ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *250821*1308*^*00501*000030975*0*P*>~
GS*HS*52095*52095*250821*1308*1487113239*X*005010X279A1~
ST*270*000030975*005010X279A1~
BHT*0022*13*000030975*2508233*1308~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*GRAHAM*KENDRA****MI*39236208~
DMG*D8*19910403*F~
DTP*291*RD8*20250821-20251119~
EQ*42~
EQ*30~
SE*14*000030975~
GE*1*30975~
IEA*1*000030975~