ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260422*1304*^*00501*000044353*0*P*>~
GS*HS*52095*52095*260422*1304*1487113239*X*005010X279A1~
ST*270*000044353*005010X279A1~
BHT*0022*13*000044353*2604112*1304~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICAID JOINT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*LEWIS*CHIPPELLA****MI*15260345~
DMG*D8*19750925*F~
DTP*291*RD8*20260422-20260721~
EQ*42~
EQ*30~
SE*14*000044353~
GE*1*44353~
IEA*1*000044353~