The purpose of this research is to investigate how culture impacts on international marketing strategy of a Swedish health service in India, a culturally distant country to Sweden. It is examined how confidence in the market is achieved to establish and maintain trust and relationships, and the level of standardization and adaptation for the acceptance of the service in the foreign market is suggested. A case study was conducted in its real life context. An inductive qualitative research method has been applied and data has been collected in the form of semi-structured interviews, direct observation and company documents. We found that the cultural dimensions of power distance and individualism/collectivism have an impact on trust development, relationships and standardization and adaptation. The study shows that innovative image of the service offering and after service maintenance act as means for competition on the private and public market. Standardization of prices and service processes comprising maintenance of service quality, support contracts and service contracts develop commitment and trust. Personal relationships with the government, doctors and involvement with customers are regarded important and should be adapted to and follow local traditions. It is further demonstrated that moral and emotional issues, respect to the human face, hierarchy and social responsibility for regional development are required to develop relationships, trust and networks. It is argued that word of mouth, tactics and diplomacy sustain the possibility of success for service providers and the acceptance of the health service by local customers. The research contributes to the International services marketing literature by developing a model and extending understanding of internationalization of health services marketing from a culture context. For future studies, it suggests a comparison between more culturally distant countries to observe how culture influences development of marketing strategy in international business. The research shows how managers can establish relationships and networks to gain trust and legitimacy in the local market.