EXHIBIT 10.18

                             STOCK OPTION AGREEMENT

     STOCK  OPTION  AGREEMENT  made as of the 3rd day of  August,  1999  between
NATIONAL  MEDICAL  HEALTH  CARD  SYSTEMS,  INC.,  a New  York  corporation  (the
"Company"), and John Ciufo (the "Optionee").

     WHEREAS,  the  Optionee  is an  employee  of the  Company  or a  subsidiary
thereof;

     WHEREAS,  the  Company  desires to provide to the  Optionee  an  additional
incentive to promote the success of the Company;

     NOW,  THEREFORE,  in  consideration  of the  foregoing,  the Company hereby
grants to the Optionee  (the  "Grant")  the right and option to purchase  Common
Shares of the Company under and pursuant to the terms and conditions of the 1999
Stock Option Plan (the "Plan") and upon and subject to the  following  terms and
conditions:

     1. GRANT OF OPTION.

     The  Company  hereby  grants to the  Optionee  the right  and  option  (the
"Option") to purchase up to Ten Thousand  (10,000)  Common Shares of the Company
(the "Option Shares") during the following periods:

          (a) All or any part of Three  Thousand  Four  Hundred  (3,400)  Common
     Shares may be purchased during the period commencing on the date hereof and
     terminating at 5:00 P.M. on August 3, 2004 (the "Expiration Date");

          (b) All or any part of Three  Thousand  Three Hundred  (3,300)  Common
     Shares may be purchased during the period commencing one year from the date
     hereof and terminating at 5:00 P.M. on the Expiration Date;

          (c) All or any part of Three  Thousand  Three Hundred  (3,300)  Common
     Shares may be  purchased  during the period  commencing  two years from the
     date hereof and terminating at 5:00 P.M. on the Expiration Date;

     2. NATURE OF OPTION.

     Such  Options to  purchase  the  Option  Shares  are  intended  to meet the
requirements  of Section 422 of the Internal  Revenue Code of 1986,  as amended,
relating to "incentive stock options".

     3. EXERCISE PRICE.

     The exercise  price of each of the Option  Shares shall be Five Dollars and
87/100 ($5.87) (the "Option Price"). The Company shall pay all original issue or
transfer taxes on the exercise of the Option.

     4. EXERCISE OF OPTIONS.

     The Option shall be  exercised in  accordance  with the  provisions  of the
Plan.  As soon as  practicable  after the receipt of notice of exercise  (in the
form  annexed  hereto as Exhibit A) and payment of the Option  Price as provided
for in the Plan, the Company shall tender to the Optionee certificates issued in
the Optionee's name evidencing the number of Option Shares covered thereby.

     5. TRANSFERABILITY.

     The  Option  shall not be  transferable  other  than by will or the laws of
descent and  distribution  and,  during the  Optionee's  lifetime,  shall not be
exercisable by any person other than the Optionee.

     6. INCORPORATION BY REFERENCE.

     The terms and conditions of the Plan are hereby  incorporated  by reference
and made a part hereof.

     7. NOTICES.

     Any  notice  or  other   communication  given  hereunder  shall  be  deemed
sufficient  if in writing and hand  delivered or sent by registered or certified
mail, return receipt requested,  addressed to the Company, 26 Harbor Park Drive,
Port Washington, New York 11050, Attention: Secretary and to the Optionee at the
address indicated below.  Notices shall be deemed to have been given on the date
of hand delivery or mailing, except notices of change of address, which shall be
deemed to have been given when received.

     8. BINDING EFFECT.

     This  Agreement  shall be  binding  upon and  inure to the  benefit  of the
parties  hereto  and their  respective  legal  representatives,  successors  and
assigns.

     9. ENTIRE AGREEMENT.

     This Agreement,  together with the Plan, contains the entire  understanding
of the parties  hereto  with  respect to the  subject  matter  hereof and may be
modified only by an instrument executed by the party sought to be charged.

     IN WITNESS WHEREOF,  the parties have executed this Agreement as of the day
and year first above written.

                                                   NATIONAL MEDICAL HEALTH CARD
                                                      SYSTEMS, INC.

                                                   By:


                                                   /s/Bert E. Brodsky
                                                   Bert E. Brodsky, Chairman

                                                   /s/John Ciufo
                                                   Signature of Optionee

                                                   John Ciufo
                                                   Name of Optionee


                                                  Address of Optionee


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                                    EXHIBIT A

                   NATIONAL MEDICAL HEALTH CARD SYSTEMS, INC.

                              OPTION EXERCISE FORM

     The  undersigned  hereby  irrevocably  elects to exercise the within Option
dated _____________ to the extent of purchasing  ________________  Common Shares
of National  Medical Health Card Systems,  Inc. The  undersigned  hereby makes a
payment of $_____________ in payment therefor.

                                                 John Ciufo
                                                 Name of Optionee

                                                 Signature of Optionee

                                                 Address of Optionee

                                                 Date