ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260622*1306*^*00501*000047916*0*P*>~
GS*HS*52095*52095*260622*1306*1487113239*X*005010X279A1~
ST*270*000047916*005010X279A1~
BHT*0022*13*000047916*2606173*1306~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*LACHICA*EVELYN****MI*57176971~
DMG*D8*19480101*M~
DTP*291*RD8*20260622-20260920~
EQ*42~
EQ*30~
SE*14*000047916~
GE*1*47916~
IEA*1*000047916~