Background: - The Ethiopian health centers reform which was developed in 2016 is established to standardized, and create more patient oriented service in health centers along with tools to monitor performance and improve quality of health. This study was performed to assess health centers pharmacy service Reform practice among Central Gondar Zone health centers with reference to Pharmacy service chapters. Methods: - A facility-based, cross-sectional study design supported with qualitative data was conducted in Central Gondar Zone health centers North west Ethiopia,2022. A total of 414 health professionals were participated with self-administered questionnaires. Data was entered using Epi Data version 4.6 and analyzed by SPSS version 26. Descriptive summary was computed using percentages, frequency and graph was used to present the results. Bi-variable and multivariable ordinary logistic regression analysis model was carried out in order to see the association between dependent and independent variables of reform practice and identify determinants respectively. P-value < 0.05 was considered as a statistically significant during multivariable logistic regression, whereas Qualitative study was conducted on six key informants using purposive sampling in-depth interview and analyzed thematically. Results:- From the total 434 Health professionals 95.4% response rate, the pharmacy service reform practice 180 (43.5%) and the value ranges from (1-7.79) was low level of practice; 104 (25.1%) medium level of practiced value ranges from (7.8-10.39); and 130 (31.4%) high level of pharmacy service reform practice, value ranges from (10.4-13). Factors significantly associated with pharmacy service reform practices were awareness on Pharmacy Service Reform Standard (AOR=0.449, 95%CI(0.251, 0.801)), integrated supportive supervision (AOR=0.398, 95%CI(0.236, 0.669)), Influence of community based health insurance (AOR=21.496, 95%CI(10.156, 45.498)), Utilization stock card (AOR=0.353, 95%CI(0.198, 0.629)) and Bin card utilization (AOR=0.383, 95%CI(0.195, 0.751)) were the last output variables from ordinary logistic regression model (p<0.05) respectively. The findings from qualitative thematic analysis like Supply chain management, CBHI implementation and Work setting were related factors for health centers pharmacy service reform practice. Conclusion: - The health centers pharmacy service reform practice was lower than the study conducted in Amhara region 2019, but short of the minimum score expected from higher performing—it would have been > 80 %. The current standard score of pharmacy service reform practice was low. Therefore it needs a concerted effort to improve health professionals practice in pharmacy service reform using different modalities. In addition, the standard needs to rectify its gaps and to make its practice successfully. Key words: -Standards, Pharmacy Service, Health center reform