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["Załącznik nr 3/1.9               "]
["nr sprawy ZP.12.PN.2017"]
["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,"ibuprofen","0,2g","tabl.","op.",87,"op a 60 tab."]
[2,"allopurynol","0,1g","tabl.","op.",55]
[3,"diklofenak","0,05g","tabl.","op.",5]
[4,"diklofenak","0,1g","tabl.prolong.","op.",1]
[5,"diklofenak","0,1g","czopki","op.",1]
[6,"diklofenak",0.01,"żel","op.",1]
[7,"fenylbutazon","0,25g","czopki","op.",1]
[8,"fenylbutazon",0.05,"maść","op.",78]
[9,"ibuprofen","100mg/5ml","zawiesina doustna","op.",43]
[10,"ketoprofen","0,05g","tabl.","op.",92]
[11,"ketoprofen","0,1g","tabl.","op.",20]
[12,"ketoprofen","0,1g","czopki","op.",1]
[13,"ketoprofen","0,1g/2ml","inj.","op.",20]
[14,"ketoprofen",0.025,"żel","op.",76]
[15,"naproksen",0.012,"żel","op.",67]
[16,"naproksen",0.1,"żel","op.",1]
[17,"naproksen","0,5g","tabl.","op.",1]
[18,"allopurynol","0,3g","tab.","op.",18]
[19,"kolchicyna","0,5g","tab.","op.",68]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]