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GS*HS*63092*63092*251014*1410*1487113239*X*005010X279A1~
ST*270*000034106*005010X279A1~
BHT*0022*13*000034106*2510287*1410~
HL*1**20*1~
NM1*PR*2*CIGNA HEALTH SPRING  MEDICARE HMO ADVANTAGE*****PI*10158~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*MCKENZIE*RICHARD****MI*36873604~
DMG*D8*19430823*M~
DTP*291*RD8*20251014-20260112~
EQ*42~
EQ*30~
SE*14*000034106~
GE*1*34106~
IEA*1*000034106~