Evidence-based pharmacotherapy is a central aspect of optimal patient care for many chronic conditions. However, medication non-adherence frequently inhibits the attainment of optimal pharmacotherapy regimens. In this study, we designed, developed, and implemented a multifaceted clinical decision support (CDS) intervention that supports evidence-based pharmacotherapy and enhanced medication adherence through the use of a scalable, claims-driven, and service-oriented approach. The intervention includes a medication management report and a low adherence alert based on thirteen evidence-based pharmacotherapy rules for seven chronic conditions. Reports and alerts are delivered to primary care clinics and care managers that participate in a healthcare information exchange in North Carolina. The resulting system architecture may enable this CDS intervention to be widely disseminated to healthcare networks through an open-source model.