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["Sprawa nr.ZP.16.PN.2018                                                                                                                                                                                                                                 Załącznik nr.3/1,2"]
["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,"deksametazon","4mg/1ml","inj.","op.",10,"op.10amp"]
[2,"deksametazon","8mg/2ml","inj.","op.",4,"op.10amp"]
[3,"hydrokortyzon","25mg/1ml","roztw.do wstrzykiwań","op.",1,"op.5amp"]
[4,"lewotyroksyna","50mcg","tabl.","op.",38,"op.50tabl"]
[5,"lewotyroksyna","25mcg","tabl.","op.",1,"op.50tabl"]
[6,"lewotyroksyna","100mcg","tabl.","op.",25,"op.50tabl"]
[7,"prednizon","5mg","tabl.","op.",1,"op.20tabl"]
[8,"prednizon","10mg","tabl.","op.",5,"op.20tabl"]
[9,"tiamazol","5 mg","tabl.","op.",24,"op.50tabl"]
[10,"hydrokortyzon","100mg/2ml","roztw.do wstrzykiwań","op.",30,"op.5amp"]
[11,"tiamazol","10 mg","tab.","op.",2,"op.50tabl"]
[12,"tiamazol","20 mg","tab.","op.",1,"op.50tabl"]
[13,"metyloprednizolon","4 mg","tabl.","op.",5,"op.30tab"]
[14,"metyloprednizolon","16 mg","tabl.","op.",5,"op.30tab"]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]