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Information Messages

The WDA has been withdrawn, withdrawn date is: 2025-05-07

RTF Template

Chief Pharmaceutical Inspectorate

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	GIF-N-411/1041/1-14/MP/17
2. Name of Authorisation Holder	:	ModumPharma sp. z o.o.
3. Address(es) of Site(s)	:	Ignacego Krasickiego 65, Radomsko, ŁÓDZKIE, 97-500, Poland

4. Legally registered address of Authorisation Holder	:	inż. Skrzywana 6, Łódź, ŁÓDZKIE, 93-588, Poland
5. Scope of authorisation	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesale distribution authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2017-09-26
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: Hurtownia farmaceutyczna

, Ignacego Krasickiego 65, Radomsko, ŁÓDZKIE, 97-500, Poland

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

1.3. without a Marketing Authorisation in the EEA and intended for exportation

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

2.4. Export

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.3. Cold chain products(requiring low temperature handling)

3.4. Other products: 3.4.5, 3.4.2, 3.4.4, 3.4.6

Reason for Withdrawing:

This WDA is no longer valid. It has historical value.

To zezwolenie nie jest już aktualne. Ma wartość historyczną.

Union Format for a Wholesale Distribution Authorisation	GIF-N-411/1041/1-14/MP/17
	Page 1

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