ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260717*0907*^*00501*000049214*0*P*>~
GS*HS*52095*52095*260717*0907*1487113239*X*005010X279A1~
ST*270*000049214*005010X279A1~
BHT*0022*13*000049214*2607198*0907~
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*MINER*SHANNON****MI*34154021~
DMG*D8*19901130*F~
DTP*291*RD8*20260717-20261015~
EQ*42~
EQ*30~
SE*14*000049214~
GE*1*49214~
IEA*1*000049214~