[1] It is part of the Great Lakes Basin, and is a left tributary of the Moira River.

It flows south then southeast, passes into geographic Grimsthorpe Township[3] in the municipality of Tweed, and reaches Lingham Lake.

It leaves the lake at the south and flows south into geographic Elzevir Township,[4] where it takes in the right tributary West Black River, arcs briefly west into the municipality of Madoc,[5] then returns east into Elzevir Township near the community of Queensborough.

The Moira River flows to the Bay of Quinte on Lake Ontario.

The river is used by whitewater paddlers, particularly in spring as part of the M.A.C.K.fest (Marmora Area Canoe and Kayak Festival),[6][7] with the community of Queensborough serving as a friendly access point recognized by Whitewater Ontario.