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GS*HS*52095*52095*251106*1411*1487113239*X*005010X279A1~
ST*270*000033677*005010X279A1~
BHT*0022*13*000033677*2511310*1411~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*BOND*QUYENTEN****MI*93271461~
DMG*D8*19930909*M~
DTP*291*RD8*20251106-20260204~
EQ*42~
EQ*30~
SE*14*000033677~
GE*1*33677~
IEA*1*000033677~