1. Authorisation Number

:

1941 V

2. Name of Authorisation Holder

:

Medista

(ORG-100039348 / LOC-100082484)

2.a. Alternative name of authorisation holder (optional)

:

Medista N.V.

3. Address(es) of Site(s)

:

Rue Camille Hubert 22, Gembloux, 5032, Belgium 

4. Legally registered address of Authorisation Holder

:

Hermesstraat 5, Zaventem, Vlaams-Brabant, 1930

5. Scope of authorisation

:

ANNEX 1

6. Legal basis of authorisation

:

Art. 99 of Regulation (EU) 2019/6

7. Name of responsible officer of the competent authority of the member state granting the wholesale distribution authorisation

:

Confidential, Confidential

8. Signature

:

9. Date

:

2025-06-25

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: Medista

(ORG-100039348 / LOC-100096659)

, Rue Camille Hubert 22, Gembloux, 5032, Belgium   

Veterinary medicinal products

*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

1941 V

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