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RTF Template

Bezirksregierung Detmold

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_NW_02_WDA_2019_0029/24.05.02-041
2. Name of Authorisation Holder	:	Westfalen Medical GmbH
3. Address(es) of Site(s)	:	Werner-von-Siemensstr. 14, Gütersloh, 33334, Germany

4. Legally registered address of Authorisation Holder	:	Industriestraße 26, Brachbach, 57555, 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	:	2019-11-14
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: Westfalen Medical GmbH

, Werner-von-Siemensstr. 14, Gütersloh, 33334, 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

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.2. Medicinal gases

Any restrictions or clarifying remarks (for all users): The authorisation is limited to wholesale with medical oxygen (liquid oxygen)

Großhandel mit medizinischem Sauerstoff (Flüssigsauerstoff)

Union Format for a Wholesale Distribution Authorisation	DE_NW_02_WDA_2019_0029/24.05.02-041
	Page 1

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