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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/517-02.13/01,0407
2. Name of Authorisation Holder	:	Elbe Life Science GmbH
3. Address(es) of Site(s)	:	Hamburger Str. 11, c/o Regus Business Center, Hamburg, Hamburg, 22083, Germany

4. Legally registered address of Authorisation Holder	:	Ringstr. 164, Hamburg, Hamburg, 22145, 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	:	2019-03-28
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: Elbe Life Science GmbH

, Hamburger Str. 11, c/o Regus Business Center, Hamburg, Hamburg, 22083, 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): ref 2: drop shipment only and supply only within collection by customer

zu 2.: nur Streckengeschäft und Abgabe im Rahmen einer Abholung

Union Format for a Wholesale Distribution Authorisation	DE_HH_01_WDA/517-02.13/01,0407
	Page 1

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