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GS*HS*52095*52095*260410*1404*1487113239*X*005010X279A1~
ST*270*000041561*005010X279A1~
BHT*0022*13*000041561*2604100*1404~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE COMMERCIAL JOINT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*BOST*CHERYL****MI*081069141~
DMG*D8*19670305*F~
DTP*291*RD8*20260410-20260709~
EQ*42~
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GE*1*41561~
IEA*1*000041561~