ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251021*1710*^*00501*000034364*0*P*>~
GS*HS*52095*52095*251021*1710*1487113239*X*005010X279A1~
ST*270*000034364*005010X279A1~
BHT*0022*13*000034364*2510294*1710~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*DAVIDSON*KEITH****MI*78293483~
DMG*D8*19481107*M~
DTP*291*RD8*20251021-20260119~
EQ*42~
EQ*30~
SE*14*000034364~
GE*1*34364~
IEA*1*000034364~