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RTF Template

Department of Occupational Health and Safety, Customer Protection and Health

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	G3-5423/phoenix/02/29.05.2017
2. Name of Authorisation Holder	:	PHOENIX Pharmahandel GmbH & Co KG
3. Address(es) of Site(s)	:	Niederlassung der PHOENIX Pharmahandel GmbH & Co KG, Gubener Straße 53, Cottbus, Brandenburg, 03042, Germany

4. Legally registered address of Authorisation Holder	:	Pfingstweidstrasse 10 - 12, Mannheim, 68199, Germany
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	:	2017-05-29
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: PHOENIX Pharmahandel Vertriebszentrum Cottbus

, Niederlassung der PHOENIX Pharmahandel GmbH & Co KG, Gubener Straße 53, Cottbus, Brandenburg, 03042, Germany

1. MEDICINAL PRODUCTS

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

1.2. without a Marketing Authorisation in the EEA and intended for EEA market

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1.1. Narcotic or psychotropic products

3.1.2. Medicinal products derived from blood

3.1.3. Immunological medicinal products

3.3. Cold chain products(requiring low temperature handling)

3.4. Other products: explosives Explosivgrundstoffe

Any restrictions or clarifying remarks (for all users): Layout plan of 2015-11-01

Lageplan vom 01.11.2015

*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	G3-5423/phoenix/02/29.05.2017
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