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RTF Template

Freie und Hansestadt Hamburg, Ministry of Justice and Consumer Protection

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	DE_HH_01_WDA/516-11.03/019,001
2. Name of Authorisation Holder	:	Vita-Apotheke e.K. (ORG-100040127 / LOC-100065142)
3. Address(es) of Site(s)	:	Heussweg 37, Eimsbuettel, Hamburg, 20255, Germany

4. Legally registered address of Authorisation Holder	:	Heussweg 37, Eimsbuettel, Hamburg, 20255
5. Scope of authorisation (complete for each site under 4)	:	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 wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2022-02-10
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: Vita-Apotheke e.K.

(ORG-100040127 / LOC-100065142)

, Heussweg 37, Eimsbuettel, Hamburg, 20255, Germany

Human medicinal products

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1.2. Medicinal products derived from blood

3.1.3. Immunological medicinal products

3.3. Cold chain products(requiring low temperature handling)

Any restrictions or clarifying remarks (for all users): see Annex 1 of Wholesale Distribution Authorisation

The owner of the license to wholesale medicinal products is Ms. Sarina Melanie Tilgner e.K., owner of the operating license to run the Vita pharmacy

siehe Anlage 1 der Erlaubnis zum Großhandel mit Arzneimitteln

Inhaberin der Erlaubnis zum Großhandel mit Arzneimittel ist Frau Sarina Melanie Tilgner e.K., Inhaberin der Betriebserlaubnis zum Führen der Vita-Apotheke

*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_HH_01_WDA/516-11.03/019,001
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