1. Authorisation Number

:

W12404/00001

2. Name of Authorisation Holder

:

Millicent Pharma Limited

3. Address(es) of Site(s)

:

Block 4, Floor 2, Quayside Business Park, Mills Street, Dundalk, Co. Louth, -, A91 KA9R, Ireland 

4. Legally registered address of Authorisation Holder

:

Block 4, Floor 2, Quayside Business Park, Mills Street, Dundalk, Co. Louth, -, A91 KA9R, Ireland

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

:

2019-06-05

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: Millicent Pharma Limited

, Block 4, Floor 2, Quayside Business Park, Mills Street, Dundalk, Co. Louth, -, A91 KA9R, Ireland   

Any restrictions or clarifying remarks (for all users):  3.4.1 Prescription only medicinal products3.4.4 Unauthorised medicinal products

Reason for Withdrawing:

This WDA was withdrawn at the request of the company.

Union Format for a Wholesale Distribution Authorisation

W12404/00001

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