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["Sprawa nr    ZP.16.PN.2019                                                                                                                                                    Załącznik nr.3/1,1"]
["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,"granuflex  10cmx10cm lub podobne",null,"opatrunek hydrokoloidowy","szt",5]
[2,"alantoina",0.02,"maść","op.",19,"op.30g"]
[3,"benzynum",null,"płyn","op.",5,"op.1litr"]
[4,"aphtin lub podobne",0.2,"płyn do stosowania w jamie ustnej","op.",4,"op.10g"]
[5,"natamycyna","prep.złożony","krem","op.",5,"op.15g"]
[6,"natamycyna","prep.złożony","maść","op.",11,"op.15g"]
[7,"cepan lub podobne",null,"krem","op.",1,"op.35g"]
[8,"chloramfenikol",0.02,"maść","op.",51,"op.5g"]
[9,"chloramfenikol",0.01,"maść","op.",1,"op.5g"]
[10,"denotywir",0.03,"krem","op.",16,"op.3g"]
[11,"dermosan lub podobne",null,"krem","op.",24,"op.40g"]
[12,"dermosan N+R lub podobne",null,"krem","op.",32,"op.40g"]
[13,"dimetynden",0.001,"żel","op.",31,"op.30g"]
[14,"erytromycyna",0.02,"maść na skórę","op.",1,"op.25g."]
[15,"etakrydyna",0.005,"żel","op.",14,"op.30g"]
[16,"etanolowy wyciąg z koszyczków rumianku",null,"płyn","op.",2,"op.100ml"]
[17,"fiolet gencjany",0.01,"roztwór wodny","op.",1,"op.20g"]
[18,"fiolet gencjany",0.01,"roztwór spirytusowy","op.",1,"op.20ml"]
[19,"granugel",null,"żel hydro-koloidowy na rany","op.",1,"op.15g"]
[20,"hydrokortyzon",0.01,"krem","op.",50,"op.15g"]
[21,"gazik jałowy nasączony 70% alkoh.izopropylowym",null,null,"op.",141,"op.100szt"]
[22,"klotrimazol","10mg/g","krem","op.",2,"op.20g"]
[23,"maść tranowa",null,"maść","op.",1,"op.20g"]
[24,"mometazon",0.001,"krem","op.",25,"op.30 g."]
[25,"mometazon",0.001,"maść","op.",5,"op.30g"]
[26,"nadtlenek wodoru",0.03,"płyn","op.",50,"op. 100g"]
[27,"neomycyna","0,0068g/ml","aerozol","op.",1,"op.55 ml."]
[28,"octan hydrokortyzonu+oksytetra-cyklina","0,01g+0,03g/1g","maść","op.",1,"op.10g"]
[29,"octan hydrokortyzonu+oksytetra-cyklina","0,00133g+0,004g/1g","aerozol","op.",1,"op.55 ml."]
[30,"octanowinian glinu",0.01,"żel","op.",86,"op.75g"]
[31,"parafina ciekła",null,"płyn","op.",8,"op.800 g."]
[32,"sudokrem",null,"krem","op.",5,"op.125g."]
[33,"puder płynny ",null,"płyn","op.",7,"op.100g."]
[34,"retinol (vit.A)","400j.m./g.","maść","op.",148,"op.25g."]
[35,"sól srebrowa sulfatiazolu",0.02,"krem","op.",30,"40 g."]
[36,"spirytus salicylowy ",0.02,"płyn","op.",15,"op.100g."]
[37,"spirytus salicylowy ",0.02,"płyn","op.",2,"op.800 g."]
[38,"wyciąg z krwi",0.1,"żel","op.",1,"op.20g"]
[39,"wyciąg z krwi",0.05,"maść","op.",1,"op.20g"]
[40,"galusan bizmutawy",null,"proszek do stosowania na skórę","op.",1,"op 5g"]
[41,"collagenasum","1,2j/g","maść","op.",5,"op.20g"]
[42,"granuflex ",null,"pasta hudrokoloidowa","op.",1,"op 30g."]
[43,"opatrunek aquacel Ag 10cmx10cm lub podobne",null,null,"szt",1]
[44,"opatrunek atrauman Ag 10cmx20cm lub podobne",null,null,"szt.",20]
[45,"opatrunek atrauman Ag 10cmx10cm lub podobne",null,null,"szt.",1]
[46,"parafina ciekła",null,"płyn","op.",45,"op.100g"]
[47,"talk",null,null,"op.",25,"op.100g"]
[48,"klindacyn T lub podob.",null,",zel","op.",7,"op.30g"]
[{"$nulls":3},"Wartość (zł)"]
[]
[]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[{"$nulls":7},"………………………………………………"]
["Brutto:…………………………………………………………………………………………………………………............................",{"$nulls":6},"Pieczęć i podpis wykonawcy"]