To describe the development and growth of a pharmacotherapy medication therapy management (MTM) practice.Multispecialty medical clinic.MTM practice based in a multispecialty medical clinic with a community pharmacy. The practice serves primarily internal medicine, family medicine, bariatric surgery, and solid-organ transplant surgery patients that are referred by clinic providers. The practice serves 30 to 40 patients per month and employs approximately one pharmacist spending 50% to 75% of his/ her time performing MTM.This MTM practice serves both primary care and specialty care patients via different practice models in a physician office setting. Unlike many MTM practices, this practice is financially self-sustaining.Sustainability, continued growth, financial viability.After early slow growth, the pharmacotherapy MTM practice at Mayo Clinic Florida has grown into multiple practice models.Institutions can use this practice model as a guide to assist them in the creation of future institutional pharmacotherapy MTM models.