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GS*HS*52095*52095*260416*1304*1487113239*X*005010X279A1~
ST*270*000044112*005010X279A1~
BHT*0022*13*000044112*2604106*1304~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*AGUILAR CRUZ*KELDIN****MI*28348184~
DMG*D8*20010522*F~
DTP*291*RD8*20260416-20260715~
EQ*42~
EQ*30~
SE*14*000044112~
GE*1*44112~
IEA*1*000044112~