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RTF Template

Ministry Of Health Welfare And Sport

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	109269 G
2. Name of Authorisation Holder	:	Msa B.V. (ORG-100044461 / LOC-100073474)
3. Legally registered address of Authorisation Holder	:	Euroweg 21, Amersfoort, 3825 HA
4. Address(es) of Site(s)	:	Euroweg 21, Amersfoort, 3825 HA, Netherlands
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:	Art. 77(1) of Directive 2001/83/EC
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2023-05-01
10. Annexes attached	:	Annex 1 Scope of wholesale distribution authorisation Annex 2 (Optional) Address(es) of contract wholesale distribution sites and their authorisation number Annex 3 (Optional) Name(s) of responsible person(s) Annex 4 (Optional) Date of Inspection on which authorisation was granted Annex 5 (Optional) Additional provisions based on national requirements

ANNEX 1

SCOPE OF WHOLESALE DISTRIBUTION AUTHORISATION

Name and address of the site: Msa B.V.

(ORG-100044461 / LOC-100073474)

, Euroweg 21, Amersfoort, 3825 HA, Netherlands

Human medicinal products

1. MEDICINAL PRODUCTS

1.1 with a Marketing Authorisation in EEA country(s)

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.2 Holding

2.3 Supply

*Art 5 of Directive 2001/83/EC or Art 83 of Regulation EC/726/2004

**Without prejudice to further authorisations as may be required according to national legislation

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