| | | | | | | | | | | | | | | |
| | |
 | Issue Date FY: 2022 ( Subtotal = -$152,000 ) |
| | 2022 | 2019 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 3 | 1 | 8/25/2022 | SUPPLEMENT FOR EXPANSION | -$152,000 |
|
| Issue Date FY: 2019 ( Subtotal = $220,000 ) |
| | 2019 | 2019 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 1 | 1 | 5/7/2019 | SUPPLEMENT FOR EXPANSION | -$152,000 |
| | 2019 | 2019 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 0 | 1 | 10/1/2018 | NEW | $220,000 |
| | 2019 | 2019 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 2 | 1 | 7/1/2019 | NEW | $152,000 |
|
|
