Five years ago, when Sam Chamakura decided to become an independent pharmacist, the business was attractive. New independent pharmacies were opening throughout New York City, dispensing pills and raking in profits.

So Chamakura, at 26, had high hopes when he took over Malcolm X Pharmacy in Central Harlem.

Now, the great recession has hit the young pharmacist’s cash register. With Harlem’s unemployment rate topping 20 percent, his revenue is down 15 percent compared to last year. Many customers, he says, still need medication but can no longer afford to buy it. And more of them are running tabs that he hopes will be paid off eventually.

Chamakura has been forced to cut the frequency of his pharmaceutical orders and to haggle with suppliers. He devotes much of his energy to strategizing on ways to keep his business afloat. Lately, he has visited neighborhood doctors, striving to drum up customers.

Meanwhile, like many independent pharmacists across the city, Chamakura continues to battle against a big-chain competitor down the street, relying on a personal touch to retain trade.

"Any little thing that I can do to have an edge over the chains like CVS I try to take advantage of and hope it can help my business," Chamakura said. "No one from CVS is going to visit doctors."

He also worries about cuts in Medicaid reimbursement, a vital source of revenue for drug stores in low-income neighborhoods. In Harlem, more than 26,000 people rely on the health care program, more than double the dependency in 2,000. Pharmacies are taking a 4 percent cut on reimbursements as a result of changes in rates set by the New York Department of Health in July 2008.

Still, he said, he's lucky that he has not been hit harder with so many independent pharmacies being forced to close. In 2008 alone, 200 pharmacies closed in New York City, many of them independent, said Charles Catalano, president of the New York City Pharmacists Society.

The financial squeeze often shows up in Chamakura’s own buying pattern.

"We used to purchase a lot more and keep stocked up, but now we wait until we run out of the drug or we get the money to pay for it," he said. "It could be a lot worse."

Chamakura hopes he can continue working in a business he's grown to love. When he was studying at St. John's University, his dad -- a forensic scientist investigating crime scenes for the New York police -- gave him the option of studying to be a doctor or a pharmacist. Unlike his older brother and sister, he chose pharmacy.

He began working at a pharmacy straight out of college, and nine years later he's not looking back. Though he has worked at a chain pharmacy, Rite Aid, he prefers being an independent pharmacist because he feels like he's really helping customers -- even if that means taking on some of the hurt financially.

He said in the last year he's seen a lot more of his customers struggle. Some of them get several medications prescribed, but will only get one because they cannot afford the co-pays. Other times they cannot pay the co-pay on the spot, so he gives them the medication anyway, keeping their balance on tab.

"Some of them have to wait to pay it off when they get their paychecks, but sometimes they don't and so it gets absorbed by the pharmacy," he said.

A looming worry is competition with big chains like CVS, which Chamakura said have not been hit as hard. That is because independent pharmacies get roughly 90 percent of their revenue through prescription drug sales, whereas chains rely on "front of the store" retail sales. Chamakura tries to fight this by offering more than just a prescription.

"I don't know the pharmacist at CVS," said Florence Floyd, a 39-year-old mother of two who has been filling her prescriptions at Chamakura's pharmacy since it opened. "Here, he knows my son, and he knows the medication that he's on."

Floyd said Chamakura’s genuine personality keeps her coming back.

Chamakura concedes that things may soon get worse for his small business, but he remains optimistic that his personal connection with customers and physicians will prevent him from being the next independent pharmacy to close its doors.