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RTF Template


Federal Agency For Medicines And Health Products

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products


1. Authorisation Number

:

114 H

2. Name of Authorisation Holder

:

Pharmacies Populaires De Verviers Et Arrondissement

(ORG-100016067 / LOC-100079504)

2.a. Alternative name of authorisation holder (optional)

:

Pharmacies Populaires De Verviers Et Arrondissement S.C.

3. Address(es) of Site(s)

:

Rue De L Avenir 12, Thimister-Clermont, 4890, Belgium 




4. Legally registered address of Authorisation Holder

:

Rue De L'Avenir 12, Thimister-Clermont, Liege, 4890

4.a. Additional details on units inspected of registrant's legal address (optional)

:

PPVA

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

:

2026-09-01

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: Pharmacies Populaires De Verviers Et Arrondissement

(ORG-100016067 / LOC-100079504)

, Rue De L Avenir 12, Thimister-Clermont, 4890, Belgium   



Human medicinal products


1. MEDICINAL PRODUCTS

   1.1. with a Marketing Authorisation or registration 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. Narcotic or psychotropic products** 

   3.2. Products requiring low temperature handling 

     3.2.1. Temperatures between 2 to 8 °C 




Any restrictions or clarifying remarks (for all users):  2.3 Full line wholesaler

2.3 Grossiste-répartiteur



**Without prejudice to further authorisations as may be required according to national legislation.













Union Format for a Wholesale Distribution Authorisation

114 H


Page 1





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