The bio pharmaceutical unit of Oncology Clinic (UBCO) of the hospital of Tours (France) produces between 100 and 300 injections per day for three hospital units of Tours. The production of chemotherapy drugs consists of two steps: a sterilization step and a preparation step performed by pharmacists. The production process can be modeled as an hybrid flow shop scheduling problem. Once the drugs are completed, they have to be delivered to the patient at a given due date. The delivery problem is a variant of the multi-trip vehicle routing problem. We propose in this paper a multi-level heuristic to solve the integrated production and delivery problem. Computational experiments are conducted on real-life based instances to compare multiple settings and to evaluate the efficiency of the proposed approach. HCSE2019, 013, v5 (final): 'Multi-level heuristic to optimize the chemotherapy production. . .