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RTF Template

Chief Pharmaceutical Inspectorate

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	NOH.5100.35.2017.1103.MG.4
2. Name of Authorisation Holder	:	Med Interplast Sp. z o.o. (ORG-100038117 / LOC-100080378)
3. Address(es) of Site(s)	:	Ul. Laurowa 7, Barszczewo, Podlaskie, 16-070, Poland

4. Legally registered address of Authorisation Holder	:	Ul. Mariana Zdziechowskiego 3 Lok 79, Warsaw, 02-659
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	:	2026-01-20
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: Med Interplast Sp. z o.o.

(ORG-100038117 / LOC-100103130)

, Ul. Laurowa 7, Barszczewo, Podlaskie, 16-070, Poland

Human medicinal products

1. MEDICINAL PRODUCTS

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

1.3. without a Marketing Authorisation or registration in the EEA and intended for exportation

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

2.4. Export

Union Format for a Wholesale Distribution Authorisation	NOH.5100.35.2017.1103.MG.4
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