The stream flows southeast through the townships of Dixville and Millsfield before joining the Androscoggin River in the town of Errol.
It was organized for voting purposes in 1960, and the village of Dixville Notch is commonly known as the first place to cast votes in U.S. elections.
The river passes through the townships of Dixville and Dix's Grant before joining the Dead Diamond River in the Dartmouth College Grant.