Raw X12 — CIN NQ34064X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0712*|*00501*518763134*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0712*763134*X*005010X279A1~ST*270*3134*005010X279A1~BHT*0022*13*202608120712000001*20260812*0712~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*202608120712000001*00000000ND~NM1*IL*1******MI*NQ34064X~EQ*30~DTP*291*D8*20260812~SE*13*3134~GE*1*763134~IEA*1*518763134~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0312*^*00501*172033530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031238*172033530*X*005010X279A1~ST*271*172033530*005010X279A1~BHT*0022*11*202608120712000001*20260812*031238~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*202608120712000001*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*20260812~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*172033530~GE*1*172033530~IEA*1*172033530~