1. Authorisation Number

:

503 H

2. Name of Authorisation Holder

:

Servier R&D Benelux SA

3. Address(es) of Site(s)

:

Boulevard International 57, Bruxelles, 1070, Belgium 

4. Legally registered address of Authorisation Holder

:

Boulevard International 57, Bruxelles, 1070, Belgium

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

:

2017-12-18

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

Name and address of the site: Servier R&D Benelux SA

, Boulevard International 57, Bruxelles, 1070, Belgium   

Reason for Withdrawing:

after a note by inspector for radiation:
indicating that the logistics of clinical studies are managed by the
from France.

Union Format for a Wholesale Distribution Authorisation

503 H

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