EXHIBIT 10.1

FOURTH AMENDMENT, dated as of December _, 2009 (“Fourth Amendment”), to the
AMENDED AND RESTATED LOAN AND SECURITY AGREEMENT, dated as of September 26, 2007
(as amended, restated, supplemented or otherwise modified, the “LSA”), among
BioScrip Pharmacy Services, Inc. (“Pharmacy Services”), BioScrip Infusion
Services, Inc. (“Infusion Services Inc”), BioScrip Pharmacy (NY), Inc.
(“Pharmacy (NY)”), BioScrip PBM Services, LLC (“PBM Services”), BioScrip
Pharmacy, Inc. (“Pharmacy”), Natural Living, Inc. (“Natural Living”), BioScrip
Infusion Services, LLC (“Infusion Services LLC) and Bradhurst Specialty
Pharmacy, Inc. (“Bradhurst”, and together with Pharmacy Services, Infusion
Services Inc, Pharmacy (NY), PBM Services, Pharmacy, Natural Living and Infusion
Services LLC, each a “Borrower” and collectively, jointly and severally, the
“Borrowers”), as borrowers, and HFG Healthco-4 LLC (together with its successors
and assigns, the “Lender”), as the lender.  Unless otherwise defined herein,
terms in the LSA are used herein as therein defined.
 
The Borrowers and the Lender have agreed to amend the LSA on the terms and
subject to the conditions set forth herein.
 
Accordingly, in consideration of the foregoing and for other good and valuable
consideration, the receipt and sufficiency of which hereby are acknowledged, and
subject to the fulfillment of the conditions set forth below, the parties hereto
agree as follows:
 
SECTION 1.            AMENDMENTS TO LSA.
 
The following amendments shall become effective as of the Effective Date:
 
1.1.            The defined term “Consolidated Fixed Charge Coverage Ratio”
appearing in Exhibit I of the LSA is hereby amended by (i) deleting
such  defined term in its entirety, and (ii) substituting therefor the following
new defined term:
 
“Consolidated Fixed Charge Coverage Ratio” means the ratio, as determined as at
the end of each fiscal quarter of the Parent for the immediately prior 12 month
period, (x) Consolidated EBITDA of the Parent and its Subsidiaries for such
period, to (y) the sum of each of the following items to the extent paid or
payable by the Borrowers in cash during such period: (i) the current portion
long-term Debt, plus (ii) the current portion of Capital Leases, plus (iii)
Consolidated Capital Expenditures (to the extent not funded by or being acquired
under permitted purchase money loans or capital leases), plus (iv) Consolidated
Interest Expense, plus (v) taxes, plus (vi) payment of dividends, distributions,
advances, and loans to officers, Affiliates, and shareholders.

1.2.            The defined term “Debt/EBITDA Ratio” appearing in Exhibit I of
the LSA is hereby amended by adding the following proviso at the end of such
defined term:
 
provided, that for the purposes of calculation of the covenant set forth in
clause (v) of Exhibit V hereto, “Debt/EBITDA Ratio” shall mean the ratio, as
determined as at the end of each fiscal quarter of the Parent, of (x) the
average Debt of the Borrowers for such fiscal quarter, calculated as the
arithmetic average of all daily balances during such fiscal quarter, to (y)
Consolidated EBITDA for the immediately prior 12 months.

 
 

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1.3.            Exhibit V of the LSA is hereby amended by (i) deleting clauses
(t) and (u) in their entirety, and (ii) substituting therefor the following new
clauses (inserted in their respective appropriate alphabetical locations):
 
(t)            Consolidated Net Worth.  The Consolidated Net Worth, calculated
as at the end of each fiscal quarter of the Parent, is less than (i) $95,000,000
minus (ii) any and all write offs of goodwill, deferred tax assets, intangible
assets and other non-cash items as reflected in the Parent’s financial
statements.

(u)           Current Ratio.  The ratio of (i) Current Assets to (ii) Current
Liabilities for each Fiscal Quarter during which the principal amount of the
Revolving Loan exceeded 50% of the Borrowing Limit at any time, is less
1.10:1.00.

SECTION 2. CONDITIONS PRECEDENT
 
2.1. Effective Date of this Fourth Amendment.  This Fourth Amendment shall
become effective as of the date (the “Effective Date”) at such time when the
Lender shall have received fully executed counterparts of this Fourth Amendment.
 
SECTION 3.            MISCELLANEOUS
 
3.1. The Borrowers each hereby certify, represent and warrant that, after giving
effect to this Fourth Amendment, (i) except as otherwise disclosed in public
filings made by the Parent with the United States Securities and Exchange
Commission, the representations and warranties in the LSA are true and correct,
with the same force and effect as if made on such date, except as they may
specifically refer to an earlier date, in which case they were true and correct
as of such date, (ii) no unwaived Default or Event of Default has occurred or is
continuing (nor any event that but for notice or lapse of time or both would
constitute a Default or an Event of Default), (iii) each of the Borrowers has
the corporate power and authority to execute and deliver this Fourth Amendment,
and (iv) no consent of any other person (including, without limitation,
shareholders or creditors of any Borrower), and no action of, or filing with any
governmental or public body or authority is required to authorize, or is
otherwise required in connection with the execution and performance of this
Fourth Amendment, other than, in each case, such that have been obtained.
 
3.2. The terms “Agreement”, “hereof”, “herein” and similar terms as used in the
LSA shall mean and refer to, from and after the effectiveness of this Fourth
Amendment, the LSA as amended by this Fourth Amendment, and as it may in the
future be amended, restated, modified or supplemented from time to time in
accordance with its terms.  Except as specifically agreed herein, nothing herein
shall be deemed to be an amendment or waiver of any covenant or agreement
contained in the LSA or any other Document and each of the parties hereto agrees
that all of the covenants and agreements and other provisions contained in the
LSA and the other Documents, as amended, waived or otherwise modified hereof,
are hereby ratified and confirmed in all respects and shall remain in full force
and effect in accordance with their terms from and after the date of this Fourth
Amendment.
 

 
 

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3.3.            Parent and Chronimed, LLC (f/k/a Chronimed Inc.) each hereby
ratifies its Guarantee of the Guaranteed Obligations (as defined in that certain
Amended and Restated Guaranty, effective as of October 1, 2007, made by Parent
and Chronimed, LLC (f/k/a Chronimed Inc.) (the “Guaranty”)) pursuant to the
Guaranty and each of the Borrowers, Parent and Chronimed, LLC (f/k/a Chronimed
Inc.) hereby ratifies its grant of a security interest made under the Documents.
 
3.4.            This Fourth Amendment shall constitute a Document under the LSA
 
3.5. THIS FOURTH AMENDMENT SHALL, IN ACCORDANCE WITH SECTION 5-1401 OF THE
GENERAL OBLIGATIONS LAW OF THE STATE OF NEW YORK, BE GOVERNED BY THE LAWS OF THE
STATE OF NEW YORK, WITHOUT REGARD TO ANY CONFLICT OF LAWS PRINCIPLES THEREOF
THAT WOULD CALL FOR THE APPLICATION OF THE LAWS OF ANY OTHER JURISDICTION.
 
3.6.            The captions in this Fourth Amendment are for convenience of
reference only, are not part of this Fourth Amendment and shall not affect the
construction of, or be taken into consideration in interpreting, this Fourth
Amendment.
 
3.7.            Any provision of this Fourth Amendment held to be invalid,
illegal or unenforceable in any jurisdiction shall, as to such jurisdiction, be
ineffective to the extent of such invalidity, illegality or unenforceability
without affecting the validity, legality and enforceability of the remaining
provisions hereof, and the invalidity of a particular provision in a particular
jurisdiction shall not invalidate such provision in any other jurisdiction.
 
3.8. This Fourth Amendment may be executed in counterparts, each of which when
so executed shall be deemed to be an original and all of which when taken
together shall constitute one and the same agreement.
 
3.9. Delivery of an executed counterpart of a signature page by telecopier, .pdf
or similar electronic transmission shall be effective as delivery of a manually
executed counterpart.
 

 
 

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IN WITNESS WHEREOF, the parties hereto have caused this Fourth Amendment to be
executed by their respective officers thereunto duly authorized, as of the date
first above written.
 
BIOSCRIP INFUSION SERVICES, INC.
 
By:       ______________________________
             Name:
             Title:
BIOSCRIP PHARMACY SERVICES, INC.
 
By:       ______________________________
             Name:
             Title:
 
BIOSCRIP PBM SERVICES, LLC
 
By:       ______________________________
             Name:
             Title:
 
BIOSCRIP PHARMACY (NY), INC.
 
By:       ______________________________
             Name:
             Title:
 
NATURAL LIVING, INC.
 
By:       ______________________________           
             Name:
             Title:
 
BIOSCRIP PHARMACY, INC.
 
By:       ______________________________
             Name:
             Title:
 
BIOSCRIP INFUSION SERVICES, LLC
 
By:       ______________________________
             Name:
             Title:
 
BRADHURST SPECIALTY PHARMACY, INC.
 
By:       ______________________________           
             Name:
             Title:
 
Solely with respect to Section 3.3 hereof:
 
 
BIOSCRIP, INC.
 
By:       ______________________________           
             Name:
             Title:
 
CHRONIMED, LLC (f/k/a Chronimed Inc.)
 
By:       ______________________________           
             Name:
             Title:

 
 

 
 

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HFG HEALTHCO-4 LLC,
as Lender
 
By:  HFG Healthco-4, Inc., a member
 
By:       _____________________________ 
             Name: 
             Title:
 

 

 
 

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