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Manufacturing capability is a crucial component of every nation’s economy and pharmaceuticals are frequently a significant part of the manufacturing sector. Pharmaceutical supply chains are essential to health-care systems, contributing to living quality and shorter hospital stays. This study aims to examine the role of multiple integrations on business performance (BP) through supply chain flexibility (SCF) and supply chain agility (SCA).

Data was collected from 198 supply chain professionals in the pharmaceutical sector of the developing economy of Pakistan. The sample was collected based on a nonprobability purposive sampling approach. A five-point Likert-scale survey was used and analyzed with the PLS-SEM technique using SmartPLS 4.

This study found that process integration (PI) does not affect SCA, whereas relationship integration and measurement integration positively affect SCA. SCA positively impacts BP. In contrast, all integrations significantly influenced supply flexibility and BP except for PI. Finally, SCF significantly mediates the relationship between all integrations and BP.

This study examined the relationships of multiple integrations on BP, directly and indirectly, through SCF and agility. The theory of dynamic capabilities has been applied and extended to increase the comprehensiveness of the findings. A developing economy’s pharmaceutical industry supply chain was examined, producing empirical evidence of the results.