ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260702*1007*^*00501*000048204*0*P*>~
GS*HS*52095*52095*260702*1007*1487113239*X*005010X279A1~
ST*270*000048204*005010X279A1~
BHT*0022*13*000048204*2607183*1007~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*EYA*FLORENCE****MI*92233797~
DMG*D8*19260929*F~
DTP*291*RD8*20260702-20260930~
EQ*42~
EQ*30~
SE*14*000048204~
GE*1*48204~
IEA*1*000048204~