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RTF Template

Bezirksregierung Köln

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	53.6/11-03-3
2. Name of Authorisation Holder	:	Faust Apotheke
3. Address(es) of Site(s)	:	Grabenstraße 83, Eschweiler, 52249, Germany

4. Legally registered address of Authorisation Holder	:	Grabenstraße 83, Eschweiler, 52249, Germany
5. Scope of authorisation	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesale distribution authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2011-05-31
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: Faust Apotheke

, Grabenstraße 83, Eschweiler, 52249, Germany

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

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 Städteregion Aachen (CityRegion Aachen) with the responsible officer Ms Mitra Mielke 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 Städteregion Aachen mit der ausstellenden Mitarbeiterin Mitra Mielke. Lediglich aus technischen Gründen erscheint die Bezirksregierung Köln und ein Mitarbeiter der Bezirksregierung Köln in diesem elektronischen Eintrag. Maßgebend ist die Originalurkunde.

Union Format for a Wholesale Distribution Authorisation	53.6/11-03-3
	Page 1

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