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[]
["Sprawa nr.ZP.16.PN.2018                                                                                                                                                                                                                                                                                      Załącznik nr.3/7"]
["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,"gliklazyd","60mg","tabl.o zmodyfikowanym uwalnianiu","op.",30,"op.szpitalne 60tabl."]
[2,"indapamid","1,5 mg","tabl.o powolnym uwalnianiu","op.",5,"op.szpitalne\n90tabl."]
[3,"trimetazydyna","35 mg","tabl.o zmodyfikowanym uwalnianiu","op.",105,"op.szpitalne\n90 tabl."]
[4,"peryndopryl","5mg","tabl.powl.","op.",24,"op.szpitalne\n90 tabl."]
[5,"peryndopryl","10mg","tabl.powl.","op.",7,"op.szpitalne\n90 tabl."]
[6,"tianeptyna","12,5mg","tabl.powl.","op.",4,"op.szpitalne\n90 tabl."]
[7,"Peryndopryl + indapamid","2,5mg + 0,625mg","tabl.powl.","op,",5,"op.szpitalne\n90 tabl."]
[8,"Peryndopryl + indapamid","5mg+1,25mg","tabl.powl.","op.",28,"op.szpitalne\n90 tabl."]
[9,"Peryndopryl + amlodypina","5mg + 5mg","tabl.","op.",5,"op.szpitalne\n90 tabl."]
[10,"Peryndopryl + amlodypina","5mg + 10mg","tabl.","op.",1,"op.szpitalne\n90 tabl."]
[11,"Peryndopryl + amlodypina","10mg + 5mg","tabl.","op.",1,"op.szpitalne\n90 tabl."]
[12,"Peryndopryl + amlodypina","10mg + 10mg","tabl.","op.",2,"op.szpitalne\n90 tabl."]
[13,"Ivabradyna","5mg","tabl.","op,",11,"op.szpitalne 112 tabl."]
[{"$nulls":6},"Razem (zł)"]
[]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]