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GS*HS*3432*3432*250815*1408*1457998957*X*005010X279A1~
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BHT*0022*13*000000080*2508227*1408~
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NM1*PR*2*UHC AHCCCS/ALTCS*****PI*3432~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*IRWIN*JOYCE****MI*A97050372~
DMG*D8*19510223*F~
DTP*291*RD8*20250815-20251113~
EQ*42~
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IEA*1*000000080~