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["Sprawa nr ZP.16.PN.2019                                                                                                                                       Załacznik nr.1/1.9"]
["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,"ibuprofen","0,2g","tabl.","op.",87,"op. 60 szt"]
[2,"allopurynol","0,1g","tabl.","op.",55,"op.50szt"]
[3,"diklofenak","0,05g","tabl.","op.",5,"op.30szt"]
[4,"diklofenak","0,1g","tabl.prolong.","op.",1,"op.20szt"]
[5,"diklofenak","0,1g","czopki","op.",1,"op.10szt"]
[6,"diklofenak","11,6mg/g","żel","op.",16,"op.100 g"]
[7,"fenylbutazon","0,25g","czopki","op.",3,"op.5szt"]
[8,"fenylbutazon",0.05,"maść","op.",115,"op.30g"]
[9,"ibuprofen","100mg/5ml","zawiesina doustna","op.",55,"op.100ml"]
[10,"ketoprofen","0,05g","kaps.","op.",68,"op.20 szt"]
[11,"ketoprofen","0,1g","tabl.","op.",7,"op.30szt"]
[12,"ketoprofen","0,1g","czopki","op.",1,"op.10szt"]
[13,"ketoprofen","0,1g/2ml","inj.","op.",28,"op.10amp"]
[14,"ketoprofen",0.025,"żel","op.",11,"op.100g"]
[15,"naproksen",0.012,"żel","op.",49,"op.50g"]
[16,"naproksen",0.1,"żel","op.",40,"op.50g"]
[17,"naproksen","0,5g","tabl.","op.",1,"op.20szt"]
[18,"allopurynol","0,3g","tab.","op.",32,"op.30szt"]
[19,"kolchicyna","0,5g","tab.","op.",71,"op.20szt"]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]