ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260423*1604*^*00501*000002172*0*P*>~
GS*HS*52095*52095*260423*1604*1073904009*X*005010X279A1~
ST*270*000002172*005010X279A1~
BHT*0022*13*000002172*2604113*1604~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*JACKSON*EDWARD****MI*02163156~
DMG*D8*19460128*M~
DTP*291*RD8*20260423-20260722~
EQ*42~
EQ*30~
SE*14*000002172~
GE*1*2172~
IEA*1*000002172~

