Exhibit 10.43


Certain portions of this Exhibit have been omitted based upon a request for 
confidential treatment pursuant to Rule 406 under the Securities Act of 1933. 
The omitted portions have been filed separately with the Securities and 
Exchange Commission.


     AMENDMENT NUMBER ONE TO DRUG DISTRIBUTION BUSINESS MANAGEMENT
                        AND SERVICE AGREEMENT


         This Agreement ("Amendment") is made and entered into by and between 
Southern Health Systems, Inc., a Tennessee corporation ("SHS"), Texas Health 
Pharmaceutical Resources, a Tennessee general partnership (hereinafter 
referred to "THPR"), and Nova Factor, Inc., a Tennessee corporation 
(hereinafter referred to "NFI").

                           WITNESSETH

         WHEREAS, SHS and THPR entered into a Drug Distribution Business 
Management and Service Agreement dated           , 1995 ("Service 
Agreement"); and

         WHEREAS, THPR is engaged in the business of providing distribution 
of drugs and SHS is in the process of withdrawing from that business; and

         WHEREAS, THPR, NFI and SHS desire to amend the Service Agreement to 
substitute NFI for SHS and to provide that SHS's obligations thereunder shall 
hereinafter be performed by NFI.

         NOW THEREFORE, for and in consideration of the mutual promises 
contained herein and for other good and valuable consideration, the receipt 
and adequacy of which is hereby acknowledged, the Service Agreement is 
amended, effective as of the date hereof ("Effective Date"), as follows:

         1.       Except as set out in Section 4 hereof, THPR, SHS and
                  NFI agree that from and after the Effective Date, all
                  privileges, rights, duties and obligations of SHS under
                  the Service Agreement shall be and hereby are assigned
                  and transferred to NFI and that the Service Agreement
                  shall, from the Effective Date, be an agreement solely
                  by and between NFI and THPR.

         2.       Except as set out in Section 4 hereof, NFI hereby
                  accepts the assignment and transfer of all rights,
                  privileges, duties and obligations of SHS under the
                  Service Agreement, and from and after the Effective
                  Date, agrees to carry out the duties and obligations of
                  SHS set forth in the Service Agreement.

         3.       All references to SHS in the Service Agreement shall be
                  deleted and NFI shall be substituted therefor.

         4.       From and after the Effective Date, SHS shall have no
                  further liability or responsibility under the Service
                  Agreement, and THPR shall have no further obligation
                  and liabilities to SHS thereunder.  Notwithstanding the
                  preceding sentence, all obligations and duties which



                  were to be performed by THPR or SHS and all rights and
                  privileges which accrued in favor of SHS or THPR, prior
                  to the Effective Date, shall continue to be in effect,
                  including the indemnity contained in the Service
                  Agreement for matters occurring prior to the Effective
                  Date.  In addition, SHS and THPR agree to continue to
                  observe the confidentiality provisions of the Service
                  Agreement, as well as their respective obligations to
                  maintain records, all as concern information and
                  records generated prior to the Effective Date.  All
                  monies earned or owed to SHS or THPR under the Service
                  Agreement prior to the Effective Date shall promptly be
                  paid in accordance with the terms of the Service
                  Agreement as in effect prior to the Effective Date.

         5.       Effective March 1, 1996, Section 2 of the Service
                  Agreement entitled Compensation is amended to delete
                  the reference to "* of THPR
                  during that month" and to substitute in place thereof
                  the following:  "* of THPR
                  during that month."  In addition, Section 2 is amended
                  to provide that if the total sum of $* is
                  exceeded, the excess shall be split among NFI,
                  PharmaThera, Inc., HealthEffects, Inc. and CliniCall,
                  Inc. in a manner agreed upon by those four parties.  It
                  is further agreed that these changes in Section 2 of
                  the Service Agreement shall be in effect until June 30,
                  1996, at which time, NFI and THPR will negotiate a new
                  fee arrangement mutually acceptable to both parties.

         6.       All provisions of the Service Agreement shall
                  hereinafter be in full force and effect by and between
                  NFI and THPR except as otherwise specifically stated
                  herein.

         7.       NFI and SHS also entered into a Drug Distribution
                  Management and Services Subcontract dated             ,
                  1995 (the "Subcontract").  The parties hereby agree
                  that said Subcontract shall be, and is, terminated and
                  cancelled as of the Effective Date.

         IN WITNESS WHEREOF, each of the parties hereto have caused this 
Amendment to be executed by their duly authorized officers this    day of     
       , 1996.

                                               SOUTHERN HEALTH SYSTEMS, INC.

                                               By: /s/ illegible
                                                  ----------------------------
                                               Title: Chairman
                                                     -------------------------


* Omitted information is the subject of a request for confidential treatment 
  pursuant to Rule 406 under the Securities Act of 1933 and has been filed 
  separately with the Securities Exchange Commission.




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                                               NOVA FACTOR, INC.

                                               By: /s/ David Stevens
                                                  ---------------------------
                                               Title:  President
                                                     ------------------------


                                               TEXAS HEALTH PHARMACEUTICAL
                                               RESOURCES, INC., a partnership

                                               By: Nova Factor, Inc., one of
                                                 its general partners
 
                                               By: /s/ David Stevens
                                                  ---------------------------
                                               Title:  President
                                                     ------------------------

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