The absence of pharmacies in impoverished neighborhoods in West Baltimore presents a significant barrier for older adults and those with chronic illnesses. The community has one of Maryland's highest rates of hospitalization for HIV, diabetes, cancer, and heart disease. "There's not enough quality pharmacy in West Baltimore," says Jennifer Joseph, director of pharmacy at Total Health Care, which has 10 clinics in Baltimore, six with pharmacies. Research suggests that low-income neighborhoods in major cities with higher African-American and Latino populations are likely to be underserved by pharmacies. A 2014 study in Health Affairs illustrated that pattern in Chicago. West Baltimore's shortage of primary care physicians exacerbates the need for pharmacists who can counsel patients about basic health issues. A pharmacist is often the first line of defense for someone with a health condition, notes Natalie Eddington, dean of the University of Maryland School of Pharmacy. West Baltimore's low-income residents do have some alternatives to community pharmacies, including two Total Health Care clinics. Patients there can get prescriptions right after seeing the doctor. CVS' 10-month closure in West Baltimore posed special hardship for some customers. CVS, with 27 stores in Baltimore, is the nation’s largest community pharmacy chain. It outmatches local competitors on product variety and supply plus offers better hours.