ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251129*1111*^*00501*000036434*0*P*>~
GS*HS*52095*52095*251129*1111*1487113239*X*005010X279A1~
ST*270*000036434*005010X279A1~
BHT*0022*13*000036434*2511333*1111~
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*VOLAND*THERESA****MI*21296647~
DMG*D8*19570710*M~
DTP*291*RD8*20251129-20260227~
EQ*42~
EQ*30~
SE*14*000036434~
GE*1*36434~
IEA*1*000036434~