ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251112*1611*^*00501*000035547*0*P*>~
GS*HS*52095*52095*251112*1611*1487113239*X*005010X279A1~
ST*270*000035547*005010X279A1~
BHT*0022*13*000035547*2511316*1611~
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*PIERCE*SHANNON****MI*481008540~
DMG*D8*19841016*F~
DTP*291*RD8*20251112-20260210~
EQ*42~
EQ*30~
SE*14*000035547~
GE*1*35547~
IEA*1*000035547~