The challenges of managing up in a merging organization that is structured as a matrix and provides services to others in a network organization are described. Managing up in the merging organization, which may be characterized by instability, jockeying for position, conflicts of organizational cultures, inconsistent or conflicting policies, and a lack of vision, calls for the development of relationships, support for the merger, a focus on pharmaceutical care, and consideration of all factions. Managers are advised to be aware of shifts of power and to focus on issues rather than people when forced to take a "side." Identifying bosses, keeping multiple bosses satisfied, and avoiding upper-level politics are challenges posed by managing over in the matrix organization. Recommended strategies include communicating with and understanding each boss, developing relationships, and keeping the goals and visions of the organization in mind. Managers in a matrix organization should remember to whom they ultimately report and should be honest with their primary boss about conflicts. Managing across may be complicated by differences in the objectives of network institutions, the customer-based relationship among these institutions, and the need for a vision that clearly recognizes mutual responsibilities. Establishing a relationship that benefits both institutions, tailoring services to institutions, specifying the services to be provided in a contract, developing relationships, and checking regularly on the quality of services are among the strategies for managing across. Services should not merely be transplanted from one institution to another, and relationships that are not mutually beneficial should be re-evaluated. Specific challenges, strategies, and cautions are associated with managing up in a merging organization, over in a matrix organization, and across in a network organization, but success in any of these situations requires vision, a strong team, influence, a strong network of relationships, effective communication, the ability to focus on goals, and a history of delivering on promises.