ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260707*0807*^*00501*000042374*0*P*>~
GS*HS*52095*52095*260707*0807*1487113239*X*005010X279A1~
ST*270*000042374*005010X279A1~
BHT*0022*13*000042374*2607188*0807~
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*JACKSON*ERIC****MI*67259295~
DMG*D8*19541007*M~
DTP*291*RD8*20260707-20261005~
EQ*42~
EQ*30~
SE*14*000042374~
GE*1*42374~
IEA*1*000042374~