Abstract: A cart system for distributing pharmaceutical items includes a cart and a plurality of totes. The cart has a wheeled base, framework, a door, and a locking mechanism. The framework extends upwardly from the base and forms an interior storage region having a front, a rear, and opposing sides. An access opening at the front is provided, with the door movable to a closed position that partially blocks the access opening. The locking mechanism selectively locks the door in the closed position. In a shipping state, the totes are loaded within the storage region and the door locked. The totes are visible from an exterior of the cart, but cannot be removed without evidence of tampering. The framework can divide the storage region into two or more columns, and includes platforms within the columns and arranged to define compartments sized to receive respective ones of the totes.