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Acquisitions and Investments - Profarma and Specialty Joint Ventures (Details) - USD ($)
$ in Thousands
1 Months Ended 3 Months Ended
Sep. 30, 2018
Jan. 31, 2018
Dec. 31, 2018
Mar. 31, 2018
Business Acquisition [Line Items]        
Goodwill $ 6,664,272   $ 6,697,547  
Deferred tax liability 1,829,410   $ 1,879,532  
Specialty Joint Venture        
Business Acquisition [Line Items]        
Investment in specialty joint venture $ 23,600 $ 15,600    
Ownership interest in specialty joint venture 89.90%     64.50%
Goodwill   3,500    
Estimated fair value of accounts receivable   65,000    
Estimated fair value of inventory   29,100    
Estimated fair value of accounts payable   54,300    
Assumed short-term debt   32,700    
Assumed cash   28,900    
Estimated fair value of intangible assets acquired   $ 4,600    
Weighted average useful life of intangible asset (in years)     15 years  
Specialty Joint Venture | Customer relationships        
Business Acquisition [Line Items]        
Weighted average useful life of intangible asset (in years)   15 years    
Specialty Joint Venture | Tradename        
Business Acquisition [Line Items]        
Weighted average useful life of intangible asset (in years)   15 years    
Profarma        
Business Acquisition [Line Items]        
Investment in Profarma   $ 62,500    
Ownership interest in Profarma       38.20%
Goodwill   142,000    
Estimated fair value of accounts receivable   160,100    
Estimated fair value of inventory   190,500    
Estimated fair value of accounts payable   167,700    
Assumed short-term debt   209,900    
Assumed long-term debt   12,400    
Assumed cash   150,800    
Noncontrolling interest   168,000    
Estimated fair value of intangible assets acquired   84,600    
Deferred tax liability   50,100    
Profarma | Customer relationships        
Business Acquisition [Line Items]        
Estimated fair value of intangible assets acquired   25,900    
Profarma | Tradename        
Business Acquisition [Line Items]        
Estimated fair value of intangible assets acquired   $ 58,700    
Minimum | Profarma | Tradename        
Business Acquisition [Line Items]        
Weighted average useful life of intangible asset (in years)   15 years    
Maximum | Profarma | Tradename        
Business Acquisition [Line Items]        
Weighted average useful life of intangible asset (in years)   25 years