It rises in the Medicine Bow Mountains, northwest of Medicine Bow Peak in southeastern Carbon County. It flows north, past Elk Mountain, then northeast, then northwest past the town of Medicine Bow and between the Shirley Mountains to the north and the Medicine Bow Mountains to the south. It joins the North Platte in the Seminoe Reservoir, with the lower 10 mi (16 km) of the river forming an arm of the reservoir.
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