ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251013*1210*^*00501*000003303*0*P*>~
GS*HS*52095*52095*251013*1210*1487113239*X*005010X279A1~
ST*270*000003303*005010X279A1~
BHT*0022*13*000003303*2510286*1210~
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*WEST*MICHAEL****MI*75335134~
DMG*D8*19630911*M~
DTP*291*RD8*20251013-20260111~
EQ*42~
EQ*30~
SE*14*000003303~
GE*1*3303~
IEA*1*000003303~