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RTF Template

Agencia Espanola de Medicamentos y Productos Sanitarios

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	6666E
2. Name of Authorisation Holder	:	Andromaco Pharma S.L. (ORG-100006966 / LOC-100011306)
3. Address(es) of Site(s)	:	Doctor Zamenhof, 36, MADRID, Madrid, 28027

4. Legally registered address of Authorisation Holder	:	Calle Del Doctor Zamenhof 36, Madrid, 28027
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:	WDA-D824-2010
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2022-04-25
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: ANDRÓMACO PHARMA, S.L.

(ORG-100006966 / LOC-100011306)

, Doctor Zamenhof, 36, MADRID, Madrid, 28027

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

2.4. Export

2.5. Other activities(s): Laboratorio TAC de medicamentos / MAH of medicinal products with warehouse

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1.1. Narcotic or psychotropic products

3.4. Other products: muestras de retención/ retention samples

*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	6666E
	Page 1

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