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["Załącznik nr 3/1.12               "]
["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,"budezonid","0,125mg/ml ","zaw.do inhalacji z nebulizatora","op.",1]
[2,"budezonid","0,25mg/ml ","zaw.do inhalacji z nebulizatora","op.",45]
[3,"ambroksol","0,03g","tabl.","op.",45]
[4,"ambroksol","0,015g/5ml","syrop","op.",22]
[5,"ambroksol","0,03g/5ml"," syrop","op.",1]
[6,"ambroksol","0,015mg/2ml","płyn do inhalacji z nebulizatora","op.",41]
[7,"benzydamina ",null,"aerozol do stosowania w jamie ustnej igardle","op.",75,"op a 30 ml"]
[8,"antazolina","0,1g/2ml","inj.","op.",2]
[9,"bromheksyna","8mg","tabl.","op.",266]
[10,"bromheksyna","4mg/5ml","syrop","op.",50]
[11,"tussipect","prep.złożony","syrop","op.",1,"op,140 g."]
[12,"budezonid","200mcg","proszek do inh.w kaps.","op.",38]
[13,"budezonid","400mcg","proszek do inh.w kaps.","op.",1]
[14,"budezonid","0,05mg/dawkę","aerozol do nosa","op.",18]
[15,"cetyryzyna","10mg","tabl.","op.",45]
[16,"chlorchinaldol","0,002g","tabl.do ssania","op.",166]
[17,"chlorheksydyna + vit.C","0,005g+0,05g","tabl.do ssania","op.",300]
[18,"neoazarina","prep.złożony","tab.","op.",1]
[19,"difenhydramina+nafazolina","0,001g+0,33mg/1ml","krople do nosa","op.",1]
[20,"drosetux",null,"syrop","op.",1]
[21,"fenoterol","0,1mg/dawkę","aer.wziewny","op.",1]
[22,"fenoterol+bromek ipratropium","0,5mg+0,25mg/daw.inhalacyjną","aer.wziewny","op.",1]
[23,"fenoterol+bromek ipratropium","0,5mg+0,25mg/1ml","płyn do inhalacji z nebulizatora","op.",72]
[24,"fenspiryd","0,08g","tabl.","op.",3]
[25,"fenspiryd","0,002g/ml","syrop","op.",79]
[26,"prometazyna","25mg","draż.","op.",1]
[27,"gwajakolosulfonian potasu+kodeina","0,3g+0,015g","tabl.","op.",10]
[28,"klemastyna","1mg","tabl.","op.",84]
[29,"klemastyna","0,5mg/5ml","syrop","op.",82]
[30,"tietylperazyna","6,5mg","czopki","op.",1]
[31,"ksylometazolina",{"v":0.0005,"d":"0.05%"},"krople do nosa","op.",76]
[32,"loratadyna","10mg","tabl.","op.",1]
[33,"niketamid+glukoza","0,125g+1,5g","tabl.do ssania","op.",11]
[34,"syrop prawoślazowy",null,"syrop","op.",5,"op.125 g."]
[35,"prometazyna","5mg/5ml","syrop","op.",29]
[36,"prometazyna","10mg","tabl.","op.",1]
[37,"klemastyna","2mg/ml","inj.","op.",1]
[38,"sal ems",null,"tabl.mus.","op.",37,"po 40 tabl."]
[39,"salbutamol","2mg","tabl.","op.",1]
[40,"salbutamol","0,1mg/daw.inhalacyjną","aer.wziewny","op.",2]
[41,"salmeterol","50mcg/daw.inhalacyjną","dysk","op.",1]
[42,"budezonid","0,5mg/ml ","zaw.do inhalacji z nebulizatora","op.",16]
[43,"sulfatiazol+nafazolina+chloreton","0,05g+0,001g+0,005g","krople do nosa","op.",31]
[44,"syrop prawoślazowy ",null,"syrop","op.",43,"po 1,25kg"]
[45,"syrop sosnowy złożony",null,"syrop","op.",2,"po 1kg"]
[46,"syrop tymiankowy","prep.złożony","syrop","op.",1,"po 1kg"]
[47,"teofilina","0,3g/250ml","roztwór do wlewu","szt.",10,"0,12g teofiliny +5,4g glukozy/ 100ml but. po 250ml"]
[48,"teofilina","0,15g","tabl.prol.","op.",1]
[49,"teofilina","0,3g","tabl.prol.","op.",7]
[50,"teofilina","0,1g","tabl.","op.",1]
[51,"tietylperazyna","6,5mg","tabl.","op.",3]
[52,"tussipect","prep.złożony","syrop","op.",4,"po 1kg"]
[53,"tussipect",null,"draż.","op.",58]
[54,"bromek ipratropium","0,25mg/ml ","płyn do inhalacji z nebulizatora","op.",6]
[55,"bromek ipratropium","20mcg/dawka inh.","areozol wziewny","op.",1]
[56,"mesna","5mg/doza","areozol ","op.",8,"12,5ml"]
[57,"actitrin lub podobne",null,"syrop","op.",53]
[58,"teofilina","20mg/ml","Inj. 10 ml","op.",5]
[59,"salbutamol","0,5mg/ml ","inj.","op.",1]
[60,"flutykazon","250mcg/daw.inh.","areozol wziewny","op.",1,"60 dawek"]
[{"$nulls":4},"Razem (zł)"]
["SŁOWNIE (zŁ)"]
[]
["Netto:…………………………………………………………………………………………………………………….........................                                                 "]
[]
["VAT:……………………………………………………………………………………………………………………..........................."]
[]
["Brutto:…………………………………………………………………………………………………………………............................"]
[]
[{"$nulls":7},"………………………………………………"]
[{"$nulls":7},"Pieczęć i podpis wykonawcy"]