ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260903*1309*^*00501*000050391*0*P*>~
GS*HS*52095*52095*260903*1309*1487113239*X*005010X279A1~
ST*270*000050391*005010X279A1~
BHT*0022*13*000050391*2609246*1309~
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*KOLK*MICHAEL****MI*93354883~
DMG*D8*19700103*M~
DTP*291*RD8*20260903-20261202~
EQ*42~
EQ*30~
SE*14*000050391~
GE*1*50391~
IEA*1*000050391~