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RTF Template

Behoerde Fuer Gesundheit Und Verbraucherschutz Der Freien Und Hansestadt Hamburg

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	DE_HH_01_WDA/517-03.30,0138
2. Name of Authorisation Holder	:	Medizinisches Versorgungszentrum am Marienkrankenhaus gGmbH (ORG-100040254 / LOC-100081272)
3. Address(es) of Site(s)	:	Hinrichsenstrasse 1, Borgfelde, Hamburg, 20535, Germany

4. Legally registered address of Authorisation Holder	:	Alfredstrasse 9, Hohenfelde, Hamburg, 22087
5. Scope of authorisation	:	ANNEX 1
6. Legal basis of authorisation	:	Art. 77(1) of Directive 2001/83/EC
7. Name of responsible officer of the competent authority of the member state granting the wholesale distribution authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2025-07-10
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: Medizinisches Versorgungszentrum am Marienkrankenhaus gGmbH

(ORG-100040254 / LOC-100096167)

, Hinrichsenstrasse 1, Borgfelde, Hamburg, 20535, Germany

Human medicinal products

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.2. Products requiring low temperature handling

3.3. Other products: (please specify here or make a reference to Annex 5) Medicinal Products derived from blood

Union Format for a Wholesale Distribution Authorisation	DE_HH_01_WDA/517-03.30,0138
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