Bill Mather, a pharmacist in Greenfield, Iowa, wants to make sure that his neighbor can dispense medicine without driving long distances or waiting long hours.

Therefore, when chain pharmacies and large-scale stores began to expand into the rural market, he sold his pharmacy to Pamida, a grocery chain under Shopko Department Store, in 2007, hoping that this would allow his business to continue. Then, in 2019, when Shopko declared bankruptcy and closed more than 360 stores, he and another Shopko pharmacist helped open a new pharmacy in the city of about 2,000 people.

Across the country, when large chain pharmacies and large stores with pharmacies exit small communities, pharmacists like Mather are filling the vacancies. In some areas, pharmacists who were fired when large chain stores closed are now opening new pharmacies, usually in the same location. In other areas, pharmacy owners from neighboring towns are opening new branches. Without them, many communities would not have pharmacies.

It was not like this before. Hypermarkets like Shopko started to enter the pharmacy market 30 years ago, hoping that customers can fill their trolleys while the store dispenses them. Large chain stores have established beachhead positions in small towns by acquiring independent pharmacies or eliminating them.

According to the US Bureau of Labor Statistics, the number of pharmacists employed in hypermarkets peaked in 2012, exceeding 31,800. But with the growth of online sales and mail delivery of consumer goods and prescription drugs, there is no reason for hypermarkets to stay. By 2019, the number of large pharmacies had fallen to less than 18,000. (The bureau no longer reports the number.)

“Large stores enter smaller and smaller communities and, in essence, they outperform all other pharmacies in the area in competition,” said David Zgarik, Professor of Pharmacy at Northeastern University, Boston. “Now they are completely gone, pharmacy services and everything they provide are gone. They have left a vacuum in many places.”

With CVS Health recently announcement 300 stores will be closed every year for the next three years, and more towns may lose another tier of pharmacies: large chain pharmacies. CVS has not yet revealed which stores will be closed.

“We consider many factors when making these decisions, including local market dynamics, demographic changes, store density, and the needs of underserved communities,” said Mike DeAngelis, a spokesperson for CVS Health. “In fact, throughout the pandemic, reaching out to underserved people has been our top priority, such as obtaining the tests and vaccines we provide.”

Kathleen Bashur Spokesperson National Chain Pharmacy Association, Indicating that chain pharmacies of various types and sizes play an important role in meeting the health and healthcare needs of communities across the country. “The decision to close a store was a difficult decision,” she said.

Zgarik attributed most of the decline in large pharmacies to Amazon and other online merchants, which undermined the profitability of its non-pharmacy sales. In the past, large stores could treat pharmacies as loss-making leaders and make up for their income by selling other goods. Now, Zgarrick says, large stores have to ask tricky questions about how to allocate space: “After all, how do we maximize revenue per square foot? Is it by owning a pharmacy or selling tires?”

Nelson Lichtenstein, Professor of History, University of California, Santa Barbara, chronicle The rise of Wal-Mart says that large stores are constantly re-evaluating their store locations, closing lower-margin stores, and opening new stores where they think they can make money.

“They just maintain a slow drain,” he said.

Lichtenstein said that the cost of building a large store is about 10 million U.S. dollars, and the annual revenue of such a store can reach 200 million U.S. dollars. Therefore, if revenue drops, leaving a certain location is not a huge loss for large companies.

“So they will close the store and leave a destroyed town because Wal-Mart has let others close down,” he said.

Wal-Mart did not answer questions about its closure.

Driven by people shopping at home during the covid-19 pandemic, online selection of various commodities has increased, which has put further pressure on large stores.

“Compared with five years ago, they are less likely to do that kind of roaming shopping now,” said Adam Hartung, a business strategy consultant. Spark partners“They won’t say,’Oh, let’s get a prescription, and while we are here, let’s walk through the store to see the vacuum cleaner.’ This won’t happen again.”

Hartung said that there is a surplus of stores in the US retail market, which is as high as 40% compared with other countries, and more large stores may close in the next few years.

However, the closure provides an opportunity for regional chain stores or pharmacists who are willing to strike on their own.

In Orofino, Idaho, after Shopko withdrew, the mayor, chamber of commerce and many residents appealed to Rod Arnzen, a pharmacist. So Arnzen started delivering goods to Orofino from his store in Kamiah, 23 miles away. Then, he opened a branch in Orofino in the building left by the pharmacy that sold the business to Shopko.

Andy Pottenger, who owns a pharmacy in Lewiston, Idaho, 45 miles away, opened his first store in Orofino, a population of about 3,000, after receiving hundreds of responses. Two pharmacies.

“It’s overwhelming,” he said. “This reinforces the idea that we should do this.”

In Montana, after Shopko closed, Mike Matovich, a third-generation pharmacist, opened stores in Roundup and Hardin.

“This is a pretty large community, and there is a hospital and clinic in the town,” Matovic said of Roundup. “Suddenly, people drove 50 miles to replenish sick children with antibiotics in a way.”

Matovic has seen what happens when a rural community loses its only pharmacy.

“If there were hospital clinics and pharmacies, they would do quite well,” Matovic said. “Once you lose one of them, the community will start to struggle because people start to leave to get closer to healthcare.”

For the residents of Greenfield, Iowa, Shopko’s decision meant they had to scramble. Shopko sold the pharmacy record to a Walgreens 50 miles away. Some people turn to nearby Hy-Vee grocery stores in Atlantic or Winterset, Iowa, or Wal-Mart in Creston—each of which is at least half an hour’s drive away. Others switched to mail order.

“It’s a mess,” said Rachel Hall, a former Shopko pharmacist. “People are trying to figure out what to do and where to send the prescription.”

Mather, Hall, and other staff at Greenfield received only one week’s notice after being told they didn’t need to worry. Their pharmacy has been one of the fastest growing locations for chain stores.

“We did have Shopko trophies, but we threw them away when we left,” Hall said.

A former Shopko executive contacted by KHN declined an interview request. Shopko Optical, which operates in 11 states, said it is no longer associated with Shopko Stores and declined to comment.

Mather and Hall didn’t want to give up Greenfield. They contacted NuCara, a chain of 30 retail pharmacies in five states, and agreed to help them open a pharmacy in their city.

NuCara opened pharmacies in two other communities vacated by Shopko. Brett Barker, vice president of NuCara Pharmacy, said that in Cokato and North Branch, Minnesota, NuCara works with pharmacists who previously sold pharmacies to Shopko.

In Greenfield, before Shopko officially closed, Hall and Mather were prohibited from introducing customers to the new NuCara pharmacy. Hall stated that Shopko’s management wanted to maintain the value of the customer files it sold to Walgreens. Therefore, Hall and Mather asked the local chamber of commerce to release news.

They found temporary space in a local hospital, which moved the billing office to accommodate them. A year later, they moved back to their original location in the old Shopko building and rented space from the new owner who runs a home furnishing store there.

After serving three generations of Greenland customers, Mather breathed a sigh of relief. There is also a pharmacy in the town. But he couldn’t understand how Shopko ended things.

“The way they slammed the door, I was really upset,” Mather said. “It’s not fair to everyone in Greenfield’s pharmacy and the people in Greenfield. Shopko doesn’t care at all.”

However, this move gave Mather a complete victory. Greenfield still has a pharmacy, just like when he started at Murdy Drug in 1968. It’s just a different storefront with a new name on the sign.