ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260128*1601*^*00501*000039456*0*P*>~
GS*HS*52095*52095*260128*1601*1487113239*X*005010X279A1~
ST*270*000039456*005010X279A1~
BHT*0022*13*000039456*260128*1601~
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*FARMER*LUCY****MI*85322638~
DMG*D8*19620918*M~
DTP*291*RD8*20260128-20260428~
EQ*42~
EQ*30~
SE*14*000039456~
GE*1*39456~
IEA*1*000039456~