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GS*HS*SKMD0*SKMD0*260501*1205*1073904009*X*005010X279A1~
ST*270*000002196*005010X279A1~
BHT*0022*13*000002196*2605121*1205~
HL*1**20*1~
NM1*PR*2*MARYLAND MEDICAID*****PI*SKMD0~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ROBBINS*BENSION****MI*48603561800~
DMG*D8*20260501*M~
DTP*291*RD8*20260501-20260730~
EQ*42~
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GE*1*2196~
IEA*1*000002196~