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| Issue Date FY: 2019 ( Subtotal = $389,197 ) |
| 2019 | 2019 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 2 | 1 | 4/18/2019 | SUPPLEMENT FOR EXPANSION | $404,163 |
| 2019 | 2015 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 1 | 1 | 2/7/2019 | SUPPLEMENT FOR EXPANSION | -$14,966 |
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| Issue Date FY: 2017 ( Subtotal = $1,773,371 ) |
| 2017 | 2017 | Amer. Samoa | American Samoa Medicaid Agency 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | Medical Assistance Program | 0 | 1 | 3/1/2017 | SUPPLEMENT FOR EXPANSION | $1,773,371 |
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