1. Authorisation Number

:

1850 H

2. Name of Authorisation Holder

:

Urgo SA

3. Address(es) of Site(s)

:

Chaussée de Ruisbroek 76, Bruxelles, 1180, Belgium 

4. Legally registered address of Authorisation Holder

:

Chaussée de Ruisbroek 76, Bruxelles, 1180, Belgium

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

:

2020-09-16

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

Name and address of the site: Urgo SA

, Chaussée de Ruisbroek 76, Bruxelles, 1180, Belgium   

Any restrictions or clarifying remarks (for all users):  2.1.
Also procurement of medicinal products from others country of European Community (or from the European Economic Space) than Belgium

2.1.
Egalement acquisition de médicaments via d'autres pays de la Communauté européenne (ou de l'Espace Economique Européen) que la Belgique

*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

1850 H

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