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GS*HS*87726*87726*260601*1806*1457998957*X*005010X279A1~
ST*270*000047096*005010X279A1~
BHT*0022*13*000047096*2606152*1806~
HL*1**20*1~
NM1*PR*2*UHC MEDICARE ADVANTAGE*****PI*87726~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*BUTLER*CHARMELLE****MI*104523838~
DMG*D8*19740114*F~
DTP*291*RD8*20260601-20260830~
EQ*42~
EQ*30~
SE*14*000047096~
GE*1*47096~
IEA*1*000047096~