Pharmacy Ownership Doesn't Have to Wait: A Conversation With Josuah Tilus

Introduction

Host Sonja Pagniano, Executive Director of the NCPA Foundation, interviews guest Josuah Tilus, Owner of Chinook Pharmacy in Forks, Washington. The episode focuses on Josuah's journey to pharmacy ownership and the experiences that led him to ownership, right out of pharmacy school.

Interview

Sonja: Welcome to the Script Your Future podcast from the NCPA Foundation. I'm Sonja, the Executive Director of NCPA Foundation, and today I'm excited to be joined by Josuah Tilus. Josuah, thanks so much for taking the time to speak with us today. Where are you joining us from?

Josuah: Thank you so much, Sonja. I'm coming from Forks, Washington, out in the Pacific Northwest. I just came back from The Cascadia Pharmacy Group's ownership meeting, so I'm coming back supercharged, ready to get back into the action, back in Forks in my store.

Sonja: Excellent. Well, I know our listeners will be eager to hear your story of becoming a pharmacy owner right out of pharmacy school. But before we dive in, could you tell us a bit about yourself and your background that initially led you to pursue pharmacy?

Josuah: Yeah, so I'm originally from Fort Lauderdale, Florida, so pretty far away. Both of my parents are from Haiti, and they came to America to give my sister and I a better life. My mother's a home care nurse, and that's kind of how I got exposed to the pharmacy profession. After shadowing her for a day, I recognized that I probably don't want to be a nurse in the future. It's just a little too hands-on for me. I don't mind doing that for my immediate family, but it's a tough job.

Sonja: Sure.

Josuah: Not for everybody, but I was really fascinated by the medications. Seeing how does this little pill affect the body, for better or for worse, and I asked what profession does that? And she said pharmacy. That was back in fifth grade, and ever since then, it was pretty much set. I know a lot of people kind of experiment with a lot of career paths, and I did too in high school, but it was pretty clear pharmacy was the way for me.

Sonja: That's very, very cool that that started so early for you.

Sonja: So you're quoted in our 2024 annual report saying that your dream of pharmacy ownership began when you stepped into a pharmacy about seven years before. What was it about that experience that first sparked your interest in pharmacy ownership?

Josuah: Yeah, so the pharmacy I went to was Atlantis Pharmacy in Lake Worth, Florida, in a subsidy called Atlantis. Ever since I came in, it was awesome that the owner and all the other pharmacists and even the staff knew everybody by name. It was really cool that they connected with the community and they really served them well.

But I also liked the business side. The fact that if my boss, Dr. Damian Simmons, wanted to make a change, he would just talk to a couple of the techs and talk to one of the pharmacists and implement it that day.

Sonja: Oh, wow.

Josuah: Instead of, you know, months or years of red tape to eventually get told no. I just love the nimbleness of independent community pharmacies. Specifically, we're like the jet skis versus the big cruise ships of the big chains. We can bend, we're more nimble, and we can really serve our population better. I love the fact that I get to serve patients, but also build a great system. That duality of the business and the patient care is what I loved. So I knew that what my boss was doing is what I wanted to do.

Sonja: That was a great analogy of the difference between the two. I always say that as well. I feel like independent community pharmacies can be so much more nimble. And I mean, we see that with our work with disaster relief. They're the first ones out there getting stuff running again.

Sonja: So what inspired you or gave you the confidence to pursue pharmacy ownership directly out of pharmacy school?

Josuah: Yeah, when I first thought about ownership and how to do that, most people were like, "Well, you want to work in a chain for 10 years, get some experience and some capital, and do all that."

Sonja: Right, right.

Josuah: Even thinking about it now, it was really part of what the foundation does. The foundation provides some scholarships for students to go to the ownership workshop. I did that as a first-year because I knew I wanted to be an owner and needed to find the people who do that. That's how I found NCPA and found that scholarship to go to the ownership workshop.

I'm a 2020 start for pharmacy school, so we started in COVID. That workshop was actually virtual.

Sonja: Oh, so also the COVID situation affected you.

Josuah: Yes, that's also woven into my story. But it was the last day, and they had a Q&A session with people from the McKesson RX ownership team. I asked, "Hey, I'm a new student in pharmacy school, really want to own a pharmacy. I've been told it takes like 10 years and all that. What's your perspective?" A couple were like, "That's usually wise," but a couple of them said, "No, you can actually own earlier and there are models and junior partnerships and things to allow access earlier."

05:45: They kind of inspired me to say, "Hey, if there's even a 1% chance that this can happen right out of school, I'm going to dive in for it and see if it happens. And if I don't meet the stars, I'll land on the moon. I'll get someplace great." They really catapulted me to say, "Okay, we can do this right out of school."

Sonja: That's definitely unusual to go to the ownership workshop so early as a pharmacy student, but how lucky were you to do that? And during COVID when things were virtual, to have the courage to ask the question of "Is this possible? Can I do this?"

Josuah: Oh yeah, praise God it's been... I didn't even really think until now - that was really a seed in my brain. I think they saw that and thought, "Hey, there's this ambitious young kid. You don't know where this will go, but if we can help him along in the journey and kind of light a spark and ignite something..." And honestly, they really did.

There are some other people in NCPA like Ken Thai out in California, who's on the board of NCPA as well. He said, "Hey, I started owning a pharmacy in my second year after graduating, and my only regret was not doing it right when I got out."

Sonja: Okay, so that was probably a really good mentor for you too.

Josuah: Yeah, I did a rotation with him in my fourth year. I got to see the 986 Pharmacy Group as well. They're really innovative and expanding quickly. I got to do about five business plans with him, so he really helped me build a business acumen of how to look at a location, analyze the financials, and analyze whether this is a good store to buy or not, which really helped me.

Sonja: Now, I know the ownership workshop was several years ago for you, but do you remember some specific aspects of it that were really helpful to you as you were going for ownership?

Josuah: Honestly, I actually went twice. I went as a first-year, and then knowing that ownership was more imminent in my fourth year, I went again.

I'd say for anybody thinking about it, especially students, I definitely highly recommend the ownership workshop. It not only gives you some of the skills and tools, especially if you don't have a distinct business background (I was blessed with an MBA), but even with that, there's still a lot to the business of pharmacy and buying a pharmacy - what the banks are looking for, what the lawyers are looking for, the team you need to grab and get ahold of. The workshop provides a really solid foundation for what anybody will need to own a pharmacy. That’s the main piece, and that’s awesome.

And then there's the networking - getting to meet some 20-plus store owners, hearing their experience of ownership and what it's really like to own. They all say the hardest part about ownership is the ownership of ownership - that everything ends with you.

Sonja: Yeah, it's all your responsibility.

Josuah: So if the lights go out or there's a break-in, it's yours. You can't just clock in and clock out - it becomes kind of like a child. Their insight and perspective, as well as the perspective of the people around you, it’s the beauty of school. In school, you're not alone in your journey - there are classmates that you get to fight through school together with.

In the same way, the ownership workshop creates a little class of people who are all going to fight this beast of ownership together. I'm still in contact with four or five of us who were around my table. We connect and text back and forth with questions.

So between the raw teaching the education part of the ownership workshop and the networking, I'd say it's a class I've done - I've done every ownership-type education besides POLA as a student, and by far the NCPA RxOwnership workshop had the highest ROI in terms of prepping me for ownership besides my MBA.

Sonja: Excellent. So speaking of NCPA and NCPA's ownership workshop, what was your experience like with the student chapters at NCPA that eventually led to you becoming the student leadership council president?

Josuah: Yeah, so it's funny. NCPA was a very small chapter at my school when I first came, but I thought, "Hey, these are the independent people, so these are my people." At the end of my first year, the current president of that student chapter pulled me aside and said, "Hey, our entire e-board is P3s, all of us are going to go into P4 year, our last rotation year, and we don't have anybody else on the e-board besides you, our P1 liaison. Would you mind running for president?"

I was like, "Hey, this would be awesome." I think we grew our chapter from about six people to about 30 in three months, so we grew by like 500%. Honestly, running a chapter is like a microcosm of running a business, and it taught me that I love business and management.

I realize there are two kinds of work - there's the work that’s good work, but still feels like work, and when I was building a program or preparing for a speaker or preparing to speak, I would lose myself in that, so I knew I found a passion of mine through the NCPA student chapter - I love management and I love people, and what can I do to build a system to make the team more successful so… at the end of the day, it's not about me being awesome because I built this chapter - it's really about the group of six of us that got us to that point. Seeing where they all are now - a couple are in residencies, a couple are junior partners or about to buy a pharmacy - and seeing how all of them became successful through the one year that I got to work with them.

I knew I was built for management, and that's how I met Carlie Traylor.

Sonja: Oh, okay.

Josuah: Yeah, she was the Director of Student Affairs and Strategic Initiatives at NCPA at the time. I think she moved to McKesson, but through that experience, I met her, and she showed me that what I was doing at the local level was awesome, and she could see my passion for independent community pharmacy.

From there, I got invited to apply to the Student Leadership Council, which I'd still say, and I tell every student to this day, well, it got me this pharmacy, so in terms of ROI, is the highest ROI experience as a student, is really the networking I got with the 16 other students around the country, learning how to run a bigger operation…really catapulted me to solidify that I’m built for administration, leadership, and management. I wouldn’t trade those moments for the world.

It also got me into conferencing. I think my final number from the four years in school was about 31 conferences.

Sonja: Oh my gosh, that's so many.

Josuah: And I know at least a third of those were NCPA.

Sonja: Wow. So you definitely dove right into all of the different resources that are available to you, especially in terms of networking. Like you said, those connections you make are priceless, and you never know when one door is going to open up to another one.

Sonja: So I have to know, though, how you managed to grow the student chapter so exponentially. Was it just that no one had ever really taken the time to ask people to join, or what was the recipe for success there?

Josuah: Yeah, as you work, you find your strengths. I'd say the highest ROI for growth was our career fair. Usually, people approach career fairs with all the alphabet soup organizations.

Sonja: Yeah, yeah.

Josuah: And all the first-year students are like, "What is all going on?" The main thing we focused on - I usually had a bigger group, about five people instead of the usual one or two to show presence.

Sonja: Okay, so you're like, it doesn't matter that this is half our people.

Josuah: Yes, it's who shows up that matters. And my goal wasn't to sell our organization - it was to guide students to their future in whatever ways we could. That meant for maybe 20% of people who came to our booth, we were actually pointing them to other booths.

Sonja: Okay, okay.

Josuah: And that's okay because the point is not to sell us - the point is to help them find their future. Actually, more people respected that about us because they thought, "Hey, these guys just care about us."

Sonja: Yeah.

Josuah: "They just care about us and our future. Even if it's not with them, we had a great conversation with this little NCPA team, and community pharmacy doesn't seem that bad."

From those conversations, and showing that, and having very concrete benefits - we had programs where they would know or meet an owner by the end of the year, have an experience, get connections to future employers, so a job could be in the pipeline. When we had tangible benefits that we knew the students needed (we also offered community service hours at our school; so you could get 2 hours with us serving the homeless), so with a concrete operation behind us, people saw that this wasn't just a bunch of smiling faces - there was substance behind us. We looked active and we cared about them.

I've noticed even as a hiring manager now, the best way I motivate my employees is that I have a good system around them so they feel supported, and I care about them. With that, we pretty much got about a third of the first-years that year.

Sonja: Yeah, you're building trust and relationships as an honestly expert relationship builder, because that method you were talking about is actually what's recommended for fundraising.

Josuah: Exactly.

Sonja: 17:56 Because it's not so much about raising the funds for your organization - it's about showing how much you care about the mission and the work that you're doing. Whether you're a student representing a chapter or you're an owner of a pharmacy, when you are true to those values and the work that you're doing, it's contagious. People want to be part of that. So that's truly a testament to you also just as a person having that natural gift. That's incredible.

Josuah: Thank you. And it's honestly fun - it's awesome to see people grow in that way. Even now, thinking of the 30 students and where they all are now - a lot of them didn't end up in independent community pharmacy, but a lot of them have a respect for it and know we're not just retail, which is one of our main goals at NCPA. We're not the big chains - we really are the beautiful hybrid of community and patient care [with] the clinical side too.

Sonja: Let's set the scene. Your pharmacy is pretty rural, right? So my understanding is it's the only pharmacy within 50 miles of your community.

Josuah: Yes, the other pharmacy is about an hour and 15 minutes away.

Sonja: Okay, so what drew you to establish a pharmacy there?

Josuah: Yeah, finding that pharmacy was a testament to the connections through NCPA. I didn't really know about this store at all and wasn't looking for rural healthcare - I just stumbled upon it.

As an NCPA SLC member, we get to be on some of the national committees to get exposure to the main operations of NCPA and kind of where they are going. The first day when committees start, they fly everybody out to DC. We meet as a group, talk about different initiatives in the committees, and then have dinner afterward.

At that dinner, there were about 20 of us in the group. I was in the developing opportunities committee, honestly with the top 1% of innovators in community pharmacy all at the same table. I remember there was this really tall guy sitting across from me - didn't know him, just chatting. As the SLC president, I had told pretty much the entire board and everybody I knew, including Carlie, that I wanted to own right out of school, so if they knew anybody who is selling, let me know.

That really tall guy, Jeff Harrell - I think the current NCPA board president...

Sonja: Yeah, current NCPA board president.

Josuah: Just looked at me out of the blue - never met him - and said, "Hey, I think I have a store for you. I'll help pay your loans. I'll give you a good salary and equity in the business if you can move 3,000 miles away."

Sonja: Oh my gosh.

Josuah: I was like, "Tell me more. Where is it?" And I was thinking, "Is this real?" He said, "Yeah, look up Forks, and we'll talk tomorrow." And afterwards, he talked about being an owner and the opportunities you can get. That night, we got home around 11, and from 11 to midnight… I'm looking up Forks…

I'm like, "Okay, this is besides Twilight. What's the demographic like?" And I thought, "This is actually really cool." We talked about it the next day, and he explained that when you're so rural, insurance companies play nicer with you.

Sonja: Good point.

Josuah: Because if you say no to their plan, they essentially lose access to that region. And we serve three tribes as well - the Makah tribe, the Quileute, and the Hoh tribe.

Sonja: Okay.

Josuah: The tribes you need to play nice with as well. From there, I was like, "Okay, I need to see it." I'm a Florida guy, so if I'm going to move...

Sonja: Right, right. You're talking Washington state versus Florida. That's so different geography-wise.

Josuah: And it's funny because I'm a pretty simple guy. All I need is a church, a gym, a bed, and a desk, and I could pretty much live anywhere. But the only thing I asked was, "I just don't want Montana snow. I don't want to have to shovel snow for 20 minutes before I can get to work."

Sonja: Okay.

Josuah: And he said, "Well, good news, there's no snow. There's just like 130 inches of rain a year."

Sonja: Right. There's so much rain.

Josuah: I thought, "I think I can deal with rain."

Sonja: But Florida has rain too, doesn't it? So I guess it's comparable.

Josuah: Yes, it's different though. Forks is like a constant mist that doesn't end for several months. Florida's like a downpour at two o'clock for the four months of spring - that really muggy, humid…

Versus here it's dry but wet, if that makes sense - just not humid. So he flew me out there during December. I made sure to visit during the more undesirable time in Forks.

Sonja: That's smart. That's just like what they say about buying a house - make sure it's on a really crappy day so you can see if there are leaks or other issues they're not disclosing.

Josuah: Exactly. The old owners at the time, Chuck and Pura, really showed me the beauty of Forks, the lay of the land, and the cool opportunities you can do here.

The beauty of Forks is that there are only a few providers in the area, so they're all very close. I've already had dinner with a couple of PAs, so there's really strong collaboration. All the innovative practice models that they talk about - collaborative practices, - things I learned through NCPA - point of care testing, leaning into long-term care at home - all of that was ripe because the pharmacy was doing well enough just running on script filling and vaccines. So it's fertile soil for a lot of innovation.

That, along with being in the Cascadia Pharmacy Group, which is a group of about 40 stores now, is incredible.

Sonja: That's incredible.

Josuah: 25:48 Besides the innovative practice, it's also the mentorship. I am a new grad, 25 - I bought a store at 24. There is a lot of life and experience that I don't have. Even if I could just buy a store on my own in Florida and maybe get mentorship for a couple of months from the old owner, the sheer volume of resources and support that Cascadia Pharmacy Group has is really second to none.

It made it almost a no-brainer when I thought about the financial support, the opportunities I could have as a manager to launch my [clinical services], and really take care of this community in a unique way that's never been seen before. The support from Cascadia Pharmacy Group made it a no-brainer to go for this store. It's not that I didn't have opportunities in Florida - I think I had about five opportunities to buy there.

Sonja: Okay.

Josuah: But when I looked at this opportunity in Washington state, it was almost a no-brainer. I thought about it, prayed about it, and everything was leading in that direction. It became a "why not" at that point.

Sonja: Mm-hmm. Yeah.

Josuah: At that point, I'm like, "Okay, let's do it."

Sonja: I think there's a lot to be said for following your intuition. I think, and this is just my personal superstition, but I feel like our bodies tell us when things are right or wrong. We get that feeling of inspiration and hope and drive, or we get that feeling of dread and fear and caution. Following that is probably pretty wise because nine times out of 10, it works out, as it has for you.

Josuah: Yeah, I've noticed fear is a smokescreen. It keeps us from where we need to go, and when we lean into it, when we force ourselves to walk through that smokescreen, you realize it's not that bad, and you find the rewards on the other side. For me, it was like, "I guess we're going to move to someplace I never knew, with no connections besides the current owners but…why not dive into a challenge, make some new friends, be uncomfortable?" From there, I knew I'd grow a lot, and this community would be served better by it.

Sonja: So talking about serving that community and what it means to you, what unique responsibilities do you feel now towards this place, especially as a pharmacy owner?

Josuah: I remember the first day that I bought it, August 30th, and it felt like getting sat on by an elephant - the slow weight of responsibility.

Sonja: Oh, no.

Josuah: Yeah, the 3,300-plus lives that live in Forks directly rely on the services I'm giving, because if you have a sick kid, you don't really want to travel an hour and a half.

Sonja: Right, exactly.

Josuah: So what we get to do here, really be[ing] a point of access for them, is huge. But what's more poignant to me as a manager is that I have 10 to 15 staff members, and the business directly funds their lives.

Sonja: Yeah.

Josuah: Business decisions that we make, for better or worse, affect them. Of course, they don't have as much risk, but if I make a poor financial decision, they can be affected either directly by patient backlash or indirectly by things like less of a bonus.

I was taught early that my first patient is the employee. Because I can only serve so many people...

Sonja: Okay. Yeah.

Josuah: But if I take care of my staff, they will take better care of the people they serve.

Sonja: That is great advice.

Josuah: So as a manager, I'm unusually HR-focused because I want to make sure every person feels valued and supported, that we're building them as individuals while meeting our goals as a company.

The reason why people don't like chains isn't because they don't have an efficient system - they're quick with what they do. But they build their success by exploiting their staff. I feel like a great company should use the dreams and strengths of their staff and build a system to become successful because of those. So people come to work energized and enthusiastic - it's a motivation that I can't even build in them. It comes from them because they know they're not just here to fill scripts or type things, but because this is the best place for their future, and this company is sold out on helping them get there.

So I spend a lot of time, and my managers spend a lot of time, making sure we're helping build our employees personally and professionally so that whether they're here for five months or 50 years, they got better as individuals because of their time here.

Sonja: Well, you give me hope for the future. How do you envision your pharmacy evolving over the next five years?

Josuah: In Forks, for this pharmacy, it really is a matter of when. All the advanced payment models, clinical services, point of care testing, maybe even expanding into primary care - it's all ripe here because there's a primary care issue. There aren't enough primary care providers in the area; the shortage is very poignant here. Most Forks patients are seen by doctors in Port Angeles, not here.

Sonja: Okay.

Josuah: So there's a gap. We're working with the hospital right now to see how we can fill this gap. Maybe we're doing point of care testing for the easy stuff to allow them to take more of those complex patients, maybe it's helping with refills, building an AmCare clinic, or just building a clinic itself.

Sonja: Right.

Josuah: There are a lot of avenues I can see us going into, especially with our partnership with the tribes, doing more long-term care at home. For me as an owner, I'm like, "There are so many cool things I can do."

Sonja: Yeah, like a kid in a candy store. Like, where do I start?

Josuah: I probably should sleep! But I know at least for the immediate future, we're going to start with flu point of care testing. It's a small town, so we don't want to take away from the hospital and urgent care business, but rather augment them.

Sonja: Yeah, give them time to focus on the bigger stuff.

Josuah: Exactly. We're formulating exactly what that looks like, but I think we all agree that in order to keep a bigger system from trying to come in and meet that need, we can meet that need together through various levels of partnership.

Sonja: Yeah, collaborating and partnering, which you seem to be an expert at. So I know you'll for sure do great navigating those relationships.

Sonja: Well, Josuah, thank you so much for joining us today. How can listeners connect with you if they're interested in learning more about your journey?

Josuah: Oh, yeah. You can connect with me on LinkedIn, Facebook, Instagram, and maybe I can send those to you, Sonja, and you can put them in the show notes.

Sonja: Yeah, that'd be great.

Josuah: Connect, especially if you're a student listening to the podcast and thinking, "Hey, I kind of want to do ownership too, how does that work?" feel free to send a message. If you love community pharmacy and you’re passionate about that too, feel free to connect with me.

Sonja: Terrific. Thanks so much.

Josuah: Yeah, thank you, Sonja. Hope you have a great rest of your day.

Contact Information

LinkedIn: https://www.linkedin.com/in/josuah-tilus/Instagram: https://www.instagram.com/jtilus24/Facebook: https://www.facebook.com/JosuahTilus/Email: tilus24@outlook.comPhone: 954-504-1069

Episode Summary

This inspiring episode of the Script Your Future Podcast with host Sonja Pagniano, Executive Director of the NCPA Foundation, showcases how networking, mentorship, preparation, and the courage to seize opportunities, can lead to success in pharmacy ownership, even at a young age. Josuah's story, at just 25 years old, demonstrates that with the right support systems and mindset, pharmacy ownership directly out of school is not just possible but can be a pathway to meaningful professional fulfillment and community impact. Josuah Tilus, owner of Chinook Pharmacy in Forks, Washington, shares his remarkable journey of becoming a pharmacy owner immediately after graduating from pharmacy school.