Bottlenecks in the supply chain at the district commodity management organizations (DCMOs) in Zambia were causing stockouts and inefficient distribution of medicines. A pilot study tested two models - Model A kept storage at the district level while Model B eliminated intermediate storage. Model B performed significantly better with stockout rates decreasing from 40-72% to 1-33% compared to comparison districts. Zambia is now implementing Model B nationally and utilizing regional cross-docking hubs to further reduce bottlenecks and improve "last mile" delivery to health facilities. The new system more efficiently transports pre-packed orders from the central medical stores to hubs and then to facilities, resulting in lower stockout rates.