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RTF Template

Austrian Agency For Health And Food Safety

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products and Veterinary medicinal products

1. Authorisation Number	:	481081
2. Name of Authorisation Holder	:	Jacoby GM Pharma GmbH (ORG-100001589 / LOC-100007855)
3. Address(es) of Site(s)	:	Emil-Hoelzel-Weg 56, Klagenfurt Am Woerthersee, 9073

4. Legally registered address of Authorisation Holder	:	Teichweg 2, Au, Hallein, Salzburg, 5400
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 Art. 99 of Regulation (EU) 2019/6
7. Name of responsible officer of the competent authority of the member state granting the wholesaling authorisation	:	Confidential, Confidential
8. Signature	:
9. Date	:	2001-09-03
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: Jacoby GM Pharma GmbH

(ORG-100001589 / LOC-100007867)

, Emil-Hoelzel-Weg 56, Klagenfurt Am Woerthersee, 9073

Human medicinal products

Veterinary medicinal products

1. MEDICINAL PRODUCTS

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

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.1. Procurement

2.2. Holding

2.3. Supply

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.1.1. Narcotic or psychotropic products

3.1.2. Medicinal products derived from blood

3.1.3. Immunological medicinal products

3.3. Cold chain products(requiring low temperature handling)

Any restrictions or clarifying remarks (for all users): Jacoby GM Pharma GmbH; Ad 3.3: Arzneimittellagerung bei / storage of medicinal products at -80 – -60°C / -25 – -15°C

Jacoby GM Pharma GmbH; Ad 3.3: Arzneimittellagerung bei / storage of medicinal products at -80 – -60°C / -25 – -15°C

*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	481081
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