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RTF Template

State Medicines Control Agency under the Ministry of Health of the Republic of Lithuania

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	0940
2. Name of Authorisation Holder	:	UAB Laisva prekyba
3. Address(es) of Site(s)	:	Gedimino pr. 28, Vilniaus m. sav., Vilniaus m., LT-01104, Lithuania

4. Legally registered address of Authorisation Holder	:	Gedimino pr. 28, Vilniaus miesto sav., Vilniaus m., LT-01104, Lithuania
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	:	2021-06-14
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: UAB Laisva prekyba

, Gedimino pr. 28, Vilniaus m. sav., Vilniaus m., LT-01104, Lithuania

1. MEDICINAL PRODUCTS

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

1.2. without a Marketing Authorisation in the EEA and intended for EEA market

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.3. Supply

2.4. Export

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1.3. Immunological medicinal products

3.3. Cold chain products(requiring low temperature handling)

3.4. Other products: Medicinal products of human or animal origin, biotechnological, herbal, homeopathic Žmogaus ar gyvūninės kilmės, biotechnologiniai, augaliniai, homeopatiniai preparatai.

Any restrictions or clarifying remarks (for all users): Agreement on service No. MS-E-21-003 of 22 March 2021 with UAB „VILNIAUS TRANZITAS" , Jurgio Dobkevičiaus g. 7, Vilniaus m., Vilniaus m. sav., Lithuania (Wholesale Distribution Authorisation No. 0865). Wholesale distribution operations performed according to the agreement: reception, holding (storage) and collection of medicinal products.

2021-03-22 paslaugos sutartis Nr. MS-E-21-003 su UAB "VILNIAUS TRANZITAS", Jurgio Dobkevičiaus g. 7, Vilniaus m., Vilniaus m. sav. (Didmeninio platinimo licencija Nr. 0865). Pagal sutartį vykdomi didmeninio platinimo veiksmai: vaistinių preparatų priėmimas, laikymas (sandėliavimas) ir surinkimas.

*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	0940
	Page 1

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