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RTF Template

Health Products Regulatory Authority

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	W11515/00003
2. Name of Authorisation Holder	:	Air Liquide Healthcare Ireland Limited (ORG-100014650 / LOC-100023069)
3. Address(es) of Site(s)	:	Smithstown, Shannon, Limerick, V14 N568, Ireland

4. Legally registered address of Authorisation Holder	:	25-28 North Wall Quay, North Wall, Dublin 1, D01 H104, Ireland
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	:	2020-06-29
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: Air Liquide Healthcare Ireland Limited

(ORG-100014650 / LOC-100093371)

, Smithstown, Shannon, Limerick, V14 N568, Ireland

Human medicinal products

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.2. Holding

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.3. Other products: (please specify here or make a reference to Annex 5) Please see restrictions or clarifying remarks (for all users).

Any restrictions or clarifying remarks (for all users): 3.3.1 Prescription only medicinal productsThe scope of this wholesale distribution authorisation is restricted to the holding of medicinal gases on behalf of Air Liquide Healthcare Ireland Limited (W11515/00001)3.3.14 Medicinal gases

Union Format for a Wholesale Distribution Authorisation	W11515/00003
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