ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251022*1010*^*00501*000034397*0*P*>~
GS*HS*52095*52095*251022*1010*1487113239*X*005010X279A1~
ST*270*000034397*005010X279A1~
BHT*0022*13*000034397*2510295*1010~
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*VALENCIA*MARY****MI*26143554~
DMG*D8*19430504*F~
DTP*291*RD8*20251022-20260120~
EQ*42~
EQ*30~
SE*14*000034397~
GE*1*34397~
IEA*1*000034397~