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RTF Template

Landesamt für soziale Dienste Schleswig-Holstein

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	DE_SH_01_WDA_2015_0004
2. Name of Authorisation Holder	:	G. Pohl-Boskamp GmbH & Co. KG
3. Address(es) of Site(s)	:	Kieler Strasse 11, Hohenlockstedt, 25551, Germany Kaddenbusch 4 und 11, Daegeling, 25578, Germany

4. Legally registered address of Authorisation Holder	:	Kieler Strasse 11, Hohenlockstedt, 25551, 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	:	2015-03-12
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: G. Pohl-Boskamp GmbH & Co. KG

, Kieler Strasse 11, Hohenlockstedt, 25551, Germany

1. MEDICINAL PRODUCTS

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

1.3. without a Marketing Authorisation in the EEA and intended for exportation

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): National legal basis of authorisation:
§ 52 a Section 1 of German Drug Law (Arzneimittelgesetz)