ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260707*1407*^*00501*000042670*0*P*>~
GS*HS*52095*52095*260707*1407*1487113239*X*005010X279A1~
ST*270*000042670*005010X279A1~
BHT*0022*13*000042670*2607188*1407~
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*DANNA****MI*64196455~
DMG*D8*19520117*F~
DTP*291*RD8*20260707-20261005~
EQ*42~
EQ*30~
SE*14*000042670~
GE*1*42670~
IEA*1*000042670~