The reasons for and consequences of the location of a flourishing industrial anomaly ouside the predominant region of concentration is of continuing geographic interest. This paper is an examination of both structural and agency factors for the historical establishment and consistent success of pharmaceutical giant Eli Lilly and Company. Along with its recent medical device spinoff, Lilly is the only ‘Fortune 500’ firm in Indianapolis, and one of few outside the Mid-Atlantic states cluster. Industry-locational exceptionalism is sustained by a cross-sectoral concentration of related manufacturing and service companies to create a health ensemble. A consciously constructed local metropolitan and state sociopolitical niche further nurtures industry-specific and mutually beneficial growth. Theories on agglomeration-sustaining patterns are considered in light of this empirical study.
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