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GS*HS*12345*12345*260608*1206*1073904009*X*005010X279A1~
ST*270*000002155*005010X279A1~
BHT*0022*13*000002155*2606159*1206~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*COGSWELL*WILLIAM****MI*981947402~
DMG*D8*19350805*M~
DTP*291*RD8*20260608-20260906~
EQ*42~
EQ*30~
SE*14*000002155~
GE*1*2155~
IEA*1*000002155~

