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RTF Template

Landesamt für Gesundheit und Soziales Mecklenburg-Vorpommern

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	01.18/410.5502
2. Name of Authorisation Holder	:	provita arndt GmbH
3. Address(es) of Site(s)	:	Kranichstraße 6 und 22, Neustrelitz, Mecklenburg-Vorpommern, D-17235, Germany

4. Legally registered address of Authorisation Holder	:	Kranichstraße 6 und 22, Neustrelitz, Mecklenburg-Vorpommern, D-17235, Germany
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	:	2018-01-30
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: provita arndt GmbH

, Kranichstraße 6 und 22, Neustrelitz, Mecklenburg-Vorpommern, D-17235, Germany

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

2.5. Other activities(s): additional storage at commissioned wholesalerzusätzliche Lagerung bei beauftragtem Großhändler

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.2. Medicinal gases

Any restrictions or clarifying remarks (for all users): Address and permission number of authorized wholesaler:
Co-med GmbH & Co. KG
Logistikcenter für Arzt- und Krankenhausbedarf
Hochstraße 1
D-66265
5040 - Co-med

Anschrift und Erlaubnisnummer beauftragter Großhändler:
Co-med GmbH & Co. KG
Logistikcenter für Arzt- und Krankenhausbedarf
Hochstraße 1
D-66265
5040 - Co-med

Union Format for a Wholesale Distribution Authorisation	01.18/410.5502
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