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In 2020 the Fortune 500 looks very different. Fortune now includes service businesses, so the two top companies by sales are retailers – as would also have been true in 1955. But the current leaders are retailers that did not exist in 1955: Walmart and Amazon. No fewer than four companies are names that probably mean little to non-US readers – they are intermediaries in the fabulously costly US healthcare system. United Health is an insurer, McKesson and Cencora (previously known as AmerisourceBergen) are distributors of pharmaceutical products and CVS Health is both insurer and retailer.