ISA*00*          *00*          *ZZ*10353          *ZZ*10353          *260528*1205*^*00501*000002364*0*P*>~
GS*HS*10353*10353*260528*1205*1073904009*X*005010X279A1~
ST*270*000002364*005010X279A1~
BHT*0022*13*000002364*2605148*1205~
HL*1**20*1~
NM1*PR*2*HUMANA CHOICECARE*****PI*600083~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*GOMEZ*RAFAEL****MI*H66312195~
DMG*D8*19430111*M~
DTP*291*RD8*20260528-20260826~
EQ*42~
EQ*30~
SE*14*000002364~
GE*1*2364~
IEA*1*000002364~

