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RTF Template

Gobierno De La Comunidad De Madrid

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products and Veterinary medicinal products

1. Authorisation Number	:	0060-MAD
2. Name of Authorisation Holder	:	Serviconsulting Farmalab S.L. (ORG-100036650 / LOC-100064124)
3. Address(es) of Site(s)	:	Calle Haya 15 1º Nave 10 P I Aguacate, Poligono Tamames-Aguacate, Madrid, 28044, Spain

4. Legally registered address of Authorisation Holder	:	Calle Haya 15 1º Nave 10 P I Aguacate, Poligono Tamames-Aguacate, Madrid, 28044
5. Scope of authorisation	:	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 wholesale distribution authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2025-05-07
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: Serviconsulting Farmalab S.L.

(ORG-100036650 / LOC-100064124)

, Calle Haya 15 1º Nave 10 P I Aguacate, Poligono Tamames-Aguacate, Madrid, 28044, Spain

Human medicinal products

Veterinary 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

2.5. Other activities(s): (please specify) ALMACÉN POR CONTRATO (CONTRACT WHOLESALE)

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1. Narcotic or psychotropic products**

3.3. Other products: (please specify here or make a reference to Annex 5) MEDICAMENTOS VETERINARIOS/VETERINARY MEDICINAL PRODUCTS)

**Without prejudice to further authorisations as may be required according to national legislation.

Union Format for a Wholesale Distribution Authorisation	0060-MAD
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