This work describes the development of medicines governance within an ambulance service, building on a limited fractional governance presence and the introduction of formal oversight. Early activity focused on strengthening governance structures, policies, and assurance processes to support safe and effective medicines management across approximately 70 dispersed operational sites. As the role developed, these foundations enabled wider modernisation, including improved systems, standardisation, and strengthened clinical leadership to drive quality and innovation. The work highlights the practical and operational challenges of embedding governance alongside service transformation. It demonstrates how robust oversight can act as a catalyst for change, supporting safer and more consistent practice across a geographically distributed frontline ambulance system.