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GS*HS*10085*10085*260122*1201*1487113239*X*005010X279A1~
ST*270*000039285*005010X279A1~
BHT*0022*13*000039285*260122*1201~
HL*1**20*1~
NM1*PR*2*CAREFIRST BC/BS DC*****PI*10085~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*BARBOUR*WANDA****MI*FCN932751622~
DMG*D8*19620813*F~
DTP*291*RD8*20260122-20260422~
EQ*42~
EQ*30~
SE*14*000039285~
GE*1*39285~
IEA*1*000039285~