OBJECTIVE To describe telepharmacy-related services and outcome. METHODS Suburban western Washington State during 2007 to 2008. METHODS Five network clinics without in-house pharmacies are remotely connected to a central pharmacy to provide telepharmacy services. METHODS Automated drug dispensing system (ADDS) units, webcams, and electronic medical charts were used to provide remote medication order processing/dispensing, patient counseling, refill authorizations, and medication assistance referral services. METHODS Patient demographics; numbers of dispensed medications, patient consultations, refill authorizations, and service referrals; pharmacist feedback; and workflow changes. RESULTS At five network sites, 12,000 patients received 3,282 new prescriptions per month with webcam-enabled consultations, 589 monthly refill prescriptions, 2,800 pharmacist-provided refill authorizations, and 250 medication assistance referrals. Antibiotics were the most frequently dispensed medications. Pharmacists commented that webcam-enabled interviews provided better privacy and longer counseling duration. Six new staff members (one pharmacist and five pharmacy technicians) were added. Workspace and staff responsibilities were reassigned to facilitate medication prepackaging and ADDS prescription processing. CONCLUSIONS Expanded application of telepharmacy technology can improve patient access to pharmaceutical care beyond remote medication dispensing to include point-of-care refill authorization and medication assistance referrals. Further research to explore patient-focused services and to assess economic, humanistic, and clinical outcomes of telepharmacy services is needed.