Raw X12 — CIN UW77138Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1911*|*00501*648275900*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1911*275900*X*005010X279A1~ST*270*5900*005010X279A1~BHT*0022*13*202608131911000001*20260813*1911~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*202608131911000001*00000000ND~NM1*IL*1******MI*UW77138Z~EQ*30~DTP*291*D8*20260814~SE*13*5900~GE*1*275900~IEA*1*648275900~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1511*^*00501*536128930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151111*536128930*X*005010X279A1~ST*271*536128930*005010X279A1~BHT*0022*11*202608131911000001*20260813*151111~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*202608131911000001*00000000ND~NM1*IL*1*KHAKIMOV*MOUNIS****MI*UW77138Z~N3*155 BEACH 19 STREET           15A~N4*FAR ROCKAWAY*NY*11691~DMG*D8*19730523*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*1*IND*30**MA Eligible~MSG*CNTY CD=66 523~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~SE*34*536128930~GE*1*536128930~IEA*1*536128930~