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Objectives: Remdesivir is an FDA approved treatment for hospitalized patients with COVID-19 infection and, in randomized controlled trials, RDV shortened time to recovery and improved clinical outcomes. Data are scarce on RDV utilization in real-world settings or how use has changed over the course of the pandemic. Using chargemaster inpatient data from the Premier Healthcare Database, we describe the patient population and use of RDV following Emergency Use Authorization. Methods: In this retrospective cohort study, adult patients admitted May 1st - Nov 30th 2020 with a primary or secondary discharge diagnosis of COVID-19 (ICD-10-CM: U07.1) were identified and their first COVID-related hospital admission was considered. Descriptive statistics were reported for demographic characteristics of RDV and non-RDV treated patients. RDV utilization over time and by region was examined. Results: Of the 190,529 patients hospitalized for COVID-19 in 823 hospitals, 55,030 (29%) were treated with RDV in 589 hospitals. RDV utilization over time increased from 5% of patients in May to 47% in Nov 2020. In Nov, RDV utilization was 57% in the West, followed by 49% in the South, 48% in the Midwest and 27% in the Northeast. Over time, RDV was initiated earlier in the course of hospitalization. Initiation within the first 2 days of hospitalization increased from 40% to 85% from May to Nov 2020. The average age was 63.6 years (SD=15.3) and 63.5 years (SD=17.3) for RDV-treated and non-RDV treated patients, respectively. More than half of the patients were male (RDV: 56%;Non-RDV: 52%) and about a quarter had commercial insurance (RDV: 28%;Non-RDV: 22%). Racial distribution (white, black, and other) was similar between RDV and non-RDV patients. Conclusions: Overall use of RDV and initiation within the first two days of hospitalization have substantially increased over the course of the pandemic in the United States.