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RTF Template

Gobierno Del Pais Vasco

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	48808
2. Name of Authorisation Holder	:	Cardiva 2 S.L. (ORG-100035323 / LOC-100056015)
3. Address(es) of Site(s)	:	Poligono La Cruz Parcela P 5-2, Lezama, 48196, Spain

4. Legally registered address of Authorisation Holder	:	Blq A 1, Calle De Anabel Segura 11, Alcobendas, 28108
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:	Real Decreto 782/2013, de 11 de octubre
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2023-02-14
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: Cardiva 2 S.L.

(ORG-100035323 / LOC-100065108)

, Poligono La Cruz Parcela P 5-2, Lezama, 48196, Spain

Human medicinal products

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

3.3. Cold chain products(requiring low temperature handling)

Any restrictions or clarifying remarks (for all users): REPRESENTANTE LOCAL EN ESPAÑA DEL MEDICAMENTO EU/1/06/361/001 Luminity 150 microlitros/ml gas y disolvente de Lantheus EU limited

REPRESENTANTE LOCAL EN ESPAÑA DEL MEDICAMENTO EU/1/06/361/001 Luminity 150 microlitros/ml gas y disolvente de Lantheus EU limited

*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	48808
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