Raw X12 — CIN NQ34064X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1029*|*00501*357778246*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1029*778246*X*005010X279A1~ST*270*8246*005010X279A1~BHT*0022*13*202608101029000001*20260810*1029~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*202608101029000001*00000000ND~NM1*IL*1******MI*NQ34064X~EQ*30~DTP*291*D8*20260806~SE*13*8246~GE*1*778246~IEA*1*357778246~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0629*^*00501*237863730*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062933*237863730*X*005010X279A1~ST*271*237863730*005010X279A1~BHT*0022*11*202608101029000001*20260810*062933~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*202608101029000001*00000000ND~NM1*IL*1*MARTE*EMMANUEL*N***MI*NQ34064X~N3*3424 FULTON ST 2ND FL~N4*BROOKLYN*NY*11208~DMG*D8*20120317*M~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 500~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*27*237863730~GE*1*237863730~IEA*1*237863730~