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GS*HS***260121*1601*1073904009*X*005010X279A1~
ST*270*000001512*005010X279A1~
BHT*0022*13*000001512*260121*1601~
HL*1**20*1~
NM1*PR*2*CAREFIRST BC/BS DC*****PI*6005~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*COYLE*DENNIS****MI*WWW000140~
DMG*D8*19640624*M~
DTP*291*RD8*20260121-20260421~
EQ*42~
EQ*30~
SE*14*000001512~
GE*1*1512~
IEA*1*000001512~

