Background: The cold chain remains a highly vulnerable element of any immunization program all over the world. To improve management, the World Health Organization (WHO) has created a set of practice guidelines for different service levels, which include immunization techniques, vaccine monitoring, cold chain management and reporting system. Objective: The objective of this study was to assess knowledge and practices of health care providers on pharmaceutical cold chain management and associated factors in Bahir dar Zuria District, West Gojjam, Ethiopia. Methods: Institutional based cross sectional study was conducted In Bahir Dar Zuria District from March to April 30/2018. Total of 154 health care providers have been selected using systematic random sampling technique. Data was collected by structured questionnaire with observation checklist. The statistical package for social sciences (SPSS) version 23 was used for data entry and analysis. Odds ratio with 95% confidence interval was computed to determine the level and strengths of statistical association. Result: From 41 health facilities visited, 26 (63.4%) had functional refrigerators with fridge tags, and from which 11(42.3%) had alternative power generator for emergency power outage. But, 15(36.6%) had no refrigerators which indicated that there is a non standardized cold chain management system. From a total 154 respondents participated, 39.6%, 27.3% & 66.9% had good knowledge about the most vaccines sensitive to heat, excessive cold and light respectively. Knowledge about the most heat and light sensitive vaccines, practices of contingency plan and action taking when temperature is below the normal range, and the availability of policy, procedure and guidelines were the most factors that had association with KAPCCM (p<0.05, 95%CI=2.415-24.858,1.070-16.301,5.233-66.308,4.325-71.264 &1.429-14.308 respectively ). Over all, according to this finding, 41.6% of the respondents were rated as having good knowledge and practices on cold chain management. Conclusion: This finding revealed that the majority of (58.4%) health care providers working in Bahir dar Zuria District HFs had poor knowledge and practices of pharmaceutical cold chain management which could compromise the potency of vaccines thereby decreased quality of immunization services.