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RTF Template

Bezirksregierung Düsseldorf

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_NW_03_WDA_2021_0016/ 24.05.05.01-MEDI 99
2. Name of Authorisation Holder	:	MEDI 99 Praxisbedarf UG
3. Address(es) of Site(s)	:	Strippchens Hof 36, Mülheim an der Ruhr, 45479, Germany

4. Legally registered address of Authorisation Holder	:	Strippchens Hof 36, Mülheim an der Ruhr, 45479, Germany
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2021-06-24
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: MEDI 99 Praxisbedarf UG

, Strippchens Hof 36, Mülheim an der Ruhr, 45479, 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

Any restrictions or clarifying remarks (for all users): Die Erlaubnis wird mit der Einschränkung erteilt, dass
(1) keine Lagerung von Arzneimitteln in der oben genannten Betriebsstätte erlaubt ist. Es erfolgt auch keine Lagerung durch beauftragte Betriebe.

(2) ausschließlich die Beschaffung und Lieferung von Haut- und Händedesinfektionsmitteln sowie Infusionslösungen nach § 47 Abs. 1 AMG in der oben genannten Betriebsstätte erlaubt ist.

*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	DE_NW_03_WDA_2021_0016/ 24.05.05.01-MEDI 99
	Page 1

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