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GS*HS*SKAZ0*SKAZ0*250918*0709*1457998957*X*005010X279A1~
ST*270*000000163*005010X279A1~
BHT*0022*13*000000163*2509261*0709~
HL*1**20*1~
NM1*PR*2*AHCCCS*****PI*SKAZ0~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*CHARLES*MARSHALL BURGESS****MI*A43030299~
DMG*D8*19631226*M~
DTP*291*RD8*20250918-20251217~
EQ*42~
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IEA*1*000000163~