROSARIO CEDEÑO, MILAGROS
POUERIET CIPRIAN, YESENIA
MERCEDES , YOLANDA
LOPEZ MERCEDES, AMAURIS
RIJO LEONARDO, JENNY
PAYANO SANTANA, CINDY BEATRIZ
MOTA , VIDAL
RIVERA CASTILLO, LUIS FERNANDO
CONTRERA MERCEDES, RAQUEL
MONI , ROSSIO ARIELYS
CEDENO AQUINO, MARY LENNY
PEGUERO , CIPRIAN
SANTANA ESPIRITUSANTO, JISSELL
MONTERO REYES, TONY GADIEL
GUERRERO , TEODOSIA
ACEVEDO ZABALA, LORANNY MARITZ
GIL DE JESUS, LUCRECIA
JEAN PIE, MARIA
ARIAS ESPIRITUSANTO, KARINA
MEJIA RODRIGUEZ, EVELIN ELIZABET
DE LA ROSA PILIER, VERONICA
NUÑEZ MORLA, MAYLIN
DE LA CRUZ CASTRO, RUBEN
SANTANA ESPIRITUSANTO, JISSELL
CASTILLO RIJO, YELITZA NATHALIES
PERALTA , DORIS ALTAGRACIA
PEGUERO PEÑA, PRISCILA
CASTILLO BASTARDO, CARMEN ESME
NUÑEZ DE LOS SANTOS, DOSTIN
CASTILLO ALFONSO, ZOILA
SANTOS SANTANA, DEMETRIA DE LO
URENA MENDEZ, KAREN ALEXANDR
TAVERAS CARO, FERNANDO DARIO
MERCEDES , DALIA MARIA
BENZON , NANCY
1,316.00 4,620.00 1,353.50 126.00 1,872.50 416.00 1,540.00 2,276.00 2,496.00 1,606.40 432.00 456.00 740.00 1,288.00 1,130.50 2,660.00 1,872.50 1,242.50 378.00 1,122.50 2,893.00 1,540.00 2,187.50 711.20 1,176.00 508.90 504.00 2,100.00 812.00 1,046.50 1,580.00 1,190.00 346.50 1,660.00 626.50 770.00 448.00 1,540.00 1,484.00 1,820.00
1,880.00 6,600.00 2,980.00 180.00 2,675.00 520.00 1,925.00 2,845.00 3,120.00 2,422.00 540.00 570.00 1,775.00 1,840.00 1,615.00 3,325.00 2,675.00 1,775.00 540.00 1,965.00 4,010.00 2,200.00 3,125.00 1,016.00 1,680.00 727.00 720.00 3,000.00 1,160.00 1,495.00 1,975.00 1,700.00 495.00 2,075.00 895.00 1,100.00 640.00 2,200.00 2,120.00 2,600.00
AMBUL
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AMBUL
AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
1,250.20 4,389.00 1,285.82 119.70 1,778.87 395.20 1,463.00 2,162.20 2,371.20 1,526.08 410.40 433.20 703.00 1,223.60 1,073.97 2,527.00 1,778.87 1,180.37 359.10 1,066.37 2,748.35 1,463.00 2,078.12 675.64 1,117.20 483.45 478.80 1,995.00 771.40 994.17 1,501.00 1,130.50 329.17 1,577.00 595.17 731.50 425.60 1,463.00 1,409.80 1,729.00
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
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B0101308304
B0101308304
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B0101308304
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B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
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B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
B0101308304
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Page 16
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF Factura
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
29/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
30/04/2021
2021-1543832
2021-1544073
2021-1546295
2021-1548480
2021-1549027
2021-1549630
2021-1550076
2021-1550246
2021-1139972
2021-1140361
2021-1142167
2021-1142250
2021-1142278
2021-1143575
2021-1143780
2021-1143860
2021-1539224
2021-1584233
2021-1380467
2021-1587419
2021-1589674
2021-1590820
2021-1590884
2021-1591208
2021-1591389
2021-1591722
2021-1591781
2021-1594079
2021-1595258
2021-1595323
2021-1595350
2021-1595897
2021-1377548
2021-1378114
2021-1379271
2021-1379955
2021-1585772
SILVESTRE CEDEÑO, KEYLER
DE JESUS RODRIGUEZ, AMAL LUCIA
ROBLES , LARIMAR
PION TAVERAS, AMBIORIX
ROSARIO , JODARLYN
MONCION , MARIA ALTAGRACIA
VALLEJO ENCARNACION, KAREIMY KA
DE CASTRO SANTANA, YOKAIRA
ESPIRITUSANTO , ESPERANZA
REYNOSO , ANTONIA
MERCEDES , YOLANDA
BRITO VILORIO, JUANITO
BRITO VILORIO, JUANITO
JAQUEZ LOPEZ, JOSE ALEJO
DALMASI PALMERO, IRSA ANGELICA
CANELA ROSARIO, JULIAN
PIERRE , FONISE
DE JESUS, SATURNINA
NUÑEZ ROSARIO, JULIO CESAR
CEDEÑO FULGENCIO, FELIX
DE LOS SANTOS TAPIA, CARMEN JULI
BIDO , WAN DANIEL
BETANCES JIMENEZ, ROCIO
MERCEDES SOTO, RUTH
MORALES GARCIA, JAIME
BATISTA NUÑEZ, ICERLIN ERIDANIA
AGRAMONTE MATOS, BELLANIDE
RAMIREZ URRACA, MARIA JOSEFINA
CASTILLO SOLER, JUAN
GUERRERO SEPULVEDA, YASMIN
TINEO MORFFE, SAFANY
ABREU VARGAS, EVANGELISTA
DE LEON DE JESUS, YESENIA
SANTANA RAMIREZ, RAILIN
NUÑEZ DE JESUS, ELIZABETH
SERRA PEREZ, JULIANA EVELYN
MARTINEZ , YISMERLIN CARPIO
896.00 192.50 1,095.50 735.00 360.50 1,330.00 791.00 1,817.60 308.00 760.00 500.00 3,292.00 1,708.00 2,056.00 1,040.00 1,460.00 966.00 1,452.50 1,980.00 628.60 787.50 1,533.00 1,214.50 94.50
1,407.00 311.50 378.00 2,677.50 892.50 3,738.00 493.50 1,155.00 1,120.00 276.00 2,808.00 3,280.00 1,225.00
1,280.00 275.00 1,565.00 1,050.00 515.00 1,900.00 1,130.00 2,945.00 385.00 950.00 625.00 4,115.00 3,290.00 2,570.00 1,300.00 1,825.00 1,380.00 2,075.00 2,475.00 898.00 1,125.00 2,190.00 1,735.00 135.00 2,010.00 445.00 540.00 3,825.00 1,275.00 5,340.00 705.00 1,650.00 1,400.00 345.00 3,510.00 4,100.00 1,750.00
AMBUL
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AMBUL
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AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
AMBUL
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
05/05/2021
5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00 5.00
851.20 182.87 1,040.72 698.25 342.47 1,263.50 751.45 1,726.72 292.60 722.00 475.00 3,127.40 1,622.60 1,953.20 988.00 1,387.00 917.70 1,379.87 1,881.00 597.17 748.12 1,456.35 1,153.77 89.77
1,336.65 295.92 359.10 2,543.62 847.87 3,551.10 468.82 1,097.25 1,064.00 262.20 2,667.60 3,116.00 1,163.75
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Page 17
PROVEEDOR : 00000001490ALMACENES IBERIA SRL
Fecha Ocurre.Tipo
FechaRecibido
Monto aPagar
MontoReclamo
Autorización Número Paciente
761,862.42
Impuesto S/Renta
Deducciones
Total Reclamos
No. Solicitud 2275086
CARRETERA MELLA KM. 1. 1/2HIGUEY, REPUBLICA DOMINICANA
Tel.: (809) 554-4444
% Desc.
MontoNeto
723,768.22
TRANSFERENCIA A LA CUENTA # 725126841, E-MAIL [email protected]
18/06/2021
MAPFRE SALUD ARS
Liquidación al ____________________
Santo Domingo, D.N.: Ave 27 de Febrero #50, El Vergel, desde el interior sin cargos 1-809-200-1450Santiago: Bartolomé Colón, Plaza Texas apdo. 157
Tels: 809-381-5000 / Fax 809-381-4646RNC No. 1-01-76158-1
DIRECCION :
Código
Tipo de Proveedor
Estado Pagada
Cli/Lab/Far
D E T A L L E L I Q U I D A C I O N
NCF
Otros DescuentosTotal Deducciones
38,094.20 0.00
38,094.20
Neto a Pagar
Factura
Itbis 0.00
:
: : : :
:
L I Q U I D A C I O N D E R E C L A M O S
MontoGlosado Motivo Glosa
DISPONIBILIDAD DE SOPORTES DE PAGO EN NUESTRA PAGINA WEB:Les recordamos que en nuestra página web www.mapfresaludars.com.do pueden revisar y/o descargar los soportes de los pagos realizados por los servicios prestados anuestros afiliados, accediendo a la opción "Consulta Tu Cuenta" en la barra inferior de la página, luego elegir la opción "Prestadores", donde podrán digitar su usuario ycontraseña. La primera vez que utilicen este servicio, deben colocar su número de código tanto en el campo usuario como en el campo contraseña y el sistema lessolicitará que realicen cambio de este último, personalizando su contraseña. Para poder descargar de forma más rápida sus soportes, utilizar: Google Chrome o Mozilla Firefox,anexamos los Links de dichos buscadores: https://www.google.com/intl/es/chrome/browser/?hl=es y http://www.mozilla.org/es-ES/firefox/new/.Cualquier inquietud estamos en la mejor disposición de asistirle en la dirección electrónica [email protected] y en el número de teléfono (809)381-5923.
LLENADO DE FORMULARIO DE RECLAMACION POR SERVICIOS PRESTADOS:Les recordamos que el adecuado llenado de las reclamaciones por servicios prestados es uno de los requisitos para el procesamiento de las mismas y el posterior pago por nosotros, en estesentido les solicitamos completar correctamente todos los campos del formulario "Reclamación por Servicios Prestados", haciendo hincapié en: Numero de Cobertura: Elemento másexacto para determinar el servicio prestado. Fecha de Servicio: Debe ser igual al día de prestación del servicio, no debe solicitarse posteriormente. Numero de Afiliado: Indica el afiliado alcual le fue prestado el servicio. Código del Prestador: Numero único para cada Prestador. Diagnostico: Nombre Científico por el cual fue prestado el servicio. Monto Reclamado: Montototal acordado por MAPFRE SALUD ARS y el Prestador para el servicio prestado. Monto Autorizado: Monto que MAPFRE SALUD ARS Pagara. Diferencia a Pagar: Monto que pagara elpaciente/Afiliado. Firma del Afiliado/Paciente: Firma del afiliado que recibio el servicio o de su representante. Firma y Sello del Prestador: Firma y sello del PSS que prestó el servicio.
El no cumplimiento a esta solicitud, será motivo de no pago de las reclamaciones sometidas a procesamiento, a lo cual solicitamos su colaboración con la finalidad decontinuar realizando los pagos de forma oportuna.
