To determine the factors, including a preparation test, that best predict pharmacy students' performance on the Pharmacy Curriculum Outcomes Assessment (PCOA). Two cohorts of third-year pharmacy students completed a 100-item locally created PCOA pre-test, the PCOA Prep. This PCOA Prep was a cumulative knowledge test that was administered in the fall semester. In the spring semester, the students completed the 200-item PCOA and a separate survey on study habits and confidence. A retrospective review of students' demographics data, pre-pharmacy admission variables, and pharmacy school factors were collected. Correlation and regression analyses were conducted to evaluate which factors predicted students' PCOA total scaled score as well as scores in areas 1-4. One hundred seventy-nine students were included in the study. The majority were female (55%), white (54%), and 28 (SD=5.4) years old on average. Students' average score on the PCOA Prep test was 80.7% (SD=7.8). The stepwise multiple linear regression model for the PCOA total scaled score included the PCOA Prep test, cumulative GPA at the end of the didactic curriculum, race/ethnicity, Pharmacy College Admission Test (PCAT) Verbal, PCAT Biology, and a class identifier. Including the PCOA Prep test explained more variance than the model without the test. This study revealed that student performance on a locally created cumulative knowledge test best predicted the PCOA Total Scaled Score. These results offer insights into additional contributing factors that influence students' PCOA performance and how colleges and schools of pharmacy could identify at-risk students who may need knowledge remediation prior to beginning advanced pharmacy practice experiences.