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RTF Template

Department of Occupational Health and Safety, Customer Protection and Health

UNION FORMAT FOR A WHOLESALE DISTRIBUTION AUTHORISATION

1. Authorisation Number	:	G3-5423/critical_care/01/30.06.2016
2. Name of Authorisation Holder	:	Critical care Gesellschaft fuer home care Medizintechnik mbH & Co. KG
3. Address(es) of Site(s)	:	Berliner Allee 7 a, Fehrbellin, 16833, Germany

4. Legally registered address of Authorisation Holder	:	Bollweg 11, Schmalfeld, Schleswig-Holstein, 24640, 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	:	2016-06-30
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: critical care Gesellschaft für home care Medizintechnik GmbH & Co.KG

, Berliner Allee 7 a, Fehrbellin, 16833, 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

3. MEDICINAL PRODUCTS WITH ADDITIONAL REQUIREMENTS

3.2. Medicinal gases

Any restrictions or clarifying remarks (for all users): The Wholesale of compressed gas cylinders is carried out on the premises according to the map from 14.05.2008 .

Der Großhandel mit Druckgasflaschen wird in den Räumen gem. dem Lageplan vom 14.05.2008 durchgeführt.

*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	G3-5423/critical_care/01/30.06.2016
	Page 1

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