Five companies account for 76.1% of the 340B contract pharmacy market, according to Drug Channels.
Since Congress established the 340B program in 1992, the program has expanded to include 32,069 participating pharmacies — nearly 60% of all U.S. drug stores, according to the report.
340B requires drugmakers to provide discounts to select healthcare providers. Eligible facilities include children’s hospitals, federally qualified health centers and disproportionate-share hospitals.
This market has become increasingly concentrated with the “340 big five,” according to the report. Drug Channels analyzed companies with the most contractual pharmacy relationships in 2025:
1. CVS Health — 77,000 contract pharmacy relationships
2. Walgreens Boots Alliance — 51,000
3. Walmart — 19,000
4. Express Scripts (Cigna) — 15,000
5. Optum Rx (UnitedHealth Group) — 13,000
In 2010, HHS’ Health Resources and Services Administration, which oversees the program, allowed 340B entities to access discounted prices at an unlimited number of contract pharmacies. These relationships grew from 42,290 in 2016 to 229,531 in 2025, according to the report.
A mail-order and specialty pharmacy can operate as a contract pharmacy for hundreds of 340B covered entities, while an average retail pharmacy is a contract location for fewer than five entities, according to Drug Channels.
