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RTF Template

Landesamt für soziale Dienste Schleswig-Holstein

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_SH_01_WDA_2021_0001
2. Name of Authorisation Holder	:	Philco Pharma - Carsten Philipps (e. K.)
3. Address(es) of Site(s)	:	Barkholt 63 - 65, Großhansdorf, 22927, Germany

4. Legally registered address of Authorisation Holder	:	Barkholt 63 - 65, Großhansdorf, 22927, 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	:	2021-01-11
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: Philco Pharma - Carsten Philipps (e. K.)

, Barkholt 63 - 65, Großhansdorf, 22927, 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

2.4. Export

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

Outsourced activities: storage of medicinal products
Contract company: HANSE-SERVICE Internationale Fachspedition GmbH
Site address: Dratelnstr. 18, 21109 Hamburg, Germany

*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_SH_01_WDA_2021_0001
	Page 1

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