Raw X12 — CIN RN94830N

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1024*|*00501*357462610*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1024*462610*X*005010X279A1~ST*270*2610*005010X279A1~BHT*0022*13*202608101024000001*20260810*1024~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*202608101024000001*00000000ND~NM1*IL*1******MI*RN94830N~EQ*30~DTP*291*D8*20260806~SE*13*2610~GE*1*462610~IEA*1*357462610~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0624*^*00501*237407730*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062418*237407730*X*005010X279A1~ST*271*237407730*005010X279A1~BHT*0022*11*202608101024000001*20260810*062418~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*202608101024000001*00000000ND~NM1*IL*1*DZHURAYEVA*OSNAT****MI*RN94830N~N3*140-39 69TH AVE~N4*FLUSHING*NY*11367~DMG*D8*19640122*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~SE*29*237407730~GE*1*237407730~IEA*1*237407730~