ISA*00*          *00*          *ZZ*               *ZZ*               *260317*1403*^*00501*000001906*0*P*>~
GS*HS***260317*1403*1073904009*X*005010X279A1~
ST*270*000001906*005010X279A1~
BHT*0022*13*000001906*260376*1403~
HL*1**20*1~
NM1*PR*2*VIRGINIA ANTHEM MEDICAID*****PI*600099~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*MENDEZ UGARTE*DAISY****MI*153125801014~
DMG*D8*19671001*F~
DTP*291*RD8*20260317-20260615~
EQ*42~
EQ*30~
SE*14*000001906~
GE*1*1906~
IEA*1*000001906~