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General - Customers Exceeding Ten Percent of Consolidated Net Revenues (Details)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2019
USD ($)
item
Jun. 30, 2018
USD ($)
Jun. 30, 2019
USD ($)
item
Jun. 30, 2018
USD ($)
Operating results by business segment        
Revenues $ 1,788,336 $ 1,810,923 $ 3,527,825 $ 3,616,000
Minimum        
Operating results by business segment        
Term of contracts with customers     1 year  
Term of contract extensions or renewals     1 year  
Maximum        
Operating results by business segment        
Term of contracts with customers     3 years  
Term of contract extensions or renewals     2 years  
Virginia Contracts        
Operating results by business segment        
Revenues     $ 391,200 228,800
CCC Plus Contract        
Operating results by business segment        
Term of contracts with customers     5 years  
Term of contract extensions or renewals     12 months  
Termination notice     90 days  
CCC Plus Contract | Maximum        
Operating results by business segment        
Number of contract extensions or renewals | item 5   5  
Medallion Contract        
Operating results by business segment        
Number of contract extensions or renewals | item 6   6  
Term of contract extensions or renewals     12 months  
Termination notice     180 days  
New York Contract        
Operating results by business segment        
Revenues     $ 400,600 356,600
Massachusetts Contracts        
Operating results by business segment        
Revenues     $ 360,900 330,900
SCO Contract        
Operating results by business segment        
Term of contract extensions or renewals     1 year  
Termination notice     180 days  
SCO Contract | Maximum        
Operating results by business segment        
Number of contract extensions or renewals | item 5   5  
CMS Contract        
Operating results by business segment        
Term of contracts with customers     1 year  
Healthcare        
Operating results by business segment        
Revenues $ 1,220,642   $ 2,384,895  
Healthcare | Customer A        
Operating results by business segment        
Revenues     118,061 307,902
Pharmacy Management        
Operating results by business segment        
Revenues $ 612,658   1,229,118  
Pharmacy Management | Customer B        
Operating results by business segment        
Revenues     $ 174,535 $ 176,650