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GS*HS***260507*1305*1073904009*X*005010X279A1~
ST*270*000002212*005010X279A1~
BHT*0022*13*000002212*2605127*1305~
HL*1**20*1~
NM1*PR*2*HUMANA ESSENTIALS*****PI*00004~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ROSARIO*INES****MI*H71468473~
DMG*D8*19370822*F~
DTP*291*RD8*20260507-20260805~
EQ*42~
EQ*30~
SE*14*000002212~
GE*1*2212~
IEA*1*000002212~