ISA*00*          *00*          *28*9000000454     *ZZ*J00370         *070926*0342*U*00401*000489661*0*P*:~
GS*HP*9000000454*J00370*20070926*03421826*489660*X*004010X091A1~
ST*835*489662~
BPR*I*6519.36*C*ACH*CCP*01*075906003*DA*0000194917*1351840597*00454    *01*021000021*DA*304677450*20070926~
TRN*1*EFT2545408*1351840597*00454~
DTM*405*20070925~
N1*PR*NATIONAL GOVERNMENT SERVICES  00454~
N3*5151 CAMINO RUIZ~
N4*CAMARILLO*CA*930128645~
REF*2U*00454~
N1*PE*GOLDEN LIVINGCENTER FOLEY*FI*204120517~
N3*1000 FIANNA WAY~
N4*FORT SMITH*AR*72919~
REF*PQ*015032~
LX*210712~
TS3*015032*21*20071231*8*19760.22*9175.8*10584.42**8905.8**-2334****9175.8*2604*******8*8905.8~
TS2*11509.8**********2*41*41~
CLP*0073294416 070299289*19*856.96*769.14**MA*20725800001702*21*2~
CAS*CO*94*-284.18~
CAS*PR*2*372*0~
NM1*QC*1*BRADY*LEO*F***HN*140079398A~
NM1*82*2*GOLDEN LIVINGCENTER FOLEY*****XX*1538110192~
NM1*TT*2*WPS - TRICARE FOR LIFE*****PI*000060000~
MIA*0***1141.14*MA02**********3*****MA44~
REF*EA*0073294416~
DTM*050*20070913~
DTM*23