For independent pharmacies, providing COVID-19 vaccine can be a vial of tears and troubles. But this Montco drugstore has no regrets.

Four weeks ago, Eric’s RX Shoppe in Horsham became one of the first independent drugstores in Pennsylvania to provide COVID-19 vaccine to health-care workers, the top-priority group under the state’s phased immunization plan.

Providing the shots wasn’t a particularly smart business move, given the red tape, logistical challenges, and vagaries of reimbursement. But pharmacist Eric Abramowitz and his business partner, pharmacy technologist Marc Ost, believed that they owed it to their community.

The operation went smoothly until seven days in, when the Trump administration upended the phased rollout that states had spent months crafting with federal guidance. Health and Human Services Secretary Alex Azar told the states to push to the front of the line a vast group of people he wanted to be there from the start — people age 65 and over — as well as younger people with chronic health conditions.

Eric’s RX was suddenly swamped by 20,000 calls and emails. Its new online appointment system crashed. Frustrated shot-seekers reacted with confusion and anger.

“We got a lot of calls saying: ‘I’ve been a loyal customer. You owe me a vaccine,’” Abramowitz said through his mask Wednesday. “But there’s not enough vaccine, not enough vaccinators, and not enough time. We’re doing the best we can to be fair. We all have to be patient.”

Across the country, pharmacies have become an increasingly vital part of the pandemic immunization effort, a mammoth undertaking that got off to a sluggish, disorganized start.

Big drugstore chains have federal contracts to vaccinate nursing home residents and, eventually, the general public. Local jurisdictions, such as Philadelphia, also have contracted with chains. The deals are potentially so lucrative that one financial analyst estimated CVS could make $1 billion in gross profits over the next year.

For the nation’s 23,000 independent pharmacies, though, the decision to pitch in may be mostly a matter of altruism, not capitalism. Unlike mundane flu shots, the vaccines that could spell world salvation require pharmacies to meet extraordinary training, handling, and reporting requirements.

Abramowitz, 54, is working seven days a week to straddle his regular pharmacy business and the vaccine clinic. Ost, 36, is awake into the wee hours checking emails and voicemails. Even so, they’ve had to hire more staff and bring in volunteers to keep up with the workload.

The partners’ families understand.

“My wife and I thought if I can do something to help us get back to normal, that would be important,” Ost said.

To be sure, the partners hope to make a profit by building the volume of their four-day-a-week clinic, which now averages 100 shots a day. Medicare reimburses $16.94 for a senior’s first shot and $28.39 for the second. But not all payors are on a par with Medicare; one pharmacy benefit plan reimburses 5 cents per shot given, Ost said. And the state requires the shot to be given “regardless of the vaccine recipient’s ability to pay or coverage status.”

While the finances evolve, Abramowitz said, patients’ “tears of happiness” and grateful emails are priceless.

Abramowitz has spent 23 years as an independent pharmacist, including 11 at his eponymous store. He’s a people person, quick with a quip, a hug (these days, an elbow bump), and epigrams that would be corny if they weren’t so heartfelt.

“I consider my customers to be my family,” he said.

He wells up with pride talking about his daughter Callie, a recent pharmacy school graduate who has been volunteering at the vaccine clinic.

» READ MORE: The city trusted a group of ‘college kids’ to lead its vaccine rollout. But Philly Fighting COVID was full of red flags from the start.

Ost, who joined Eric’s RX two years ago, is the unflappable, tech-savvy manager and problem solver. Ost also has a family pedigree; he used to work at the Philadelphia drugstore still run by his father, Richard, a pharmacist who used to be in business with Abramowitz.

Long before the Pfizer-BioNTech and Moderna vaccines received emergency approval in December, Abramowitz and Ost began laying the ground for their clinic. Literally. Eric’s RX had no space for a socially distanced waiting room plus three small rooms to give shots. But a vacant storefront three doors away in the Welsh Road strip mall did. Their landlord, BEM Realty, was kind enough to agree to let them use it for free until a paying tenant came along.

Getting certified by the Pennsylvania Department of Health — which distributes its federal vaccine allotment to providers throughout the state — was a months-long tribulation because Eric’s RX had to qualify to join the Statewide Immunization Information System, or SIIS. Vaccine orders, inventory information, patient data, and more go through SIIS.

“You can’t get access to SIIS without being approved and going through their training. And you can’t get vaccine from the state without having access to SIIS,” Ost said.

He added: “Overall, the PADOH has been a great partner. They have a lot on their plate and the systems are getting better and better each week.”

» READ MORE: Two lawmakers test positive for coronavirus, one after receiving both doses of vaccine

Howard Hecht, 78, and his wife, Teri, 70, have been getting their prescriptions from Abramowitz for decades.

On Wednesday, as the pharmacist prepared to jab the Fort Washington couple with the Moderna vaccine, they bantered and teased one another.

“You’re not sick today, are you, Howard?” Abramowitz said in asking the standard screening question.

“You mean mentally?” Teri interjected as her husband laughed.

“Are you pregnant?” Abramowitz asked Howard.

After they got the vaccine, Teri, a breast cancer survivor, said to Abramowitz: “I’m not kidding. You are so important to us.”

» READ MORE: If you’re pregnant, here’s what you need to know about a new Penn COVID-19 vaccine study

Customer service and personal ties are points of pride for mom-and-pop pharmacies. West Virginia — which boasts the second-highest COVID-19 vaccination rate in the nation despite its rural, rugged geography — attributes its relative success in part to contracting with a network of independent drugstores.

“I don’t think independent pharmacies are the end-all and be-all,” Ost said. “But I think we are part of the solution.”

By last week, Eric’s RX had given more than 1,200 doses of the Moderna vaccine. (The store doesn’t have the ultracold freezers needed for Pfizer’s vaccine.) Now that expanded eligibility has unleashed a scramble for vaccine, most people getting shots through Eric’s RX are not longtime customers. No-shows and cancellations have become a problem, as people sign up with multiple vaccine providers and go with the first opening.

But being a neighborhood resource has helped Eric’s RX with that problem.

“We have our list of eligible customers,” Ost said. “They live close by and if we have an opening, we call them.”

Outreach also helps the pharmacy make sure every precious inoculation is used.

“We get 10 shots per vial and they have to be used within six hours,” Ost said. “One of our goals when we started was no waste.”