Q2 2013 | Triple Tree Presentation
May 24. 2013
Pipeline confidential & proprietary materials
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PipelineRx | Mission Statement
Combining its deep expertise, cognitive insights and robust
operating processes, Pipeline provides medication
management via clinical pharmacy services to ensure the
highest level of patient safety and optimal clinical outcomes.
Pipeline confidential & proprietary materials
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PipelineRx | Company Overview
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Company Profile
 Founded Q4 2009, 1st Paying Customer Q1 2010.
 Revenue run rate of $XX million, sales pipeline of over $XX million
 Qualified Lead to Close – Average Sales Cycle is 6 months.
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 100 Active Clinical Telepharmacists – all W-2 employees
 Clinically verified over 2.0 million medication line orders since inception
 Licensed in 28 States and Operate in 11 States.
Installed Customer Footprint
 41 clients ranging from 25 to 722 beds each and covering > 4,800 hospital beds
 2 notable 2012 accounts wins – UCSF and CHS (133 unit national chain)
 Typically experience a 30% order volume growth, 6 months post go-live with
hospital
 24x7 flexibility – ability to cover first, second and third shifts
Pipeline confidential & proprietary materials
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PipelineRx | Leadership Organization
• Brian Roberts – President
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 15 years of executive leadership in healthcare staffing and pharmacy services companies
 Former CEO of Canopy Healthcare Staffing, SVP of Business Development for CHG Healthcare
 Former healthcare venture capitalist for Acacia Venture Partners & Summit Partners
David White – CIO, SVP Operations
 20 years of Information Systems and Healthcare technology, development and leadership
 Stars Behavior Health, Posit Science, eBioCare (Curative Health)
Eric Carter – CTO
 XX years experience developing enterprise level healthcare IT solutions
 Former Evolute CTO and VP of Services
Chris Ciolko, RPh – SVP Business Development
 34 years of pharmacy, sales, and business development
 RPh on the Go, Cardinal Healthcare, Baxter Healthcare
Jeff Gustafson – Chief Financial Officer
 20 years of financial leadership
 Partner with Propeller Industries, CFO for high growth companies
Chuck Dunlap – National Sales Director
 20 years experience selling complex clinical IT solutions into acute care hospital sector
 Allscripts, McKesson and Meditech
Hong Lam, PharmD – Director of Pharmacy
 13 years of clinical pharmacist leadership with focus on formulary & drug management
 6 years of telepharmacy leadership experience
Pipeline confidential & proprietary materials
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PipelineRx | National Presence
Pipeline confidential & proprietary materials
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PipelineRx | Clinical Telepharmacy Services
• PipelineRx mirrors and extends the exact cognitive clinical
roles and responsibilities of the client hospital’s onsite clinical
pharmacists, 24/7.
• PipelineRx executes upon a client intimacy approach by
mapping to the hospital client’s exact clinical pharmacy
policies and procedures.
• Pipeline clinically verifies the safety of each and every
medication line order.
• A hospital’s clinical pharmacist process on average 17-20
medication line orders per hour; Pipeline’s clinical
telepharmacists process 30 medication line orders per hour.
Pipeline confidential & proprietary materials
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Future of Clinical Pharmacy
Enabling the ASHP Practice Model
• ASHP - Aspirational Goals
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Achieve 25-40% in labor savings
24x7 Pharmacy Coverage reduces exposure and liability
Deliver an ROI for the hospital
Increase clinical quality and patient safety
Address all pharmacy complexities, specialties and locations
• Pipeline – Business model to deliver these ASHP goals
 Create a comprehensive + on-demand pharmacist network
(CTPs)
 Codify a hospital’s idiosyncratic policies and procedures
 Deliver robust methodologies, processes and detailed order
documentation
 Eliminate traditional geographic barriers – recruit the highest
quality CTPs
Pipeline confidential & proprietary materials
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Current Hospital Reality | Challenges
• EHR Require Increased Level of Clinical Activity (CPOE,
BMV)
 Meaningful Use Deadlines
• Competing with Other Industries for Qualified Pharmacists
 Internal Competition for limited resources
 Skills Required (Clinical) vs. Skill Pool (Retail) Inconsistent
 Availability of Skilled Pharmacists within local recruiting area
• 24/7 Hospital Environment Creates Hiring Challenges
 PTO or Shift Differential creates unpredictable staffing
 Fulfill the complex hiring demands of the Night and Weekend
Shifts
Pipeline confidential & proprietary materials
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Telepharmacy | Competitive Landscape 1.0
• Hospital Providers
 Larger hospitals covering smaller affiliated hospitals
 When volumes spike, smaller hospitals are not the priority
 Longer turnaround times, limited hours and client clinical
responsiveness
• Third Party Legacy Providers
 Remote Order Processors
 Limited by Hours & PIS
 Discourage Clinical Interventions & push back orders
 Encourage High Volume Med Order Input – key metric is Order
Volume
 Call Center, Facility Based (Centralized) – limited recruiting
geographically
Pipeline confidential & proprietary materials
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Nascent Market Dynamics
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Today – CPO is Disorganized and Fragmented
 No clear lead company, guidelines or existence proof
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CPO is perceived to be of limited scope & value
 Replacing/augmenting existing pharmacy function
 Selling into complex ecosystems with no clinical standards and/or standard behavior
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Providers struggle to differentiate
 Poorly defined value proposition
 Forces many to structure offering based on lowest common denominators
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Prospective clients have bought into the image created by the industry
 Service providers don’t know how to change – price is their only lever
 Clients make “buying” decision based on cost & who provides least worst service
 Reinforces self-destructive behavior and creates a race to the bottom
Pipeline confidential & proprietary materials
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CPO Sales Process | Current Landscape
• Care Provider: Chief Nursing Officer
 Real power behind Telepharmacy buying decision – core driver is
Patient Safety
 Pipeline - demonstrate its ability to enable greater Patient Safety
• Directors of Pharmacy
 Limited power in economic buying decision but acts as a
Gatekeeper
 Under current budget constraints – considered a cost center
 Pipeline – articulate savings, create an advocate/evangelist
• C-Suite: Hospital Executives & Administrators
 Reacts to Regulatory Issues and Immediate Financial
Considerations
 Pipeline - enables regulatory compliance
 Pipeline - delivers an ROI of 2-3X in reduced labor overhead
Pipeline confidential & proprietary materials
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Telepharmacy | Competitive Landscape 2.0
• Emerging Providers – Clinical Telepharmacy
 Address Current Challenges of Hospital Pharmacy (Encourage Clinical
Interventions)
 Built on Patient/Medication Safety and Client Responsiveness
 Residence Office Based (De-Centralized) – greater/better skill sets to
choose
• HIPAA Compliant/Connectivity to Hospital’s Native PIS
• CTP teams built to meet Client Needs & Clinical Activities
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 Real-time - Medication Review, Verification, Resolution
 STAT order Prioritization
Dedicated Team of CTPs
 Trained on Individual Pharmacy Policies & Procedures, Nuances
 Remain Current on Individual Formulary and Clinical Initiatives
 Encourage Interaction and Real-time Access with Client’s Staff (Nursing
and Medical)
 Extensive Check-ins/outs with documentation
Pipeline confidential & proprietary materials
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Pipeline | Clinical Activities
• Process All Inbound Medication Orders
 Discontinued or Modified
 Received, Reviewed, Entered, or Verified
 Duplicate Orders
 Patient Demographic Additions or Changes
• Clinical Recommendations
 Consultation & Interaction - Nursing or Physicians/Hospitalists
 Therapeutic/Auto Substitution (i.e. IV to PO)
 Clinical Initiatives - Renal Dosing, Antibiotic Stewardship,
Duplicate Therapy
 Analysis - Labs, Allergy, Dosing, Drug/Drug Interactions
• Client Reporting and Coordinated Hand-offs
 Seamless front & back-end shift transitions
Pipeline confidential & proprietary materials
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PipelineRx | Competitive Differentiation &
Complementary Business Models
Legacy Telepharmacy Providers
PipelineRx’s Clinical Solution
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Night coverage only
Adult internal medicine only
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24/7 Coverage
Adult, Pediatrics, Oncology services
Essential CPOE & PIS conversions
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Compete on Price
Offer a clinical compromise
Offer a service compromise
Unsustainable in ACO environment
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Compete on demonstrated clinical value
No comprises
Zero lost clients on clinical quality
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1099 Contractors
Blend of Retail and Clinical Skills
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All W-2 Pipeline employees
65% hold PGY1 and PGY2 degrees
Average 7 years hospital experience
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Medication Order Approval Only
Regional Call Centers - bullpens
Rejected Orders on every shift
Slow Turnaround Times
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Medication Order Clinical Verification
Dedicated Pharmacy Work Teams
No Rejected Orders
Average Turnaround time of 8 minutes
STATS turnaround times are faster and are
flagged
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Loose on State Regulations
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Meet all State regulations
Exceed ASHP guidelines
Pipeline confidential & proprietary materials
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Technology Report | CPOE Inbound Integration Requirements
for Inbound Medication Order Integration into PipelineRx
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Gaining proper clinical data access: Requires third-party (PipelineRx) to have 24/7, 100% real-time, reliable access to the
hospital client’s internal UNVERIFIED medication order data. The required CPOE medication data fields exist today and
resides within the PIS (Pharmacy Information System). Currently, Pipeline gets this medication information via fax, scan.
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How does one get reliable access to this UNVERIFIED clinical data? Optimally, with advanced IT connectivity tools
embodied in a flexible, configurable and scalable integration engine that can simultaneously accommodate various hospital
EMR and PIS systems. Upon confirming due diligence in Q2/Q3 with 3 PIS vendors, (HMS, Allscripts and EPIC), without
scale, working directly with PIS vendors to build point-to-point integration to individual hospitals is sub-optimal.
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Do these hospital integration engines exist for this application? Yes, see the next slide for overview of the vetted IT HL7
integration vendor/partners.
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Why is this CPOE integrated approach considered transformative? Remote clinical telepharmacy services is a new industry,
no one has imagined the need to have real-time access this UNVERIFIED medication data OUTSIDE the processing
environment of the client’s PIS system. This distributed workflow approach is transformative, enabling Pipeline to effectively
create a scalable industry workflow standard – similar to the standards created by GE & Siemens in tele-radiology.
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Why is this novel? With the advent of CPOE (stimulated via Meaningful Use incentives) – for the first time, the inbound
medication order information to the pharmacy is now in an electronic format. With the UNVERIFIED data in an electronic
format it can be inbound integrated (automatically accepted) into PipelineRx and thereby eliminate the manually intensive
medication order entry requirements by Pipeline’s clinical telepharmacists. No one has monetized this fundamental sea
change of clinical pharmacy distributed clinical workflow. CPOE for care providers is analogous to retail banking consumers
inputting their own specific banking transaction requests at any remote ATM machine versus the labor intensive, facility
centric legacy teller process.
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How does CPOE increase demand for telepharmacy? The care provider is now under a real time electronic audit, creates
objective clinical workflow visibility. In addition, post CPOE, Pipeline as seen a 20-30% order increase per shift.
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For Pipeline, how significant an impact does this inbound integration have on the number of medication orders processed
per hour? This inbound integration will allow a Pipeline clinical telepharmacist to increase by 50% their productivity without
sacrificing any clinical quality or turnaround times from 30 to 45 medication orders per hour.
Pipeline confidential & proprietary materials
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PipelineRx | PipelineRx CPOE Integration
PipelineRx CPOE Inbound
Integration Workflow Schema
Hospital Computer Network
PipelineRx Innovation
Hospital 1
Hospital 2
Internal
Communication
Medication
Medication Order
Order
Entered
Entered via
via CPOE
CPOE
Pharmacy
Software Server
(PIS)
Unverified CPOE Order Data
Integration
Enables Inbound
PIS Data Capture
Integration
Enables PIS Data
Standardization
Integration
Enables workflow
efficiency
External
Communication
Internal
Communication
Consolidated
Work Queue
Pipeline
Pipeline Exchange
Exchange
PipelineRx
PipelineRx Order
Order
Management
Management
Telepharmacist
Telepharmacist
ORDER VERIFICATION
Existing Communication
Remote Access to
Hospital PIS
PipelineRx Innovation
Pipeline confidential & proprietary materials
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PipelineRx | PipelineRx CPOE Integration
PipelineRx CPOE Bidirectional
Integration Workflow Schema
Hospital Computer Network
PipelineRx Innovation
Hospital 1
Hospital 2
Integration
Enables Inbound
PIS Data Capture
Internal
Communication
Medication
Medication Order
Order
Entered
Entered via
via CPOE
CPOE
Integration
Enables Data
Standardization
External
Communication
Pharmacy
Software Server
(PIS)
Integration
Enables workflow
efficiency
Consolidated
Work Queue
Internal
Communication
Pipeline
Pipeline Exchange
Exchange
PipelineRx
PipelineRx Order
Order
Management
Management
PHC
PHC RPh
RPh
Unverified and Verified
CPOE Order Data
Existing Communication
PipelineRx Innovation
Pipeline confidential & proprietary materials
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CPOE Integration | Phase I and Phase II
Pipeline
Enters
orders
into client
PIS
Pipeline
Enters
orders
into
PipelineRx
Pipeline
Reviews
order data
Pipeline
approves
orders in
client PIS
Orders are
already
entered
into client
PIS
Pipeline
Enters
orders
into
PipelineRx
Pipeline
Reviews
order data
Pipeline
approves
orders in
client PIS
Orders are
already
entered
into client
PIS
Orders
already
entered
into
PipelineRx
Pipeline
Reviews
order data
Pipeline
approves
orders in
client PIS
Orders are
already
entered
into client
PIS
Orders
already
entered
into
PipelineRx
Pipeline
Reviews
order data
Pipeline
approves
orders in
PipelineRx
Current
Fax/scan
CPOE
No integration
CPOE
Integration
Bidirectional
Integration
Pipeline confidential & proprietary materials
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PipelineRx IT Platform
Strategy
Pipeline IT Platform Strategy
On-Demand Telepharmacy Solution
ON-DEMAND TELE-PHARMACY SOLUTION
Inbound Pharmacy Order Origin
Paper
Electronic
FAX / Scan
CPOE
PipelineRx
On-Demand Clinical Service
PIS
Order Management
Pharmacy Management
Exceed Thresholds
DISPLAY ONLY
Patient Data
Order Queue
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Clinically Verified Order
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Clinical Interventions
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Reporting / Analytics
Web-based, Cloud IT
Demographics
Past Orders
Lab Results
Inventory
Allergies
Physician
Nurse
Clinical Workflow
Incoming Order
Order Queuing System
Pharmacist
Perfected Order
Web-based & Client / Server
Client / Server
HL7 Transport
Bi-Directional Integration
Pipeline confidential & proprietary materials
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PipelineRx | CPOE Integration Progress
• Focus on Cerner, Meditech and McKesson Paragon – PIS
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vendors.
Largest impact with CPOE and Gross Margin for current
account installed base.
First Client – Canton-Potsdam (New York) – April 1 –
Meditech account.
Detailed CPOE rollout roadmap schedule – see attachment.
Pipeline confidential & proprietary materials
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Integration GM Impact | Phase I and II
• Post-CPOE
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 Fundamentally Reduce COGS/Order
 Improve GM
Established IT Product Development Roadmap | 3 Phases
 Phase 1: Incremental operational efficiency gain via UI (underway)
 Phase 2: Inbound CPOE Integration
 Achieve 45 orders/hour
 Phase 3: Full Integration through Uberqueue
 One User Screen and 100% Clinical Work Flow
 Achieve 60 orders/hour
• COGS/Script | Targeted Cost Reductions
 Today: PipelineRx | $2.07/order | at maximum of 30 orders/hour
 Q4/Q1: Inbound CPOE Integration | $1.38/order | 45 orders/hour | a
33% cost decrease
 2014: Uberqueue | $1.03/order | 60 orders/hour | a 50% cost decrease
 Remove actual costs – too sensitive and bankers and prospective
Pipeline confidential
proprietary
clients &(who
arematerials
potential competitors) do not need to know until
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Pipeline’s Role in a Health System’s Viability
Client
Challenges
Pipeline’s
Audience
Client’s Upside
• C-suite
• CNO
• DOP
Financial Incentives
IDN Consolidator
•Real Constraints
• C-suite
• CFO
Regulatory &
Accreditation:
• CNO
• DOP
Brand Recognition
• C-suite
• CNO
• DOP
Brand Recognition
Meaningful Use:
•New technologies
•Process changes
•Behavioral changes
Budget Reality:
Client’s Downside
↓ Reimbursement
•Patient safety
•Patient satisfaction
Assist:
PIS
eMAR/BMV/CPOE
ACO Environment
↑ Clinical Demands
↓ Financial Resources
Financial Penalties
24/7 requirements
•Joint Commission
•State Dept of Health
•MERP
Best Practices:
Pipeline’s
Value Proposition
Pipeline confidential & proprietary materials
Brand Risk
Cost-Effective:
Hard 3:1 ROI
Variable Costs
Compliance:
24/7 Coverage
Clinical Expertise:
Exceed
ASHP Guidelines
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CPO – Pharmacy – following the patient
Pipeline confidential & proprietary materials
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The Future of Telepharmacy
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Acute Care – multi-billion $ market
 Services Expansion - Day Work, ER Work, Discharge Planning
 Tactical – med reconciliation, rounding, remote monitoring, 24/7
 Large System Opportunities (C-Suite) – CHS, Vanguard, CHI, Ascension, HMA
New Distribution Channels
 CareFusion
 GPOs, Healthcare and Operational Consulting Firms
 Other telehealth providers and also national staffing firms
 Full Pharmacy Outsourcers – PharmaCare, CompleteRx
Specialty Hospitals and Outpatient Opportunities
 Heart, Psych, and other focused hospitals
 Rehab, LTACs – HealthSouth, Select Medical
 All have meaningful use requirements and labor constraints
Outpatient
 Long Term Care, Assisted Living, Home Care, Dialysis
 Outpatient pharmacies for hospitals
Other important pharmacy settings for remote model
 Retail pharmacy
 Prison Systems
 State and Federal Organizations – large
 Mail Order/PBMs - ExpressScripts
Acquisitions/Tuck-ins
 Both Pure Play mom/pop competitors and also Divisions of Larger Companies (CPS)
 Internal Telepharmacy Efforts within Health Systems – Adventist, Via Christi
Pipeline confidential & proprietary materials
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PipelineRx Core Assets:
• Technology
 PipelineRx IP and trade secrets
 Pipeline IT (Evolute)
 Uberqueue
• Proprietary Distributed Workforce Model
 Triage
 Home office based
 Highly experienced team of employee clinical tele-pharmacists
• State Legislative/Regulatory Experts
• Highest Quality Expert Pharmacists
Pipeline confidential & proprietary materials
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Benefits of PipelineRx’s Integration Into Larger
Organization
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Resources for Uberqueue
 Bidirectional Integration
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True Marketing Dollars
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Access to Established Distribution Strategy and Salesforce
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Activates and Accelerates our Values in a Profitable Manner
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Bundling
 Complementary of existing services
 Complementary of future services
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SCALE
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Ensure Highest Level of Patient Safety to all Patients at Lowest Cost
Pipeline confidential & proprietary materials
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PipelineRx
Partner Universe Spectrum
Drug Distribution
Clinical Services
Hospital
Patient Care
A.B.C.
Mckesson
Outsourcing
Players
CFN
Omnicell
Cardinal
CPS
Patient
Discharge/Homecare
Walgreens
CVS
PipelineRx
Pipeline confidential & proprietary materials
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PipelineRx
Partner Universe Spectrum
Partner Universe Spectrum
Drug Distribution
Clinical Services
• ABC
• Mckesson
Hospital Patient
Care
Outsourcing
Players
• CFN
• Omnicell
• Cardinal
• CPS
Patient
Discharge/Homecare
• Walgreens
• CVS
PipelineRx
Pipeline confidential & proprietary materials
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