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RTF Template

Apothekerkammer Niedersachsen

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	DE_NI_05_WDA_2022_0055
2. Name of Authorisation Holder	:	Jürgen Boom
3. Address(es) of Site(s)	:	Bahnhofstrasse 89, Brake, 26919, Germany

4. Legally registered address of Authorisation Holder	:	Bahnhofstr. 89, Brake, 26919
5. Scope of authorisation (complete for each site under 4)	:	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 wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2022-11-24
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: Weser Apotheke Inh. Juergen Boom

(ORG-100040294 / LOC-100065688)

, Bahnhofstrasse 89, Brake, 26919, Germany

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

3.1.1. Narcotic or psychotropic products

3.1.2. Medicinal products derived from blood

3.1.3. Immunological medicinal products

3.3. Cold chain products(requiring low temperature handling)

Any restrictions or clarifying remarks (for all users): - Point 3.1.1 does not include substances and preparations that are narcotics within the meaning of § 1 Narcotics Act (BtMG) and which are listed in the currently valid version of Annexes I and III to the BtMG

- The permit is valid for the operating space shown on the site plan on November 4, 2022.

- Punkt 3.1.1 umfasst keine Stoffe und Zubereitungen, die Betäubungsmittel im Sinne des § 1 Betäubungsmittelgesetz (BtMG) sind und welche in der jeweils gültigen Fassung der Anlagen I und III zum BtMG aufgelistet sind.
- Die Erlaubnis gilt für den am 4. November 2022 im Lageplan angezeigten Betriebsraum.

*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	DE_NI_05_WDA_2022_0055
	Page 1

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