1. Authorisation Number

:

DE_TH_01H_WDA_2023_04

2. Name of Authorisation Holder

:

Lichtenau-Apotheke Frank Keiner e.K.

(ORG-100041297 / LOC-100067987)

3. Address(es) of Site(s)

:

Benshaeuser Strasse 2, Benshausen, Zella-Mehlis, Thuringia, 98544, GERMANY 

4. Legally registered address of Authorisation Holder

:

Benshaeuser Strasse 2, Benshausen, Zella-Mehlis, Thuringia, 98544

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

:

2023-09-11

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

Name and address of the site: Lichtenau-Apotheke Frank Keiner e.K.

(ORG-100041297 / LOC-100067987)

, Benshaeuser Strasse 2, Benshausen, Zella-Mehlis, Thuringia, 98544, GERMANY   

Human medicinal products

Any restrictions or clarifying remarks (for all users):  ref. 2.3: Supply only within collection by customer ("ex works")

zu 2.3: Nur Abgabe im Rahmen einer Abholung ("ex works")

*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_TH_01H_WDA_2023_04

Page 1