ISA*00*          *00*          *ZZ*               *ZZ*               *260920*1109*^*00501*000002761*0*P*>~
GS*HS***260920*1109*1073904009*X*005010X279A1~
ST*270*000002761*005010X279A1~
BHT*0022*13*000002761*2609263*1109~
HL*1**20*1~
NM1*PR*2*ANTHEM MEDICARE ADVANTAGE*****PI*10115~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*TO*BOEUN****MI*YTW430W05446~
DMG*D8*19451202*F~
DTP*291*RD8*20260920-20261219~
EQ*42~
EQ*30~
SE*14*000002761~
GE*1*2761~
IEA*1*000002761~

