1. Authorisation Number

:

0119

2. Name of Authorisation Holder

:

Berlin Chemie Menarini Baltic UAB

(ORG-100003346 / LOC-100009817)

3. Address(es) of Site(s)

:

Sirvintu R Sav, Klonenu Vs. 1, Sirvintu R. Sav., Vilnius County, 19156, Lithuania 

4. Legally registered address of Authorisation Holder

:

Jasinskio Str. 16a, Vilnius, 01112

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

:

2005-04-27

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: Berlin Chemie Menarini Baltic UAB

(ORG-100003346 / LOC-100064821)

, Sirvintu R Sav, Klonenu Vs. 1, Sirvintu R. Sav., Vilnius County, 19156, Lithuania   

Human medicinal products

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

Union Format for a Wholesale Distribution Authorisation

0119

Page 1