Offers one-on-one counseling with a clinical pharmacist or pharmacy intern/resident for medication therapy management or disease state management. Incldues a comprehensive review of a patient's medications. The pharmacist will consider cost, effectiveness, safety, medical need and adherence for each medication. Recommendations for medication changes will be discussed with the primary care provider. Patients will receive education about their medications, including reasons for taking the medications, how to take the medication, possible side effects and monitoring for effectiveness and safety.