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RTF Template

State Medicines Control Agency under the Ministry of Health of the Republic of Lithuania

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	0135
2. Name of Authorisation Holder	:	Uždaroji akcinė bendrovė "MORFĖJUS"
3. Address(es) of Site(s)	:	Žalgirio g. 93-42, Vilniaus m. sav., Vilniaus m., LT-08218, Lithuania

4. Legally registered address of Authorisation Holder	:	S. Žukausko g. 34-3, Vilniaus m. sav., Vilniaus m., LT-08235, Lithuania
5. Scope of authorisation (complete for each site under 4)	:	ANNEX 1
6. Legal basis of authorisation	:
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2005-05-19
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: Uždaroji akcinė bendrovė "MORFĖJUS"

, Žalgirio g. 93-42, Vilniaus m. sav., Vilniaus m., LT-08218, Lithuania

1. MEDICINAL PRODUCTS

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

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.3. Supply

2.4. Export

Any restrictions or clarifying remarks (for all users): Agreement No. 19-644 of 15 December 2003 with UAB „ARMILA", Molėtų pl. 75, Vilniaus m., Vilniaus m. sav. Lithuania (Wholesale Distribution Authorisation No. 0125). Wholesale distribution operations performed according to the agreement: reception of medicinal products, holding (warehousing), collection and transportation.

2003-12-15 sutartis Nr. 19-644 su UAB "ARMILA", Molėtų pl. 75, Vilniaus m., Vilniaus m. sav. (Didmeninio platinimo licencija Nr.0125). Pagal sutartį vykdomi didmeninio platinimo veiksmai: vaistinių preparatų priėmimas, laikymas (saugojimas), surinkimas ir transportavimas.

*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	0135
	Page 1

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