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RTF Template

Department Of Occupational Health And Safety Customer Protection And Health

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	DE_BB_01_WDA_2023/G3-6300.GH/M1_Aesthetics/04/01.01.2023/CE_01
2. Name of Authorisation Holder	:	M1 Aesthetics GmbH (ORG-100017339 / LOC-100026666)
3. Address(es) of Site(s)	:	Lilienthalstrasse 3a, Waltersdorf, Schoenefeld, Brandenburg, 12529, Germany

4. Legally registered address of Authorisation Holder	:	Lilienthalstrasse 3a, Waltersdorf, Schoenefeld, Brandenburg, 12529
5. Scope of authorisation	:	ANNEX 1
6. Legal basis of authorisation	:	§ 52a German Drug Law
7. Name of responsible officer of the competent authority of the member state granting the wholesale distribution authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2023-01-01
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: M1 Aesthetics GmbH

(ORG-100017339 / LOC-100026666)

, Lilienthalstrasse 3a, Waltersdorf, Schoenefeld, Brandenburg, 12529, 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

2.3. Supply

2.4. Export

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1.1. Narcotic or psychotropic products

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): The seat (office) of the company M1 Aesthetics GmbH is in 12529 Schönefeld, Lilienthalstr. 3 a.

Storage and logistics are carried out on the premises of Dr. Holz Pharmaservice GmbH, Ludwig-Prandtl-Str. 47, 12526 Berlin.

In accordance with the present delimitation of responsibility agreement, storage/logistics is carried out using the rooms and the staff of Dr. Holz Pharmaservice GmbH.

Union Format for a Wholesale Distribution Authorisation	DE_BB_01_WDA_2023/G3-6300.GH/M1_Aesthetics/04/01.01.2023/CE_01
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