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RTF Template

National Authority of Medicines and Health Products, I.P.

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	A029/21/H/001/2021
2. Name of Authorisation Holder	:	Efervescente, Design E Comunicação Lda. (ORG-100035726 / LOC-100056583)
3. Address(es) of Site(s)	:	Praceta Da Flamenga 1, Loures, 2660-260, Portugal Rua Joao Fandango 9 B Loja, Loures, 2670-529, Portugal

4. Legally registered address of Authorisation Holder	:	Praceta Da Flamenga 1, Loures, 2660-260
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 National legal basis of authorisation: Art. 94.º of Decree-law 176/2006, of 30th August
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2021-12-28
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: Efervescente, Design E Comunicação Lda.

(ORG-100035726 / LOC-100056583)

, Praceta Da Flamenga 1, Loures, 2660-260, Portugal

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

Any restrictions or clarifying remarks (for all users): The scope of this Wholesale Distribution Authorisation is restricted to the distribution of the Kits "Syringe Exchange Program".

WDA scope activity - Wholesale Distributor.

The Authorisation number A029/21/H/001/2021 replaces the previous one with the Authorisation number A019/18/H/001/2018, of 2018-07-20.

Name and address of the site: Efervescente, Design E Comunicação Lda.

(ORG-100035726 / LOC-100064923)

, Rua Joao Fandango 9 B Loja, Loures, 2670-529, Portugal

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

*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	A029/21/H/001/2021
	Page 1

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