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RTF Template


Bezirksregierung Koeln

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products


1. Authorisation Number

:

DE_NW_04_WDA_2021-0171

2. Name of Authorisation Holder

:

Ipsum Pharmavertrieb GmbH

3. Address(es) of Site(s)

:

Schulstr. 24, Overath, 51491, Germany  Suspended




4. Legally registered address of Authorisation Holder

:

Schulstr. 24, Overath, 51491

5. Scope of authorisation

:

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 wholesale distribution authorisation

:

Confidential, Confidential

8. Signature

:


9. Date

:

2021-06-07

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: Ipsum Pharmavertrieb GmbH

, Schulstr. 24, Overath, 51491, Germany    Suspended



Human medicinal products


1. MEDICINAL PRODUCTS

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


2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

   2.1. Procurement 

   2.3. Supply 

   2.5. Other activities(s): drop shippmentStreckengeschäft



Any restrictions or clarifying remarks (for all users):  Only X-ray contrast media are traded in drop shipping.

Es werden ausschließlich Röntgenkontrastmittel im Streckengeschäft gehandelt.















Union Format for a Wholesale Distribution Authorisation

DE_NW_04_WDA_2021-0171


Page 1





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