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RTF Template

District Government of Arnsberg

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	53/3-Aap-3
2. Name of Authorisation Holder	:	Frau Mechthild Bludau-Hülsmann
3. Address(es) of Site(s)	:	Wellinghofer Str. 97, Dortmund, 44263, Germany

4. Legally registered address of Authorisation Holder	:	Wellinghofer Str. 97, Dortmund, 44263, 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	:	2019-03-27
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: Frau Mechthild Bludau-Hülsmann

, Wellinghofer Str. 97, Dortmund, 44263, 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

Any restrictions or clarifying remarks (for all users): This WDA has been registered for data-technical reasons by the Bezirksregierung Arnsberg [District Government of Arnsberg] in EUDRAGMDP. Issuer of the original document and competent authority is the City of Dortmund with the responsible officer Georg Bühmann. Only for technical reasons the Bezirksregierung Arnsberg and an officer of the Bezirksregierung Arnsberg appear in this electronic entry. Decisive is the original document.

Diese Großhandelserlaubnis ist aus datentechnischen Gründen von der Bezirksregierung Arnsberg in EUDRAGMDP eingetragen worden. Aussteller der Originalurkunde und zuständige Behörde ist die Stadt Dortmund mit dem ausstellenden Mitarbeiter Georg Bühmann. Lediglich aus technischen Gründen erscheint die Bezirksregierung Arnsberg und ein Mitarbeiter der Bezirksregierung Arnsberg in diesem elektronischen Eintrag. Maßgebend ist die Originalurkunde.

*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	53/3-Aap-3
	Page 1

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