Custom veterinary software in Baltimore: what it really costs, and when to build your own store instead

The practices this is actually about

It is worth being precise about the business in question, because most writing about veterinary software is aimed either at a hundred-hospital corporate group with a procurement team or at a solo house-call practice run out of a station wagon, and the practice we mean sits between them.

We mean the independent small-animal hospital: two to five veterinarians, a building the owner probably has a mortgage on, a technician team that knows every regular client's dog by name, a lobby that is chaotic between eight and ten in the morning, and an owner-veterinarian who is still seeing appointments while also deciding which software to buy. The American Veterinary Medical Association's own profile of a companion-animal practice puts it at a little over 2.6 full-time-equivalent veterinarians, about 6.35 technicians and assistants, and roughly 4.1 non-medical staff. That is a business with fifteen or so people in it and, on typical figures of $1.1 to $1.4 million of gross revenue per full-time veterinarian, somewhere between two and four million dollars a year passing through the front desk.

There are fewer of these in Baltimore City than most people assume, and the distribution says something useful. We pulled the Maryland State Board of Veterinary Medical Examiners' own roster of licensed veterinary hospitals and counted it ourselves rather than trusting a directory. Across the state the board's list runs to 585 licensed hospitals. Baltimore City accounts for 19 of them. Baltimore County accounts for 82 — more than four times as many — and Montgomery County leads the state outright with 98. The city has the density of rowhouses and the county has the density of animal hospitals, which means an article about veterinary practices in Baltimore is really an article about the metro ring: the roughly hundred practices across the city and county line, from Canton and Hampden out through Towson, Catonsville, Pikesville and Owings Mills. That roster is the most recent full list the board has published, so treat the exact counts as a snapshot rather than a live figure; the shape of the distribution has not changed.

What has changed is who owns them. Corporate and private-equity ownership of American veterinary clinics has gone from something like 8% of sites in 2011 to roughly half today, with independents now holding a bare majority. Baltimore has felt it directly: Terravet Real Estate Solutions bought Eastern Animal Hospital in a $7.75 million transaction in September 2025, one of the more visible local examples of a national pattern in which the real estate and the practice change hands together. If you own an independent practice in this market, you are already competing with buyers who have a software budget, a negotiated drug price and a procurement department. That is the context for every decision below.

Two companies sell you almost everything

Here is the structural fact that makes veterinary software different from every other vertical we have looked at, and it deserves stating plainly before any pricing.

The practice-management market is not competitive in the way the brochures imply. On the best available estimate of installed base, IDEXX and Covetrus between them account for something close to 79% of all named practice-management installations — IDEXX at about 40%, carrying Cornerstone, ezyVet and Neo, and Covetrus at about 38.6%, carrying AVImark, Pulse and Impromed. Cornerstone alone sits in the region of 14,000 practices, ezyVet around 9,500 globally, Impromed around 6,000. Two companies, six products, four in every five practices.

Now notice what else those two companies sell. IDEXX is a diagnostics company: it makes the in-house analyzers on your treatment room bench and runs the reference laboratory your send-out samples go to. Covetrus is a distributor: it sells you the drugs, and through vRxPro it runs the online pharmacy that carries your practice's name. So the company that holds your medical records also prices your bloodwork, or holds your medical records and also prices your amoxicillin. In a dental practice or a law firm, the software vendor sells software. Here the software is a position in a much larger supply relationship, and the subscription line is arguably the least interesting thing about it.

We want to be fair about this, because "consolidated" is not a synonym for "bad." Cornerstone and AVImark are deep, mature systems with twenty-plus years of accumulated clinical detail in them, and the practices running them are not naive. ezyVet is a genuinely excellent cloud product. And the pharmacy services are not a racket — the home-delivery model does what it claims. A well-cited research project run for Vets First Choice found that ten practices that moved low-margin items, therapeutic diets and preventives, onto their online pharmacies averaged 14% growth, equivalent to about $88,000 of added revenue per full-time veterinarian. That is real, and a practice that refuses to offer home delivery in 2026 is not protecting its pharmacy, it is donating it to Chewy. The problem is not that these services exist. The problem is that you cannot find out what they cost.

Three pricing pages that no longer exist

We went through the pricing pages in this category in July 2026 the same way we did for law firms, auto shops and childcare centers, and this time the result was worse than usual. In those categories vendors hid their prices behind demo forms. Here, a set of confidently quoted prices turned out to have nothing behind them at all.

Search for veterinary software pricing and you will be told, repeatedly and with apparent authority, that Shepherd starts at $299 per doctor per month, that Vetspire runs $299 for Standard and $379 for Pro per DVM, and that Hippo Manager starts at $119 per veterinarian. Those figures appear across comparison sites, review aggregators and best-of-2026 roundups. We requested all three vendors' pricing pages directly. All three returned HTTP 404. Shepherd's own site publishes no price and leads everywhere to "Schedule a demo." Vetspire has moved to a new domain and has no pricing page on it. Hippo Manager's site is live and its pricing URL is gone. We are not accusing anyone of anything — prices change, sites get rebuilt, and any of those numbers may have been accurate when it was written. But undated secondary data presented as a current price is how an owner ends up budgeting against a figure that no vendor is offering, and in this category that is now the normal experience.

Here is what actually publishes, verified against the vendors' own pages rather than an aggregator.

Read down the right-hand column and the shape of the market announces itself. The one vendor that behaves like a normal software company is Provet Cloud, which prints a complete self-serve ladder and does something the rest of the category avoids: it separates the platform from the people. A $249 monthly platform fee that includes one veterinarian, then $99 for each additional veterinarian, with every technician, receptionist and practice manager free. That is an honest meter, because it charges you for the doctors who generate revenue rather than for the front-desk seats that a growing practice needs most. Onward Vet's $300 flat for an independent clinic is equally legible. ezyVet's $260.50 is at least a real number on a real page, even if everything past it requires a call.

And then there is the line that made us stop reading. On Provet Cloud's own published pricing page, alongside the software tiers, sits its payments product. The price column says $0. The note beside it says "(Share of revenue)."

We do not think that is a gotcha; we think it is the most honest thing published anywhere in this category. It states the business model out loud. The software is priced, and the movement of money is not. Every vendor here works that way — the difference is that Provet wrote it down.

The number nobody prints

So let us talk about the meter that actually matters, which is not the subscription at all.

A veterinary practice is unusual among small businesses in that a large fraction of its revenue is retail. Historically the pharmacy was about 30% of a practice's gross. The working benchmarks now put it lower — commonly 14% to 16% from the pharmacy plus another 9% or so from heartworm, flea and tick prevention — and we use 22% in our own modeling as a deliberately conservative number. On a three-doctor Baltimore practice grossing around $2.5 million, that is roughly $550,000 a year crossing the product counter.

That counter no longer sits behind the front desk. It sits in a browser, and increasingly it sits in someone else's browser. iVET360's benchmark work calls the shift "the Chewy Effect," and the direction is not in dispute: product-only visits have fallen by around 7%, and routine medication purchases have moved to lower-cost online sellers. The strategic position hardened considerably this year. On April 8, 2026, Chewy announced it was acquiring Modern Animal and its 29 owned clinics, taking Chewy Vet Care from 18 locations to 47 and adding more than $125 million of annualized run-rate revenue. The company that took your refills now owns veterinary practices. Chewy's own CEO described the deal as completing "the preeminent end-to-end pet health ecosystem." Read that from behind a Baltimore front desk and it means something specific: your largest retail competitor is now also a colleague, a referral source and a benchmark your clients will price you against.

The defensive move the category offers is a white-label online store — Vetsource Prescription Management or Covetrus vRxPro — that carries your practice's name, handles fulfillment, and pays you a margin on what your clients buy. It genuinely works. It is also the single largest financial relationship in the practice whose terms are published nowhere. Vetsource's prescription management page contains no rate, no commission and no revenue share; its only dollar figure is the $499-a-month value it assigns to a client-engagement app it bundles in free, which tells you what it thinks the relationship is worth without telling you what it costs. Covetrus's vRxPro pages claim practices "generate 2x more revenue" and publish no rate either. Practice managers comparing line items report the predictable consequence — one noted that the service "costs more than other online pharmacys unless you reduce veterinarian's profit to very little," and documented complaints show the same drug at $1.10 a tablet through the platform against $0.53 at a local pharmacy, and a prescription diet at $131.99 before shipping against $102.00 including shipping elsewhere.

You cannot do arithmetic on a rate nobody publishes. So do the arithmetic that is actually available: work out what each point of margin is worth at your volume, and negotiate against that. This is the table we build for practices before they sit down with a rep.

The subscription row uses Provet Cloud's published Core pricing because it is the clearest real ladder in the category: $249 a month covering the platform and the first veterinarian, plus $99 for each additional veterinarian, with support staff included. A three-doctor practice therefore pays $249 plus two times $99, which is $447 a month, or $5,364 a year — and that is the most transparent, fully-published number this market offers.

Set it against the row above. For that same three-doctor practice, moving five points of margin on the product counter is worth $27,500 a year. Five points. Not the whole relationship, not the difference between having a pharmacy partner and not having one — five percentage points of retained margin on the products you were going to sell anyway is worth more than five times your entire software bill. At five doctors the multiple is 5.7×. And the vendor on the other side of that conversation is the only party who knows what the current number is.

This is why we think practices in this market are optimizing the wrong line. Owners will spend three months and four demos choosing between platforms whose annual difference is perhaps two thousand dollars, and sign the pharmacy agreement in an afternoon because it has no price on it.

The other percentage: what the cards take

There is a second uncapped meter, and unlike the pharmacy it has been publicly quantified — by a vendor, with a product to sell, which is worth keeping in mind while reading it. Otto, which sells veterinary payment processing, published arithmetic showing an average clinic at $2,524,500 of annual revenue paying about 3.5% in card processing, which comes to $88,358 a year, and puts a typical two-doctor practice at around $43,000. Their proposed fix is surcharging, which they would say, since they sell it. But their underlying numbers are not controversial: veterinary card processing generally runs between 2.5% and 3.5%, and a point of it on a mid-sized practice is worth twenty-odd thousand dollars a year.

Two corrections are worth making for Maryland practices, because the advice circulating online is wrong on both.

First, you will read that Maryland caps credit card surcharges at 4%. There is no such Maryland statute. Maryland does not ban surcharging and does not set a percentage ceiling for it; the 4% figure is an old card-network rule, and Visa lowered its own cap to the lesser of your merchant discount rate or 3% effective April 15, 2023. What does bind you in Maryland is the Consumer Protection Act's treatment of undisclosed or misleading fees, which is a disclosure obligation rather than a numeric cap. Second, whatever you do, you may not surcharge debit or prepaid cards even when they are run as credit, and you must notify your acquirer at least 30 days before you start. A practice that adds a blanket 3.5% "card fee" to every transaction is out of compliance on two counts at once.

And if you offer client financing, price it honestly. CareCredit's standard non-promotional merchant rate is around 4.7%, and the longer promotional periods cost the practice more, not less — the deferred-interest structure that looks like zero-interest to the client is paid for on your side of the counter.

The part no national platform models

Everything above is national. This section is the one we would actually spend money on, because it is where a Baltimore practice's software quietly stops fitting.

Start with the tax treatment of your own shelf, which is genuinely strange and which we have never seen a veterinary storefront handle correctly out of the box. Maryland exempts animal medicine from sales tax by an elegant piece of reasoning: the Comptroller's Office has exercised its authority to define physicians to include veterinarians, so a sale of drugs or medical supplies to or by a veterinarian is exempt. But the exemption stops at the edge of the medicine cabinet, and the Comptroller is explicit about where.

"However, not all pet supplies sold to or by a veterinarian are exempt. For example, the sale of prescription diet food for pets and the sale of flea and tick powders, collars and sprays does not qualify for the medicine or medical supplies exemption."

Sit with that for a second, because it is the whole reason this section exists. A client checks out with a heartworm preventive and a bag of prescription diet food. Those two items are on the same invoice, prescribed by the same veterinarian on the same visit, and one is exempt while the other carries 6%. A Seresto collar is taxable; the oral prescription parasiticide that replaced it on most shelves reads as a drug and therefore as exempt — a defensible reading of a list that names powders, collars and sprays and does not name chewables, but a reading rather than a ruling, and exactly the kind of question your storefront has to answer on every single line. Here is the shelf, as Maryland sees it.

Notice the last two rows together. The grooming appointment is not taxable, but the shampoo you sell the client on the way out is. The bath is a service; the bottle is tangible personal property. No off-the-shelf storefront knows that, and no national platform's default tax configuration will get it right for a Maryland practice without per-product tax codes that somebody has to set and maintain. Get it wrong in the generous direction and you owe the state the difference on every order you ever shipped; get it wrong in the cautious direction and you have been quietly overcharging your own clients 6% on their heartworm pills.

Then there is dispensing itself, which Maryland specifies in more detail than most practices' label templates do. Under COMAR 15.14.01.12-2 a veterinarian may dispense only where a veterinarian-client-patient relationship exists, may not dispense more than the animal needs, and must produce a label carrying ten specific elements: the hospital's name, address and telephone number; the prescribing veterinarian's name; the client's and the animal's names; the drug's name, quantity and strength; directions for use; route of administration; length of treatment; cautionary statements including withdrawal times where they apply; the date dispensed; and the expiration date. Route of administration and length of treatment are the two that generic e-commerce fulfillment tends to drop, because a normal online store has no concept of either.

Records are a three-year obligation here, not a seven-year one — COMAR 15.14.01.10 requires patient records be kept three years after a patient's last visit, specifies what they must contain down to the milligrams or volume and concentration of any medication, its frequency and its route, and requires that a copy be released to an owner or a subsequent treating veterinarian on request. Radiographs and other non-written records are loaned rather than surrendered, and must come back within 30 days. That is a workflow, and almost nobody has built it: most practices handle records requests as an email thread and a scanner.

The telemedicine rules are tighter than the national conversation suggests. Maryland still requires the veterinarian-client-patient relationship to be established in person, and it applies to one veterinarian rather than to the practice. For the narrow telemedicine that is permitted without a relationship, the animal must reside in the state, and the provider must tell the client in writing their full name, location, license number, licensure status and the limitations of the medium. If you are building client-facing digital care into your practice, that written disclosure is a product requirement, not a legal footnote.

Controlled substances add a piece of Maryland administrative theater worth knowing about in advance. A veterinarian holding a Maryland CDS registration must be registered with the Prescription Drug Monitoring Program in order to obtain or renew it — but veterinarians are exempt from reporting dispensings to the PDMP, and the statute does not give them authority to query the data either. You must register with a database you cannot feed and cannot read. Budget an afternoon for it and do not expect the software to help.

Finally, the boring recurring facts: your hospital license is $300 a year with a $200 late fee, your own registration is $300 a year expiring every June 30, and the board inspects every licensed hospital at least once every two years — in practice closer to every eighteen months — against the sanitation standards in COMAR 15.14.03. None of that is hard. All of it is a calendar with real consequences attached, and it lives in somebody's head rather than in the practice-management system.

What we would actually build, and what it costs

Nothing above is an argument for replacing your practice-management system. We want to be blunt about that, because it is the recommendation an agency is supposed to avoid making.

Cornerstone, AVImark, ezyVet and Pulse contain two decades of accumulated clinical detail — controlled-drug logs, anesthetic monitoring records, in-house analyzer integrations, reminder engines, boarding and grooming calendars, referral letters, rabies certificate generation on the state-approved form. Rebuilding that surface is a seven-figure project with a multi-year timeline, and any studio that tells an independent practice otherwise is selling something. Keep the system you run. What we build is the layer that sits above it and the storefront that sits beside it — the parts where you are currently paying a percentage to somebody else for a capability that does not actually require them.

The store is the one we would start with in this vertical, and the arithmetic above is why. A storefront you own, wired to your own merchant account, does not take a percentage of your refills. On a practice doing $550,000 a year across the product counter, protecting even five points of margin returns $27,500 in the first year against a $6,000 build. That is not a marginal call.

But it comes with a real caveat that we would rather say here than in a sales meeting: build the store, do not try to build the pharmacy. Those are different businesses. Dispensing prescription drugs by mail means pharmacy licensure, cold chain, DEA and state controlled-substance handling, manufacturer authorization and genuine inventory risk — and that is precisely what Vetsource and Covetrus do well and are worth paying for. Diets, over-the-counter preventives, supplements, food, retail and wellness plan billing require none of it, and they are a large share of what actually ships. Keeping the prescription channel with a fulfillment partner while running everything else through a store you own is usually the right split. It is also the one arrangement no vendor in this category will ever propose to you, because the two halves are worth more to them together.

When you should not build

We turn this work down more often than we take it, so here is the honest test. Do not build if any of the following is true of your practice:

• Your product and pharmacy revenue is under roughly $150,000 a year — at one doctor the margin points are worth $8,250, the arithmetic is thin, and your time is better spent on the card processing rate and on getting a written pharmacy margin than on a build.
• You are within two or three years of selling. A buyer will migrate you onto their group's stack, and custom software is at best neutral and at worst a diligence question.
• Nobody in the practice owns the outcome. Every system we have seen fail failed because it belonged to whoever happened to be on the front desk that month.
• Your practice-management system is genuinely working. If Cornerstone or ezyVet does what you need, the answer is not a new system; it is a thin layer over the one you have.

Everyone else: the question is not whether to build, it is which one thing to build first, and it is nearly always the store.

Why we work this way

We are a small studio in Baltimore. There are two of us and we do the building ourselves, which means the person who scopes your project is the person who writes the code and the person who answers when something breaks at seven in the morning during your Monday rush.

We price everything fixed and we agree it before any code is written, which is unusual in this business and deliberate. A practice owner who has just spent an article's worth of reading discovering that nobody in their software category will publish a price should not then be asked to sign an open-ended hourly engagement. You get a number, you get a date, and you own what we build — the code, the data and the domain. If we think you should keep renting something instead of building it, we will tell you that on the first call and we will not send an invoice for the conversation.

Questions we get from practice owners

How much does veterinary practice management software cost in 2026?

Less than you would guess from the listicles, and harder to find out than it should be. Provet Cloud publishes a full ladder — a $249 monthly platform fee that includes one veterinarian, plus $99 for each additional veterinarian on the Core plan, with support staff free — which works out to about $5,364 a year for a three-doctor practice. Onward Vet publishes $300 a month for independent clinics. ezyVet publishes a starting figure of $260.50 a month and gates the rest. Everyone else in the category quotes after a demo, and the widely circulated per-doctor numbers for Shepherd, Vetspire and Hippo Manager are aggregator figures whose vendor pricing pages returned 404 when we checked them in July 2026. But the subscription is not the expensive part of running a veterinary practice. The product and pharmacy counter is roughly a fifth of practice revenue, and the cut taken from the online store that carries your practice's name is published by nobody. A custom build is priced differently: our fixed packages run from a $3,500 one-week prototype to $6,000 for an online store and $12,000 for a full operations system, agreed before any code is written, and you own it at the end.

Why can't I find pricing for Shepherd, Vetspire or Hippo Manager?

Because the pages those prices came from no longer exist. The figures you will find quoted everywhere — Shepherd at $299 per doctor per month, Vetspire at $299 or $379 per DVM, Hippo Manager from $119 per veterinarian — appear on comparison sites, review aggregators and best-of-2026 roundups rather than on the vendors' own sites. We requested all three pricing pages directly in July 2026 and all three returned HTTP 404. Shepherd's site now leads to "Schedule a demo." Vetspire has moved domains and has no pricing page at the new one. Hippo Manager's site is live but its pricing URL is gone. None of this means the numbers were never real; it means they are undated secondary data being presented as current, which is exactly the trap this category sets. Ask each vendor to put the subscription, the processing rate and the pharmacy margin in writing before you sit through a pitch.

What does a veterinary online pharmacy like Vetsource or Covetrus cost the practice?

Neither company publishes a rate, a commission, a revenue share or a margin figure anywhere on its public site, and we looked carefully. Vetsource's prescription management page carries no pricing at all and routes to "Request Info"; the only dollar figure on it is the $499-a-month value it assigns to the client-engagement app it bundles in free. Covetrus's vRxPro pages publish no rate either and route to "Request a demo." Provet Cloud is the one vendor that states the shape of the deal plainly, and it is worth reading twice: its payments product is listed on its own pricing page at "$0" with the parenthetical "(Share of revenue)." That is the category's business model in a single line — the software is priced and the money movement is not. Because no rate is public, the only arithmetic you can actually run is the sensitivity: work out your annual product revenue, then price what each five points of retained margin is worth, and negotiate against that number rather than against a subscription.

How much of a veterinary practice's revenue comes from pharmacy and products?

Historically about 30%, and the working benchmark now is closer to a fifth — commonly cited as 14% to 16% from the pharmacy plus another 9% or so from heartworm, flea and tick prevention. We use 22% in our own modeling as a deliberately conservative figure. On a three-doctor Baltimore practice grossing around $2.5 million, that is roughly $550,000 a year crossing the product counter, which means every five points of margin on it is worth about $27,500 — more than five times what the same practice would pay for a published, self-serve practice-management subscription. That ratio is the whole argument. The subscription is a rounding error next to the storefront, and the storefront is the piece most practices do not own.

Is custom-built veterinary software cheaper than ezyVet or Covetrus Pulse?

As a full replacement, almost never, and we will say so before you ask. A practice-management system carries two decades of accumulated detail — controlled-drug logs, anesthetic records, lab-machine integrations, reminder engines, boarding calendars — and rebuilding that is a seven-figure exercise that no independent practice should attempt. The honest comparison is not replacement but ownership of the layer above it. A storefront you own, wired to your own merchant account, does not take a percentage of your refills, and on a practice doing $550,000 a year in product revenue, the margin it protects pays for a $6,000 online store many times over in the first year. Keep Cornerstone or ezyVet or Pulse. Own the shop.

What does Maryland require that veterinary software doesn't handle out of the box?

More than any national platform models, and most of it lands on the retail side. Maryland exempts medicine and disposable medical supplies for animals from sales tax — the Comptroller has defined "physicians" to include veterinarians — but it explicitly taxes prescription diet food, flea collars, flea powder, flea and tick soap, tick sprays, vitamins, shampoo, grooming products, collars, leashes and toys at 6%. So two items on the same shelf, sold in the same order, carry different tax treatments, and a storefront has to get that right line by line. Beyond tax: COMAR 15.14.01.12-2 requires ten specific elements on every dispensing label, including route of administration, treatment length and expiration date; COMAR 15.14.01.10 requires patient records be kept three years after the last visit and released to an owner on request; the veterinarian-client-patient relationship must still be established in person, and for telemedicine without one the animal must reside in the state; a Maryland CDS registration requires PDMP registration even though veterinarians are exempt from reporting to it and cannot query it; and the hospital license runs $300 a year with a board inspection at least every two years.

Should a Baltimore veterinary practice build its own online pharmacy or store?

Build the store; do not try to build the pharmacy. Those are different things and conflating them is the expensive mistake. Dispensing prescription drugs by mail means licensure, cold chain, DEA and state controlled-substance handling, manufacturer authorization and inventory risk — that is what Vetsource and Covetrus genuinely do for you, and it is why they are worth paying. But diets, preventives sold over the counter, supplements, food, retail and wellness plans do not need any of that, and they are a large share of what actually ships. Keeping the prescription channel with a fulfillment partner while running everything else through a storefront you own is usually the right split, and it is the one arrangement the category never proposes to you, because both halves are more profitable to them together.

Do I pay Maryland sales tax on veterinary practice management software?

Probably, and it is a newer line than most practices realize. Since July 1, 2025, Maryland has applied a 3% sales and use tax to data and information technology services under House Bill 352 — the categories captured by NAICS 518, 519, 5415 and 5132, which sweep in software as a service, hosting, data services and IT consulting. Sold for use in an enterprise computer system the rate is 3%; sold for individual use, standard software can still fall under the 6% rate. It applies to your subscription and it applies to our invoice, so budget for it either way. It is not a large number against a $5,000 annual subscription, but it is one more thing that is true in Maryland and modeled by no national vendor's quote.