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GS*HS*Gil Messick*Gil Messick*260211*1502*1487113239*X*005010X279A1~
ST*270*000040909*005010X279A1~
BHT*0022*13*000040909*260242*1502~
HL*1**20*1~
NM1*PR*2*MEDICAID*****PI*2~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*ECHEVARRIA DAUGHTON*TIMOTHY****MI*47101797300~
DMG*D8*19741018*M~
DTP*291*RD8*20260211-20260512~
EQ*42~
EQ*30~
SE*14*000040909~
GE*1*40909~
IEA*1*000040909~