ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *250922*1609*^*00501*000032745*0*P*>~
GS*HS*52095*52095*250922*1609*1487113239*X*005010X279A1~
ST*270*000032745*005010X279A1~
BHT*0022*13*000032745*2509265*1609~
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*THOMAS*ADRIENNE****MI*57227943~
DMG*D8*19660615*F~
DTP*291*RD8*20250922-20251221~
EQ*42~
EQ*30~
SE*14*000032745~
GE*1*32745~
IEA*1*000032745~