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["Sprawa nr ZP.13.PN 2020                                                                                                                                                             Załącznik nr.3/10"]
["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,"dekstrometorfan","15 mg","tabl.","op.",400,"op.20 szt."]
[2,"dekstrometorfan","0,15g/100ml","syrop junior","op.",30,"op.100 ml"]
[3,"drotaweryna","40 mg","tabl.","op.",60,"op.20 szt."]
[4,"drotaweryna","80 mg","tabl.","op.",95,"op.20 szt."]
[5,"drotaweryna","0,04g/2ml","inj.","op.",20,"op.5 amp."]
[6,"ambroksol","0,015mg/2ml","płyn do inhalacji z nebulizatora","op.",70,"op.100 ml"]
[{"$nulls":6},"RAZEM"]
[]
[]
[]
[]
[]
[]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]