EDI Sample File 1

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W05*N*DL60000439*CPO1234567***30

N1*SF**6*MEM~
N1*SO*REGIONAL MEDICAL CENTER OF NEA*91*0000164968~
N3*4800 EAST JOHNSON AVE~
N4*Jonesboro*AR*72401*US~
N1*ST*REGIONAL MEDICAL CENTER OF NEA*91*0000164968~
N3*4800 EAST JOHNSON AVE~
N4*Jonesboro*AR*72401*US~
G62*04*20151209~
NTE*TRA*FEDXAM~
LX*1~
W01*1*EA**PL*10*ND*1234567890******13001234~
W76*1~

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