The Auditable pharmaceutical transaction and service (APTS) system is a set of datadrivenrninterventions to establish responsible, transparent, and accountable pharmacy practice.rnIt also optimizes utilization of medicine budget, improves access to medicine, workflow,rngenerates reliable information for decision making, and improves patient satisfaction.rnPharmaceutical transactions and facilities were particularly vulnerable to mismanagementrndue to a lack of transparency and accountability due to a lack of transparency andrnaccountability, which resulted in poor planning, decision-making, prescribing andrndispensing, and reporting, risking both the availability and usage of medicines. The objectivernof this study is to assess the outcomes of APTS implementation using the five APTS resultrnareas in Tikur Anbessa Specialized Hospital. A facility based cross-sectional descriptivernstudy design was employed by using a structured questionnaire on pharmacy professionalsrnand patients who received pharmacy service at TASH. Key informant interviews werernconducted with the hospital's pharmacy director, finance director, and internal auditor, andrndirect observation of the availability of medications was also used. A systematic randomrnsampling technique was maintained to recruit the study population. Descriptive statisticsrnwere computed using the statistical package for social sciences version 22.The vast majorityrnof pharmacists (68.5%, 72.6%, and 90.4%) believe that APTS provides employmentrnopportunities for pharmacists, and improves the transparency of drug transactions andrnpharmacy record keeping practices respectively. 65.8% of them agreed that APTS is vital tornimproving pharmacy services. But, 56.1% of them were dissatisfied with their jobs.rnxrnIncreased workload, attrition rates among pharmaceutical professionals, and delays inrncreating an indemnity policy and the lack of a performance management and reward systemrnwere the major challenges. Medicine availability is 63.3% at stores and 55% at dispensaries.rnThe findings were not comparable to the APTS-implemented public hospitals in Gamo Gofarnwhere 85 percent of patients were enrolled. [Carmichael JM et al, 2017], Dessie referralrnhospital (84%) [Kasahun Bogale .., et al 2021], and Amanueal mental hospital (84%)rn[Alemayehu Y, et al, 2017] of the patients reported that prescribed drugs were available.rn65.5% of patients were dissatisfied with the availability of certain drugs. The labelingrninformation is lower than the WHO recommendation (100%). More than half of pharmacistsrnand 34.5% of patients said auditable pharmaceutical transactions and services satisfied them.rnSeveral obstacles hampered the pharmacy service's smooth adoption. To improvernpharmaceutical service, it is recommended that workload be determined, indemnity and otherrnincentive mechanisms be implemented, management ownership be taken on, and follow uprnbe done.