In 2001, in response to an escalation of rural community pharmacy closings in the state, the North Dakota State Board of Pharmacy established Pilot Telepharmacy Rules to explore the feasibility of using telepharmacy to restore and retain pharmacy services in medically underserved remote rural communities of North Dakota. 

In September of 2002, the NDSU College of Pharmacy received a federal grant from the Office for the Advancement of Telehealth (OAT), Division of Health Resources and Services Administration, Department of Health and Human Services, to implement a state-wide telepharmacy program to save rural pharmacies from closing and to test the new telepharmacy pilot rules established by the Board of Pharmacy. In FY'2002, a total of ten North Dakota rural communities were involved in the first year of the federal OAT grant. Four central pharmacy sites in Killdeer, Watford City, Rugby, and Forman, North Dakota, were established to serve six remote telepharmacy sites in Beach, New England, New Town, Rolette, Maddock, and Gwinner, North Dakota. 

In June 2003, due to the overwhelming success of the telepharmacy pilot project, the North Dakota State Board of Pharmacy established permanent rules allowing telepharmacy to be practiced on a broader scale in North Dakota. These permanent rules allow a retail pharmacy to open and operate in certain remote rural areas of the state without a licensed pharmacist being physically present in the store and allows a pharmacist to supervise a registered pharmacy technician at a remote telepharmacy site using telepharmacy technology for the purposes of dispensing prescriptions to patients, providing drug utilization review, and patient education counseling.  

In September of 2003, the NDSU College of Pharmacy received a second year of federal funding from OAT/HRSA. In FY'2003, a total of eight new North Dakota rural communities were added to the North Dakota Telepharmacy Project. Three new central pharmacy sites in Minot, Bismarck, and LaMoure, North Dakota, were established to serve five remote telepharmacy sites in Mohall, New Salem, Enderlin, Lisbon, and Oakes, North Dakota. 

In September of 2004, the NDSU College of Pharmacy received a third year of federal funding from OAT/HRSA. In FY'2004, nine new communities were added to the Telepharmacy Project and one community, Rugby, obtained an additional site.  Four central pharmacy sites in Turtle Lake, Fargo, Rugby, and Hankinson, North Dakota, are being established to serve six remote telepharmacy sites in McClusky, Underwood, Harvey, Devils Lake, and Lidgerwood, North Dakota, and in Karlstad, Minnesota.  The North Dakota Telepharmacy Project added its first hospital telepharmacy sites to the project this year (three hospitals) and added its first interstate telepharmacy site, a remote telepharmacy site in Minnesota.  

As of November 2004, twenty-eight pharmacies were involved in the North Dakota Telepharmacy Project, eleven central pharmacy sites and seventeen remote telepharmacy sites. Of the twenty-eight pharmacies involved, twenty-five were retail pharmacies and three were hospital pharmacies.  

As of January 2006, fifty-seven pharmacies are involved in the North Dakota Telepharmacy Project, twenty-one central pharmacy sites and thirty-six remote telepharmacy sites. Of the fifty-seven pharmacies involved, forty-four are retail pharmacies and thirteen are hospital pharmacies. Thirty-three (62%) of North Dakota's fifty-three counties are involved in the project and two in Minnesota. Approximately 40,000 rural citizens have had pharmacy services restored, retained or established through the North Dakota Telepharmacy Project since its inception. The project has restored valuable access to health care in remote medically underserved areas of the state and has added approximately $12 million in economic development to the local rural economy. 

To date there are eighty-one pharmacies involved in the North Dakota Telepharmacy Project, twenty-five central pharmacy sites and fifty-six remote telepharmacy sites. Of the eighty-one pharmacies involved, fifty-three are retail pharmacies and twenty-eight are hospital pharmacies. Thirty-eight (73%) of North Dakota's fifty-three counties are involved in the project and two in Minnesota. Approximately 80,000 rural citizens have had pharmacy services restored, retained or established through the North Dakota Telepharmacy Project since its inception. The project has restored valuable access to health care in remote medically underserved areas of the state and has added approximately $26.5 million in economic development to the local rural economy.