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RTF Template

National Agency for Medicines and Medical Devices

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	534D
2. Name of Authorisation Holder	:	S.C. COSMOFARM IMPEX S.R.L.
3. Address(es) of Site(s)	:	B-dul Gării nr.1, Mun. Braşov, Jud. Braşov, cod poştal 500148, Romania

4. Legally registered address of Authorisation Holder	:	Str. Matei Basarab nr. 6, ap. 3, Mun. Braşov, Jud. Braşov, cod poştal 500008, Romania
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2016-12-20
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: COSMOFARM IMPEX S.R.L.

, B-dul Gării nr.1, Mun. Braşov, Jud. Braşov, cod poştal 500148, Romania

1. MEDICINAL PRODUCTS

1.1. with a Marketing Authorisation in EEA country(s)

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.3. Cold chain products(requiring low temperature handling)

3.4. Other products: dietary supplements, medical devices, cosmetics, suplimente alimentare, dispozitive medicale, cosmetice

Any restrictions or clarifying remarks (for all users): The current WDA is valid only if the terms of the transportation services agreement signed with SC MSL LOGISTIC SERVICES DISTRIBUTION S.R.L. are complied with.

Prezenta Autorizaţie de distribuţie angro este validă numai respectându-se prevederile contractului de prestări servicii de transport încheiat cu SC MSL LOGISTIC SERVICES DISTRIBUTION S.R.L.

*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

Union Format for a Wholesale Distribution Authorisation	534D
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