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["Sprawa nr ZP.13.PN.2020                                                                                                                                Załącznik nr.3/1.12"]
["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,"budezonid","0,25mg/ml ","zaw.do inhalacji z nebulizatora","op.",40,"op.20 szt/2ml"]
[2,"ambroksol","0,03g","tabl.","op.",2,"op.20szt"]
[3,"ambroksol","0,015g/5ml","syrop","op.",5,"op.120ml"]
[4,"benzydamina ",null,"aerozol do stosowania w jamie ustnej igardle","op.",80,"op .30g"]
[5,"antazolina","0,1g/2ml","inj.","op.",2,"op.10amp"]
[6,"bromheksyna","8mg","tabl.","op.",180,"op.20szt"]
[7,"bromheksyna","4mg/5ml","syrop","op.",65,"op.120ml"]
[8,"tussipect","prep.złożony","syrop","op.",6,"op,140 g."]
[9,"budezonid","200mcg","proszek do inh.w kaps.","op.",7,"op.60szt"]
[10,"budezonid","400mcg","proszek do inh.w kaps.","op.",1,"op.60szt"]
[11,"budezonid","0,05mg/dawkę","aerozol do nosa","op.",10,"op.10ml"]
[12,"cetyryzyna","10mg","tabl.","op.",90,"op.20szt"]
[13,"chlorchinaldol","0,002g","tabl.do ssania","op.",150,"op.20szt"]
[14,"chlorheksydyna + vit.C","0,005g+0,05g","tabl.do ssania","op.",250,"op.20szt"]
[15,"fenoterol+bromek ipratropium","0,5mg+0,25mg/daw.inhalacyjną","aer.wziewny","op.",2,"op.10ml"]
[16,"fenoterol+bromek ipratropium","0,5mg+0,25mg/1ml","płyn do inhalacji z nebulizatora","op.",30,"op.20ml"]
[17,"gwajakolosulfonian potasu+kodeina","0,3g+0,015g","tabl.","op.",13,"op.10szt"]
[18,"klemastyna","1mg","tabl.","op.",50,"op.30szt"]
[19,"klemastyna","0,5mg/5ml","syrop","op.",50,"op.100ml"]
[20,"tietylperazyna","6,5mg","czopki","op.",1,"op.6szt"]
[21,"ksylometazolina",{"v":0.0005,"d":"0.05%"},"krople do nosa","op.",50,"op.10ml"]
[22,"loratadyna","10mg","tabl.","op.",16,"op.30szt"]
[23,"niketamid+glukoza","0,125g+1,5g","tabl.do ssania","op.",10,"op.10szt"]
[24,"syrop prawoślazowy",null,"syrop","op.",1,"op.125 g."]
[25,"prometazyna","5mg/5ml","syrop","op.",18,"op.150ml"]
[26,"klemastyna","2mg/ml","inj.","op.",1,"op.5amp"]
[27,"sal ems",null,"tabl.mus.","op.",45,"op.40 szt"]
[28,"salbutamol","2mg","tabl.","op.",1,"op.30szt"]
[29,"salbutamol","0,1mg/daw.inhalacyjną","aer.wziewny","op.",2,"op.200dawek"]
[30,"salmeterol","50mcg/daw.inhalacyjną","dysk","op.",1,"op.60dawek"]
[31,"budezonid","0,5mg/ml ","zaw.do inhalacji z nebulizatora","op.",60,"op.20 szt/2ml"]
[32,"syrop prawoślazowy ",null,"syrop","op.",43,"op. 1250g"]
[33,"syrop sosnowy złożony",null,"syrop","op.",1,"op. 1000g"]
[34,"syrop tymiankowy","prep.złożony","syrop","op.",1,"op. 1250g"]
[35,"teofilina","0,15g","tabl.prol.","op.",1,"op.50szt"]
[36,"teofilina","0,3g","tabl.prol.","op.",7,"op.50szt"]
[37,"teofilina","0,1g","tabl.","op.",1,"op.30szt"]
[38,"tietylperazyna","6,5mg","tabl.","op.",4,"op.50szt"]
[39,"tussipect","prep.złożony","syrop","op.",5,"op. 1000g"]
[40,"tussipect",null,"draż.","op.",25,"op.20szt"]
[41,"bromek ipratropium","0,25mg/ml ","płyn do inhalacji z nebulizatora","op.",4,"op.20ml"]
[42,"bromek ipratropium","20mcg/dawka inh.","areozol wziewny","op.",4,"op.200dawek"]
[43,"mesna","5mg/doza","areozol ","op.",1,"op.12,5ml"]
[44,"actitrin lub podobne",null,"syrop","op.",20,"op.100ml"]
[45,"teofilina","20mg/ml","Inj. 10 ml","op.",2,"op.5amp"]
[46,"salbutamol","0,5mg/ml ","inj.","op.",2,"op.10amp"]
[47,"flutykazon","250mcg/daw.inh.","areozol wziewny","op.",1,"op.60 dawek"]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]