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[]
["Sprawa nr ZP.16.PN.2019                                                                                                                                                            Załącznik nr.3/1,11"]
["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,"chloropromazyna",{"v":0.04,"d":"4%"},"krople doustne","op.",3,"op. 10g"]
[2,"kwetiapina","25 mg","tabl.powl.","op.",16,"op. 30szt."]
[3,"doksepina","10mg","kaps.","op.",1,"op.30szt"]
[4,"doksepina","25mg","kaps.","op.",1,"op.30szt"]
[5,"gentamycyna+deksametazon","0,5+0,03%","maść oczna","op.",3,"op.3g"]
[6,"gentamycyna",{"v":0.003,"d":"0.30%"},"krople oczne","op.",8,"op.5ml"]
[7,"hydrokortyzon+oksytetracyklina","10mg+10mg/1g","maść oczna","op.",1,"op.3g"]
[8,"hydroksyzyna","10mg","tabl.","op.",43,"op.30szt"]
[9,"hydroksyzyna","25mg","tabl.","op.",291,"op.30szt"]
[10,"hydroksyzyna",{"v":0.002,"d":"0.20%"},"syrop","op.",24,"op.250g"]
[11,"kromoglikan disodowy",{"v":0.02,"d":"2%"},"krople oczne","op.",8,"op,10ml"]
[12,"kwas acetylosalicylowy","0,5g","tabl.dojelitowe","op.",1,"op.10szt"]
[13,"kwas acetylosalicylowy","0,3g","tabl.","op.",1,"op.10szt"]
[14,"lidokaina typA",{"v":0.02,"d":"2%"},"żel","op.",2,"op.30g"]
[15,"lidokaina",{"v":0.02,"d":"2%"},"roztwór do wstrzykiwań","op.",1,"fiolki  50 ml  op.5 fiol."]
[16,"metamizol","0,5g","tabl.","op.",347,"op.12szt"]
[17,"metamizol","2,5g/5ml","inj.","op.",7,"op.5amp"]
[18,"metamizol","1g/2ml","inj.","op.",1,"op.5amp"]
[19,"neomycyna",{"v":0.005,"d":"0.50%"},"maść oczna","op.",9,"op.3g"]
[20,"lorazepam","2,5 mg","tabl.","op.",1,"op.25szt"]
[21,"neomycyna+gramicydyna+ fludrokortyzon","2,5mg+0,25mg+1mg/1ml","zaw.do oczu i uszu","op.",29,"op.5ml"]
[22,"opipramol","50mg","tabl.","op.",2,"op.20szt"]
[23,"paracetamol","0,12g/5ml","syrop/zaw.doustna","op.",15,"op.150g"]
[24,"paracetamol","0,25g","czopki","op.",2,"op.10szt"]
[25,"paracetamol","0,5g","czopki","op.",1,"op.10szt"]
[26,"paracetamol","0,125 g","czopki","op.",1,"op.10szt"]
[27,"piracetam","1,2g","tabl.","op.",5,"op.60szt"]
[28,"piracetam","0,8g","tabl.","op.",5,"op.60szt"]
[29,"piracetam","1g/5ml","inj.","op.",1,"op.12amp"]
[30,"promazyna","0,025g","tabl.","op.",1,"op.60szt"]
[31,"salicylamid+vit.C+rutozyd","0,3g+0,1g+0,005g","tabl.","op.",1,"op.20szt"]
[32,"salicylan choliny",{"v":0.2,"d":"20%"},"krople do uszu","op.",8,"op.10g"]
[33,"sulfacetamid",{"v":0.1,"d":"10%"},"krople oczne","op.",29,"op.12szt"]
[34,"diazepam","5mg/2,5ml,","wlewki ","op.",1,"op.5szt"]
[35,"tramadol","0,05g","kaps.","op.",267,"op.20szt"]
[36,"tramadol","0,1g/2ml","inj.","op.",7,"op.5amp"]
[37,"tramadol","0,1g","tabl.prol.","op.",2,"op. 30szt."]
[38,"winpocetyna","5mg","tabl.","op.",58,"op.50 szt"]
[39,"lidokaina typ U",{"v":0.02,"d":"2%"},"żel","op.",4,"op.30g"]
[40,"oxytetracyklina+polimiksyna+hydrokortizon","(5mg+10000j.m+15 mg)/ml","krople do oczu i uszu-zaw.\nuszu,zawiesina","op.",1,"op.5ml"]
[41,"deksapantenol","0,25g/5g","żel do oczu","op.",1,"op.10g"]
[42,"cytalopram","20 mg","tabl.powl.","op.",21,"op.28 szt."]
[43,"perazyna","25 mg","tabl.","op.",5,"op.20szt"]
[44,"perazyna","100 mg","tabl.","op.",2,"op.30szt"]
[45,"paracetamol","0,5g","tab","op.",339,"op.50 szt"]
[46,"karbamazepina","200mg","tab","op.",1,"op.50 szt"]
[47,"karbamazepina","200mg","tab. zmod.uwal","op.",1,"op.50 szt"]
[48,"karbamazepina","400mg","tab. zmod.uwal","op.",1,"op.50 szt"]
[49,"amitryptylina","25mg","tab.powl.","op.",1,"op.50 szt"]
[50,"haloperydol","1mg","tabl.","op.",1,"op.40szt"]
[51,"haloperydol","2mg/ml","krople doustne","op.",1,"op.10ml"]
[52,"haloperydol","5mg/ml","inj.","op.",1,"op.10amp"]
[53,"diazepam","0,01g/2ml","inj.","op.",1,"op,5amp"]
[54,"diazepam","2mg","tabl.","op.",1,"op.20szt"]
[55,"estazolam","2mg","tabl.","op.",218,"op.20szt"]
[56,"klorazepan dipotasowy","10mg","kaps.","op.",5,"op.30szt"]
[57,"klorazepan dipotasowy","5mg","kaps.","op.",34,"op.30szt"]
[58,"temazepam","10mg","tabl.","op.",1,"op.20szt"]
[59,"diazepam","5mg","tabl.","op.",4,"op.20szt"]
[60,"rysperydon","2mg","tab.powl.","op.",1,"op.20szt"]
[61,"rysperydon","1 mg","tab.powl.","op.",3,"op.20szt"]
[62,"sertralina","50mg","tab.powl.","op.",1,"op.28szt"]
[63,"sertralina","100mg","tab.powl.","op.",1,"op.28szt"]
[64,"wenlafaksyna","75mg","kaps.o przed.uw.","op.",1,"op.28szt"]
[65,"alprazolam","0,5mg","tab","op.",1,"op.30szt"]
[66,"lewomepromazyna","25mg","tab.powl.","op.",4,"op.50 szt"]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]