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| Issue Date FY: 2021 ( Subtotal = -$9,001 ) |
| 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 6 | 1 | 3/30/2021 | SUPPLEMENT FOR EXPANSION | $271,465 |
| 2021 | 2020 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 5 | 1 | 2/4/2021 | SUPPLEMENT FOR EXPANSION | $0 |
| 2021 | 2020 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 4 | 1 | 1/21/2021 | SUPPLEMENT FOR EXPANSION | -$280,466 |
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| Issue Date FY: 2020 ( Subtotal = $558,927 ) |
| 2020 | 2020 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 2 | 1 | 4/1/2020 | SUPPLEMENT FOR EXPANSION | $140,000 |
| 2020 | 2020 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 0 | 1 | 10/1/2019 | NEW | $140,000 |
| 2020 | 2020 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 3 | 1 | 7/1/2020 | SUPPLEMENT FOR EXPANSION | $138,927 |
| 2020 | 2020 | Amer. Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | Medical Assistance Program | 1 | 1 | 1/1/2020 | SUPPLEMENT FOR EXPANSION | $140,000 |
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