Raw X12 — CIN PZ00131S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1954*|*00501*305246764*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1954*246764*X*005010X279A1~ST*270*6764*005010X279A1~BHT*0022*13*202608091954000001*20260809*1954~HL*1**20*1~NM1*PR*2*NYSDOH*****PI*EMEDNY~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~PRV*PE*PXC*251B00000X~HL*3*2*22*0~TRN*1*202608091954000001*00000000ND~NM1*IL*1******MI*PZ00131S~EQ*30~DTP*291*D8*20260806~SE*13*6764~GE*1*246764~IEA*1*305246764~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1554*^*00501*315036930*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*155402*315036930*X*005010X279A1~ST*271*315036930*005010X279A1~BHT*0022*11*202608091954000001*20260809*155402~HL*1**20*1~NM1*PR*2*NYSDOH*****FI*141797357~PER*IC*EMEDNY PROVIDER SERVICES*TE*8003439000*UR*www.emedny.org~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~HL*3*2*22*0~TRN*2*202608091954000001*00000000ND~NM1*IL*1*POLANCO*ARIANNA*M***MI*PZ00131S~N3*12202 GRAYSON ST FL 1~N4*SPRINGFIELD GAR*NY*11413~DMG*D8*20081027*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*95~MSG*CNTY CD=66 5C8~LS*2120~NM1*Y2*2*HEALTH FIRST PHSP INC*****PI*SF~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*88~SE*29*315036930~GE*1*315036930~IEA*1*315036930~