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GS*HS*10000*10000*250930*1409*1487113239*X*005010X279A1~
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HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*GRIFFIN*DOROTHY****MI*1F20R24XH27~
DMG*D8*19530617*M~
DTP*291*RD8*20250930-20251229~
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IEA*1*000033021~