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BHT*0022*13*000002129*2604107*0704~
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NM1*PR*2*HUMANA GOLD CHOICE*****PI*6013~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*VANDELINDE*CHARLES****MI*H42593078~
DMG*D8*19411117*M~
DTP*291*RD8*20260417-20260716~
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IEA*1*000002129~