OBJECTIVES: To measure the cost of pharmaceutical service for outpatients and inpatients in a class A tertiary hospital in Sichuan, China, provide evidence for the measures of public hospital compensation after implementing drug sale with no markup. METHODS: the method of item cost accounting was used in term of prescription/order and medicines individually. Cost items were identified based on literature review and field investigation in hospital. Data was collected from related departments in sample hospital and analyzed using a series of pre-set statistic charts and formulas. RESULTS: The cost of pharmaceutical service in hospital included cost of drug dispensing, drug storage, which composed by manpower cost and material cost. In 2010, total 998014 prescriptions(outpatients) and 4266155 orders(inpatients) were dispensed, 5704696(outpatient) and 12304914(inpatients) medicines were sold in sample hospital. For drug dispensing cost, the total manpower cost was 13040.63$ for outpatients and  22392.61$ for inpatients, on average 0.16$/prescription or 0.028$/medicine for outpatients, and 0.063$/order or 0.022$/medicine for inpatients; the total material cost was 109163.87$ for outpatients and 31020.99$ for inpatients, on average 0.11$/prescription or 0.020$/medicine for outpatients, and 0.009$/order, or 0.003/medicine for inpatients. For drug storage cost, the total manpower cost was 8212.09$, on average 0.0053/medicine, the total material cost was 15287.82$, on average 0.0008$/medicine. In sum, the total cost of pharmaceutical service in sample hospital was 58933.15$ in 2010, including 35433.24$ dispensing cost and 23499.91$ storage cost, on average 0.30$/prescription for outpatients and 0.09$ for inpatients, or 0.055$/medicine for outpatients and 0.031$ for inpatients. Manpower cost composed 61.3% of pharmaceutical service cost for outpatients and 87.7% for inpatients. Sensitive analysis showed the salary level of hospital staff and professional was the key factor influenced the pharmaceutical service cost. CONCLUSIONS: Manpower cost was the main component of pharmaceutical service cost, measure should be taken to make up the insufficient of this part after implementing drug sale with no markup.