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 | Issue Date FY: 2025 ( Subtotal = $102,733,467 ) |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQTADM | Medicaid entitlement for 5 - FY 2025 - T19 | 1 | 1 | CMS | 4/24/2025 | $1,000,000 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQ1935 | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 10/1/2024 | $528,009 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQTMAP | Medicaid entitlement for 5 - FY 2025 - T19 | 1 | 1 | CMS | 4/24/2025 | -$1,000,000 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQTMAP | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 10/1/2024 | $92,030,000 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQELEN | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 12/18/2024 | $312,067 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQTADM | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 10/1/2024 | $1,200,000 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQ5021 | Medicaid entitlement for 5 - FY 2025 - T21 | 1 | 1 | CMS | 1/2/2025 | $4,726,912 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2505AQ5021 | Medicaid entitlement for 5 - FY 2025 - T21 | 0 | 1 | CMS | 10/1/2024 | $3,937,361 |
| | 2025 | 2025 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQTADM | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 4/23/2025 | $51,386 |
| | 2025 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQELEN | Medicaid entitlement for 5 - FY 2024 - T19 | 1 | 1 | CMS | 3/13/2025 | -$882 |
| | 2025 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQTMAP | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 4/23/2025 | -$51,386 |
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| Issue Date FY: 2024 ( Subtotal = $96,977,277 ) |
| | 2024 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQTADM | Medicaid entitlement for 5 - FY 2024 - T19 | 0 | 1 | CMS | 10/1/2023 | $1,200,000 |
| | 2024 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQELEN | Medicaid entitlement for 5 - FY 2024 - T19 | 0 | 1 | CMS | 8/7/2024 | $63,000 |
| | 2024 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQTMAP | Medicaid entitlement for 5 - FY 2024 - T19 | 0 | 1 | CMS | 10/1/2023 | $90,110,000 |
| | 2024 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQ5021 | Medicaid entitlement for 5 - FY 2024 - T21 | 1 | 1 | CMS | 5/9/2024 | -$109,355 |
| | 2024 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQ5021 | Medicaid entitlement for 5 - FY 2024 - T21 | 0 | 1 | CMS | 10/1/2023 | $9,344,185 |
| | 2024 | 2024 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2405AQ1935 | Medicaid entitlement for 5 - FY 2024 - T19 | 0 | 1 | CMS | 10/1/2023 | $473,461 |
| | 2024 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 7 | 1 | CMS | 1/1/2024 | -$2,000,000 |
| | 2024 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 6 | 1 | CMS | 10/20/2023 | -$2,000,000 |
| | 2024 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ3002 | Medicaid entitlement for 5 - FY 2023 - T21 | 3 | 1 | CMS | 3/18/2024 | -$104,014 |
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| Issue Date FY: 2023 ( Subtotal = $104,748,560 ) |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQTADM | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 10/1/2022 | $1,200,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ5021 | Medicaid entitlement for 5 - FY 2023 - T21 | 0 | 1 | CMS | 4/21/2023 | $1,254,294 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ5MAP | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 3/10/2023 | $0 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ5ADM | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 3/10/2023 | $0 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 5 | 1 | CMS | 7/18/2023 | $994,868 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 4 | 1 | CMS | 7/1/2023 | $2,000,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 3 | 1 | CMS | 5/16/2023 | -$2,500,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 10/1/2022 | $2,500,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 1 | 1 | CMS | 1/1/2023 | $1,500,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQARPT | Medicaid entitlement for 5 - FY 2023 - T19 | 2 | 1 | CMS | 4/1/2023 | $2,000,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ3002 | Medicaid entitlement for 5 - FY 2023 - T21 | 0 | 1 | CMS | 10/1/2022 | $6,054,488 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ3002 | Medicaid entitlement for 5 - FY 2023 - T21 | 2 | 1 | CMS | 3/22/2023 | $680,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ3002 | Medicaid entitlement for 5 - FY 2023 - T21 | 1 | 1 | CMS | 1/1/2023 | $899,067 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQ1935 | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 10/1/2022 | $439,421 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2305AQTMAP | Medicaid entitlement for 5 - FY 2025 - T19 | 0 | 1 | CMS | 10/1/2022 | $89,210,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 1805AQ5MAP | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 3/10/2023 | $1,319 |
| | 2023 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 7 | 1 | CMS | 11/3/2022 | $182,912 |
| | 2023 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 4 | 1 | CMS | 3/3/2023 | $18,210 |
| | 2023 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQIMPL | Medicaid entitlement for 5 - FY 2023 - T19 | 1 | 1 | CMS | 1/26/2023 | -$217,032 |
| | 2023 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 8 | 1 | CMS | 2/10/2023 | -$1,414,179 |
| | 2023 | 2018 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 1805AQ1935 | Medicaid entitlement for 5 - FY 2018 - T19 | 1 | 1 | CMS | 3/10/2023 | -$53,489 |
| | 2023 | 2018 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 1805AQ5ADM | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 3/10/2023 | -$1,319 |
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| Issue Date FY: 2022 ( Subtotal = $98,057,098 ) (Continued on the next page) |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 1 | 1 | CMS | 5/12/2022 | -$177,500 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQIMPL | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 4/1/2022 | $520,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQTADM | Medicaid entitlement for 5 - FY 2022 - T19 | 1 | 1 | CMS | 10/12/2021 | $700,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | AMERICAN SAMOA | USA | 2205AQTADM | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 10/1/2021 | $500,000 |
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