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RTF Template

Landesdirektion Sachsen

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_SN_01/L24-5114/1003/12
2. Name of Authorisation Holder	:	Gregor Wendler
3. Address(es) of Site(s)	:	Frankenberger Straße 207, Chemnitz, 09131, Germany

4. Legally registered address of Authorisation Holder	:	Frankenberger Straße 207, Chemnitz, 09131, Germany
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	:	2015-04-14
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: Falken-Apotheke Inh. Gregor Wendler e.K.

, Frankenberger Straße 207, Chemnitz, 09131, Germany

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

2.4. Export

Any restrictions or clarifying remarks (for all users): This authorisation does not apply for wholesale distribution of medicinal products which need to be stored at cool, cold, refrigerator, or freezer conditions.

Diese Erlaubnis gilt nicht für den Großhandel mit kühl oder tiefgekühlt zu lagernden Arzneimitteln.

*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	DE_SN_01/L24-5114/1003/12
	Page 1

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