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GS*HS*15004*15004*260502*1405*1073904009*X*005010X279A1~
ST*270*000002198*005010X279A1~
BHT*0022*13*000002198*2605122*1405~
HL*1**20*1~
NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*FRANCIS*JOSEPH****MI*7NX9VM9ND19~
DMG*D8*19360601*M~
DTP*291*RD8*20260502-20260731~
EQ*42~
EQ*30~
SE*14*000002198~
GE*1*2198~
IEA*1*000002198~

