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GS*HS*15004*15004*260630*0806*1073904009*X*005010X279A1~
ST*270*000002536*005010X279A1~
BHT*0022*13*000002536*2606181*0806~
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*TODD*JOHN****MI*4TE8AW5XP43~
DMG*D8*19361115*M~
DTP*291*RD8*20260630-20260928~
EQ*42~
EQ*30~
SE*14*000002536~
GE*1*2536~
IEA*1*000002536~

