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GS*HS*60054*60054*260521*0905*1487113239*X*005010X279A1~
ST*270*000046176*005010X279A1~
BHT*0022*13*000046176*2605141*0905~
HL*1**20*1~
NM1*PR*2*AETNA*****PI*60054~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*GILKIS*NAUM****MI*00000~
DMG*D8*19351116*M~
DTP*291*RD8*20260521-20260819~
EQ*42~
EQ*30~
SE*14*000046176~
GE*1*46176~
IEA*1*000046176~