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GS*HS*52095*52095*260520*0705*1487113239*X*005010X279A1~
ST*270*000046120*005010X279A1~
BHT*0022*13*000046120*2605140*0705~
HL*1**20*1~
NM1*PR*2*KAISER MEDICARE ADV JOINT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*CLIFTON*ALICE****MI*99304480~
DMG*D8*19530602*F~
DTP*291*RD8*20260520-20260818~
EQ*42~
EQ*30~
SE*14*000046120~
GE*1*46120~
IEA*1*000046120~