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GS*HS*10000*10000*260521*1105*1487113239*X*005010X279A1~
ST*270*000046187*005010X279A1~
BHT*0022*13*000046187*2605141*1105~
HL*1**20*1~
NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*ADAMS*ARLENE****MI*1VC6G65MW56~
DMG*D8*19250417*F~
DTP*291*RD8*20260521-20260819~
EQ*42~
EQ*30~
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GE*1*46187~
IEA*1*000046187~