BENTONVILLE, Ark. —Mike Duke's name may be unfamiliar to those in the chain drug industry, but that will change early next year when he replaces Lee Scott as president and chief executive officer of Wal-Mart. For the past three years, Duke has served as vice chairman of Wal-Mart's international division and has understandably spent much of his time outside of the United States, where Wal-Mart operates roughly 3,300 stores in 13 countries. While Duke was immersed in streamlining and expanding the operations of the international division—the company exited Germany and South Korea, increased its presence in China and Brazil and entered India—major healthcare developments unfolded domestically. Wal-Mart launched generic drug-pricing programs, developed electronic medical records, engaged critics of its benefits programs and positioned itself for a seat at the table with a new administration eager to reform the nation's healthcare system.