ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251029*0910*^*00501*000034679*0*P*>~
GS*HS*52095*52095*251029*0910*1487113239*X*005010X279A1~
ST*270*000034679*005010X279A1~
BHT*0022*13*000034679*2510302*0910~
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*FULTON*NENITA****MI*48273862~
DMG*D8*19610213*F~
DTP*291*RD8*20251029-20260127~
EQ*42~
EQ*30~
SE*14*000034679~
GE*1*34679~
IEA*1*000034679~