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RTF Template

Ministerie van Volksgezondheid Welzijn en Sport

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	5159 G
2. Name of Authorisation Holder	:	Novo Nordisk B.V. (ORG-100000230 / LOC-100098463)
3. Address(es) of Site(s)	:	Koningin Wilhelminaplein 2 C, Amsterdam, Noord-Holland, 1062 HK, Netherlands

4. Legally registered address of Authorisation Holder	:	Koningin Wilhelminaplein 2 C, Amsterdam, Noord-Holland, 1062 HK
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	:	2026-05-19
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: Novo Nordisk B.V.

(ORG-100000230 / LOC-100098463)

, Koningin Wilhelminaplein 2 C, Amsterdam, Noord-Holland, 1062 HK, Netherlands

Human medicinal products

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.3. Supply

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.2. Products requiring low temperature handling

3.2.1. Temperatures between 2 to 8 °C

Union Format for a Wholesale Distribution Authorisation	5159 G
	Page 1

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