ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251128*1511*^*00501*000036428*0*P*>~
GS*HS*52095*52095*251128*1511*1487113239*X*005010X279A1~
ST*270*000036428*005010X279A1~
BHT*0022*13*000036428*2511332*1511~
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*WALLACE*SADE****MI*88306832~
DMG*D8*19941028*F~
DTP*291*RD8*20251128-20260226~
EQ*42~
EQ*30~
SE*14*000036428~
GE*1*36428~
IEA*1*000036428~