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RTF Template

Bezirksregierung Köln

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	531/253.24.11-GH1
2. Name of Authorisation Holder	:	Simon Jakob Gosk
3. Address(es) of Site(s)	:	Uferstr. 47, Köln, 50996, Germany

4. Legally registered address of Authorisation Holder	:	Eygelshovener Str. 13, Köln, 50996, Germany
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2020-09-09
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: sigopharm e.K. Pharma Großhandel

, Uferstr. 47, Köln, 50996, Germany

1. MEDICINAL PRODUCTS

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

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): This WDA has been registered for datatechnical reasons by the Bezirksregierung Köln (District Government of Cologne) in EUDRA GMDP.
Issue oft he original document and competent authority is the Stadt Köln (City Cologne) with the responsible officer Dr. Simone Schmidt Only for technical reasons the Bezirksregierung Köln and an officer of the Bezirksregierung Köln appear in this electronic entry. Decisive is the original document.

Diese Großhandelserlaubnis ist aus datentechnischen Gründen von der Bezirksregierung Köln in EUDRA GMDP eingetragen worden.
Aussteller der Originalurkunde und zuständige Behörde ist die Stadt Köln mit der ausstellenden Mitarbeiterin Dr. Simone Schmidt. Lediglich aus technischen Gründen erscheint die Bezirksregierung Köln und ein Mitarbeiter der Bezirksregierung Köln in diesem elektronischen Eintrag. Maßgebend ist die Originalurkunde.

*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	531/253.24.11-GH1
	Page 1

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