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RTF Template

Behoerde Fuer Gesundheit Und Verbraucherschutz Der Freien Und Hansestadt Hamburg

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	DE_HH_01_WDA/517-02.13/01,0461
2. Name of Authorisation Holder	:	MGF Via Medical GmbH (ORG-100046903 / LOC-100077422)
3. Address(es) of Site(s)	:	Alter Wall 32, Hamburg-Altstadt, Hamburg, 20457, Germany

4. Legally registered address of Authorisation Holder	:	Alter Wall 32, Hamburg-Altstadt, Hamburg, 20457
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	:	2024-12-09
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: MGF Via Medical GmbH

(ORG-100046903 / LOC-100077422)

, Alter Wall 32, Hamburg-Altstadt, Hamburg, 20457, Germany

Human medicinal products

1. MEDICINAL PRODUCTS

1.2. without a Marketing Authorisation or registration in the EEA and intended for EEA market*

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.3. Supply

2.5. Other activities(s): (please specify) Storage at at a contracted companyLagerung bei einem beauftragten Betrieb

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1. Narcotic or psychotropic products**

Any restrictions or clarifying remarks (for all users): Ref. 2.: Drop shipment only
Ref. 3.1.1: subject to a corresponding permit in accordance with Section 3 of the German Narcotics Act (BtMG)

Zu 2.: nur Streckengeschäfte
Zu 3.1.1: vorbehaltlich einer entsprechenden Erlaubnis nach § 3 Betäubungsmittelgesetz (BtMG)

*Art. 5 of Directive 2001/83/EC, Art. 83 of Regulation (EC) 726/2004 and Art. 110 of Regulation 2019/6.

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

Union Format for a Wholesale Distribution Authorisation	DE_HH_01_WDA/517-02.13/01,0461
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