This research establishes a Lean Manufacturing framework aimed at improving warehouse management within the Ethiopian pharmaceutical supply chains, specifically targeting the Nekemte Hub of the Ethiopian Pharmaceutical Supply Service (EPSS). The study identifies various inefficiencies, including excess inventory, stock outs, delays, and product damage, which arise from inadequate layout design, insufficient standardization, and a lack of workforce training. Primary data were collected through interviews, questionnaires, and on-site observations involving 73 participants, including employees, customers, and logistics providers. Secondary data consisted of literature related to Lean warehousing and pharmaceutical supply chain management. A root cause analysis utilizing 5W1H and Pareto analysis revealed 22 significant inefficiencies, categorized into areas such as storage systems, standardization, human resources, warehouse design, and training deficiencies. The analysis quantitatively demonstrated that a small number of causes were responsible for the majority of inefficiencies. For instance, in addressing transportation waste, the Pareto analysis revealed that the top three causes poor warehouse layout design (19%), inadequate material handling equipment (14%), and poor product storage designation (14%) collectively accounted for nearly 50% of the problem. Similarly, issues related to human resources (23%) and technology/equipment (17%) were identified as the primary clusters, jointly responsible for 40% of all warehousing wastes. The proposed Lean framework, integrating tools like 5S, Value Stream Mapping (VSM), Kaizen, and the PDCA cycle, directly targets these root causes. The study concludes that the systematic implementation of this framework can lead to a significant reduction in lead times, fewer stockouts, minimized product damage, and improved overall warehouse performance, thereby strengthening the reliability of Ethiopia's pharmaceutical supply chain Keywords: Lean Manufacturing, Warehouse Management, Pharmaceutical Supply Chain, Pareto analysis, Continuous Improvement.