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RTF Template

Chief Pharmaceutical Inspectorate

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	NZOH.5100.18.2023.AKE.3
2. Name of Authorisation Holder	:	Geodis Poland Sp. z o.o. (ORG-100045211 / LOC-100074586)
3. Address(es) of Site(s)	:	Building C4, Ul. Moszna-Parcela 29, Moszna-Parcela, Brwinow, 05-840, Poland

4. Legally registered address of Authorisation Holder	:	Ul. Postepu 17b, Warsaw, 02-676
5. Scope of authorisation (complete for each site under 4)	:	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 wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2025-06-26
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: Geodis Poland Sp. z o.o.

(ORG-100045211 / LOC-100078355)

, Building C4, Ul. Moszna-Parcela 29, Moszna-Parcela, Brwinow, 05-840, 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*

1.3. without a Marketing Authorisation or registration in the EEA and intended for exportation

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.2. Holding

2.3. Supply

2.4. Export

2.5. Other activities(s): (please specify) Patrz Zastrzeżenia uwagi pkt 2.5

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.3. Other products: (please specify here or make a reference to Annex 5) 3.4.4 produkty lecznicze bardzo silnie działające, określone we właściwej Farmakopei, 3.4.5 zioła 3.4.4 (Medicinal products with very strong effect, 3.4.5 Herbs

Any restrictions or clarifying remarks (for all users): Zastrzeżenia pkt 2.5 - usługi logistyczne i transportowe w zakresie obrotu hurtowego na rzecz podmiotów odpowiedzialnych, wytwórców, importerów i przedsiębiorców zajmujących się obrotem hurtowym.

*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	NZOH.5100.18.2023.AKE.3
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