Pharmacy service is the last and critical step for client’s services in hospitals. Since the ultimate health outcome is determined by appropriate selection, quantification, procurement and rational use of pharmaceuticals, pharmacy services should be designed to provide assurance that quality and safety is maintained at all stages of service provision. Pharmacy chapter of the previous version of Ethiopian Hospital Reform Implementation Guideline (EHRIG) prepared in 2010, guided hospitals in the implementation of critical operational standards. It helped hospitals in the delivery of quality services and enabled Ministry of Health, Regional Health Bureaus and hospitals to evaluate their performance using predefined indicators. Consequently, commendable achievements have been registered in terms of improving pharmacy service delivery. Currently, many operational standards set in the first version have been achieved by majority of hospitals in the country. Following the launching of the Health Sector Transformation Plan (HSTP) and its emphasis to increasing equity and quality of health care, hospital pharmacy services are expected to have substantial contributions in realizing this vision by rendering measurable and better quality services in a more responsible and accountable. Moreover, within the last five years, Ethiopian hospitals have been implementing a number of initiatives including APTS and Clinical pharmacy services which were not adequately addressed in the operational standards of the first version. Therefore, it is found necessary to update operational standards and implementation guidance so as to reflect these and other new developments such as chronic diseases management and provision of poison information. In addition, there was a need to develop robust measurement approaches and applicable indicators that are in line with the health sector expectations in the coming five years. Therefore, the standards and guidance set in this chapter are designed to align with and support hospital pharmaceutical services to meet the demands of the health sector transformation plan of the nation.