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[]
["Sprawa nr.                                                                                                                                                                                                                                 Załącznik nr.3/1,4"]
["FORMULARZ ASORTYMENTOWO-CENOWY"]
["(zamawiający zastrzega sobie prawo do zakupu mniejszych ilości towaru)"]
[null,"Nazwa asortymentu","dawka","postać leku","J.m.","Ilość","Uwagi","Cena jedn. Netto (zł)","Wart. netto (zł)","VAT %","VAT (zł)","Wartość brutto (zł)"]
[1,"acenokumarol","4 mg","tabl.","op.",15,"op.60 tabl"]
[2,"amiloryd + hydrochlorotiazyd","5 mg + 50 mg","tabl.","op.",21,"op.50 tabl"]
[3,"amiloryd + hydrochlorotiazyd","2,5 mg + 25 mg","tabl.","op.",4,"op.50 tabl"]
[4,"warfaryna","3mg","tab.","op.",35,"op.100tabl"]
[5,"warfaryna","5mg","tab.","op.",55,"op.100tabl"]
[6,"arcalen lub podobne",null,"maść","op.",10,"op.30g"]
[7,"klonidyna","0,075mg","tab","op.",29,"op.50 tabl"]
[8,"furosemid","0,02 g/2 ml","inj.","op.",1,"op. 5 amp."]
[9,"bisoprolol","2,5 mg","tabl.powl.","op.",137,"op.28 tabl."]
[10,"cardiol C ",null,"krople","op.",231,"op.40g"]
[11,"digoksyna","0,25mg","tabl.","op.",4,"op.30 tabl."]
[12,"digoksyna","0,5g/2ml","inj.","op.",5,"op.5 amp."]
[13,"diltiazem","120 mg","tabl","op.",2,"op.30 tabl."]
[14,"diltiazem","60 mg","tabl.","op.",2,"op. 60 tabl"]
[15,"dopamina","4%/5ml","inj.","op.",6,"op.10 amp"]
[16,"enalapryl","20 mg","tabl.","op.",1,"op,60 tabl."]
[17,"enalapryl","10 mg","tabl.","op.",1,"op,60 tabl."]
[18,"enalapryl","5 mg","tabl.","op.",1,"op,60 tabl."]
[19,"epinefryna","1mg/1ml","inj.","op.",12,"op.10 amp"]
[20,"etamsylat","250 mg","tabl.","op.",113,"op.30 tabl."]
[21,"fitomenadion","10 mg","tabl.","op.",2,"op.30 tabl."]
[22,"furosemid","0,02 g/2 ml","inj.","op.",160,"op.50 amp."]
[23,"furosemid","40 mg","tabl.","op.",900,"op.30 tabl."]
[24,"hemorectal",null,"czopki","op.",15,"op.10 szt"]
[25,"heparyna","25000j.m./5ml","inj.i.v.","op.",2,"op.10 amp"]
[26,"heparyna","300j.m./g","krem","op.",53,"op.20 g"]
[27,"hydrochlorotiazyd","25 mg","tabl.","op.",16,"op.30 tabl."]
[28,"kaptopryl","12,5 mg","tabl.","op.",17,"op.30 tabl."]
[29,"kaptopryl","25 mg","tabl.","op.",11,"op.30 tabl."]
[30,"kwas acetylosalicylowy","75 mg","tabl. powl.","op.",40,"op.60 tabl"]
[31,"kwas acetylosalicylowy","150 mg","tabl. powl.","op.",10,"op.60 tabl"]
[32,"kwas acetylosalicylowy+magnez","150mg+21mg","tab.","op.",1,"op.50 tabl"]
[33,"kwas foliowy","5 mg","tabl.","op.",1,"op.30 tabl."]
[34,"kwas foliowy","15 mg","tabl.","op.",52,"op.15 tab"]
[35,"mannitol 100ml",{"v":0.2,"d":"20%"},"roztwór do wlewów i.v.","op.",7]
[36,"mannitol 250 ml",{"v":0.2,"d":"20%"},"roztwór do wlewów i.v.","op.",1]
[37,"metoprolol","100 mg","tabl.","op.",1,"op.30 tabl."]
[38,"metoprolol","50 mg","tabl.","op.",69,"op.30 tabl."]
[39,"metoprolol","5mg/5ml","inj.","op.",18,"op.5 amp."]
[40,"digoksyna","0,1 mg","tabl.  ","op.",11,"op.30 tabl."]
[41,"midodryna","2,5 mg","tabl.","op.",2,"op.20 tab"]
[42,"molsydomina","4 mg","tabl.","op.",5,"op.30 tabl."]
[43,"hydrochlorohiazyd","12,5mg","tab","op.",5,"op.30 tabl."]
[44,"monoazotan izosorbidu","50 mg","tabl.prolong.","op.",4,"op.30 tabl."]
[45,"nicergolina","10mg","tabl.","op.",29,"op.30 tabl."]
[46,"nitrendypina","10 mg","tabl.","op.",1,"op.30 tabl."]
[47,"nitrendypina","20 mg","tabl.","op.",8,"op.30 tabl."]
[48,"pentoksyfilina","0,4g","tabl.prolong.","op.",12,"op.60 tabl"]
[49,"pentoksyfilina","0,1g","tabl.","op.",1,"op.60 tabl"]
[50,"propafenon","150 mg","tabl.","op.",3,"op.60 tabl"]
[51,"propranolol","40 mg","tabl.","op.",3,"op.50szt"]
[52,"siarczan magnezu",{"v":0.2,"d":"20%"},"inj.","op.",4,"10amp/10ml"]
[53,"spironolakton","100 mg","tabl.","op.",16,"op.20szt"]
[54,"spironolakton","25 mg","tabl.","op.",53,"op.100szt"]
[55,"gąbka hemostatyczna","80 x 50 x 10 mm","gąbka hem.standard","op.",12,"op 10 szt."]
[56,"gąbka hemostatyczna","80x50x1mm","gąbka hem.specjal","op.",2,"op. 20 szt."]
[57,"trokserutyna","200 mg","kaps.","op.",4,"op.64szt"]
[58,"werapamil","80 mg","tabl.","op.",1,"op.20szt"]
[59,"żelaza (II) siarczan","105mg","tabl.prolong.","op.",321,"op.30szt"]
[60,"norepinefryna","1mg /1ml","inj.","op.",1,"op.10amp"]
[61,"fitomenadion","10mg/ 1ml","inj.","op.",5,"op.10amp"]
[62,"propafenon","70mg/20ml","inj.","op.",1,"op,5amp"]
[63,"triazotan glicerylu","0,4mg","aerozol","op.",4,"200dawek 11g"]
[64,"triazotan glicerylu","10mg/10ml","inj.","inj.",2,"op.10amp"]
[65,"molsidomina","2mg","tab","op.",1,"op.30szt"]
[66,"chlortalidon","50mg","tab.","op.",9,"op.20szt"]
[67,"metoprolol","23,75 mg","tab.o przedłuż.uwaln.","op.",20,"op.28szt"]
[68,"metoprolol","47,5mg","tab.o przedłuż.uwaln.","op.",20,"op.28szt"]
[69,"metoprolol","95mg","tab.o przedłuż.uwaln.","op.",20,"op.28szt"]
[70,"monoazotan izosorbidu","75mg","tab o przedł.uwal.","op.",1,"op.30szt"]
[71,"werapamil","40mg","tab powl.","op.",1,"op.20szt"]
[72,"diltiazem","90mg","tab powl.","op.",1,"op.30szt"]
[73,"walsartan","160mg","tabl.powl.","op.",20,"op.28 tabl."]
[74,"bisoprolol","5 mg","tab.powl.","op.",388,"op30 tabl."]
[75,"bisoprolol","10  mg","tab.powl.","op.",108,"op.30 tabl."]
[76,"carvedilol","6,25mg","tab","op.",10,"op.30 tabl."]
[77,"carvedilol","12,5 mg","tab","op.",10,"op.30 tabl."]
[78,"etamsylat","125mg/ml","inj.","op.",10,"op.5amp."]
[79,"etamsylat","125mg/ml","inj.","op.",15,"op 50 amp."]
[80,"urapidyl","5mg/ml.","inj.","op.",2,"op.5amp."]
[81,"werapamil","120 mg","tabl.","op.",1,"op.20szt"]
[82,"amlodypina","5 mg","tabl.","op.",55,"op.30szt"]
[83,"amlodypina","10 mg","tabl.","op.",52,"op.30szt"]
[84,"doksazosyna","4 mg","tabl.","op.",107,"op,30szt"]
[{"$nulls":3},"Razem (zł)"]
[]
[]
[null,"SŁOWNIE (zŁ)"]
[]
[null,"Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
[null,"VAT:……………………………………………………………………………………………………………………..........................."]
[]
[null,"Brutto:…………………………………………………………………………………………………………………............................"]