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RTF Template

Freie und Hansestadt Hamburg, Ministry of Health and Consumer Protection

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_HH_01_WDA/517-02.13/01,0058
2. Name of Authorisation Holder	:	Fair-Med Healthcare GmbH
3. Address(es) of Site(s)	:	Dorotheenstraße 48, Hamburg, 22301, Germany

4. Legally registered address of Authorisation Holder	:	Dorotheenstraße 48, Hamburg, 22301, 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	:	2020-01-21
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: Fair-Med Healthcare GmbH

, Dorotheenstraße 48, Hamburg, 22301, Germany

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.3. Supply

2.5. Other activities(s): holding as an outsourced activity in two external warehouses (see annex 5)Lagerung bei zwei beauftragten Betrieben (siehe Anlage 5)

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.3. Cold chain products(requiring low temperature handling)

Union Format for a Wholesale Distribution Authorisation	DE_HH_01_WDA/517-02.13/01,0058
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