1. The National Landscape: Featured State Analysis

Based on MXVigil analysis of 3,235 U.S. Counties and Territories.

Our database confirms a widening gap in healthcare equity. According to the International Pharmaceutical Federation (FIP), the global mean community pharmacy density is 2.75 per 10,000 residents. The United States is seeing extreme regional variance.

Note: Featured states shown below. See complete state-by-state data at the end of this report.

State	Population (2024 Est.)	All Types	Retail	Solo (1)	Small Grp (2-9)	Mid Chain (10-49)	Large Chain (50+)	Mega Chain	All Density	Retail Density	Pharmacy Desert Counties
National	333,834,041	66,557	49,061	18,633	8,199	3,242	9,063	27,420	1.99	1.47	1,033
Texas	29,243,342	5,596	4,247	1,662	657	199	926	2,152	1.91	1.45	88
Kansas	2,935,922	620	365	181	112	31	54	242	2.11	1.24	64
Minnesota	5,695,292	1,020	588	175	113	151	250	331	1.79	1.03	57
Missouri	6,154,422	1,253	841	268	202	96	188	499	2.04	1.37	55
New Jersey	9,249,063	1,821	1,377	701	211	56	186	667	1.97	1.49	0
New Hampshire	1,379,610	279	229	30	12	18	55	164	2.02	1.66	0
District of Columbia	670,587	115	90	40	14	5	18	38	1.71	1.34	0
Delaware	993,635	211	155	46	24	5	19	117	2.12	1.56	0

Key Findings:

Top State (Retail Density): West Virginia (2.21 retail pharmacies per 10k)
Bottom State (Retail Density): American Samoa (0.00 retail pharmacies per 10k)

2. Pharmacy Infrastructure Categories

Understanding the distinction between pharmacy types is critical for assessing true community access:

Pharmacy Category	Est. Count (2026)	Density (per 10k)	Metric Significance
All Types (Total)	66,557	1.99	Total infrastructure — every registered pharmacy type combined.
Retail (Community)	49,061	1.47	Walk-in frontline pharmacies; the primary public access point. Includes chains and independents.
Specialty	3,714	0.11	High-cost/complex therapy: infusion, compounding, nuclear, home infusion. Often requires prior authorization.
Long-Term Care (LTC)	8,122	0.24	Closed-door facilities serving nursing homes and assisted-living residents only; not accessible to the public.
Hospital / Clinic	2,325	0.07	Outpatient and inpatient institutional pharmacies; generally not open to general public.
Mail Order	927	0.03	Remote dispensing across state lines; high-volume chronic medication fulfillment.
Wholesale / 3PL	686	0.02	Supply-chain distributors and third-party logistics; no direct patient dispensing.
Remote / Telepharmacy	1,722	0.05	Rural-access kiosks and satellite telepharmacy sites; serves underserved areas with limited in-person access.

Key takeaways: Retail community pharmacies represent 73.7% of all registered locations (density: 1.47/10k). Specialty pharmacies account for 5.6%, while closed-door facilities (LTC + Hospital + Wholesale) — invisible to the public — make up 16.7% of total infrastructure. The International Pharmaceutical Federation (FIP) reports a global mean community pharmacy density of 2.75 per 10,000 residents; the U.S. retail density of 1.47 places the country below that benchmark.

3. The 2026 Pharmacy Desert Leaders: Counties at Critical Risk

The Fragility Map: U.S. Counties at Risk of Total Access Collapse

While national headlines focus on corporate closures, the real story is found in the Single-Point-of-Failure counties. Our data identifies regions where a single administrative error or PBM audit could eliminate pharmacy access for entire communities.

In Apache County, Arizona, there is only 0.15 retail pharmacy per 10,000 residents. These counties represent the most vulnerable areas where low retail pharmacy density combined with low provider vigilance scores creates extreme fragility in healthcare access.

County, State	Population	Retail Density	Avg Vigilance	Primary Risk Factor	Risk Description
Apache County, Arizona	66,054	0.15	62.0	9.20	Critical — collapse likely
Holmes County, Ohio	44,273	0.23	69.0	5.70	Critical — collapse likely
Williams County, North Dakota	39,076	0.26	62.5	5.29	Critical — collapse likely
LaGrange County, Indiana	40,364	0.25	68.3	5.27	Critical — collapse likely
Upshur County, Texas	41,261	0.24	78.5	5.06	Critical — collapse likely
Harris County, Georgia	34,914	0.29	60.0	4.83	High Risk — one closure = Pharmacy Desert
Pittsylvania County, Virginia	60,541	0.33	48.7	4.58	High Risk — one closure = Pharmacy Desert
Jefferson County, Idaho	31,383	0.32	54.5	4.55	High Risk — one closure = Pharmacy Desert
Dallas County, Iowa	100,367	0.30	63.8	4.54	High Risk — one closure = Pharmacy Desert
Green County, Wisconsin	37,066	0.27	82.7	4.34	High Risk — one closure = Pharmacy Desert
Brookings County, South Dakota	34,631	0.29	79.5	4.16	High Risk — one closure = Pharmacy Desert
Goochland County, Virginia	24,906	0.40	36.0	4.10	High Risk — one closure = Pharmacy Desert
Aguas Buenas Municipio, Puerto Rico	24,136	0.41	36.0	4.00	High Risk — one closure = Pharmacy Desert
Fluvanna County, Virginia	27,442	0.36	59.0	3.92	High Risk — one closure = Pharmacy Desert
Chisago County, Minnesota	56,927	0.35	65.6	3.84	High Risk — one closure = Pharmacy Desert
Calumet County, Wisconsin	52,361	0.38	59.5	3.70	High Risk — one closure = Pharmacy Desert
Tattnall County, Georgia	24,309	0.41	50.0	3.66	High Risk — one closure = Pharmacy Desert
Cataño Municipio, Puerto Rico	23,060	0.43	45.0	3.60	High Risk — one closure = Pharmacy Desert
Minidoka County, Idaho	21,626	0.46	36.0	3.57	High Risk — one closure = Pharmacy Desert
Posey County, Indiana	25,226	0.40	61.0	3.48	High Risk — one closure = Pharmacy Desert
Osage County, Oklahoma	46,004	0.43	51.0	3.47	High Risk — one closure = Pharmacy Desert
Juniata County, Pennsylvania	23,535	0.42	55.0	3.45	High Risk — one closure = Pharmacy Desert
Colusa County, California	21,811	0.46	44.0	3.39	High Risk — one closure = Pharmacy Desert
Caswell County, North Carolina	22,747	0.44	51.3	3.38	High Risk — one closure = Pharmacy Desert
Assumption Parish, Louisiana	21,067	0.47	48.0	3.23	High Risk — one closure = Pharmacy Desert
Bandera County, Texas	21,182	0.47	48.0	3.23	High Risk — one closure = Pharmacy Desert
Menominee County, Michigan	23,433	0.43	61.0	3.23	High Risk — one closure = Pharmacy Desert
Plaquemines Parish, Louisiana	23,305	0.43	61.5	3.22	High Risk — one closure = Pharmacy Desert
Sherburne County, Minnesota	97,820	0.41	68.0	3.22	High Risk — one closure = Pharmacy Desert
Franklin County, Indiana	22,850	0.44	61.0	3.16	High Risk — one closure = Pharmacy Desert
Klickitat County, Washington	22,798	0.44	61.0	3.16	High Risk — one closure = Pharmacy Desert
Meigs County, Ohio	22,242	0.45	58.0	3.16	High Risk — one closure = Pharmacy Desert
Ward County, North Dakota	69,532	0.43	65.2	3.13	High Risk — one closure = Pharmacy Desert
Grand Forks County, North Dakota	72,927	0.41	71.8	3.13	High Risk — one closure = Pharmacy Desert
Polk County, Wisconsin	45,128	0.44	64.3	3.08	High Risk — one closure = Pharmacy Desert
Washington County, Missouri	23,580	0.42	70.7	3.08	High Risk — one closure = Pharmacy Desert
Saunders County, Nebraska	22,374	0.45	64.3	3.02	High Risk — one closure = Pharmacy Desert
Crawford County, Missouri	23,023	0.43	73.8	2.93	High Risk — one closure = Pharmacy Desert
Texas County, Oklahoma	21,144	0.47	67.3	2.82	High Risk — one closure = Pharmacy Desert
Morgan County, Missouri	21,169	0.47	74.8	2.66	High Risk — one closure = Pharmacy Desert

Risk Level Legend: Stable (<1.0) | Vulnerable (1.0-2.5) | High Risk (2.5-5.0) | Critical (≥5.0)

Formula: R = (1 / retail_density) × (1 + (100 − avg_vigilance) / 100). Lower density and lower pharmacy vigilance scores produce higher risk.

Complete State-by-State Pharmacy Statistics

Comprehensive data for all 50 states and the District of Columbia. Territories excluded from this analysis.

State	Population (2024 Est.)	All Types	Retail	Solo (1)	Small Grp (2-9)	Mid Chain (10-49)	Large Chain (50+)	Mega Chain	All Density	Retail Density	Pharmacy Desert Counties
National	333,834,041	66,557	49,061	18,633	8,199	3,242	9,063	27,420	1.99	1.47	1,033
Alabama	5,028,092	1,146	903	337	127	39	54	589	2.28	1.80	17
Alaska	734,821	134	71	28	31	5	39	31	1.82	0.97	20
American Samoa	49,710	1	0	1	0	0	0	0	0.20	0.00	4
Arizona	7,172,282	1,352	966	204	159	118	255	616	1.89	1.35	2
Arkansas	3,018,669	733	440	267	118	44	94	210	2.43	1.46	18
California	39,356,104	6,194	4,512	1,926	623	227	1,026	2,392	1.57	1.15	18
Colorado	5,770,790	980	702	169	94	76	167	474	1.70	1.22	21
Connecticut	2,737,362	693	510	158	81	30	60	364	2.53	1.86	0
Delaware	993,635	211	155	46	24	5	19	117	2.12	1.56	0
District of Columbia	670,587	115	90	40	14	5	18	38	1.71	1.34	0
Florida	21,634,529	5,060	3,693	1,304	541	307	200	2,708	2.34	1.71	10
Georgia	10,722,325	2,336	1,684	583	239	147	163	1,204	2.18	1.57	41
Guam	153,836	14	9	7	7	0	0	0	0.91	0.59	1
Hawaii	1,450,589	193	122	49	51	2	29	62	1.33	0.84	4
Idaho	1,854,109	381	272	90	91	36	67	97	2.05	1.47	15
Illinois	12,757,634	2,224	1,761	413	246	114	386	1,065	1.74	1.38	23
Indiana	6,784,403	1,269	974	206	140	44	157	722	1.87	1.44	24
Iowa	3,188,836	700	438	153	123	79	175	170	2.20	1.37	32
Kansas	2,935,922	620	365	181	112	31	54	242	2.11	1.24	64
Kentucky	4,502,935	1,143	843	332	217	56	82	456	2.54	1.87	20
Louisiana	4,640,546	1,170	888	410	160	14	120	466	2.52	1.91	12
Maine	1,366,949	313	252	53	14	31	86	129	2.29	1.84	1
Maryland	6,161,707	1,057	754	303	131	73	241	309	1.72	1.22	2
Massachusetts	6,984,205	1,195	923	192	92	53	129	729	1.71	1.32	1
Michigan	10,057,921	2,116	1,569	753	332	94	407	530	2.10	1.56	22
Minnesota	5,695,292	1,020	588	175	113	151	250	331	1.79	1.03	57
Mississippi	2,958,846	650	482	292	74	13	49	222	2.20	1.63	19
Missouri	6,154,422	1,253	841	268	202	96	188	499	2.04	1.37	55
Montana	1,091,840	263	146	108	61	3	47	44	2.41	1.34	33
Nebraska	1,958,939	427	270	134	77	14	63	139	2.18	1.38	53
Nevada	3,104,817	541	406	151	47	9	79	255	1.74	1.31	5
New Hampshire	1,379,610	279	229	30	12	18	55	164	2.02	1.66	0
New Jersey	9,249,063	1,821	1,377	701	211	56	186	667	1.97	1.49	0
New Mexico	2,112,463	332	243	85	50	2	39	156	1.57	1.15	13
New York	19,994,379	5,010	4,052	2,347	413	143	622	1,485	2.51	2.03	6
North Carolina	10,470,214	2,257	1,681	546	304	37	231	1,139	2.16	1.61	17
North Dakota	776,874	145	43	71	32	6	30	6	1.87	0.55	44
Northern Mariana Islands	47,329	5	5	2	3	0	0	0	1.06	1.06	2
Ohio	11,774,683	2,315	1,766	506	315	113	503	878	1.97	1.50	20
Oklahoma	3,970,497	854	532	299	136	78	68	273	2.15	1.34	33
Oregon	4,229,374	743	520	145	85	51	185	277	1.76	1.23	8
Pennsylvania	12,989,208	2,585	1,948	710	342	65	302	1,166	1.99	1.50	16
Puerto Rico	3,272,382	740	649	349	114	68	72	137	2.26	1.98	15
Rhode Island	1,094,250	207	160	31	16	13	29	118	1.89	1.46	1
South Carolina	5,142,750	1,107	893	261	164	30	61	591	2.15	1.74	5
South Dakota	890,342	191	106	56	23	50	28	34	2.15	1.19	43
Tennessee	6,923,772	1,542	1,179	422	196	19	173	732	2.23	1.70	14
Texas	29,243,342	5,596	4,247	1,662	657	199	926	2,152	1.91	1.45	88
U.S. Virgin Islands	87,146	8	5	7	0	0	0	1	0.92	0.57	3
Utah	3,283,809	535	353	134	83	70	41	207	1.63	1.07	14
Vermont	643,816	144	115	24	16	7	46	51	2.24	1.79	2
Virginia	8,624,511	1,553	1,197	303	170	69	179	832	1.80	1.39	39
Washington	7,688,549	1,324	913	222	211	115	309	467	1.72	1.19	10
West Virginia	1,792,967	495	396	116	87	20	41	231	2.76	2.21	6
Wisconsin	5,882,128	1,143	747	225	199	92	217	410	1.94	1.27	34
Wyoming	577,929	122	76	46	19	5	16	36	2.11	1.32	6

Data Notes:

All Types: Includes retail, hospital, clinic, mail-order, and specialty pharmacies
Retail: Community pharmacies with direct patient access (taxonomy 3336*)
Solo (1): Single-location independent pharmacies
Small Grp (2-9): Small pharmacy groups with 2-9 locations
Mid Chain (10-49): Regional chains with 10-49 locations
Large Chain (50+): Large chains with 50 or more locations
Mega Chain: National chains with 1,000+ locations (CVS, Walgreens, etc.)
All Density / Retail Density: Pharmacies per 10,000 population
Pharmacy Desert Counties: Counties with fewer than 1.0 retail pharmacies per 10,000 population

About This Index

Data Sources

State pharmacy board registries (2025-2026), U.S. Census Bureau 2020 population data, NPI National Provider registry.

Contact

For questions about this report or data corrections, visit MXVigil.com