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                                                                     EXHIBIT 4.5

                             SUPPLEMENTAL INDENTURE

      SUPPLEMENTAL INDENTURE (this "Supplemental Indenture"), effective as of
November 5, 2004, among Mountain Vista Medical Center, LP (the "Guaranteeing
Subsidiary"), a subsidiary of IASIS Healthcare LLC (or its permitted successor),
(the "Company"), the Company, IASIS Capital Corporation (or its permitted
successor), ("IASIS Capital," and together with the Company, the "Issuers"), the
other Guarantors (as defined in the Indenture referred to herein) and The Bank
of New York Trust Company, N.A., as trustee under the Indenture referred to
below (the "Trustee").

                               W I T N E S S E T H

      WHEREAS, the Issuers have heretofore executed and delivered to the Trustee
an indenture (the "Indenture"), dated as of June 22, 2004 providing for the
issuance of 8 3/4% Senior Subordinated Notes due 2014 (the "Notes");

      WHEREAS, the Indenture provides that under certain circumstances the
Guaranteeing Subsidiary shall execute and deliver to the Trustee a supplemental
indenture pursuant to which the Guaranteeing Subsidiary shall unconditionally
guarantee all of the Company's Obligations under the Notes and the Indenture on
the terms and conditions set forth herein (the "Subsidiary Guarantee"); and

      WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is
authorized to execute and deliver this Supplemental Indenture.

      NOW THEREFORE, in consideration of the foregoing and for other good and
valuable consideration, the receipt of which is hereby acknowledged, the Parties
mutually covenant and agree for the equal and ratable benefit of the Holders of
the Notes as follows:

      1. CAPITALIZED TERMS. Capitalized terms used herein without definition
shall have the meanings assigned to them in the Indenture.

      2. AGREEMENT TO GUARANTEE. The Guaranteeing Subsidiary hereby agrees to
provide an unconditional Guarantee on the terms and subject to the conditions
set forth in the Subsidiary Guarantee and in this Indenture including but not
limited to Article 11 thereof.

      3. NO RECOURSE AGAINST OTHERS. No past, present or future director,
officer, employee, incorporator, stockholder or agent of the Guaranteeing
Subsidiary, as such, shall have any liability for any obligations of the Issuers
or any Guaranteeing Subsidiary under the Notes, any Subsidiary Guarantees, the
Indenture or this Supplemental Indenture or for any claim based on, in respect
of, or by reason of, such obligations or their creation. Each Holder of the
Notes by accepting a Note waives and releases all such liability. The waiver and
release are part of the consideration for issuance of the Notes. Such waiver may
not be effective to waive liabilities under the federal securities laws and it
is the view of the SEC that such a waiver is against public policy.

      4. NEW YORK LAW TO GOVERN. THE INTERNAL LAW OF THE STATE OF NEW YORK SHALL
GOVERN AND BE USED TO CONSTRUE THIS SUPPLEMENTAL INDENTURE BUT WITHOUT GIVING
EFFECT TO APPLICABLE PRINCIPLES OF

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CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF ANOTHER
JURISDICTION WOULD BE REQUIRED THEREBY.

      5. COUNTERPARTS. The parties may sign any number of copies of this
Supplemental Indenture. Each signed copy shall be an original, but all of them
together represent the same agreement.

      6. EFFECT OF HEADINGS. The Section headings herein are for convenience
only and shall not affect the construction hereof.

      7. THE TRUSTEE. The Trustee shall not be responsible in any manner
whatsoever for or in respect of the validity or sufficiency of this Supplemental
Indenture or for or in respect of the recitals contained herein, all of which
recitals are made solely by the Guaranteeing Subsidiary and the Issuers.

                            [Signature Pages Follow]

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IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture
to be duly executed, all as of the date first above written.

                             MOUNTAIN VISTA MEDICAL CENTER, LP

                             By:  /s/ W. Carl Whitmer
                                 -----------------------------------------
                             Name:  W. Carl Whitmer
                             Title: Chief Financial Officer

                             IASIS HEALTHCARE LLC

                             By:  /s/ W. Carl Whitmer
                                 -----------------------------------------
                             Name:  W. Carl Whitmer
                             Title: Chief Financial Officer

                             IASIS CAPITAL CORPORATION

                             By:  /s/ W. Carl Whitmer
                                 -----------------------------------------
                             Name:  W. Carl Whitmer
                             Title: Chief Financial Officer

                             ARIZONA DIAGNOSTIC & SURGICAL CENTER, INC.
                             BAPTIST JOINT VENTURE HOLDINGS, INC.
                             BEAUMONT HOSPITAL HOLDINGS, INC.
                             BILTMORE SURGERY CENTER, INC.
                             BILTMORE SURGERY CENTER HOLDINGS, INC.
                             BROOKWOOD DIAGNOSTIC CENTER OF TAMPA, INC.
                             IASIS PHYSICIAN SERVICES, INC.
                             CLINICARE OF TEXAS, INC.
                             CLINICARE OF UTAH, INC.
                             DAVIS HOSPITAL HOLDINGS, INC.
                             DAVIS SURGICAL CENTER HOLDINGS, INC.
                             FIRST CHOICE PHYSICIANS NETWORK HOLDINGS, INC.
                             IASIS FINANCE, INC.
                             IASIS HEALTHCARE HOLDINGS, INC.
                             IASIS HOME INFUSION AND MEDICAL EQUIPMENT, INC.
                             IASIS MANAGEMENT COMPANY
                             IASIS TRANSCO, INC.
                             JORDAN VALLEY HOSPITAL HOLDINGS, INC.
                             MCS/AZ, INC.

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                             METRO AMBULATORY SURGERY CENTER, INC.
                             NORTH VISTA HOSPITAL, INC.
                             PALMS OF PASADENA HOMECARE, INC.
                             PIONEER VALLEY HEALTH PLAN, INC.
                             PIONEER VALLEY HOSPITAL, INC.
                             ROCKY MOUNTAIN MEDICAL CENTER, INC.
                             SALT LAKE REGIONAL MEDICAL CENTER, INC.
                             IASIS HOSPITAL NURSE STAFFING COMPANY
                             SOUTHRIDGE PLAZA HOLDINGS, INC.
                             SSJ ST. PETERSBURG HOLDINGS, INC.
                             TAMPA BAY STAFFING SOLUTIONS, INC.

                             By: /s/ Frank A. Coyle
                                 ---------------------------------------
                                 Name:  Frank A. Coyle
                                 Title: Secretary

                             SEABOARD DEVELOPMENT LLC

                             By: /s/ Frank A. Coyle
                                 ---------------------------------------
                                 Name:  Frank A. Coyle
                                 Title: Secretary

                             IASIS FINANCE TEXAS HOLDINGS, LLC

                             By: /s/ Frank A. Coyle
                                 ---------------------------------------
                                 Name:  Frank A. Coyle
                                 Title: Secretary

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                             ST. LUKE'S BEHAVIORAL HOSPITAL, LP
                             MEMORIAL HOSPITAL OF TAMPA, LP
                             MESA GENERAL HOSPITAL, LP
                             PALMS OF PASADENA HOSPITAL, LP
                             SOUTHWEST GENERAL HOSPITAL, LP
                             ST. LUKE'S MEDICAL CENTER, LP
                             TEMPE ST. LUKE'S HOSPITAL, LP
                             TOWN & COUNTRY HOSPITAL, LP

                             By: IASIS HEALTHCARE HOLDINGS, INC.,
                                       as General Partner

                             By: /s/ Frank A. Coyle
                                 ---------------------------------------
                                 Name:  Frank A. Coyle
                                 Title: Secretary

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                             THE BANK OF NEW YORK TRUST
                             COMPANY, N.A., as Trustee

                             By:  /s/ Barbara K. Royal
                                 -----------------------------------------
                                 Authorized Signature
                                      Barbara K. Royal
                                      Asst. Vice President<PAGE>

                                                                   EXHIBIT 10.17

           ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
                        DIVISION OF BUSINESS AND FINANCE
                               CONTRACT AMENDMENT

                                                                     PAGE 1 OF 2

1. AMENDMENT NO.:   2. CONTRACT NO.:    3. EFFECTIVE DATE    4. PROGRAM:
                                           OF AMENDMENT:
       09             YH04-0001-03       OCTOBER 1, 2004     DHCM-ACUTE

5. CONTRACTOR/PROVIDER NAME AND ADDRESS:

                              HEALTH CHOICE ARIZONA
                           1600 W. BROADWAY, SUITE 260
                            TEMPE, ARIZONA 85282-1136
6. PURPOSE:

       To revise language in the contract.

7. The above referenced contract is hereby amended as follows:

      A.    CHANGES IN REQUIREMENTS: In accordance with Section E, Paragraph 30,
            "Changes", various changes in contract requirements are indicated in
            this contract amendment as follows:

      B.    Section D, Paragraph 53, Compensation; remove references to CYE '04
            as follows:

            "The following risk factors will be included..."
            "RECONCILIATION OF PPC COSTS TO REIMBURSEMENT: AHCCCSA..."
            "RISK SHARING FOR TITLE XIX WAIVER MEMBERS: AHCCCSA..."

      C.    Section D, Paragraph 57, Reinsurance; remove reference to CYE '04
            as follows:

            The following table represents deductible and coinsurance levels:

      D.    Section D, Paragraph 30, Primary Care Provider Standards: The
            following language: "Beginning in CYE '05, AHCCCSA may develop a
            methodology to reimburse providers, such as clinics for the homeless
            and school based clinics, who provide primary care services to acute
            care members enrolled with the Contractor, but who are unable to
            fulfill the requirements to obtain a contract as a PCP. The
            Contractors will be responsible for payment of these services to
            either the clinics directly or to AHCCCSA."

            Is changed to: "Beginning in CYE '05, Contractors will work with
            AHCCCSA to develop a methodology to reimburse clinics for the
            homeless and school based clinics. AHCCCSA and Contractors will
            identify coordination of care processes and reimbursement mechanisms
            to be implemented by March 1, 2005. The Contractor will be
            responsible for payment of these services directly to the clinics."

      E.    Section D, Paragraph 39, Specialty Contracts: The following sentence
            in the second to last paragraph of this section is deleted:

            ".... AHCCCSA reserves the right to make direct payments to
            specialty contractors on behalf of the Contractor. ..."

      F.    Section D, Paragraph 73, Business Continuity and Recovery Plan:
            Delete the following sentence:

            "This plan is currently under review and will be placed in the
            Bidder's Library upon completion."

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                                                                     PAGE 2 OF 2

      G.    Attachment A, Minimum Subcontract Provisions, Paragraph 3)
            Certification of Compliance-Anti-Kickback and Laboratory Testing,
            change "Health Care Financing Administration" to "Centers for
            Medicare and Medicaid Services"

      H.    Attachment A, Minimum Subcontract Provisions: Change title of the
            Paragraph 14) to "General Indemnification"

      I.    Attachment A, Minimum Subcontract Provisions: Add paragraph 26)
            Offshore Performance of Work Prohibited:

            26) OFF SHORE PERFORMANCE OF WORK PROHIBITED
            Due to security and identity protection concerns, all services under
            this contract shall be performed within the borders of the United
            States. All storage and processing of information shall be performed
            within the borders of the United States. This provision applies to
            work performed by subcontractors at all tiers.

      J.    Attachment H (1), Enrollee Grievance System, Paragraph 28,2)
            Delete the following language
                  ".... the denial represents..."
            Insert the following language
                  "....that the requested service/treatment is ...."

            Attachment H (1), Enrollee Grievance System, Paragraph 32, 2) a)

            Insert the following language after "...enrollee's right to request
            a State fair hearing..."

            "...hearing (including the requirement that the enrollee must file
            the request for a hearing in writing) no later than....."

      K.    Attachment L, Cost Sharing Copayments: Change all non-emergent use
            of ER copayments from $5 to $1.

      L.    By signing this contract amendment, the Contractor is agreeing to
            the terms of the contract as amended.

NOTE: Please sign, date and    Gary L. Callahan, Contract Management Supervisor
return both originals to:      AHCCCS Contracts and Purchasing
                               701 E. Jefferson, MD 5700
                               Phoenix, AZ 85034

8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL
CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL
EFFECT.

IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT.

9. NAME OF CONTRACTOR:                10. ARIZONA HEALTH CARE COST CONTAINMENT
HEALTH CHOICE ARIZONA                 SYSTEM

SIGNATURE OF AUTHORIZED INDIVIDUAL:   SIGNATURE: /s/ Michael Veit
/s/ Carolyn  Rose                                ------------------------------
------------------------
TYPED NAME: CAROLYN ROSE              TYPED NAME: MICHAEL VEIT

TITLE: CHIEF EXECUTIVE OFFICER        TITLE: CONTRACTS AND PURCHASING
                                      ADMINISTRATOR

DATE                                  DATE: NOVEMBER 2, 2004

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