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RTF Template

Landesamt Fuer Arbeitsschutz Soziales Und Gesundheit Schleswig-Holstein

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	DE_SH_01_WDA_2020_0001
2. Name of Authorisation Holder	:	Queisser Pharma GmbH & Co. KG (ORG-100000726 / LOC-100002550)
3. Address(es) of Site(s)	:	Schleswiger Strasse 74, Flensburg, Schleswig-Holstein, 24941, Germany Bregenberg 11, Handewitt, 24976, Germany

4. Legally registered address of Authorisation Holder	:	Schleswiger Strasse 74, Suedstadt, Flensburg, Schleswig-Holstein, 24941
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	:	2020-01-09
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: Queisser Pharma GmbH & Co. KG

, Schleswiger Strasse 74, Flensburg, Schleswig-Holstein, 24941, 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

2.4. Export

Any restrictions or clarifying remarks (for all users): National legal basis of authorisation:
§ 52 a Section 1 of German Drug Law (Arzneimittelgesetz)

Name and address of the site: Queisser Pharma GmbH & Co. KG

, Bregenberg 11, Handewitt, 24976, Germany

Human medicinal products

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.2. Holding

2.3. Supply

2.4. Export

Any restrictions or clarifying remarks (for all users): National legal basis of authorisation:
§ 52 a Section 1 of German Drug Law (Arzneimittelgesetz)

Union Format for a Wholesale Distribution Authorisation	DE_SH_01_WDA_2020_0001
	Page 1

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