U.S. Military Medals and Insignia Pride and Patriotism Act of 2009 - Prohibits a military exchange store or other nonappropriated fund instrumentality of DOD from purchasing for resale any military decorations, ribbons, badges, medals, insignia, or other military accoutrements not produced in the United States (Buy American requirement). Provides an exception when the Secretary determines that a satisfactory quality and sufficient quantity of an item produced in the United States cannot be procured. Includes U.S. territories and possessions within the definition of "United States" for purposes of this Act.