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 | Issue Date FY: 2023 ( Subtotal = $99,403,909 ) |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | 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 | HAWAII | 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 | HAWAII | 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 | HAWAII | USA | 2305AQTADM | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 10/1/2022 | $1,200,000 |
| | 2023 | 2023 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2305AQTMAP | Medicaid entitlement for 5 - FY 2023 - T19 | 0 | 1 | CMS | 10/1/2022 | $89,210,000 |
|
| Issue Date FY: 2022 ( Subtotal = $98,057,098 ) |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 3 | 1 | CMS | 4/1/2022 | $1,333,517 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQ1935 | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 10/1/2021 | $413,763 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | 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 | HAWAII | USA | 2205AQTADM | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 10/1/2021 | $500,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | 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 | HAWAII | USA | 2205AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 10/1/2021 | $220,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQTMAP | 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 | HAWAII | USA | 2205AQTMAP | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 10/1/2021 | $87,360,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 2 | 1 | CMS | 9/22/2022 | $700,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 1 | 1 | CMS | 4/21/2022 | $254,010 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 0 | 1 | CMS | 10/1/2021 | $6,447,643 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 6 | 1 | CMS | 8/24/2022 | -$720,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 5 | 1 | CMS | 8/24/2022 | $1,099,751 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 4 | 1 | CMS | 7/1/2022 | $1,500,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 2 | 1 | CMS | 11/16/2021 | $95,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 1 | 1 | CMS | 1/1/2022 | $720,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQIMPL | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 4/1/2022 | $520,000 |
| | 2022 | 2022 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2205AQARPT | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 10/1/2021 | $1,525,000 |
| | 2022 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQARPT | Medicaid entitlement for 5 - FY 2021 - T19 | 1 | 1 | CMS | 8/24/2022 | -$3,200,000 |
| | 2022 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 4 | 1 | CMS | 1/18/2022 | -$109,000 |
| | 2022 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 3 | 1 | CMS | 2/3/2022 | -$160,263 |
| | 2022 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQIMPL | Medicaid entitlement for 5 - FY 2022 - T19 | 2 | 1 | CMS | 1/18/2022 | -$106,781 |
| | 2022 | 2019 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 1905AQINCT | Medicaid entitlement for 5 - FY 2019 - T19 | 3 | 1 | CMS | 8/25/2022 | -$152,000 |
| | 2022 | 2017 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 1705AQ5ADM | Medicaid entitlement for 5 - FY 2022 - T19 | 11 | 1 | CMS | 10/7/2021 | -$1,257 |
| | 2022 | 2017 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 1705AQ1935 | Medicaid entitlement for 5 - FY 2022 - T19 | 1 | 1 | CMS | 12/27/2021 | -$4,785 |
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| Issue Date FY: 2021 ( Subtotal = $95,440,043 ) (Continued on the next page) |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2005AQINCT | Medicaid entitlement for 5 - FY 2021 Quarter 2 - T19 | 1 | 1 | CMS | 1/21/2021 | $59,500 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQARPT | Medicaid entitlement for 5 - FY 2021 - T19 | 0 | 1 | CMS | 7/1/2021 | $3,200,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 2 | 1 | CMS | 9/21/2021 | $400,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 1 | 1 | CMS | 1/1/2021 | $1,415,557 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQ5021 | Medicaid entitlement for 5 - FY 2022 - T21 | 0 | 1 | CMS | 10/1/2020 | $4,669,782 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 3 | 1 | CMS | 7/1/2021 | $160,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 2 | 1 | CMS | 7/16/2021 | $59,500 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 1 | 1 | CMS | 4/20/2021 | -$220,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQINCT | Medicaid entitlement for 5 - FY 2022 - T19 | 0 | 1 | CMS | 12/21/2020 | $220,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQTIMP | Medicaid entitlement for 5 - FY 2021 Quarter 1 - T19 | 1 | 1 | CMS | 12/21/2020 | -$486,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQTIMP | Medicaid entitlement for 5 - FY 2021 Quarter 1 - T19 | 0 | 1 | CMS | 10/9/2020 | $486,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2005AQIMPL | Medicaid entitlement for 5 - FY 2021 Quarter 2 - T19 | 6 | 1 | CMS | 3/30/2021 | $271,465 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQTMAP | Medicaid entitlement for 5 - FY 2021 Quarter 1 - T19 | 0 | 1 | CMS | 10/1/2020 | $84,350,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQTADM | Medicaid entitlement for 5 - FY 2021 Quarter 1 - T19 | 0 | 1 | CMS | 10/1/2020 | $1,200,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQTINC | Medicaid entitlement for 5 - FY 2021 Quarter 1 - T19 | 1 | 1 | CMS | 12/21/2020 | -$220,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQTINC | Medicaid entitlement for 5 - FY 2021 Quarter 1 - T19 | 0 | 1 | CMS | 10/1/2020 | $220,000 |
| | 2021 | 2021 | American Samoa Medicaid Agency | 998383 Tafuna Road #306 | PAGO PAGO | AS | 96799 | HAWAII | USA | 2105AQIMPL | Medicaid entitlement for 5 - FY 2022 - T19 | 1 | 1 | CMS | 12/21/2020 | $486,000 |
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