ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260911*1109*^*00501*000050760*0*P*>~
GS*HS*52095*52095*260911*1109*1487113239*X*005010X279A1~
ST*270*000050760*005010X279A1~
BHT*0022*13*000050760*2609254*1109~
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*PILGRIM*HUGH****MI*37260229~
DMG*D8*19760807*M~
DTP*291*RD8*20260911-20261210~
EQ*42~
EQ*30~
SE*14*000050760~
GE*1*50760~
IEA*1*000050760~