Instalasi Farmasi Rumah Sakit RSUD ciapyung menghadapi paradoks logistik berupa stock out dan kedaluwarsa terjadi bersamaan, mencerminkan disfungsi sistemik pada pengelolaan persediaan farmasi. Penelitian bertujuan menganalisis implementasi manajemen logistik menggunakan kerangka 5 M, serta merumuskan rekomendasi berbasis bukti. Desain non eksperimental mixed method dilaksanakan Januari – Mei 2026 menggunakan data operasional 2025, melalui wawancara mendalam (6 informan), observasi, checklist, serta analisis kuantitatif ABC-VEN, ITR, fill rate, dan stock out time tracer. Dari 12 indikator kinerja, hanya 3 yang tercapai, dan 3 outcome krusial justru tidak mencapai target; fill rate obat 79,9%, stock-out time tracer 101,8 hari, dan expire rate 7,08% (Rp 64,9 juta/42 item). Terdapat dua akar masalah yang teridentifikasi; SDM terbatas → inakurasi SIMRS → ketidakakuratan RKO → stock out; dan over procurement antidiabetik (+Rp 141 juta) → kegagalan FIFO/FEFO → kedaluwarsa. Kegagalan tersebut bersifat struktural sehingga perbaikan prosedural saja tidak cukup. Rekomendasi prioritas dengan optimalisasi SIMRS (ROP otomatis, alarm kedaluwarsa bertingkat), penerapan MMSL untuk 43 item Katergori Prioritas, pembaruan formularium melalui penguatan KFT, redistribusi tugas SDM, dan penggantian infrastruktur penyimpanan cold chain.

The Pharmacy Installation of RSUD Cipayung faces a logistics paradox in which stock out and medicine expiry occur simultaneously, reflecting systemic dysfunction in pharmaceutical inventory management. This study aimed to analyze the implementation of logistics management using the 5M framework and to formulate evidence-based recommendations. A non-experimental mixed methods design was conducted from January to May 2026 using 2025 operational data, through in-depth interviews (6 informants), observation, checklists, and quantitative analyses of ABC-VEN, ITR, fill rate, and stock out time tracer. Of 12 performance indicators, only 3 were met, while 3 critical outcome indicators failed to reach their targets: fill rate 79.9%, stock-out time tracer 101.8 days, and expire rate 7.08% (Rp 64.9 million/42 items). Two root causes were identified: limited human resources → SIMRS inaccuracy → inaccurate RKO → stock-out; and anti-diabetic over-procurement (+Rp 141 million) → FIFO/FEFO failure → expiry. These failures are structural, making procedural fixes alone insufficient. Priority recommendations include SIMRS optimization (automated ROP, tiered expiry alerts), MMSL implementation for 43 Priority Category items, formulary renewal through strengthened KFT, internal task redistribution, and replacement of cold chain storage infrastructure.