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RTF Template

Agence nationale de sécurité du médicament et des produits de santé

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	MD 14/83
2. Name of Authorisation Holder	:	LOGIPHARM
3. Address(es) of Site(s)	:	ZONE INDUSTRIELLE RUE DE LA PEROUSE, BLANQUEFORT, 33290, France

4. Legally registered address of Authorisation Holder	:	ZONE INDUSTRIELLE RUE DE LA PEROUSE, BLANQUEFORT, 33290, France
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	:	2014-05-26
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: LOGIPHARM - BLANQUEFORT

, ZONE INDUSTRIELLE RUE DE LA PEROUSE, BLANQUEFORT, 33290, France

1. MEDICINAL PRODUCTS

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

1.2. without a Marketing Authorisation in the EEA and intended for EEA market

2. AUTHORISED WHOLESALE DISTRIBUTION OPERATIONS

2.2. Holding

2.3. Supply

2.4. Export

Any restrictions or clarifying remarks (for all users): This site is authorized as a wholesale distributorthe wholesale distributor shall not export medicinal products when acting by order and on behalf of licensed pharmacists of pharmacy or structures mentioned in article D. 5125-24-16

Cet établissement est grossiste-répartiteur le grossiste-répartiteur ne doit pas distribuer de médicaments en dehors du territoire national quand il agit d'ordre et pour le compte de pharmaciens titulaires d'officine ou de structures mentionnées à l'article D. 5125-24-16

*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	MD 14/83
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