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RTF Template

Chief Pharmaceutical Inspectorate

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	IZOH.5100.128.2024.AKE.3
2. Name of Authorisation Holder	:	Berlin-Chemie Menarini Polska Sp. z o.o. (ORG-100010775 / LOC-100055733)
3. Address(es) of Site(s)	:	Ul. Rajdowa 9, Konotopa, Ozarow Mazowiecki, 05-850, Poland

4. Legally registered address of Authorisation Holder	:	Zygmunta Slominskiego 4, Warsaw, 00-204
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	:	2026-09-22
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: Berlin-Chemie Menarini Polska Sp. z o.o.

(ORG-100010775 / LOC-100095188)

, Ul. Rajdowa 9, Konotopa, Ozarow Mazowiecki, 05-850, Poland

Human medicinal products

1. MEDICINAL PRODUCTS

1.1. with a Marketing Authorisation or registration in EEA country(s)

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

Any restrictions or clarifying remarks (for all users): Zakres zastrzeżeń jest zbyt obszerny i przekracza wielkość niniejszej rubryki. Zastrzeżenia należy sprawdzać w Rejestrze Hurtowni Farmaceutycznych lub bezpośrednio w decyzji udzielającej zezwolenia na prowadzenie hurtowni farmaceutycznej.

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

Union Format for a Wholesale Distribution Authorisation	IZOH.5100.128.2024.AKE.3
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