ISA*00*          *00*          *12*1234567890     *ZZ*EZRIRX         *170725*0400*U*00401*000000001*0*P*
GS*PR*1234567890*EZRIRX*20220722*1719*1421*X*004010
ST*855*1001
BAK*00*AD*R123456789*20220722
REF*VR*12345678
DTM*067*20220722
N1*ST*Example Pharmacy, LLC*11*0018619
PO1*1*1*EA*31.99**VC*571013*N4*42571013027
ACK*IA*1*EA*011*20220722**N4*42571013027
PO1*2*1*EA*7.15**VC*218448*N4*00591044401
ACK*IA*1*EA*011*20220722**N4*00591044401
CTT*2
SE*10*1001
GE*1*1421
IEA*1*000004438