OBJECTIVES: With the emergence of the Affordable Care Act and Hospital Readmission Reduction Program, health-system performance is increasingly being evaluated through readmission rates. As a result, health organizations are investigating novel ways to reduce readmissions; however, funding new programs remains a challenge. This has created opportunities for pharmacy service expansion through combined efforts of hospitals and academia. The purpose of this study is to describe the collaborative care model established by Touro University California and Sharp Healthcare, focused on expanding pharmacist roles and reducing readmissions. METHODS: This is a retrospective, descriptive study conducted from July 2011 to July 2015. A faculty pharmacist, PGY2 pharmacist resident, and student pharmacist were integrated into a multidisciplinary team called the Continuum of Care Network (CCN). Transitions of care (TOC) services impacted post-discharge medication adherence and readmission rates. A constructed timeline illustrates phases of program implementation, expansion, and future direction. RESULTS:  The CCN includes 2.0 FTE’s, supporting up to nine student pharmacists per rotation. TOC services were provided to over 1650 physician-referred and heart failure inpatients. From 2011-13, CCN contributed to a significant readmission rate reductions following index hospitalization for heart failure (ARR 12%; RRR = 48%, p=0.0005). Additionally, CCN expansion into skilled nursing from 2013-14 shows similar reductions in mean time to readmissions (from 17.6 days to 11.0 days, p=0.0019). CONCLUSIONS:  The implementation of CCN is associated with significant reduction in readmission rates in multiple settings such as community hospitals, skilled nursing facilities, and acute care. The interventions of TOC pharmacists in transition programs demonstrate an effective method to reduce rate of readmissions and time to readmissions . Future collaborative practice between health-systems and academia may prove successful in TOC for other disease states as well.