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RTF Template

Chief Pharmaceutical Inspectorate

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

Human medicinal products

1. Authorisation Number	:	GIF-N-411/659/1-3/MSH/12
2. Name of Authorisation Holder	:	Merkury S.A. (ORG-100037749 / LOC-100059582)
3. Address(es) of Site(s)	:	Ul. Sejnenska 16, Bialystok, 15-399, Poland

4. Legally registered address of Authorisation Holder	:	Ul. Sejnenska 16, Bialystok, 15-399
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	:	2025-09-01
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: Merkury S.A.

(ORG-100037749 / LOC-100059582)

, Ul. Sejnenska 16, Bialystok, 15-399, Poland

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

2.2. Holding

2.3. Supply

2.5. Other activities(s): (please specify) *Patrz zastrzeżenia lub uwagi wyjaśniające

Any restrictions or clarifying remarks (for all users): Obrót hurtowy ograniczony do produktów leczniczych dopuszczonych do obrotu w sklepach zielarsko-medycznych oraz sklepach ogólnodostępnych, wymagających przechowywania w temperaturze pokojowej.
* Pkt 2.5 Usługi logistyczne w zakresie obrotu hurtowego na rzecz podmiotów odpowiedzialnych, wytwórców, importerów i przedsiębiorców zajmujących się obrotem hurtowym produktami leczniczymi.

Union Format for a Wholesale Distribution Authorisation	GIF-N-411/659/1-3/MSH/12
	Page 1

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