Raw X12 — CIN YZ16153N

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2007*|*00501*565258566*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2007*258566*X*005010X279A1~ST*270*8566*005010X279A1~BHT*0022*13*202608122007000001*20260812*2007~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*202608122007000001*00000000ND~NM1*IL*1******MI*YZ16153N~EQ*30~DTP*291*D8*20260813~SE*13*8566~GE*1*258566~IEA*1*565258566~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1607*^*00501*534409530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160734*534409530*X*005010X279A1~ST*271*534409530*005010X279A1~BHT*0022*11*202608122007000001*20260812*160734~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*202608122007000001*00000000ND~NM1*IL*1*SWINSON*TAKEIA****MI*YZ16153N~N3*350      EAST 137TH STREET    13F~N4*BRONX*NY*10454~DMG*D8*19780721*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=03~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*9309153LE20~REF*6P*RX8312~LS*2120~NM1*P4*2*CAREMARK (CVS)*****PI*DV~N3*POST OFFICE BOX 52057~N4*PHOENIX*AZ*850722057~PER*IC*PROVIDER SERVICES*TE*8006245060~LE*2120~SE*38*534409530~GE*1*534409530~IEA*1*534409530~