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RTF Template

Ministry Of Health Welfare And Sport

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products


1. Authorisation Number

:

109269 G

2. Name of Authorisation Holder

:

Msa B.V.

(ORG-100044461 / LOC-100073474)

3. Legally registered address of Authorisation Holder

:

Euroweg 21, Amersfoort, 3825 HA

4. Address(es) of Site(s)

:

Euroweg 21, Amersfoort, 3825 HA, Netherlands 

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

:

2023-05-01

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: Msa B.V.

(ORG-100044461 / LOC-100073474)

, Euroweg 21, Amersfoort, 3825 HA, Netherlands   



Human medicinal products


1. MEDICINAL PRODUCTS

  1.1 with a Marketing Authorisation in EEA country(s)


2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS


  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

















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