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GS*HS***260728*1607*1073904009*X*005010X279A1~
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BHT*0022*13*000002635*2607209*1607~
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NM1*PR*2*BCBS CAREFIRST*****PI*600110~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ACHEBE*CHRISTINE****MI*XIL901631215~
DMG*D8*19791216*F~
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IEA*1*000002635~