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GS*HS***251115*1211*1073904009*X*005010X279A1~
ST*270*000001021*005010X279A1~
BHT*0022*13*000001021*2511319*1211~
HL*1**20*1~
NM1*PR*2*ANTHEM HEALTHKEEPERS CCC PLUS*****PI*600112~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*RANDOLPH*BRIANNA****MI*YTW711W07937~
DMG*D8*19921124*F~
DTP*291*RD8*20251115-20260213~
EQ*42~
EQ*30~
SE*14*000001021~
GE*1*1021~
IEA*1*000001021~

