ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260623*0906*^*00501*000002506*0*P*>~
GS*HS*15004*15004*260623*0906*1073904009*X*005010X279A1~
ST*270*000002506*005010X279A1~
BHT*0022*13*000002506*2606174*0906~
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*HURLBERT*JOHN****MI*4PK2G90TW84~
DMG*D8*19560821*M~
DTP*291*RD8*20260623-20260921~
EQ*42~
EQ*30~
SE*14*000002506~
GE*1*2506~
IEA*1*000002506~

