Abstract Body: Background: Pharmacy access is important for medication adherence and may be a modifiable factor which could improve health equity in the management of cardiovascular disease risk factors.

Methods: We geocoded all MN pharmacies in 2022 and determined the population weighted, mean drive times from each census tract to the nearest pharmacies. Census tracts were stratified by urban and rural status and divided into quartiles by poverty defined as the proportion of families living below the 75% poverty line. Poverty quartiles were characterized by demographic and income data from the 2016-2019 American Community Survey. We evaluated differences in pharmacy access by poverty quartile using one-way ANOVA.

Results: In both rural and urban quartiles, the lowest poverty quartile (Q1) was majority white (96% and 83% respectively) with more college graduates (30% and 50% respectively) compared to the highest poverty quartile (Q4, 20% and 31% respectively). Q4 was more racially diverse – rural 88% white, 1% Black, 5% Hispanic; urban 61% white, 18% Black, 10% Asian, 10% Hispanic. Among urban census tracts Q1-Q3 had similar pharmacy drive times (3.3-3.5 min, Table) while Q4 (highest poverty) had a shorter mean drive time (2.8 min) and more pharmacies available within 10 and 15 min drive times compared to Q1 (Table, p<0.01 for all pharmacy access measures). Among rural census tracts, drive time to the nearest pharmacy was shortest in Q1 and Q4. Compared to Q1, rural residents in Q4 had a longer drive to the 2^nd nearest pharmacy (15.5 min vs 13.1 min) and fewer pharmacies within 15 min drive time (2.6 vs 5.9; Table, p<0.01 for all measures).

Conclusion: Pharmacy access may be an important factor in low income rural communities. However, restricted pharmacy access did not correlate strongly with under-resourced neighborhoods in urban communities. Barriers to medication access are likely multifactorial and may differ between urban and rural areas