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[]
["Sprawa nr ZP. 13.PN.2020                                                                                                                                       Załacznik nr.3/6"]
["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)","Wartość VAT","Wartość brutto (zł)"]
[1,"sól sodowa kwasu walproinowego+kwas walproinowy","200mg+87 mg","tabl.powl.o przedłuż.uwalnianiu","op.",5,"op.30 szt."]
[2,"sól sodowa kwasu walproinowego+kwas walproinowy","333mg+145mg","tabl.powl.o przedłuż.uwalnianiu","op.",10,"op.30 szt."]
[3,"amiodaron","0,15g/3ml","inj.","op.",70,"op.6 amp."]
[4,"amiodaron","0,2 g","tabl.","op.",80,"op.30 szt."]
[5,"adenozyna","6mg/2ml","inj.","op.",2,"op.6 fiol."]
[6,"sulfonian polistyrenu A","proszek",null,"op.",2,"op.454g."]
[7,"monoazotan izosorbidu","10 mg","tabl.","op.",15,"op.60 szt."]
[8,"monoazotan izosorbidu","20 mg ","tabl.","op.",10,"op.60 szt."]
[9,"monoazotan izosorbidu","60 mg","tabl.","op.",10,"op.30 szt."]
[10,"monoazotan izosorbidu","100 mg ","tabl.","op.",10,"op.30 szt."]
[11,"sól sodowa enoksaparyny","40 mg","amp.strzyk.","op.",100,"op,10amp.strzyk"]
[12,"sól sodowa enoksaparyny","60  mg","amp.strzyk.","op.",400,"op,10amp.strzyk"]
[13,"sól sodowa enoksaparyny","80mg","amp.strzyk.","op.",600,"op,10amp.strzyk"]
[14,"klopidogrel","75mg","tabl.powl.","op.",400,"op.28tabl."]
[15,"ramipryl","2,5mg","tabl.","op.",100,"op.28 tabl."]
[16,"ramipryl","5 mg","tabl.","op.",200,"op.28 tabl."]
[17,"ramipryl","10 mg ","tabl.","op.",200,"op.28 tabl."]
[18,"klopidogrel","300mg","tabl.powl.","op.",5,"op.30 tabl."]
[19,"glimepiryd","2 mg","tabl.","op.",30,"op,30tabl."]
[20,"glimepiryd","3 mg","tabl.","op.",30,"op,30tabl."]
[21,"glimepiryd","4 mg","tabl.","op.",20,"op,30tabl."]
[{"$nulls":4},"Razem (zł)"]
[]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]