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GS*HS*15004*15004*250821*1408*1487113239*X*005010X279A1~
ST*270*000031175*005010X279A1~
BHT*0022*13*000031175*2508233*1408~
HL*1**20*1~
NM1*PR*2*MEDICARE*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*BRIGHT*ARCHIE****MI*9NA2X86FT93~
DMG*D8*19450915*M~
DTP*291*RD8*20250821-20251119~
EQ*42~
EQ*30~
SE*14*000031175~
GE*1*31175~
IEA*1*000031175~