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Actelion Pharmaceuticals Ltd

AC-065A303
Subject Dispensation Confirmation

Fax: +1 703-814-8501 ICON Clinical Research Web: http://icophone.iconplc.com
ICOPhone Help Desk: Dial ATT 0808-03-4288 then 888-426-8801

This document contains confidential information and is intended only for the use of the individual or entity named on
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Site Information

User Name: Constantinescu Tudor

Investigator Name: Miron Bogdan

Site Number: 6901

Date/Time: 01/Nov/2013 12:27pm EET


Subject Information

Subject Number 22649

Visit Description Visit 3 (Week 8)

Dose N/A

Bottle Numbers Assigned 574262, 574263, 574264, 574265, 574266, 574267, 574268,
574269, 574270

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