This study aims to assess fleet practice and implications for fleet performance in Ethiopian pharmaceutical supply agency (EPSA). EPSA is encountering aging fleets, higher fleet expenses, lack of spare parts, and excessive service delays. EPSA was chosen as it was the major public pharmaceutical procurer and distributor in Ethiopia. Institution-based descriptive and explanatory cross-sectional study designs with mixed approaches were employed. Descriptive findings reveal that vehicle tracking is the most practiced activity. Correlation and regression analysis show that maintenance, fuel, and tracking activities have significant association and predictive power for fleet performance. Qualitative findings show that delay of vehicle maintenance was the major challenge. EPSA higher officials may emphasize having well-organized workshop. The findings can be considered as input by policymakers in the transport sector. The limitation was the use of a homogenous purposive sampling method for the qualitative study. Thus, future study can be conducted using other reliable methods.